Orthopadie (Heidelberg, Germany)最新文献

Congenital hip dislocation represents the most severe form of developmental dysplasia of the hip (DDH) and, if left untreated, it leads to permanent functional impairment. Since the nationwide implementation of ultrasound screening in Germany in 1996, the condition can be detected and managed early on. The primary goal of treatment is a stable concentric reduction of the femoral head to allow normal acetabular development. In irreducible hips, operative reduction and additional corrective osteotomies may be required. Early diagnosis, standardized treatment protocols, and close follow-up are essential to achieve optimal long-term outcomes.

Background: Obesity is a well-recognized risk factor for knee osteoarthritis and contributes to the increasing demand for total knee arthroplasty (TKA). Excess body weight alters gait mechanics, increases joint loading, and accelerates degeneration, potentially compromising outcomes. Although cruciate-retaining (CR) and posterior-stabilized (PS) prostheses are widely used, their comparative outcomes in obese patients remain controversial. This study aimed to compare outcomes of CR versus PS prostheses in obese patients undergoing primary TKA.

Methods: A retrospective cohort study included 79 knees from 56 obese female patients (BMI > 30 kg/m²) who underwent cemented primary TKA between 2011 and 2017. All procedures were performed by a single surgeon using the Vanguard® Knee System. Patients were grouped according to implant design. Clinical outcomes were assessed using the visual analogue scale (VAS), Lysholm knee score, and Knee Society score (KSS). Radiological evaluation followed the Knee Society roentgenographic system.

Results: The mean follow-up was 41.3 ± 20.8 months. Both groups showed significant postoperative improvement in all clinical scores (p < 0.01). The PS group achieved greater postoperative range of motion (ROM) (p = 0.035) and higher KSS-knee scores (p = 0.022). No significant differences were observed in VAS, Lysholm, or KSS-function scores. Radiolucent lines were noted in 8.9% of knees without migration or loosening. Prosthesis survival was 100% in both groups.

Conclusion: Both CR and PS implants yield satisfactory outcomes in obese patients undergoing TKA. PS designs may provide superior range of motion and functional recovery. Further prospective studies are needed to confirm these findings.

Background: Cerebral palsy (CP) is one of the most common causes of physical disability in childhood. While the Gross Motor Function Classification System (GMFCS) describes motor abilities, a unified classification for musculoskeletal pathologies was lacking. The newly proposed four-stage system-based on the Mercer Rang model-describes the progression of lower limb pathology and supports diagnosis, treatment planning, and research. STAGE 1: Hypertonia: From birth to about 6 years, spasticity and delayed motor development predominate; contractures are rare. Early intervention and spasticity management (e.g., botulinum toxin) are the focus. STAGE 2: Contractures: Between the ages of 4 and 12 years, discrepancies between muscle-tendon length and bone growth cause a reduced range of motion. Surgical muscle or tendon lengthening may be indicated. STAGE 3: Bony deformities: Bony deformities such as increased femoral anteversion or pes valgus occur simultaneously with soft tissue contractures; rotational osteotomies and combined multilevel surgeries (SEMLS) are often required. STAGE 4: Decompensated pathology: After puberty, irreversible deformities and joint degeneration develop. Surgery usually aims at pain reduction or stabilization (e.g., arthrodesis).

Conclusion: This classification raises awareness of disease progression, helps select stage-appropriate treatments, and may prevent over- or undertreatment. Early recognition and intervention are crucial to avoid decompensation and improve long-term musculoskeletal and functional outcomes.

Background: Differentiating full thickness from partial thickness rotator cuff tears is crucial for optimal surgical planning and clinical decision making. Conventional MRI assessment relies largely on subjective interpretation and may lead to diagnostic variability.

Purposes: This study aimed to develop and validate an MRI-based radiomics model capable of accurately distinguishing full thickness from partial thickness rotator cuff tears and to evaluate its diagnostic performance and potential clinical utility.

Methods: A total of 120 patients were included (full thickness, n = 60; partial thickness, n = 60). Shoulder MRI, with proton density-weighted fat-suppressed imaging as the core acquisition, was used for region of interest segmentation by two radiologists. The IBSI-compliant radiomic features were extracted, preselected by mRMR, and modelled using LASSO regularization. Patients were stratified by class into a training set (n = 84) and an independent testing set (n = 36). Using fivefold cross-validation and a fixed threshold, we evaluated the AUC, accuracy, sensitivity, and specificity in both cohorts.

Results: The final radiomics model comprising five features achieved an AUC of 0.86 (95% confidence interval, CI 0.78-0.94) in the training set and 0.82 (95% CI 0.68-0.96) in the testing set. On the testing set, sensitivity was 0.83 (95% CI 0.61-0.94), specificity 0.61 (95% CI 0.39-0.80), and accuracy 0.72 (95% CI 0.56-0.84).

Conclusion: An interpretable radiomics model derived from routine shoulder MRI reliably distinguishes full from partial thickness rotator cuff tears and shows promise as a quantitative tool for preoperative stratification and decision support.

Gait disturbances are a central sign of underlying hip pathologies in children and adolescents, reflecting muscular insufficiencies, structural deformities, and compensatory strategies. Typical patterns such as Trendelenburg and Duchenne gait exhibit pelvic drop and lateral trunk lean, which can mask functional deficits but may also lead to secondary misloading. Instrumented 3D gait analysis provides objective data on joint angles, muscle activity, and joint loading. Therapy includes long-term physiotherapy, targeted strengthening of the hip abductors, and, if necessary, surgical corrections to optimize leverage and reduce joint stress. Early detection and a differentiated assessment of gait patterns are essential for targeted therapy planning, monitoring progress, and preventing degenerative changes.

Background: Arthroscopy of the finger joints was first described by Chen in the 1970s. Menon (1996) and Berger (1997) published the first articles on arthroscopic treatment of the trapeziometacarpal joint. Since then, the techniques and procedures of arthroscopy of thumb and finger joints have evolved.

Trapeziometacarpal joint: Arthroscopy for the trapeziometacarpal joint was first used to diagnose rhizarthrosis especially in early stages, and therapeutic procedures have been developed. Debridement and synovectomy with capsular shrinkage and arthroscopic hemi- or total resection for advanced rhizarthrosis are complementary minimally invasive adjunctive techniques to the established open surgical procedures.

Metacarpophalangeal joints: The metacarpophalangeal joints are well suited for arthroscopic assessment and treatment, but arthroscopy is rarely performed. For arthroscopic synovialectomy of the metacarpophalangeal joints in rheumatoid arthritis good results have been reported. The treatment of primary and secondary arthrosis, osteochondral lesions, joint stiffness and septic arthritis, as well as arthroscopically assisted procedures are also possible. There are still few publications on this subject in the literature.

Interphalangeal joints: Arthroscopy of the interphalangeal joints is not very common, and only few articles have been published. It is used for therapy-resistant synovialitis in rheumatoid arthritis, primary or secondary osteoarthritis in the early stages and the removal of free joint bodies and the treatment of joint stiffness.

Aim: The article provides an overview of the anatomical basics as well as the diagnostic and therapeutic options of arthroscopy for diagnosis and treatment of the trapeziometacarpal joint and the finger joints.

Robotic-assisted total knee arthroplasty (rTKA) represents a technological advancement aiming to improve implant alignment and soft tissue balancing. Current evidence confirms increased precision and reproducibility; however, no significant benefits have been shown compared to manual TKA (mTKA) regarding functional outcomes, patient satisfaction, or implant longevity. Challenges such as longer operative time and workflow complexity can be mitigated with structured training and process optimization. Registry data and clinical studies so far do not indicate a survival benefit. Nevertheless, robotic systems offer promising advantages in complex anatomies, and individualized alignment strategies. High-quality long-term studies are needed to definitively assess the clinical value of rTKA.

Objective of the surgery: Proximal femur resection with EPR aims to achieve oncological tumor removal while preserving surrounding soft tissue and neurovascular structures, ensuring functional restoration of hip joint stability.

Indications: Malignant bone tumors of the proximal femur, pathological fractures due to tumor involvement, recurrent tumors after previous resection, extensive destruction of the proximal femur due to metastases.

Contraindications: Extensive soft tissue infiltration with inadequate reconstruction potential, generalized metastases without curative treatment options, severe infections in the surgical area, critical general condition prohibiting major surgery.

Surgical technique: A longitudinal skin incision is made, incorporating the biopsy scar. After sequential soft tissue preparation and preservation of neurovascular structures, femoral osteotomy is performed according to preoperative planning. The hip capsule is preserved and reconstructed. The tumor resection is followed by endoprosthetic reconstruction with a modular tumor prosthesis and subsequent soft tissue reconstruction to ensure optimal stability.

Follow-up: Postoperative management includes early functional mobilization with partial weight-bearing. Adjuvant therapy is planned individually based on tumor staging. Regular radiological follow-up is essential for long-term success.

Evidence: EPR following tumor resection is an established procedure with good functional outcomes and oncological safety. Long-term studies demonstrate satisfactory functional results and acceptable complication rates.

Artificial intelligence (AI) offers new opportunities to enhance diagnostics and therapy planning in orthopaedic oncology-a field marked by the rarity of musculoskeletal tumors and associated clinical challenges. This review presents the current state of AI-based image analysis, segmentation, and prognostic modeling, and highlights key applications including differential diagnosis, surgical planning, and workflow optimization. In addition to outlining the technological foundations, the article addresses limitations, ethical concerns, and essential requirements for successful clinical integration. It aims to provide a realistic perspective on both the potential and the limitations of AI in this specialized domain.