Total hip arthroplasty using a cementless dual-mobility cup provides increased stability and favorable gait parameters at five years follow-up.

BACKGROUND: Rates of dislocation following primary total hip arthroplasty (THA) vary from 0.5 to 10%. Dual-mobility cups in THA demonstrate increased stability. Clinical outcomes following THA with dual-mobility cups have been reported, but gait has not been assessed. Therefore we performed a retrospective case control study to answer: (1) is gait better in patients following THA with a dual-mobility cup than in frail, elderly patients of the same age? (2) Are clinical outcomes better in patients following THA with a dual-mobility cup than in frail, elderly patients? (3) What is the dislocation rate following THA with a dual-mobility cup? HYPOTHESIS: We hypothesized that patients who underwent THA with a dual-mobility cup have a better gait compared to frail, elderly patients of the same age. PATIENTS AND METHODS: Twenty patients (22 hips), mean age 79.9±7.7 (range, 62.3-88.3) years were assessed in this retrospective case-control series 5.6±1.4 (range: 4.1-8.8) years following dual-mobility cup THA. A reference group consisted of 72 "frail elderly" patients in a rehabilitation hospital for health problems unrelated to the lower limb, with no lower limb surgery or neurological conditions. Temporal and spatial gait performance were measured with four miniature gyroscopes, mounted on each thigh and calf, while patients walked freely along a 30m corridor. Harris Hip Score, WOMAC, radiological outcomes, and dislocation rate were determined. RESULTS: All gait parameters were better in the dual-mobility group compared to the frail elderly group. The dual-mobility group had a higher cadence (100.3 steps/minute versus 75.6 steps/minute), shorter (relative to gait cycle time) stance (61.6% versus 67.8%), shorter (relative to gait cycle time) double stance (23.3% versus 36.0%), longer stride (1.13m versus 0.80m), and faster walking speed (0.96m/s versus 0.52m/s). Range of motion of the shank, thigh and knee were better in the dual-mobility group. Harris Hip Score was 87.6±13.9 (range 51-100) and WOMAC score was 11.3±12.1 (range 0-34) in the THA group. We observed no dislocations. DISCUSSION: Gait patterns five years following THA with the dual-mobility cup were better or comparable to published study populations. LEVEL OF EVIDENCE: III, retrospective case-control series.

[Infection of a total knee prosthesis with Brucella spp]. / Infection d'une prothèse totale du genou par "Brucella spp".

Brucellosis, an "anthropophitic" disease of worldwide distribution can involve several organs and tissues but the osteoarticular disease is the most common complication. It can occur as sacroiliitis, bursitis, tenosynovitis or osteomyelitis. Prosthetic joint infection is a serious complication of total joint arthroplasty, with coagulase negative staphylococci and Staphylococcus aureus accounting for 50% of cases. Treatment of prosthetic infections remains complex. Prosthetic infections caused by Brucella spp are rarely described in the literature. We report a patient with a prosthetic joint infection due to Brucella spp, documented by a polymerase chain reaction. The patient has been cured after two-stage exchange of the prosthesis and long-term antimicrobial therapy.

Percutaneous retrograde screwing for stabilisation of acetabular fractures.

OBJECTIVES: To evaluate the results of retrograde percutaneous screw fixation (PSF) in minimally or undisplaced acetabular fractures in a geriatric population. PATIENTS AND METHODS: Between July 1998 and July 2001, 21 consecutive patients with an acetabular fracture underwent fluoroscopic guided percutaneous fixation. The mean age was 81 years (range 67--90 years). In all cases, the fracture was minimally or undisplaced (<2mm). Two cannulated cancellous 7.3mm screws were inserted in a retrograde fashion to stabilise the posterior and the anterior column. Bed to chair transfer began after 24h. Weight bearing as tolerated was allowed at 4 weeks. RESULTS: Eighteen patients were reviewed at a mean of 3.5 years (range 2--5 years). Soft tissue dissection was minimal. There were no intraoperative or postoperative complications. At the latest follow-up there was no radiographical evidence of secondary displacement of fragments, degenerative changes, or screw failure. Fractures healed at a mean time of 12 weeks (range 8--15 weeks). Clinical results were satisfactory in 17 patients. CONCLUSION: Our results show that percutaneous screw fixation under fluoroscopic control is a safe technique to treat some pattern of acetabular fracture.

Mycobacterium tuberculosis gene-amplification in breath condensate of patients with lung tuberculosis.

The applicability of Mycobacterium tuberculosis-gene-amplification test (NAT) in breath condensate (BC) was examined in lung tuberculosis (TB). Ten patients with bacteriologically confirmed lung TB have been examined by ligase chain reaction (LCx). In BC the NAT were negative in all patients as well as the examination of acid fast smears and of solid phase or liquid media cultures were. This indicates that the use of NAT in BC can not replace or complement sputum or materials obtained invasively in patients with lung TB.

Traumatic hernia of the abdominal wall after pelvic and acetabular fracture: a case report.

Traumatic hernia of the abdominal wall is a rare and easily missed injury in the presence of major pelvic and abdominal lesions. We present a radiographically documented case of combined pelvic and acetabular fracture with a major contralateral traumatic hernia with avulsion of the internal oblique, the external oblique and the transverse abdominal muscles diagnosed four months after the initial trauma. To our knowledge no similar case has been described in the current literature.

A dynamic analysis of knee ligament injuries in alpine skiing.

The aim of this study is to understand better the dynamic mechanisms of anterior cruciate ligament (ACL) rupture in alpine skiing. As a result of these findings, improvements in the boot-binding release systems are proposed. Six patients who sustained ACL rupture, aged 19 to 43 years, were studied. A step by step reconstruction of the accident was made using a questionnaire followed by an interview. The skiing equipment was tested in a specialized laboratory and the release levels of the boot-binding systems were measured in twist and in forward lean. ACL injury was confirmed by arthroscopy or surgery. Most patients had recent skiing equipment; their binding systems were correctly mounted and in perfect working order. Release levels of the bindings were equal to or slightly above those suggested by the ISO standards. The mechanisms of injury were valgus-external rotation in knee flexion of more than 90 degrees, internal rotation in knee flexion of more than 120 degrees with anterior drawer loads, internal rotation-valgus in knee flexion of less than 30 degrees with anterior drawer loads, external rotation-valgus in knee flexion of more than 120 degrees with anterior drawer loads, external rotation in knee flexion of about 100 degrees with anterior drawer loads and internal rotation-valgus. Even with a modern boot-binding system, properly adjusted, ACL injury remains possible. The improvements in the current equipment should be concerned with the behavior when confronted with combined loads producing friction in the system. We concluded that for lateral release at the toe, there should be a better compensation of the vertical parasite forces and an improvement of the antifriction devices. In order to prevent excessive anterior drawer loads on the ACL an additional release direction of the binding system, especially backwards, could, if properly adjusted, enhance the opportunities of early release in a dangerous backward lean "out of control" position.

[Results of hyposensitization with bee and wasp venom]. / Ergebnisse der Hyposensibilisierung mit Bienen- und Wespengift.

The immunotherapy with purified bee and wasp venom is indicated for patients with severe general reactions after insect stings, positive prick test and positive RAST. One hundred seventy four persons were treated for three years with bee venom (SSW Dresden) and 34 patients with wasp venom (Reless). Challenge by a stinging bee after treatment proved in 90 per cent complete protection. There were no general reactions during hyposensitization with wasp venom, but in 46 per cent occurred general reactions during immunotherapy with bee venom. Therefore rush desensitization should be performed in indoor patients till a top dose of 100 micrograms/ml is reached. Booster injections can be given to outdoor patients. All individuals with systemic reactions after insect stings have to get an emergency treatment kit and must be familiar with its application.

[Psychogenic bronchial asthma]. / Zur Psychogenie des Asthma bronchiale.

The extensively discussed problem of psychopathological components in bronchial asthma has been investigated in patients of the authors' hospital. The results are compared with the most frequent opinions published. Using a questionnaire, the intensity of bodily complaints and psychic alterations was compared in following groups: asthmatics, neurotics, and patients with acute lung diseases. Considering bodily complaints, the intensity is comparable in asthmatics and neurotics, and higher than in patients with acute lung diseases. Psychic alterations are more pronounced in neurotics, and there is no difference between asthmatics and patients with acute lung diseases. The importance of these results with regard to the general assessment and the immediate medical care for patients with bronchial asthma is discussed.

[Comparative studies on the mucolytic effectiveness of Mucosolvin oral and Mucosolvin inhalant]. / Vergleichende Untersuchungen zur mukolytischen Wirksamkeit von Mucosolvin oral und Mucosolvin-Inhalat.

Here the clinic comparison between both inhaling and oral Mucosolvin therapy is reported on. To determine the virtual viscosity of sputum has proved to be the deciding parameter to measure the effect of Mucosolvin. Both Mucosolvin inhalable and oral are equally effective. But whereas with oral therapy there were no side effects (e.g. bronchospasm) necessitating withdrawal of the drug such side effects occurred with inhaling therapy. Thus Mucosolvin allowes an effective mucolytic therapy independent of using any inhalation appliance.

[Indications for diagnostic thoracoscopy, based on biopsy results of 400 studies]. / Indikationen der diagnostischen Thorakoskopie, abgeleitet aus den bioptischen Resultaten von 400 Untersuchungen.

It is reported on the results of 401 thoracoscopies. The main indication for thoracoscopic examination was the differential diagnosis of pleural effusions (262 cases = 65.3%). A morphological confirmation was achieved in 88.0% of all malignant and in 43.0% of tuberculous pleural and lung diseases. A histopathological diagnosis was also found in 94.3% of diffuse lung diseases. For diagnosis of non-specific pleurisy it is necessary to exclude all other etiologic factors. Lympho-plasmacellular infiltrates were found in all cases of non-specific pleurisies. Thoracoscopic biopsy is also of great importance for accurate diagnosis of rheumatic pleuro-pulmonary manifestations. All other clinical methods are uncertain for rheumatic diseases affecting the pleura and lung. In cases of spontaneous pneumothorax it is possible to get valuable additional informations by thoracoscopic investigation. Indications of thoracoscopy are represented as a result of the review of literature and of the present material. Variations of thoracoscopy are discussed.

[References for allergy testing in a polyclinic department of lung diseases and tuberculosis]. / Hinweise zur Allergentestung in der PALT.

Because of the high prevalence of bronchial asthma and allergic rhinitis allergological tests are necessary upon a large scale. General reactions are seldom, therefore it is recommended to do skin tests in an outpatient department taking into consideration special directions. The extracts to be used are proposed.

[Method for evaluating sputum viscosity]. / Eine Methode zur Beurteilung der Sputumviskosität.

Continuing a study on mucolytically and secretolytically effective drugs, a viscometrically energetic principle was designed for controlling both the virtual viscosity and the adhesion of sputum. The technique used is integral in character, an amount of 2 to 4 ml of inhomogeneous purulent and foam-free sputum being sufficient for the purpose. The data are shown in a curve the characteristic of which is a piecewise e-function giving separate descriptions of the virtual viscosity and the adhesive behaviour. The curves are used to record the progress of the therapy used. "Technique and device for measuring viscosity" was registered at the Amt für Erfindungs- und Patentwesen der DDR HA Rechtsschutz in 1984 (WP G 01 N/251 817 5) the authors being Scheuler, Fischer and Felgenhauer. Details are given in.

[Viscometric study of secretolytically and mucolytically active inhalants]. / Viskosimetrische Untersuchung sekretolytisch und mukolytisch wirksamer Inhalate.

Hypercrinism, dyscrinism and mucostasis are the principal symptoms accompanying diseases of the respiratory system. Both the viscosity and the adhesion of the secretion are affected by secretolytics and mucolytics. Evidence on changes in the quality of the secretion was obtained following a nine-day inhalation therapy using mucosolvin, tacholiquin, bromhexin and physiological NaCl-solution, a new viscosimetric measuring device with non-Newton liquids being applied in the investigation. The device allows for a control of the secretolytic and mucolytic treatment used.

[Lymphogranulomatosis and persistent left superior vena cava. Contribution to the diagnostic problem of the interference of morphologically different images]. / Lymphogranulomatose und V. cava superior sinistra persistens. Beitrag zur diagnostischen Problematik bei Interferenz morphologisch unterschiedlicher Erscheinungen.

Unilateral mediastinal dilatations are suspicious of the presence of a lymphogranulomatosis. It is reported on a case in which the diagnosis of Hodgkin's disease was rendered more difficult by a persistent left superior vena cava. The discussion of the case shows that in the differential-diagnostically problematic mediastinal region - corresponding to the clinical appearance - all methods available must be used for the clarification of the etiology.

[Hemodynamics of microcirculation during thoracoscopy under anesthesia]. / Untersuchungen zur Hämodynamik im kleinen Kreislauf unter den Bedingungen der Narkose-Thorakoskopie.

Under the conditions of the thoracoscopy under anaesthesia the behaviour of the haemodynamic measuring values is investigated in 10 patients of either sex. The time of intubation and the phase of the open thorax represent the most remarkable periods of examination which are parallel to the alterations of the arterial oxygen partial pressure and the pressure parameters of the circulations within the lesser an the systemic circulatory system. The investigation results obtained from the behaviour of the oxygen partial pressure will prove to be decisive, whether treatment with thorax opening under simultaneously carried out analytic blood-gas measurements should be recommendable.

[Detection of the incidence of increased sensitization to molds in patients with bronchial asthma and allergic rhinitis]. / Nachweis einer erhöhten Sensibilisierungshäufigkeit gegenüber Schimmelpilzen bei Patienten mit Asthma bronchiale und allergischer Rhinitis.

The incidence of sensibilization against extracts of moulds produced by VEB SSW Dresden was investigated by intracutaneous tests in 354 persons (controls and patients - adults and children - with bronchial asthma and allergic rhinitis). Even in the nonallergic controls the tests were positive in 20-30%. Patients with asthma and rhinitis were significantly more often positive than controls with Mucor, Cladosporium and mixed-mould. There was no difference between the groups with Aspergillus and Penicillium. Testing with extract of mixed-mould is not effective. Positive results with the individual moulds were not excluded although the test with mixed-mould was negative. There was no essential difference in the incidence of sensibilization between adults and children with bronchial asthma using mould extracts of VEB SSW Dresden.