Transvaginal emergence of a broken cup marker ring 21 years after total hip arthroplasty.

Broken cups, wires, and cable systems have the potential to cause complications, and they can migrate into joints, abdominal and thoracic organs. We describe a case of migration and transvaginal emergence of a marker wire from a polyethylene cup.

The effect of stress-reducing, low-dose ethanol infusion on frequency of bleeding complications in long-term alcoholic patients undergoing major surgery.

Perioperative low-dose ethanol infusion is a feasible option for stress reduction and prophylaxis of alcoholism-associated complications. Because alcohol has inhibitory effects on hemostasis, our study focused on the effect of perioperative low-dose ethanol infusion on bleeding complications, defined as transfused blood units and reoperations, in alcoholic patients undergoing major surgery. We included 44 long-term alcoholic patients scheduled for tumor resection of the aerodigestive and gastrointestinal tract. Patients were randomly assigned to the ethanol or control group. Ethanol infusion (0.5 g ethanol/kg body weight/24 hours) started before surgery and was continued until the postoperative Day 3. Regarding all patients, there was no statistically significant difference in the amount of transfused blood between the ethanol and control groups. However, the effect of ethanol infusion on bleeding complications depended on the site of surgery. Ethanol infusion resulted in an increased number of transfused blood units in gastrointestinal patients and a decreased number of transfused units in patients undergoing tumor resection of the aerodigestive tract. In conclusion, perioperative ethanol infusion in long-term alcoholic patients with tumor resections of the aerodigestive tract is an option for stress reduction without increased risk for blood transfusion. In contrast, ethanol infusion in patients with tumor resections in the gastrointestinal tract could increase the risk for bleeding complications.

A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation.

BACKGROUND: Despite the use of modern instruments in total knee arthroplasty, component malalignment remains a problem. Whether a computer-assisted implantation technique can improve the accuracy of the spatial positioning of an implant is a matter of debate. The objective of this study was to determine whether computer-assisted total knee arthroplasty is superior to the conventional surgical method with regard to the precision of implant positioning. METHODS: The spatial positioning of the implant in sixty total knee arthroplasties (thirty-two imageless computer-assisted and twenty-eight conventional implantations) was determined three-dimensionally with use of computed tomographic measurement, which allowed derotation and full extension of the knee in order to avoid projection-related imaging errors. RESULTS: The overall mechanical axis showed a range of between 4.8 degrees of valgus and 6.6 degrees of varus alignment in the frontal plane for conventionally implanted arthroplasty components compared with a significantly smaller range of between 2.9 degrees of valgus and 3.1 degrees of varus alignment for computer-assisted implantations (p = 0.004). In relation to the tibial implant, the mean deviation (and standard deviation) from the mechanical axis was 2.0 degrees +/- 1.7 degrees for the conventional surgical method and 1.4 degrees +/- 0.9 degrees for the navigated implantation. The rotational deviation from the referenced axis of the femoral component was between 3.3 degrees of internal rotation and 5.0 degrees of external rotation for the conventional implantation method, with a mean deviation of 0.1 degrees +/- 2.2 degrees. Femoral components implanted with computer assistance showed a deviation of between 4.7 degrees of internal rotation and 2.2 degrees of external rotation, with a mean deviation of 0.3 degrees +/- 1.4 degrees. CONCLUSIONS: In this study, with our technique of filtering out projection-related imaging errors, computer-assisted implantation of total knee replacements improved the frontal and sagittal alignment of the femoral component but not of the tibial component. We found that the rotational alignment of the component was not improved through navigation by solely referencing to the epicondylar axis for the femur and the tuberosity for the tibia.

Autologous bone marrow-derived cells enhance muscle strength following skeletal muscle crush injury in rats.

Insufficient post-traumatic skeletal muscle regeneration with consecutive functional deficiency continues to be a serious problem in orthopedic and trauma surgery. Transplantation of autologous muscle precursor cells has shown encouraging results in muscle trauma treatment but is associated with significant donor site morbidity. In contrast to this, bone marrow-derived (BMD) cells can be obtained without any functional deficit by puncture. The goal of this study was to examine whether regular muscle regeneration can be improved by local application of autologous BMD cells in a rat model of blunt skeletal muscle trauma. One week after standardized open blunt crush injury to the left soleus muscle, 10(6) autologous BMD cells were injected into the traumatized muscle of male Sprague Dawley rats. Rats of the control group received saline solution as treatment. Three weeks after application, the fast twitch and tetanic contraction capacity of the soleus muscles was measured bilaterally by stimulating the sciatic nerves. Contraction forces of injured soleus muscles in control animals recovered to 39 +/- 10% (tetanic) and 59 +/- 12% (fast twitch) of the contralateral noninjured soleus muscles (p < 0.001). In contrast, autologous BMD cell injection significantly restored contractile forces to 53 +/- 8% (tetanic) and 72 +/- 13% (fast twitch) compared to those observed in contralateral noninjured soleus muscles. Thus, muscle function was significantly increased by BMD cell treatment (tetanic, p = 0.014; fast twitch, p = 0.05). In conclusion, autologous BMD cell grafting leads to an increase in contraction force, 14% in tetanic and 13% in fast twitch stimulation, demonstrating its potential to improve functional outcome after skeletal muscle crush injury.