Thesis (Ph. D.)--University of Missouri--Columbia, 2003. / "December 2003." Typescript. Vita. Includes bibliographical references (leaves 162-175). Also available on the Internet.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010.

Source: Masters Abstracts International, Volume: 47-06, page: 3565. Adviser: Benjamin Amick. Includes bibliographical references.

Pasaulyje operacijos minimaliai invazine metodika tampa vis labiau populiaresnės. Literatūroje galima rasti argumentų ,,už” ir ,,prieš” šia metodiką.. Minimalios invazijos šalininkai teigia, kad pagrindinis metodikos privalumas — greitesnė pacientų reabilitacija. Oponentų teigimu minimalios invazijos totalinis kelio sąnario endoprotezavimas nėra pranašesnis už įprastinį, netgi mano, jog tai padidina komponentų padėties klaidų tikimybę, bei komplikacijų riziką. 70 kelio sąnario artroze sergančių pacientų buvo įtraukta į atsitiktinių imčių tyrimą. 35 pacientai operuoti minimaliai invazine metodika, 35 įprastine. Mes tyrėme operacijos laiką, kelio sąnario judesius. Po 6 ir 12 savaičių kelio sąnario funkcija buvo vertinta pagal Kelio Sąnario draugijos skalę. Rentgenologiniam ištyrimui priekinę, šoninę kelio bei priekinę visos kojos rentgenogramas. Ligonių pasiskirstymas pagal, lytį amžių, kūno masės indeksą bei kelio sąnario pakitimus statistiškai reikšmingai tarp grupių nesiskyrė. Tyrimo metu nustatėme minimaliai invazinė metodika operuotų pacientų greitesnį kelio judesių atsistatymą, geresnius funkcinius rezultatus po 6 sav., bei ilgesnę operacijos trukmę. Po 12 savaičių skirtumo tarp grupių nenustatėme. Taip pat nenustatėme protezo komponentų padėties skirtumų tarp grupių. / Minimally invasive surgery is getting more interest in literature recently. However the reports regarding the effectiveness of this particular technique are controversial. There are reports in the literature that minimally invasive technique is associated with increased number of technical mistakes. Advantages of this technique are faster rehabilitation. In randomized controlled trial we analyzed 70 knee osteoarthritis patients admitted for elective total knee replacement. All patients were randomized to do surgery using minimally invasive or conventional technique. We analyzed operation time, range of motions 1-6 days after surgery. After 6 and 12 week we evaluated total knee replacement patiens according KSS score. For radiographic examination we performed anterior, lateral and long standing x-rays after the surgery. Preoperative data such as severity of osteoarthirtis, sex, age, and functional score did not differ within the groups. Minimally invasive group was associated with longer operation time, faster recovery of range of motions, better knee function 6 weeks after surgery. 12 week after total knee replacement we did not find any differences between the groups. Component position and leg axis deviation did not differ between the groups.

Darbo objektas: trys limfinio drenažo technikos, taikytos pacientams po kelio sąnario endoprotezavimo. Darbo problema: augant kelio sąnario endoprotezavimo operacijų skaičiui, dažnai po operacijos atsiranda komplikacijos. Viena labiausiai paplitusių komplikacijų yra kojos patinimas, sukeltas dėl infekcijos, kuri sukelia limfos tekėjimo sutrikimus. Norint pagerinti limfos tekėjimą, sumažinti patinimą, skausmą ir pagerinti judesio amplitudę patartina taikyti limfinio drenažo technikas. Darbo tikslas: palyginti skirtingų limfinio drenažo technikų poveikį pacientams po kelio sąnario endoprotezavimo. Tyrimo uždaviniai: 1. Nustatyti ir palyginti kojos apimčių aukščiau ir žemiau kelio sąnario pokyčius, taikant manualinio limfinio drenažo, presoterapijos ir masažinės technikos „Andulation“ technikas. 2. Nustatyti ir palyginti kelio sąnario lenkimo amplitudės pokyčius, taikant manualinio limfinio drenažo, presoterapijos ir masažinės technikos „Andulation“ technikas. 3. Nustatyti ir palyginti skausmo pokyčius, taikant manualinio limfinio drenažo, presoterapijos ir masažinės technikos „Andulation“ technikas. Tyrimo metodika: tyrime dalyvavo 15 pacientų, iš jų 6 vyrai ir 9 moterys. Moterų amžiaus vidurkis siekė 55,8 metus, o vyrų – 56,5 metus. Pasirinktos trys limfinio drenažo technikos: manualinis limfinis drenažas taikytas 5 pacientams, presoterapija -5 pacientams ir nauja „Andullation“ masažo terapija taikyta 5 pacientams. Gydymas taikytas 4 savaites, prieš ir po technikų taikymo... [toliau žr. visą tekstą] / Object of the research: three lymphatic drainage techniques, used for patients after knee arthroplasty. Problem of research: there are increased numbers of complications after knee arthroplasty operations. One of the most common complications is swelling, caused by infection, which cause disorders of the lymph flow. It is recommended to use lymphatic drainage techniques to improve lymph flow, decrease pain and increase range of motion of the knee. Aim of this research: to compare three lymphatic drainage techniques used on patients after the knee arthroplasty. Goals of the research: 1. Define and compare volumes of the leg, higher and lower knee, after using manual lymphatic drainage, pressotherapy and massage therapy „Andullation“. 2. Measure and compare knee range of motion of bending, after using manual lymphatic drainage, pressotherapy and massage therapy „Andullation“. 3. Identify and compare changes of the pain, after using manual lymphatic drainage, pressotherapy and massage therapy „Andullation“. Methods and organization of the research: There were 15 patients in the research: 6 men and 9 women. The average age of the women was 55.8 years and 56.5 for men. There were three lymphatic drainage techniques used: manual lymphatic drainage on 5 patients, pressotherapy on 5 patients and a new “Andullation” massage therapy, which was performed on 5 patients disregarding their gender and age. There were three parameters used to determine and compare the results: visual... [to full text]

The composition of orthopaedic wear testing lubricants used to mimic synovial fluid (SF) is known to significantly affect in vitro polyethylene (PE) wear; however, some wear testing standards may be promoting the use of lubricants that are not clinically relevant. The present thesis evaluated the biochemical composition of human osteoarthritic and periprosthetic SF in order to propose changes to lubricant specifications in current wear testing standards. Using this data, pin-on-disc wear tests were conducted to explore the effects of more clinically relevant lubricants on PE wear. Results showed that wear decreased using a more clinically relevant lubricant. Samples of these lubricants were biochemically evaluated and compared to the SF results previously obtained, which showed that current standards for wear testing lubricants are biochemically different from SF. The findings from the present thesis encourage the modification of standardized lubricant specifications to improve wear testing protocols and guarantee clinically relevant wear testing.

For more than 50 years total hip replacements have been a common and successful procedure to increase patient mobility and quality of life. The 10-year implant survival rate is 97.8%. However, for longer implantation times there are limitations linked to the negative biological response to wear and corrosion products from the currently used biomaterials. In this thesis silicon nitride (SiNx) coatings were evaluated for use in total hip replacements, on the articulating bearing surface and modular taper connections. Homogeneous, dense SiNx coatings were deposited using reactive high power impulse magnetron sputtering (HiPIMS) up to a thickness of 8 µm. The N/Si atomic ratios ranged from 0.3 to 1.1 and the coatings showed a low surface roughness. The wear rate of a SiNx coated cobalt chromium molybdenum alloy (CoCrMo) was similar to that of bulk Si3N4, and less than one 46th of uncoated CoCrMo, an alloy that is commonly used in joint replacements. Wear debris generated from SiNx coatings was round in shape, with a mean size of 40 nm, and ranged between 10 and 500 nm. Model particles, similar in size and shape as the wear debris, were soluble in simulated body fluid. The dissolution rate was higher than the expected rate of debris generation. Along with the size of the debris, which is not in the critical range for macrophage activation, this dissolution may limit negative biological reactions. The SiNx coatings also dissolved in simulated body fluid. The coating with the highest N/Si ratio exhibited the lowest dissolution rate, of 0.2 to 0.4 nm/day, while CoCrMo under the same condition dissolved at a rate of 0.7 to 1.2 nm/day. SiNx-coated CoCrMo exhibited a reduced release of Co, Cr and Mo ions into the solution by two orders of magnitude, compared to uncoated CoCrMo. Si3N4 evaluated under micro-displacement in a corrosive environment, replicating the modular taper, showed a lower corrosion current compared to common biomedical alloys. SiNx coatings may also act beneficially to reduce issues associated with this type of contact. SiNx coatings have shown several properties in a laboratory environment that are hypothesised to increase the longevity of joint replacements. The promising results encourage further evaluation closer to the clinical application of total hip replacements, in particular in the articulating bearing surface and in modular tapers.

The composition of orthopaedic wear testing lubricants used to mimic synovial fluid (SF) is known to significantly affect in vitro polyethylene (PE) wear; however, some wear testing standards may be promoting the use of lubricants that are not clinically relevant. The present thesis evaluated the biochemical composition of human osteoarthritic and periprosthetic SF in order to propose changes to lubricant specifications in current wear testing standards. Using this data, pin-on-disc wear tests were conducted to explore the effects of more clinically relevant lubricants on PE wear. Results showed that wear decreased using a more clinically relevant lubricant. Samples of these lubricants were biochemically evaluated and compared to the SF results previously obtained, which showed that current standards for wear testing lubricants are biochemically different from SF. The findings from the present thesis encourage the modification of standardized lubricant specifications to improve wear testing protocols and guarantee clinically relevant wear testing.

Tyrimo objektas: tiriamųjų funkcinė būklė. Tyrimo tikslas: įvertinti skirtingų kineziterapijos programų poveikį pacientų, kuriems endoprotezuotas klubo sąnarys, funkcinei būklei. Hipotezė: kineziterapija salėje bei kineziterapija vandenyje turės didesnį poveikį pacientų, kuriems endoprotezuotas klubo sąnarys, funkcinei būklei, nei tik kineziterapija salėje. Uždaviniai: 1. Įvertinti pacientų, kuriems taikyta kineziterapija salėje, funkcinės būklės kaitą. 2. Įvertinti pacientų, kuriems taikyta kineziterapija salėje ir kineziterapija vandenyje, funkcinės būklės kaitą. 3. Palyginti skirtingų kineziterapijos metodų efektyvumą. Tyrimo metodika: Tyrimas atliktas VŠĮ ,,Tulpė“ ir AB Birštono sanatorija ,,Versmė“. Trisdešimt tiriamųjų – asmenų, kuriems buvo atliktas klubo sąnario endoprotezavimas, – suskirstyti atsitiktine tvarka į dvi grupes po 15 ligonių. Vienai grupei buvo taikoma kineziterapija salėje, o kitai grupei – kineziterapija salėje ir vandenyje. Taikant šias priemones buvo pildomas tyrimo protokolas reabilitacijos eigoje: 1. Skausmui vertinti naudota VAS skalė (analoginė skausmo skalė); 2. Klubo sąnario judesių amplitudei vertinti naudotas goniometras; 3. Šlaunies apimčiai išmatuoti naudota centimetrinė juostelė; 4 . Funkciniam mobilumui ir griuvimo rizikai nustatyti naudotas ,,Stoti ir eiti“ testas; 5. Klubo sąnario funkcijai nustatyti naudota Harris Hip skalė. Visi matavimai atlikti I-ą dieną atvykus ir po 18 reabilitacijos dienų. Įvertinus abiejų grupių tiriamųjų... [toliau žr. visą tekstą] / The object of the Thesis: functional state for persons with endoprosthetic hip joint. The aim of the Thesis: to assess the effect of different physiotherapy methods on the functional state for persons with endoprosthetic hip joint. Hypothesis: Physiotherapy combined with aquatic therapy had a greater impact on persons functional status than only physiotherapy in the gym. The tasks of the Thesis: 1. To assess the effect of physiotherapy on the functional state for persons with endoprosthetic hip joint. 2. To asses the effect of physiotherapy combined with aquatic therapy on the functional state for persons with endoprosthetic hip joint. 3. To compare the effectiveness of different physiotherapy methods. The methods of the Thesis: The study was performed in ,,Tulpė“ sanatorium and sanatorium ,,Versmė“ in Birštonas. Thirty research subjects - persons with endoprosthetic hip joint – were randomly divided into two groups with 15 patients in each. One group received physiotherapy, the other – physiotherapy compared with aquatic therapy. While applying these modalities, a research protocol was completed during the rehabilitation: 1. VAS scale to assess pain; 2. Goniometer was used to assess the range of hip joint motions; 3. Measuring tape was used to assess thigh volume; 4. ,,Stand up and go“ test was used to assess functional mobility and risks of falls; 5. Harris Hip scale was used to assess joint function. All measurements were performed 1 day after arrival and 18 day after... [to full text]

New surgical approaches for total hip arthroplasty (THA) are being developed to reduce muscle damage sustained during surgery, in the hope to allow better muscle functioning afterwards. The goal of this study was to compare the muscle sparing anterior (ANT) approach to a traditional lateral (LAT) approach with three-dimensional motion analysis. Kinematics and kinetics were obtained with an infrared camera system and force plates. It was hypothesized that (1) the ANT group would have closer to normal range of motion, moments and powers, compared to the LAT group, and that (2) the ANT group would have higher peak hip abduction moment than the LAT group. Forty patients undergoing unilateral THA for osteoarthritis between the ages of 50 and 75 (20 ANT, 20 LAT) were asked to perform three trials of walking, stair ascent and stair descent. Patients were assessed between six to twelve months postoperatively. Twenty age- and weight-matched control participants (CON) provided normative data. Results indicated that both THA groups had gait anomalies compared to the CON group. Both THA groups had reduced hip abduction moment during walking (CON vs. ANT: p<0.001; CON vs. LAT: p=0.011), and the ANT group had a significantly lower hip abduction moment compared to the LAT group (p=0.008). Similar results were observed during stair descent, where the ANT group had reduced peak hip abduction moment compared to the CON group (p<0.001) and the LAT group (p=0.014). This indicates that the anterior approach did not allow better gait and stair climbing ability after THA. It is therefore thought that other variables, such as preoperative gait adaptations, trauma from the surgery, or postoperative protection mechanisms to avoid loading the prosthetic hip, are factors that might be more important than surgical approach in determining the mechanics of THA patients after surgery.