Summary: During the last 20 years almost 3000 uncemented total hip replacements have been used in the treatment of osteoarthritis and rheumatoid arthritis. The development of an axially located prosthesis is outlined, and the causes of failure indicated. Uncemented prostheses have the advantage of a relatively low mortality and morbidity and the rate of infection in particular is low. Interface pain, with or without frank prosthetic loosening, is the commonest cause of failure, but revisional surgery is relatively easy, and usually successful. Loss of function without significant pain may occur after many years from distal migration of the femoral component. The development of an uncemented metal-onplastic joint has produced better short-term results than the metal-on-metal articulation, probably because of its lower frictional coefficient and the use of a wider range of pelvic and femoral components.
The author gives a short review of the history of the brisement forcé (forcible breaking) which initially has been indicated only for the knee joint. Then he discusses the techniques of mobilization used today, which are applied under anesthesia. The indications for brisement forcé are presented, and some special conditions are described which must be considered if the performance of a brisement is intended. The further part of the study treats the technical execution of the brisement at the individual joints and gives a critical analysis of the indications and the results and chances of such a brisement.
Ventral spondylodesis is said to be a useful method for the treatment of lumbar illness in combination with instability and pain. Between 1969 and 1983 62 patients of the Orthopedic University Hospital Berlin were operated for a ventral fusion of the lumbar column, excluded the Dwyer spondylodesis indicated in lumbar scoliosis. 50 of them could be re-examined. The result was good and fair in seventy per cent; the consolidation rate 62 per cent in no relation to the clinical result. Best satisfaction was got by those patient who suffered from spondylolisthesis without any compressions of sciatic nerve. Any previous operation of the nerve root with persistent symptoms lowers the aim of spondylodesis as a salvage procedure. With the experience of the surgeon the method itself is without a higher rate of complication than any other way of spondylodesis.
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