High Re-Operation Rates Using Conserve Metal-On-Metal Total Hip Articulations.

INTRODUCTION: Metal-on-metal hip articulations have been intensely debated after reports of adverse reactions and high failure rates. The aim of this study was to retrospectively evaluate the implant of a metal-on.metal total hip articulation (MOM THA) from a single manufacture in a two-center study. MATERIALS AND METHODS: 108 CONSERVE(®) MOM THA were implanted in 92 patients between November 2005 and December 2010. Patients had at time of retrospective evaluation their journals reviewed for re-operations and adverse reactions. RESULTS: 20 hips were re-operated (18.4%) at a mean follow up of 53 months. 4 pseudotumors were diagnosed at time of follow up but no substantiated link was made between adverse reactions and re-operations. CONCLUSION: The high re-operation rates found in this study raised concern about the usage of the MOM THA and subsequently lead to the termination of implantation of this MOM THA at the two orthopaedic departments.

Albuminuria, intermittent hyperfiltration and salt wasting in patients with stroke: a pilot study.

OBJECTIVE: To investigate whether different types of stroke influence renal excretion of albumin, major electrolytes and water. MATERIAL AND METHODS: Timed urine collections were started shortly after admission in 5 patients with haemorrhagic stroke (group A), 5 with ischaemic stroke (group Bx), 6 with presumed ischaemic stroke (groups By/z) and 6 with subarachnoid haemorrhage (group C). Albuminuria was also investigated in four patients undergoing elective abdominal surgery. RESULTS: Increased levels of albuminuria were observed in all patients in groups A and B, but were found to decline with observation time and appeared to be related to outcome in group B. In group C, albuminuria was detected in 4 out of 6 patients. Elective surgery did not affect albumin excretion. In a setting with high urinary osmolality, high excretion rates for creatinine, urea, sodium, potassium and large diuresis were intermittently observed in groups A, B and C. None of these patients was in steady-state condition. CONCLUSIONS: Different types of stroke elicit a complex change in renal function which resembles the response to a hypervolaemic and hyperosmolar signal, possibly mediated by a breakdown of renal autoregulation of blood flow in the presence of high vasopressin activity. Acute changes in excretion of albumin might be an indicator of prognosis in stroke. The findings point to the existence of unrecognized pathways between the central nervous system and the kidneys. Further studies on the mechanisms underlying alterations in renal function in stroke and their implication for treatment and outcome are indicated.

Housing of the elderly.

The housing conditions of the elderly in Denmark are undergoing rapid improvement. The main reason for this is that the first generations to benefit from the growth of prosperity that started in the 1950s are now joining the ranks of the elderly. Similarly, the oldest of the elderly population--many of whom live in some of the country's oldest, smallest and technically worst housing--are now dying off. Most of the new elderly generation own their own home, usually a detached house, and the vast majority of them must be expected to be extremely satisfied with their homes and to want to remain in them in their old age. However, this may present difficulties, partly because it requires a certain income and partly because the dwellings require quite a lot of maintenance, gardening, street-cleaning, etc. The general rule seems to be that the elderly mainly only move from a good, big home when they lose their husband or wife or reach a point at which they need more care. Danish policy on housing for the elderly attaches importance to supporting the elderly in their own homes, and the available resources are largely concentrated on this intention. Here at the beginning of the 1990s this policy has run into difficulties because it has led to the allocation of resources being slanted in favour of relatively well-situated elderly people, while the weakest and poorest old people with the biggest need for care are not served satisfactorily.(ABSTRACT TRUNCATED AT 250 WORDS)

[Appointment to orthopedic surgical courses in 1983-1986]. / Ortopaedkirurgiske kursistansaettelser 1983-1986.

The Danish orthopaedic surgical trainee arrangement with decentralized appointments was analysed after the first three years. A total of 591 applicants were involved and the majority of these had applied previously. Thus, 150 different qualified applicants sought 32 appointments. The postgraduate seniority of the applicants was 6.8 years. All of the applicants were found to be well qualified or optimally qualified for the positions concerned. No qualitative assessment was attempted of the scientific research made by the applicants but there was a definite tendency for more and more scientific studies to be necessary to obtain a trainee appointment. This tendency continued after the conclusion of the period under observation and the intensifying effect of this single criterion for appointment is emphasized.

Fractures of the shaft of the tibia treated with Hoffmann external fixation.

Ninety-six compound or unstable fractures of the tibial shaft were treated with external fixation of different mountings. The median healing time was 10 months without a statistically significant difference between the healing time after treatment with unilateral frames and quadrilateral frames. The rate of pin-track infection was 36%, which is comparable to those of other published series. Seven cases of chronic osteitis and four pseudarthroses required further surgical management. We had no primary or secondary amputations in this series.

Osteosynthesis of femoral neck fracture. The sliding-screw-plate with or without compression.

In a prospective study of 220 displaced femoral neck fractures treated with a sliding-screw-plate, the cases were allocated to osteosynthesis with or without compression. In surviving patients followed for at least 1 year, union occurred in 57/85 with compression and 58/71 without compression. At 2 years, necrosis was radiographically evident in 9/37 and 7/36 united fractures. Thus, compression cannot be recommended when displaced femoral neck fractures are treated with a sliding-screw-plate.

Holding power of different screws in the femoral head. A study in human cadaver hips.

The holding power of four different bone screws was measured by a pull-out test in 40 cadaver hips from 10 females and 10 males over 70 years of age. Each femoral head was used to test a 6.5 mm cancellous bone screw and a 12.7 mm hip compression screw. The holding power was higher in screws with a long or wide thread. Generally, the holding power in bones from females was about 70 per cent of that in bones from males.