Zeitschrift fur Orthopadie und ihre Grenzgebiete最新文献

Aim: A major advantage of the unicompartmental knee arthroplasty (UKA) is the quick rehabilitation, small traumatisation of tissue and the mostly uncomplicated revision to a total knee arthroplasty. The aim of the study is to examine whether the conversion to the total endoprosthesis, as is frequently is recommended at present in cases of defect of the sleigh system, is always necessary or whether a revision can have good chances of success with use of the unicondylar system under certain conditions.

Method: 116 revisions were studied after unicompartmental knee arthroplasty at the first appearance of problems and during the follow-up of 45 months (range: 10-86 months) using the Knee Society Score and analyses of the various additional procedures as well as the anterior cruciate ligament substitute, the correction of slope etc. Revisions, with exchange of components or a conversion to a total arthroplasty, were included.

Results: In 60.3 % of all cases a revision could be performed within the unicompartmental knee system, with a mean score of 167.4 (range: 144-173). The outcome score corresponded to the outcome of primary UKA implantations and to conversion operations to total endoprosthesis in the literature (p < 0.05 Wilcoxon test).

Conclusion: Under critical contemplation of the low case number and this short- to medium-term examination, individual revision solutions seem to have their entitlement within the unicondylar system as also do conversion operations to the TKA. Long-term results and larger case numbers are absolutely necessary prior to further judgment.

Aim: Are autologous blood transfusions sufficient or do we need the transfusion of unwashed or washed wound drainage blood in total hip arthroplasty?

Method: 253 patients undergoing total hip arthroplasty were retrospectively randomized to autologous blood transfusion or transfusion of unwashed wound drainage. We compared the haemoglobin and haematocrit levels as well as the rate of complications.

Results: Postoperative blood salvage and reinfusion after total hip joint arthroplasty didn't show any advantages. In 10 % we saw complications after transfusion of unwashed wound drainage.

Conclusion: We do not recommend the transfusion of wound drainage.

Aim: Aiming to reduce known complications of stemmed implants, such as resorptive bone remodeling or bone damage in revision, implants with only epi-metaphyseal anchorage have been developed. In the following study the influence of three different femoral neck endoprostheses, CUT, CIGAR (ESKA Implants Lübeck) and TPP (SulzerMedica) on the postoperative load transfer to the femur was investigated in comparison to a cementless hip stem.

Methods: Using a composite femur model and photoelastic coating technique, the pre- and postoperative osseous strain was measured under static loading. The load corresponded to the absolute maximum of the hip joint load during walking. Statistical analysis was based on the interval of 99 % confidence which was generated by the preoperative measurements.

Results: The different anchorage concepts of the femoral neck endoprostheses exhibited a significant influence on the load transfer, especially along the medial and lateral cortical bone. But, in comparison, the cementless hip stem caused more pronounced stress-shielding which can induce resorptive bone remodelling.

Conclusion: One specific femoral neck anchorage concept led to a change from preoperative tension to postoperative compression at the lateral cortical bone. This regionally limited effect may influence in the mid- or long-term the local bone remodeling in a negative manner.

Aim: The aim of this study is to report the survival and mid-term results including patient-relevant outcome measures with a small-sized cemented stem (CDH-stem) for the treatment of coxarthrosis secondary to developmental dysplasia of the hip.

Method: 33 total hip replacements were performed with the CDH stem, 29 of which (88 %) were included in the follow-up after an average of 7.6 years. According to the classification system of Hartofilakidis et al., 10 hips were classified as type 1, 15 as type 2, and 3 as type 3. Survival was predicted using Kaplan-Meier survivorship analysis with revision as the end point. Results were assessed using the Harris hip score, as well as the WOMAC and SF-36 as patient-relevant outcome measures.

Results: Survival at thirteen years was predicted to be 92.4 % for the stem and 87.6 % for the varying acetabular implants used. At the time of the final follow-up, the average Harris hip score was 82.45 points. The global WOMAC index averaged 2.1, the average SF-36 score was 66.2 points.

Conclusions: The data support the use of a small-sized cemented stem in small femora for total replacement of the dysplastic hip. To the best of our knowledge, this is the first study utilising the well validated WOMAC and SF-36 as patient-relevant outcome measures in this subgroup of patients.

Aim: We treated 74 patients with symptomatic osteoid osteoma by CT-guided radiofrequency ablation (CT-RF) and investigated the rate of success and complications.

Patients and methods: 74 patients were treated by CT-RF between March 1997 and August 2001. The nidus was first located by thin-cut CT sections and then penetrated by a 2 mm coaxial drill or an 11-gauge Jamshidi needle followed by insertion of the RF probe and heat application for a period of 4-6 minutes at 90 degrees C. We investigated the recurrence of pain, complications, hospital stay, duration of postoperative pain and function.

Results: Nine recurrences occurred after the initial procedure, and one after a second CT-RF (rate of primary success 87.8 %, rate of secondary success 88.8 %; 98.6 % success rate in all). There was one minor complication in one case.

Conclusions: CT-guided RF ablation cured 73 of 74 patients (98.6 %). It is a safe, simple, cost effective and minimally invasive treatment, which has stood the test of a long-term follow-up and we suggest it to be the treatment of choice in most cases.

Background: According to a recent review by Hüppe and Raspe effects of multidisciplinary treatment programs for patients with chronic low back pain in Germany seem to be rather weak and not to have persisting effects. Factors which could counteract possible benefits of treatment are, among others, psychic and job-related stresses and strains persisting after treatment. A multidisciplinary, in-patient treatment program for patients with chronic low back pain, therefore, was amended by multidisciplinary diagnosis and assignment and measures to support vocational solutions.

Method: To evaluate the effects of the multidisciplinary program in comparison to a control group with the usual care, a prospective longitudinal study was conducted. 307 patients were assigned to the multidisciplinary in-patient treatment program, whereas 176 patients with comparable complaints had the standard rehabilitation program. Besides the full sample, we analyzed a subgroup of patients with chronic low back pain.

Results: We found positive moderate and strong effects in the intervention group concerning function, pain, psychic strains as well as the number of sick days and return to work rates 10 months after discharge. Effects in the intervention group exceeded the effects achieved in the control group. Beside the full sample, we analyzed a subgroup of patients with chronic low back pain, who received an intense activating group treatment. Also in this subgroup we found moderate and strong effects of treatment superior to those in the control group for function, psychic strains and sick days.

Conclusion: We attribute these persisting and superior effects in the treatment group to an efficient treatment of occupational and psychic problems as well as to more homogeneous treatment groups attained by a multidisciplinary diagnosis and team-based assignment. They also show the significance of in-patient-treatment which is effective, when -- based on multidisciplinary diagnosis -- differential treatment groups can be formed.

The causes of hip pain in adults can vary greatly. We present the case of a 44-year-old woman with recurrent hip pain over a period of years. Medical history and clinical examination did not provide any decisive information. The X-rays revealed a loose body in the cavity of the hip joint. The MRI scan made the following differential diagnosis plausible: osteochondrosis dissecans coxae, osteochondroma and chondromatosis. The final diagnosis of osteochondrosis dissecans coxae was confirmed by surgical dislocation of the hip as modified by Ganz and histological examination of the loose body. This case supports the importance of including rare lesions in the differential diagnostic work-up of joint pain. The advantages of the offset operation as modified by Ganz versus arthroscopy of the hip are outlined.