RESUMO
The neuropathic foot is described with relation to cause, presentation, dysfunction and identification. The various mechanisms of neuropathic foot lesions are outlined--overload, diabetic gangrene, continuous pressure, direct injury and cutting and temperature effects. The orthotic treatment of the foot is discussed and in particular the importance of proper shoe provision and patient education and indoctrination emphasised. The use of plaster casts and fenestrations to control pressure distribution is described. Finally results of an intensive treatment programme are presented to identify the effect on outcome, as measured by delay in amputation.
Assuntos
Úlcera do Pé/terapia , Aparelhos Ortopédicos/normas , Doenças Vasculares Periféricas/terapia , Sapatos/normas , Idoso , Fenômenos Biomecânicos , Moldes Cirúrgicos , Úlcera do Pé/classificação , Úlcera do Pé/etiologia , Úlcera do Pé/fisiopatologia , Humanos , Educação de Pacientes como Assunto , Doenças Vasculares Periféricas/classificação , Doenças Vasculares Periféricas/etiologia , Doenças Vasculares Periféricas/fisiopatologia , Índice de Gravidade de Doença , Resultado do Tratamento , Suporte de CargaRESUMO
The clinical and radiographic results in 126 primary CAD total hip replacements were assessed after 2 years in a prospective study. The clinical overall results were satisfactory, with 89 per cent of the hips being free from significant pain. Femoral component loosening was radiographically evident in 6 per cent. The walking speed was increased by 83 per cent in patients with unilateral hip disease. This increase was partly achieved during the second postoperative year.
Assuntos
Articulação do Quadril/cirurgia , Prótese de Quadril , Adulto , Idoso , Reabsorção Óssea , Feminino , Colo do Fêmur/patologia , Articulação do Quadril/diagnóstico por imagem , Prótese de Quadril/efeitos adversos , Humanos , Locomoção , Masculino , Pessoa de Meia-Idade , Dor , Complicações Pós-Operatórias , RadiografiaRESUMO
Ninety-nine per cent of the arthroplasties available for follow-up after a minimum of 5 years were assessed clinically and radiologically. Of the original 151 hips, 14 had been reoperated on with exchange of the femoral components because of aseptic loosening. Thirty-one of the 115 re-examined hips showed radiological evidence of femoral component loosening and in 15 hips loosening was suspected. One acetabular component was loose. No deep infection was detected. In 10 of the 31 hips with femoral stem loosening, no complication was suspected after clinical examination only. Varus position of the prosthesis and insufficient cement support at the proximal and distal parts of the stem were associated with increased loosening rates. In patients with a body-weight over 80 kg and in patients younger than 60 years at the operation, loosening had occurred in over 50 per cent of the hips. The clinical overall results were satisfactory, with 79 per cent of the hips being free from significant pain.
Assuntos
Prótese de Quadril/efeitos adversos , Adulto , Fatores Etários , Idoso , Peso Corporal , Reabsorção Óssea/etiologia , Feminino , Fêmur/patologia , Colo do Fêmur/patologia , Seguimentos , Marcha , Quadril/diagnóstico por imagem , Humanos , Hipertrofia , Masculino , Pessoa de Meia-Idade , Osteoartrite/etiologia , Radiografia , ReoperaçãoRESUMO
A prospective study of 238 total hip replacements, with the Müller prosthesis, is presented. The complications in the total material and the results in 216 hips with follow-up times from 2 to 7 years are described. Eighty-four per cent of the hips were free from significant pain and 64 per cent had a total range of motion exceeding 160 degrees. Aseptic loosening of the femoral component, entailing reimplantation, has occurred in 6.7 per cent and, in addition, 9.2 per cent show radiological evidence of deterioration of the fixation of the femoral component. No deep infection has been encountered. None of the hips has ended as an excision arthroplasty.