Prospective randomized comparative study of early functional outcome of 2 knee joint endoprosthesis systems--rotation plateau versus fixed polyethylene inlay

AIM: Different systems are used for total knee arthroplasty (TKA). Compared were a press-fit femur condyle replacement system with fixed tibial PE-inlay versus a rotating tibia component system with an emphasis on the early functional results. METHOD: Patient selection and the use of the Knee Society Score for this randomized and prospective study were based on the directives for TKA of the german Society for Orthopaedic and Trauma Surgery (DGOT). We examined the patients post-operatively after 1 week, 2 weeks, 6 weeks, 3 months, 6 months, and 1 year. RESULTS: After 6 weeks an increase of the total knee score could be seen in both groups. The total knee score of the rotating tibia component increased from 93.96 pre-operatively to 113.57 after 6 weeks, to 139.82 after 3 months, to 154.32 after 6 months, and to 159.65 after one year. The total score with the fixed PE-inlay increased from 79.75 to 111.5 after 6 weeks, to 128.25 after 3 months, to 134.08 after 6 months, and to 130.08 after one year. CONCLUSION: After 6 weeks the implant with the rotating tibia component showed a lasting higher score as compared to the implant with a fixed PE-inlay component using the same early rehabilitation and mobilization techniques.     

Incisional hernia of the urinary bladder following internal hemipelvectomy

INTRODUCTIONHemipelvectomies are uncommon operations, usually performed for primary or metastatic malignant disease and less frequently for benign-aggressive tumours. There are very few reports in literature regarding complications of these procedures and even fewer reports about post hemipelvectomy hernias in particular.PRESENTATION OF CASEWe present the only reported case of an incisional hernia of the urinary bladder following internal hemipelvectomy for aneurysmal bone cyst of the pubic bone. A careful literature review is also performed.DISCUSSIONThe development of the incisional hernia in the case of our patient can most likely be explained by the absence of advanced malignant disease of the pelvis that not only reduces the life expectancy but also overshadows other complications post hemipelvectomy. Furthermore, her young age and level of fitness allowed for a full postoperative rehabilitation which, combined with the proven anatomical changes of the internal organs following hemipelvectomies and the weakening of the tissues around the operative site, predisposed to the hernia formation.CONCLUSIONHemipelvectomies are extensive, anatomically disruptive operations, with significant detriment to the psychosomatic well being of the patients. We presented the only reported case of incisional hernia of the urinary bladder following internal hemipelvectomy and our reconstructive method of choice. We believe that, in the case of our patient, if a mesh had been used to reconstruct the primary defect during the initial surgery, this complication could have been prevented.     

Septic dislocation of the hip after internal fixation of trochanteric fractures

Infection of the hip joint is described in three patients after nail-plate fixation of trochanteric fractures. This led to subluxation of the joint in one case and to dislocation in the other two. None of the patients walked again. Attention is drawn to the difficulty in diagnosis and the poor prognosis of this uncommon complication of operating for hip fracture.     

Gait and function in patients with a femoral endoprosthesis after tumor resection

We performed gait analysis in 18 patients with a femoral endoprosthesis: 12 distal, 3 proximal and 3 total. Follow-up after surgery was mean 12 (0.6-19) years. The gait parameters measured were walking velocity, step length, duration of stance phase and swing phase. Goniometry of the hip, knee and ankle in both legs was determined during free-paced walking. The functional outcome score of the Musculoskeletal Tumor Society (MSTS) and the Ambulation score were also assessed in all patients.

The mean free-paced walking velocity was 88% of normal. The step length of the uninvolved leg was longer than that of the involved one. The swing phase of the involved leg was longer than that of the uninvolved leg, and the stance phase of the involved leg was shorter than that of the uninvolved leg. Goniometry showed three abnormal patterns in the involved leg: a stiff knee gait in 10 patients, a flexed knee gait in 6, and an abnormal flexion-extension pattern in the hip in 9. Goniometry of the uninvolved leg was normal. The mean MSTS score was 22 points (72%). This showed a significant positive correlation to the Ambulation score, but no correlation to any of the temporal variables.

Our findings indicate that the time of load on the involved leg, whether conscious or not, is reduced. Follow-up studies are needed to evaluate the effects of the asymmetrical gait pattern observed and the abnormal goniometric results on the development of endoprosthesis-related complications.     

Destruction of the gliding inlay of a hip endoprosthesis caused by intra-articular cement particles]

In this case study of a 78-year-old female with a Hybrid-TEP prosthesis, extensive damage of the polyethylene inlay and strong foreign-body reaction in the neighboring soft tissue were seen four years following implantation. The introduction of just a few cement particles during implantation of hip prosthesis may lead to considerable damage of especially the polyethylene cup as well as the metal backing component. Wear particles from the prosthesis then can lead to unfavorable reactions within the surrounding tissue, including resorption of bone in the femoral neck and consequent loosening of the implant. Critical to the success of hip prosthesis implantation is a clean cementing technique.     

Complete dorsal dislocation of the carpal scaphoid with perilunate dorsal dislocation

Complete dorsal dislocation of the carpal scaphoid combined with dorsal perilunate dislocation is an extremely rare carpal injury. We describe the case of a 23-year-old man who presented with a complete dorsal dislocation of the carpal scaphoid, combined with a perilunate dislocation. Surgical treatment was performed with open reduction and interosseus ligament repair. At 4 years follow up, the patient''s wrist pain had completely resolved without limitations of wrist joint motion and without evidence of avascular necrosis of the carpal scaphoid.     

Nontraumatic, spontaneous dislocation of polyethylene tibial insert 1 year after TKA

The authors report a case of nontraumatic, spontaneous dislocation of a polyethylene insert detected 1 year after total knee arthroplasty. The patient demonstrated initial improvement and returned to work 4 months postoperatively. At 6 months postoperatively, the patient developed pain and a clunking sensation with motion; however, he denied any traumatic precipitating events. An arthroscopic procedure revealed arthrofibrotic formations but no signs of locking mechanism failure. At 12 months postoperatively, the patient developed sudden instability, and radiographs demonstrated an anteriorly dislodged insert. Revision surgery was performed, and the insert was removed. The insert showed some signs of fatigue due to the locking mechanism. We postulated that repetitive flexion produced an anterior superior force leading to failure of the locking mechanism.     

Complete dislocation of the talus unaccompanied by fracture

Total dislocation of the talus without a concomitant fracture is an extremely rare injury. Such a case was treated by immediate closed reduction and 6 weeks of cast immobilization. At the 9-year follow-up, the patient had a full range of ankle motion without any signs of avascular necrosis or arthritis.     

Dissociation of the metal inlay from the polyethylene liner in an uncemented threaded cup

We describe a case of spontaneous dissociation of the metal inlay from the polyethylene cup of a sandwiched metal-on-metal total hip prosthesis manufactured from Co-28Cr-6Mo SM 21 alloy. The patient, a 51-year-old active woman, started to feel groin pain 50 months postoperatively. The pain progressed after a slight trauma and led to final revision after 66 months in situ. No signs of impingement were observed. The polyethylene cup showed an approximately 2 mm-deep groove in the superior wall, and the head was heavily worn on the lateral side. In addition to the typically observed abrasive wear patterns, several types of severe wear defects were noticed. Extensive metallosis and necrosis were observed histologically. This unusual case of substantial deformation of the head and the cup was presumed to have occurred as a result of the increased friction and consequent high wear of the metal head.     

Treatment of bilateral dorsal dislocation fracture of the shoulder joint by total endoprosthesis replacement

A 48-year-old patient sustained depressed fracture dislocations of both shoulder joints during a grand mal epileptic seizure. Surgical treatment consisting of implantation of two Neer total replacements was successful: the functional result was good, and within 12 weeks the patient was free of pain and able to resume work.     

Complete dislocation of the trapezium. Case report.

A 24-year-old woman presented with complete, closed dislocation of the trapezium after a skiing accident. Treatment by closed reduction and fixation with a Kirschner wire gave an excellent clinical result with early return to full function. There were no radiological signs of arthrosis or avascular necrosis at 2 years follow-up.