A prospective study: hyperbaric oxygen therapy in diabetics with chronic foot ulcers.

Research suggests that hyperbaric oxygen therapy may have beneficial effects on ulcer healing and amputation rates in diabetic patients. This paper describes the design of a study that is evaluating its effects on chronic diabetic foot ulcers.

In vitro biocompatibility testing of polymers for orthopaedic implants using cultured fibroblasts and osteoblasts.

The biocompatibility of two polymers for potential use as orthopaedic implant materials in an isoelastic hip prosthesis was investigated. The interactions of polyetheretherketone (PEEK) and epoxy resin polymers (with and without carbon fibre reinforcement) with both fibroblasts and osteoblasts were tested using cell protein, intracellular reduced glutathione (GSH), leakage of lactate dehydrogenase and the MTT assay as indices of cellular cytotoxicity. The epoxy resin polymer was slightly cytotoxic to and inhibited the growth rate of fibroblasts (as assessed by total cell protein), and depleted GSH in both cell types. In contrast, the PEEK material did not display overt signs of cytotoxicity and, in fact, increased osteoblast cell protein content. This suggests that, of these two materials, PEEK would be the one of choice for development of an isoelastic implant and, in view of its stimulatory effect on osteoblast protein content, it may encourage ingrowth of bone around the prosthesis and thus minimize joint loosening.

Proprioception in classical ballet dancers. A prospective study of the influence of an ankle sprain on proprioception in the ankle joint.

We studied prospectively the influence of ankle sprains on proprioception as measured by recording the postural sway of classical ballet dancers. Excellent balance and coordination are important for classical ballet dancers, and postural stability requires adequate proprioception from the ankle joint. Fifty-three professional dancers from the Royal Swedish Ballet, Stockholm, and 23 nonathletes, the control group, participated in the investigation. Postural sway was recorded and analyzed with a stabilimeter using a specially designed, portable, computer-assisted force plate. Six dancers sustained ankle sprains during followup. The recordings were obtained of these dancers before and after the injuries. The stabilometry results differed among the male and female dancers and the control group as follows: 1) the male dancers demonstrated a smaller total area of sway, and 2) both the male and female dancers had a smaller mean sway on the left foot than on the right (no mean difference in sway was found between the left and right foot in the control group). In comparison with the condition before injury and with the uninjured foot, the postural stability of the dancer was impaired for several weeks after the ankle sprain. Postural stability gradually improved during rehabilitation and improvement still occurred several weeks after professional dancing had resumed.

Walking ability after total hip replacement. A comparison of gait analysis in unilateral and bilateral cases.

We studied 50 patients before and after unilateral total hip replacement, and compared them, using gait analysis, with 22 having staged bilateral operations. The average age of the patients was 65 years at the first operation. The mean follow-up was 53 months for the unilateral cases and 27 months, after the second THR, for the bilateral cases. The average interval between first and second THR was 24 months. Patients with bilateral hip disease did not gain optimal function, even on the first side, until both hips had been replaced. Unilateral replacement gave better gait analysis results than did either side after bilateral procedures.

Hallux valgus in ballet dancers: a myth?

Among dancers it is widely believed that ballet dancing induces hallux valgus. Revision of radiographs of 63 active and 38 retired dancers of both sexes showed no increase in the valgus angulation of the hallux compared with that of nondancers.

Acetabular cement temperature in arthroplasty. Effect of water cooling in 19 cases.

In 19 patients who underwent total hip arthroplasty the temperature was studied at the bone-cement interface in the acetabulum during the polymethyl methacrylate curing process. To evaluate the effect of fluid cooling, the patients were randomized into two groups: one group with no irrigation, the other with continuous irrigation with Ringer solution during cement curing. The temperature was recorded with a thermocouple at the bone-cement interface. Without water cooling, the median maximum temperature was 49 (41-67) degrees C. In 9 out of 11 patients the temperature elevations were sufficient to cause impaired bone regeneration or thermal necrosis of bone. Continuous water irrigation reduced the amount of heat at the bone-cement interface; median maximum temperature was 41 (37-48) degrees C.

Postural stability after total hip replacement.

Changes in postural stability were recorded before and after total hip replacement using a specially designed computer-assisted forceplate system. Twenty-one patients with unilateral osteoarthritis of the hip were randomised into two groups after operation with either a cemented Charnley or a non-cemented HP-Garches prosthesis. Postural stability was improved in both groups one year after operation and the sway pattern became normal.

Subsidence of porous coated noncemented femoral components in total hip arthroplasty. A roentgen stereophotogrammetric analysis.

Roentgen stereophotogrammetric analysis was used in the evaluation of subsidence in nine noncemented femoral components of the Biomet Taperloc prosthesis. After 2 years three components had subsided 0.7-0.9 mm. No distinct symptoms related to the micromotion appeared. The subsidence in this investigation was smaller than the reported subsidence of other noncemented prostheses.

Subsidence of the femoral component in the noncemented total hip. A roentgen stereophotogrammetric analysis.

Roentgen stereophotogrammetric analysis was used in the evaluation of subsidence in eight noncemented femoral components of the HP-Garches prosthesis. After 2 years, seven components had subsided 0.6-3.9 mm, i.e., more than observed in some cemented prostheses. No distinct symptoms related to the micromotion appeared.

Total hip replacement. A comparison between cemented (Charnley) and non-cemented (HP Garches) fixation by clinical assessment and objective gait analysis.

In 119 patients with total hip replacement (THR) 61 were operated on with cemented (Charnley) and 58 with non-cemented (HP Garches) fixation. The assessment was performed by clinical examination and objective registration by gait analysis 6 and 12 months postoperatively. The group with cemented fixation (Charnley) demonstrated better results in all variables. The greatest difference between the groups was found at the 6 months' follow-up. The gait analysis was valuable in the assessment of locomotor function.

Low polymerization temperature with Boneloc. In vivo measurements in 11 hip replacements.

We investigated the thermal properties of a new bone cement, Boneloc, during total hip replacement, using a thermocouple connected to a digital thermometer. In 10 of 11 cases the maximum temperature was below 43 degrees C at the bone-cement interface in the acetabulum. This is a considerable reduction in the polymerization temperature in comparison with earlier studies of conventional bone cement. We found no difference regarding the setting time of the cement.

Ankle sprain and postural sway in basketball players.

The present study compares postural ankle stability between previously injured basketball players, uninjured players and a control/group. Postural sway was recorded and analysed by stabilometry using a specially designed computer-assisted forceplate. Recordings were obtained for 60 s on each foot. The stabilometric results in the players with no previous injuries did not differ from those in the controls. Players with a previously injured ankle differed significantly from the control group. These players had a larger mean postural sway and used a larger sway area.

Spinal sagittal mobility and joint laxity in young ballet dancers. A comparative study between first-year students at the Swedish Ballet School and a control group.

The present study compares spinal configuration, spinal range of motion and joint mobility in first-year students of the Swedish Ballet School and in nondancing students of corresponding age and sex in a state school. The study comprises all the first-year (fourth grade) students (n = 23) at the Swedish Ballet School: 11 boys and 12 girls. Their dance practice time was 10 h per week. Thirty-six children in the fourth grade at a state school comprised the control group. None of the controls took ballet classes or participated in organised gymnastics out of school. The neutral spine configuration in standing and the sagittal spine mobility were measured using Debrunner's kyphometer and Myrin's inclinometer. Joint laxity was measured by employing a modified form of the Contompasis method. Compared with the controls, the dancers showed a higher incidence of joint hypermobility, greater mobility of the thoracic spine, a less prominent lordosis of the lumbar spine and a less prominent kyphosis in the thoracic spine in the neutral standing position. The dancers had done little or no ballet training before entering the ballet school at the age of ten. The results agree with those of earlier studies and suggest that increased flexibility is an asset for those being selected as future ballet dancers.

Activation of cascade systems by hip arthroplasty. No difference between fixation with and without cement.

The acrylic bone cement has been regarded as a very potent activator of the hemostatic mechanisms. A battery of coagulation, fibrinolytic, and kallikrein variables were studied perioperatively in 21 patients undergoing hip arthroplasty with fixation of the prosthesis either with (Charnley) or without (HP-Garches) cement. Epidural analgesia was used and dextran 6 per cent as thromboprophylaxis. The HP-Garches procedure was shorter and caused less blood loss. No differences were found between the two surgical procedures regarding the activation of the cascade systems. The coagulation and fibrinolytic systems were activated early, but a week postoperatively the latter seems to predominate. A marked activation of the kallikrein system was apparent. Our study shows that despite thromboprophylaxis a marked activation of the coagulation, fibrinolytic, and kallikrein systems occurs in relation to hip arthroplasty irrespective of the use or nonuse of cement and irrespective of the volume of blood loss during surgery. It may be the reaming of the bone marrow that initiates the activation of the cascade systems.

Influence of acetabular component position in non-cemented total hip arthroplasty. A radiologic and clinical study.

Radiologic grading of non-cemented acetabular components in HP Garches total hip replacements was used to evaluate the relationship between a lack of supero-lateral cover of the acetabular component and clinical outcome. In 63 hips, three to five years after total hip arthroplasty, we observed that the acetabular component was partially uncovered in 56 per cent of cases. The fact that several components were partially uncovered did not influence the clinical outcome. Although the follow-up time is short the present study indicates that non-cemented HP Garches total hip arthroplasty is a technique which allows for stable fixation of the acetabular component.

Biodegradable fixation of ankle fractures. A roentgen stereophotogrammetric study of 32 cases.

We performed a prospective randomized study comparing fixation with biodegradable polyglycolic acid (PGA) rods (n 15) or screws (n 17) in 32 selected displaced supination-eversion fractures. Immediate postoperative weight bearing in a walking cast was encouraged. An exact reconstruction of the ankle mortise was achieved in 26/32 ankles. Roentgen stereophotogrammetric analysis (RSA) revealed rather small movements in the ankle mortise during fracture healing. A better stability was achieved by using screws. After 6 months the clinical results did not differ. One case of sinus formation and one with local effusion occurred; both healed without impairing the clinical result. To compare the results with a nondegradable osteosynthesis technique, a reference group of supination-eversion fractures previously operated on with cerclage-wires, staples and pins was used. RSA showed better fracture stability with nondegradable fixation. The clinical results, however, did not differ.