Title: Human locomotion after total hip replacement Objectives: The aim of this thesis is to perform a gait analysis of patients after total hip replacement and to find out, how chosen temporo-spatial, kinetic and kinematic parameters change during the first half a year after the surgery. The deviations found in gait stereotypes of individual patients are further compared with results of international studies. Methods: The thesis is theoretical-empirical, with small number of patients. 3D kinematic gait analysis was performed by Qualisys system and ground reaction forces by two Kistler force plates. The following parameters are being monitored: length of step, stance phase duration, cadence, walking speed, lateral shift of the pelvis and trunk in standing phase, contralateral pelvic drop in standing phase of the leg, maximum range of motion of the hip joint in sagital plain, maximum of vertical and medio-lateral component of the ground reaction forces in the standing phase. Results: The highest side deviations between legs were found in 3 months after the surgery and remained until 6,5 months after the surgery. In this time period a lower value of the length of step, stance phase duration, maximum range of motion of the hip joint in sagital plain and also a higher lateral shift of the pelvis was...

Every year 16 000 individuals receive a total hip arthroplasty (THA) in Sweden. Even though THA is a common procedure, adverse events do occur. The most dramatic complication is death in the postoperative phase. The overall aim of this thesis was to describe and investigate early mortality after THA in Sweden. Sweden has an ideal platform for national observational registry studies, thanks to the use of personal identity numbers. Operation-specific information was collected from the Swedish Hip Arthroplasty Register, medical information from the National Board of Health and Welfare, and socioeconomic information was collected from Statistics Sweden. Main outcome was 90-day mortality. Study I was a prospective observational register study investigating the risk of mortality after a simultaneous bilateral THA compared with staged bilateral THA. There was no clinically relevant difference in early postoperative mortality between the two groups. Studies II and III were nation-wide matched cohort studies, with adjustment for comorbidity and socioeconomic background. Adjusted early mortality in femoral neck fracture patients receiving a THA is about double compared with a matched control population. Young (60-69 years) femoral neck fracture patients receiving a THA have a low absolute mortality risk, while those who are older than 80 years with a higher degree of medical comorbidity run a high risk of early death (II). In study III healthier, younger patients with higher socioeconomic status tended to be selected for cementless THA, resulting in selection bias. Even after accounting for this bias, however, there remains a small absolute and adjusted increase in the risk of death within 14 days after elective THA surgery using fully cemented implants. Study IV was a nationwide prospective cohort study comparing different comorbidity measures in terms of predicting early postoperative mortality after THA. A less data-demanding comorbidity measure is better at predicting 90-day mortality than more commonly used coding algorithms. In conclusion, socioeconomic background and the presence of comorbidities have an important influence on early mortality after THA, while the type of fixation is of less importance. Future mortality studies could benefit from the use of data that are routinely collected, and thus avoid the logistically complicated procedure now necessary to merge national databases.

Background: Total hip replacement (THR) with post-operative surveillance is recommended for debilitating osteoarthritis (OA). Using self-reported pain, function or walking performance is one alternative to address increasing surveillance demands. Objective: A cross-sectional cohort study to evaluate the associations of pain, function and performance with two radiographic markers of potential THR failure. Participants: 110 patients, median 6 years after THR surgery for OA. Methods: Questionnaires assessed demographics, co-morbidity, arthritis severity, pain, pain catastrophizing, and functional status. Performance was measured using the six minute walk test. THR outcome was assessed radiographically. Results: Few patients had pain, functional impairment or radiographic markers of potential THR failure. A larger percentage of patients with some intermittent pain (10.7 versus 8.6%) and pain iii after walking performance (40.0 versus 27.6%) had higher wear, but these differences were not significant. Conclusion: Measures of pain are potentially important for larger studies aiming to develop alternative methods of post-operative surveillance.

Background: Total hip replacement (THR) with post-operative surveillance is recommended for debilitating osteoarthritis (OA). Using self-reported pain, function or walking performance is one alternative to address increasing surveillance demands. Objective: A cross-sectional cohort study to evaluate the associations of pain, function and performance with two radiographic markers of potential THR failure. Participants: 110 patients, median 6 years after THR surgery for OA. Methods: Questionnaires assessed demographics, co-morbidity, arthritis severity, pain, pain catastrophizing, and functional status. Performance was measured using the six minute walk test. THR outcome was assessed radiographically. Results: Few patients had pain, functional impairment or radiographic markers of potential THR failure. A larger percentage of patients with some intermittent pain (10.7 versus 8.6%) and pain iii after walking performance (40.0 versus 27.6%) had higher wear, but these differences were not significant. Conclusion: Measures of pain are potentially important for larger studies aiming to develop alternative methods of post-operative surveillance.

Total hip replacement is one of the most extensively and highly effective operating methods in orthopaedics. The patients are brought back the self-sufficiency, life without the pain and noticeably motion restriction. Irreplaceable function here is a role of the nurse, who helps the patient to return back to his common life...The aim of this work was to find out, how the patients feel the role of the nurse and its influence to given nursing care before and after the total hip replacement as the less fulfilled. There were following research questions set: How the patients feel the role of the nurse before and after the total hip replacement? How the patients before and after the total hip replacement feel the interpretation of the nurse roles? How the patients before and after the total hip replacement feel the role of the nurse and its influence to given nursing care. Which of the nurse roles are felt by the patient as the unsatisfactory in postoperative care? The patients before and after the total hip replacement feel through the everyday nurse activities the nurse in her role of the caregiver and education giving person, following the nurse vindicator and the nurse bearer of changes. The patients feel the care thanks these roles as a quality, holistic and continual. Nevertheless was the role of the education giving named as the least fulfilled. In connection with these research results was created a manual, a Guide book for the patients before and after the total hip replacement. This Guide book was given to testing purposes. This Guide book was appreciated by the patients very positive despite a large amount of information, which were surprising for many of them. We gained some data, which gave the impulse to complete the information in the Guide.The created Guide book can´t replace the effective communication of the patient with the medical staff, which could be always the most suitable "source" of information.

This thesis deals with the experimental study of lubrication of hip joint replacements. The influence of the synovial fluid composition and the head material to the lubricating film thickness were asssesed by using a pendulum hip joint simulator. Both of these effects were assesed under static and dynamic loading conditions. The experimental results showed that the movement of the head against the cup is unnecessary for the separation of the rubbing surfaces by a layer of adsorbed proteins. Composition of the synovial fluid then significantly influences the thickness of the lubricating film. Two opposite extremes have been observed during tests with two model synovial fluids. The first fluid formed a very strong lubricating film. The second sample almost prevent adsorption of proteins and consequently formed only very thin lubricating film. The influence of the material is noticeable when comparing the results obtained with a metal head and ceramic heads. Metal head formes under the same conditions thicker lubricating film. This evidence may be partly influenced by different diametrical clearances, which were in the case of ceramic heads higher.

No description available.

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.

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...

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.