0000000000022126
AUTHOR
A. Eckardt
Ergebnisse zementfreier Endoprothesen bei der nichttraumatischen Hüftkopfnekrose
AIM OF THE STUDY The results from 56 patients with osteonecrosis of the femoral head who underwent 66 uncemented total hip replacements were analyzed and compared with current reports in the literature on cemented endoprosthesis. METHODS In the retrospective study in 30 of those cases the Zweymuller and in 25 cases the HA-coated ABG prosthesis were used. In addition the results of 11 patients with a polyethylene Endler cup in combination with a Zweymuller stem are presented. The mean age at surgery was 48 years, the mean follow-up was 5.9 years. Clinical examination, registration of the Merle d'Aubigne score and a radiological examination were performed. RESULTS The clinical results did not…
Verlaufsbeobachtung des Kollagen- und Knochenstoffwechsels bei Patienten mit zementfreier Hüfttotalendoprothese*
Introduction This study investigated the influence of concentration and activity of several markers of the collagen and bone metabolism and their impact on ingrowth of non-cemented total hip arthroplasty. Methods 40 patients underwent an implantation of a ABG-prosthesis. Before surgery and 1, 2, 12 and 24 weeks after it serum concentrations of PICP, ICTP, IGF-1, ON, b-AP, Calcium, Phosphate, GPT and Creatinin were measured and a collagen ratio (CQ) was calculated. Results PICP decreased until 1st week, increased at 2nd week and decreased again after that time. ICTP increased significantly in 1st week, reached a maximum in 2nd week and decreased after that. b-AP decreased in 1st week but inc…
Vergleich radiologischer Verfahren zur präoperativen Beurteilung der Verankerungsfestigkeit von Wirbelsäulenimplantaten
PURPOSE To compare three techniques with regards to their ability to estimate pull out strength of spinal fusion hardware. MATERIAL AND METHODS VDS-screw fixation strength in 50 human cadaveric vertebral bodies was approximated by means of pull out force measurement. Bone quality was assessed by Dual X-ray Absorptiometry (DXA). Quantitative Computed Tomography (QCT) and T2*-relaxation time. For each of these techniques, correlation with axial pull out force strength was investigated. RESULTS Highest correlation was found for cancellous bone density measured by QCT (r = 0.72; p < 0.001). Immediately followed by DXA (r = 0.70; p < 0.001), which involves all bone components. Inverted T2*-relax…
New aspects in the histological examination of polyethylene wear particles in failed total joint replacements.
The most important long-term complication in total joint replacements is aseptic osteolysis. Wear particles such as polyethylene (PE) debris are considered to be one of the causes that play a central role. Several studies indicated that PE can be visualised in paraffin-embedded tissue sections not only by polarised light, but also after oil red staining. To determine whether oil red staining enables sensitive detection of PE, we examined staining of mechanically-produced PE particles by oil red. Furthermore, we studied oil red staining of paraffin-embedded tissue specimens of patients with failed uncemented and cemented total knee and hip prostheses. We applied double labelling of sections …
Standardisiertes postoperatives Schmerztherapieschema in der Orthopädie
In order to treat patients with postoperative acute pain effectively, we have developed a standardised algorithm for analgesia. This process includes three levels and the appropriate supply of medication. The therapy level is defined based on the scale of the operation. Accordingly, the prescription and handling of the pain medication is simplified for the attending physician and nurses. The pain level has to be measured by the nursing staff sing a visual analogue scale (VAS). Thus, the efficiency of the analgesics will be continuously evaluated and controlled. The standardised supply medication can be applied in those cases with pain levels > or = 4 (VAS). It is possible to up- or down-gra…
Bone Mineral Density and Vitamin D Status in Female and Male Patients with Osteoarthritis of the Knee or Hip
<i>Objective:</i> Osteoporosis (OP), osteoarthritis (OA) and vitamin D deficiency are age-related disorders. We investigated the association between bone mineral density (BMD), vitamin D and OA in patients undergoing total hip or knee replacements. <i>Method:</i> In total, 82 women and 35 men with mean ages of 70 and 68 years, respectively, were recruited for the study. The BMD of the lumbar spine and the proximal femur were measured by dual-energy X-ray absorptiometry. The vitamin D status was assessed by 25(OH)D levels, with a cut-off of ≤30 ng·ml<sup>–1</sup>. <i>Results:</i> In total, 84.7% of the patients had a vitamin D deficiency; 20% o…
The impact of Syme amputation in surgical treatment of patients with diabetic foot syndrome and Charcot-neuro-osteoarthropathy
Charcot-neuro-osteoarthropathy with its severe destruction of bones remains a challenge for physicians and surgeons. The aim of the study was to characterise a patient population treated in a specialised foot care centre who underwent surgical treatment for their diabetic foot syndrome. Special attention was paid to patients who suffered from Charcot-neuro-osteoarthropathy and the impact of Syme amputation if amputation of the foot was inevitable. A total of 121 patients with diabetic foot syndrome and ulcerations underwent an interdisciplinary strategy for diagnostic and therapeutic procedures including MRI and surgical interventions. If peripheral arterial vessel disease was present, reva…
Robotic total knee arthroplastyThe accuracy of CT-based component placement
Accurate alignment of the components in total knee arthroplasty is important. By use of postoperative CT controls, we studied the ability of a robotic effector to accurately place and align total knee arthroplasty (TKA) components according to a purely CT-based preoperative plan.Robotic TKA was performed in 13 patients (6 men) with primary gonarthrosis. Locator screws were placed into femur and tibia under spinal anesthesia. A CT-scan including the femoral head, knee and ankle was performed. In the preoperative planning software, virtual components were positioned into the CT volume. In a second operation, the robot milled femur and tibia with a high-speed milling tool according to the preo…
Messung der Pfannenwanderung bei zementfreien Hüftimplantaten
PURPOSE Migration measurements of acetabular components using a special computer aided method (EBRA = abbreviation for the German term "Ein-Bild-Rontgenanalyse") were performed to evaluate early results of the implants and predict aseptic loosening. METHODS Standard ap-radiographs of the pelvis were marked, specific points were digitised. Simulating the spatial situation the programme computes longitudinal and vertical migration of the cup. 74 acetabular components in 71 patients could be studied by migration measurements. RESULTS 14 patients showed migration of more than 1 mm, which is the confidence limit of this method. Each of these patients showed diverse reasons for the migration, i.e…
Einige vermeidbare Behandlungsfehler bei der Therapie von Erkrankungen des Bewegungsapparates
Vermeintlich vermeidbare Fehler bei der Behandlung von Patienten besonders in operativen Fachgebieten sind der Grund fur die standig steigende Zahl der Haftpflichtprozesse und Antrage an die Schlichtungskommissionen der Arztekammern. Typische Fehlermoglichkeiten liegen zum einen in der Indikationsstellung zu operativen Eingriffen, ebenso mussen Patienteninformation und Aufklarung mit aller Sorgfalt und unter Berucksichtigung der Rechtslage erfolgen. Daruber hinaus konnen naturlich Fehler auch im Rahmen des operativen Vorgehens und der Nachbehandlung unterlaufen. Der vorliegende Uberblick soll unter Hinweis auf die empfohlenen Richtlinien einzelner Institutionen und unter Berucksichtigung de…
Die interdisziplin�re Therapie des diabetischen Fu�syndroms
Noch immer werden in Deutschland 28.000 Amputationen/Jahr bei Patienten mit diabetischem Fussyndrom (DFS) durchgefuhrt.Bei gleichzeitig haufig vorhandener ischamischer und osteomyelitischer Komponente fuhrt ein operatives Vorgehen in der Regel zu Wundheilungsstorungen,Nachamputationen und oft auch Extremitatenverlust.Die Ergebnisse eines interdisziplinaren Therapieregimes werden evaluiert und im Literaturvergleich bewertet. Nach Diagnostik hinsichtlich des Vorliegens einer Polyneuropathie,Osteomyelitis und vor allen Dingen einer pAVK hat nach Infektkontrolle die primare distale Bypasschirurgie hochste Prioritat, ihr Erfolg ist richtungsweisend fur den weiteren Verlauf der Erkrankung.Die spa…
Interdisziplinäre Diagnostik und Therapie des ischämisch-osteomyelitischen diabetischen Fußsyndroms
Fortgeschrittene Stadien des diabetischen Fussyndroms (DFS) mit ischamischer und osteomyelitischer Komponente fuhren im Rahmen gangiger Versorgungsstrukturen regelhaft zur Minoramputation, gefolgt von ischamisch bedingter Wundheilungsstorung und Extremitatenverlust. Selbst in spezialisierten Behandlungseinrichtungen stellen periphere arterielle Verschlusskrankheit (pAVK) und Osteomyelitis die groste Herausforderung im Bemuhen um den Extremitatenerhalt dar. Wahrend die Behandlung von polyneuropathischen Fuslasionen in den Handen von Diabetologen zur erfolgreichen Domane der konservativen Medizin geworden ist, ist fur die Therapie von fortgeschrittenen, ischamisch und osteomyelitisch komplizi…
Arthrose und Osteoporose - Wirklich eine inverse Relation?
Objective Increasing bone mineral density (BMD) has been found in several studies in patients with osteoarthritis (OA). Therefore, the simultaneous occurrence of osteoporosis (OP) and OA is denied by many clinicians. Because of our clinical impression, however, we suggest that we have to consider a common occurrence. In the present study we have examined the relationship between osteoathritis of the knee or the hip and osteoporosis. Method The BMD of the lumbar spine and the proximal femur of 117 OA patients (82 postmenopausal female patients aged 50-83 and 35 male patients aged 36-86 years) who subsequently required hip or knee replacements, but were otherwise healthy, was measured by dual…
Die Chronisch rekurrierende multifokale Osteomyelitis (CRMO)*: - Teil 2 Klinisch-radiologisch-histopathologische Studie zum kindlich-jugendlichen „Beckentyp” bei 11 Patienten -
We report about the juvenile and adolescent pelvic type of CRMO in 7 girls and 4 boys. The results show from solitary up to 7 pelvic lesions (average 3 lesions) predominantly in the acetabular and paraacetabular region (sometimes with hip joint effusion as a sign for concomitant coxitis).Tc99m-bone-scan is helpful to evaluate exactly the pattern of bone affection. We find 3 stages of an primarily chronic, non-purulent osteomyelitis going along with a "plasma-cell-sclerotic process", leading to a Garre-type sclerosing end-stage, which probably heals after some years spontaneously, projecting on clinical symptoms and radiological appearance. The concomitant coxitis ("sympathetic coxitis") is …
Effectiveness of low-energy extracorporal shock waves for chronic plantar fasciitis
Summary Over a period of 4 years we performed a prospective randomized trial on 100 patients in order to compare the effects of low-energy extracorporal shock-wave therapy (ESWT) in the treatment of painful heel (chronic plantar fasciitis). Patients in group I were treated three times at weekly intervals with 1000 impulses of 0.08 mJ/mm 2 given around the heel spur. Group II received treatment three times with 10 impulses of the same energy density at weekly intervals. Follow-up examinations were done at 12 and 52 weeks, respectively. The main outcomes assessed were reduction in severity of pressure pain, period of pain-free walking, and patient satisfaction. At 12 weeks, 16 of 50 patients …
Radiologische Veränderungen nach Implantation zweier unterschiedlicher zementfreier Hüftschaftsysteme
PURPOSE: Of the study was to evaluate radiological alterations of the femoral bone after implantation of two different prostheses. METHODS: 81 patients with 87 hips underwent total hip arthroplasty by using the Zweymuller-stem fixating in the medullary canal, and 175 patients with 182 ABG-stems with a proximally fixating, anatomical design were followed up clinically and radiologically. RESULTS: Adaptive bone remodelling in Zweymuller-stems showed in some patients thickening of the cortex of the femur and proximal bone-stock loss; reactive lines were seen in the proximal areas surrounding the prosthesis. Radiographs of patients with ABG-stems showed these lines in the distal, smooth part of…
Wirbelsäulenmanifestationen der chronischen rekurrierenden multifokalen Osteomyelitis (CRMO)
Chronic recurrent multifocal osteomyelitis (CRMO) is a systemic osteo-articular disease that is characterized by a sterile, primarily chronic osteomyelitis with various distribution patterns of the individual lesions. In this article, we describe the "axial type" with predominant involvement of the spine, which represents 13 of our 41 CRMO cases of different age groups. The important element of its diagnosis is the typical lympho-plasmacellular spondylitis that can be detected and staged by scintigraphy, MRI and conventional radiography. Potentially affected are all vertebrae from the mid-cervical spine to the sacrum. One or several segments can be involved, sometimes as transient inflammat…
Cementless total hip replacement with subtrochanteric femoral shortening for severe developmental dysplasia of the hip.
Total joint replacement in patients suffering from developmental dysplasia of the hip poses specific technical difficulties due to insufficient bone stock at the site of the original and secondary acetabulum and a narrow, cranially displaced proximal femur. Twelve hips with severe congenital dislocation (4 Crowe type II, 5 type III, 3 type IV) were treated with cementless, porous structured total hip replacement. The cup was implanted at the anatomic height, a femoral segment was resected below the minor trochanter to reduce the femoral component in all cases. One femoral component was exchanged for a longer stem after 2 months due to insufficient fit and fill. After a mean follow-up of 5.1…
The Artek cup for total hip replacement of dysplastic hip joints.
One specific difficulty in total hip replacement for developmental dysplasia of the hip is a shallow acetabulum with a short anteroposterior diameter. In a prospective cohort study we investigated the short-term results of the Artek cup, designed with a shallow outline and a height-reduced metal inlay for a large size 38 mm metal head, in a group of female patients with mild dysplasia of the hip.Fourteen consecutive patients with 17 dysplastic hip joints were included in the study. Their average age was 42 years. Fourteen hips had dysplasia Crowe grade I; 3 hips had dysplasia Crowe grade II. The femoral head centre was localized according to Pagnano in zone 1 in 3 cases, in zone 3 in 6 case…