1/32. Polyester fibre prosthetic anterior cruciate ligament implant rupture: necrosis of ingrown connective tissue.AIMS: To describe the histopathological and microanalytical features in seven cases of ruptured Apex(R) polyester (Terylene(R)) fibre anterior cruciate ligament prosthesis. methods AND RESULTS: Transmitted and polarized light microscopy was performed in all cases; one case was investigated by immunohistochemistry, transmission electron microscopy and scanning electron microscopy, with backscatter and X-ray detectors for elemental microanalysis. For comparison we also studied synovial biopsy material and unused polyester fibres. In the excised ligaments there was much ingrowth of fibrous tissue accompanying a florid giant cell reaction to the individual intact polyester fibres throughout the ligaments. phagocytosis of particles of prosthesis-derived material was demonstrated and a striking finding was of necrosis of the ingrown connective tissue in the central portions of the ligaments. Hyalinized areas and 'neoligament growth' were less striking. A consistent finding in the polyester fibres was of small particles containing antimony, used as a catalyst in the manufacturing process. CONCLUSIONS: The pattern of reaction to the prosthetic material and the presence of necrosis differ from previous descriptions in animal and human explants of this and other prosthesis types. The mechanical effect of the necrosis is unlikely to be of significance with this ligament, which is load-bearing ab initio.- - - - - - - - - - ranking = 1keywords = connective (Clic here for more details about this article) |
2/32. Palliation of pyloric stenosis caused by gastric cancer using an endoscopically placed covered ultraflex stent: covered stent inside an occluded uncovered stent.A 71-year-old man developed pyloric stenosis caused by gastric cancer. vomiting and nausea resolved after the insertion of an uncovered Ultraflex stent (length 10 cm, inner diameter 18-23 mm) through a 7-cm-long stenosis, and the patient was able to eat a soft diet. After 6 weeks, stent occlusion occurred due to tumor ingrowth and accumulation of food residue. Endoscopic observation showed a very narrow residual lumen. A covered Ultraflex stent (length 10 cm, inner diameter 18-23 mm) was inserted through the first stent and expanded to its maximum diameter over the next 2 days. The patient's vomiting and nausea improved rapidly. He died 6 months after the second stenting procedure, from metastatic tumor spread, having remained free of nausea and vomiting. In this case, a covered metallic stent prevented tumor ingrowth and maintained gastrointestinal patency.- - - - - - - - - - ranking = 0.091747398067261keywords = soft (Clic here for more details about this article) |
3/32. Disassembly of a Howmedica modular resection system.We report the postoperative disassociation of a Morse taper junction of a Howmedica Modular Resection system implanted after the resection of a malignant distal femoral bone tumor. The disassembly occurred without apparent trauma. This complication was managed by closed reduction under epidural anesthesia. This disassembly probably occurred because of decreased tension of the soft tissue around the prosthesis or an impaired locking mechanism.- - - - - - - - - - ranking = 0.091747398067261keywords = soft (Clic here for more details about this article) |
4/32. arthroscopy after dysfunctional total knee arthroplasty: two cases with peg fracture of the polyethylene insert.arthroscopy may be indicated in patients with painful dysfunction of the knee joint following total joint replacement. Arthrofibrosis, impacted soft tissue, patellar malalignment, synovialitis, and intra-articular foreign bodies can be treated with the promise of a good outcome. Two cases of peg fracture of the polyethylene insert of a semiconstrained knee prosthesis are presented. In relation to fracture position, instability and locking-up of the joint were clinically manifest. When arthroscopy is used judiciously, its merits are found in ensuring the proper diagnosis and in the reliable planning of treatment. When the patient reports locking-up of the joint, the rare complication of a polyethylene peg fracture must be considered.- - - - - - - - - - ranking = 0.091747398067261keywords = soft (Clic here for more details about this article) |
5/32. The Ilizarov method for failed knee arthrodesis following septic TKR.Knee arthrodesis is a well-recognized salvage procedure in patients with infected total knee arthroplasties. If a fusion is achieved, it offers the opportunity for a stable lower limb and eradication of infection, but at the expense of knee motion. However, knee arthrodesis in this setting may be difficult to achieve because of poor bone stock, persistent infection, soft tissue compromise, and often the poor general health of the patient. We report two cases of failed knee arthrodesis following periprosthetic infection where a fusion was successfully achieved with open debridement and a hybrid advanced Ilizarov fixator.- - - - - - - - - - ranking = 0.091747398067261keywords = soft (Clic here for more details about this article) |
6/32. Extensive osteolytic cystlike area associated with polyethylene wear debris adjacent to an aseptic, stable, uncemented unicompartmental knee prosthesis: case report.We present the case of a patient who after uncemented unicompartmental knee arthroplasty developed a large osteolytic cystlike area in the lateral aspect of the tibial metaphysis, contralateral to a well-fixed tibial component at revision surgery. The lesion contained fibrotic soft tissue, evidence of a foreign-body giant cell reaction and polyethylene particles, but no metal wear debris, infection, or malignancy. This case demonstrates that there is a direct communication between the joint cavity and the cyst.- - - - - - - - - - ranking = 0.091747398067261keywords = soft (Clic here for more details about this article) |
7/32. Extra-articular migration of the patellar component following total knee arthroplasty.Complications related to patellar resurfacing are well recognized. We present an unusual case where the patellar button, after separating from the patella, extruded from the knee joint to lie within the extra-articular soft tissues.- - - - - - - - - - ranking = 0.091747398067261keywords = soft (Clic here for more details about this article) |
8/32. Fluordeoxyglucose positron emission tomography detection of inflammatory reactions due to polyethylene wear in total hip arthroplasty.A patient experienced chronic pain 8 years after total hip arthroplasty. radiology and bone scanning showed no signs of aseptic loosening, but fluorine-18 fluorodeoxyglucose positron-emission tomography ((18)F-FDG-PET) showed intensive glucose metabolism in the joint capsule and around the prosthesis neck. The surgical intervention revealed soft tissue reaction in this area. Histologic examination showed a granulomatous foreign body reaction against polyethylene debris particles. infection and rheumatoid arthritis could be excluded clinically, histologically, microbiologically, and with the bone scan. Therefore, FDG-PET detected inflammatory reaction caused by polyethylene wear in total hip arthroplasty and allowed clinicians to decide on interventions, including removal of granulomatous tissue and the replacement of worn artificial joint components to prevent aseptic loosening.- - - - - - - - - - ranking = 0.091747398067261keywords = soft (Clic here for more details about this article) |
9/32. Positive leukocyte and negative bone scintigraphy in extensive arthroplasty infection.An 85-year-old male resident of a nursing home presented after a fall with a painful left hip, confusion, and fever. He had multiple medical problems including severe vascular disease and poor vision as a result of macular degeneration. An Austin Moore left hip prosthesis had been inserted for a fractured femoral neck several years before. A septic workup showed a raised leukocyte count but no other focal abnormality. Plain radiography showed a periprosthetic fracture of the left hip. blood cultures grew beta-hemolytic group A streptococcus sensitive to penicillin. Bone scintigraphy was thought to be consistent with loosening of the prosthesis without evidence of a recent fracture. Tc-99m leukocyte scintigraphy was markedly abnormal, with extensive soft-tissue uptake suggestive of a large periprosthetic infective collection. This was confirmed at surgery with drainage of 200 mL pus from the left hip, and deep and superficial soft tissues of the thigh. The trochanteric fracture was well granulated and thought to be of long standing. The prosthesis was removed and the patient was treated with appropriate antibiotics with good effect.- - - - - - - - - - ranking = 0.18349479613452keywords = soft (Clic here for more details about this article) |
10/32. Ruptured synthetic expanded polytetrafluoroethylene chordae tendinae.Synthetic sutures are used for mitral valve repair and as synthetic chordae tendinae to resuspend the mitral valve. The sutures soon get covered with connective tissue and work well for long periods. We report the first instance (in the literature) of rupture of a synthetic (PTFE) chordae tendinae. The synthetic suture (PTFE) was associated with calcification.- - - - - - - - - - ranking = 0.2keywords = connective (Clic here for more details about this article) |
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