Zeitschrift fur Orthopadie und ihre Grenzgebiete最新文献

Aim: Ruptures of the distal tendon of the biceps muscle should be treated operatively. A minimally invasive technique and the use of suture anchors may decrease the intraoperative risks. But can satisfactory clinical results be achieved?

Method: We present the results of a clinical study. Between 1999 and 2005 nine patients were operated for distal biceps tendon avulsion. A minimally invasive operating technique using a suture anchor was established and the technique is described. Rantanen and Orava's score was used to compare clinical and radiological findings.

Results: Clinical follow-up was performed at 6 months after operation. In six patients excellent results according to Rantanen and Orava were achieved. No loss of strength was noticed in 6 of 9 cases. Range of motion was unlimited in six patients. In two cases we found heterotopic ossifications.

Conclusion: On the basis of our results we suggest that minimally invasive surgery using a suture anchor should be performed more often. The technique described leads to results that are comparable to those found in the literature.

Aim: Evidence-based medicine is still discussed controversially. The current literature offers a huge amount of tables, recommendations and modifications for the levels of evidence and degrees of recommendations. The scientist who is critical of new techniques and who wants to continue his education might be confused by the different recommendations. Unfortunately, the gradation of the recommendations is not always cited which has led to the controversially held discussion about evidence-based medicine. It was, therefore, the aim of the current article to present the most often used gradations and to discuss them critically.

Method: In the current study we performed an analysis of the currently used recommendations and gradations in evidence-based medicine and discussed them critically.

Results: The great number of the available divisions to evidence-based medicine are often technical and partially differ considerably. An unambiguous assignment of the evidence classes and of recommendation degrees can only succeed if the source is indicated clearly.

Conclusion: As far as the authors are concerned, the confusing status of evidence-based medicine makes one gradation necessary, which should be accepted and used worldwide.

Aim: Evaluation of an unconstrained pyrocarbon prosthesis (Ascension) in the treatment of idiopathic degenerative arthritis of the proximal interphalangeal joint of the hand.

Methods: In this study 10 patients (13 implants), that were treated with this type of prosthesis between February 2002 and January 2005 were clinically and radiologically studied.

Results: All but one patient were satisfied with the postoperative situation and would agree to another operation. A significant pain reduction was observed. The average ROM was 58 degrees. Five patients demonstrated a free extension, two patients had a swan neck deformity, which could be actively compensated for, and the remaining six patients had an extension deficit of 30-45 degrees. The average flexion was 76 degrees (+/-12 degrees). X-ray examination was unremarkable in eight patients with a regular position of the endoprosthesis. However, in five patients significant radiolucent lines (>or=1 mm) were observed. So far, a luxation of the prosthesis has not occurred and all implants are still in-situ. However, a dorsal tenoarthrolysis had to be performed in 3 patients.

Conclusion: The results of this study show a high rate of patient satisfaction with a significant pain reduction. A missing osteointegration may be an explanation for the radiological results. The prosthesis has to be closely monitored in the future. Long-term results with a higher number of patients are necessary. A central registry for finger implants is recommended.

Introduction: BMP-2 can replace autogenous bone grafting in lumbar one-level anterior lumbar interbody fusions (ALIF). The current G-DRG system does not reimburse the upfront price of 2,970 euro per BMP-2 application for hospitals in Germany. The purpose of the current study was to create a health economic model to evaluate the financial savings for health care providers (hospitals) and health care payers (health care insurance) that can be achieved by the use of BMP-2 in spine surgery.

Methods: A previously published pooled data analysis was used in which BMP-2 showed significant improvements in the treatment after ALIF surgery compared to autogenous bone grafting, including earlier return to work time and reduced revision rates. These medical findings were transformed into economic data based on the regulations of the German health system of 2005.

Results: The significantly shorter return to work time under BMP-2 treatment generates important financial savings for health care insurances offsetting the upfront prize of 2,970 euro for BMP-2. Savings for hospitals are mainly related to shorter surgery time due to the absence of the bone grafting procedure and faster discharge of the patient.

Conclusions: The combination of improved medical outcome by BMP-2 treatment for the patient and net savings for the entire health care system in Germany represents a "dominant" strategy from a health economic perspective. This implicates that BMP-2 in ALIF procedures is to be recommended from a health economic point of view for the German health care system.

Aim: We assessed to what degree orthopaedic patients use the internet as an information platform and how these patients rate the information they obtain over the World Wide Web (WWW).

Methods: 450 consecutive patients consulting the out-patient department of our university clinic for the first time anonymously filled out a three-page questionnaire. Apart from clinical and sociodemographic data, the questionnaire addressed aspects such as the availability of computers and internet. Also, questions concerning the use and interpretation of medical information freely available on the WWW were asked.

Results: 402 questionnaires were evaluated. 54 % of the patients stated that they readily had access to the internet. Of the remaining patients without internet access, 19 % planned the installation in the near future. The prevalence of the use of the WWW of patients in the age group up to 40 years was 72 % and in patients over 40 years only 49 %. Compared with internet non-users, internet users were younger (p < 0.001), more frequently men (p < 0.05), and of a higher education level (p < 0.001). 68 % used the internet on a regular basis with regard to queries concerning their health and well being. More than every third patient (38 %) had consulted the internet about the specific orthopaedic ailment prior to seeking advice in our clinic. Almost half of the patients judged the previous treatment to be partially in accordance with the information obtained from the internet. 86 % considered the information obtained over the WWW as helpful or very helpful. 85 % would recommend other patients to use the internet for information concerning their orthopaedic complaint. 65 % of all patients objected to an orthopaedic on-line consultation via internet.

Conclusion: The internet seems to be an important source of information for orthopaedic patients. The prevalence concerning the use of the WWW is particularly high in younger, well educated patients.

Aim: In the event of destruction of both knee joints, is bilateral total arthroplasty a reliable operation that the patient can reasonably be expected to undergo?

Method: In 140 patients [35 men, 105 women, average age 48.6 (range 24-78) years], a bilateral sequential TEP implantation was performed under one anaesthesia session, due to verified destruction of both knee joints (Larsen stage III-IV). All patients were treated with a cemented surface replacement prosthesis with resurfacing of the patella (Duracon Total Knee System, Stryker/Howmedica). Functional assessment was done with the aid of the Lysholm score preoperatively as well as 6, 12 and 18 months postoperatively.

Results: The operation was conducted under one anaesthesia session in all patients. The average Lysholm scores improved from 26 (19-45) preoperatively, to 72 (49-81) 6 months postoperatively, 76 (48-85) 12 months postoperatively and 77 (49-87) 18 months postoperatively, whereby no significant difference between sides was observed. 96% of the patients said that they would undergo the operation again. The following complications occurred: 6 prosthesis infections (2.1%), 2 aseptic loosenings (0.7%), 8 superficial wound healing disorders (2.9%) and 2 deep vein thromboses (0.7%).

Conclusion: Sequential bilateral total knee arthroplasty under one anaesthesia session in patients with rheumatoid arthritis facilitates a much quicker rehabilitation, while the overall perioperative risk is not increased.

The subacromial impingement syndrome describes the pathological contact between the rotatory cuff and the acromion. It is only a symptom and not a generic term for the different pathological diseases of the subacromial region. It is the diagnostical aim to verify the pathogenesis of the impingement syndromes and it is essential to differentiate structural versus functional causes. The diagnosis "impingement syndrome" should not have an acromioplastic procedure as general consequence. Because the expression "impingement syndrome" does not show causal approach it should no longer be used as a diagnosis. The term subacromial syndrome, in conjunction with the underlying pathological cause, acquires more therapeutic and prognostic clarity.

Calcific tendinitis at the femoral insertion of the glutaeus maximus tendon is an unusual but well-described location for an ossifying enthesopathy. Extracorporeal shock-wave lithotripsy has become a standard therapy for various pathologies in orthopaedics. We report a case of a 50-year-old man with painful calcific tendinitis at the femoral insertion of the glutaeus maximus tendon who successfully underwent extracorporeal shock-wave treatment.