Ten-year follow-up of the non-porous Allofit cementless acetabular component.

Cementless acetabular fixation has demonstrated superior long-term durability in total hip replacement, but most series have studied implants with porous metal surfaces. We retrospectively evaluated the results of 100 consecutive patients undergoing total hip replacement where a non-porous Allofit component was used for primary press-fit fixation. This implant is titanium alloy, grit-blasted, with a macrostructure of forged teeth and has a biradial shape. A total of 81 patients (82 hips) were evaluated at final follow-up at a mean of 10.1 years (8.9 to 11.9). The Harris Hip Score improved from a mean 53 points (23 to 73) pre-operatively to a mean of 96 points (78 to 100) at final review. The osseointegration of all acetabular components was radiologically evaluated with no evidence of loosening. The survival rate with revision of the component as the endpoint was 97.5% (95% confidence interval 94 to 100) after 11.9 years. Radiolucency was found in one DeLee-Charnley zone in four acetabular components. None of the implants required revision for aseptic loosening. Two patients were treated for infection, one requiring a two-stage revision of the implant. One femoral stem was revised for osteolysis due to the production of metal wear debris, but the acetabular shell did not require revision. This study demonstrates that a non-porous titanium acetabular component with adjunct surface fixation offers an alternative to standard porous-coated implants.

Extra-large press-fit cups without screws for acetabular revision.

This retrospective study reports the 4- to 6-year results of clinical and radiologic follow-up of 60 acetabular revisions using extra-large hemispherical press-fit cups without additional screw fixation. Bone grafts were used in 17 cases. One cup loosened and required re-revision after 12 months. Initial migration was noted in 6 cases, but showed no progression after less than 2 years. In 2 hips that were revised for deep infection, the cups were found incorporated. At final follow-up, 57 hips (95%) were found firmly fixed radiologically. The Harris Hip score improved from a mean of 58.7 points preoperatively to 90.6 points. Provided a high friction coefficient is present, extra-large hemispherical cups offer sufficient stability even in severe cases. Most do not require additional screw fixation.

Lengthening of the iliotibial band by femoral detachment and multiple puncture. A cadaver study.

BACKGROUND: Lengthening of the iliotibial band by various methods such as distal detachment, Z-plasty, or multiple puncture are common procedures for balancing the contracted valgus knee in total knee arthroplasty. This study was performed to measure the lengthening effect of multiple puncture and release of the distal femoral attachment of the iliotibial tract. METHODS: In a cadaver study on 14 knees, we studied the possible elongation of the iliotibial band by distal femoral detachment (release of Kaplan's fibers) and multiple puncture of the distal half of the tract. Maximum elongation was measured under a constant tension of 60 N. RESULTS: The average gain in length of the combination of both procedures was 16.3 mm (range 12-23 mm) with a tension force of 60 N applied. CONCLUSION: The results show that a sufficient release of the iliotibial band can be achieved with the techniques except for severe cases of valgus deformation, where more effective methods to release the iliotibial band such as Z-plasty or complete dissection should be performed.

[Mannerfelt arthrodesis of the wrist joint in patients with chronic polyarthritis. A retrospective analysis of 24 cases]. / Die Arthrodese des Handgelenkes nach Mannerfelt bei Patienten mit chronischer Polyarthritis. Eine retrospektive Analyse von 24 Fällen.

AIM: Mannerfelt established his technique of wrist arthrodesis with stabilisation by an intraosseous rushpin as a secure method for patients with rheumatoid arthritis. This study was performed to evaluate the mid-term results in a consecutive group of patients. METHODS: Out of a group of 39 operations 24 wrist arthrodeses (61%) in 19 patients have been followed 12-96 months postoperatively (average 44 mths) by clinical testing and radiographic examination. All operations were performed in the original technique. All patients suffered from rheumatoid arthritis in an advanced stage (Larsen III-V). RESULTS: All but one patient were free of pain. Function and strength of the hand increased significantly in all patients. All patients had additional resection of the ulnar head that led to normal pro-supination of the forearm. 18 patients were very satisfied with the result of the procedure. All but one of the wrists showed complete fusion. In one case there was an intraoperative perforation of the pin through the radial cortex, in another case we saw a fissure of the shaft of the third metacarpal bone. One patient showed a dysesthesia in the third finger. CONCLUSION: The results in this group of patients confirmed the advantages of Mannerfelt's technique such as simple operative technique, high fusion rate and low incidence of complications.

[Rheumatoid orthopedics and endoprosthetics of the shoulder joint]. / Rheumaorthopädie und Endoprothetik am Schultergelenk.

The first part of the present article gives a comprehensive description of the pathology, diagnostics and forms of therapy of rheumatically impaired shoulder joints. Improved operative methods and methods such as bursectomy, synovectomy, reconstructive soft-tissue management and joint replacement depending on the stage of impediment have enhanced the use of surgery in the treatment of rheumatic shoulder joints. The second part gives a critical evaluation of indications, methods and results of modern shoulder joint replacement. A survey of written publications on the results of hemi- and total endoprostheses on the one hand, our own clinical experiences on the other, have shown that the use of modular hemiendoprostheses produces clinically excellent results with no problems of loosening of the glenoid part.

[10 years of cementless implantation of total hip endoprosthesis using Zweymüller's stem]. / 10 Jahre zementfreie Implantation von Hüfttotalendoprothesen unter Verwendung des Zweymüller-Schaftes.

A retrospective study of the first consecutive 111 cementless Zweymüller Stems has been performed. 56 cases have been followed clinically and radiologically with an interval of 10-11 years. The average harris hip score was 90.7 pts, the cumulative success rate of the stem was 97.96% after 10-11 years. The frequency of bony reactions around the stem and their changes during the course of time could be followed in 40 implants with a complete radiologic documentation at 5 and 10 years postoperative. Hypertrophic changes of the bone around the tip of the stem remained unchanged from the fifth to the tenth year but there was an increase of proximal lucencies (27% at 5 yrs, 35 at 10 yrs), widening of the calcar (20% at 5 yrs, 25% at 10 yrs) and stress shielding (30% at 5 yrs, 47% at 10 yrs).

[Orthopedic treatment of arthrosis of the large joints]. / Die orthopädische Behandlung von Arthrosen grosser Gelenke.

Osteoarthritis most frequently occurs in the hip and knee joints. The present state of art of its treatment considering orthopaedic and surgical measures recommended are discussed. Preoperative management of the patients advising them, amongst others, on joint-preserving behaviour after surgery seems particularly important. Medication and electro-medical therapy in early manifestations of arthritis are reviewed. The importance of joint-preserving interventions, which have been somewhat neglected in the past years, is particularly stressed. Advantages and disadvantages of total joint arthroplasty are discussed.

[Comparative morphological studies on the incorporation of various cementless implanted artificial patellas]. / Vergleichende morphologische Untersuchungen zum Einbauverhalten verschiedener zementfrei implantierter künstlicher Kniescheiben.

Twelve uncemented, artificial patellar components clinically and radiologically without signs of loosening after an implantation period of 9-48 Months were investigated histologically and microradiographically. The components correspond to the system GSB-"old", GSB-"new", PCA and APS. Within the observed implantation period the artificial patellar components GSB-"old", GSB-"new" and PCA showed severe patho-morphological changes of the surrounding tissue and point to loosening. The dowel system according to APS shows after the longest period of time of 14 Months morphologically a fully bony encasement with wide spread direct contacts between the living bone and the metallic Titanium surface. The observation points urgently to the fact, that Polyethylene must not be in direct contact with the bony bed. On the basis of the patho-morphological reactions a partial armament of the polyethylene surface with metallic structures must be rejected as a general principle.

[Results 2 to 5 years after implantation of the cement-free "APS" total knee prosthesis. A retrospective study of the first 160 cases]. / Zwei bis fünf Jahresergebnisse nach Implantation der zementfreien "APS" Knietotalprothese. Eine retrospektive Studie der ersten 160 Fälle.

One hundred-and-forty-seven out of 160 cementless APS total knees replacements have been clinically and radiologically evaluated with a mean follow-up period of 38 (24-60) months. Primary diagnosis has been osteoarthrosis in two thirds and rheumatoid arthritis in one. Reoperations have been performed in 4.9% due to aseptic loosening of the tibial tray, and in 3.7% due to patellar problems (aspetic loosening in 1.2% and luxation in 2.5%). There have been three late infections of the joint leading to arthrodesis in two or exchange operation in one case. The radiologic course of the remaining 126 implants showed excellent or good osseous integration of the implants in more than 80%. We were able to show that rheumatoid arthritis as well as malimplantation of the prosthesis can decrease the rate of osseous integration.

[Radiologic and sonographic screening study of shoulder joints of patients with rheumatoid arthritis]. / Radiologische und sonographische Screening-Untersuchung an Schultergelenken von Patienten mit Rheumatoid-Arthritis (RA).

In the course of a prospective study at our department the shoulder joints of 50 RA-patients were examined. Two criteria have been applied: only righthanded patients have been examined in order to ascertain any prevalence of changes in the dominant extremity, and only patients who were primarily admitted to our department because of complaints other than those of the shoulder. Examination consisted of anamnesis, clinical tests, radiography and sonography. Reports in the literature concerning involvement of 60%. This percentage was confirmed in our clinical and radiological examinations. If, however, sonography is used, it increases to 96%. Lesions of the rotator cuff can be demonstrated, beginning on the synovial side above bone erosions, without any clinical signs or radiographic changes. Radiographic changes have been rated according to Larsen stages 0-5. Upward migration of the humeral head already before massive bone destruction of the shoulder seems to confirm an early involvement of the rotator cuff. Involvement of the acromioclavicular joint begins with Larsen stage 2 and often includes a distension of the joint cavity. The dominant extremity was not found to be affected predominantly. The therapeutic consequences resulting from this examination are discussed.

Long-term results after implantation of McKee-Farrar total hip prostheses.

From 1973 to 1976, McKee-Farrar total hip arthroplasties were performed in the Orthopaedics Department at the Centre of Pulmology. In the present study, only patients with a complete record of radiological changes at the bone/implant or bone/cement interface were evaluated. A series of 81 patients with 100 total hip prostheses in situ according to the Mayo Clinic hip score and 36 patients who had undergone 36 revision operations were studied. The design of the metal cup with metal studs at the outer surface has a favourable effect on the stability of the implant/cement combination: loosening at the implant/cement interface did not occur in any of these cases and there were few cement fractures. In spite of the metal-to-metal combination, abrasion is slight and there is no danger of metallosis.

[Intra-operative shaft fissure--a possible cause of postoperative shaft pain following cement-free hip joint implantation. 2d experimental study]. / Intraoperative Schaftfissuren--eine mögliche Ursache für postoperative Schaftschmerzen nach zementfreier Hüftgelenksimplantation. Zweite experimentelle Studie.

Two experimental studies carried out at the Institute of Pathology and Bacteriology, Baumgartner Höhe, Vienna, in cooperation with the Department of Orthopaedics of the Centre of Pulmology, City of Vienna, confirm the danger of intraoperative shaft fissures occurring during implantation of cementless hip endoprostheses. It appears that such lesions are not visible either during implantation or on postoperative radiographs. The study was made using the Zweymüller shaft system which is normally implanted at our department. Pain of unknown origin in the shaft area during the phase of patients mobilization may be connected with shaft fissures due to implantation.

The APS knee joint prosthesis. A review of 32 patients.

First clinical and radiographic results with a new knee joint prosthesis, implanted without cement, are reported and the characteristics of the implant (dowel fixation and special instrumentation) presented. The first series of 35 joints with a follow-up period of 1-3 years shows excellent results. Radiographically, primary osseous integration cannot be positively identified in all cases, but it could be proved in most instances. Cement-free implantation requires good preoperative bone quality and an operative technique which inserts the implant anatomically. If these two conditions are met, there is every probability of successful implantation. No problems specific to the implant have been encountered.

Shaft fissures due to implantation of cementless total endoprostheses of the hip joint. An experimental study.

Since 1982, at the Orthopedic Department of the Pulmologic Center of the City of Vienna we have used the Zweymüller shaft system and the pyramidal threaded socket by Schwägerl when implanting cementless hip endoprostheses. Some patients repeatedly complained about pains in the shaft region within the first postoperative months, though these complaints could not be explained clinically or radiographically. On 15 human cadavers we implanted a total of 20 Zweymüller shafts and examined the femurs for ruptures of the shaft. Our special interest was the course of the fracture lines, their localization, and their display on roentgenograms. It appeared that fissures of the shaft are easily caused by the forced driving-in of the prosthesis. In about half of all cases the fissure cannot be seen on roentgenograms because of the site is covered by the implant itself. The fracture lines do not always begin intertrochanterally or from the calcar femoris; therefore, they cannot be recognized during surgery. This problem should be considered during implantation as well as during postoperative remobilization.

[Rheumatoid hip joint and its orthopedic surgical treatment]. / Das rheumatische Hüftgelenk und seine orthopädisch-chirurgische Behandlung.

In the early stage of the disease, synovectomy of the hip seems to be a successful technique, but the timing of the operation is difficult because of interference with conservation treatment. Osteotomy in rheumatoid arthritis of the hip is not very successful; arthrodesis is not recommended. In the late stage of the disease the treatment of choice is joint replacement. Here osteoporosis and the protrusion of the acetabulum present more technical problems than in other hip diseases. Implants with various designs and various implantation techniques with or without bone cement are used. The use of bone grafts, especially for protrusion, represents real progress, and there is a trend toward using cementless implantation, especially for young patients. Failures are due to difficulties in morphology, but there are no more reoperations than in osteoarthritis, and mortality seems to be higher than in osteoarthritis.

[Orthopedic problems of vitamin D-resistant rickets (phosphate diabetes)]. / Zur orthopädischen Problematik der Vitamin D-resistenten Rachitis (Phosphat-Diabetes).

Results of the operative treatment of phosphate-diabetes are presented on the basis of our own patients. Deformations of the lower extremities need in case of a disturbed function and disfigurement of the gait picture a surgical correction, by which we should strive as much as possible for physiological axial proportions in both planes. For young children osteoclasis with fixation in plaster cast will suffice, for adolescents and grown-ups we prefer stable osteosynthesis. An adequate straightening, combined with a regular control of the mineral metabolism and an appropriate drug therapy, guarantee good long-term results and absence of recidivity.