Clinics in podiatry最新文献

In summary, implants are highly successful because encapsulation occurs around the implant without rejection and no other fixation is necessary. There is relatively no shortening or instability of the toe, such as a floppy toe. This seems to prevent painful stiff pseudoarthrosis or arthritis because it acts as a spacer to prevent narrowing of the joint and allows for movement. It prevents a short first toe and prevents any undesired cosmetic results, as it provides the joint with a pain-free range of motion, allowing it to become more mobile and stable. Also, ulnar implants have been used with the same indications and contraindications. The most important consideration about implant surgery is that these implants, that is, the Silastic and the Swanson design, are nonabsorbable. They will not cause tissue reaction and the fibrous encapsulation forms all that is necessary to encapsulate the implant itself; therefore, there is very little bony rejection. From recent literature and through professional experience, it has been proved that implants act primarily as a spacer. They provide a pain-free range of motion but not as well as desired. Implants provide stability to the joint, which is of the utmost importance. The Silastic implants have stood the test of time in most cases. However, the search for better biomaterials, better results, and better functions is never ending. There is a great need for continued research into this field. Podiatry must continue to maintain, contribute, and improve this research.

Silicone rubber arthroplasty has been used in the foot with great success and with devastating failure. In an effort to understand why certain cases are successes and why certain cases are failures, a systematic investigation of several factors is necessary. A certain relationship exists among the material of which the implant is made, the design of the implant and the function it is asked to perform, and the host response to the material or implant. Simply because a material has been shown inert when placed in relatively large pieces in the body is not reason enough to support its use. The design of the implant must be such that it re-establishes function parallel to an anatomic manner. Host response to a prosthesis may be viewed in light of the tissue response to the foreign body and also with regard to its effect on bone, synovium, and articular cartilage as an organ. One must consider not only biologic compatibility but also compatibility of physical properties and physiologic function. This article has attempted to address and organize implant surgery in just this manner described. Silicone rubber arthroplasty has been a very satisfying procedure for both patient and surgeon. Complications do occur, and it is up to the surgeon to provide the analysis. The manufacturer may provide the prosthesis but the responsibility lies with the surgical community to use implantation in a proper and appropriate manner.

The topic of artificial tendons and ligaments for the foot and ankle has been investigated. Close attention has been given to three implants, the Silastic-rod implant, the carbon-fiber implant, and Marlex mesh. A brief historical background was given to the development of the lateral ankle reconstructive procedures and to the development of the individual artificial prostheses. The biologic reactions produced by the implants have been presented. Carbon-fiber implants and Marlex mesh induce a fibrous growth that produces a neotendon or neoligament, depending on their use. Silastic-rod implantation establishes a hollow tube with qualities very similar to the normal tendon sheath. Carbon fiber and Marlex mesh are directly implanted and used as a temporary tendon or ligament. During this time, they act as a scaffold on which the new tendon or ligament is formed. Silastic-rod implants are incorporated into a two-stage tendon-graft procedure. The Silastic rod is used during stage one to develop a new tendon sheath. Placement of an autologous tendon within the newly formed sheath occurs in stage two. Details of the actual procedure have been presented. Any tendon used in the transfer should be of similar strength with similar expansive qualities. These implants have many potential uses in podiatry. They are particularly useful in trauma cases and patients that present with ankle instability. Research pertaining to the development of an ideal suture and anastomosis technique is still needed.

The results of approximately 1000 digital implant arthroplasties performed since 1977 are reported. Only 10 have been removed, 8 from infection and 2 from trauma. The complication ratio is considered minimal, and the procedure is recommended in selected cases as an alternative to or in lieu of resection arthroplasty or digital arthrodesis.