ABSTRACT
The occurrence of aseptic hip necrosis was investigated in 546 renal transplant patients (639 transplants) with graft survival for a minimum of 12 months. Aseptic hip necrosis developed in 39 hips in 29 patients (5.3%) from 3 to 121 months (mean 22 months) after the renal transplantation. There was no sex-related difference in incidence of hip necrosis. The complication was significantly more common among patients younger than 20 than among those older than 40 years. The development of hip necrosis did not correlate with type of renal disease, origin of graft (cadaver of living relative donor), side of transplant or length of dialysis treatment. The number of transplantations per patient did not influence the occurrence of hip necrosis. Analyses of serum concentrations of creatinine, calcium, phosphorus and parathormone before and at different periods after transplantation revealed no patterns predictive of hip necrosis. The pathogenesis of aseptic necrosis of the femoral head obviously is multifactorial.
Subject(s)
Femur Head Necrosis/etiology , Kidney Transplantation , Adolescent , Adult , Aged , Child , Creatinine/blood , Female , Follow-Up Studies , Graft Survival , Humans , Male , Middle Aged , Parathyroid Hormone/blood , Postoperative Complications/etiology , Renal Dialysis , RiskABSTRACT
Serial anteroposterior (AP) radiographs of the weight-bearing pelvis and hips were taken of 29 patients with total hip replacement (THR). For constant positioning the patient stands with straight knees on a board with a block between the heels. A U-shaped mercury level strapped to the patient provides a horizontal reference line on the radiograph. On the average, individual variation of pelvic tilt in serial films was 1 degree and pelvic rotation 3.5 degrees confirming satisfactory reproducibility. The horizontal reference enables estimation of pre- and postoperative leg length inequality (LLI) and of the angle of the acetabular cup (AA). Reproducibility allows assessment of the exact position of the femoral component and quantitative evaluation of radiolucency and bone resorption around the prosthetic implant in the follow-up of THR.
Subject(s)
Hip Prosthesis , Pelvic Bones/diagnostic imaging , Humans , Leg Length Inequality/diagnostic imaging , Methods , Posture , RadiographyABSTRACT
The subject of our study was 546 renal transplant recipients with a graft survival for minimum 12 months. Of these, 29 renal recipients (5.3%) developed aseptic necrosis of the femoral head. The examination revealed that there were no significant differences between the renal recipients with hip necrosis and the control group in the total quantities of administered glucocorticosteroids, whereas there was a highly significant correlation between the two groups in the number of the intravenously administered methylprednisolone pulse doses.
Subject(s)
Femur Head Necrosis/etiology , Glucocorticoids/adverse effects , Kidney Transplantation , Azathioprine/therapeutic use , Humans , Postoperative Complications/etiologyABSTRACT
In both emergency and chronically infected cases, the exposed knee joint cavity should be immediately covered using a simple method which provides well-vascularized elastic tissue over the joint. We used a gastrocnemius musculocutaneous or muscle flap over the exposed knee joint in three emergency cases of complex, massive avulsion injury of the lower extremity and in two infected cases. No infectious complications were observed, although ligament reconstructions were made under the transposed muscle in one and the same session.
Subject(s)
Knee Injuries/surgery , Adolescent , Adult , Child , Debridement , Female , Humans , Male , Middle Aged , Skin Transplantation , Surgical FlapsABSTRACT
Segmental blood pressure criteria for below-knee amputations were assessed retrospectively. 40 patients underwent 44 below-knee amputations for advanced lower limb ischaemia. Preoperative systolic blood pressure measurements using a Doppler device as a distal sensor were performed on 31 limbs to be amputated. Healing occurred in all limbs with calf systolic pressures of 68 mmHg or more and distal thigh systolic pressures of 100 mmHg or more. With calf pressures below 35 mmHg and distal thigh pressures of 60 mmHg or less, all amputations failed. Diabetes did not affect the pressure criteria except for one obvious case with mediasclerosis. It appeared that pressure data could be used to improve the preoperative assessment of the amputation level.
Subject(s)
Amputation, Surgical , Blood Pressure Determination , Diabetes Mellitus/physiopathology , Leg/surgery , Wound Healing , Aged , Female , Humans , Ischemia/therapy , Leg/blood supply , Male , Middle Aged , Prognosis , Retrospective StudiesABSTRACT
The series comprises 100 patella fractures treated during the period 1974-1977. Seventy-eight patients were treated operatively. The most common operative method was partial excision, which was performed in 36 patients. Twenty-four patients were treated with equatorially placed cerclage wires, while 10 patients were treated with tension band fixation only (AO). All the operated patellas were immobilized postoperatively in a plaster cast cylinder for a mean duration of 5.2 weeks. The average observation time was 18 weeks. At follow-up attention was paid to subjective symptoms and radiological findings, clinical status and duration of incapacity for work. The clinical results were considered excellent or good in 71 patients and the subjective assessments were excellent or good in 63. Superficial infections were recorded in three cases and in seven patients the osteosynthesis had deteriorated. The results suggest that tension band fixation and partial excision of the patella are methods of choice for patellar fractures requiring operative management.
