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Berlin Brandenburg

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  • 1
    Language: English
    In: Acta orthopaedica Belgica, 1997, Vol.63 Suppl 1, pp.20-7
    Description: To determine from routine clinical radiographs the diversity of cortical bone structural quality, i.e. the cortical index, of the proximal femur in 117 hips prior to hip arthroplasty and to evaluate its variance associated with patient demographic variables (gender, age at the time of surgery, height, weight, body mass index (BMI), and preoperative diagnosis). A cross-sectional study was conducted using preoperative anteroposterior radiographs of the hip from 110 consecutive patients with 117 hip arthroplasty procedures, in which the patients at the time of surgery had an average age of 69.9 years (range, 19 to 92 years). The primary diagnosis leading to hip surgery was either degenerative joint disease (68 hips) or femoral neck fracture (49 hips). The cortical index, as a measure of cortical bone structural quality, was determined by one experienced reader for the proximal femur of each hip from conventional preoperative anteroposterior radiographs. Correlation analysis was performed between the cortical index and patient demographic variables to assess factors associated with the cortical index. For the entire cohort the average femoral cortical index was 47.9% (range, 25.8% to 64.8%). The hips in female patients had a lower average cortical index than in male patients (mean value of 46.9% and 50.0% respectively). Statistical analysis demonstrated highest significant positive correlation between cortical index and BMI (r = +.441, p 〈 0.0001) and with body weight (r = +0.396, p 〈 0.0001). Significant negative correlation was also found between cortical index and age at the time of hip surgery (r = -0.423, p 〈 0.0001). Significant differences were found between the cortical index and preoperative diagnosis with lower values among the hips diagnosed with femoral neck fractures (mean value, 43.9%) compared to hips with degenerative joint disease (mean value, 50.9%). A simple radiogrammetric parameter obtained from routine radiographs, i.e. the femoral cortical index, was found to demonstrate diversity of cortical bone structural quality among patients prior to hip arthroplasty. The cortical index decreased with older patients and increased with heavier (weight) and obese (BMI) patients. It was significantly lower among the hips with femoral neck fractures in patients who were predominantly fragile older females with lower body mass index, which would corroborate published studies associating lower bone mass with risk of hip fracture.
    Keywords: Arthroplasty, Replacement, Hip ; Femur -- Diagnostic Imaging
    ISSN: 0001-6462
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 2
    Language: English
    In: The Lancet, 22 September 2012, Vol.380(9847), pp.1088-1098
    Description: Severe traumatic brain injury remains a major health-care problem worldwide. Although major progress has been made in understanding of the pathophysiology of this injury, this has not yet led to substantial improvements in outcome. In this report, we address present knowledge and its limitations, research innovations, and clinical implications. Improved outcomes for patients with severe traumatic brain injury could result from progress in pharmacological and other treatments, neural repair and regeneration, optimisation of surgical indications and techniques, and combination and individually targeted treatments. Expanded classification of traumatic brain injury and innovations in research design will underpin these advances. We are optimistic that further gains in outcome for patients with severe traumatic brain injury will be achieved in the next decade.
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
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  • 3
    Language: English
    In: Journal of Biomechanics, 15 March 2013, Vol.46(5), pp.949-955
    Description: Stem–cement and cement–bone interfacial failures as well as cement fractures have been noted in cemented total hip arthroplasty (THA) as the cause of aseptic loosening. Attempts to reduce the risk of femoral component loosening include improving the stem–cement interface by various coatings, using a textured or porous coated stem surfaces or by using a tapered stem having a highly-polished surface. The latter approach, often referred to as “force-closed” femoral stem design, would theoretically result in stem stabilization subsequent to debonding and ‘taper-lock’. Previous work using three-dimensional finite element analysis has shown a state of stress at the stem–cement interface indicative of ‘taper-lock’ for the debonded stem and indicated that stem–cement interface friction and bone cement creep played a significant role in the magnitudes of stresses and subsidence of the stem. However, the previous analysis did not include the viscoelastic properties of bone, which has been hypothesized to permit additional expansion of the bone canal and allow additional stem subsidence ( ). The goal of this study was to investigate the effect of bone viscoelastic behavior on stem subsidence using a 3D finite element analysis. It was hypothesized that the viscoelastic behavior of bone in the hoop direction would allow expansion of the bone reducing the constraint on bone over time and permit additional stem subsidence, which may account for the discrepancies between predicted and clinical subsidence measurements. Analyses were conducted using physiological loads, ‘average peak loads’ and ‘high peak loads’ for ‘normal patient’ and ‘active patient’ ( ) from which short and long term subsidence was predicted. Results indicated that bone creep does contribute to higher stem subsidence initially and after 10 years of simulated loading. However, it was concluded that the “constraint” upon the cement mantle is not mitigated enough to result in stem subsidence equivalent to that observed clinically.
    Keywords: Cemented Total Hip Arthroplasty ; Cortical Bone Creep ; Bone Cement Creep ; Stem Subsidence ; Stem–Cement Interface Failure ; Medicine ; Engineering ; Anatomy & Physiology
    ISSN: 0021-9290
    E-ISSN: 1873-2380
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  • 4
    Language: English
    In: The Thoracic and Cardiovascular Surgeon, 2/2011, Vol.59(S 01)
    ISSN: 0171-6425
    E-ISSN: 1439-1902
    Source: Thieme Publishing Group (via CrossRef)
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  • 5
    Language: English
    In: European Urology Supplements, 2011, Vol.10(2), pp.314-314
    Keywords: Medicine
    ISSN: 1569-9056
    E-ISSN: 1878-1500
    Source: ScienceDirect Journals (Elsevier)
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  • 6
    In: Prostate Cancer and Prostatic Diseases, 2010, Vol.13(3), p.285
    Description: We compared bipolar and monopolar TURP in a prospective controlled study at two urology centers. The objective of the study was to establish whether there were differences between the two methods with regard to frequency of the transurethral resection (TUR) syndrome, amount of fluid absorbed during surgery, risk of hemorrhage, duration of postoperative catheterization and duration of hospitalization. The duration of surgery, improvement in maximum flow rate (Q-max), residual urine volume, International Prostate Symptom Score (IPSS) and Quality of Life (QoL) score were also compared. Overall, our study showed that there were no major differences between bipolar and monopolar TURP. During follow-up, the clinical efficacy of bipolar TURP has been maintained to the same degree as with the traditional method, with no significant differences for Q-max, IPSS and QoL scores after 1 year. Although the risk of developing TUR syndrome seemed to be smaller with bipolar resection (serum sodium change bipolar versus monopolar: +1.2 versus -0.1 mmol [l.sup.-1]), the bleeding tendency with both methods was the same (14.0 g [l.sup.-1] hemoglobin loss after 1 day in both groups). On the basis of our findings, we think that the monopolar technique has still a place in TURP. Prostate Cancer and Prostatic Diseases (2010) 13, 285-291; doi:10.1038/pcan.2010.1; published online 9 February 2010 Keywords: BPH; TURP; urological surgical procedures
    Keywords: Prostatectomy -- Methods ; Prostatectomy -- Health Aspects ; Prostatic Hyperplasia -- Diagnosis ; Prostatic Hyperplasia -- Care And Treatment ; Prostatic Hyperplasia -- Patient Outcomes ; Urologic Diseases -- Risk Factors ; Urologic Diseases -- Prevention;
    ISSN: 1365-7852
    E-ISSN: 14765608
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  • 7
    In: The Journal of Bone & Joint Surgery, 1985, Vol.67(1), pp.48-56
    Description: We performed a detailed serial radiographic analysis of the femoral component of 323 cemented low-modulus titanium-alloy total hip prostheses. There was a low incidence of femoral component loosening as manifested by radiolucent zones at the stem-cement interface or cement fractures. There was also a low incidence of resorption of the calcar and cortical hypertrophy. Comparison of our data with those of others indicated that the incidence of loosening, calcar resorption, and cortical hypertrophy was usually lower than with similarly designed conventional high-modulus Charnley stems. These findings appear to support computer-modeling studies that have predicted a more even distribution of stresses along the entire length of the stem of the titanium-alloy prosthesis. Of the two configurations of femoral components used, the straight stems demonstrated a significantly lower incidence of radiographic evidence of loosening, calcar resorption, and cortical hypertrophy than the curved stems did. These findings have provided sufficient biomechanical rationale for the evolutionary development of the second-generation femoral components, which incorporate many features of the straight stem.
    Keywords: Hip Prosthesis;
    ISSN: 0021-9355
    E-ISSN: 15351386
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  • 8
    Language: English
    In: Journal of biomechanics, October 2001, Vol.34(10), pp.1325-33
    Description: The clinical success of polished tapered stems has been widely reported in numerous long term studies. The mechanical environment that exists for polished tapered stems, however, is not fully understood. In this investigation, a collarless, tapered femoral total hip stem with an unsupported distal tip was evaluated using a 'physiological' three-dimensional (3D) finite element analysis. It was hypothesized that stem-cement interface friction, which alters the magnitude and orientation of the cement mantle stress, would subsequently influence stem 'taper-lock' and viscoelastic relaxation of bone cement stresses. The hypothesis that creep-induced subsidence would result in increases to stem-cement normal (radial) interface stresses was also examined. Utilizing a viscoelastic material model for the bone cement in the analysis, three different stem-cement interface conditions were considered: debonded stem with zero friction coefficient (mu=0) (frictionless), debonded stem with stem-cement interface friction (mu=0.22) ('smooth' or polished) and a completely bonded stem ('rough'). Stem roughness had a profound influence on cement mantle stress, stem subsidence and cement mantle stress relaxation over the 24-h test period. The frictionless and smooth tapered stems generated compressive normal stress at the stem-cement interface creating a mechanical environment indicative of 'taper-lock'. The normal stress increased with decreasing stem-cement interface friction but decreased proximally with time and stem subsidence. Stem subsidence also increased with decreasing stem-cement interface friction. We conclude that polished stems have a greater potential to develop 'taper-lock' fixation than do rough stems. However, subsidence is not an important determinant of the maintenance of 'taper-lock'. Rather subsidence is a function of stem-cement interface friction and bone cement creep.
    Keywords: Finite Element Analysis ; Bone Cements -- Standards ; Hip Prosthesis -- Standards
    ISSN: 0021-9290
    E-ISSN: 18732380
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  • 9
    In: Annals of Surgery, 2017, Vol.266(2), pp.287-296
    Description: OBJECTIVE:: The aim of this study was to develop and evaluate the content validity of quality criteria for providing patient- and family-centered injury care. BACKGROUND:: Quality criteria have been developed for clinical injury care, but not patient- and family-centered injury care. METHODS:: Using a modified Research AND Development Corporation (RAND)/University of California, Los Angeles (UCLA) Appropriateness Methodology, a panel of 16 patients, family members, injury and quality of care experts serially rated and revised criteria for patient- and family-centered injury care identified from patient and family focus groups. The criteria were then sent to 384 verified trauma centers in the United States, Canada, Australia, and New Zealand for evaluation. RESULTS:: A total of 46 criteria were rated and revised by the panel over 4 rounds of review producing 14 criteria related to clinical care (n = 4; transitions of care, pain management, patient safety, provider competence), communication (n = 3; information for patients/families; communication of discharge plans to patients/families, communication between hospital and community providers), holistic care (n = 4; patient hygiene, kindness and respect, family access to patient, social and spiritual support) and end-of-life care (n = 3; decision making, end-of-life care, family follow-up). Medical directors, managers, or coordinators representing 254 trauma centers (66% response rate) rated 12 criteria to be important (95% of responses) for patient- and family-centered injury care. Fewer centers rated family access to the patient (80%) and family follow-up after patient death (65%) to be important criteria. CONCLUSIONS:: Fourteen-candidate quality criteria for patient- and family-centered injury care were developed and shown to have content validity. These may be used to guide quality improvement practices.
    Keywords: Australia–Standards ; Canada–Standards ; Clinical Competence–Therapy ; Communication–Therapy ; Family–Therapy ; Humans–Therapy ; New Zealand–Therapy ; Pain Management–Therapy ; Patient Education As Topic–Therapy ; Patient Safety–Therapy ; Patient-Centered Care–Therapy ; Professional-Family Relations–Therapy ; Quality Indicators, Health Care–Therapy ; Terminal Care–Therapy ; Transitional Care–Therapy ; Trauma Centers–Therapy ; United States–Therapy ; Wounds and Injuries–Therapy ; Abridged;
    ISSN: 0003-4932
    E-ISSN: 15281140
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  • 10
    Language: English
    In: Journal of Bone and Joint Surgery, 1999, Vol.81(12), p.1707
    Description: Background: A multicenter retrospective study was conducted to determine the clinical and radiographic results of primary total hip arthroplasty with insertion of the S-ROM modular femoral stem without cement in a series of patients who had been followed for four to seven years. Four centers participated in the study, with one contributing surgeon at each center. Methods: Two hundred and eight consecutive patients who had a total hip arthroplasty with implantation of the S-ROM femoral prosthesis at one of the four centers during the study period were identified. Twenty-nine patients were lost to follow-up or had incomplete radiographic data, and twenty patients died from causes unrelated to the index arthroplasty. The remaining 159 patients formed the basis of this study. Sixteen of these patients had a bilateral procedure, resulting in 175 hips with complete clinical and radiographic data. The average age of the patients at the time of the index operation was fifty-nine years (range, twenty-two to ninety-three years). The duration of clinical follow-up averaged 5.3 years (range, four to 7.8 years), and the duration of radiographic follow-up averaged 4.9 years (range, four to 7.3 years). Results: One patient (0.6 percent) had a failed femoral component, which was evidenced by progressive subsidence and lack of bone ingrowth. In addition, two patients (1 percent) had a revision of the acetabular component. The average Harris hip score increased from 35 points (range, 10 to 76 points) preoperatively to 91 points (range, 52 to 100 points) at the most recent follow-up examination. The radiographic evaluation revealed that 172 hips (98 percent) had stable bone ingrowth, two hips (1 percent) had stable fibrous ingrowth, and one hip (0.6 percent) had unstable fibrous ingrowth. Periprosthetic osteolytic lesions were noted in twelve hips (7 percent). The lesions were observed in the femur in eight hips, in the acetabulum in two hips, and in both the femur and the acetabulum in two hips. All femoral osteolytic lesions were localized within the greater trochanter or the proximal-medial portion of the femoral neck. No osteolytic lesions were evident distal to the stem-sleeve junction. Conclusions: Use of the modular S-ROM femoral prosthesis yielded excellent intermediate-term outcomes with respect to standard radiographic and clinical criteria. The issue regarding the theoretical increase in the rate of osteolysis due to metal debris generated at the modular femoral stem-sleeve junction was specifically addressed. We found that the rate of osteolysis in this series was not notably higher than that in other series reported in the orthopaedic literature. Although many possible factors may influence the rate of osteolysis in total hip arthroplasty, this finding suggests that the potential increase in osteolysis theoretically associated with this modular femoral implant was not observed at intermediate-term follow-up. Although longer follow-up is warranted so that the potential for osteolysis can be evaluated fully, no osteolytic lesions were evident distal to the stem-sleeve interface at the time of intermediate-term follow-up. This finding suggests that there is a circumferential seal at the modular junction of the stem that prevents the distal egress of wear debris.
    Keywords: Arthroplasty, Replacement, Hip ; Biocompatible Materials ; Titanium ; Femur -- Surgery;
    ISSN: 00219355
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