1/152. Fracture of the femoral component associated with polyethylene wear and osteolysis after total knee arthroplasty.Fracture of the femoral component associated with polyethylene wear and osteolysis after total knee arthroplasty (TKA) has not been well reported before. A 63-year-old man with osteoarthritis of the right knee underwent TKA with a New Jersey LCS Knee, with cementing on the tibia and patella but not on the femoral component. After 42 months, in addition to wearing of polyethylene of the tibia and patella, severe osteonecrosis of the medial femoral condyle was noted. osteonecrosis caused loss of osseous support of the medial flange of the femoral component, and the bone ingrowth of the central and lateral flange to the distal femur was so good that it overcame the yield stress of the metal of the femoral component and caused fracture of the femoral component. The osteolytic area was filled with autogenous iliac bone, and a new femoral component was inserted and cemented. The patient's condition became satisfactory with relief of pain. Although uncommon, fracture of the femoral component does occur associated with polyethylene wear and osteolysis.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
2/152. Reactions and complications after the implantation of Endobon including morphological examination of explants.In the study described here, the integration of hydroxyapatite (HA) ceramic implants (Endobon) was investigated. These implants have an interconnecting system of pores and are free from foreign protein. The material is not toxic, genotoxic, nor zytotoxic, and it is biocompatible. The progress of integration was investigated by means of clinical and radiological check-ups. From 10 patients, it was possible to obtain samples for histological analysis during a second operation (e.g., metal explantation). Microscopic examination showed bony integration with newly formed bone in direct contact with the HA ceramic; it also showed osteoblasts and osteoid seams. No second operation took place earlier than 4 months after the first operation, yet even after this relatively short period, bony integration was already evident. Clinical observation (based on x-rays, reports of pain, signs of inflammation) showed that in most cases healing was taking place without complications. More general operational complications such as thrombosis or nerve injury were observed in 4 patients. If the implant is not sufficiently protected from mechanical stress, bony integation will not take place, and the implant may fracture. HA ceramic, with a porosity between 30% and 80%, is not comparable to cortical bone but only to spongy bone. This factor must be taken into account when deciding whether a HA ceramic implant is indicated.- - - - - - - - - - ranking = 0.5keywords = fracture (Clic here for more details about this article) |
3/152. Subclavian stents and stent-grafts: cause for concern?PURPOSE: To report cases of stent and stent-graft fracture in the subclavian vessels. methods AND RESULTS: Three patients with self-expanding stents of 3 different types in 1 subclavian artery and 2 subclavian veins presented with recurrent symptoms 6 months to 2 years after stenting. All devices showed signs of compression with stent fracture. The covered stent in the subclavian artery was excised. Of the 2 venous patients, 1 was treated with first rib resection and the other refused further treatment. CONCLUSIONS: The subclavian vessels are prone to flexion during movement, and the vessels may be compressed by external structures, including the clavicle and first rib. stents that have not been designed to withstand these forces may be damaged.- - - - - - - - - - ranking = 1keywords = fracture (Clic here for more details about this article) |
4/152. Lateral insufficiency fractures of the femur caused by osteopenia and varus angulation: a complication of total hip arthroplasty.Lateral femoral insufficiency fractures in total hip arthroplasty occur due to osteopenia and varus positioning of the femoral component, the femur itself, or both. The presentation of these fractures can be unclear but usually involves the insidious onset of unexplained thigh or groin pain. The patients are likely to have significant comorbidities as well. Characteristic radiographic findings may be present, depending on when the patient presents. The insufficiency fractures generally occur at the level of the femoral stem tip on the lateral cortex of the femur. If left untreated, pain and loss of function continue. Eventually an insufficiency fracture can progress to a displaced periprosthetic fracture. Nonsurgical treatment is not successful. Recommended treatment involves revision to a long-stem femoral component. The risk of postoperative complications is significant.- - - - - - - - - - ranking = 4.5keywords = fracture (Clic here for more details about this article) |
5/152. Leaflet escape in a TEKNA and an original duromedics bileaflet valve.We report a case of leaflet escape in an Edwards-TEKNA bileaflet valve, in the mitral position. The examination findings of the explanted valve are compared with a similar case of leaflet escape in an original Edward-Duromedics prosthesis. Based on our findings alone, it is not certain whether the TEKNA valve continues to have a higher risk for fracture.- - - - - - - - - - ranking = 0.5keywords = fracture (Clic here for more details about this article) |
6/152. Failure after customized curved femoral stems in total hip arthroplasty for Paget's disease.We describe 2 patients with Paget's disease who underwent total hip arthroplasty for osteoarthrosis. In view of the femoral deformity in each case, a custom-made, long, curved femoral stem was used. Both patients have subsequently sustained periprosthetic fractures at the level of the tip of the prosthesis.- - - - - - - - - - ranking = 0.5keywords = fracture (Clic here for more details about this article) |
7/152. Disk embolization of a Bjork-Shiley convexo-concave mitral valve: a cause of sudden cardiovascular collapse and mesenteric ischemia.Strut fracture and disk embolization of a Bjork-Shiley convexo-concave valve is uncommon, but it should always be considered as a cause of sudden cardiovascular collapse in patients with such valves. Recognition of this clinical scenario is essential, given the importance of early diagnosis and the prevalence of these valves worldwide. We present a fatal case of disk embolization of a mitral prosthesis presenting with cardiogenic shock and mesenteric ischemia.- - - - - - - - - - ranking = 0.5keywords = fracture (Clic here for more details about this article) |
8/152. Fracture of posterior-stablized tibial insert in a Genesis knee prosthesis.We report a case of acute failure of a Genesis total knee arthroplasty (Smith and Nephew Orthopaedics, Memphis, TN) resulting from fracture of the eminence of the polyethylene posterior-stabilized tibial insert implanted in a revision procedure. A hyperflexion movement was responsible for shear stress on the insert with subsequent breakage. The correct diagnosis was obtained by arthroscopy, and the open substitution of the broken insert led to complete recovery of the prosthesis. This is the first report of mechanical breakage of a Genesis prosthesis.- - - - - - - - - - ranking = 0.5keywords = fracture (Clic here for more details about this article) |
9/152. Intolerance of osteosynthesis material: evidence of dichromate contact allergy with concomitant oligoclonal T-cell infiltrate and TH1-type cytokine expression in the peri-implantar tissue.BACKGROUND: We report on a 37-year-old man without history of previous allergic disease who developed an aseptic intolerance reaction to a chromium-cobalt alloy, with local discomfort, loosening, and absence of fracture healing. Both in vivo and in vitro allergoimmunologic diagnostic tests were performed. methods: Patch testing was done with a European standard series. Specific serum IgE was measured by CAP-FEIA. In addition to immunohistology (APAAP method), peri-implantar tissue was further analyzed by PCR to determine T-cell-receptor-gamma rearrangement and thus the potential clonal (antigen-driven) T-cell repertoire. The actual tissue mRNA expression for IL-4, IL-6, and IFN-gamma was visualized by RT-PCR. RESULTS: skin testing gave a delayed-type reaction to dichromate. Specific serum IgE to natural rubber latex and grass pollen was found--but without clinical symptoms. Immunohistology revealed a monocytic and dense T-cell infiltrate. The latter, instead of being random, showed an oligoclonal T-cell receptor rearrangement. In addition, there was TH1-type mediator expression (IL-6 and IFN-gamma, but not IL-4). CONCLUSIONS: skin test, examination of peri-implantar tissue, and the prompt healing after replacement of the osteosynthesis material suggest an allergic reaction. PCR analysis of peri-implantar tissue can further help to identify and understand allergy-mediated implant intolerance reactions.- - - - - - - - - - ranking = 0.5keywords = fracture (Clic here for more details about this article) |
10/152. Stem displacement during reduction of a dislocated cemented total hip arthroplasty with a polished tapered stem.Displacement of the polished stem of a total hip arthroplasty from its cemented mantle occurred as a complication of an attempted closed reduction after luxation. No cement fractures were seen during subsequent reoperation. The complication can be avoided if cement is placed over the shoulder of the prosthesis.- - - - - - - - - - ranking = 0.5keywords = fracture (Clic here for more details about this article) |
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