By Dr. med. René Liechti (auth.)
In the final 10 years, overall prosthetic alternative has develop into the hip oper ation for plenty of yet now not all surgeons. In our hospital the expanding frequency of TP has been paralleled through a discount within the frequency of 10 and HA. For the skilled orthopaedic health care professional and hip health practitioner, hip ailment has such a lot of aspects that it may well no longer most likely be tackled with one operation on my own. hence, HA turns out lately to have gained renewed reputation. It has once again turn into the technique of selection in particular instances, very likely as a result of definite hazards and problems linked to TP that have a little tempered the unique optimism. at present, the danger of an infection or loosening of the professionals thesis is such that the operation can't justifiably be prompt for sufferers less than 55-60 years of age. by contrast with HA, within the majority of situations the result of TP or 10 aren't totally predictable. The lack of joint movement is offset through vital benefits: -complete freedom from ache - complete weight bearing is feasible at the arthrodesed hip. On following up our HA operations from 1961 to 1971, we tested the advance of the operative techniques in our medical institution. We discovered that the diversity of symptoms had narrowed as stricter standards have been utilized in picking sufferers for operation. sufficient and specific operative tech niques have been built. We studied the biomechanics of the hip joint exten sively (effect of arthrodesis at the statics and dynamics of the hip joint and neighbouring joints).
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Within the final 10 years, overall prosthetic substitute has develop into the hip oper ation for plenty of yet now not all surgeons. In our sanatorium the expanding frequency of TP has been paralleled by means of a discount within the frequency of 10 and HA. For the skilled orthopaedic health care provider and hip health care professional, hip sickness has such a lot of elements that it might probably no longer very likely be tackled with one operation by myself.
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Extra resources for Hip Arthrodesis and Associated Problems
C c Fig. 28. HA with 0° offlexion. * a) Ideal standing on the arthrodesed leg. b) Lumbar lordosis reserve suffices to allow adequate step forward with opposite leg. c) Reduced length of pace on arthrodesed side since further pelvic rec1ination is impossible. d) Climbing stairs with arthrodesed leg difficult. e) Sitting uncomfortable I I I I I ,, 40 0 I , I I I I I \ J~') a, a2 b c d Fig. 29. * a1) Standing alone on arthrodesed leg almost impossible because of severe lordosis. a2) ... resulting in increased load on the non-arthrodesed side.
Bone resorption around the proximal part of the plate. b) Corresponding model Model 3 : Cobra-head plate arthrodesis with PO and moderate medial displacement (Fig. 57) Model 4 : Cobra-head plate arthrodesis with PO and extensive medial displacement (Fig. 58) Three-dimensional models were not constructed. They present technical problems, require considerable time to prepare and, last but not least, they are expensive. Furthermore, the arthrodesed hip is no longer a ball joint and can be adequately represented in two dimensions so that the expense of three dimensional models is unjustified *.
B) Immediately following double-plate arthrodesis. e) Eight months later. Clinieal and radiologieal HA union b bound to fail if instability causes it to be subjected to severe tension, compression or shear forces. H, on the other hand, the biomechanical circumstances are correctly assessed and adequate account is taken of the prevailing skeletal geometry and the correct operation is then carried out, the implant material which would otherwise have failed will prove adequate to the task. Depending on the culinary ability of the cook, a well~hung tender piece of me at may be converted into a tasty delicacy or into an indigestible piece of leather.
Hip Arthrodesis and Associated Problems by Dr. med. René Liechti (auth.)