published_or_final_version / Orthopaedics and Traumatology / Master / Master of Philosophy

Im Rahmen der vorliegenden Arbeit wurden kapselumhüllte Hüftgelenkmodelle mit 22 – 44 mm Durchmesser durch Hebelwirkung luxiert, wobei die wirkende Kraft, die resultierende Dislokation und der intraartikuläre Absolutdruck kontinuierlich gemessen wurden. Parallel dazu wurde die technische Range of Motion bis zum Impingement und bis zur Luxation bestimmt. Die durchgeführten Hebelversuche ergaben bei Zunahme des Kopfdurchmessers eine erhebliche Zunahme des Luxationswiderstandes der untersuchten Gelenkmodelle. Im Gegensatz dazu ergab die Messung der technischen Range of Motion bei größerem Gelenkdurchmesser einen geringen Zuwachs, dessen praktische Wirksamkeit durch existierende Literatur auf Grund von Knochen-Knochen-Impingement in Zweifel gezogen wird (Burroughs et al. 2005). Die Hypothese ist somit anzunehmen. Die starke Zunahme des Luxationswiderstandes und die gering erweiterte techROM sprechen neben anderen Argumenten dafür, dass die permanente hüftstabilisierende Wirkung des atmosphärischen Druckes, die auch als Weber-Effekt bezeichnet werden kann, die Hauptursache für die deutlich verminderte Luxationsneigung größerer Köpfe nach hüftendoprothetischen Eingriffen darstellt. Daraus können folgende Konsequenzen für die Hüftendoprothetik abgeleitet werden: 1. Die Schonung und Rekonstruktion der Gelenkkapsel ist eine wichtige Voraussetzung für die Wirksamkeit des Weber-Effektes. Zahlreiche Studien belegen, dass durch die Kapselrekonstruktion die Anzahl der von Luxationen betroffenen Patienten um 90 % gesenkt werden kann (Pellicci et al. 1998; Bottner und Pellicci 2006; Prietzel et al. 2014), weshalb die Kapselrekonstruktion zu empfehlen ist. 2. Gelenkköpfe mit größerem Durchmesser besitzen in Folge des Weber-Effektes eine wesentlich größere Gelenkstabilität bzw. einen höheren Luxationswiderstand. Daraus resultiert offensichtlich die klinisch nachgewiesene wesentlich geringere Luxationsra-te (Bistolfi et al. 2011; Howie et al. 2012, Zajonz et al. 2015). Gegenwärtige Nachteile größerer Köpfe wie höherer Abrieb und vermehrte Belastung von Pfannenveranke-rung und Konus müssen jedoch berücksichtigt werden. Der Einsatz größerer Gelenk-köpfe ist zukünftig in der Hüftendoprothetik anzustreben. Gegenwärtig ist bei normalem Luxationsrisiko und somit bei primären HTEP-Implantationen der Einsatz von Gelenkköpfen bis 36 mm Durchmesser vertretbar. Bei erhöhtem Luxationsrisiko (z. B. bei bestimmten HTEP-Revisionen) sind dagegen 40-mm- und 44-mm-Köpfe gerechtfertigt, soweit diese in Abhängigkeit vom Pfannendurchmesser realisierbar sind (Zajonz et al. 2015). 3. Der Einsatz einer intrakapsulären Redondrainage beschleunigt durch die Eliminierung eingedrungener Luft und durch die Minimierung des postoperativen Hämatoseroms die Restitution physiologischer Gelenkverhältnisse. Dies ist gleichfalls eine wichtige Voraussetzung für die Wirksamkeit des Weber-Effektes und daher zu empfehlen (Prietzel et al. 2007).

Thesis (M.S.)--West Virginia University, 2001. / Title from document title page. Document formatted into pages; contains ix, 80 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 75-80).

Medical imaging tools technologically supported by the recent advances in the areas of computer vision can provide systems that aid medical professionals to carry out their expert diagnostics and investigations more effectively and efficiently. Two medical application domains that can benefit by such tools are ophthalmology and Total Hip Replacement (THR). Although a literature review conducted within the research context of this thesis revealed a number of existing solutions these are either very much limited by their application scope, robustness or scope of the extensiveness of the functionality made available. Therefore this thesis focuses on initially investigating a number of requirements defined by leading experts in the respective specialisms and providing practical solutions, well supported by the theoretical advances of computer vision and pattern recognition. This thesis provides three novel algorithms/systems for use within image analysis in the areas of Ophthalmology and THR. The first approach uses Contourlet Transform to analyse and quantify corneal neovascularization. Experimental results are provided to prove that the proposed approach provides improved robustness in the presence of noise, non-uniform illumination and reflections, common problems that exist in captured corneal images. The second approach uses a colour based segmentation approach to segment, measure and analyse corneal ulcers using the HVS colour space. Literature review conducted within the research context of this thesis revealed that there is no such system available for analysis and measurement of corneal ulcers. Finally the thesis provides a robust approach towards detecting and analysing possible dislocations and misalignments in THR X-ray images. The algorithm uses localised histogram equalisation to enhance the quality of X-ray images first prior to using Hough Transforms and filtered back projections to locate and recognise key points of the THR x-ray images. These key points are then used to measure the possible presence of dislocations and misalignments. The thesis further highlights possible extensions and improvements to the proposed algorithms and systems.

Darbo tikslas Ištirti šlaunikaulio galvos diametro, tūrinio polietileno išsidėvėjimo ir chirurginės technikos įtaką atokiesiems rezultatams po klubo sąnario endoprotezavimo. Darbo uždaviniai 1. Nustatyti kartotinų operacijų dažnį po klubo sąnario endoprotezavimo Lundo Universitetinėje ligoninėje, lyginant 22 ir 32 mm šlaunikaulio galvas ir sekant pacientus nuo 9-21 metų po operacijos. 2. Palyginti suminį kartotinų operacijų dažnį po protezavimo Klaipėdos ligoninėje ir Lundo Universitetinėje ligoninėje, sekant pacientus iki 14 metų po operacijos abiejuose centruose. 3. Ištirti polietileno dėvėjimąsį esant skirtingo diametro šlaunikaulio galvoms ir nustatyti ryšį su pacientų aktyvumu, kūno masės indeksu, amžiumi ir gūžduobės inklinacijos kampu. 4. Ištirti sąnarinio skysčio kiekio t.y. ultragarsu matuojamo „kapsulinio atstumo“ ir šlaunikaulio galvos diametro ryšį protezuotame klubo sąnaryje. Metodai Mes ištyrėme 1,720 Scan Hip Classic I KSE, implantuotus 1,550 pacientams, operacijos buvo atliktos Lundo Universitetinėje ligoninėje 1983-1995 metais. Palyginome suminį revizijų dažnį tarp 22 ir 32 mm diametro šlaunikaulio galvų. Visiems pacientams buvo implantuotas tas pats Scan hip stiebas. Pacientus sekėme nuo 9 iki 21 metų po operacijos. Mes ištyrėme 655 Scan Hip Classic I KSE, implantuotus 582 pacientams Klaipėdos ligoninėje 1991 – 2001 metais ir palyginome suminį revizijų dažnį su 932 Scan Hip Classic I KSE, implantuotais 825 pacientams Lundo Universitetinėje... [toliau žr. visą tekstą] / Aseptic loosening is the major complication and causes more than 85% of the revisions in hips in Lithuania. The etiology of aseptic loosening is multifactorial, involving both mechanical and biological processes. Socket and stem micromotion and polyethylene wear are important factors that influence the long term durability of THA’s. The expected annual wear of polyethylene (PE) cups is approximately 0.1mm. This means that billions of submicron-sized wear particles are released in to the hip joint. These particles induce inflammatory process in the THA hip and have been recognized as a major reason for osteolysis and subsequent failure of the prosthetic hip. It has been recognized that besides other factors femoral head size significantly influences wear. Larger diameter femoral head is associated with increased volumetric wear in metal-PE THA . You would expect that the differences eventually would show up in different cumulative revision rates (CRR) for different head sizes. However few reports in the literature analyzed survival rates in THA with different diameter femoral heads and did not find a significant difference when followed up to 12 years. It is still unknown if a longer-term follow-up would reveal differences in CRR depending on head size. Our aim was to analyze cumulative revision rates in THA in order to investigate if a follow-up up to 21 years would reveal differences in CRR depending on head size. How surgical implantation technique and experience in THA... [to full text]

Problem. The most effective treatment of hip arthrosis at this moment is hip replacement. For thousands of people with advanced degenerative joint disease, total joint arthroplasty provides improved function, decreased pain, and the opportunity to resume a more active lifestyle (Drake et at., 2002). Hip replacement as a resort of permanent pain and disturbed daily living is serious physical and psychological shock. Because of that person may feel fear, anxiety as well as manifest unadapted behavior syndromes such as anxiety and depression. Hypothesis: applying physiotherapy straight after operation two times per day should improve patient’s physical and emotional state and decrease anxiety and depression. The purpose of the present study was to evaluate effect of physical therapy on hip function as well as anxiety and depression after hip replacement. The tasks were: 1) to evaluate functional indicators of operated extremity before and after physiotherapy; 2) to evaluate patient‘s anxiety and depression exertion after operation and after physiotherapy; 3) to estimate correlation among evaluated indicators. Subjects: 21 patient (7 male and 14 female), who undergo hip replacement in Alytus district S. Kudirkos hospital. Subjects were tested three times: before operation, before applying physiotherapy and after physiotherapy. Physiotherapy was applied straight after operation two times per day five days a week (total 40 procedures). Methods: evaluation of: hip range of... [to full text]

SUMMARY The amount of disabled people of working age is icreasing in Lithuania. In the second place in the structure of primary disablement are connective tissue and muscle-skeleton diseases. In 2002 for the first time recognized as invalids were 2898 persons, in 2003 – 3448 persons. Part of inhabitants are becoming invalids because of the joint diseases. The most effective and modern treatment of hip arthrosis and some other hip joint diseases is total hip arthroplasty. In 2003 the State Patient’s Cash has received 4704 requests for total hip arthroplasty. This problem becoms more and more urgent (State Patient’s Cashies, 2004). Kinesitherapy in the gym and in the swimming pool are the main means used in the restoring of functional abilities of the patients after total hip arthroplasty. One can find the data about the efficiency of kinesitherapy for the patients after total hip replacement, but there is no separate data about efficiency of the kinesitherapy in the swimming pool. The aim of the research: to evaluate the efficiency of the kinesitherapy in the swimming pool for the patients after total hip replacement. The tasks: 1. To evaluate the change of functional abilities of the patients, who received the kinesitherapy in the gym. 2. To evaluate the change of functional abilities of the patients, who received the kinesitherapy in the gym and in the swimming pool. 3. To compare the change of functional abilities between the patients of both groups. 4. To establish the... [to full text]

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Ortopedi ve Travmatoloji Anabilim Dalı, 2004. / Bibliyografya var.

Thesis (M.S.)--California Polytechnic State University, 2010. / Mode of access: Internet. Title from PDF title page; viewed on April 28, 2010. Major professor: Dr. Scott Hazelwood. "Presented to the faculty of California Polytechnic State University, San Luis Obispo." "In partial fulfillment of the requirements for the degree [of] Master of Science in Engineering with a specialization in Biomedical Engineering." "April, 2010." Includes bibliographical references (p. 86-90).

Thesis (doctoral)--Lund University, 1994. / Added t.p. with thesis statement inserted.