Cases reported "Prosthesis Failure"

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1/14. Difficulty in removal of the distal locking device of the Brooker-wills tibial nail.

    Complications in removal of the Brooker-wills tibial nail were encountered in eight patients, and breakage of the distal fins occurred in four of these patients. Although none of the patients experienced residual effects related to removal of the tibial nail, the procedure is associated with potential risks such as infection or nonunion. Three methods of nail removal are described.
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2/14. Periprosthetic leak and rupture after endovascular repair of abdominal aortic aneurysm: the significance of device design for long-term results.

    We present a case of abdominal aortic aneurysm treated with an endovascular bifurcated aortic graft in which a periprosthetic leak caused by a tear in the polyester prosthesis appeared between 9 and 12 months after surgery. The tear appeared adjacent to a suture breakage that caused separation of two struts of the nitinol wire framework in the body of the stent graft. The leak was sealed with insertion of a new endovascular tube graft into the body of the bifurcation. Eight months later, the patient had a nonfatal rupture of the abdominal aortic aneurysm because detachment of the second limb from the bifurcation caused a new major periprosthetic leak. According to the manufacturer of this device, suture breakage with separation of metal components is commonly seen, but perforation of the polyester prosthesis caused by movement of the metal stent against the fabric has not been reported. It is likely that this occurred in our patient. Detachment of the second limb from the bifurcated stent, causing a rupture, has been described before. Increasing angulation and tortuosity of the stent graft, as a result of either remodeling of the sac or elongation of the stent, and reduced compliance to angulation after the stent-in-stent procedure might have contributed to the detachment in this case.
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3/14. 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.
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4/14. Pitfalls associated with fixation of osteochondritis dissecans fragments using bioabsorbable screws.

    The purpose of this study was to evaluate 2 cases in which bioabsorbable screw fixation for an osteochondritis dissecans lesion of the femoral condyle resulted in complications necessitating the need for secondary surgery. We reviewed the case history of these patients and described the circumstances under which the bioabsorbable screws were used, the events leading to the need for secondary surgery, and the ultimate outcome. In the 2 cases presented, these implants were found to retain their mechanical stiffness for many months. This resulted in articular damage in 1 case after the treated lesion failed to heal. In the second case, screw breakage 8 months after implantation resulted in it becoming a loose body, which required removal during a second arthroscopic procedure. We conclude that these implants retain their mechanical properties for many months and cannot be relied on to degrade quickly. If a treated lesion fails to heal, these implants can cause mechanical problems due to their retained structural properties.
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5/14. Complications related to hydroxyapatite vertebral spacer in anterior cervical spine surgery.

    STUDY DESIGN: This is a report of complications related to the hydroxyapatite vertebral spacer used for anterior cervical reconstructive surgery. Compression of the spinal cord by broken fragments of hydroxyapatite spacer as well as its surrounding radiolucent clear zone were observed in seven patients. OBJECTIVES: To report complications related to the use of hydroxyapatite vertebral spacer for anterior cervical reconstructive surgery and to discuss how to prevent these complications. SUMMARY OF BACKGROUND DATA: Despite previous articles reporting the clinical applications of hydroxyapatite vertebral spacer for the cervical spine, clinical reports regarding the long-term results of hydroxyapatite spacer for anterior cervical surgery and its complications have been limited. methods: The authors reviewed patients who underwent anterior reconstructive surgery using the hydroxyapatite spacer at other hospitals and had postoperative complications related to hydroxyapatite spacer. RESULTS: Seven patients previously treated by anterior cervical spine surgery using the hydroxyapatite vertebral spacer were referred to the authors because of unsatisfactory surgical outcomes. All the patients had a radiolucent clear zone around the spacer and experienced severe neck pain. Four had fracture of the hydroxyapatite spacer, and two had compression of the spinal cord by retropulsed fragments of broken hydroxyapatite spacers. CONCLUSIONS: Although hydroxyapatite has been used in many medical fields because of its bioactive characteristics, its mechanical properties should be improved to lessen the risks of breakage and subsequent spinal cord compression. Gentle insertion maneuvers are also important to avoid the production of cracks inside the spacer.
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6/14. Bilateral spontaneous subluxation of scleral-fixated intraocular lenses.

    Two young men with primary ectopic lenses had intracapsular cataract extraction and scleral fixation of posterior chamber intraocular lenses (PC IOLs) using 10-0 polypropylene sutures tied to the IOL eyelets. Three to 9 years after implantation, spontaneous IOL vertical subluxation occurred in all 4 eyes (5 IOL loops), probably because of suture breakage. Late subluxation of a sutured IOL may occur several years after implantation. Double fixation and thicker sutures should be considered, especially in young patients.
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7/14. Intraarticular migration of a broken biodegradable interference screw after anterior cruciate ligament reconstruction.

    Poly-L: -lactic acid biodegradable screws have been used effectively for graft fixation in anterior cruciate ligament (ACL) reconstruction. The overall complication rate associated with the use of this implant is low, although some authors reported complications, such as osteolysis and aseptic effusion of the knee joint. We report a case of a 29-year-old female patient with a failure of a biodegradable interference screw at 22 months after ACL reconstruction using bone-patellar tendon-bone graft. In this illustrated case, the screw broke and migrated into the knee joint. In addition, we performed a detailed review of the medical literature from 1990-2005 to identify possible causes of biodegradable screw failures. We identified six published cases of bioabsorbable interference screw failure with migration into the knee joint. Several authors have reported small diameter of the screw, poor bone quality, bone resorption, and screw divergence as potential causes for intraarticular migration of metallic interference screws. With regard to bioscrews, no specific risk factors for screw breakage and intraarticular migration have been reported. ACL reconstruction with the use of bioabsorbable interference screws for fixation is considered to be reliable. However, we need to be aware of potential problems associated with the use of this implant. Early recognition of bioscrew failure may prevent associated morbidities, such as subsequent cartilage damage.
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keywords = breakage
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8/14. Traumatic breakage of the ceramic head of prosthesis in total hip replacement.

    The authors describe breakage of the 32 mm alumina AL2 O3 ceramic head in 3 cases of total hip replacement using two different models of prosthesis (Charnley-Muller and Mittelmeier). All three patients were of average height, weight, and activity (Brown et al., 1985; Callaghan et al., 1988), and the breakage had been caused by an accidental fall. The same mechanism of injury, in people the same age as our subjects, can cause femoral neck fractures. reoperation was necessary in order to replace the component. The implants all appeared to be positioned correctly, and the patients had reported no symptoms. Before the trauma that caused breakage, there had been no other injuries worth noting. All patients were satisfied with their hip replacements.
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keywords = breakage
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9/14. Breakage of the Kuntscher nail in fractures of the femur after healing has occurred.

    Four cases of breakage of Kuntscher intramedullary nails (AO model) are presented. All 4 nails broke after fracture healing had occurred and all 4 presented breakage of the stem in the same site. In these cases breakage of the nails is not due to instability of the fracture, but always derives from superficial micro-cracks, technologically inevitable, due to defects or irregularities in the metal that expand during load application.
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ranking = 3
keywords = breakage
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10/14. Fracture of polyethylene tibial component in a total knee replacement. A case report.

    Aseptic loosening is the most common mode of failure for total knee replacements. Component breakage is rare, usually attributable to errors of design or manufacture. A case is presented in which rotational malplacement of the femoral component resulted in accelerated wear and eventual fracture of the polyethylene tibial component.
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