We carried out a prospective study of 71 patients who had undergone reconstruction of the anterior cruciate ligament with the ABC scaffold. Their mean age was 28 years (18 to 50). All had either sub-acute or chronic traumatic deficiency of the ligament. The mean period of follow-up was five years (four to seven). Assessment included the use of the International Knee Documentation Committee score, the modified Lysholm score, the Tegner Activity score, the Knee Injury and Osteoarthritis Outcome score and measurement with the KT-1000 arthrometer. Two patients had mild recurrent synovitis. There were no infections and no failures of the ligament. During the period of study, two patients sustained a traumatic fracture of a femoral condyle. The implants retained their integrity in both cases. All patients returned to their previous or enhanced levels of daily activity by three months after operation and 56 (79%) achieved their pre-injury level of sporting activity by six months. The patients who were competing in National level sports returned to play at one level less after operation than before. The Lysholm score showed that 58% of the patients (41) were excellent, 34% (24) good, and 8% (6) fair, with a mean post-operative score of 93. According to the International Knee Documentation Committee score, 35% of knees (25) were ‘normal’, 52% (37) ‘nearly normal’ and 13% (9) ‘abnormal’. Complete satisfaction was noted in 90% of patients (64). The development of osteoarthritis and the management of anterior cruciate deficiency associated with laxity of the medial collateral ligament remains uncertain. Our results indicate that in the medium-term, the ABC ligament scaffold is suitable and effective when early and safe return to unrestricted activities is demanded. We acknowledge the current general hostility towards reconstruction of the anterior cruciate ligament with artificial materials following reports of early failure and chronic synovitis associatiated with the production of particulate debris. We did not encounter these problems.
We reviewed 100 cemented Endo-model rotating-hinge (Waldemar Link GMBH &
Co, Hamburg, Germany) total knee replacements in 80 patients with a mean age of 70 years (56 to 85) at a mean post-operative follow-up of 11 years (7 to 15). Good or excellent results were seen in 91% of knees and survival at 15 years was 96.1%. There were two deep infections, one dislocation and one supracondylar fracture. There were no peri-operative deaths and there was no loosening, malalignment, migration or wear. We consider this prosthesis to be ideally suited for the replacement of the deformed knee when the use of an unconstrained design may be questionable.
Surgeon who used the uncemented cup must choose between two kids of cups: the porous coated (press fit) and the threaded. Many authors present several discouraging results. Nevertheless satisfactory results have also been obtained using threaded cups and the explanation lays in the design the alloy and the surface characteristics of the acetabular component. We describe the clinical and radiological outcome of 93 THA in 81 patients using a screw-in cup (Link- type) performed between 1994–2000. Our follow-up time was and the average age of the patients was 68y,all were primary THA(78 OIA,15 sub-capital fractures).Clinical evaluation was perfomed using the Merle d’ Aubigne hip score.
The mean age was 48y. The technique consists of:
Anatomic reduction (with a C-arm), which was the most crucial point of the technique. Secure fixation with three cannulated screws (Asnis) A like tube graft from the iliac crest was placed on the neck of the femur, posteriori to increase the vascularity of the head. Weight bearing was permitted after 6 m and if the fracture was healed.
Therefore, the pathologic tissue must be excised and often a large defect is created. Different procedures have been described to repair this defect.
This procedure consists in turning down a fascia flap from the gastroknernius to bridge the gap and end-to-end suture. In 13 patients the plantaris tendon has been used as a reinforcing membrane. In 2 cases we didn’t found it. We didn’t have any postoperative complications. After care a long -leg cast is applied with sufficient equinus of the foot and flexion of the knee for 6 weeks. For 6 weeks more a short leg cast was applied with the foot in neutral position and weight hearing was slowly resumed.
We had 2 far results and 1 poor but -no rerupture. The gap that we were obliged to repair was between 3cm–8cm
It is known that patients who are undergoing major orthopaedic operations of the lower legs (fractures, total hip and knee arthroplasty) belong to a high-risk group, for the development of thromboembolic events. 20–40% of the patients develop deep vein thrombosis (DVT) of the calf and 2–4% fatal pulmonary embolism. These patients may have remarkable activation of the coagulation system, which is important for the development of deep vein thrombosis of the lower legs.
The exact estimation of these factors is necessary, so that these patients receive the suitable prophylactic antithrombotic therapy,
All patients had normal renal function, and the platelets, count, the PT and aPTT were in a normal range. The patients were hospitalized for 7 days and then they were observed as outpatients for the possibility of developing deep vein thrombosis and for a 4 weeks period. All patients received a combination of LMWH and graduated compression elastic stockings as a prophylaxis against DVT. Plasma concentration of Di-dimers and Thrombin -Antithrombin complex (TAT) were measured preoperatively and the second, the fourth and the sixth day postoperatively. Di-dimers plasma concentration were measured by automated analyzer (VidasBiomerieux) and TAT plasma concentration were measured by an enzyme-linked microimmunoabsorbent assay (microelisa Dade-Berhing)
In patients with total hip and knee arthroplasty TAT plasma concentration increased significantly the 12nd postoperative, day, decreased the 4th postoperative day and then increased again (p<
0.01). Di-dimers plasma concentration increased significantly the 2nd postoperative day and then decreased (p<
0,03). Until the 6th postoperative day Di-dimcrs concentration remained above normal range. Patients with fractures had higher TAT levels preoperatively than patients with total hip and knee arthroplasty. (p<
0.027)
100 randomized primary cementless THRs in 80 patients were reviewed retrospectively regarding the HA cover of the stem which was Waldemar Link’s, ribbed type, made of Titanium, with a collar and mostly applied without the trochanteric screw. The femoral neck was always retained high as possible. Full weight bearing on the operated leg started the 3rd postoperative day, while years earlier the 6th postoperative week. Two more or less, equal groups were formed: (A) without, (B) with HA covered stems and two subgroups: patients of 60 to70 years and 70 to 80 years. Gender was matched as possible and mean follow-up time was 8 years (range 7 to IO years). The Harris Hip Score was used for clinical evaluation and the method of “pencil and ruler” in plain X- Rays for radiographical one. Patients who died after the 8th postoperative year of evaluation were included. Results 1, The postoperative hip score was at average for group (A) 92.1 points and for gr. (B) 92,4p. 2. In gr. (A) we found* at a rate 70% 2mm of symptom less, adaptive, slow early migration, while in gr. (B) this corresponded to 1 mm of same migration at a rate 60%. In both groups migration stopped by the second postoperative year. 3. “Alarming” stem migration was found in two cases: one in each group. The cause was that the stems applied, were undersized and the patients were women on menopausal osteoporosis. Both sterns were revised. Two more “alarming” stem migrations were found, one in each group, in patients suffering from collagenosis with the relevant bone quality. This migration was related to bone retreat primarily and irrelevant to stem’s loosening, gender or age of patients. Both stems have not been revised yet. 4. Similar and minimal-2% for gr. (A) vs 4% for gr. (B)- was the rate of symptomless, limited, non-sclerotic of less than 2mm wide demarcations gradually resolving, 5. Similar and minimal-2% for gr. (A) vs 5% for gr (B)- was the rate of stress shielding phenomenon resolving in 2 years time. 6. No further mechanical or biological loosening were noticed at mid-term results 7. Similar- 20% for gr (A) vs 15% for gr (B) was the rate of mild symptomless ectopic ossifications.
