The Wagner revision prosthesis consistently restores femoral bone structure.
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The short-term results are reported for 43 hip revision operations with the long-stemmed Wagner prosthesis. The patients were followed-up for an average of 25 months. The Charnley scores were; pain 5.2, movement 4.0 and walking 4.0. All patients except one showed abundant new bone formation. The stem subsided more than 20 mm in 5 patients and in 22 the subsidence was less than 5 mm. The major complication was dislocation, which occurred in 9 patients; 8 of these were reoperated and from then on remained stable. (+info)
Limb salvage surgery for pathological fractures in osteosarcoma.
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The local treatment of pathological fracture in patients with a primary osteosarcoma remains controversial. In this paper we report the oncological outcome of the treatment of pathological fractures in 18 patients suffering from this disease. There were ten male and eight female patients, and the average age at diagnosis was 17 years. All patients received adjuvant chemotherapy. Wide resections were performed in 17, but in one there was 'contamination' of the margins of the excision. Skeletal reconstruction was performed with a locally designed and manufactured custom 'mega' prosthesis. The average follow-up was 33 months (range: 12-93 months), and 14 patients were alive on completion of the study. Local recurrence appeared in two patients, while three developed pulmonary metastases. (+info)
Late fracture of the hip after reamed intramedullary nailing of the femur.
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In a consecutive series of 498 patients with 528 fractures of the femur treated by conventional interlocking intramedullary nailing, 14 fractures of the femoral neck (2.7%) occurred in 13 patients. The fracture of the hip was not apparent either before operation or on the immediate postoperative radiographs. It was diagnosed in the first two weeks after operation in three patients and after three months in the remainder. Age over 60 years at the time of the femoral fracture and female gender were significantly predictive of hip fracture on bivariate logistic regression analysis, but on multivariate analysis only the location of the original fracture in the proximal third of the femur (p = 0.0022, odds ratio = 6.96, 95% CI 2.01 to 24.14), low-energy transfer (p = 0.0264, odds ratio = 15.56, 95% CI 1.38 to 75.48) and the severity of osteopenia on radiographs (p = 0.0128, odds ratio = 7.55, 95% CI 1.54 to 37.07) were significant independent predictors of later fracture. Five of the 19 women aged over 60 years, who sustained an osteoporotic proximal diaphyseal fracture of the femur during a simple fall, subsequently developed a fracture of the neck. Eleven of the hip fractures were displaced and intracapsular and, in view of the advanced age of most of these patients, were usually treated by replacement arthroplasty. Reduction and internal fixation was used to treat the remaining three intertrochanteric fractures. Three patients developed complications requiring further surgery; five died within two years of their fracture. (+info)
Comparison of wiring techniques for bone fracture fixation in total hip arthroplasty.
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The objective of this study was to investigate the effect of cerclage wire position and determine the number of wires necessary to prevent crack opening and stem subsidence following a proximal femoral fracture in cementless total hip arthroplasty. A cementless femoral stem one size larger than the templated size was inserted into each femur to initiate a proximal crack. A cerclage wire was wrapped around the fracture in one of two orientations: 1) parallel to the osteotomy (PO) and 2) normal to the fracture line (NF). The femur was compressed to a load of 890 N, 1780 N and 2670 N while crack opening and stem subsidence were measured. A second cerclage wire was placed parallel to NF wire and inferior to the lesser trochanter and a third wire was placed 1 cm distal and parallel to the second wire. The loading was repeated again. The mechanical evaluation of stem subsidence were verified by various computer simulations even using four wires. We have found that placement of the cerclage wires normal to the fracture line prevents stem subsidence and crack opening better than placement of the wires parallel to the osteotomy. Three cerclage wires, placed normal to the fracture line at three locations: 1) adjacent to the superior of the lesser trochanter, 2) adjacent to the inferior of the lesser trochanter and 3) 10 mm distal to the bottom of the lesser trochanter were necessary to achieve stability under higher loads. (+info)
Proximal femoral bone loss and increased rate of fracture with a proximally hydroxyapatite-coated femoral component.
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We performed a retrospective analysis of the clinical and radiological outcomes of total hip replacement using an uncemented femoral component proximally coated with hydroxyapatite. Of 136 patients, 118 who had undergone 124 primary total hip replacements were available for study. Their mean age was 66.5 years (19 to 90) and the mean follow-up was 5.6 years (4.25 to 7.25). At the final follow-up the mean Harris hip score was 92 (47.7 to 100). Periprosthetic femoral fractures, which occurred in seven patients (5.6%), were treated by osteosynthesis in six and conservatively in one. We had to revise five femoral components, one because of aseptic loosening, one because of septic loosening and three because of periprosthetic fracture. At the final follow-up there were definite signs of aseptic loosening in two patients. Radiologically, proximal femoral bone loss in Gruen zones I and VI was evident in 96.8% of hips, while bone hypertrophy in zones III and V was seen in 64.7%. In 24 hips (20.2%) the mean subsidence of the stem was 3.7 mm which occurred within the first 12 postoperative weeks. This indicated poor initial stability, which might have been aggravated by early weight-bearing. The high rate of failure in our study suggests that proximal femoral bone loss affects the long-term survival of the replacement. (+info)
Leg lengthening for short stature in Turner's syndrome.
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We describe ten patients with Turner's syndrome (karyotype 45, XO) who had leg lengthening for short stature. A high incidence of postoperative complications was encountered and many patients required intramedullary fixation as a salvage procedure. We discuss the reasons for this and highlight the differences between our findings and those of a similar series recently reported. In view of the considerable difficulties encountered, we do not recommend leg lengthening in Turner's syndrome. (+info)
Simultaneous bilateral femoral fractures: systemic complications in 14 cases.
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We have retrospectively reviewed 14 patients with bilateral femoral shaft fractures who attended our institution between January 1993 and March 1999. The mean age of the patients was 38 years (19-75) and the median injury severity score (ISS) was 16 (interquartile range 10-20). Thirteen patients were treated with intramedullary nailing and 1 with plating and nailing within 24 h of admission to hospital. The mean resuscitation requirements were 10.6 (6-16) litres of colloid and crystalloid and 8.6 (4-30) units of blood. The mean intensive care unit/high dependency unit (ICU/HDU) stay was 4 days (1-14) and the mean hospital stay was 36.3 days (3-210). There were 6 cases of adult respiratory distress syndrome (ARDS), 1 compartment syndrome, 1 case of osteomyelitis, 1 above-knee amputation and 2 deaths (14.2%). The mean time to union was 24.5 weeks (12-37). Comparison to patients with unilateral injuries revealed a higher ISS, resuscitation requirements, ARDS, hospital stay and mortality. (+info)
The Walldius hinge arthroplasty.
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Eighty-three Walldius arthroplasties, performed by one surgeon as salvage operation on the knee joint between 1966 and 1972, were independently reviewed. The fifty-seven living patients with sixty-seven arthroplasties were interviewed and examined and the clinical records of the deceased patients were inspected. Sixty-seven arthroplasties (81 per cent) were successful and sixteen failed (19 per cent). Acrylic cement was used to secure the prosthesis on eight occasions only. There were two primary infections (2-4 per cent) and two delayed (2-4 per cent). Major loosening occurred in three arthroplasties (3-6 per cent). Minor loosening was compatible with a good result. Arthrodesis was successful on the two occasions on which it became necessary to remove the implant. There were no disasters. On the basis of these results it is considered that the Walldius arthroplasty can justifiably be offered as an alternative to primary arthrodesis of the knee. (+info)