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ABSTRACT The aim of this study was to evaluate the response of the femoral head to intraosseous pressure increases and to document blood flow of periarticular soft tissue after infusion of vasoactive substances. Beside that the value and... more
ABSTRACT The aim of this study was to evaluate the response of the femoral head to intraosseous pressure increases and to document blood flow of periarticular soft tissue after infusion of vasoactive substances. Beside that the value and imagery of native MRI after induced intraosseous pressure increase should be estimated for early detection of femoral head necrosis. The alteration of intraosseous pressure and peripheral blood flow of the femoral head of beagle dogs was examined after administration of bradykinin as a vasoactive substance followed by subsequent magnetic resonance imaging (MRI). Bradykinin was injected into the arteriae circumflexae femoris lateralis and medialis of six beagle dogs. The administrations were made using a standard protocol with simultaneous measurement of venous blood flow and intraosseous pressure distribution in the epiphysis of the femoral head. Bradykinin was applied in regular time intervals followed by MRI. At a mean epiphyseal pressure 14.66 mmHg (sigma: 2.42) in the femoral head, a mean flow of 91.6 ml/min (sigma: 16.08) was measured in the vena femoralis. After an administration of a defined concentration of bradykinin an increased epiphyseal pressure was recorded in the measured area. An average increase blood flow of the vena femoralis was observed at the beginning of the bradykinin-injection, followed by a circulatory volume reduction. The post-experimental MRIs showed massive oedema in the femoral musculature after bradykinin-application, however without osseous signal alterations in T1- or STIR-weighted images. Our results indicate that acute intraosseous pressure increases are not accompanied by signal alterations in MRI. Obviously more extensive pressure induced lesions are necessary for detectable signal alterations, as these have already been demonstrated in patients with diagnosed femoral head necrosis.
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Tripolar cups can be separated into constrained and unconstrained dual-mobility cups. The latter show better survival and revision rates. The main problem is the polyethylene wear. Therefore modern types of polyethylene are used in these... more
Tripolar cups can be separated into constrained and unconstrained dual-mobility cups. The latter show better survival and revision rates. The main problem is the polyethylene wear. Therefore modern types of polyethylene are used in these cups. The indications for dual-mobility cups are recurrent dislocation and situations where the risk of dislocation is increased.
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Summary Reconstructive surgery with an ankle prosthesis for a painful ankle joint is of extreme benefit for the rheumatoid patient. In contrast to ankle fusion, ankle arthroplasty maintains mobility with early remobilisation of the... more
Summary Reconstructive surgery with an ankle prosthesis for a painful ankle joint is of extreme benefit for the rheumatoid patient. In contrast to ankle fusion, ankle arthroplasty maintains mobility with early remobilisation of the patient. The success of ankle arthroplasty depends on indication, implant design and surgical technique as well as postoperative treatment. The performance of the first ankle prosthesis generation,
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In this study 17 patients with recurrent dislocation of the patella were followed up 10 years after their Goldthwait operation. The subjective and clinical findings were excellent or good in 70%. X-radiographs indicated osteoarthritis of... more
In this study 17 patients with recurrent dislocation of the patella were followed up 10 years after their Goldthwait operation. The subjective and clinical findings were excellent or good in 70%. X-radiographs indicated osteoarthritis of the femoropatellar joint in 60%. Concerning the aetiopathological factors, we found an increased external torsion of the afflicted extremity (measured by computed tomography).
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Experimental animal studies and clinical investigations show three processes going on during extremity lengthening with the Ilizarov-method. At first degenerative changes including cell necroses in the muscles, the nerves and the tendons... more
Experimental animal studies and clinical investigations show three processes going on during extremity lengthening with the Ilizarov-method. At first degenerative changes including cell necroses in the muscles, the nerves and the tendons [corrected] occur as well as denervation of muscle fibers resulting in neurogenous muscle atrophies. These alterations are followed by reperative and regenerative processes as well as the reinnervation of the denervated muscle fibers. Secondly histoneogenesis occur which leads to a high increase of tissue-specific cells and a growth of the muscles, tendons and vessels. Therefore tensile-stress is an important factor of tissue growth. Thirdly adaptive processes proceed during leg lengthening. For example the high biosynthetic activity during tissue growth seems to indicate an increase of vasa vasorum.
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Research Interests: Pathology, Flow Cytometry, Biology, Cell Cycle, Immunohistochemistry, and 15 moreRheumatoid Arthritis, Macrophages, Medicine, DNA, Humans, Histopathology, Macrophage, Comparative Analysis, CD, Clinical Sciences, Biological markers, Immunophenotyping, Cell Proliferation, fibroblasts, and Synovial membrane
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Eigene tierexperimentelle und klinische Studien zeigten, daû in den Weichgeweben bei der Extremitätenverlängerung nach dem Ilizarov-Prinzip 3 verschiedene Prozesse nebeneinander ablaufen: 1. treten Weichteilschädigungen mit degenerativen... more
Eigene tierexperimentelle und klinische Studien zeigten, daû in den Weichgeweben bei der Extremitätenverlängerung nach dem Ilizarov-Prinzip 3 verschiedene Prozesse nebeneinander ablaufen: 1. treten Weichteilschädigungen mit degenerativen Prozessen bishin zu Zellnekrosen in den Muskeln, den Nerven und den Sehnen sowie Denervierungen der Muskelfasern mit daraus resultierenden neurogenen Muskelatrophien auf. Diese werden von Regenerationsbzw. Reparationssowie von Reinnervationsprozessen gefolgt. 2. finden Histoneogeneseprozesse statt, die so ausgeprägt sind, daû sie zu einem Gewebewachstum mit Vermehrung der gewebespezifischen Zellen in der Muskulatur, den Sehnen und Gefäûen führen. Hieraus kann gefolgert werden, daû ein kontinuierlicher, kleinschrittiger Zugreiz ein wichtiger Stimulator für das Gewebewachstum darstellt. 3. kommt es zu adaptiven Prozessen. Hierzu zählen die Vermehrung der Vasa vasorum, die der Anpassung an einen erhöhten Sauerstoffbedarf bei Wachstumsprozessen dienen dürfte.
Research Interests: Medicine and Gynecology
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ZusammenfassungFür die Behandlung von periprothetischen Infektionen von Schulterendoprothesen existieren verschiedene therapeutische Konzepte. Bei akuten periprothetischen Infektionen kann das Implantat belassen werden, alle mobilen Teile... more
ZusammenfassungFür die Behandlung von periprothetischen Infektionen von Schulterendoprothesen existieren verschiedene therapeutische Konzepte. Bei akuten periprothetischen Infektionen kann das Implantat belassen werden, alle mobilen Teile (Inlay) sollten bei einem offenen Débridement gewechselt werden und Spülungen mit antibakteriellen Lösungen wie Octinedin oder Polyhexanid durchgeführt werden. Bei Spätinfektionen sind die therapeutischen Optionen nach der Entfernung des infizierten Implantats: Einlage eines permanent verbleibenden Spacers, die Resektionsarthroplastik, einzeitige und zweizeitige Wechsel mit und ohne temporären Spacer. Die funktionellen Ergebnisse sind beim einzeitigen Wechsel am besten und die Eradikationsrate vergleichbar mit derjenigen beim zweizeitigen Wechsel. Voraussetzung für den einzeitigen Wechsel ist die Identifizierung des Keimes, um zielgerichtete Antibiotika in den Zement beizumischen und systemisch zu verabreichen.
Research Interests: Medicine and Gynecology
Introduction Synovectomy in children with juvenile rheumatoid arthritis (JRA) and psoriatic arthritis (PSA) is still subject of controversial discussion. Our results of arthroscopic synovectomy of the knee in children with chronic... more
Introduction Synovectomy in children with juvenile rheumatoid arthritis (JRA) and psoriatic arthritis (PSA) is still subject of controversial discussion. Our results of arthroscopic synovectomy of the knee in children with chronic inflammatory joint disease are presented. Material From 1989–1997 27 synovectomies were performed in 27 children with inflammatory arthritis (15 JRA, 12 PSA). Average age at surgery was 12. 5 y (2. 9–17. 8 y). Mean follow-up was 4. 9 years. Methods Onset of disease and conservative therapy was documented. Each patient was physically and radiologically examined preoperatively and 24 children postoperatively (mean follow-up 4. 9 years). For arthroscopic shaver-assisted synovectomy of the knee we used minimum 4 portals and normally 6 portals (2 anterior, 2 suprapatellar and 2 posterior portals). In addition to the physical examination we used a special clinical score (Laurin 1974). We compared the pre- and postoperative limits of active and passive knee movem...
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Die Druckscheibenprothese stellt ein Huftendoprothesenkonzept dar, bei dem die Prothese im metaphysaren Bereich des Femurs zementlos fixiert wird (Bereiter 1991, Huggler et al. 1980). Hierdurch bleibt der diaphysare Femurknochen... more
Die Druckscheibenprothese stellt ein Huftendoprothesenkonzept dar, bei dem die Prothese im metaphysaren Bereich des Femurs zementlos fixiert wird (Bereiter 1991, Huggler et al. 1980). Hierdurch bleibt der diaphysare Femurknochen unberuhrt. Deshalb wird dieser Prothesentyp von einigen Arbeitsgruppen bei Patienten unterhalb des sechzigsten Lebensjahres gegenuber den Stielprothesen bevorzugt. Der Vorteil der Druckscheibenprothese kommt bei dem Prothesenwechsel zu tragen, den Patienten dieses Alters mit sehr groser Wahrscheinlichkeit im spateren Leben benotigen werden, in dem der ungeruhrte diaphysare Knochen fur die Fixation der neuen Prothese in ungeminderter Qualitat verwendet werden kann (Huggler et al. 1993, Bereiter et al. 1991, Menge 1997).
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We evaluated the X-rays of 36 patients who underwent 50 callus distractions. With the aid of a computerized digitalisation system for analogue films, the relative X-ray density of the distraction area was calculated for each X-ray. These... more
We evaluated the X-rays of 36 patients who underwent 50 callus distractions. With the aid of a computerized digitalisation system for analogue films, the relative X-ray density of the distraction area was calculated for each X-ray. These relative X-ray densities were figured graphically for the duration of treatment for each patient. In the consolidation phase, the graph of each patient had a logarithmic relationship. The gradients of the logarithmic density curves were considered an indicator of the quantity of new bone formation. These gradients were correlated to the following clinical parameters: age of the patient, beginning of distraction after corticotomy, average speed of distraction, average weight bearing during the distraction and consolidation phase, location of corticotomy (distal femur versus proximal tibia) and diclofenac medication. Except for the location of the corticotomy and diclofenac, all parameters had an influence on osteoneogenesis by callus distraction. The...
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ABSTRACT In der Literatur finden sich sehr unterschiedliche Komplikations- und Lockerungsraten von Hüftendoprothesen bei Patienten mit Hüftkopfnekrose (HKN). Diese Schwankungen sind v. a. durch die inhomogene Zusammensetzung der... more
ABSTRACT In der Literatur finden sich sehr unterschiedliche Komplikations- und Lockerungsraten von Hüftendoprothesen bei Patienten mit Hüftkopfnekrose (HKN). Diese Schwankungen sind v. a. durch die inhomogene Zusammensetzung der Patientengruppen hinsichtlich der Ätiologie der Hüftkopfnekrose bedingt. Untersucht man die Ergebnisse der Hüftendoprothesen für die verschiedenen HKN-Ätiologien gesondert, so kristallisiert sich eine höhere Lockerungsrate bei steroidinduzierten Hüftkopfnekrosen und bei Hüftkopfnekrosen mit einer biologischen und biomechanischen Knochenalteration (z. B. der renalen Osteopathie oder der Sichelzellanämie) heraus. Grunderkrankungen, die einer Immunsuppression bedürfen und die Sichelzellanämie weisen höhere Infektionsraten von Hüftprothesen auf. Somit spielt die Ätiologie der Hüftkopfnekrose eine entscheidende Rolle für Langzeitergebnisse von Hüftendoprothesen. Moderne Zementiertechniken der 2. Generation und zementlose Hüfttotalendoprothesen scheinen bessere Ergebnisse zu liefern als früher verwendete Prothesenmodelle bzw. Zementiertechniken. In einer prospektiven Studie konnten wir bisher 52 Druckscheibenprothesen bei 45 Patienten mit Hüftkopfnekrosen und einem Mindestnachuntersuchungszeitraum von 2 (3,7 ± 1,6) Jahren postoperativ verfolgen. Es ergab sich eine Versagerquote von 9,6 % (je eine aseptische Lockerung bei renaler Osteopathie und Alkoholismus sowie 3 Infektionen bei Alkoholismus und renaler Osteopathie). Zusätzlich zeigten 5 Prothesen (9,6 %) Röntgensäume von mindestens 2 mm Breite. Inwieweit dieses Prothesenmodell mit metaphysärer Fixierung gegenüber den herkömmlichen Stielprothesen bei den jungen Hüftkopfnekrosepatienten Vorteile erbringen, müssen zukünftige Studien mit längeren Beobachtungszeiten zeigen. In literature, the results of hip arthroplasty in patients with avascular osteonecrosis of the femoral head vary. The main reason may be the nonhomogeneous patient groups concerning etiology of the femoral head necrosis (FHN). Analyzing the results of hip endoprosthesis in relation to the etiology of FHN leads to the assumption that steroid-induced FHN and FHN with underlying systemic bone diseases (renal osteodystrophy, sickle-cell hemoglobinopathy) have the highest loosening rates. Diseases with immunosuppressive medication and sickle-cell hemoglobinopathy have the highest risk of joint infection. Therefore etiology plays an important role in the long-term results of hip endoprostheses in FHN. Modern cement techniques of the second generation and new non-cemented total hip endoprostheses seem to have better results than older prostheses and cement techniques. We followed-up 52 non-cemented thrust plate prostheses in 45 patients with FHN, prospectively, for at least 2 years (3.7 ± 1.6 years). The revision rate was 9.6 % (two aseptic loosenings in one patient with renal osteodystrophy and one patient with alcohol abuse, as well as three late infections in one patient with alcohol abuse and two patients with renal osteodystrophy). Additionally, five prostheses showed radiologic lines of a minimum of 2 mm. Future studies with longer follow-up are needed to find out whether these prosthetic designs with proximal fixation of the femoral component preserving the diaphysial bone have advantages in young FHN patients.
Research Interests: Medicine and Gynecology
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UNLABELLED: Based on the results of a retrospective study of 50 patients with mild lateral tracking and lateral compression of the patella (32 patients) and recurrent patellofemoral dislocation (18 patients), we present the technique, the... more
UNLABELLED: Based on the results of a retrospective study of 50 patients with mild lateral tracking and lateral compression of the patella (32 patients) and recurrent patellofemoral dislocation (18 patients), we present the technique, the results, the complications and the indications for the endoscopic lateral retinacular release and medial drawing tight of the capsule. The average age of the patients was 28.8 years (range: 10-53). At time of follow-up (m = 51 months) the patients were examined clinically as well as radiologically. The results were scored according to a score by Crosby and Insall. 73% of the patients with mild lateral tracking and lateral compression (lateral release) were satisfied with the operative results (visual analogue scale), as well as 66.6% of the patients with recurrent patellofemoral dislocation (lateral release and medial drawing tight of the capsule). Only 40% of the patients with patellofemoral arthritis (lateral release) reported about an improvement of this procedure. The score showed significantly good results but didn't raise the differences in between the groups of different indications. 28% of the patients showed an abnormal lateral tracking of the patella in active motion, the passive patella-glide-test (Hughston) raised a patella-hypermobility to the lateral side in 36% of the cases and to the medial side in 76%. X-rays of both knees showed an increased lateral patellofemoral angle of 10.8 degrees and an increased sulcus angle of 144 degrees. There was no progression in osteoarthritis in the operated side of the patellofemoral joint found. Complications revealed in a high number of hemarthrosis right after the operation, in 2 cases an open revision was necessary. CLINICAL RELEVANCE: According to our results patients with patella compression syndrome without patellofemoral arthritis and patients with recurrent luxation or subluxation of the patella are good candidates for endoscopic lateral release and eventually medial drawing tight of the capsule. In a young population the endoscopic lateral release is a relatively simple surgical procedure making an open technique in failed cases possible.
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Not only the anatomical circumstances and/or the pathomechanical conditions at the proximal end of the femur are of special significance for the long-term behaviour of the thrust plate prosthesis (TPP), but also inherent properties of the... more
Not only the anatomical circumstances and/or the pathomechanical conditions at the proximal end of the femur are of special significance for the long-term behaviour of the thrust plate prosthesis (TPP), but also inherent properties of the bone itself and its reactions to the altered load pattern. The increasing density of bone beneath the thrust plate over time can be radiologically detected [3, 4,15,16]. Where primary or secondary disease of the bone is present, the question of “bone quality” in the areas of the femoral metaphysis and diaphysis also needs to be addressed. In these cases it cannot be taken for granted that the periprosthetic bone can withstand the altered mechanical loads or that it is capable of adjusting sufficiently to the changed load pattern. Particular attention must be paid to this aspect in prostheses that are metaphysially anchored.
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Based on the results of a retrospective study of 67 patients with diagnostic and surgical arthroscopy of the elbow from 1977 until 1991, we present our technique, results, complications, and indications for elbow arthroscopy. The average... more
Based on the results of a retrospective study of 67 patients with diagnostic and surgical arthroscopy of the elbow from 1977 until 1991, we present our technique, results, complications, and indications for elbow arthroscopy. The average age of the patients was 26 years (range: 11-59). At the time of follow-up the patients were examined clinically as well as radiologically. The results were scored according to Figgie's score, which is based on the criteria of pain, function, power and range of motion. The overall score significantly increased from 61.6 preoperatively to 85.3 postoperatively. The age of the patient did not influence the results. However, patients who were laborers had a poorer outcome than the others. Patients with preoperative pain for 2 months to two 2 years had better results than patients with a preoperative course of more than 2 years.
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Ten dogs were provided with a circular fixator. Segment resection of the fibula and tibial osteotomy in the right lower leg was performed. 5 days after surgery, a lengthening of the right lower leg by 2.5 cm was performed on 6 dogs using... more
Ten dogs were provided with a circular fixator. Segment resection of the fibula and tibial osteotomy in the right lower leg was performed. 5 days after surgery, a lengthening of the right lower leg by 2.5 cm was performed on 6 dogs using a distraction rate of 0.5 mm, twice per day. 3 dogs with leg lengthening and 2 dogs of the control group without leg lengthening were sacrificed at the end of the distraction phase of 25 days and the remaining dogs after another 25 days. Postmortally the tendons of the tibialis anterior, extensor digitorum longus, peroneus longus and the achilles tendon were taken from the operated right side and the left non-operated control side and were examined biomechanically in cyclic tests. The control group without lengthening showed no changes in the biomechanical properties in the tendons of either side nor in those of the unlengthened left side of the operated dogs. In contrast the biomechanical tests revealed a marked decrease of the elastic modulus, an increase of distraction length and an increase of modulus reduction on the lengthened side compared to the non-operated left side.
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After kidney transplantation 58 patients were examined for correlation of the incidence of appearance of avascular necrosis of the femoral head with various parameters. The only parameter which showed a significant correlation to the... more
After kidney transplantation 58 patients were examined for correlation of the incidence of appearance of avascular necrosis of the femoral head with various parameters. The only parameter which showed a significant correlation to the appearance of avascular necrosis of the femoral head, was the amount of corticosteroids given systemically.
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Aim: The incidence of periprosthetic joint infections (PJI) following aseptic knee revision arthroplasty lies between 3% and 7.5%. The aim of this study was to verify the hypothesis that the use of dual-antibiotic-impregnated cement in... more
Aim: The incidence of periprosthetic joint infections (PJI) following aseptic knee revision arthroplasty lies between 3% and 7.5%. The aim of this study was to verify the hypothesis that the use of dual-antibiotic-impregnated cement in knee revision arthroplasty leads to a lower rate of periprosthetic joint infections. Methods: We retrospectively reviewed 403 aseptic revision knee arthroplasties performed between January 2013 and March 2021 (148 revisions of a unicompartmental prosthesis, 188 revisions of a bicondylar total knee arthroplasty (TKA), 41 revisions of an axis-guided prosthesis, and 26 revisions of only one component of a surface replacement prosthesis). The bone cement Copal G+C (Heraeus Medical, Wertheim, Germany) with two antibiotics—gentamycin and clindamycin—was used for the fixation of the new implant. The follow-up period was 53.4 ± 27.9 (4.0–115.0) months. Results: Five patients suffered from PJI within follow-up (1.2%). The revision rate for any reason was 8.7%....
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Background: Synovitis, like that associated with chronic bacterial arthritis, is a very rare finding during the implantation of knee endoprostheses. In such cases, we fix the knee prostheses with cement containing two antibiotics and... more
Background: Synovitis, like that associated with chronic bacterial arthritis, is a very rare finding during the implantation of knee endoprostheses. In such cases, we fix the knee prostheses with cement containing two antibiotics and carry out a course of systemic antibiotic administration. The aim was to analyze these cases for incidence, detection of bacteria, risk factors, and outcome. Methods: Out of 7534 knee replacements between January 2013 and December 2020, 25 cases were suspected during the surgical procedure to have suffered from bacterial arthritis and were treated accordingly. Total synovectomy was carried out, whereby five intraoperative synovial samples were examined bacteriologically, and the complete synovitis was analyzed histologically. The mean follow-up was 65.3 ± 27.1 (24–85) months. Results: In nine cases (0.12%), the diagnosis of bacterial arthritis was made histologically and by clinical chemistry (elevated CRP), and in two of these cases, pathogen verificat...
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Tecnica quirurgica Exposicion ventral del femur por delante del borde lateral de la linea aspera en el septum intermuscular. Perforacion de orificios de 3,2 mm en los extremos ventral y dorsal de la tapeta osea planificada. Osteotomia del... more
Tecnica quirurgica Exposicion ventral del femur por delante del borde lateral de la linea aspera en el septum intermuscular. Perforacion de orificios de 3,2 mm en los extremos ventral y dorsal de la tapeta osea planificada. Osteotomia del femur por delante de la union del musculo vasto lateral al gluteo medio. Osteotomia dorsal asi como osteotomia transversal distal entre los orificios perforados y osteotomia distal ventral. Se completa la osteotomia ventral con un osteotomo dirigido de ventral distal a ventral proximal bajo el musculo vasto lateral. Se levanta la tapeta de femur osteotomizada con la insercion muscular. Colocacion del vastago modular no cementado de revision y fijacion de la tapeta osea con cerclajes dobles.
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BACKGROUND: The aim of this anatomic study was to analyse the spread of anatomic parameters of the elbow and to examine how these parameters are considered in the design of the most commonly used elbow endoprostheses. METHOD: The bones of... more
BACKGROUND: The aim of this anatomic study was to analyse the spread of anatomic parameters of the elbow and to examine how these parameters are considered in the design of the most commonly used elbow endoprostheses. METHOD: The bones of the humerus, ulna and radius of 46 adult cadavers (m/f 1.15:1) as well as 184 radiographs of the elbow (m/f 1.13:1) were analysed and anatomic parameters were compared to these of 9 elbow endoprostheses. The average age of the anatomic group was 76.9 (49 - 96) years and of the radiological group 56.4 (29 - 100) years. A total of 85 anatomic parameters were defined. For the 9 elbow endoprostheses 19 parameters were analysed and 8 parameters were used to assess the anatomic fit of the prostheses. RESULTS: There was a significant difference in the gender of the patients but not on the side of the elbow. The anatomic parameters of the elbow prostheses were mostly out of or in the left side of the histogram. The endoprotheses with the best fit reached 63 % of the points for anatomic fitting. The angles between the axis of the shaft and the axis of motion are 4.5° for the humerus and 8° for the ulna and are not mentioned in most protheses. The interepicondylar distance has a high correlation to the other anatomic parameters and can serve as a predictor for the preoperative planning of the humeral component size. CONCLUSION: The numbers of component sizes are too small to fit the anatomic variability of the elbow. Thus 5 sizes of the components are suggested.
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In case of failure of conservative treatment, painful ankle-joint destruction can be treated by either arthrodesis or arthroplasty. Our personal experience is almost exclusively limited to patients with rheumatoid arthritis (RA). Most of... more
In case of failure of conservative treatment, painful ankle-joint destruction can be treated by either arthrodesis or arthroplasty. Our personal experience is almost exclusively limited to patients with rheumatoid arthritis (RA). Most of them are in a difficult situation due to disease with polyarticular affection. In approximately 40% of these patients, the ankle joint is affected; very frequently, bilaerally [9]. These patients will cope very badly with a bilateral arthrodesis. The necessary long-standing plaster fixation causes serious problems for them. Due to the bad quality of the frequently osteoporotic bone, the risk of non-union is greatly increased.
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Aim of study The concept of a new developed cup arthroplasty (Durom-Cup) is the replacement of the destroyed joint surface with minimal bone resection. In cases of additional cuff arthropathy the cup can be placed in a more valgic... more
Aim of study The concept of a new developed cup arthroplasty (Durom-Cup) is the replacement of the destroyed joint surface with minimal bone resection. In cases of additional cuff arthropathy the cup can be placed in a more valgic position to articulate with the glenoid and the acromion. The aim of this prospective study was to evaluate the results of this surface replacement as a hemiarthroplasty in rheumatoid arthritis with and without cuff arthropathy. Material and Methods 35 Durom-Cups of 29 patients (23 woman, 6 men) with rheumatoid arthritis were evaluated preoperatively and every 3 months postoperatively. 7 of these shoulders additionally had cuff arthropathy. The average age was 61. 6 ± 11. 8 years and the average follow-up 33. 4 ± 11. 8 months. The Constant-Score and SAS-function-Score were used and the cups were examined radiologically. Results In rheumatic shoulders without cuff arthropathy the Constant-Score increased from 20. 6 ± 9. 5 points preoperatively to 47. 1 ± 14...
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Aims Biopsy of the periprosthetic tissue is an important diagnostic tool for prosthetic joint infection (PJI) as it enables the detection of the responsible microorganism with its sensitivity to antibiotics. We aimed to investigate how... more
Aims Biopsy of the periprosthetic tissue is an important diagnostic tool for prosthetic joint infection (PJI) as it enables the detection of the responsible microorganism with its sensitivity to antibiotics. We aimed to investigate how often the bacteria identified in the tissue analysis differed between samples obtained from preoperative biopsy and intraoperative revision surgery in cases of late PJI; and whether there was a therapeutic consequence. Methods A total of 508 patients who required revision surgery of total hip arthroplasty (THA) (n = 231) or total knee arthroplasty (TKA) (n = 277) because of component loosening underwent biopsy before revision surgery. The tissue samples collected at biopsy and during revision surgery were analyzed according to the criteria of the Musculoskeletal Infection Society (MSIS). Results In total, 178 (113 THA, 65 TKA) were classified as infected. The biopsy procedure had a sensitivity of 93.8%, a specificity of 97.3%, a positive predictive va...
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Background Preoperative diagnosis of periprosthetic joint infection (PJI) is important because of the therapeutic consequences. The aim of the present study is to investigate whether the serum C-reactive protein (CRP) level can be used as... more
Background Preoperative diagnosis of periprosthetic joint infection (PJI) is important because of the therapeutic consequences. The aim of the present study is to investigate whether the serum C-reactive protein (CRP) level can be used as a screening tool for late PJI. Materials and methods A cohort of 390 patients with revision surgery of total hip prostheses (200) or total knee prostheses (190) was assessed for late PJI by determining CRP serum level and performing preoperative aspiration with cultivation and intraoperative tissue analyses with cultivation and histologic examination, using the Musculoskeletal Infection Society (MSIS) and International Consensus Meeting (ICM) criteria. Results A total of 180 joints were rated as PJI (prevalence 46%). Of these, 42.8% (77) showed a CRP level below 10 mg/L and 28.3% (51) showed a normal CRP level of less than 5 mg/L. The 76.9% of the cases with slow-growing bacteria showed a CRP level below 10 mg/L, and 61.5% showed a normal CRP level...
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ABSTRACT
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ZusammenfassungHintergrundZu den Ergebnissen der Schulterendoprothetik im Langzeitverlauf bei Patienten mit rheumatoider Arthritis (RA) ist wenig bekannt. Das Ziel dieser Studie war die Evaluation der Ergebnisse nach zementiertem... more
ZusammenfassungHintergrundZu den Ergebnissen der Schulterendoprothetik im Langzeitverlauf bei Patienten mit rheumatoider Arthritis (RA) ist wenig bekannt. Das Ziel dieser Studie war die Evaluation der Ergebnisse nach zementiertem Oberflächenersatz des proximalen Humerus als Hemiprothese bei Patienten mit RA nach mindestens 10 Jahren postoperativ.Patienten und MethodenIm Zeitraum 1997–2000 wurden 42 zementierte Oberflächenersatz-Hemiprothesen bei 35 Patienten (Durchschnittsalter 61 Jahre) implantiert und in eine prospektive Verlaufsbeobachtungsstudie mit Follow-up nach 3, 12, > 60 und > 120 Monaten eingeschlossen. Nach 131 ± 21 Monaten konnten 16 Schultern (14 Patienten, Durchschnittsalter 70,9 Jahre) radiologisch und klinisch mittels Constant Murley Score (CMS) evaluiert werden. Sieben Patienten waren nicht reisefähig und wurden mittels CMS-Selbstevaluationsbogen sowie übermittelten Röntgenaufnahmen radiologisch erfasst.ErgebnisseDer mittlere CMS betrug 62,6 ± 10,6 Punkte (präoperativ 20,8 ± 8,3). Mit dem Behandlungsergebnis „zufrieden“ oder „sehr zufrieden“ waren 88 % der Patienten. Radiologisch zeigte sich eine deutliche Zunahme der proximalen Migration des Drehzentrums sowie der zentralen Glenoidarrosion (Glenoidtiefe). Die radiologischen Veränderungen korrelierten weder mit dem CMS noch mit der subjektiven Patientenzufriedenheit.SchlussfolgerungDer zementierte Oberflächenersatz des proximalen Humerus als Hemiprothese stellt für ältere Patienten mit RA der Schulter eine sinnvolle Versorgungsoption dar.AbstractBackgroundLittle is known about the long-term results of shoulder arthroplasty in patients with rheumatoid arthritis (RA). The goal of the present study was the clinical and radiological evaluation of a cemented resurfacing of the humeral head in patients with RA after a minimum follow-up of 10 years.Patients and methodsFrom 1997–2000 a total of 42 cemented humeral head resurfacing hemi-arthroplasties were performed in 35 patients with RA (average age 61 years) and included in a prospective long-term observational study with follow-up evaluations at 3, 12, > 60 and > 120 months postoperatively. At an average of 131 ± 21 months 16 shoulders (14 patients, average age 70.9 years) could be evaluated by the Constant Murley score (CMS) and standard radiographs. For seven patients who were unable to attend hospital a CMS self-evaluation form was used and X-rays were made elsewhere and sent for analysis.ResultsThe average total CMS was 62.6 ± 10.6 points (pre-operative 20.8 ± 8.3 points) and 88 % of the patients were satisfied or very satisfied with the results. Radiographically, a progressive proximal migration of the center of rotation and a continuous increase of the glenoid depth were observed between 3 and 130 months post-operatively. However, the radiographic progression did not correlate with either CMS values or with patient satisfaction.ConclusionsThe cemented humeral head resurfacing as a hemi-arthroplasty represents a valuable option for the treatment of advanced shoulder RA in elderly patients.
Research Interests: Medicine and Gynecology
The physiological phenomenon of changes in callus formation during distraction was first described by Codivilla at the beginning of this century. Having investigated and proved the influence of tension stress on callus formation, Ilizarov... more
The physiological phenomenon of changes in callus formation during distraction was first described by Codivilla at the beginning of this century. Having investigated and proved the influence of tension stress on callus formation, Ilizarov used this as a method to treat limb shortening and deformities. Because of his remarkable results we introduced this method in our hospital in 1990, using the original Ilizarov ring fixator. From November 1990 to December 1991, we used this technique in 10 cases of combined post-traumatic bone shortening with deformity (the tibia was affected in six patients, the femur in three and the forearm in one). The mean shortening was 3.1 cm, the mean varus or valgus deformity 9.5 degrees, the mean anteflexion or recurvation 8.3 degrees, and the mean rotation deformity 8.5 degrees. Distraction/correction lasted between 8 and 55 days (mean: 37 days). Fixation was necessary for between 60 and 339 days. If corticotomy was performed in the diaphyseal bone, fixa...
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The Ilisarov ring fixator is an extremely versatile external fixation device. There is a wide range of indications for its use, e.g. fractures, pseudarthroses and non-unions, large defects, deformities and limb shortening. The device... more
The Ilisarov ring fixator is an extremely versatile external fixation device. There is a wide range of indications for its use, e.g. fractures, pseudarthroses and non-unions, large defects, deformities and limb shortening. The device consists of rings or half-rings, which are connected to each other by threaded rods or plates and to the bone by wires under tension. This design allows neutral fixation, compression or distraction of the bone fragments. Because of its low axial stiffness at low loads and increased stiffness at higher loads, this fixator promotes osteogenesis and reduces strain on the tissues in functional treatment. Surgical intervention for its application is minimally invasive. This is a useful addition to the orthopaedic surgeon's armamentarium, providing proper attention is paid to preoperative planning, the principle rules of frame design and wire insertion technique, and postoperative management.