Electrogalvonic inflammation as the cause of aseptic implant loosening in alloarthroplasty of the hip joint (author's transl)

The appearance of pronounced cavity formation and erosion of the cortex layer in the area of the prosthetic shaft following total endoprosthetic implantation, without signs of an acute bacterial inflammatory activity, was investigated in specimens from the Orthopedic Hospital, Würzburg. The causes of these alterations, in most cases, could be electrogalvonic tension which produces inflammatory processes with lacunar disintegration of the cortex layer. In this process, the metal implant is loosened. In vitro experiments have shown that an average difference in potential of 290 mV can be established between both electrodes of the metal implant.     

Flocking hip joint endoprosthesis

The author indicates the similarity of a human tooth and an endoprosthesis in their action, which is the basis for developing a procedure of endoprosthesis and designing an endoprosthesis with dumping elements. The procedure has been developed during a long-term surgical experiment by examining the results by the following techniques: X-ray, bed testing, light and scanning electron microscope. Experimental results are convincing. For coating the prostheses, polytetrafluoroethylene velour is used in the experiment, but cauflene, the material of the same kind polytetrafluoroethylene, is employed in the clinical setting. The experiments yielded two inventions patented in the Russian Federation. This direction in their development seems to be fruitful in preventing the aseptic endoprosthetic instability that is the most common and severe complication after endoprosthesis and requires most frequently resurgery.     

Thromboembolism following total hip-replacement arthroplasty. The efficicy of dextran-aspirin and dextran-warfarin in prophylaxis

The efficacy of two antithrombotic regimens, combined dextran and aspirin and combined dextran and warfarin, was analyzed by comparing the incidence of thromboembolism following total hip replacement in two groups of similar patients. Of the 427 who received dextran and aspirin, 7 per cent had thromboembolic complications, including one case of fatal pulmonary embolus and one case of recurrent emboli that required vena caval ligation, and 15 per cent had wound-healing complications. Of the 197 patients who received dextran and warfarin, 5 per cent had thromboembolism and 24 per cent had wound healing complications. Although both prophylactic regimens seemed effective, dextran and aspirin appeared less effective in reducing thromboembolic complications than dextran and warfarin, but there were fewer wound complications in that group. One-fourth of the patients on dextran-warfarin were not adequately anticoagulated despite close supervision. In forty-five patients with a history of thromboembolism who were excluded from the study and analyzed separately, warfarin alone and the two described regimens were equally ineffective in preventing thromboembolism, and the incidence of thromboembolic complications was high. Dextran-aspirin and dextran-warfarin appear to be satisfactory and relatively simple methods of thromboembolic prophylaxis.     

A shock-absorber-damper endoprosthesis for the hip joint

The paper deals with the construction of an implant for complete thigh joint removal. The implant works on a new principle, i.e. division of the major parts of the prosthesis into load-carrying and bearing parts which are isolated all the way with damping silicone gaskets. The implant has a fundamentally new construction. It is accessible for commercial production by advanced technologies and readily applicable in clinical practice. The estimated results of its application are positive as when used, the implant brings a considerably less pressure to bear on the bone than do the well-known Russian and foreign implant models.     

Vacuum phenomenon in the hip joint: diagnostic value

Vacuum phenomenon is well known in degenerative spinal disease in the elderly, but is seldom seen in other joints, especially in children. The phenomenon does not represent a pathological finding, and can be used for imaging of the articular facets, mainly in the hip and knee joints. We report a patient with this phenomenon in the hip joint.     

Hemarthrosis and hip joint pressure in femoral neck fractures

In a prospective clinical study the intraarticular pressure of 55 patients with intracapsular femoral neck fractures was measured intraoperatively with the hip in different positions. Intraarticular hemarthrosis was quantified by a preoperative sonography examination. In 75% of the patients, increased intraarticular pressure caused by the hemarthrosis was found. The spontaneous median pressure increased significantly from 22 mm Hg with extension (28 mm Hg) and internal rotation of the hip joint (56 mm Hg). The lowest pressure was found in 70 degrees flexion (15 mm Hg). The median pressures increased within the first 24 hours after injury from 26 mm Hg in the first 6 hours to 46 mm Hg from 7 to 24 hours. Even in the first and second weeks after trauma, increased median pressures were detected (8.5 mm Hg and 13 mm Hg, respectively). No significant difference was found between undisplaced and displaced fracture types. Because increased joint pressure in other studies correlates with reduced perfusion of the femoral head, it can be deduced that reduction maneuvers without capsulotomy can compromise the circulation of the femoral head. Capsulotomy and osteosynthesis of the femoral neck at the earliest time possible is the best prophylaxis of tamponade. If the osteosynthesis is delayed, a preoperative sonography after admission and a control sonogram after 6 hours is recommended. In the event of relevant hemarthrosis, immediate therapeutic drainage is suggested for patients who will receive joint conserving osteosynthesis.     

Short term prophylaxis against heterotopic bone after cementless hip replacement

The aim of the current study was to reveal whether 7 days of indomethacin treatment sufficiently prevents heterotopic ossification after cementless total hip arthroplasty. One group received indomethacin for 14 days (n = 102), and the second for 7 days (n = 99) after cementless total hip arthroplasty. At followup 1 year postoperatively, the average Harris Hip Score was 91 points in the 14-day treatment group and 89 points in the 7-day treatment group. The incidence of heterotopic ossification as outlined by Brooker was similar in both groups. Ninety-six patients in the 14-day treatment group had heterotopic ossification Grades 0 or 1, and 6 patients had Grade II heterotopic ossification; whereas in the 7-day treatment group, 95 patients had Grades 0 or 1 heterotopic ossification and 4 patients had Grade II ossification. None of the patients had Grades III or IV heterotopic ossification. In the 14-day treatment group, headache, dizziness, or gastritic disorders develop in 10 patients, and in the 7-day treatment group, 7 patients had these effects. This study shows that treatment with 100 mg indomethacin daily for 7 days is not significantly different than 14 days of treatment for the prevention of formation of severe heterotopic ossification after cementless hip arthroplasty.     

Thromboembolism complicating surgery for cervical and uterine malignancy: incidence, risk factors, and prophylaxis

Venous thromboembolism is a leading cause of death and morbidity after extended surgery for early malignancies of the cervix and uterus. Two hundred eighty-one patients who underwent such surgery were retrospectively evaluated for associated risk factors, the incidence of clinically significant thromboembolic complications, and prophylactic value of low-dose heparin and antiembolism stockings. Significant thromboemboli were encountered in 7.8% of patients postoperatively and accounted for the only 4 postoperative deaths. Forty-five percent of patients who developed thromboemboli did so after discharge from the hospital. The preoperative risk factors found to be associated with thromboembolism, in order of statistical significance, were weight in excess of 85.5 kg, advanced clinical stage of malignancy, and radiation therapy within 6 weeks of the operative procedure. Low-dose heparin therapy and the use of antiembolism stockings as preventative measures did not appear to reduce the incidence of thromboembolic complications. A prospective study will be necessary to evaluate definitely the effectiveness of various therapeutic modalities on thromboembolism in gynecologic oncology patients.     

Arterial vascular lesions after total hip joint replacement

We report on three arterial thromboses of the external iliac artery following total hip replacement. As a result of implanted cement/spongiosa or protrusion of the acetabular component, the iliac vessels were compressed. Furthermore, we report about one intraoperative arterial vessel lesion in a 65-year-old patient during a revision operation. We recommend that in case of acute ischemic syndromes of lower limbs following total hip replacement, an angiography should be performed in order to exclude an extravascular cause of thrombosis. For therapy in those cases extra-anatomic bypasses should be preferred to thrombectomies.     

Normal pregnancy and delivery following total hip joint replacement

Total joint replacement procedures should be restricted to older individuals or persons with limited physical activities or life expectancy. However, on occasion a total joint replacement may be the only means to avoid serious disability in a young, otherwise healthy individual. This report of a 19-year-old woman who underwent a total hip joint replacement following unsuccessful treatment of a severely comminuted intracapsular hip fracture. Subsequent to the total hip joint replacement the patient experienced a normal pregnancy and delivery.     

Analysis of fluid film lubrication in artificial hip joint replacements with surfaces of high elastic modulus

The endocytic pathway of Tritrichomonas foetus, a parasitic protozoan of cattle, was studied using (a) vital dyes, such as Lucifer yellow, neutral red and acridine orange, (b) cationized ferritin, (c) gold-labeled lactoferrin and lectins: HPA, UEA, PNA and LPA, and (d) DAMP (3-(2,4-dinitroanilino) 3' amino-N-methyldipropylamine). Light and confocal laser microscopy as well as transmission electron microscopy were used in this study. Assays were monitored by fluorescence and electron microscopy after exposing the parasites to different conditions. Cells that were incubated at 15 degrees C or 20 degrees C with gold-labeled lactoferrin and processed for electron microscopy show that of 15 degrees C this ligand is found only in an early endosomal compartment and at 20 degrees C it is found in late endosomes but not in lysosomes. Immunocytochemical data from cryosections using DAMP as a pH probe show that T. foetus has acidic compartments, with a pH range of 5.2 to 6.6, with variable morphology, localization and size. Lectin-binding sites and anionic sites were also internalized and appear to be associated with membranes lining the vacuoles. Images of patching and shedding of these sites were also observed when HPA and UEA were used.     

Antibiotic and antithromboembolic prophylaxis in hip arthroplasty (a review of 700 primary implants)

The muscle attachment site (MAS) in Drosophila provides a unique and excellent model system to study the mechanism of cell-matrix adhesion in developing organisms. Here, we report on the isolation and characterization of a novel extracellular matrix (ECM) molecule localized at the MAS, encoded by the M-spondin (mspo) gene. M-spondin protein contains a thrombospondin type I repeat (TSR) previously found in a variety of ECM molecules. Furthermore, it shares two conserved domains with F-spondin, a vertebrate ECM molecule with TSRs. The presence of TSR(s) and the two homologous domains thus defines a novel gene family of ECM molecules. The mspo mRNA was expressed by a large subset of muscles in the embryonic body wall. Secreted M-spondin protein diffused and eventually became immobilized at the MAS in late embryos. When expressed in S2 cells, the protein was secreted and became concentrated in the matrix on the surface of the culture dish. Genetic analysis revealed that both deletion mutants and misexpression mutants suffered no obvious developmental defects. We propose that M-spondin, although its function is redundant, is a component of the ECM and mediates mechanical linkage between the muscles and apodemes.     

Influence of femoral lengthening on hip joint space in posttraumatic femoral shortening

AIMS: To objectively assess the psychological and psychosexual morbidity of patients with vulvar vestibulitis. METHODS: 30 patients with variable degrees of vulvar vestibulitis were recruited from a vulval clinic. Each patient underwent a detailed history and clinical examination. Friedrich's criteria were used for the diagnosis of vulvar vestibulitis. Standardised questionnaires to assess psychological and psychosexual function were completed by the patient before review. These questionnaires were the STAI and a modified psychosexual questionnaire introduced by Campion. RESULTS: Patients experienced considerable psychological dysfunction compared with controls. All aspects of psychosexual dysfunction were affected. CONCLUSIONS: When managing patients, psychosexual and psychological issues must be considered in addition to other conventional types of therapy. Vulvar vestibulitis may be a risk factor for developing psychosexual complications including vaginismus, low libido, and orgasmic dysfunction. Consideration of these factors must be an integral part of the management of patients with all chronic vulval conditions.