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…

Stellenwert der MR-Tomographie bei traumatischen Patellaluxationen

PURPOSE To describe the MR imaging findings in patients with lateral patellar dislocation. MATERIAL AND METHODS The MRIs of 31 patients with patellar dislocation were evaluated retrospectively. Arthroscopic surgery was performed in 23 cases. RESULTS Hemarthrosis was found in 30/31, contusions of the lateral femoral condyle in 30/31 and of the medial patellar facet in 26/31 cases. Injury of the medial patellar retinaculum was seen in 28/31 cases. Osteochondral fractures were found in 18 patients; compared to arthroscopy there were one false-positive and 5 false-negative findings concerning loose cartilage bodies. In 7 cases, patellar dislocation was not suspected before MR imaging. CONCLUSIO…

Effects of a 21 days space flight on the mechanical performance and the EMG power spectrum of the leg muscles

Vergleich der prognostischen Aussagefähigkeit der Catterall- und Herring-Klassifikation bei Patienten mit Morbus Perthes

QUESTION Investigation of the predictive value of the Catterall- as compared to the Herring-classification in patients with Perthes disease. METHOD A radiological follow-up study including 53 patients with a total of 59 affected hips was carried out. In the initial diagnosis the Catterall-, Waldenstrom- and Herring-stages were assessed. The epiphyseal ratio, the head-neck ratio and the lateral subluxation were measured and compared at the time of diagnosis, fragmentation stage and in a follow-up examination, which was carried out 4, 9 years after diagnosis on the average. The results of the follow-up examination were assessed using the Mose-classification and compared as well. In addition t…

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…

Die BWS-Beweglichkeit von Impingementpatienten im Vergleich zu Gesunden - eine inklinometrische Studie

AIM The aim of this study was to analyse the relation between the mobility of the thoracic spine and an impingement syndrome of the shoulder. METHOD In a prospective study, 50 patients with an impingement syndrome and 50 healthy test subjects were examined for the mobility of their thoracic spines. All patients and test subjects were examined according to a standardized protocol. The experiments were carried out in the biomechanical laboratory of our clinic with the Plurimetercompass and the Inclinometer of Rippstein. RESULTS In 23 patients a tendinosis calcarea was diagnosed radiologically, 27 patients suffered from a plain impingement without calcification, hence both groups were analyzed…

Dissatisfaction with post-operative pain management—A prospective analysis of 1071 patients

Summary A total number of 1071 patients was investigated using a modified questionnaire of the American Pain Society to evaluate the pain profile and satisfaction/dissatisfaction on the second post-operative day after different types of surgery (abdominal, traumatic, orthopaedic, urologic, gynaecologic, ENT). Patients were either treated with non-standardized pain management (no measurement of pain intensities, no regular administration of analgesics) (non-APS; n = 575) under responsibility of surgical specialties or with standardized pain management (regular assessment of pain and dose adaptation with i.v. PCA or epidurals) (APS; n = 496) by an anaesthesiology-based acute pain service. Pat…

Rechnerunterstützte Auswertung elektromyographischer und goniometrischer Meßsignale mit statistischen Signalanalyseverfahren

Stellenwert bildgebender Verfahren in der Diagnostik des lumbalen Bandscheibenvorfalles

As a seeming law of nature the possibility of making use of various multiplanar sectional imaging techniques is accompanied by diagnostic exaggeration. Simple and cost effective procedures with low radiation dosage such as plain x-rays of the spine are being thrust into the background. Not seldom are patients referred to the spine surgeon with MRI or Cat scan at hand but lacking standard radiographs. As far as the assessment of intervertebral disc disease is concerned the combination of plain X-rays of the spine and computed tomography of the level in question turned out to be sufficient for indication of the operation in more than 90% of 450 patients after nucleotomie at the Orthopedic Uni…

Okkulte Fraktur einer Achillessehnenossifikation ohne begleitende Sehnenruptur

Ossification of the Achilles tendon is the result of a traumatic, hypoxic injury of the tendon. The usually asymptomatic ossification has a clinical importance only in case of a new trauma. We report about a patient with an isolated fracture of the ossification without an accompanying rupture of the Achilles tendon. Because of the radiologically "occult" fracture the diagnosis could only be verified by MRI. With a conservative treatment without resection of the ossification we could reach painless recovery.

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…

Die Primärstabilität von manuell und roboterassistiert implantierten Hüftendoprothesenstielen: eine biomechanische Untersuchung an Kunstfemora

AIM We investigated the initial stability of cementless stems implanted with robotic milling and conventional manual broaching. METHODS Proximally porous structured stems (G2, ESKA-Implants, Luebeck, Germany) were implanted into synthetic femora. In one group, the femoral cavity was prepared by a CT-based robot (CASPAR, URS-Ortho, Germany) with a high-speed milling head. In the other group, femora were rasped manually with broaches. The broaches had 1 mm proximal press-fit, the robotic cavities 1.5 mm. The implants were exposed to 15 000 loading cycles with 1 000 +/- 500 N. The direction of forces on the implant head were chosen to simulate stair climbing. Internal rotation and translation …

Evidenz-basierte Überprüfung der Therapieempfehlungen bei Epicondylopathia humeri lateralis (Tennisellenbogen) - eine Übersicht

The guidelines of the German Orthopaedic Societies regarding the treatment of lateral elbow epicondylitis were analysed on the ground of recently published reviews or randomised placebo-controlled trials (RCT). For the acute phase, reviews or RCTs failed to show a clinical effect beyond placebo if follow-up was extended over 6 weeks. For the chronic phase a current Cochrane review failed to identify any controlled trial regarding surgical procedures during the last decades. Without an adequate control group, it is not possible to draw any meaningful conclusions about the value of this modality of treatment. Therefore surgery is not indicated before repetitive low-energy extracorporeal shock…

Ensemble Averaging and Multiple Statistical Testing of EMG Activities of Cyclically Repeated Body Motions. A Tool for Muscle Function Analysis in Experimental and Clinical Orthopaedics. Ensemblemittelung und multiple statistische Analyse von EMG-Aktivitäten zyklisch wiederholter Körperbewegungen. Ein Instrument der Muskelfunktionsanalyse in der experimentellen und klinischen Orthopädie

Coupled with suitable computerized signal recording and processing methods surface electromyography can be a powerful tool for the analysis of muscle activity in specific body movements. It can be used for this purpose in experimental and in clinical diagnostic orthopaedics as well as in physiotherapy. We describe in this paper a motion analysis system comprising this feature. It has been employed for the diagnosis of the basic angular kinematics and muscle function in human gait and other cyclically repeatable movements of the human locomotive system. Changes in the temporal characteristics of the movements and the muscle activity due to changed physical or experimental conditions can be s…

Analyse der Pfannenveränderungen bei Morbus Perthes mittels Radiomorphometrie

AIM Decreases in depth and irregularity are typical changes of the acetabulum in patients with Perthes disease and develop secondary to the femoral head involvement. Optimal timing of therapy plays an important role to prevent these secondary changes. The present study investigates the influence of the amount of femoral head involvement and the patients' age on the acetabulum and the outcome. METHODS 66 patients with 76 affected hip joints were included in the study. 20 hips had a conservative therapy, 22 an operative therapy (IVO). 34 hip joints underwent a conservative therapy at first, followed by an operative intervention. The radiomorphometric analyses at the time of diagnosis, pre- an…

Experimentelle Untersuchungen zur Reproduzierbarkeit von Ensemble-gemittelten elektromyographischen Ganganalysedaten im Bereich der experimentellen und klinischen Orthopädie / Experimental Investigation on the Reproducibility of Ensemble Averaged Electromyographic Gait Analysis Data in Experimental and Clinical Orthopaedics

With suitable application and signal processing methods, surface electromyography is a comparatively simple instrument for investigating the temporal pattern of the muscular activity of a walking subject. The influence of changes both in the external experimental conditions (e.g. orthopedic shoe design) and in the human locomotor system (due to disease or therapy) on the individual muscular gait characteristics can be documented in this way. The usefulness of this kind of investigation is basically limited by the reproducibility of the gait analytical findings of the subject, who is examined at different times with unchanged bodily state and under identical experimental conditions unchanged…