Purpose Short stems for total hip arthroplasty are an alternative to traditional conventional long stems. Short stems are designed to facilitate minimal-invasive surgery, improve bone-stock preservation, and mimic a physiological load distribution. However, there is little evidence of the long-term outcome of short stems. This study aims to analyze the ten year survival rates and clinical outcome of one specific metaphyseal short hip stem implant. Methods We retrospectively analyzed the patient records of the patients who underwent a total hip arthroplasty with a monoblock partial collum sparing metaphyseal short hip stem prosthesis in 2008 and 2009 in our clinic. Patients were contacted, and clinical follow-up was recorded using the German version of the modified Harris Hip Score. Furthermore, complications, revision surgery, and post-operative radiographs were analyzed. Results Data from 339 primary implantations in 322 patients were retrieved. The mean follow-up was 10.6 years. Seven patients underwent a revision. The ten year survival rate with any revision surgery as the endpoint was 97.5%. The mean modified Harris Hip Score was 86 points (range 30 to 91 points). Five patients had an intraoperative fracture of the femur (1.6%). Two patients (0.6%) had a dislocation of the hip. The stem tip-to-cortex distance, measured in the anterior posterior view, was 2.6 mm (range 0 to 8.3 mm). Conclusion The ten year survival rate of our used monoblock partial collum sparing metaphyseal short hip stem implant is comparable to traditional stems for total hip arthroplasty.

The right patient selection with the correct surgical treatment are prerequisite for a positive result in total hip arthroplasty (THA). Short stem implants demand a shorter anchoring length in accordance with the proper indication. Although appropriate indications for short stems have been discussed in the literature, there currently is no clear definition. The lack of an accepted categorization of short hip stems complicates the situation further. This article briefly reviews the literature and highlights the authors' results and experiences in short stem THA in an effort to establish a proper discrimination between indications and contraindications for the Metha short stem. Results presented include a retrospective data collection and follow-up examination of 126 patients who underwent short stem THA with 2- and 4-year results. Anchoring principles of the short stem are reviewed, and a complication and failure analysis based on 7 femoral revisions in 1092 short stem THAs is presented. Selection criteria for short stem THA are patients younger than 70 years with primary osteoarthritis and dysplastic femoral deformities, and indications of avascular head necrosis. Adequate bone quality must be confirmed intraoperatively, assessing whether the bone structure in the area of the femoral neck is strong enough to support the short stem load transmission. Coxa vara and high dysplastic femoral neck antetorsion are contraindications for short stems. Wide and short femoral necks, implant undersizing, and a deep stem position below the femoral osteotomy compromise stability and must be avoided with an appropriate surgical technique. Long-term data are not yet available.

Cementless revision hip arthroplasty is described as state of the art, especially in cases of advanced bone loss of the femur. A requirement for a good result from cement-free revision hip arthroplasty is classification of the bone defect and the presence of a mechanically stable anchorage in the area of the original implant or, in cases of bone defects, distal to the original area in stable diaphyseal bone. The possibility of the accumulation of autografts or allogeneic osseous grafts and the entire removal of the cement and debris has been postulated. The advantages of cementless revision hip arthroplasty include regeneration of the bone stock and the often available modularity of the revision hip system, which allows adaptation to different bone configurations and also allows a partial change of the prosthesis in rerevision cases, such as in cases of sintering or derotation. Cemented revision arthroplasty should be done only in special cases, such as with marginal bone defects or for older patients with a short life expectancy.

Die zementfreie Versorgung in der Wechselendoprothetik des Hüftschaftes kann als „state of the art“ insbesondere bei fortgeschrittener Femurdestruktion angesehen werden. Voraussetzung für ein gutes Ergebnis der zementfreien Femurrevisionsarthroplastik ist eine mechanisch stabile Verankerung im originalen Prothesenlager oder bei höhergradigen knöchernen Defekten distal des ursprünglichen Lagers am festen diaphysären Knochen. Zusätzlich sollte die Anlagerung auto- oder allogener Knochentransplantate möglich sein. Die vollständige Entfernung des Zements sowie des granulomatösen Gewebes ist zu fordern. Eine korrekte Klassifikation des knöchernen Defekts ist unverzichtbar. Wesentliche Vorteile der zementfreien Wechselendoprothetik liegen in der Regeneration des knöchernen Lagers und der oft vorhandenen Modularität des Prothesensystems, welche die Anpassung an die verschiedensten knöchernen Konfigurationen ermöglicht und auch im Rerevisionsfall einen Teilwechsel der Prothese (z. B. bei Einsintern oder Derotation) zulässt. Zementierte Wechseloperationen sollten nur in speziellen Ausnahmefällen, so bei geringen knöchernen Defekten oder älteren Patienten mit nur noch geringer Lebenserwartung, durchgeführt werden.

Noninvasive electrophysiological phenotyping in small rodents is usually done by ECG studies. However information content from few ECG leads is limited. We investigated how Cardiac Magnetic Field Mapping (CMFM) parameters change at different time points after myocardial infarction in rats. Therefore, myocardial infarction was induced by ligation of the anterior descending artery in male Sprague Dawley (SD) rats. CMFM recordings were done using a 7 channel SQUID system during a follow up of 4 weeks after myocardial infarction. Rats with myocardial infarction were compared with sham operated animals.

Rats harboring the human renin and angiotensinogen genes (dTGR) feature angiotensin (ANG) II/hypertension-induced cardiac damage and die suddenly between wk 7 and 8. We observed by electrocardiogram (ECG) telemetry that ventricular tachycardia (VT) is a common terminal event in these animals. Our aim was to investigate electrical remodeling. We used ECG telemetry, noninvasive cardiac magnetic field mapping (CMFM) at wk 5 and 7, and performed in vivo programmed electrical stimulation at wk 7. We also investigated whether or not losartan (Los; 30 mg x kg(-1) x day(-1)) would prevent electrical remodeling. Cardiac hypertrophy and systolic blood pressure progressively increased in dTGR compared with Sprague-Dawley (SD) controls. Already by wk 5, untreated dTGR showed increased perivascular and interstitial fibrosis, connective tissue growth factor expression, and monocyte infiltration compared with SD rats, differences that progressed through time. Left-ventricular mRNA expression of potassium channel subunit Kv4.3 and gap-junction protein connexin 43 were significantly reduced in dTGR compared with Los-treated dTGR and SD. CMFM showed that depolarization and repolarization were prolonged and inhomogeneous. Los ameliorated all disturbances. VT could be induced in 88% of dTGR but only in 33% of Los-treated dTGR and could not be induced in SD. Untreated dTGR show electrical remodeling and probably die from VT. Los treatment reduces myocardial remodeling and predisposition to arrhythmias. ANG II target organ damage induces VT.

The advantages of fixed-angle implants are due to the design of the screws used, which results in increased axial stability, only slight periostal contact, and better seating of the implant in bone that is already damaged. These implants can be used, for example, in the long bones, the spine and the pelvis. They can be applied for the treatment of joint fractures and fractures in the vicinity of joints, and also for the treatment of such problem fractures as those close-to prosthetic implants. It is not always possible to avoid secondary correction loss. It is important to differentiate technical surgical errors, such as selection of the wrong implant with consequent implant failure, and impaired fracture healing with deformation of the implant from correction loss that is not dependent on the implant system at all. A sound introduction to the use of the system to be applied can keep correction loss to a minimum.

Die Vorteile der winkelstabilen Implantate liegen in der Erhöhung der axialen Stabilität, dem geringen Periostkontakt und besserer Festigkeit im vorgeschädigten Knochen durch das Schraubendesign. Einsatzmöglichkeiten finden sich u. a. im Bereich der langen Röhrenknochen, der Wirbelsäule und des Beckens. Gelenk- und gelenknahe Frakturen sowie Problemfrakturen wie periprothetische Frakturen können versorgt werden. Ein sekundärer Korrekturverlust lässt sich nicht immer vermeiden. Dabei müssen operationstechnische Fehler, wie falsche Implantatwahl mit Folge des Implantatversagens, Frakturheilungsstörung mit Implantatdeformierung und systemunabhängiger Korrekturverlust unterschieden werden. Eine Minimierung des Korrekturverlusts ist durch eine kompetenzbasierte Instruktion in das jeweilige System zu erreichen.

Several studies report the intake of high-fat diets containing fatty acids high in n-3 polyunsaturated fatty acids (PUFA) limits the hypertrophy of fat depots compared with the intake of high-fat diets containing lard, beef tallow, or n-6 PUFA in rats. The effects of n-3 PUFA from fish oil have demonstrated a reduction in body fat, an increase of hepatic acyl-CoA oxidase mRNA, and the up-regulation of uncoupling protein-3(UCP-3) mRNA in skeletal muscle. PURPOSE To determine the influence of a hypocaloric diet enriched with 5% of total energy from alpha-linolenic acid (ALA) on resting energy expenditure (REE) and resting nutrient oxidation following weight loss in obese humans. METHODS 11 obese (BMI > 30), healthy, non-diabetic adults (age 20–55) were randomly assigned to one of two groups: a hypocaloric diet(CON group;n=5) or a hypocaloric diet supplemented with 5% energy from ALA (ALA group;n=6). All subjects completed baseline screening and testing consisting of a 24-hr diet recall, a seven-day food record, anthropometric measurements, indirect calorimetry to measure REE and nutrient oxidation, a resting ECG, a DEXA to measure fat free mass and fat mass, a muscle biopsy, and a fasting blood draw. CON and ALA subjects completed an underfeeding period to reduce body weight by 10%. Subjects were retested following a 4-week weight stabilization period at their reduced body weight. RESULTS No significant differences in metabolic characteristics were seen between treatment groups in the pre or the post-diet testing. Differences between the pre verses post-diet groups were due to weight loss only. There was a significant ‘Main effect for Time’ seen for the REE variable (p = .03) which simple denotes the combined means of pre REE verses post-diet REE were significantly different due to weight loss, not to treatment effect. CONCLUSIONS The results indicate a hypocaloric diet enriched with 5% energy from ALA does not influence REE and nutrient oxidation following weight loss in obese humans. Supported by USDA-Grant COL-717