171 results on '"Veth RP"'
Search Results
2. Percutaneous radiofrequency ablation of osteoid osteomas with use of real-time needle guidance for accurate needle placement: a pilot study.
- Author
-
Busser WM, Hoogeveen YL, Veth RP, Schreuder HW, Balguid A, Renema WK, Schultzekool LJ, Busser, Wendy M H, Hoogeveen, Yvonne L, Veth, Rene P H, Schreuder, H W Bart, Balguid, Angelique, Renema, W KlaasJan, and Schultzekool, Leo J
- Abstract
Purpose: To evaluate the accuracy and technical success of positioning a radiofrequency ablation (RFA) electrode in osteoid osteomas by use of a new real-time needle guidance technology combining cone-beam computed tomography (CT) and fluoroscopy.Materials and Methods: Percutaneous RFA of osteoid osteomas was performed in five patients (median age 18 years), under general anesthesia, with the use of cone-beam CT and fluoroscopic guidance for electrode positioning. The outcome parameters were technical success, meaning correct needle placement in the nidus; accuracy defined as the deviation (in mm) from the center of the nidus; and clinical outcome at follow-up.Results: In all five cases, positioning was possible within 3 mm of the determined target location (median nidus size 6.8 mm; range 5-10.2 mm). All procedures were technically successful. All patients were free of pain at clinical follow-up. No complications were observed.Conclusion: Real-time fluoroscopy needle guidance based on cone-beam CT is a useful tool to accurately position radiofrequency needles for minimally invasive treatment of osteoid osteomas. [ABSTRACT FROM AUTHOR]- Published
- 2011
- Full Text
- View/download PDF
3. Methodological systematic review: mortality in elderly patients with cervical spine injury: a critical appraisal of the reporting of baseline characteristics, follow-up, cause of death, and analysis of risk factors.
- Author
-
van Middendorp JJ, Albert TJ, Veth RP, and Hosman AJ
- Published
- 2010
- Full Text
- View/download PDF
4. Acetabular revision with impacted morsellised cancellous bone grafting and a cemented acetabular component: a 20- to 25-year follow-up.
- Author
-
Schreurs BW, Keurentjes JC, Gardeniers JW, Verdonschot N, Slooff TJ, and Veth RP
- Published
- 2009
- Full Text
- View/download PDF
5. Cemented polyethylene cups in patients younger than 40 years.
- Author
-
de Kam DC, Gardeniers JW, Hendriks JC, Veth RP, Schreurs BW, de Kam, Daniël C J, Gardeniers, Jean W M, Hendriks, Jan C M, Veth, René P H, and Schreurs, B Willem
- Abstract
Unlabelled: Although uncemented cup implants frequently are used in young patients, we believe long-term survival rates of cups in these patients are somewhat disappointing, and therefore we have continued to use cemented cups in primary THA, even in young patients. However, in cases of acetabular bone stock defects, we also use bone impaction grafting. We prospectively followed 130 patients with 175 cemented cups; no patients were lost to followup. The mean age of the patients at surgery was 31 years (range, 16-39 years). An acetabular reconstruction with bone impaction grafting was performed in 84 hips (48%). The minimum followup was 2 years (average, 8.1 years; range, 2.0-18.5 years). Twenty-one of the 175 cups (12%) were revised at an average of 8.1 years (range, 2.0-18.5 years). Reasons for revision were infection (one early, seven late), recurrent dislocations (two), traumatic loosening (one), and aseptic loosening (10). The 10-year survival rate of all cemented cups with end point of revision for any cause was 85%. Survival with end point of aseptic loosening of all cups was 92%. Survival with end point of revision for aseptic loosening was 90% for the cups without impaction grafting and 95% for the cups with impaction grafting. We believe cemented acetabular cups in young patients have acceptable midterm survival; however, in the case of acetabular bone defects, we recommend reconstruction with impaction grafting.Level Of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]- Published
- 2009
- Full Text
- View/download PDF
6. Acetabular revision with impacted morselized cancellous bone graft and a cemented cup in patients with rheumatoid arthritis. A concise follow-up, at eight to nineteen years, of a previous report.
- Author
-
Schreurs BW, Luttjeboer J, Thien TM, de Waal Malefijt MC, Buma P, Veth RP, Slooff TJ, Schreurs, B Willem, Luttjeboer, Jaap, Thien, Truike M, de Waal Malefijt, Maarten C, Buma, Pieter, Veth, René P H, and Slooff, Tom J J H
- Abstract
We previously reported our results at a minimum of three years after thirty-five revisions of total hip arthroplasty acetabular components in twenty-eight patients with rheumatoid arthritis. The revisions were performed with use of impacted morselized bone graft and a cemented cup. This update report presents the results at eight to nineteen years after the surgery, which, to our knowledge, is the longest follow-up available in the literature. No patient was lost to follow-up. Since our previous report, there were two additional cup failures due to aseptic loosening, at ten and sixteen years postoperatively. Kaplan-Meier analysis showed the probability of survival of the acetabular component at twelve years to be 80% (95% confidence interval, 65% to 95%) with removal of the cup for any reason as the end point and 85% (95% confidence interval, 71% to 99%) with aseptic loosening as the end point. Cup revisions performed with cement and use of impaction bone-grafting in patients with rheumatoid arthritis led to acceptable long-term prosthetic survival rates. This technique is attractive from a biological standpoint because of the possibility of maintaining acetabular bone stock. [ABSTRACT FROM AUTHOR]
- Published
- 2009
- Full Text
- View/download PDF
7. Morsellized bone allografting in revision total knee replacement-a case report with a 4-year histological follow-up.
- Author
-
Van Loon CJ, Buma P, De Waal Malefijt MC, Van Kampen A, and Veth RP
- Published
- 2000
- Full Text
- View/download PDF
8. Resection of a peri-acetabular chondrosarcoma and reconstruction of the pelvis. A case report
- Author
-
Nielsen, HK, primary, Veth, RP, additional, Oldhoff, J, additional, Koops, HS, additional, and Scales, JT, additional
- Published
- 1985
- Full Text
- View/download PDF
9. Results of the cemented Exeter femoral component in patients under the age of 40 : an update at ten to 20 years' follow-up.
- Author
-
Schmitz MW, Bronsema E, de Kam DC, Gardeniers JW, Veth RP, and Schreurs BW
- Subjects
- Acetabulum surgery, Adolescent, Adult, Cementation, Femur surgery, Follow-Up Studies, Humans, Prosthesis Design, Prosthesis Failure, Young Adult, Arthroplasty, Replacement, Hip, Hip Prosthesis
- Abstract
Aims: We carried out a further study of the long-term results of the cemented Exeter femoral component in patients under the age of 40 with a mean follow-up of 13.6 years (10 to 20)., Patients and Methods: We reviewed our original cohort of 104 cemented Exeter stems in 78 consecutive patients with a mean age of 31 years (16 to 39). Only one patient was lost to radiological follow-up., Results: A total of six patients (eight hips) had died for reasons unrelated to their surgery. There had been one further periprosthetic fracture from a fall and one fractured femoral stem. No revisions for aseptic loosening were undertaken during the whole study period. Overall, 11 hips had progressive radiolucent lines in one or more zones. The Kaplan Meier survival percentages at ten and 17 years were 97.1% (95% confidence interval (CI) 91.3 to 99.1) and 92.1% (95% CI 74.1 to 97.8) with revision for any reason as the endpoint, and 100% at both ten and 17 years with aseptic loosening (95% CI 83.8 to 100) as the endpoint. No additional hips were classified as radiologically loose., Conclusion: The Exeter femoral component continues to function satisfactorily in young patients for up to 17 years after surgery. Cite this article: Bone Joint J 2017;99-B:192-8., (©2017 The British Editorial Society of Bone & Joint Surgery.)
- Published
- 2017
- Full Text
- View/download PDF
10. Long-term follow-up results of primary and recurrent pigmented villonodular synovitis.
- Author
-
Verspoor FG, Zee AA, Hannink G, van der Geest IC, Veth RP, and Schreuder HW
- Subjects
- Adult, Biopsy, Disease Progression, Female, Follow-Up Studies, Humans, Magnetic Resonance Imaging, Male, Prognosis, Recurrence, Retrospective Studies, Synovitis, Pigmented Villonodular psychology, Synovitis, Pigmented Villonodular therapy, Time Factors, Disease Management, Quality of Life, Synovitis, Pigmented Villonodular diagnosis
- Abstract
Objective: Adequate documentation of the outcome of treatment of pigmented villonodular synovitis (PVNS) is sparse. Available case series show relatively short follow-up times and often combine locations or subtypes to increase patient numbers. This article describes the long-term follow-up of a single institution's large consecutive series of PVNS., Methods: Retrospectively, 107 PVNS patients were identified between 1985 and 2011 by searching pathology and radiology records. Treatment complications, recurrences and quality of life were evaluated. Most patients (85.2%) were primarily or secondarily treated at our institution., Results: Both subtypes, localized PVNS [29 (27%)] and diffuse PVNS [75 (70%)] were represented. The knee was affected in 88% of patients. Treatments received were surgery, external beam radiotherapy, radiosynovectomy, targeted therapy, immunotherapy or combinations of these. Forty-nine (46%) patients had prior treatment elsewhere. The mean follow-up from diagnosis until last contact was 7.0 years (range 0.3-27.4) for localized PVNS and 14.5 years (range 1.1-48.7) for diffuse PVNS. The 1- and 5-year recurrence-free survival rates for diffuse PVNS were 69% and 32%, respectively. Quality of life, estimated by 36-item Short Form Health Survey (SF-36) scores, were not significantly different between localized and diffuse PVNS. However, both patient groups scored lower than the general population norms on the general health component (59.2 and 56.3, respectively, P < 0.05)., Conclusion: Recurrence rates of PVNS increase with time. Long-term follow-up shows, particularly in diffuse PVNS, it is a continually recurring problem, and over time it becomes increasingly difficult to cure. The quality of life is decreased in patients with PVNS compared with the general population., (© The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
- Published
- 2014
- Full Text
- View/download PDF
11. Pigmented villonodular synovitis: current concepts about diagnosis and management.
- Author
-
Verspoor FG, van der Geest IC, Vegt E, Veth RP, van der Graaf WT, and Schreuder HW
- Subjects
- Humans, Synovitis, Pigmented Villonodular diagnosis, Synovitis, Pigmented Villonodular therapy
- Abstract
At present, the treatment strategies in patients with localized and diffuse forms of pigmented villonodular synovitis have more or less been standardized. However, these strategies are not optimal because high recurrence rates persist and studies with a sufficient level of evidence are lacking. This systematic review article describes all known treatment options for intra-articular pigmented villonodular synovitis and their clinical results. Based on this research, we provide guidelines to support physicians in making the optimal treatment decisions. Given the rarity of the disease, randomized studies are not to be expected, but an international registry through existing networks would offer the benefit of getting a better insight into the outcome of this disease. Therefore, we propose a basic set of data to be investigated and ideally to be reported on in such a registry.
- Published
- 2013
- Full Text
- View/download PDF
12. Long-term results of cemented total hip arthroplasty in patients younger than 30 years and the outcome of subsequent revisions.
- Author
-
Schmitz MW, Busch VJ, Gardeniers JW, Hendriks JC, Veth RP, and Schreurs BW
- Subjects
- Adolescent, Adult, Age Factors, Aged, Biomechanical Phenomena, Bone Cements adverse effects, Bone Transplantation, Female, Hip Joint diagnostic imaging, Hip Joint physiopathology, Hip Prosthesis, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Postoperative Complications surgery, Prospective Studies, Prosthesis Design, Prosthesis Failure, Radiography, Recovery of Function, Reoperation, Time Factors, Treatment Outcome, Young Adult, Arthroplasty, Replacement, Hip adverse effects, Arthroplasty, Replacement, Hip instrumentation, Bone Cements therapeutic use, Hip Joint surgery
- Abstract
Background: The number of total hip arthroplasties in patients under 30 years is increasing over the years. Almost all of them will face at least one or more future revisions in their life. Therefore, the implant used should have a high survival rate, and needs to be easily revisable resulting in a low re-revision rate. Several studies have evaluated the outcome of total hip arthroplasties in patients under 30 years. However, only a few reported on the follow-up outcome of 10 years or more. In addition, none of these reports published data of the subsequent revisions of these implants within their original report., Methods: We studied historically prospective collected data of 48 consecutive patients (69 hips) younger than 30 years, treated with a cemented primary total hip prosthesis between 1988 and 2004. Since the last evaluation of this cohort, two patients were lost to follow-up. For all hip revisions in this cohort, again cemented implants were used, mostly in combination with bone impaction grafting. Kaplan-Meier survival curves at 10- and 15 years for the primary total hip arthroplasties and revisions were determined., Results: The mean age at time of primary surgery was 25 years (range, 16 to 29 years). Mean follow-up of the primary hips was 11.5 years (range, 7 to 23 years). During follow-up 13 revisions were performed; in 3 cases a two-stage total revision was performed for septic loosening and 9 cups were revised for aseptic loosening. There were no aseptic stem revisions. The 10 and 15-year survival rates with endpoint revision for aseptic loosening of the primary total hip were 90% (95% CI: 79 to 96) and 82% (95% CI: 65 to 92) respectively. None of our 13 subsequent revisions needed a re-revision within 10 years after re-implantation., Conclusions: Cemented total hip implants in patients under 30 years have an encouraging outcome at 10 and 15 years after surgery in these young patients. The 13 revised hips, treated with bone grafting and the third generation cement technique, were performing well with no re-revisions within ten years after surgery.
- Published
- 2013
- Full Text
- View/download PDF
13. High fatigue scores before and after surgical treatment of bone and soft tissue tumors.
- Author
-
VAN DER Geest IC, Knoop H, Veth RP, Schreuder HW, and Bleijenberg G
- Abstract
The first objective of the present study was to investigate fatigue severity in patients diagnosed with bone and soft tissue tumors prior to the surgical treatment of the tumor and 6 months post-operatively. The second objective was to determine which variables are associated with severe fatigue. Patients diagnosed with benign or low-grade malignant bone and soft tissue tumors, undergoing surgical therapy for the tumor only, were included in this study. The control group contained patients scheduled for knee arthroscopy for suspected meniscus tears. Fatigue, pain, anxiety and self-efficacy were measured pre-operatively and after 6 months and each patient wore an actometer to quantify physical activity. In the tumor group of 43 patients, 35% were severely fatigued pre-operatively and 33% post-operatively. The tumor group reported a significantly higher level of anxiety. No differences were observed in pain, physical limitations, self-efficacy or actometer scores. Multiple regression analysis of the tumor group revealed that higher pain scores, higher state anxiety and lower self-efficacy were asssociated with fatigue severity. In the control group of 24 knee arthroscopy patients, the percentage of severely fatigued patients decreased from 38% (n=9) prior to treatment to 29% (n=7) 6 months later. A substantial number of patients were severely fatigued in both the tumor group and the knee arthroscopy group. Self-efficacy, pain and anxiety appear to be the most important variables associated with fatigue severity in tumor patients prior to surgery.
- Published
- 2013
- Full Text
- View/download PDF
14. Total hip arthroplasties in young patients under 50 years: limited evidence for current trends. A descriptive literature review.
- Author
-
De Kam DC, Busch VJ, Veth RP, and Schreurs BW
- Subjects
- Adult, Arthroplasty, Replacement, Hip mortality, Cementation, Databases, Bibliographic, Hip Joint physiopathology, Hip Joint surgery, Hip Prosthesis, Humans, Middle Aged, Pain, Postoperative Complications, Prosthesis Design, Recovery of Function, Registries, Reoperation, Survival Rate, Treatment Outcome, Young Adult, Arthroplasty, Replacement, Hip methods, Arthroplasty, Replacement, Hip trends
- Abstract
We examined all reported outcomes of uncemented and cemented total hip arthroplasty in patients younger than 50 years of age listed in Medline (1966- 1 January 2009) and PubMed, and scrutinised reference lists of relevant papers. In addition, we evaluated relevant data in the Swedish hip arthroplasty register. 109 relevant articles were identified, 37 of which had a mean follow-up longer than 10 years. Although uncemented implants are widely used in patients under 50 years of age, there are only 2 reports that fulfil the criteria published by the National Institute for Clinical Excellence (NICE) in the United Kingdom (follow-up of >10 yrs and survival of =90%). Current trends relating to implant selection remain unsupported by survival data, and additional information about the long-term results of newer implants is essential. As matters stand, the most reliable results relate to cemented implants.
- Published
- 2011
- Full Text
- View/download PDF
15. Fibrous dysplasia of bone associated with soft-tissue myxomas as well as an intra-osseous myxoma in a woman with Mazabraud's syndrome: a case report.
- Author
-
van der Wal WA, Unal H, de Rooy JW, Flucke U, and Veth RP
- Abstract
Introduction: Mazabraud's syndrome is a rare but well-described disorder characterized by fibrous dysplasia in single or multiple bones associated with one or more soft-tissue myxomas. In this report, we describe what is, to the best of our knowledge, the first case involving an intra-osseous myxoma. This finding supports, and could provide new insight into, the pathological association between fibrous dysplasia and myxomas., Case Presentation: In this report, we describe the case of a 49-year-old Caucasian woman known for years to have fibrous dysplasia in the left femur and tibia who presented with progressive pain in her left leg and soft swelling in the left quadriceps region. After surgical intervention with excision of the soft-tissue mass, the diagnosis of Mazabraud's syndrome was confirmed. During follow-up, our patient presented with a painless mass located on the lateral side of the left knee, next to a second, intra-osseous lesion with the same characteristics in the left lateral tibial plateau. The histopathological examination was consistent with a soft-tissue intra-osseous myxoma., Conclusion: In the international literature, 67 cases of Mazabraud's syndrome have been described so far.To our knowledge, the present case report is the first to describe the combination of polyostotic fibrous dysplasia and intra-muscular as well as intra-osseous myxoma.
- Published
- 2011
- Full Text
- View/download PDF
16. Subcutaneous emphysema after cryosurgery of a lesion of the femur during femoral nerve block.
- Author
-
Kadic L, Driessen JJ, van der Pluijm M, Veth RP, and Schreuder HW
- Subjects
- Humans, Male, Middle Aged, Bone Neoplasms surgery, Cryosurgery adverse effects, Femoral Nerve, Nerve Block adverse effects, Subcutaneous Emphysema etiology
- Published
- 2011
- Full Text
- View/download PDF
17. [Hip resurfacing in patients under 55 years of age].
- Author
-
Schmitz MW, Veth RP, and Schreurs BW
- Subjects
- Age Factors, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prosthesis Failure, Reoperation, Risk Factors, Time Factors, Treatment Outcome, Arthroplasty, Replacement, Hip adverse effects, Arthroplasty, Replacement, Hip methods, Osteoarthritis, Hip surgery
- Abstract
Hip resurfacing arthroplasty was introduced as an alternative to the conventional total hip arthroplasty which had shown suboptimal results in younger patients. Application of the resurfacing technique in younger patients has increased over the last few years. To date, no randomized controlled trials with a minimum follow-up span of 10 years comparing hip resurfacing to conventional hip replacement have been conducted in patients under 55 years of age. Australian and English hip registries demonstrate high revision rates after 5 years for some brands of resurfacing implants. In addition to these disappointing revision rates, the complication of aseptic lymphocytic vasculitis caused by metal particles evoking a local tissue reaction has been increasingly reported. The resurfacing procedure recently received some negative media attention in the Netherlands, leading to confusion among patients. In order to ease patient doubts, it is important to correctly inform them as to the type of implant used, for example, by means of the website or an information card.
- Published
- 2011
18. Diagnostic criteria of traumatic central cord syndrome. Part 2: a questionnaire survey among spine specialists.
- Author
-
van Middendorp JJ, Pouw MH, Hayes KC, Williams R, Chhabra HS, Putz C, Veth RP, Geurts AC, Aito S, Kriz J, McKinley W, van Asbeck FW, Curt A, Fehlings MG, Van de Meent H, and Hosman AJ
- Subjects
- Central Cord Syndrome complications, Central Cord Syndrome physiopathology, Diagnosis, Differential, Humans, Muscle Weakness etiology, Muscle Weakness physiopathology, Paralysis etiology, Paralysis physiopathology, Central Cord Syndrome diagnosis, Data Collection standards, Disability Evaluation, Muscle Weakness diagnosis, Paralysis diagnosis, Surveys and Questionnaires standards
- Abstract
Study Design: A questionnaire survey., Objectives: To evaluate the need for the introduction of quantitative diagnostic criteria for the traumatic central cord syndrome (TCCS)., Setting: An online questionnaire survey with participants from all over the world., Methods: An invitation to participate in an eight-item online survey questionnaire was sent to surgeon members of AOSpine International., Results: Out of 3340 invited professionals, 157 surgeons (5%) from 41 countries completed the survey. Whereas most of the respondents (75%) described greater impairment of the upper extremities than of the lower extremities in their own TCCS definitions, symptoms such as sensory deficit (39%) and bladder dysfunctions (24%) were reported less frequently. Initially, any difference in motor strength between the upper and lower extremities was considered most frequently (23%) as a 'disproportionate' difference in power. However, after presenting literature review findings, the majority of surgeons (61%) considered a proposed difference of at least 10 points of power (based on the Medical Research Council scale) in favor of the lower extremities as an acceptable cutoff criterion for a diagnosis of TCCS. Most of the participants (40%) felt that applying a single criterion to the diagnosis of TCCS is insufficient for research purposes., Conclusion: Various definitions of TCCS were used by physicians involved in the spinal trauma care. The authors consider a difference of at least 10 motor score points between upper and lower extremity power a clear diagnostic criterion. For clinical research purposes, this diagnostic criterion can be considered as a face valid addendum to the commonly applied TCCS definition as introduced by Schneider et al.
- Published
- 2010
- Full Text
- View/download PDF
19. Diagnostic criteria of traumatic central cord syndrome. Part 1: a systematic review of clinical descriptors and scores.
- Author
-
Pouw MH, van Middendorp JJ, van Kampen A, Hirschfeld S, Veth RP, Curt A, Hosman AJ, and van de Meent H
- Subjects
- Arm innervation, Arm physiopathology, Central Cord Syndrome complications, Diagnosis, Differential, Extremities innervation, Humans, Leg innervation, Leg physiopathology, Muscle Weakness diagnosis, Muscle Weakness etiology, Muscle Weakness physiopathology, Paralysis etiology, Central Cord Syndrome diagnosis, Central Cord Syndrome physiopathology, Disability Evaluation, Extremities physiopathology, Paralysis diagnosis, Paralysis physiopathology
- Abstract
Study Design: Systematic review., Background: The applied definition of traumatic central cord syndrome (TCCS) lacks specific quantified diagnostic criteria., Objective: To review currently applied TCCS diagnostic criteria and quantitative data regarding the 'disproportionate weakness' between the upper and lower extremities described in original studies reporting on TCCS subjects., Methods: A MEDLINE (1966 to 2008) literature search was conducted. The descriptors applied to define TCCS were extracted from all included articles. We included original studies that reported on the differences in motor score (based on the Medical Research Council scale) between the total upper extremity motor score (UEMS) and the total lower extremity motor score (LEMS), in a minimum of five TCCS patients at the time of hospital admission. The mean difference between the total UEMS and the total LEMS of the patients included in each study was calculated. Case reports were excluded., Results: None of the identified studies on TCCS patients reported inclusion and/or exclusion criteria using a quantified difference between the UEMS and LEMS. Out of 30 retrieved studies, we identified seven different clinical descriptors that have been applied as TCCS diagnostic criteria. Nine studies reporting on a total of 312 TCCS patients were eligible for analysis. The mean total UEMS was 10.5 motor points lower than the mean total LEMS., Conclusions: There is no consensus on the diagnostic criteria for TCCS. Nevertheless, this review revealed an average of 10 motor points between the UEMS and LEMS as a possible TCCS diagnostic criterion. However, further discussion by an expert panel will be required to establish definitive diagnostic criteria.
- Published
- 2010
- Full Text
- View/download PDF
20. Good results with cemented total hip arthroplasty in patients between 40 and 50 years of age.
- Author
-
de Kam DC, Gardeniers JW, Veth RP, and Schreurs BW
- Subjects
- Adult, Cementation, Female, Follow-Up Studies, Hip Joint diagnostic imaging, Hip Prosthesis adverse effects, Humans, Male, Middle Aged, Prosthesis Design, Prosthesis Failure, Radiography, Reoperation, Surveys and Questionnaires, Treatment Outcome, Arthroplasty, Replacement, Hip adverse effects, Arthroplasty, Replacement, Hip methods
- Abstract
Background and Purpose: Total hip arthroplasties in young patients have lower long-term survival rates than in older patients. We evaluated the use of a unique treatment protocol in patients aged between 40 and 50 years. In all cases we used a cemented THA, and for acetabular deficiencies we also used impacted bone grafts together with a cemented cup., Methods: In 140 consecutive patients who were between 40 and 50 years of age at index surgery, 168 cemented total hip prostheses were evaluated after a mean follow-up time of 10 (2-19) years. Acetabular deficiencies were reconstructed with wire meshes and impacted bone grafts with a cemented cup (70 hips). During follow-up, 18 patients died (27 hips); in this group 3 hips (3 patients) had been revised. None of the patients were lost to follow-up. In all surviving patients, clinical assessment was performed with hip-score questions and all radiographs were evaluated., Results: All clinical questionnaires showed an improved clinical hip score. 29 hips (17%) were revised after a mean of 8 (0.3-18) years. Kaplan-Meier survival analysis showed a survival of 88% (95% CI: 82-94) after 10 years with revision of either component for any reason. Survival with endpoint revision for aseptic loosening of either component was 94% (95% CI: 90-99) after 10 years., Interpretation: Cemented implants in young patients have satisfying long-term results. Reconstruction of acetabular deficiencies with impacted bone grafts show promising results.
- Published
- 2010
- Full Text
- View/download PDF
21. [Total hip arthroplasty in patients under 40 years of age and, if indicated, reconstruction of acetabular defects with bone impaction grafting].
- Author
-
de Kam DC, Gardeniers JW, Veth RP, and Schreurs BW
- Subjects
- Adolescent, Adult, Age Factors, Arthroplasty, Replacement, Hip mortality, Bone Cements therapeutic use, Female, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Male, Postoperative Complications epidemiology, Prosthesis Failure, Range of Motion, Articular, Reoperation statistics & numerical data, Time Factors, Treatment Outcome, Young Adult, Acetabulum surgery, Arthroplasty, Replacement, Hip methods, Bone Transplantation methods, Osteoarthritis, Hip surgery
- Abstract
Objective: To determine the long-term results of primary cemented total hip arthroplasty in patients under the age of 40. In cases of acetabular defects, initial reconstruction with bone impaction grafting was performed., Design: Cohort analysis., Methods: Details of patients under the age of 40 who underwent primary cemented total hip arthroplasty between 1 January 1988 and 30 June 2004 were analysed. The primary goal of this study was to determine the time until revision surgery. Kaplan Meier analysis was used to calculate prosthesis survival., Results: A total of 175 total hip arthroplasties in 130 patients were included in the study. Acetabular reconstruction using bone impaction grafting was performed on 84 hips (48%). The average age at surgery was 31 years. Six patients (8 hips) died during follow-up; none of these had undergone revision surgery. Average follow-up was 8.1 years (range: 2.0-18.5). In total, 24 hips (14%) were revised. Reasons for revision were: septic loosening (n = 8), recurrent dislocations (n = 4), traumatic loosening (n = 1) and aseptic loosening (n = 11). The 10-year prosthesis survival was 83% (95% CI: 76-90) with the endpoint 'revision for any reason' and 92% (95% CI: 86-98) with the endpoint 'revision for aseptic loosening'. Aseptic survival of the cups with and without bone impaction grafting was 95% (95% CI: 89-100) and 90% (95% CI: 81-99) (p = 0.73), respectively., Conclusion: Hip replacement with cemented total hip arthroplasty in patients under the age of 40 produced good long-term results. Acetabular deficiencies reconstructed with bone impaction grafting also produced good results in this group of patients.
- Published
- 2010
22. Aneurysmal bone cyst: the role of cryosurgery as local adjuvant treatment.
- Author
-
Peeters SP, Van der Geest IC, de Rooy JW, Veth RP, and Schreuder HW
- Subjects
- Adolescent, Adult, Child, Child, Preschool, Female, Humans, Male, Middle Aged, Bone Cysts, Aneurysmal surgery, Cryosurgery methods, Curettage methods
- Abstract
Background: Aneurysmal bone cysts (ABCs) are most often treated with intralesional surgery (curettage) and additional bone grafting. There is debate on whether or not to use adjuvant therapy to decrease the local recurrence rate. This study is done to assess the outcome of curettage and cryosurgery as a treatment of ABC., Methods: We analyzed 80 consecutive cases of ABC treated with curettage and cryosurgery. Patients were followed minimal 24 months after surgery (average 55 months, range 24-122 months) with physical examination and radiographs. Functional outcome was evaluated using the musculoskeletal tumor society score (MSTS)., Results: The 80 patients were all treated with curettage and cryosurgery. Additional bone grafting was used in 73 patients, osteosynthesis in 12 and spondylodesis in 1 patient. Four local recurrences were found in this study, a recurrence rate of 5%. All local recurrences were treated successfully with curettage and cryosurgery again 7-33 months after the initial surgery. Postoperative one fracture, one wound infection, and three transient nerve palsy occurred. The average MSTS score was 29.2 at follow-up., Conclusions: The use of cryosurgery as adjuvant therapy results in a lower local recurrence rate when compared to other publications for the treatment of ABC and excellent functional results., (Copyright 2009 Wiley-Liss, Inc.)
- Published
- 2009
- Full Text
- View/download PDF
23. Metastatic potential of an aneurysmal bone cyst.
- Author
-
van de Luijtgaarden AC, Veth RP, Slootweg PJ, Wijers-Koster PM, Schultze Kool LJ, Bovee JV, and van der Graaf WT
- Subjects
- Antibodies, Monoclonal therapeutic use, Antibodies, Monoclonal, Humanized, Antineoplastic Agents therapeutic use, Bevacizumab, Bone Cysts, Aneurysmal genetics, Bone Cysts, Aneurysmal therapy, Bone Neoplasms genetics, Carcinoma complications, Cell Transformation, Neoplastic pathology, Diabetes Mellitus, Type 2 complications, Embolization, Therapeutic, Female, Humans, Hyperplasia, In Situ Hybridization, Fluorescence, Kidney Neoplasms secondary, Lung Neoplasms secondary, Middle Aged, Neoplasms, Second Primary genetics, Neoplasms, Second Primary therapy, Osteosarcoma genetics, Osteosarcoma therapy, Thyroid Gland pathology, Uterine Neoplasms complications, Bone Cysts, Aneurysmal pathology, Bone Neoplasms pathology, Neoplasms, Second Primary pathology, Osteosarcoma pathology, Proto-Oncogene Proteins genetics, Ubiquitin Thiolesterase genetics
- Abstract
Aneurysmal bone cysts (ABCs) are benign bone tumors consisting of blood-filled cavities lined by connective tissue septa. Recently, the hypothesis that ABCs are lesions reactive to local hemodynamics has been challenged after the discovery of specific recurrent chromosomal abnormalities. Multiple cases of malignant transformation of ABC into (osteo)sarcoma have been described, as well as a number of cases of telangiectatic osteosarcoma which had been misdiagnosed as ABC. We herewith document a case of a pelvic ABC metastatic to the lung, liver, and kidneys. Diagnosis was confirmed by the presence of a break in the USP6 gene, which is pathognomonic for ABC, in a pulmonary metastasis of our patient. Sarcomatous transformation as an explanation for this behavior was ruled out by demonstrating diploid DNA content in both the pulmonary lesion and the primary tumor.
- Published
- 2009
- Full Text
- View/download PDF
24. Survival of massive allografts in segmental oncological bone defect reconstructions.
- Author
-
Bullens PH, Minderhoud NM, de Waal Malefijt MC, Veth RP, Buma P, and Schreuder HW
- Subjects
- Adolescent, Adult, Aged, Bone Neoplasms mortality, Bone Neoplasms pathology, Child, Disease-Free Survival, Female, Follow-Up Studies, Fracture Fixation, Intramedullary instrumentation, Fracture Fixation, Intramedullary methods, Fractures, Bone etiology, Fractures, Bone surgery, Humans, Internal Fixators, Male, Middle Aged, Netherlands epidemiology, Postoperative Complications, Survival Rate, Young Adult, Bone Neoplasms surgery, Bone Transplantation, Graft Survival, Limb Salvage methods, Plastic Surgery Procedures methods, Plastic Surgery Procedures mortality
- Abstract
Reconstructions of large segmental bone defects after resection of bone tumours with massive structural allografts have a high number of reported complications including fracture, infection and non-union. Our goal is to report the survival and complications of massive allografts in our patients. A total of 32 patients were evaluated for fracture, infection, non-union rate and survival of their massive allograft reconstructions. The average follow-up for this group was five years and three months. The total fracture rate was 13% with a total infection rate of 16%. We found a low union rate of 25%. The total survival of the allografts was 80.8% (+/- 18.7%) after five years. We found a five-year allograft survival of 80.8% which is comparable with other studies.
- Published
- 2009
- Full Text
- View/download PDF
25. The stability of impacted morsellized bone grafts in a metal cage under dynamic loaded conditions: an in vitro reconstruction of a segmental diaphyseal bone defect.
- Author
-
Bullens PH, Schreuder BH, de Waal Malefijt MC, Veth RP, Buma P, and Verdonschot N
- Subjects
- Animals, Bone Nails, Bone Transplantation methods, Cattle, Diaphyses surgery, Osseointegration, Plastic Surgery Procedures, Femur surgery
- Abstract
Introduction: Reconstructions of segmental diaphyseal bone defects with massive allografts are related to complications like nonunion and fractures. A reconstruction of these defects with a cage filled with an impacted morsellized bone graft could be an alternative. The bone graft in these cages should ideally be loaded to prevent resorption. Loading of morsellized bone grafts however can cause instability. The goal of this study was to assess the stability of an impacted morsellized bone graft in a cage under dynamic loaded conditions in an in vitro reconstruction of a segmental diaphyseal bone defect. The second goal was to assess the influence of cage type, washing of the graft and bone-cage fit., Materials and Methods: Two different cage types were filled with impacted morsellized bone graft. The grafts were used washed and unwashed and in variable bone-cage fit conditions. We recorded the bone graft deformation in the cage under dynamic loaded conditions., Results: Stability appeared to be not very sensitive to the cage type and whether the bone chips were washed or not. However, quality of the fit of the cage with the bone segment was an important parameter and should be optimized during surgery., Conclusions: Morsellized impacted bone graft in a cage is stable in dynamic loaded conditions in an in vitro reconstruction of a segmental diaphyseal bone defect. We believe that this method of reconstruction is a promising alternative for the reconstruction of large diaphyseal bone defects and should be tested relative to its biological merits in animal experiments.
- Published
- 2009
- Full Text
- View/download PDF
26. Polyurethane scaffold formation via a combination of salt leaching and thermally induced phase separation.
- Author
-
Heijkants RG, van Calck RV, van Tienen TG, de Groot JH, Pennings AJ, Buma P, Veth RP, and Schouten AJ
- Subjects
- Animals, Biocompatible Materials chemistry, Dimethyl Sulfoxide chemistry, Materials Testing, Porosity, Solvents chemistry, Spectroscopy, Fourier Transform Infrared, Surface Properties, Temperature, Tissue Engineering methods, Polyurethanes chemistry, Salts chemistry, Tissue Scaffolds
- Abstract
Porous scaffolds have been made from two polyurethanes based on thermally induced phase separation of polymer dissolved in a DMSO/water mixture in combination with salt leaching. It is possible to obtain very porous foams with a very high interconnectivity. A major advantage of this method is that variables like porosity, pore size, and interconnectivity can be independently adjusted with the absence of toxic materials in the production process. The obtained compression moduli were between 200 kPa and 1 MPa with a variation in porosity between 76 and 84%. Currently the biological and medical aspects are under evaluation., (2008 Wiley Periodicals, Inc.)
- Published
- 2008
- Full Text
- View/download PDF
27. The medium-term results of the cemented Exeter femoral component in patients under 40 years of age.
- Author
-
de Kam DC, Klarenbeek RL, Gardeniers JW, Veth RP, and Schreurs BW
- Subjects
- Adolescent, Adult, Arthroplasty, Replacement, Hip standards, Female, Follow-Up Studies, Humans, Male, Patient Satisfaction, Prosthesis Design, Prosthesis Failure, Range of Motion, Articular, Time Factors, Treatment Outcome, Arthroplasty, Replacement, Hip methods, Bone Cements standards, Cementation methods, Hip Joint surgery, Hip Prosthesis standards
- Abstract
We evaluated the outcome of 104 consecutive primary cemented Exeter femoral components in 78 patients (34 men, 44 women) under the age of 40 years who underwent total hip replacement between October 1993 and May 2004. The mean age at operation was 31 years (16 to 39). No hip was lost to follow-up, but three patients (four hips) died. None of the deaths were related to the surgery. At a mean follow-up of 6.2 years (2 to 13), three femoral components had been revised for septic loosening. Using Kaplan-Meier survival analysis, the seven-year survival of the component with revision for any reason as the endpoint was 95.8% (95% confidence interval 86.67 to 98.7). The seven-year survival with aseptic femoral loosening as the endpoint was 100% (95% confidence interval 100). The cemented Exeter femoral component in patients under the age of 40 shows promising medium-term results. As it is available in a wide range of sizes and offsets, we could address all types of anatomical variation in this series without the need for custom-made components.
- Published
- 2008
- Full Text
- View/download PDF
28. Oncological and functional results of cryosurgical therapy of enchondromas and chondrosarcomas grade 1.
- Author
-
van der Geest IC, de Valk MH, de Rooy JW, Pruszczynski M, Veth RP, and Schreuder HW
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Bone Cements therapeutic use, Bone Neoplasms pathology, Bone Plates, Bone Transplantation, Chondroma pathology, Chondrosarcoma pathology, Curettage, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasm Recurrence, Local surgery, Postoperative Complications, Bone Neoplasms surgery, Chondroma surgery, Chondrosarcoma surgery, Cryosurgery
- Abstract
Background and Objectives: Cryosurgery using liquid nitrogen is used as adjuvant treatment after intralesional resection of bone tumours to induce cell death. It is applied to enlarge the oncological margins of resection and to reduce the local recurrence rate. The objective of this study is to analyze the oncological and functional results., Methods: We studied the oncological and functional results of curettage and cryosurgery in 123 patients with 130 tumors. There were 75 enchondromas and 55 chondrosarcomas grade 1. The minimal follow-up period for all patients was 2 years (range 24-119 months)., Results: During follow-up one local recurrence of an active enchondroma and one local recurrence of an aggressive enchondroma occurred. They were treated with curettage and cryosurgery again. Both patients were disease-free at minimum of 3 years follow-up. No local recurrences after treatment of chondrosarcoma grade 1 were seen. Functional scores, according to the MSTS scoring system, showed an average score of 28 points (94%) at 2 years follow-up. Post-operative fractures were seen in 18 patients (14%)., Conclusions: Curettage and cryosurgery for enchondroma and chondrosarcoma grade 1 has excellent oncological and functional results. The post-operative management has been adjusted to reduce the number of fractures., ((c) 2008 Wiley-Liss, Inc.)
- Published
- 2008
- Full Text
- View/download PDF
29. Effect on tissue differentiation and articular cartilage degradation of a polymer meniscus implant: A 2-year follow-up study in dogs.
- Author
-
Welsing RT, van Tienen TG, Ramrattan N, Heijkants R, Schouten AJ, Veth RP, and Buma P
- Subjects
- Animals, Biocompatible Materials adverse effects, Biomechanical Phenomena, Cartilage, Articular pathology, Cell Differentiation drug effects, Dogs, Female, Follow-Up Studies, Foreign-Body Reaction pathology, Implants, Experimental, Male, Menisci, Tibial pathology, Polyesters adverse effects, Polyurethanes adverse effects, Cartilage, Articular drug effects, Menisci, Tibial surgery, Prosthesis Implantation, Tissue Scaffolds adverse effects
- Abstract
Background: Replacement of the meniscus by an implant could potentially avoid cartilage degeneration., Hypothesis: An implant of degradable polycaprolacton-polyurethane should act as a temporary scaffold enabling regeneration of a new meniscus by slow degradation of the polymer and simultaneous in-growth and differentiation of tissues into the typical cartilage-like tissue of the meniscus., Study Design: Controlled laboratory study., Methods: In 13 dogs' knees, the lateral meniscus was replaced with a porous polymer implant (6 and 7 for 6- and 24-month follow-up, respectively); in 7 knees only a meniscectomy was performed. In 6 knees, no surgery was performed. After 6 and 24 months, the implants and the articular cartilage were histologically evaluated. Compression-stress tests were performed on implant biopsy specimens., Results: The implants were fully integrated into the tissue without formation of a capsule. The foreign body reaction did not exceed grade I. Differentiation from fibrous- to cartilage-like tissue was pronounced after 24 months. Viable cells were particularly absent after 24 months in central parts of the most anterior part of the scaffold. The mechanical properties of the implants were intermediate between the scaffold before implantation and native meniscus tissue and were not different between 6 and 24 months. After both 6 and 24 months, small areas of the implant were not covered with tissue. Cartilage degeneration was not prevented., Conclusion: A final remodeling of tissue into neomeniscus tissue could not take place since the original structure of the polymer was still present after 24 months. The implant did not prevent cartilage degradation. Several factors are discussed that may be responsible for this., Clinical Relevance: Although clinical application of a polymer implant for the replacement of the entire meniscus is not supported by this study, the authors strongly believe in the concept, but further improvements in the implant and surgical technique are needed before such an implant can be recommended for human clinical use.
- Published
- 2008
- Full Text
- View/download PDF
30. The cryosurgical treatment of chondroblastoma of bone: long-term oncologic and functional results.
- Author
-
van der Geest IC, van Noort MP, Schreuder HW, Pruszczynski M, de Rooy JW, and Veth RP
- Subjects
- Adolescent, Adult, Bone Neoplasms pathology, Bone Transplantation, Chondroblastoma pathology, Curettage, Female, Follow-Up Studies, Humans, Male, Neoplasm Recurrence, Local, Retrospective Studies, Treatment Outcome, Bone Neoplasms surgery, Chondroblastoma surgery, Cryosurgery
- Abstract
Background: Chondroblastoma of bone is a rare tumor that occurs most often in the epiphysis or apophysis of long bones. This benign tumor sometimes shows aggressive or malignant behaviour, and rarely metastases occur. Since wide resection often leads to growth impairment, intra-lesional curettage followed by an adjuvant therapy is developed to decrease the negative effects on growth and function without increased recurrence rates., Patients and Methods: Between 1980 and 2001, 18 patients were treated for chondroblastoma of bone. Since 1989 cryosurgery has been used as an adjuvant treatment. The functional and oncologic results at follow-up were studied., Results: Four patients were treated with curettage, and four with wide resection without adjuvant therapy. One patient developed a local recurrence and distant metastases. Ten patients were treated with curettage and cryosurgery. One patient developed a local recurrence 6 years later that was treated with curettage and cryosurgery again. No serious complications from cryosurgery occurred and the functional results at follow-up were excellent [mean MSTS score at follow-up 29]., Conclusions: Chondroblastoma of bone is a benign tumor with a relatively high recurrence rate. The local recurrence rates can be decreased with cryosurgery as a local adjuvant therapy with excellent functional results., ((c) 2007 Wiley-Liss, Inc.)
- Published
- 2007
- Full Text
- View/download PDF
31. [Favourable long-term results from cemented total hip arthroplasty combined with acetabular bone impaction grafting in patients under the age of 50].
- Author
-
Busch VJ, Gardeniers JW, Slooff TJ, Veth RP, and Schreurs BW
- Subjects
- Adult, Follow-Up Studies, Hip Joint, Humans, Middle Aged, Postoperative Complications epidemiology, Prospective Studies, Prosthesis Failure, Reoperation, Treatment Outcome, Acetabulum surgery, Arthroplasty, Replacement, Hip methods, Bone Cements therapeutic use, Bone Transplantation
- Abstract
Objective: Determination of long-term results of hip replacements in patients who, at the time of operation, were under the age of 50. Procedures whereby an existing acetabulum defect was filled with bone chips that were impacted into a strong layer, after which a cemented total hip prosthesis was implanted., Design: Descriptive., Method: Prospectively collected data from patients who were under the age of 50, and had undergone a hip replacement operation at our hospital between 1 July 1979 and 31 December 1987 were analysed. Data were collected up to 31 December 2002. The main outcome was time to revision. Survival was calculated by the Kaplan-Meier method., Results: The study group consisted of 25 patients, 17 women and 8 men with 29 prosthetic hips. The average age at operation was 37.6 years (range: 20-49). Follow-up time was 15-23 years (median: 18.7 years). 1 patient (1 hip) was lost to follow-up. 3 patients (4 hips) died within 15 years after the operation; none of them had undergone revision. 4 revisions had been performed: I septic loosening (14 years p.o.) and 3 aseptic loosenings (6, 15, 20 years p.o.). The cumulative survival with the end-point 'revision for any reason' was 96% (95% CI: 88-100) at to years and 88% (95% CI: 74-100) at 20 years; after exclusion of the septic loosening the survival at 20 years was 92% (95% CI: 80-100)., Conclusion: Hip replacement including a reconstruction technique for an acetabulum defect in patients under the age of 50 was regarded as successful if after 10 years, at least 90% of the prostheses were still in situ.
- Published
- 2007
32. [Choice of hip prosthesis in patients younger than 50 years].
- Author
-
Schreurs BW, Busch VJ, and Veth RP
- Subjects
- Adult, Humans, Middle Aged, Prosthesis Design, Prosthesis Failure, Registries, Risk Factors, Time Factors, Treatment Outcome, Arthroplasty, Replacement, Hip instrumentation, Arthroplasty, Replacement, Hip methods, Bone Cements, Hip Prosthesis standards
- Abstract
There is no agreement about the most ideal type of hip prosthesis to be used in patients younger than 50 years. The most commonly used hip prostheses in patients younger than 50 years are uncemented or resurfacing prostheses and to a lesser extent cemented prostheses. A good result of a hip prosthesis can be defined as follows: 10 years after surgery more than 90% of the prostheses should be still in situ during endpoint revision for any reason. No trials are available comparing cemented, uncemented or resurfacing hip prostheses. Studies are available of cemented hip prostheses in patients younger than 50 years that prove that more than 90% of the hips are still in situ after 50 years. There are no studies available of uncemented or resurfacing hip prostheses in younger patients that prove that after to years of follow-up 90% or more of the prostheses are still in situ. The Scandinavian hip registers show that the highest rate of prostheses still in situ after 10 years is achieved by cemented hip prostheses.
- Published
- 2007
33. Epithelioid sarcoma: Still an only surgically curable disease.
- Author
-
de Visscher SA, van Ginkel RJ, Wobbes T, Veth RP, Ten Heuvel SE, Suurmeijer AJ, and Hoekstra HJ
- Subjects
- Adolescent, Adult, Child, Child, Preschool, Disease-Free Survival, Female, Humans, Infant, Male, Middle Aged, Neoplasm Staging, Netherlands, Prognosis, Retrospective Studies, Sarcoma pathology, Sarcoma therapy, Treatment Outcome, Epithelioid Cells pathology, Sarcoma surgery
- Abstract
Background: Epithelioid sarcoma is a rare soft tissue sarcoma with a known high propensity for locoregional recurrence and distant metastases. The clinical behavior and prognostic factors that influence the survival of patients with epithelioid sarcoma were studied., Methods: Twenty-three patients, including 16 men (70%) and 7 women (30%), who were treated for epithelioid sarcoma between 1979-2003 at the University Medical Center Groningen and Radboud University Nijmegen Medical Center, were reviewed retrospectively. The median age at diagnosis was 22 years (range, 1-54 years). At the time of diagnosis, 11 patients (48%) had metastases. Six patients with distant metastasis and 1 patient with an unresectable tumor received palliative treatment (30%). The remaining 16 patients underwent surgical treatment of local disease (11 patients) or locoregional disease (5 patients). Five patients in that group received isolated limb perfusion with tumor necrosis factor and melphalan., Results: The 5-year and 10-year disease-free survival rates for all patients were 34% and 17%, respectively; for the 16 patients who received curative treatment, both rates were 56%. In the latter group, 8 patients developed local recurrence (50%) after a median follow-up of 4 months (range, 1-14 months). Nine patients were disease free after a median follow-up of 50 months (range, 6-290 months). Tumor size >5 cm (P < .0026) at diagnosis and local recurrence (P < .0008) were significant predictors of survival., Conclusions: The prognosis for patients with epithelioid sarcoma is poor, because a substantial number of patients present with extensive disease, lymph node metastases, and/or distant metastases. Treatment consists of radical surgical excision of the tumor and, if indicated, therapeutic lymph node dissection. In patients who have large tumors, isolated limb perfusion may be useful., (Copyright 2006 American Cancer Society.)
- Published
- 2006
- Full Text
- View/download PDF
34. Meniscal replacement in dogs. Tissue regeneration in two different materials with similar properties.
- Author
-
Tienen TG, Heijkants RG, de Groot JH, Schouten AJ, Pennings AJ, Veth RP, and Buma P
- Subjects
- Animals, Biocompatible Materials chemistry, Biocompatible Materials metabolism, Biomedical Engineering, Collagen Type I metabolism, Collagen Type II metabolism, Dogs, Female, Male, Materials Testing, Molecular Structure, Surface Properties, Implants, Experimental, Menisci, Tibial anatomy & histology, Menisci, Tibial surgery, Polyesters chemistry, Polyesters metabolism, Polyurethanes chemistry, Polyurethanes metabolism, Regeneration
- Abstract
In earlier studies, meniscal replacement with a porous polymer implant led to regeneration of neo-meniscal tissue. To evaluate the influence of the chemical properties on the tissue regeneration in the implant, in the present study, the meniscus in the dog's knee was replaced with either an aromatic 4,4-diphenylmethanediisocyanate based polyesterurethane implant (Estane) (n = 6) or with an aliphatic 1,4-butanediisocyanate based polyesterurethane implant (PCLPU) (n = 6). After 6 months, the knee joints were resected and the tissue behavior in the two different prostheses was evaluated microscopically. In both prostheses, a meniscus-like distribution of the tissue phenotype was found with collagen type I in the peripheral fibrous zones and collagen type II in the central, more cartilaginous zones. The compression-stress behavior of the implant-tissue construct remained in between the stiffness of the polymer material and that of the native meniscus. The PCLPU implant seemed to provoke less synovial tissue reaction. After meniscectomy solely, in 5 out of 6 cases, a meniscus-like regenerate was formed. Furthermore, the articular cartilage degeneration after placing a PCLPU implant did also not exceed the degeneration after the Estane implant or after meniscectomy. The differences between these two implants did not seem to influence the tissue regeneration in the implant. However, PCLPU seemed to evoke less tissue reaction and, therefore, is thought to be less or even nontoxic as compared with the Estane implant. Therefore, for studies in the future, the authors prefer the PCLPU prostheses for replacement of the meniscus., (Copyright 2005 Wiley Periodicals, Inc.)
- Published
- 2006
- Full Text
- View/download PDF
35. Replacement of the knee meniscus by a porous polymer implant: a study in dogs.
- Author
-
Tienen TG, Heijkants RG, de Groot JH, Pennings AJ, Schouten AJ, Veth RP, and Buma P
- Subjects
- Animals, Dogs, Female, Male, Menisci, Tibial surgery, Netherlands, Porosity, Knee Joint surgery, Menisci, Tibial transplantation, Polymers, Prostheses and Implants
- Abstract
Background: Meniscectomy will lead to articular cartilage degeneration in the long term. Therefore, the authors developed an implant to replace the native meniscus., Hypothesis: The porous polymer meniscus implant develops into a neomeniscus and protects the cartilage from degeneration., Study Design: Controlled laboratory study., Methods: In a dog model, a porous polymer scaffold with optimal properties for tissue infiltration and regeneration of a neomeniscus was implanted and compared with total meniscectomy. The tissue infiltration and redifferentiation in the scaffold, the stiffness of the scaffold, and the articular cartilage degeneration were evaluated., Results: Three months after implantation, the implant was completely filled with fibrovascular tissue. After 6 months, the central areas of the implant contained cartilage-like tissue with abundant collagen type II and proteoglycans in their matrix. The foreign-body reaction remained limited to a few giant cells in the implant. The compression modulus of the implant-tissue construct still differed significantly from that of the native meniscus, even at 6 months. Cartilage degeneration was observed both in the meniscectomy group and in the implant group., Conclusion: The improved properties of these polymer implants resulted in a faster tissue infiltration and in phenotypical differentiation into tissue resembling that of the native meniscus. However, the material characteristics of the implant need to be improved to prevent degeneration of the articular cartilage., Clinical Relevance: The porous polymer implant developed into a polymer-tissue construct that resembled the native meniscus, and with improved gliding characteristics, this prosthesis might be a promising implant for the replacement of the meniscus.
- Published
- 2006
- Full Text
- View/download PDF
36. Altered phase-transitions in tibialis anterior and medial gastrocnemius during walking after limbsaving surgery.
- Author
-
De Visser E, Veth RP, Schreuder HW, and Duysens J
- Subjects
- Adult, Ankle Joint innervation, Ankle Joint physiology, Electromyography, Female, Humans, Leg physiology, Male, Middle Aged, Muscle, Skeletal innervation, Proprioception physiology, Walking physiology, Weight-Bearing physiology, Gait physiology, Leg surgery, Limb Salvage rehabilitation, Muscle, Skeletal physiology
- Abstract
Objective: In normal gait onset activity in tibialis anterior at end stance is closely linked to reduction in activity in medial gastrocnemius. Is a similar transition also present in patients undergoing limb-saving surgery?, Methods: Nineteen subjects after limb-saving surgery of the lower extremity and ten age-matched controls were compared. Patients walked on a treadmill at their preferred speed. Bipolar surface EMG activity was recorded from the tibialis anterior and the medial gastrocnemius., Results: Patients showed asymmetry in gait. In controls a close tibialis anterior and medial gastrocnemius connection was seen. The close link between ipsilateral tibialis anterior and medial gastrocnemius was absent in patients. Instead, a link was found between tibialis anterior onset in the affected and medial gastrocnemius onset in the non-affected leg., Conclusions: This finding suggests that two control mechanisms can be seen: a contralateral connection between tibialis and gastrocnemius and a less important ipsilateral connection. This means that automated phase switching in patients does not rely primarily on ipsilateral mechanisms but that instead the onset of the ipsilateral swing is linked to the moment of load acceptance by the contralateral leg These results are strikingly similar to those obtained in simulated limping by normal subjects., Significance: Patients after limbsaving surgery have a clinically significant problem that creates aberrant gait patterns. This study provides new information about linking of ankle dorsiflexors and plantarflexors, as well as reporting the uncoupling of this mechanism in these patients after major surgery.
- Published
- 2005
- Full Text
- View/download PDF
37. Assessment of tissue ingrowth rates in polyurethane scaffolds for tissue engineering.
- Author
-
Ramrattan NN, Heijkants RG, van Tienen TG, Schouten AJ, Veth RP, and Buma P
- Subjects
- Animals, Cell Proliferation, Dermatologic Surgical Procedures, Male, Polyurethanes analysis, Rats, Rats, Wistar, Image Interpretation, Computer-Assisted methods, Materials Testing methods, Polyurethanes chemistry, Regeneration physiology, Skin cytology, Skin growth & development, Tissue Engineering methods
- Abstract
The continuous development of new biomaterials for tissue engineering and the enhancement of tissue ingrowth into existing scaffolds, using growth factors, create the necessity for developing adequate tools to assess tissue ingrowth rates into porous biomaterials. Current histomorphometric techniques evaluating rates of tissue ingrowth tend either to measure the overall tissue content in an entire sample or to depend on the user to indicate a front of tissue ingrowth. Neither method is particularly suitable for the assessment of tissue ingrowth rates, as these methods either lack the sensitivity required or are problematic when there is a tissue ingrowth gradient rather than an obvious tissue ingrowth front. This study describes a histomorphometric method that requires little observer input, is sensitive, and renders detailed information for the assessment of tissue ingrowth rates into porous biomaterials. This is achieved by examining a number of computer-defined concentric zones, which are based on the distance of a pixel from the scaffold edge. Each zone is automatically analyzed for tissue content, eliminating the need for user definition of a tissue ingrowth front and thus reducing errors and observer dependence. Tissue ingrowth rates in two biodegradable polyurethane scaffolds (Estane and polycaprolactone-polyurethane [PCLPU]) specifically designed for tissue engineering of the knee meniscus were assessed. Samples were subcutaneously implanted in rats with follow-up until 6 months. Especially at the earlier follow-up points, PCLPU scaffolds showed significantly higher tissue ingrowth rates than Estane scaffolds, making the PCLPU scaffold a promising candidate for further studies investigating meniscus tissue engineering.
- Published
- 2005
- Full Text
- View/download PDF
38. Uncatalyzed synthesis, thermal and mechanical properties of polyurethanes based on poly(epsilon-caprolactone) and 1,4-butane diisocyanate with uniform hard segment.
- Author
-
Heijkants RG, van Calck RV, van Tienen TG, de Groot JH, Buma P, Pennings AJ, Veth RP, and Schouten AJ
- Subjects
- Biocompatible Materials analysis, Butanes analysis, Catalysis, Compressive Strength, Elasticity, Hardness, Materials Testing, Molecular Weight, Nitriles analysis, Polyesters analysis, Stress, Mechanical, Surface Properties, Temperature, Transition Temperature, Absorbable Implants, Biocompatible Materials chemistry, Butanes chemistry, Nitriles chemistry, Polyesters chemistry
- Abstract
Polyurethanes based on poly(epsilon-caprolactone) (PCL) (750-2800 g/mol) and 1,4-butane diisocyanate (BDI) with different soft segment lengths and constant uniform hard segment length were synthesized in absence of catalysts for the production of a degradable meniscus scaffold. First the polyesterdiols were endcapped with BDI yielding a macrodiisocyanate with a minimal amount of side reactions and a functionality of 2.0. Subsequently, the macrodiisocyanates were extended with 1,4-butanediol in order to obtain the corresponding polyurethane. The polyurethanes had molecular weights between 78 and 160 kg/mol. Above molar masses of 1900 g/mol of the polyesterdiol crystalline PCL was found while the hard segment showed an increase in melting point from 78 to 122 degrees C with increasing hard segment content. It was estimated that the percentage crystallinity of the hard segment varied between 92 and 26%. The Young's modulus varied between 30 and 264 MPa, the strain at break varied between 870 and 1200% and tear strengths varied between 97 and 237 kJ/m2.
- Published
- 2005
- Full Text
- View/download PDF
39. Displacement of the medial meniscus within the passive motion characteristics of the human knee joint: an RSA study in human cadaver knees.
- Author
-
Tienen TG, Buma P, Scholten JG, van Kampen A, Veth RP, and Verdonschot N
- Subjects
- Aged, Aged, 80 and over, Analysis of Variance, Cadaver, Female, Humans, In Vitro Techniques, Knee Joint diagnostic imaging, Male, Menisci, Tibial diagnostic imaging, Radiography, Range of Motion, Articular, Rotation, Stress, Mechanical, Tantalum, Tibia physiology, Torque, Knee Joint physiology, Menisci, Tibial physiology
- Abstract
The objective of this study was to validate an in vitro human cadaver knee-joint model for the evaluation of the meniscal movement during knee-joint flexion. The question was whether our model showed comparable meniscal displacements to those found in earlier meniscal movement studies in vivo. Furthermore, we determined the influence of tibial torque on the meniscal displacement during knee-joint flexion. Three tantalum beads were inserted in the medial meniscus of six human-cadaver joints. The knee joints were placed and loaded in a loading apparatus, and the movements of the beads were determined by means of RSA during knee-joint flexion and extension with and without internal tibial (IT) and external tibial (ET) torque. During flexion without tibial torque, all menisci moved in posterior and lateral direction. The anterior horn showed significantly greater excursions than the posterior horn in both posterior and lateral direction. Internal tibial torque caused an anterior displacement of the pathway on the tibial plateau. External tibial torque caused a posterior displacement of the pathway. External tibial torque restricted the meniscal displacement during the first 30 degrees of knee-joint flexion. The displacements of the meniscus in this experiment were similar to the displacements described in the in vivo MRI studies. Furthermore, the application of tibial torque confirmed the relative immobility of the posterior horn of the meniscus. During external tibial torque, the posterior displacement of the pathway on the tibial plateau during the first 30 degrees of flexion might be restricted by the attached knee-joint capsule or the femoral condyle. This model revealed representative meniscal displacements during simple knee-joint flexion and also during the outer limits of passive knee-joint motion.
- Published
- 2005
- Full Text
- View/download PDF
40. Angiosarcoma with malignant peripheral nerve sheath tumour developing in a patient with klippel-trénaunay-weber syndrome.
- Author
-
Ploegmakers MJ, Pruszczynski M, De Rooy J, Kusters B, and Veth RP
- Abstract
Purpose: We discuss the coexistence of Klippel-Trénaunay-Weber syndrome with various malignancies, the possible histogenetic pathways and therapeutic implications., Patient: We report on a 46-year-old man presenting with increasing pain and swelling of his right lower leg after fracturing his fibula. Since birth he was known as having the uncommon syndrome of Klippel-Trénaunay-Weber of his right lower leg., Methods: Our patient underwent an above-knee amputation for biopsy-proven malignant vascular tumour, first thought to be a composite hemangio-endothelioma and/or angiosarcoma with lung metastases., Results: In the amputated extremity, a vascular malformation was found with tumour showing various components with foci of angiosarcoma adjacent to diffuse neurofibroma and areas with high-grade malignant peripheral nerve sheath tumour. Amputation and palliative chemotherapy were indicated, but he died of pulmonary and cerebral metastases 2 months postoperatively., Discussion: This case describes an angiosarcoma with malignant peripheral nerve sheath tumour developing in a patient with Klippel-Trénaunay-Weber syndrome. A case never described before in literature and probably, as in our case, difficult to diagnose at first biopsy.
- Published
- 2005
- Full Text
- View/download PDF
41. Chemotherapy affects the pattern of failure after shear loading of the proximal tibial growth plate.
- Author
-
van Leeuwen BL, Hartel R, Jansen HW, Verkerke GJ, Veth RP, Kamps WA, and Hoekstra HJ
- Subjects
- Animals, Male, Rats, Rats, Wistar, Stress, Mechanical, Antineoplastic Agents pharmacology, Cisplatin pharmacology, Doxorubicin pharmacology, Growth Plate drug effects, Methotrexate pharmacology, Tibia drug effects
- Abstract
Introduction: Tibial bones are shorter and less resistant to shear forces after treatment with doxorubicin, methotrexate, or cisplatin. We investigated the pattern of failure after shear loading of the proximal tibial growth plate in rats treated with these chemotherapeutic agents., Materials and Methods: Male Wistar rats from the age of 4 weeks were given doxorubicin intravenously at 15 mg/m2 body surface area (BSA), methotrexate 60 mg/m2 BSA, or cisplatin 7.5 mg/m2 BSA. There was one nontreated control group fed ad libitum an d a diet control group for each drug-treated group. At the age of 13 weeks the tibial bones were dissected. The proximal growth plate was shear loaded to failure in the posteroanterior direction. The pattern of failure through the growth plate was examined., Results: In rats fed ad libitum the failure pattern ran mainly through the transitional zone between proliferating and hypertrophic chondrocytes, but the pattern of failure showed considerable variability. The pattern in rats treated with methotrexate or cisplatin and that in their diet controls were comparable. In rats treated with doxorubicin the fracture ran mainly through the trabecular zone., Conclusions: Doxorubicin affects the pattern of failure after shear loading of the proximal tibial growth plate, but methotrexate and cisplatin do not. Special attention should be paid to epiphyseal injuries in children treated with doxorubicin.
- Published
- 2004
- Full Text
- View/download PDF
42. Prosthetic replacement of the medial meniscus in cadaveric knees: does the prosthesis mimic the functional behavior of the native meniscus?
- Author
-
Tienen TG, Verdonschot N, Heijkants RG, Buma P, Scholten JG, van Kampen A, and Veth RP
- Subjects
- Aged, Aged, 80 and over, Cadaver, Female, Humans, Joint Instability physiopathology, Male, Materials Testing, Polyurethanes, Torque, Weight-Bearing physiology, Knee Joint physiology, Knee Prosthesis, Menisci, Tibial surgery, Range of Motion, Articular physiology
- Abstract
Unlabelled: Meniscus replacement by a polymer meniscus prosthesis in dogs resulted in generation of new meniscal tissue., Hypothesis: Optimal functioning of the prosthesis would involve realistic deformation and motion patterns of the prosthesis during knee joint motion., Study Design: Controlled laboratory study., Methods: The movements of the meniscus were determined during knee joint flexion and extension with and without internal and external tibial torque by means of roentgen stereophotogrammetric analysis. Subsequently, the meniscus in 6 human cadaveric knee joints was replaced by a meniscus prosthesis., Results: All different parts of the meniscus showed a posterior displacement during knee joint flexion. The anterior horn was more mobile than the posterior horn. The prosthesis mimicked the movements of the meniscus. However, the excursions of the prosthesis on the tibial plateau were less. The knee joint laxity was not significantly higher after replacement with the meniscus prosthesis., Conclusions: The prosthesis approximated the behavior of the native meniscus. Improvement in both the gliding characteristics of the prosthetic material and the fixation of the prosthesis may improve the function., Clinical Relevance: The meniscus prosthesis needs to be optimized to achieve a better initial function in the knee joint., (Copyright 2004 American Orthopaedic Society for Sports Medicine)
- Published
- 2004
- Full Text
- View/download PDF
43. Wire mesh allows more revascularization than a strut in impaction bone grafting: an animal study in goats.
- Author
-
Bolder SB, Schreurs BW, Verdonschot N, Veth RP, and Buma P
- Subjects
- Animals, Goats, Statistics, Nonparametric, Bone Transplantation instrumentation, Bone Wires, Femur blood supply, Femur surgery, Sternum transplantation, Surgical Mesh
- Abstract
Segmental defects can be reconstructed with a cortical strut or a metal wire mesh when using bone impaction grafting in the femur. We hypothesized that structural grafts would negatively influence revascularization of the underlying impacted grafts compared with an open wire mesh. A standardized large medial wall defect was reconstructed with a strut or a mesh in six goats per group. In all femurs impaction grafting was done in combination with a cemented collarless double-tapered highly polished Exeter stem. After 6 weeks the femurs were harvested. A high rate of periprosthetic fractures was observed (three of seven and two of six for the strut and mesh groups, respectively). Histologic analysis showed different revascularization and tissue ingrowth patterns for both reconstruction techniques. In the strut group, fibrous tissue ingrowth was limited to the edges of the defect. Medially behind the strut no or limited fibrous tissue ingrowth was found. In the mesh group, fibrous tissue and blood vessels penetrated the mesh and a superficial zone of revascularized grafts was observed. Although revascularization, concomitant graft resorption and bone incorporation may compromise the short-term stability of the stem after surgery, the long-term stability of the stem probably is best guaranteed by graft incorporation.
- Published
- 2004
- Full Text
- View/download PDF
44. Acetabular revision with impacted morsellised cancellous bone grafting and a cemented cup. A 15- to 20-year follow-up.
- Author
-
Schreurs BW, Bolder SB, Gardeniers JW, Verdonschot N, Slooff TJ, and Veth RP
- Subjects
- Acetabulum diagnostic imaging, Adult, Aged, Aged, 80 and over, Bone Cements, Female, Follow-Up Studies, Hip Prosthesis, Humans, Male, Middle Aged, Prosthesis Failure, Radiography, Reoperation methods, Survival Analysis, Treatment Outcome, Acetabulum surgery, Arthroplasty, Replacement, Hip methods, Bone Transplantation methods
- Abstract
This study presents the clinical and radiological results of 62 consecutive acetabular revisions in 58 patients, at a mean of 16.5 years follow-up (15 to 20). The Kaplan-Meier survivorship for the cup with end-point revisions for any reason, was 79% at 15 years (95% confidence interval (CI); 67 to 91). Excluding two revisions for septic loosening at three and six years, and one revision of a well-fixed cup after 12 years in the course of a femoral revision, the survivorship was 84% at 15 years (95% CI; 73 to 95). At review there were no additional cases of loosening, although seven acetabular reconstructions showed radiolucent lines in one or two zones. Acetabular revision using impacted large morsellised bone chips (0.7 cm to 1.0 cm) and a cemented cup, is a reliable technique of reconstruction, when assessed at more than 15 years.
- Published
- 2004
45. Tissue engineering of the meniscus.
- Author
-
Buma P, Ramrattan NN, van Tienen TG, and Veth RP
- Subjects
- Animals, Cell Culture Techniques instrumentation, Disease Models, Animal, Humans, Prosthesis Design, Tissue Engineering instrumentation, Transplants, Treatment Outcome, Cell Culture Techniques methods, Knee Injuries surgery, Knee Prosthesis, Menisci, Tibial growth & development, Tibial Meniscus Injuries, Tissue Engineering methods
- Abstract
Meniscus lesions are among the most frequent injuries in orthopaedic practice and they will inevitably lead to degeneration of the knee articular cartilage. The fibro-cartilage-like tissue of the meniscus is notorious for its limited regenerative capacity. Tissue engineering could offer new treatment modalities for repair of meniscus tears and eventually will enable the replacement of a whole meniscus by a tissue-engineered construct. Many questions remain to be answered before the final goal, a tissue-engineered meniscus is available for clinical implementation. These questions are related to the selection of an optimal cell type, the source of the cells, the need to use growth factor(s) and the type of scaffold that can be used for stimulation of differentiation of cells into tissues with optimal phenotypes. Particularly in a loaded, highly complex environment of the knee, optimal mechanical properties of such a scaffold seem to be of utmost importance. With respect to cells, autologous meniscus cells seems the optimal cell source for tissue engineering of meniscus tissue, but their availability is limited. Therefore research should be stimulated to investigate the suitability of other cell sources for the creation of meniscus tissue. Bone marrow stroma cells could be useful since it is well known that they can differentiate into bone and cartilage cells. With respect to growth factors, TGF-beta could be a suitable growth factor to stimulate cells into a fibroblastic phenotype but the problems of TGF-beta introduced into a joint environment should then be solved. Polyurethane scaffolds with optimal mechanical properties and with optimal interconnective macro-porosity have been shown to facilitate ingrowth and differentiation of tissue into fibro-cartilage. However, even these materials cannot prevent cartilage degeneration in animal models. Surface modification and/or seeding of cells into the scaffolds before implantation may offer a solution for this problem in the future.This review focuses on a number of specific questions; what is the status of the development of procedures for lesion healing and how far are we from replacing the entire meniscus by a (tissue-engineered) prosthesis. Subquestions related to the type of scaffold used are: is the degree of tissue ingrowth and differentiation related to the initial mechanical properties and if so, what is the influence of those properties on the subsequent remodelling of the tissue into fibro-cartilage; what is the ideal pore geometry and what is the optimal degradation period to allow biological remodelling of the tissue in the scaffold. Finally, we will finish with our latest results of the effect of tear reconstruction and the insertion of prostheses on articular cartilage degradation.
- Published
- 2004
- Full Text
- View/download PDF
46. Design, synthesis and properties of a degradable polyurethane scaffold for meniscus regeneration.
- Author
-
Heijkants RG, van Calck RV, De Groot JH, Pennings AJ, Schouten AJ, van Tienen TG, Ramrattan N, Buma P, and Veth RP
- Subjects
- Animals, Biocompatible Materials chemical synthesis, Butylene Glycols chemistry, Cell Division, Collagen metabolism, Compressive Strength, Dogs, Elasticity, Equipment Design, Isocyanates chemistry, Materials Testing, Membranes, Artificial, Menisci, Tibial surgery, Porosity, Proteoglycans metabolism, Surface Properties, Tissue Engineering instrumentation, Transition Temperature, Treatment Outcome, Absorbable Implants, Menisci, Tibial cytology, Menisci, Tibial physiology, Polyesters chemistry, Polyurethanes chemistry, Regeneration physiology, Tissue Engineering methods
- Abstract
Longitudinal lesions in menisci are among the most frequent orthopedic problems of the knee. Repair by simple techniques is only limited to the vascular part of the meniscus. For repair of the avascular part of the meniscus a scaffold, which will assist the body in the formation of new meniscus cell tissue, might be applicable. In this study a biomedical segmented polyurethane with poly(epsilon-caprolactone) as soft segment and 1,4-butanediisocyanate and 1,4-butanediol as uniform hard segments has been synthesised. The material has a micro phase separated morphology and excellent mechanical properties. A porous scaffold was prepared via a combination of liquid-liquid phase separation and salt leaching. The foams prepared combined a very high interconnectivity and porosity with the desired compression modulus. After six months of implantation in the knees of beagles full ingrowth with cells was obtained and it was found that meniscus like tissue had been formed in the scaffold. Moreover, compression behaviour appeared to be comparable to native meniscus tissue.
- Published
- 2004
- Full Text
- View/download PDF
47. Fatigue after treatment for malignant and benign bone and soft tissue tumors.
- Author
-
Servaes P, Verhagen S, Schreuder HW, Veth RP, and Bleijenberg G
- Subjects
- Adolescent, Adult, Aged, Fatigue diagnosis, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Middle Aged, Surveys and Questionnaires, Bone Neoplasms complications, Bone Neoplasms therapy, Fatigue etiology, Soft Tissue Neoplasms complications, Soft Tissue Neoplasms therapy
- Abstract
Fatigue has been mentioned as an important complaint in several groups of disease-free patients after curative treatment for cancer. However, it has never been investigated in a sample of patients who have been treated for a bone or soft tissue tumor in the past. In the current study, these patients participated. Measurement included posted questionnaires at baseline and at follow-up (two years later). Baseline results indicated that fatigue is a severe problem for 28% of the investigated patients. Percentages were equal for patients who were treated for malignant or benign tumors. Fatigue complaints seem to be most severe for patients who finished treatment relatively recently, and for patients who had to undergo more than one operation. In addition, fatigue was associated with several psychological and physical variables. At follow-up, the majority of all patients who were severely fatigued at baseline continued to be severely fatigued. Severe fatigue at follow-up was predicted by oncological complications after initial treatment, less optimism, and more somatization. It can be concluded that fatigue is an important problem for more than a quarter of a sample of patients who have been treated for a malignant or benign bone or soft tissue tumor in the past.
- Published
- 2003
- Full Text
- View/download PDF
48. Reorganization of gait after limb-saving surgery of the lower limb.
- Author
-
de Visser E, Veth RP, Schreuder HW, Duysens J, and Mulder T
- Subjects
- Adult, Aged, Bone Neoplasms physiopathology, Chondrosarcoma physiopathology, Chondrosarcoma surgery, Exercise Test, Female, Humans, Leg physiopathology, Locomotion physiology, Male, Middle Aged, Osteosarcoma physiopathology, Osteosarcoma surgery, Recovery of Function physiology, Task Performance and Analysis, Vision, Ocular physiology, Bone Neoplasms surgery, Gait physiology, Leg surgery, Salvage Therapy
- Abstract
Objective: In this study, the concept of a cognitive dual-task performance and visual restriction during walking has been used to study the recovery of gait after limb-saving surgery in ten patients., Design: All patients were recovering from some form of treatment to tumors of the lower limbs. Patients had to walk on a treadmill at their preferred speed. During the course of recovery, we measured normal walking, walking while performing an attention-demanding dual task, and walking during restricted vision, starting 5 mo postoperatively., Results: Patients are able to reach an acceptable level of gait within 15 mo, especially when the basic locomotor activity (i.e., step-cycle duration, walking speed, gait symmetry) is taken into account. Nevertheless, the results showed that during the recovery, the patients were still hindered by the dual task and visual restriction while walking because they exhibited a decrease in step-cycle duration under these conditions., Conclusions: In general, an improvement in walking speed and a decrease in asymmetry was seen. On the other hand, patients still had a basically reduced control of gait after the 15-mo recovery period. This can be attributed to a lack of gait automatism caused by an irreversible loss of somatosensory input.
- Published
- 2003
- Full Text
- View/download PDF
49. Scheuermann kyphosis: the importance of tight hamstrings in the surgical correction.
- Author
-
Hosman AJ, de Kleuver M, Anderson PG, van Limbeek J, Langeloo DD, Veth RP, and Slot GH
- Subjects
- Adult, Cohort Studies, Humans, Kyphosis diagnosis, Kyphosis diagnostic imaging, Lumbar Vertebrae physiopathology, Male, Movement, Pelvis physiopathology, Radiography, Knee, Kyphosis surgery, Tendons physiopathology
- Abstract
Study Design: A historic cohort study of the sagittal alignment in 33 consecutive patients with surgically corrected thoracic Scheuermann kyphosis., Objectives: To determine if postsurgical imbalance, sagittal malalignment, and decreased lumbar-pelvic range of motion in patients with thoracic Scheuermann kyphosis is related to tight hamstrings., Summary of Background Data: Tight hamstrings are a frequent sign in Scheuermann kyphosis. The importance of tight hamstrings in the surgical management of Scheuermann kyphosis has not yet been studied., Methods: Thirty-three patients with Scheuermann kyphosis were managed by surgical correction and fusion. Tight hamstrings, lumbar-pelvic range of motion, and sagittal balance were evaluated. Sixteen patients had tight hamstrings, and 17 patients had nontight hamstrings. Hamstrings were considered tight if the popliteal angle was >30 degrees., Results: Patients with tight hamstrings have a significantly greater risk of postoperative imbalance (P = 0.05), and these patients can only compensate for this risk by reducing their lumbar lordosis (P = 0.0227). Furthermore, the limitations in the lumbar and pelvic range of motion are predicted by tight hamstrings (P
- Published
- 2003
- Full Text
- View/download PDF
50. The management of clear cell sarcoma.
- Author
-
Kuiper DR, Hoekstra HJ, Veth RP, and Wobbes T
- Subjects
- Adolescent, Adult, Chemotherapy, Adjuvant, Child, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pelvic Neoplasms surgery, Radiotherapy, Adjuvant, Sarcoma, Clear Cell drug therapy, Sarcoma, Clear Cell radiotherapy, Survival Analysis, Treatment Outcome, Lower Extremity surgery, Sarcoma, Clear Cell surgery, Upper Extremity surgery
- Abstract
Clear cell sarcoma is a rare soft tissue tumour, constituting approximately 1% of all soft tissue sarcomas. Prognosis is reported to be poor due to the great propensity to metastasise regionally and distantly. In this paper, we report the surgical experience of two university hospitals. Both disease-free and overall survival after resection of clear cell sarcoma in this limited study were excellent, which may be explained by relatively small tumour size in seven out of eight patients and adjuvant radiation treatment. The current treatment for clear cell sarcoma is wide local tumour excision, with adjuvant radiation therapy for resection margins of less than 1 mm.
- Published
- 2003
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.