In endoprosthesis surgery there are typically a high percentage of implant defects, these can lead to failure of the whole prosthesis. One type of total hip replacement function loss is acetabular cup loosening from the pelvic bone. This disertation examines manufacture perturbations as one of the possible reasons for this kind of failure. Both dimension and geometry manufacturing perturbations of ceramic head and polyethylen cup were analyzed. We find that perturbations in the variables analysed here affect considered values of contact pressure and frictional moment. Furthermore, contact pressure and frictional moment are quantities affecting replacement success and durability. From obtained results it can be recommended to fit head and cup with a clearance of between 0 mm and 0.05 mm. It can not be recommend using interference type of fit because of strong deterioration of the contact conditions. Roundness perturbation of ceramic head should not exceed 0.025 mm.

BACKGROUND:Anticoagulation with vitamin K antagonists such as warfarin has historically been used for the long term management of patients with thromboembolic disease. However, these agents have a slow onset of action which requires bridging therapy with heparin and its analogues, which are available only in parenteral route. To overcome these limitations, new oral anticoagulants such as factor Xa inhibitors and direct thrombin inhibitors have been developed. The aim of this article is to systematically review the phase 3 clinical trials of new oral anticoagulants in common medical conditions.METHODS:We searched PubMed (Medline) from January 2007 to February 2013 using "Oral anticoagulants", "New oral anticoagulants", "Randomized controlled trial", "Novel anticoagulants", "Apixaban", "Rivaroxaban", "Edoxaban", "Dabigatran etexilate", "Dabigatran" and a combination of the above terms. The available evidence from the phase 3 RCTs was summarized on the basis of individual drug and the medical conditions categorized into "atrial fibrillation", "acute coronary syndrome", "orthopedic surgery", "venous thromboembolism" and "medically ill patients".RESULTS:Apixaban, rivaroxaban and dabigatran have been found to be either non-inferior or superior to enoxaparin in prophylaxis of venous thromboembolism in knee and hip replacement with similar bleeding risk, superior to warfarin for stroke prevention in atrial fibrillation with significant reduction in the risk of major bleeding, non-inferior to aspirin for reducing cardiovascular death and stroke in acute coronary syndrome with significant increase in the risk of major bleed. Rivaroxaban and dabigatran are also superior to the conventional agents in the management of symptomatic venous thromboembolism. However, compared to enoxaparin, apixaban and rivaroxaban use lead to significantly increased bleeding risk in medically ill patients. Additional studies evaluating the specific reversal agents of these new drugs for the management of life-threatening bleeding or other adverse effects are necessary.CONCLUSION:Considering their pharmacological properties, their efficacy and bleeding complications, the new oral agents offer a net favourable clinical profile in orthopedic surgery, atrial fibrillation, acute coronary syndrome and increase the risk of bleeding in critically ill patients. Further studies are necessary to determine the long term safety and to identify the specific reversal agents of these new drugs.

Title: Consequences of forced hypokinesia on human movement aparatus. Objectives: The aim of this study was to find out the influence of forced hypokinesia after total hip replacement on the excitability of α motoneurons. I deal with the changes of H-reflex and M-wave latencies and the changes of the recruitment curves. The results of the operated and non-operated (kontrol) lower limb were compared. Methods: Five volunteers 3 - 4 weeks after total hip replacement participated in this study. The age was 62,4 (± 3,01). The H-reflex was elicited by stimulation of tibial nerve in a poplitel fossa. The H-reflex and M-wave latencies and its recruitment curves were obtained. After that the values of the operated lower limb were compared with the non-operated one (control). The results were evaluated as case studies. The EMG device Grass Telefactor was used to detect the electrical potential of soleus muscle. The rectangular pulses of 0,5 ms duration were used for stimulation tibial nerve by Grass 88 Stimulator. Then the data were transduced by CED Power 1401 device. Results: We found out that the H-reflexes of both lower limbs were not elicited in the case study no. 2 and the H-reflex of a control lower limb was not elicited in case study no. 1. The stimulus intensities for eliciting H-reflex and M-wave...

Dizertační práce se zabývá mechanismy mazání v náhradách kyčelního kloubu. Byla provedena systematická studie formování proteinového filmu při zahrnutí různých materiálů a provozních podmínek. Hlavní pozornost je přitom věnována roli jednotlivých proteinů obsažených v synoviální kapalině při současné přítomnosti dalších proteinů. Jelikož metody aplikované v předchozích studiích neumožňovaly separovat jednotlivé složky maziva, byla vyvinuta optická měřící metoda na principu fluorescenční mikroskopie. Z důvodu verifikace metody byly provedeny dvě nezávislé studie zaměřené na měření tloušťky mazacího filmu a dělení maziva na výstupu mazaného kontaktu. Z důvodu určitých limitací fluorescenční mikroskopie byla dále využita i metoda optické interferometrie, jejíž využití je ilustrováno ve studii zabývající se formováním mazacího filmu v náhradách kyčelního klubu při uvažování reálné konformity třecích povrchů. Závěrečná část práce představuje nový metodologický přístup založený na in situ pozorování kontaktní oblasti umožňující popsat roli jednotlivých proteinů ve vztahu k vývoji tloušťky mazacího filmu. Práce obsahuje originální výsledky, které přináší nové poznání v oblasti biotribologie náhrad kyčelního kloubu vedoucí k dalšímu vývoji implantátů při snaze zabránit jejich selhání v důsledku omezené životnosti.

No description available.

Bei der Rekonstruktion des durch Krankheit oder Trauma geschädigten Hüftgelenkes hat sich der Ersatz des Gelenkes durch eine totale Endoprothese heute allgemein durchgesetzt. Dabei hat unter Beachtung einer differenzierten Indikationsstellung sowohl die zementierte als auch die zementfreie Technik ihre Anwendungsberechtigung. Das Problem der dauerhaften Verankerung der zementfreien Hüftendoprothese ist jedoch trotz ständiger Weiterentwicklung von Operationstechnik, Implantatdesign und Werkstoffen bis heute nicht abschließend gelöst. Die häufigste Versagensursache ist dabei die aseptische Schaftlockerung, die mit Veränderungen des knöchernen Lagers einhergeht. Mit der Osteodensitometrie existiert eine Technik, die eine schnelle, nichtinvasive und quantitative Beurteilung der Knochenmasse erlaubt. In der vorliegenden Querschnittsstudie wurden 95 Zweymüller-Schaftimplantate zwei, vier bzw. sechs Jahre nach Implantation untersucht. Dabei wurden die Ergebnisse der klinischen Untersuchung und der konventionellen a.p. Röntgenaufnahme den mit Hilfe der DEXA-Technik ermittelten Knochendichteänderungen am Femur gegenübergestellt. Der Vergleich von Knochendichteänderungen in einzelnen Femurabschnitten in Abhängigkeit von der Implantationsdauer läßt Rückschlüsse auf das Schaftdesign zu. / When hip function is several impaired by disease or trauma, total hip replacement is preferred treatment of choice today. The consideration of a differentiated position of indication justifies both - the application of the cemented as well as the cement free technique. But despite of constant further development of operation techniques, design of implantation and the used materials is the problem of a permanent embodiment of the non-cemented hip prosthesis till today not finally solved. The aseptic relaxation of the stem is the most frequent reason for failure. This is accompanied by changes of the osseous bed. With the osteodensitometry exists a technique that makes a fast, non-invasive and quantitative assessment of the bone mass possible. In this present cross-section study 95 Zweymüller-stem-implants were examined two, four and six years after the implantation. The results of the clinical examination and the results of the conventional X-ray picture were compared with the changes of the thigh femur bone density that were ascertained by the DEXA-technique. The comparison of changes of the bone density in single femur sections in dependence on the duration of the implantation allows one to draw conclusions from the design of the stem.

Observative prospektive Kohortenstudie mit 22 Patienten über 3 Jahre. Wir untersuchten, ob die intensive Schulung der Diskrimination des Hüftgelenks von Beckenbewegungen Auswirkungen auf die Harmonisierung des Gangbilds in der postoperativen Rehabilitation habe. Es wurde anhand der videogestützten Ganganalyse auf dem Laufband ein Score der Gangharmonie gebildet, der neben dem Gang als Ganzkörperbewegung auch koordinative Faktoren wie den Bewegungsfluß berücksichtigt. Faktoren wie Schmerz und Erfahrung in übenden Verfahren wurden in einer Regressionsanalyse auf ihre Assoziation mit der Gangharmonie überprüft. Modelle des Bewegungslernens wurden auf langfristige Strategien der Rehabilitation angewendet. / Prospective observative cohort study over 3 years. A cohort of people with OA of the hip due to CDH was followed up over 3 years. The discrimination of hip movements from pelvis movements was measured and compared with the gait harmony. A Gait Harmony Score reflecting total body movement and coordinative factors has been developed and validated. In a regression analysis we measured the association between confounding variables like preoperative pain and experience in exercise with gait harmony and hip proprioception. Models of motor learning in rehabilitation have been applied to the postoperative development of the gait in order to establish models for longterm rehabilitation strategies.

No description available.

Epidural analgesia causes a temporary cessation of nerve conduction via administration of low concentration of local anaesthesia, or opioid, into epidural space. The resulting temporary discontinuation of nerve conduction is called central neuroaxial anaesthesia and it facilitates the process of surgical intervention. An epidural catheter is usually inserted during epidural desensitisation. It helps to control the amount of administered anaesthesia and hence to respond to surgery progress, but it also enables to keep the catheter within the epidural space for the following postoperative analgesia, which will promote timely postoperative rehabilitation and pain management.The research project was conducted on basis of quantitative and qualitative investigation. The quantitative research was performed via questionnaires directed at the nursing staff, and the qualitative research took form of semi-structured interviews with patients. The quantitative investigation was conducted in fourteen health care facilities in the Czech Republic. Respondents of the quantitative research were nurses working in orthopaedic departments, multidisciplinary ICU or ARO (Anaesthesiology Resuscitation Dept.), who provided care to patients after TKR or THR with an epidural catheter insitu. Qualitative research respondents were patients hospitalised in orthopaedic departments for TKR or THR, with epidural catheter insitu and who agreed to participate at the interview. Quantitative research data were processed in Excel 2010 and presented in graphs, frequency and contingency tables, whereas the qualitative research data were processed using charts of the Smart Art program. After the agreement with the management of health care facilities, this dissertation will promote education and aid situation improvement. The Standard of Nursing Care Assisting a Patient with Epidural Catheter during Insertion and Care will be an outcome of this project. Moreover, we will design a patient information booklet and a quality of care indicator that will focus on monitoring of complications occurrence such as infections in patients with epidural catheter. The findings may help to design a training course specialised in nursing care provision to those patients and also to provide basis for further research.

A identificação de fatores relacionados à segurança e qualidade das próteses para artroplastia de quadril na visão do ortopedista especialista, bem como a busca e checagem por informações advindas dos instrumentos legais de regulação, tais como localização do Registro do Ministério da Saúde e rótulo de instruções de uso, com exata descrição das características dos dispositivos, a notificação e procura por alertas da Tecnovigilância podem apontar critérios que minimizem a possibilidade de erros e surgimento de eventos adversos na escolha dos implantes para quadril durante o processo de indicação, solicitação, liberação, implantação e utilização do produto. Investigando este contexto, foram entrevistados os membros da Sociedade Brasileira de Quadril, e do retorno das respostas surgiram dados que mostram que 72% dos sujeitos não acreditam que o Registro da ANVISA faça parte de um processo de segurança e qualidade no cadastramento de produtos para saúde no Brasil, e outros 72% desconhecem a ferramenta Tecnovigilância para monitoramento pós-comercialização. Todavia, 94% da amostra refere já ter constatado falha protética ao longo da carreira, outros 94% indicam que a falha ocorreu com próteses nacionais, e que em 60% das ocorrências o fornecedor foi contatado, e não a ANVISA, e em outros 30% das falhas nada foi feito. Estes dados são preocupantes, pois refletem o descompasso entre a Agência Nacional de Saúde e a classe de médicos assistentes no que tange ao monitoramente de tecnologias em saúde, estes por não notificarem os EA (evento adverso) e QT (queixa técnica) ao órgão regulatório, e a Agência que, por conseguinte, não divulga amplamente esta ferramenta a quem de fato deveria ser o alvo de atenção, pois são estes que utilizam, na prática diária, os produtos registrados no Brasil. Na tentativa de facilitar a conferência de dados imprescindíveis relacionados à OPME(órteses, próteses e materiais especiais) entre eles próteses para quadril, elaborou-se uma revista eletrônica intitulada Guia Prático para checagem de questões sobre segurança e qualidade de dispositivos médicos cirúrgicos de acordo com procedimentos da ANVISA. / Identification factors related to safety and quality of prostheses for total hip arthroplasty according to the orthopedic specialists, as well as the search and checking for information from the legal instruments of regulation such as the registry made by the Ministry of Health and corresponding label functioning instructions containing the exact description of the characteristics of the devices, alert notifications for technical surveillance, etc., can lead to criteria that minimize errors and avoid adverse events when choosing hip implants, during the process of request, release, deliver and use of the product. In order to investigate this context, a survey was made by means of a questionnaire where members of the Hip Brazilian Society answered selected questions. Data from answers have shown that 72% of respondents do not believe that the ANVISA (National Health Agency) product registration is part of a safety and quality process for health products in Brazil, and another 72% are unaware of the pos market monitoring tool called Tecnovigilância. However, 94% of the medical doctors state that they already have found prosthetic failure throughout their career, other 94% indicate that the failure occurred with national prostheses, and in 60% of these cases the supplier was contacted and not the ANVISA, and for other 30 % of failures nothing was done. The exposure of these data is worrying since it reflects the gap between ANVISA and the physicians in regard to monitoring health technologies. Also, the doctors do not notify adverse events to the regulatory Agency and the Agency therefore does not disseminate this tool to those who actually should be the focus of attention since they use the products in their daily practice. Finally, in order to facilitate data verification of health products, in special hip phrostheses, a practical electronic guide was developed where questions and doubts about safety and quality of medical devices can be checked according to the ANVISA procedures.