Orthopade最新文献

Background: Short stems have constantly gained popularity in primary total hip arthroplasty (THA) over the last decade. Although cementless short stems are not primarily designed to be used as revision implants, there may be certain indications for which downsizing the femoral component in failed conventional THA is potentially advantageous.

Methods: In this single center retrospective case series, six patients who underwent revision using a calcar-guided short stem after failed THA are presented. The mean follow-up was 3.32 years (SD 0.63 years). The health status was evaluated by the EQ-5D-5L score. Patient reported outcome measurements (PROM) were recorded using the Harris hip score (HHS) and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pain and satisfaction were assessed using a visual analogue scale (VAS). Radiographic analysis was performed by evaluating osteolysis, stress shielding, alignment and signs of aseptic loosening. Complications were documented.

Results: At last follow-up the mean EQ-5D-5L index was 0.851 (SD 0.098). Clinical outcome was excellent (HHS ≥ 90) in 4 patients and moderate (HHS 71 and 79) in 2 patients. The mean WOMAC score was 9.20% (SD 12.61%). Pain and satisfaction on VAS were 1.00 (SD 1.15) and 9.17 (SD 0.37), respectively. No major complications occurred. To date, no further revision surgery was needed. Radiologically, no signs of subsidence, aseptic loosening, stress shielding and fractures were obvious.

Conclusion: The present case series indicates that in failed conventional THA downsizing may be considered a treatment option, using short stem THA in selected cases.

Background: Femoroacetabular impingement syndrome (FAIS) is one of the most common prearthritic hip deformities. Since FAIS is a mechanical pathology, surgical correction of the underlying deformity is the sole causal treatment. If surgery is indicated, a surgical technique that results in complete deformity correction with least morbidity should be selected.

Arthroscopy: Due to advancements in techniques and instruments, most pathologies in FAIS can nowadays be addressed arthroscopically. Hip arthroscopy can be successfully performed if the locations of the pathologies are anterior and lateral.

Mini-open approach: In special cases and indications-like periarticular pathologies, pathologies of the hip capsule and large labral reconstructions and transplantations, a combination of arthroscopy with a mini-open approach is advantageous. Furthermore, the learning curve of hip arthroscopy can be improved with an additional open approach.

Surgical hip dislocation: Global and circumferential pathologies still have to be addressed in surgical hip dislocation to avoid residual deformities. Finally, extraarticular osteotomies have to be considered in cases with significant rotational deformities.

Purpose: Two-surgeon, simultaneous bilateral total knee arthroplasty (TKA) is considered as an unpredictable, complex procedure in terms of its radiographic and functional outcomes because of different surgeons and teams, and too many instruments and hands in a narrow space. We compared radiological and functional results of simultaneous bilateral TKA and single-surgeon sequential bilateral TKA.

Methods: The 136 participants with a minimum of 24 months follow-up were prospectively randomized into 2 groups: two-surgeon bilateral TKA and single-surgeon bilateral TKA. We prespecified primary outcome of the study as between-group differences in terms of component alignment in the coronal and sagittal planes. Short-term functional outcomes were evaluated prospectively using the Oxford Knee Score (OKS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

Results: Each group consisted of 136 knees of 68 patients. The mean tibial medial angles (TMA) were 89° ± 3 ° and 88° ± 5° in two-surgeons and single surgeon groups, respectively (p = 0.24). Radiological outcomes showed that the mean femoral lateral angles (FLA) were 87.9 ± 3.5° and 85.84 ± 3.7° (p = 0.12), posterior tibial slope angles (PTSA) were 8.2 ± 16.9° and 7.6 ± 17.8° (p = 0.84), and femoral flexion angles (FFA)were 86.8 ± 3.8° and 86.3 ± 3.5° (p = 0.41), anterior femoral offset ratios (AFOR) (%) were 29.5 ± 11.1 and 27.7 ± 7.9 (p = 0.31), and posterior femoral offset ratio (PFOR) (%) were 108.41 ± 31.3 and 108.45 ± 25.7 (p = 0.98), respectively.

Conclusion: Two-team simultaneous bilateral TKA is as safe as single stage one-surgeon sequential bilateral TKA in terms of short-term component radiological and the functional outcomes.

Background: Femoroacetabular impingement syndrome (FAIS) is a relevant cause of groin pain in adolescents. Athletes are particularly affected.

Objectives: The article shall provide an evidence-based background for FAIS counseling and therapy in adolescents.

Material and methods: On the basis of the current literature, an overview of the prevalence and pathogenesis, evaluation and diagnostics, as well as the therapeutic recommendations for FAIS in adolescents was compiled.

Results and discussion: FAIS in adolescents primarily affects physically active patients. Certain sports favor the development of FAIS. Cam impingement, pincer impingement, and combined FAIS are the most common entities in this age group. Cam morphology occurs shortly before closure of the proximal femoral growth plate. In cam impingement, the slipped capital femoral epiphysis (SCFE) must be distinguished from the primary cam morphology. SCFE requires rapid surgical treatment with stabilization of the epiphysis, while primary cam impingement can be analyzed electively, and conservative treatment is first recommended. Damage to the labrum and cartilage is regularly observed. A systematic radiological evaluation using X‑rays and MRI is mandatory in order to develop an adequate treatment plan. In adolescent patients with FAIS, a conservative attempt at therapy should always be made; if this is unsuccessful, surgical repair with hip arthroscopy is indicated. The postoperative results are very good in adolescents, with a rapid improvement in symptoms, few complications, and a high return-to-sport rate.

During the last two decades femoroacetabular impingement syndrome (FAIS) has gained importance and is one of the main causes of hip pain in young adults. FAIS is a motion-related clinical pathology of the hip that represents symptomatic contact between the proximal femur and the acetabulum. Symptoms, clinical signs, and imaging findings must be present to diagnose FAIS. Especially the development of the cam-FAIS seems to be associated with an overuse of the growth plate during adolescence. Here an approach may be found for the prevention of the development of FAIS. Sufficient evidence through high-quality long-term results is yet lacking.

We present a rare case of clavicle fracture following reverse shoulder arthroplasty (RSA). This complication may be caused by the higher tension of the deltoid muscle after RSA, similarly to stress fractures of the acromion. Associated bone disease, i.e. osteoporosis, may contribute. In the few case reports available, the affected patients showed significant functional impairments. In the current case, the fracture was addressed with plate fixation. Despite good intraoperative results, osteosynthesis failure with secondary dislocation of the fracture occurred.

Background: Properly performed high-quality imaging is critical in the diagnosis of femoroacetabular impingement syndrome (FAIS). Currently, conventional imaging in the form of an anteroposterior view of the pelvis and at least a second view is still the first step in the diagnosis of FAIS. Here, by determining the various parameters, the acetabular configuration should also be accurately assessed with regard to a combination with dysplasia or acetabular retroversion. MRI: MRI should also be demanded as standard before joint-preserving surgery. It allows for more precise detection of morphology, secondary chondrolabral damage, and thus helps identify outcome-relevant risk factors and cases that are too advanced in terms of degenerative aspects.

Other imaging methods: Depending on the problem, MRI can be supplemented by intravenous or intra-articular application of contrast agents (indirect or direct MRA), determination of torsion, and, if necessary, even with the performance of a traction MRA. While the importance of invasive MRA has decreased due to the improvements of 3‑Tesla scanners in clinical practice, rotational analysis has gained in importance. Computed tomography (CT), although associated with increased radiation exposure, allows high-resolution imaging of bony structures and extremely illustrative 3D planning of complex corrections, and is an alternative to MRI for this purpose or in contraindications.

Prospects: 4D simulations appear useful and may make diagnostics and therapy planning safer and easier in the future. Thus, a broad portfolio of imaging techniques is available today, the advances of which have contributed significantly to the development of differentiated joint-preserving surgery of the hip joint.

Femoroacetabular impingement syndrome (FAIS) surgery aims to restore the natural anatomical relationships between bones and the soft tissues comprising the hip joint. Most cartilage repair methods for the hip are based on basic science and strategies that were developed for the knee. Currently, there is a lack of information in the literature regarding systematic reviews on evidence-based options in treating cartilage injuries of the hip joint. The aim of this article is to assess treatment options and their related outcomes for chondral injuries in the hip based on the available evidence whilst highlighting new and innovative techniques.