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Possible factors to optimize the stability of endoprostheses after cementless implantation are: • Surface design (coating with enlargement of surface) • Press-ﬁt design of the implant (interface) • Additional ﬁxation features (primary implantation and revision) Joint-Preserving and Joint-Replacing Procedures Compared 143 These points explain why prostheses implanted without cement react far more sen- sitively to modiﬁcations and design cheap 30gm himcolin mastercard, to force introduction, and to bonding of the implant to bone (osseointegration). With regard to their stability in living bone com- pared to cemented prostheses, cementless prostheses are required to prove their advantages over and over again. Implant Characteristics The Bicontact Family The Bicontact hip stem (Fig. Bilateral ﬂanges and the characteristic antirotation wing make use of the greater trochanter area and provide the implant with a high level of primary stability in the sense of proximal load transmission. The outward expression of rotational stability in particular is the absence of tiresome, occasionally intolerable, thigh pain. As a modular system with different implant sizes and stem shapes, the Bicontact system also meets the requirements of dysplastic deformities with the possibility of deciding on cementless or cemented anchorage of the prosthetic components during the intervention. Therefore, the Bicontact system meets all the requirements for universality [4–6]. In this context, it is necessary to remember that: • The external design of the Bicontact implant for different implantation types has remained unchanged since its introduction. The Bicontact hip system with stem, cup, and head components for primary, dysplastic, special anatomy, and revision procedures 144 S. Bicontact Osteoproﬁler system: no rasping, no reaming, no removal of bone. Compres- sion of cancellous bone structures (A-Osteoproﬁler) and cutting of the proximal Bicontact shape (B-Osteoproﬁler) for proximal load transfer. With the so-called Osteoproﬁler System—reaming or rasping explicitly is not wanted here—no vital living bone is sacriﬁced in the metaphyseal part of the femur. On the contrary, the cancellous structures present are compressed (con- densed) to guarantee optimum stress transmission (stress introduction) This point, last but not least, has been a learning result of our earlier experiences with numerous revision operations, quite often associated with considerable bone defects (osteolysis) and general periprosthetic bone loss. Therefore, to pay attention to these facts, we say: “During each primary opera- tion—and also after every revision—a subsequent intervention must be borne in mind. Load and stress-transfer should occur exclusively in the intertrochanteric region, whereas a distal “press-ﬁt” of the prosthe- sis stem is avoided for the primary implantation (Fig. The principle of bone-preserving-implantation techniques is pursued similarly on the acetabular side.
Space does not allow us to go into all the possible options here himcolin 30 gm with amex, but the following suggestions listed in Figure 8. Common strategies will be to simply follow good assessment practices we have described elsewhere and to be flexible in your insistence on assignment deadlines and in the time allowed in formal examinations. ASSESSING STUDENTS AS GROUPS With the increasing use of group and team-based learning, such as in problem-based learning, there is the related challenge of assessing the outcomes of group learning in ways that are fair to individuals but which recognise the particular dynamics and realities of such learning. More detailed descriptions of this assessment approach are given in Miller et al. Remember to keep group size down (greater than six members is too large); help students to work as effective group members; form groups randomly and change membership at least each semester; and ensure all students understand the assess- ment mechanisms you will use to encourage the diligent and forewarn the lazy. Marking group submissions can be a way of assessing more students but taking up less time on your part. When allocating marks, the following strategies will be helpful: Give all members of a group the same mark where it was an objective to learn that group effectiveness is the outcome of the contribution of all. For example, if the group report was given a mark of 60 per cent and there were 4 members, give the group 240 (4 x 60) to divide up. This will be best managed if you have forewarned the group and assisted them with written criteria at the onset as to how they will allocate marks. An alternative is to have members draw up a contract to undertake certain group responsibilities or components. Components may be marked separately, or students may be given the task of assessing contributionsthemselves. Enhance the reliability of this form of assessment by conducting short supplementary interviews with students (e.
The White Paper emphasised that the government was ‘addressing inequality with a range of initiatives on education purchase himcolin 30gm without a prescription, welfare-to-work, housing, neighbourhoods, transport and environment, which will help health’ (DoH 1999:x) Critics pointed out that this wide range of government initiatives against inequality did not include the provision of higher levels of welfare benefits. The White Paper later asserted that ‘the strong association between low income and health is clear’ and immeditely added that ‘for many people the best route out of poverty is through employment’ (DoH 1999:45). For the many people for whom that route was not practicable, the White Paper offered no alternative. Given the continuing controversy around health inequalities, it is worth briefly tracing its evolution during the 1990s. The concerns of the 1980s that increasing differentials in income were resulting in a growing gap between the health of the rich and that of the poor, became an increasingly prominent focus of medical research and discussion in the 1990s. Encouraged by Donald Acheson, the Kings Fund sponsored a series of investigations and seminars which culminated in the publication of Tackling Inequalities in Health in 1995, subtitled ‘an agenda for action’ (Benzeval et al. The BMA produced a report in the same year recommending a wide range of economic and social policies in 90 THE POLITICS OF HEALTH PROMOTION response to this problem (BMA 1995). Both before and after its 1997 election victory, New Labour adopted the issue of health inequalities as one of its major themes, a preoccupation that is reflected in its public health policy documents. At first inspection, the extent of medical and political concern with health inequalities appears puzzling. Though, as we have seen, class differentials have persisted, in real terms the health of even the poorest sections of society is better than at any time in history: indeed the health of the poorest today is comparable with that of the richest only twenty years ago (see Chapter One). Furthermore, it appears that the preoccupation with social class in the sphere of health (as indicated by the scale of academic publications) has grown in inverse proportion to the salience of class in society in general. After the emergence of the modern working class following the industrial revolution in the mid-nineteenth century, the question of class and its potential for causing social conflict and, for some, social transformation, dominated political life. It appears that after this era finally came to an end with the collapse of the Eastern bloc and the Soviet Union in 1989–90, and the political and social institutions organised around class polarisation lost their purpose, the subject suddenly became of much greater medical and academic interest. No longer subversive, class had acquired a new significance in relation to the social anxieties of the 1990s. A closer examination of recent debates about issues of class and health reveals some of the concerns underlying the discussion of health inequalities.
Waldman BJ (2002) Minimally invasive total hip replacement and perioperative man- agement: early experience himcolin 30 gm. DiGioia AM III, Plakseychuk AY, Levison TJ, et al (2003) Mini-incision technique for total hip arthroplasty with navigation. Sculco TP, Jordan LC (2004) The mini-incision approach to total hip arthroplasty. Fehring TK, Mason JB (2005) Catastrophic complications of minimally invasive hip surgery. Bal BS, Haltom D, Aleto T, et al (2005) Early complications of primary total hip replacement performed with a two-incision minimally invasive technique. Woolson ST, Mow CS, Syquia JF, et al (2004) Comparison of primary total hip replace- ments performed with a standard incision or a mini-incision. J Bone Joint Surg [Am] 86A(7):1353–1358 Minimally Invasive Hip Replacement Surgery 193 19. Minimally Invasive Two-Incision Surgery for Total Hip Replacement (2005) National Institute for Clinical Excellence Interventional Procedure Guidance 112, London. Single Mini-Incision Hip Replacement (2006) National Institute for Health and Clini- cal Excellence Interventional Procedure Guidance 152, London. Canadian Joint Replacement Registry 2005 Report (2005) Canadian Institute for Health Information, Ottawa. The purpose of the present study was to review the indications and assess the clinical results of a current metal-on-metal hip resurfacing design in a population of patients treated for secondary osteoarthritis (OA) in which 208 patients (238 hips) underwent metal-on-metal hybrid hip resurfacing with a diagnosis of nonprimary OA. The study group presented greater risk factors [Surface Arthroplasty Risk Index (SARI) score] for resurfacing than a control group of patients operated for primary OA. All clinical scores showed signiﬁcant improvements postop- eratively (P < 0. Kaplan–Maier survivorship at 4 years was 95%, using any revi- sion as endpoint. In comparison with primary OA patients, the study group had slightly inferior results, explained by the difference in risk factors.