[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the clinical and radiological outcome of the Total Evolutive Shoulder System (TESS) in patients with cuff tear arthropathy and patients in need of a revision arthroplasty.
In this sequential study, 67 patients (56 non-stemmed, 11 stemmed) were evaluated after a mean follow-up of 17.5 months. The relative Constant and DASH scores, radiological joint geometry changes, complications and postoperative problems, which are not likely to affect the outcome, were evaluated.
A significant increase was noticed for the relative Constant (11.3 vs. 78.8 %) and DASH scores (73.7 vs. 31.8) without significant differences between both etiology groups. Complication rates were similar to previous studies. An aseptic loosening of the non-stemmed humeral component was not noticed in the cuff tear arthropathy group, whereas one case with a loosening was noticed in the revision arthroplasty group. With nine cases (13.4 %), scapular notching rates were very low. On average, the acromiohumeral distance increased by 17 mm and the humeral offset by 13.9 mm; the height of the center of rotation decreased by 4.6 mm and the lateral glenohumeral offset by 6.1 mm, p < 0.05, respectively.
Regarding the joint geometry, surgery with the TESS system provided adequate distalization and medialization of the humerus and the center of rotation. This corresponds to a good clinical outcome. The use of the surgical opportunity to implant the prosthesis with a relatively low neck-shaft angle might explain the low rates of scapular notching in our series. Regarding the case with a loosening of the humeral component, the surgeon should carefully indicate a stemless version for metaphyseal press-fit fixation in patients with revision arthroplasty.
Archives of Orthopaedic and Trauma Surgery 04/2015; 135(7). DOI:10.1007/s00402-015-2218-6 · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Total hip replacement is one of the most successful operation of the last century. However, there are still patients with complaints with a total hip replacement. The diagnostic workout is not always easy. The cause for complaints can be multiple. Mechanical causes (intra- And extracapsular) can be differentiated from infection and other causes outside the hip itself. Of main importance for the diagnostic workup is the specific pain history, the clinical examination including the gait analysis. Plain x-rays include the pelvis as well as the complete femur. The onset of pain in relation to the implantation of the implant can also give some clues. Infection is still the most important problem to rule out. Leg length discrepancies are also important clinical and legal problem. Sometime even diagnostic arthroscopy is necessary.
[Show abstract][Hide abstract] ABSTRACT: Die zurzeit auf dem Markt befindlichen Hüftkurzschäfte unterscheiden sich erheblich und lassen sich differenzieren in schenkelhalserhaltende, -teilerhaltende und -resezierende Systeme. Im vorliegenden Beitrag werden die Abweichungen in den Designmerkmalen dargestellt. Besonderer Wert wird dabei auf die unterschiedlichen Implantationstechniken sowie die Besonderheiten der einzelnen Systeme hinsichtlich der Reproduzierbarkeit der individuellen Anatomie des Patienten, aber auch die osteologische Potenz gelegt.
Der Orthopäde 07/2014; 43(8). DOI:10.1007/s00132-014-2308-0 · 0.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Humeral resurfacing arthroplasty represents an alternative option to hemiarthroplasty for treatment of cuff tear arthropathy (CTA), with the advantages as follows: suitability for relatively young and high-demand patients because of preservation of bone stock and no loss of length, less invasive surgery, shorter operation time, no risk of periprosthetic stem fractures, and revision surgery can be undertaken easily. In the current study, resurfacing arthroplasty in combination with latissimus dorsi tendon transfer for CTA was performed. Three hypotheses: first, humeral resurfacing arthroplasty in combination with latissimus dorsi tendon transfer would improve the overall functional outcome in patients with CTA. Second, this combination would improve humeral external rotation. Third, this combination would improve abduction and shoulder elevation.
Study was conducted as an observational case series. Fourteen patients (nine ♀ and five ♂) having CTA were included. Follow-up was carried out at the end of the 28th month for all patients. Constant Score was used for follow-up evaluation. Dorso-axillary approach was used for latissimus dorsi tendon transfer and ventral deltopectoral approach for Copeland resurfacing. Tendons were fixed to the greater tuberosity with two anchors.
The absolute Constant Score significantly improved from 34 preoperatively to 69 postoperatively, relative Constant Score from 42 to 91 %, elevation from 95° to 138°, abduction from 88° to 147°, and external rotation from 16° to 22° (not significant).
Humeral resurfacing arthroplasty in combination with latissimus dorsi tendon transfer in patients having CTA with preserved subscapularis function has satisfactory short-term functional clinical outcome. LEVEL OF EVIDENCE: IV.
European Journal of Orthopaedic Surgery & Traumatology 03/2014; 24(7). DOI:10.1007/s00590-014-1434-z · 0.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose:
The purpose of the present study was to evaluate the MRI of the hip musculature as well as specific blood parameters on comparison of the Bauer approach with the minimally invasive ALMI approach.
Material and methods:
We compared two patient groups after total hip replacement, which were operated either via the Bauer or the ALMI approach. All 47 patients had the same cementless hip design. All surgeries were performed by two experienced hip surgeons with experience of more than 1200 ALMI approaches. The patient groups did not differ concerning age, sex or side which was operated on. All MRI were performed in a standardised technique with a Philips Outlook Proview (0.23 Tesla). Patients were scanned preoperatively, within 2 weeks after surgery and at time of follow-up 14 months after surgery. The evaluation of the MRI findings was performed by two independent and blinded examiners. In order to document the muscle damage we documented myoglobin (the day before surgery, 6 hours postoperatively and at the first postop. day) und troponin (6 hours postoperatively).
Preoperatively the male patients showed a significantly larger diameter of the gluteus medius muscle. We also could demonstrate in many patients a fatty degeneration even before surgery. At time of follow-up there was no significant difference between the two patient populations concerning the fatty degeneration. There was also no significant difference concerning the muscle atrophy. Muscle oedema, that was present before surgery, however, was no longer present at the time of follow-up. Two patients even preoperatively showed a lesion of the gluteus medius tendon. The range of the postoperative myoglobin level was high (118-5411 µg/L), in the ALMI group the standard deviation was 1445 µg/L, in the Bauer group it was 738 µg/L. There was no significant difference between both groups. Similar findings were documented for the troponin levels.
Conclusion and clinical relevance:
Even before THR many patients show significant degeneration in the hip muscles. Muscle oedema that was present before surgery had disappeared at the time of follow-up. The fatty degeneration was still present at the time of follow-up. There was no difference concerning the muscle atrophy between the ALMI and the Bauer groups.
[Show abstract][Hide abstract] ABSTRACT: Objectives To evaluate two doses of botulinum toxin A [BoNT-A] for the treatment of chronic myofascial pain syndrome [MPS]. Methods: A 12-week, open-label, randomized study in which patients [N = 163] with MPS in the neck and shoulder girdle muscles were treated with intramuscular injections of 200 U [25 Utrigger point [TrP]] or 320 U [40 UTrP] BoNT-A. Results: At Week 7, 34.8 percent of BoNT-A 200 U and 34.3 percent of BoNT-A 320 U patients had clinically significant improvement in pain. Treatment was well-tolerated. Conclusions: Both doses provided effective relief from chronic MPS; benefits were maintained for at least three months.
[Show abstract][Hide abstract] ABSTRACT: Posterior calcaneal exostosis treatment modalities have given rise to many controversial opinions. After failure of the conservative treatment, surgical bursectomy and resection of the calcaneal exostosis are indicated by many authors. But clinical studies also show a high rate of unsatisfactory results with a relative high incidence of complications. The minimally invasive surgical technique by an endoscopic calcaneoplasty (ECP) could be an option to overcome some of these problems.
Between 1999 und 2010 we operated 164 patients with an age range between 16 and 67 years, 81 males and 83 females. The radiological examination prior to surgery documented in all cases a posterior superior calcaneal exostosis that showed friction to the Achilles tendon. All patients included in the study had no clinical varus of the hind foot, nor cavus deformities. All patients had undergone a trial of conservative treatment for at least 6 months and did not show a positive response. The average follow-up was 46.3 (range: 8-120) months.
According to the Ogilvie-Harris score 71 patients presented good and 84 patients excellent results, while 5 patients showed fair results, and 4 patients only poor results. All the post-operative radiographs showed sufficient resection of the calcaneal spur. In 61 patients the preoperative MRI showed a partial rupture of the Achilles tendon close to the insertion side. In no case could we observe a complete tear at the time of follow-up. Only minor postoperative complications were observed. In many patients we could observe a chondral layer at the posterior aspect of the calcaneus. Close to the intersion the Achilles tendon showed also in many patients a chondroide metaplasia.
ECP is an effective and minimally invasive procedure for the treatment of patients with calcaneal exostosis. After a short learning curve the endoscopic exposure is superior to the open technique, has less morbidity, less operating time, and nearly no complications. Moreover, the pathology can be better differentiated.
[Show abstract][Hide abstract] ABSTRACT: The presently available short hip stem designs show significant differences and can be differentiated into those containing the neck, those partially containing the neck and neck resection designs. In this article the currently available designs will be presented. Except for the Mayo stem there are no long-term results available. There are significant differences between the the systems especially with respect to reproducibility of the individual anatomy of patients therefore DEXA and DSA studies are needed in order to identify problematic stem designs early before clinical failures are produced in a large number of patients.
Der Orthopäde 11/2011; 40(12):1075-83. DOI:10.1007/s00132-011-1848-9 · 0.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In over-head motion athletes a dysfunction of the suprascapular nerve has been described. In the literature a relation between the spinoglenoid ligament and the dysfunction of the suprascapular nerve is mentioned. An appreciable variability of this ligament is described. The purpose of the present study was the anatomic documentation of the spinoglenoid ligament and its relation to the suprascapular nerve.
In 36 shoulder specimen the suprascapular nerve, the spinoglenoid and bony parameter of the scapula were documented. The statistic evaluation was performed with SPSS12.0.
In all but one specimen a spinoglenoid ligament was present. In 20 cases (56 %) the infraspinatus muscle inserted at the spinoglenoid ligament. In five cases (14 %) the spinoglenoid ligament reached the glenohumeral joint capsule. In two cases the suprascapular nerve was completely fixed with the ligament, in four cases the perineural soft tissue had a close connection to the ligament. In four cases a branch of the nerve passed through the ligament. All together in 28 % of the specimen there were mechanical conflicts. In one case a ganglion compressed the nerve.
Our anatomic study showed in a significant number of cases a possible entrapment of different origins. These findings have implications both for diagnostics and treatment.
[Show abstract][Hide abstract] ABSTRACT: Osteoarthritis (OA) is a degenerative joint disease that is characterized by increasing loss of cartilage, remodeling of the periarticular bone, and inflammation of the synovial membrane. Besides the common OA therapy with nonsteroidal anti-inflammatory drugs (NSAIDs), the treatment with chondroprotectives, such as glucosamine sulfate, chondroitin sulfate, hyaluronic acid, collagen hydrolysate, or nutrients, such as antioxidants and omega-3 fatty acids is a promising therapeutic approach. Numerous clinical studies have demonstrated that the targeted administration of selected micronutrients leads to a more effective reduction of OA symptoms, with less adverse events. Their chondroprotective action can be explained by a dual mechanism: (1) as basic components of cartilage and synovial fluid, they stimulate the anabolic process of the cartilage metabolism; (2) their anti-inflammatory action can delay many inflammation-induced catabolic processes in the cartilage. These two mechanisms are able to slow the progression of cartilage destruction and may help to regenerate the joint structure, leading to reduced pain and increased mobility of the affected joint.
International Journal of Rheumatology 08/2011; 2011(3):969012. DOI:10.1155/2011/969012
[Show abstract][Hide abstract] ABSTRACT: The purpose of the study was to analyse different parameters before and after implantation of a modern short-stem hip design.
In this prospective radiological study 250 consecutive hips with degenerative hip osteoarthritis were included (246 patients). The patients were operated by five different surgeons at 4 different hospitals and a metadiaphysial fixed short-stem prothesis (Mini Hip, Corin) was used. Standardised X-rays were performed with the same technique pre- and postoperatively in all patients. Different anatomic parameters of the hip were documented by using the pre- and postoperative Xrays (ofset, CCD angle, length of leg). All measurements were performed by an independent examiner. The 246 patients included 129 females and 117 males. The average age of the patients was 59.7 years (range: 27-82 years).
The offset only changed by + 0.28 cm (SD: 0.45 cm) after surgery. We could document only a small decrease of -0.51° (SD: 4.10°) of the CCD angle. The length of the leg increased on average by + 0.09 cm (SD: 0.34 cm). We found no difference between the measurements of female and male patients. Conspicuous was also the increasing use of small protheses (size 2) for hips with a small CCD angle and the increasing implantation of large protheses (size 9) in hips with a high CCD angle.
Our results showed that we could reconstruct the individual geometry of the hip quite well by using the metadiaphysial short-stem prothesis. The tendency of an increasing CCD angle and a decrease of the offset seems not to be existent with the design of this kind of short-stem prothesis.
[Show abstract][Hide abstract] ABSTRACT: In der letzten Dekade hat sich vieles im Bereich des perioperativen Managements bei Patienten, die eine Hüftendoprothese erhalten,
geändert. Dieses beginnt bereits bei der präoperativen Vorbereitung. Viele Patienten haben sich auch bereits im Vorfeld gut
informiert, dennoch verbessern standardisierte Patientenschulungen das klinische Ergebnis und optimieren den Klinikablauf.
Im Bereich der perioperativen Schmerztherapie haben sich ebenfalls deutliche Verbesserungen ergeben. Hier sollte und darf
der Operateur jedoch nicht allein auf den anästhesiologischen Partner zurückgreifen, sondern sollte intraoperativ auch die
ihm zur Verfügung stehenden Möglichkeiten wahrnehmen.
Der Belastungsaufbau ist postoperativ deutlich progressiver als früher. Es spricht nichts gegen eine schmerzadaptierte Vollbelastung
bei einer regelrecht implantierten primären Hüftendoprothese, soweit keine individuellen patientenspezifischen Besonderheiten
vorliegen. Auch die Sportfähigkeit wird deutlich positiver Beantwortet als früher. In der Regel kann der Patient die Sportarten
wieder ausüben, die er auch vorher beherrschte. Dieses gilt beispielsweise auch für das alpine Skifahren.
During the last decade there have been significant changes in the perioperative management of total hip replacement patients.
This process begins in the preoperative phase. Many patients are much better informed and standardized preoperative patient
programs improve patient outcome and optimize the clinical pathways. The techniques in perioperative pain management have
also significantly improved. The surgeon should not only rely on the anesthesiologist but should also use the options available
Postoperative weight bearing is handled in a much more progressive way than previously. In a standard primary hip replacement
pain-adapted full weight bearing is possible if there are no patient-specific problems. There has also been a shift in the
postoperative capability of performing athletic or recreational activities. In general patients can perform those activities
that were performed before the surgery, which also includes, for example downhill skiing.
Der Unfallchirurg 01/2010; 113(1):6-13. DOI:10.1007/s00113-009-1718-7 · 0.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives:The primary objective was to compare a single, 6 ml, intra-articular injection of hylan G-F 20 with placebo in patients with symptomatic knee osteoarthritis. The safety of a repeat injection of hylan G-F 20 was also assessed.Methods:Patients with primary osteoarthritis knee pain were randomly assigned to arthrocentesis plus a 6 ml intra-articular injection of either hylan G-F 20 or placebo in a prospective, double-blind (one injector/one blinded observer) study. Results were evaluated at 4, 8, 12, 18 and 26 weeks post-injection. The primary outcome criterion was change from baseline over 26 weeks in Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index A pain. Secondary outcome measures included WOMAC A1 and C, patient global assessment (PGA) and clinical observer global assessment (COGA) and Outcome Measures in Rheumatology, Osteoarthritis Research Society International responder rates. A 4-week, open, repeat treatment phase evaluated safety only.Results:A total of 253 patients (Kellgren–Lawrence grade II or III) was randomly assigned. Patients receiving hylan G-F 20 experienced statistically significantly greater improvements in WOMAC A pain scores (−0.15, SE 0.076, p = 0.047), and several of the secondary outcome measures (WOMAC A1, PGA and COGA), than patients receiving placebo. There was no difference between the safety results of the two groups. No increased risk of local adverse events was observed in the open, repeat treatment phase.Conclusions:This placebo-controlled study demonstrated that, in patients with knee osteoarthritis, a single 6 ml intra-articular injection of hylan G-F 20 is safe and effective in providing statistically significant, clinically relevant pain relief over 26 weeks, with a modest difference versus placebo.Trial registration number:NCT00131352.
[Show abstract][Hide abstract] ABSTRACT: During the last decade there have been significant changes in the perioperative management of total hip replacement patients. This process begins in the preoperative phase. Many patients are much better informed and standardized preoperative patient programs improve patient outcome and optimize the clinical pathways. The techniques in perioperative pain management have also significantly improved. The surgeon should not only rely on the anesthesiologist but should also use the options available during surgery. Postoperative weight bearing is handled in a much more progressive way than previously. In a standard primary hip replacement pain-adapted full weight bearing is possible if there are no patient-specific problems. There has also been a shift in the postoperative capability of performing athletic or recreational activities. In general patients can perform those activities that were performed before the surgery, which also includes, for example downhill skiing.
Der Unfallchirurg 01/2010; 113(1):6-13. · 0.65 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to evaluate the stop screw method inserted with a minimal invasive technique in the treatment of flexible flatfoot in children.
We evaluated the results in a series of 21 flat feet in the age group ranging from 8 to 14 years between 1999 and 2007. The correction was evaluated clinically by assessment of heel valgus angle, range of motion of the ankle joint, and the photopodographic grading. The radiological assessment was performed by measuring the talonavicular angulation (Meary's line).
At time of follow-up there was significant improvement in the heel valgus angle during rest and during tiptoe standing, significant improvement in the dorsiflexion from neutral position, and in podographic grading. Radiologically talonavicular angulation improved significantly from 162+/-8.9 degrees preoperatively to 174+/-5.8 degrees postoperatively.
We can conclude that subtalar arthroereisis is relatively simple, effective, and minimally invasive procedure in treating flexible flatfoot in pediatric age.
Foot and Ankle Surgery 12/2009; 15(4):174-8. DOI:10.1016/j.fas.2009.01.004
[Show abstract][Hide abstract] ABSTRACT: Die vorliegende Übersichtsarbeit stellt zunächst die Epidemiologie und Pathophysiologie der Epikondylitiden am Ellenbogen
dar. Anschließend werden die diagnostischen Möglichkeiten erörtert. Hier ist es besonders wichtig die Vielzahl der Differentialdiagnosen
abzuklären. Nur für wenige konservative Therapieoptionen gibt es eine gute Evidenz in der Literatur. Bei einer klinisch manifesten
Epikondylopathie ist als erstes eine Belastungspause gerechtfertigt sowie der Einsatz von lokalen und systemischen NSAID evtl.
in Kombination mit einer kurzfristigen Ruhigstellung. Bei anhaltenden Beschwerden zeigen Cortisoninjektionen einen kurzfristigen
Erfolg und krankengymnastische Maßnahmen einen langfristigen Erfolg mit guter Evidenz in der Literatur. Die ESWL zeigt ebenfalls
einen guten Effekt. In Einzelfällen kann bei der vorliegenden Studienlage auch die Anwendung von Botulinumtoxin vor der Durchführung
einer operativen Intervention indiziert sein. Die arthroskopische/endoskopische Operationstechnik zeigt bei der radialen Epikondylopathie
vergleichbare Ergebnisse zur offenen OP-Technik. Unter Berücksichtigung der Tatsache, dass bei der operativen Therapie ein
Ausschluss von intraartikulären Pathologien angezeigt ist, hat die arthroskopische Technik einige Vorteile.
The present review covers epidemiological and pathophysiological aspects as well as the different treatment options for patients
with epicondylitis of the elbow. It is important to exclude the different pathologies that could mimic epicondylitis. Only
for a few conservative treatment modalities is there good evidence in the literature. A reduction in the activities of daily
life or the athletic activities in combination with local or systemic NSAIDs and a short period of immobilization is the first
line therapy. If this is not successful, local steroid injection shows good results in the short term and physiotherapy in
the long-term follow-up. Extracorporal shock waves also shows good evidence. In some patients local botulinum toxin can be
beneficial. Arthroscopic surgical management has results similar to open conventional surgery with the additional advantage
of intraarticular inspection.