Total joint replacement at the base of the thumb.

Total joint replacement at the base of the thumb has been used for almost two decades in cases of trapezium-metacarpal arthritis. The procedure involves the insertion of a titanium metacarpal component and a polyethylene trapezium implant. The system articulates in a semiconstrained ball and socket joint that allows a full range of motion with inherent stability. Methylmethacrylate cement is optional for the metacarpal component and is routinely used in the trapezium. Revision components are available if excision of the trapezium is required because of fracture, severe arthritic deterioration, or loss of bone stock. A trapezium revision procedure converts the system into a spacer arthroplasty, which requires standard soft tissue stabilization. There have been no implant fractures or evidence of excessive wear, infections, or unstable articulated components in 80 cases that have been carefully followed up for over 10 years. Trapezium components loosening in cement cases and metacarpal subsidence in uncemented cases have a complication rate of less than 10%. These cases respond to revision procedures that permit continued functional use of the thumb. Total joint replacement appears to be safe and reliable. It is especially helpful in older patients in whom host tissues are not optimal for joint stabilization and early mobilization is desired. Total joint replacement can also be combined with associated procedures such as metacarpal phalangeal joint capsulodesis, carpal tunnel release, and tendon transfers in performing complex reconstruction of the thumb.

Antibiotic-loaded acrylic cement: current concepts.

Antibiotic-loaded acrylic cement has been used routinely since 1972 at the authors' hospitals, where a series of some 22,000 joint arthroplasty operations was performed from 1964-1983. The current status of the material is presented with up-to-date follow-up statistics on prophylactic therapy and on established deep infections. The results of 869 exchange arthroplasties are compared with results published in 1981. In the future, results will be presented in the form of survival curves. The method by which survival tables and curves are constructed is critical. Investigators should use survival curves for ease of comparison and because of the wide range of possibilities in an analysis of covariable factors. A retrospective actuarial analysis was made of 825 one-stage reimplantations in which antibiotic-loaded acrylic cement was used for infected total hip arthroplasties. Staphylococcus aureus was the most commonly encountered organism. Failure rates of prostheses infected by S. aureus, S. species, and anaerobic corynebacteria did not differ statistically. A factor that significantly contributed to failure of this method of treatment was Pseudomonas infection. By actuarial analysis five years after operation, a success (survival) rate of 77% was calculated.

[Deaths in orthopedics]. / Todesfälle in der Orthopädie.

Seventy-four deaths during treatment at the orthopedic university hospital Homburg/Saar between 1965 and 1981 are reported, causes and basic diseases are analyzed. Deathrate was 0,22% at our hospital comparing 0,61% average standard deathrate at West-German orthopedic hospitals. Main risk groups are patients with para--or tetraplegia (28 cases), patients following total hip replacement (16 cases), bone tumors (18 cases - 4 of these cases are figured as well in the first group because of the clinical sign of paraplegia). All other patients (about 29 000) are represented with 16 deaths. Comparing literature deathrate of paraplegia and total hip replacement are detailed discussed.

Evaluation of outcomes in total joint arthroplasty for rheumatoid arthritis.

As the causes of most chronic diseases are multifactorial, so are their outcomes. The first two decades of joint arthroplasty witnessed rapid technologic advances and diffusion. Short-term outcomes measured by traditional clinical parameters show remarkable successes. Long-term results measured traditionally and including patient- and society-oriented outcomes, e.g., health status, cost, and satisfaction, need greater emphasis in the evaluation of surgical management of polyarticular disease. Long-term studies that use standardized outcome measurement are crucial in the future development of the technology and in the refinement of patient selection criteria to achieve optimal outcome. A larger view of the end-results can be measured reliably, but their interpretation and refinement need careful study.

The natural history of the patient with an infected total hip replacement.

Deep infection, the most serious local complication of total hip replacement, prompted a study of the records of 135 patients (137 hips) thus afflicted in a nationwide survey of Canada. Particular attention has been paid to the natural history of the infection, and the problems of diagnosis are described. Twenty-one patients died after the insertion, or removal, of the prosthesis, and of the survivors of the original 135 patients only eighteen have been able to retain the prosthesis without further problems with the wound. The remaining patients had the prosthesis removed, and most dry wounds. Certain suggestions are made on management. The advice that a second total hip prosthesis should be inserted after a deep infection of the first implant is not supported.

A comparison of internal fixation and prosthetic replacement in the treatment of displaced subcapital fractures.

This paper presents a retrospective review of 348 operations performed for subcapital fractures of the neck of the femur. A similar proportion of satisfactory results was obtained with internal fixation and prosthetic replacement. The mortality was higher in those treated by prosthetic replacement and careful selection of patients for this treatment is required.

[Early general complications of total hinged knee prosthesis]. / Complications générales précoces dans les prothéses totales du genou á charniére cimentées

16 early deaths (within 24 hours) were observed after 758 knee joint replacements. In eight instances the patient died during the operation, and the other eight few hours later. The author discussed several possible causes: toxicity of the monomere, fat embolism hyperpressure in the medullary canal, hemorrhage. Several per and post operative precautions are recomanded.