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SURGICAL TECHNOLOGY INTERNATIONAL VII.
$175.00
STI VII contains 58 articles with color illustrations.
Universal Medical Press, Inc.
San Francisco, 1998, ISBN: 1-890131-00-8
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Orthopaedic Surgery
A Modular System for Cemented and Cementless Implantation of Femoral Stem Prostheses
Christoph Eingartner, M.D.; Rüdiger Volkmann, M.D.; Thomas Ilchmann, M.D.; Kuno Weise, M.D.; Siegfried Weller, M.D. - Eberhard-Karls University, Tübingen, Germany
A femoral stem [BiContact, Aesculap, Germany) has been developed which is suitable for both cemented and uncemented implantation. Thus a highly standardized procedure and a standard implant for any iritraoperative finding is available. While the cemented stems have a smooth surface, the cementless implants are proximally coated with a microporous titanium plasmaspray [Plasmapore]. The strategy based on the intraoperative choice of the surgeon to use either cemented or cementless implants after bone preparation turned out to be very successful in our institution. A consecutive series of 250 cases with cemented implantation and 250 cases with uncemented implantation was analyzed in a prospective follow-up study, Pollow-up time averaged 7 years for cemented and 6.5 years for uncemented THRs. The follow-up rate was 88. 7% in cases treated with cemented stems and 93.1% in cases treated with uncemented stems. The rate of aseptic loosening was 1.2% for the cemented version and 0.4-% for the uncemented stem. Radiological loosening could be observed in another 1.2% of the cemented stems and was not to be found in the uncemented cases. Our data suggest an excellent midterm stability of both the cemented and the uncemented version of the BiContact hip system. The long-term results for both the cemented and uncemented prostheses of our series are still to be evaluated.
The Use of Hydroxyapatite-Coated Implants in Revision Surgery for Acetubular Component Loosening
Christian Nourissat, M.D. - Clinique du Renaison, Roanne, France; Jose Adrey, M.D. - Polyclinique St. Roch, Montpellier, France; Daniel Berteaux, M.D., Clinique de la Presentation, Orleans, France; Alan Gueret, M.D. - Epinal, France; Christian Goalard; Georges Hamon, M.D., Valenciennes, France; ABG Scientific Group, Roanne France
Since 1989,the authors have used the Hydroxyapatite (HA)-coated ABG prosthesis for both primary and revision hip replacement. Hydroxyapatite is osteoconductive, and therefore speeds up bone formation and ensures a direct contact between the implant and the host bone, without any interposed fibrous tissue. The cup can thus be firmly fixed in the bony acetabulum, with eventual osseointegration into the host bone. The quality of the results achieved, at primary hip replacement, with bioactively coated devices has been highlighted in a large number of publications.
Hydroxyapatite Coated (HAC) Femoral Component
Jordi Casas-Sabater, M.D.; Marc Cots-Pons, M.D.; Joaquim Rodriguez-Miralles, M.D., Ph.D. - Hospital General de Catalunya, Barcelona, Spain
For years, custom hip prosthesis cemented with methyl-metacrylate has been the only alter native to traditional cements because of its excellent performance. Nevertheless, different complications associated with its use, mainly loosenings, required complex and difficult surgical revisions that greatly hindered its utility. Newly developed materials and cementation techniques have improved clinical and radiological outcomes of the cemented prosthesis. This has allowed better long-term survival, particularly among elderly patients. Nevertheless, lifestyles of young patients still overcome the mechanical properties of the prosthesis and affects the life-span of the acrylical cement used to bind it to the bone. The latter has led to the development of new models of implants that differ in its form and coatings but that still keep its metal composition.
Factors Affecting Stability of Press Fit Acetubular Cups
Michael D. Ries, M.D. - Bassett Healthcare, Cooperstown, N.Y.
Press fitting cementless porous coated acetabular components without screw fixation is desirable to minimize debris-related problems. Compression between the bone and periphery of an acetabular component which is slightly larger than the reamed acetabulum provides implant fixation while oversizing at the dome may adversely affect stability. In most primary total hip arthroplasties, the acetabulum can be reamed to a hemispherical cavity and assessed using acetabular sizing trials prior to implanting the cup. Use of an implant with a hemispherical dome and gradual transition to a wider peripheral dimension maximizes peripheral bone strains and implant stability with less impaction force and overall deformation than a larger oversized hemispherical cup.
Use of External Minifixators in Hand Pathology
Salvatore Pagliuca, M.D. - Traumatologic Orthopaedic Center (C.T.O.), Naples, Italy
In the field of osteosynthesis, biomechanical research now decisively tends towards elastic and very versatile fixation systems. Consequently, a progressive abandonment of the concept of rigidity as an essential presupposition to obtain the reduction of fractures has occurred. Furthermore, from the analysis of recent studies, an exaltation of the biological potentiality of the bone tissue emerges as well as the repairing capacity of this tissue if it is properly treated. Particularly in hand surgery, an absolute respect of the bone tissue and of the other anatomic structures is a prerequisite for a functional renewal.
Results of Prescription Use of Pulse Ultrasound Therapy in Fracture Management
Victor H. Frankel, M.D., Ph.D. - Hospital for Joint Diseases Orthopaedic Institute, New York University, New York, N.Y
As of October 17, 1994,a pulsed ultrasound device has been used on a prescription basis by orthopaedic surgeons in the United States (Fig. 1). The Food and Drug Administration released this device for use in fresh tibial diaphysis and fresh distal radial metaphysis fractures. A patient registry that records all clinical data concerning both on-label and off-label prescription use of ultrasound, including other bones and different durations of fracture age, has been analyzed, Table 1 summarizes the data from October 17, 1994 to July 14, 1997. The overall healing rate was 91.6%. This includes fresh, delayed, and nonunited fractures.
Absorbable Polyglycolide and Polylactide Devices for Fracture Fixation
Harri Pihlajamäki, M.D., Ph.D.; Ole Böstman, M.D., Ph.D.; Pentti Rokkanen, M.D., Ph.D. - Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Helinski, Finland
The use of absorbable internal fracture fixation devices instead of conventional metallic ones abolishes the need for subsequent implant removal procedures. Absorbable fracture fixation devices have been increasingly used during the past decade. Approximately 150,000 patients in many countries have already been treated with such implants. The vast majority of the clinically used biodegradable devices are made of polyglycolide (PGA) or polylactide (PLA). The polylactide osteosynthesis devices in clinical use today usually consist of polylevolactide (PLLA). During the past decade, the assortment of implants for fracture fixation purposes has become broader and now includes many different kind of devices.
Techniques of Posterior Cervical Spine Fusion
Matthew Songer, M.D. - Marquette, Mich.
This chapter focuses on techniques of posterior cervical and occipitocervical fusions. The various wiring techniques described are reliable, cost-effective methods of treating cervical instability. Many of the established techniques have been modified to incorporate the use of the Songer Cable System.