The Müller acetabular reinforcement ring--still an option in acetabular revision of Paprosky 2 defects? Longterm results after 10 years.

BACKGROUND: Aim of this study was to measure the clinical and radiological longterm outcome after acetabular revision arthroplasty (RTHA) using the Müller acetabular reinforcement ring. MATERIAL AND METHODS: 86 patients with 90 revision arthroplasties and a mean age of 68 years (41 to 84) were included. The mean follow-up was 10 years (range 7-12). The Harris Hip Score and the WOMAC Index were used to assess pain and functional outcome. Furthermore clinical examination of range of motion and radiologic examinations were performed in 34 patients. RESULTS: The radiologic analysis reports no signs of loosening in 79%, 15% showed possibly loosening and 6% probable loosening. Definite radiologic loosening has not been detected. In the meantime 12 patients (13.3%) of 90 revision total hip arthroplasty underwent a revision of the acetabulum with change of the acetabular component which means a survival rate of 86.7% after 10 years follow-up. The mean center of rotation of the hip moved 0.15 cm (SD 0.74 cm) laterally and 0.1 cm (SD 0.97 cm) cranially based on the geometrically reconstructed center of rotation. A mean score of 58 points for the Harris Hip Score (range 14-93) indicated a poor functional outcome, while a mean value of 96 points (range 0-223) for the WOMAC Index indicated good results for functional outcome in daily living. CONCLUSIONS: The revision arthroplasty in cases with acetabular defects using the Müller acetabular reinforcement ring shows acceptable longterm results. LEVEL OF EVIDENCE: Level IV.

[Localisation of hepatic lesions to liver segments according to sonography (US), computed tomography (CT) and surgery (OP): a comparative study]. / Untersuchung der Segmentzugehörigkeit von Leberraumforderungen in Sonografie (US), Computertomografie (CT) und intraoperativ (OP): eine Vergleichsstudie.

INTRODUCTION: The localisation of focal liver lesions is usually performed according to the Couinaud classification system. The exact description of localisation and size of liver lesions is especially important for surgical procedures. The aim of this prospective study was the evaluation of differences and agreements in the localisation and size of hepatic lesions as found by ultrasound (US), computed tomography (CT) and according to the intraoperative status (OP). MATERIAL AND METHODS: 32 patients (21 male, 11 female) were enrolled in the study. The results obtained from sonography, computed tomography and surgery were classified into 5 categories for localisation and for size, respectively. RESULTS: According to the agreement between sonography and computed tomography, 25 % of all hepatic lesions were classified into category 1 (exact agreement), whereas 40.6 % were ranked into category 2 (almost exact agreement). Correlating sonography and intraoperative results, 31.3 % of the lesions were classified into category 1 and 46.9 % into category 2. In the comparison of CT with OP, 34.4 % of the lesions were found to be in category 1 and 43.8 % in category 2. Concerning the size of the lesions, almost half of the tumours (46.9 %) were classified into category 1 on the basis of the correlation between US and CT and 21.9 % on the basis of the correlation between US and OP. DISCUSSION: The localisation and description of the size of hepatic lesions is mainly similar or even identical on the basis of the different methods. Further improvements might be achieved by the introduction of a consistent nomenclature.

[Proximal fixation of hip endoprostheses with porous surface: results of 6 years]. / Proximale Verankerung von Hüft-Endoprothesen mit poröser Oberfläche: 6-Jahres-Ergebnisse.

PROBLEM: The anatomically shaped pcl (ESKA) total hip replacement has a porous coating of the proximal stem and the cup to allow for bony ingrowth. The tip of the stem is polished. METHOD: We report the results of 96 THR 6.2 years (5.25-6.7) after implantation. RESULTS: There were no revisions during this period. One stem showed radiographic loosening at follow-up. There was stress-shielding in 9.4% in contrast to the concept of proximal fixation. Thigh-pain was found in 9.4%. One patient demonstrated disabling thigh-pain despite radiologic bony ingrowth. By drilling the femur distal to the tip of the stem a remarkable relief was achieved. CONCLUSION: Despite numerous cases of stress-shielding (9.4%), bony ingrowth occurs in 97%. The tcl-THR performs sufficiently after 6 years of implantation.