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ABSTRACT: PURPOSE: The aim of this study was to compare total knee arthroplasty (TKA) procedures between different countries with regard to epidemiological data and surgical technique by reference to the worldwide arthroplasty registers. METHODS: A systematic search was carried out using the EFORT website to identify the relevant arthroplasty registers. We extracted data with respect to the number of implanted TKAs, patients' age distribution, procedure types, and revision rates. After identification of 28 national arthroplasty registers, 11 offered sufficient data regarding the above mentioned parameters and were therefore included in the final analysis. RESULTS: A large variation was found in the annual number of primary TKA implantations per inhabitant with a reported range from 30 to 199 per 100,000 (mean 106). The fixation method varied strongly between the different registers as well, e.g. 90 % of totally cemented TKAs in Sweden, England and Wales, Slovakia, and New Zealand versus 54 % cemented fixation in Australia. Another significant difference between included countries was observed with respect to the use of patellar resurfacing in TKA. Whilst the Danish knee arthroplasty register reports a percentage of 72 % using a patellar button in TKA the register from Norway reports only a minority of 2 %. CONCLUSIONS: The comparison of arthroplasty registers revealed large differences regarding the annual number of primary TKAs per inhabitant and primary TKA procedure types. These variations may be explained by several factors such as patient demographics (prevalence of osteoarthritis) and national conditions such as healthcare systems (insurance status), number or availability of performing surgeons, medical facilities and surgeon-dependent factors such as definition of indications, education, tradition and experience.
International Orthopaedics 05/2013; · 2.03 Impact Factor
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International Orthopaedics 08/2012; 36(11):2395. · 2.03 Impact Factor
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ABSTRACT: Soft tissue sarcomas are a group of rare mesenchymal neoplasms comprising 0.8% of all malignant tumors. Workup should include medical history, physical examination, magnetic resonance imaging, biopsy, and thoracoabdominal computed tomography scan, in that order. Centralized multimodality treatment in a cross-disciplinary setting is mandatory. Treatment not according to current clinical practice guidelines is a common problem before referral to a specialized institution. The purpose of this 10-year, single-institution review was to investigate the influence of curative surgery on outcome, with a special emphasis on surgery before referral. A cohort of 266 patients who underwent curative surgery for soft tissue sarcoma between 1998 and 2008 was analyzed. One hundred thirty-one (49%) patients underwent surgery contrary to current clinical guidelines before referral, most (73%) at primary care units. One hundred thirteen (86%) of these patients underwent surgery without previous biopsy with a higher rate of intralesional margins (P<.001), a smaller mean diameter of primary lesion (P<.001), a higher rate of subcutaneous situs (P<.001), a lower mean American Joint Committee on Cancer score (P=.008), a higher rate of additional plastic surgery after re-resection (eg, flap surgery) (P<.001), and a longer period before referral (P<.001). No influence on survival, local recurrence, or metastasis existed. Prereferral surgery necessitating re-resection has no influence on survival but leads to an unfavorable clinical course. More effort should be made to improve awareness and referral modalities for general practitioners and physicians at community hospitals.
Orthopedics 08/2012; 35(8):e1214-20. · 2.66 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the tibial and femoral insertion site of the anterior cruciate ligament (ACL) using an objective coordinate system in a cadaver study in order to confirm radiological assumptions of previous investigators who identified the tibial footprint (T) of the ACL on T (5.3; 5.5) and the femoral footprint (F) on F (2.9; 3.5).
The tibial and femoral insertion site of the ACL was analysed on 30 human cadaver knee joints preserved according to the technique by Thiel. Thirty femora and tibiae were photographed under standardised methods and measured on a coordinate system twice by two examiners with respect to the ACL's footprint. We evaluated these measurements by use of the Cohen's kappa inter- and intraobserver coefficient for two observers.
The photographs and tibial and femoral measurements were achieved with an almost perfect and a substantial agreement of inter- and intraobserver coefficients. Further, we could demonstrate that assumptions of anatomic points in previous radiological investigations were correct.
Our findings confirmed the anatomic tibial and femoral ACL footprint of a previous investigation and further the reproducibility of our coordinate system as an objective method for graft placement evaluation.
Injury 07/2012; 43(10):1771-5. · 1.98 Impact Factor
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ABSTRACT: The aim of the study was to investigate outcome differences between female and male patients after implantation of low-contact-stress (LCS) mobile-bearing total knee prostheses at a minimum follow-up of five years with respect to clinical and radiological parameters.
We retrospectively analysed 128 prostheses in 126 patients (90 women and 34 men) using our hospital database. Data was extracted with respect to range of motion (ROM), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, the Knee Society Score (KSS) and radiolucent lines on conventional X-rays.
At follow-up, we observed no significant differences between female and male patients after LCS total knee prostheses. Benefit after implantation of LCS total knee prostheses after five years of minimum follow-up was not significantly different between female and male patients in terms of clinical outcome or radiolucent lines.
We found no factors in favour of gender-specific total knee prostheses.
International Orthopaedics 01/2012; 36(7):1393-7. · 2.03 Impact Factor
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ABSTRACT: Low-contact-stress (LCS) mobile-bearing total knee arthroplasty (TKA) (Johnson & Johnson, New Brunswick, NJ; previously: DePuy, Warsawa, USA) provides excellent functional results and wear rates in long-term follow-up analyses. Radiological analysis shows radiolucent lines (RLL) appearing immediately or two years after primary implantation, indicative of poor seat. Investigations proved RLL to be more frequent in uncemented TKA, resulting in a consensus to cement the tibial plateau, but their association with clinical findings and patients discomfort and knee pain is still unknown.
553 patients with 566 low-contact-stress (LCS) total knee prostheses were screened for continuous moderate knee pain. We compared tibial stress shielding classified by Ewald in patients suffering from pain with a matched, pain-free control group on blinded X-rays. We hypothesized a positive correlation between pain and radiolucency and higher frequency of such radiolucent lines in the most medial and most lateral zones of the tibial plateau.
Twenty-eight patients suffered from knee pain in total. Radiolucencies were detected in 27 of these cases and in six out of 28 matched controls without knee pain. We could demonstrate a significant correlation of knee pain and radiolucencies, which appeared significantly more frequently in the outermost zones of the tibial plateau.
Our findings suggest that radiolucent lines, representing poor implant seat, about the tibial plateau are associated with knee pain in LCS patients. Radiolucencies are observed more often in noncemented LCS, and cementing the tibial plateau might improve implant seat and reduce both radiolucent lines and associated knee pain.
BMC Musculoskeletal Disorders 06/2011; 12:142. · 1.58 Impact Factor
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The Journal of Bone and Joint Surgery 09/2005; 87(8):1822-7. · 3.27 Impact Factor
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The Journal of Bone and Joint Surgery 01/2004; 85-A(12):2429-33. · 3.27 Impact Factor
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ABSTRACT: Although surgery for the treatment of hallux valgus is frequently performed, the exact rate of deep vein thrombosis following this procedure is unknown. We performed a single-center, prospective, phlebographically controlled study to quantify the rate of venous thrombosis following operative correction of hallux valgus.
Consecutive patients undergoing chevron bunionectomy for correction of hallux valgus deformity were enrolled in the study. Patients with clinical or hematological risk factors for venous thrombosis were excluded. One hundred patients with a mean age of 48.9 years were operated on and did not receive medical prophylaxis against thrombosis. All patients were assessed with phlebography at a mean of twenty-nine days postoperatively.
Venous thrombosis was found in four patients (4%). The mean age of these patients (and standard deviation) was 61.7 +/- 6.1 years compared with a mean age of 48.4 +/- 13.9 years for the patients in whom thrombosis did not develop (p = 0.034).
Patients are at a low risk for venous thrombosis following surgical treatment of hallux valgus. The need for prophylaxis against thrombosis should be calculated individually for each patient according to his or her known level of risk. Routine medical prophylaxis against thrombosis might be justified for patients over the age of sixty years.
The Journal of Bone and Joint Surgery 08/2003; 85-A(7):1204-8. · 3.27 Impact Factor
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ABSTRACT: A prospective single-cohort study was designed to include 20 patients with enchondromas but was stopped because of poor early results. Four patients with an enchondroma, three in the proximal humerus and one in the distal femur, were treated by curettage and filling of the defect with Norian SRS cement. Clinical and radiological follow-up including CT and MRI was carried out for 18 months. All three patients with lesions in the proximal humerus had severe pain and limited movement of the shoulder. The radiological and CT appearances of the cement were unchanged at follow-up. There were characteristic appearances of synovitis and periosteitis on MRI in two patients. Since the cement induces a soft-tissue reaction the bony cavity should be sealed with the curetted and burred bone after curettage and introduction of Norian cement, especially in sites where a tourniquet cannot be applied.
Journal of Bone and Joint Surgery - British Volume 04/2003; 85(2):238-9. · 2.83 Impact Factor
