Background and purpose Femoral deformity associated with osteoarthritis is a challenge for both the surgeon and the implant. Many of the patients with these deformities are young. Standard implants can be difficult to fit into these femurs. We prospectively evaluated the outcome of custom uncemented femoral stems in young patients.Methods 61 consecutive patients (72 hips) underwent surgery for osteoarthritis because of femoral deformity at a mean age of 35 (22–40) years. The patients received a CT3D-A custom-made femoral stem and an uncemented cup. The mean follow-up time was 14 (10–16) years. 2 patients died at 7 and 8 years after surgery, otherwise, none of the patients were lost to follow-up.Results At follow-up, the femoral prosthesis had not been revised in 59 patients (70 hips). 3 patients (3 hips) had required revision surgery due to loosening of the acetabular component; 2 hips were awaiting revision surgery for loosening of the acetabular cup. There were no cases of dislocation or infection. At review, all stems were considered stable according to the radiographic criteria. No migration or subsidence was observed on plain radiographs.Interpretation Our results are comparable to published results of custom stems regarding survival and outcome. Considering the young age and the deformities in this series of uncemented custom femoral stems, and the fact that there was follow-up of up to 16 years, the survival is remarkable. This technique appears to be a reasonable alternative in younger patients with femoral deformities.
The osteogenic potential of bone and bone matrix has been characterised only by its biological effects and the parameters influencing it. Recently, the osteoinductive ability of bone matrix had been defined chemically by the description of a bone morphogenetic protein (BMP), and the parameters of osteogenic factors from different species have now been recognised. The current state of isolation, purification and characterisation of these factors is summarised in this review. General aspects of the isolation and testing of BMP preparations, and the results of orthotopic application of BMP implants, including clinical cases, are reported.
Long-term anchorage of foreign material in vital bone has proven to be the main problem in endoprosthetics. In the authors' opinion, modelling an endoprosthetic anchorage component to the individual anatomic needs is, at present, the best way to transmit stresses harmoniously from the prosthesis to the sensitive bone, in order to utilize functional adaptation, and to guarantee long-term function. The production of a true-to-scale joint model is possible with computer-assisted tomography. This model of the joint or bone canal can be used to construct an individual endoprosthesis prior to surgery. A procedure described.
A new method of manufacturing temporary orthoses is described. Immobilization--as much as necessary and as little as possible--is attainable with these orthoses, which reduce damage by immobilization and simplify rehabilitation. Recommendation to the manufacture regarding the characteristics of the material and accessory aids are presented.
The purpose of the present study was to document the osteotomy plane for the thrust plate prosthesis, and to evaluate the question whether the geometry of the thrust plate itself correlates with the range of motion after implantation and whether the osteointegration area can be optimised. For the first part of the study, the two-dimensional geometry of the osteotomy was demonstrated in 12 computer-reconstructed femurs after performing a virtual cut at a CCD angle of 135 degrees. In the second part we constructed a prototype of an I-TPP with an optimised thrust plate and corpus geometry. In a final step, we documented the range of motion with computer-aided movement mapping. The results showed a wide variance in osteotomy geometry in the 12 femurs. With the I-TAP we were able to obtain a much better surface adaptation of the thrust plate. Movement mapping showed a much lower range of motion in the I-TPP implant.
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