Objectives. Prosthetic joint infection (PJI) is a devastating complication following total joint arthroplasty. Non-contact induction heating of metal implants is a new and emerging treatment for PJI. However, there may be concerns for potential tissue necrosis. It is thought that segmental induction heating can be used to control the thermal dose and to limit collateral thermal injury to the bone and surrounding tissues. The purpose of this study was to determine the thermal dose, for commonly used metal implants in orthopaedic surgery, at various distances from the heating centre (HC). Methods. Commonly used metal orthopaedic implants (hip stem, intramedullary nail, and locking compression plate (LCP)) were heated segmentally using an induction heater. The thermal dose was expressed in cumulative equivalent minutes at 43°C (CEM43) and measured with a thermal camera at several different distances from the HC. A value of 16 CEM43 was used as the threshold for thermal damage in bone. Results. Despite high thermal doses at the HC (7161 CEM43 to 66 640 CEM43), the thermal dose at various distances from the HC was lower than 16 CEM43 for the hip stem and nail. For the fracture plate without corresponding metal screws, doses higher than 16 CEM43 were measured up to 5 mm from the HC. Conclusion.
Our aim was to assess the outcome of the treatment of
INTRODUCTION. Standing spinal alignment has been the center of focus recently, particularly in the setting of adult spinal deformity. Humans spend approximately half of their waking life in a seated position. While lumbopelvic sagittal alignment has been shown to adapt from standing to sitting posture, segmental vertebral alignment of the entire spine is not yet fully understood, nor are the effects of DEGEN or DEFORMITY.
Introduction.
This prospective multicentre study was undertaken
to determine segmental movement, disc height and sagittal alignment
after total disc replacement (TDR) in the lumbosacral spine and
to assess the correlation of biomechanical properties to clinical
outcomes. A total of 173 patients with degenerative disc disease and low
back pain for more than one year were randomised to receive either
TDR or multidisciplinary rehabilitation (MDR).
Aim.
Introduction.
Introduction.
Study Design: Retrospective study. Objective: To describe a modified cervico-thoracic extension osteotomy and evaluate clinical &
radiographic outcomes. Subjects: 10 patients with fixed cervico-thoracic kyphosis, average age 56 years, minimum 12 months follow-up. Three patients had psoriatic spondyloarthropathy, Three patients had previous lumbar osteotomies. Technique: General anaesthesia and SSEP spinal cord monitoring was used. Complete laminectomy of C7, hemilaminectomy of C6 and T1, plus pedicle subtraction osteotomy and decancellisation of C7 was performed. Upon completion of the osteotomy, controlled halo manipulation allowed closure of the osteotomy: the pivot point being the anterior longitudinal ligament.
Summary Statement. Bio-impedance analysis (BIA) provides a convenient method for the estimation of whole body and segmental measurement of skeletal muscle mass (SMM). BIA-measured SMM parameters may be effectively used for the normalisation of muscle strength and removing body-size dependence. Introduction. Despite an increasing interest in using bio-impedance analysis (BIA) for the estimation of segmental skeletal muscle mass (SMM); existing data is sparse. On the other hand, there is a need for better understanding of the influence of SMM on gender-related differences in muscle strength. Using BIA technique, this study aimed to measure the SMM, determine its correlation with muscle strength, and examine its relation with gender-related differences in muscle strength. Patients and Methods.
Purpose: To assess the usefulness of Bone Transport and other “compression-distraction” systems for the treatment of
Introduction We review our experience with the use of plate and screw (C1 lateral mass and C2 pedicle) method of fixation in the treatment of 300 patients with disorders of the craniovertebral junction during a 17-year period at our center. We previously described this method of fixation in 1994. Methods Between 1988 and 2004, 250 patients with atlantoaxial instability were treated with the use of a plate and screw method of fixation at our institution. The various aetiologies of atlantoaxial instability were congenital, trauma and rheumatoid arthritis. All patients had mobile, completely reducible atlantoaxial subluxation. The male: female ratio was 3:1. C1 lateral mass screw and C2 pedicle screw were anchored to a plate bilaterally. For 3 months postoperatively, a hard cervical collar was used. The mean follow-up period was 42 months (range, 4 mo–17 yr). Recently, we have modified the technique by distracting the lateral facet joints, placing a cage bilaterally and then performing the lateral mass fixation for a subgroup of 50 patients with either fixed atlantoaxial joint subluxation or basilar invagination. Results Three patients died in the postoperative phase. Successful stabilization of the atlantoaxial region was documented with dynamic radiography in the other patients. In one patient, one screw was found to be broken 18 months after surgery; however, firm bony fusion was documented in this patient. There were no neurological, vascular, or infective complications. Discussion
Nonunions and segmental bone defects associated with infection are challenging problems faced by the orthopaedic surgeon. Antibiotic cement-coated (ACC) interlocking nails, prepared in the operating theatre using nails and materials generally available, can be used to treat these conditions. Two different types of moulds can be used (reusable or disposable). Materials and Methods: The infected nonunion/segmental bone defect was treated by débridement followed by ACC nailing in 52 patients (12 female, 40 male, age range 16–86 years). Other procedures for deformity correction, bone defect etc were carried out simultaneously as indicated. Infected nonunion was seen in 34 patients, 1 was an acute fracture after external fixator.
Common cell based strategies for treating bone defects require time-consuming and expensive isolation and expansion of autologous cells. We developed a novel expedited technology creating gene activated muscle grafts. We hypothesized that BMP-2 activated muscle grafts provide healing capabilities comparable to autologous bone grafting, the clinical gold standard. Two male, syngeneic Fischer 344 rats served as tissue donors. Muscle tissue was harvested from hind limbs and incubated with an adenoviral vector carrying the cDNA encoding BMP-2. Bone tissue was harvested from the iliac crest.
Aim: Bone grafts and bone graft substitutes are often used at radical surgical procedures such as; trauma, congenital anomalies, tumor surgery, bone infections, revision arthroplasty surgery, spinal surgery. However autograft and allograft bone are frequently used, they have some limitations. ABM/P-15 (Pepgen P-15) is a combination of anorganic bovine derived hydroxyapa-tite matrix coupled with a synthetic-cell binding peptide (P-15). This tissue engineered particulate bone replacement graft has been established for the treatment of periodontal osseous defects. The aim of this study is to determine the effect of ABM/P-15 on the healing of a critical sized segmental defect in rat radius. Methods: 36 Wistar rats were used at this study. A critical sized segmental defect was created in each rat radius. 13 defects were filled with ABM/P-15 Flow (putty form), 12 defects were filled with ABM/P-15, and 11 defects were used as a control group. The rats were killed at 10 weeks. The healing of defects was evaluated with radiographic and histological studies. Results: The use of ABM/P-15 and ABM/P-15 Flow were demonstrated improved healing of segmental bone defects in rat radius on radiographic and histological studies compared with control group. Statistical evaluation showed that there were significant differences between control sites, and sites treated with P-15 and P-15 Flow (p<
0.005). The highest radiological and histological grades were achieved by P-15. Osteogenic proliferation was seen at the P-15 group more than P-15 flow. Conclusion:
Background: To determine whether the operation of LSD destabilizes the lumbar spine and leads to an increase in any pre-existing scoliosis or spondylolisthesis. Lumbar spondylosis, which commonly includes a degenerative listhesis and a scoliosis, is the commonest cause for stenosis in the lumbar spine. The standard operation for spinal stenosis remains a laminectomy with fixation and fusion in the presence of possible instability. The laminectomy, however, destabilises the spine and the instrumented fusion makes it a much bigger operation in patients often not best placed to cope with it. The more limited operation of LSD, which has previously been reported to this society, avoids a simultaneous fusion or instrumentation and has been shown to give long term symptomatic relief (. 1. ) Its possible effect on the stability of the spine has not previously been reviewed. Methods: A retrospective clinical and radiological review of consecutive patients operated on for degenerative spinal canal stenosis with either a pre-existing scoliosis or degenerative listhesis or both. Sixty-one patients (44 female and 17 male) with a mean age at operation of 72.8ys (range: 54–85). Pre-operatively 35patients (57%) had a degenerative listhesis, 14 patients (23%) a lumbar scoliosis and 12 (20%) had both. The mean postoperative follow-up was three years (range from one to fourteen years). Results: None of the 47 patients with a preoperative degenerative spondylolisthesis had any change in grade of the listhesis. Also no patient developed a new spondylolisthesis. Of the 26 patients with a preoperative scoliosis, 10 progressed by a mean of 4.9° (range 2°–15°). Conclusion: The results show that the operation of LSD was not associated with the development of a spondylolisthesis or a further progression of a pre-existing listhesis, and no patient developed a scoliosis. In those who had a scoliosis pre-operatively, 38% progressed and this only to a degree which we believe falls within the natural progression to be expected in such a group of patients. We believe these results support the view that the operation of Limited