M Handel

Universität Regensburg, Regensburg, Bavaria, Germany

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Publications (48)38.84 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of the study was to determine possible differences in the mid-term results of total knee arthroplasty in patients treated with and without denervation of the patella. This study included 80 total knee replacements in 71 patients who were treated with total knee replacement, either with (n = 40) or without (n = 40) simultaneous denervation of the patella out of a total population with 122 knee replacements in 100 patients. Comparability of both groups was achieved by applying matching criteria. All patients were reviewed by isokinetic tests, physical and radiological examination. The mean follow-up time was 2.2 years. The mean hospital for special surgery (HSS) score revealed no statistically significant differences between both groups (with denervation 77.9 ± 11.1 and without denervation 77.8 ± 11.0, p = 0.976). The isokinetic torque measurements with low angle velocity (60°/s) indicated slightly higher values during extension (60.2 ± 32.2 Nm versus 55.8 ± 25.2 Nm, p = 0.497) and flexion (52.4 ± 28.3 Nm versus 46.1 ± 22.3 Nm, p = 0.272) movements of the affected knee joint. However, the differences did not reach statistical significance. At high angle velocity (180°/s) no differences could be found between both groups. No cases of postoperative necrosis of the patella were observed. Anterior knee pain after denervation was reported in 6 cases (15 %) compared to 10 cases (25 %) in patients who were treated without denervation (p = 0.402). No statistically significant differences could be found between patients with and without denervation of the patella for total knee arthroplasty.
    Der Orthopäde 01/2014; · 0.51 Impact Factor
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    ABSTRACT: Ziel unserer Untersuchung war es, den Einfluss einer retropatellaren Denervierung auf die mittelfristigen Ergebnisse nach Implantation von Knietotalendoprothesen (KTEP) zu untersuchen.Es wurden 122 Kniegelenkendoprothesen ohne Retropatellarersatz von 100 Patienten nachuntersucht, bei denen in 58 Fällen im Rahmen der Implantation eine retropatellare Denervierung durchgeführt worden war, und 64 Fälle, bei denen auf diese Prozedur verzichtet wurde. Durch ein Matchingverfahren wurden 2 vergleichbare Gruppen mit jeweils 40 KTEP bei insgesamt 71 Patienten gebildet, welche entweder mit oder ohne retropatellare Denervierung operiert worden waren. Diese Gruppen wurden nach durchschnittlich 2,2 Jahren klinisch, radiologisch und mit einem isokinetischen Dynamometer nachuntersucht.Beide Gruppen zeigten vergleichbare Werte beim Hospital-for-special-surgery(HSS)-Score (mit Denervierung 77,9 ± 11,1; ohne Denervierung 77,8 ± 11,0; p = 0,976). Bei niedriger Winkelgeschwindigkeit (60°/s) erzeugten die Patienten mit Denervierung durchschnittlich sowohl bei Extension (60,2 ± 32,2 vs. 55,8 ± 25,2 Nm; p = 0,497) als auch bei Flexion im Kniegelenk (52,4 ± 28,3 vs. 46,1 ± 22,3 Nm; p = 0,272) leicht höhere Drehmomentwerte als die Patienten ohne Denervierung. Die gemessenen Unterschiede waren jedoch statistisch nicht signifikant. Bei hoher Winkelgeschwindigkeit (180°/s) waren die gemessenen Drehmomentwerte in beiden Gruppen nahezu identisch. Eine Patellanekrose wurde bei keinem der Patienten beobachtet. Patienten mit Denervierung klagten mit 6 (15 %) gegenüber 10 Fällen (25 %) etwas seltener über retropatellare Schmerzen. Die unterschiedliche Häufigkeit war jedoch ebenfalls statistisch nicht signifikant (p = 0,402).Es zeigten sich mittelfristig nach Knieprothesenimplantation keine signifikanten Unterschiede bei Patienten mit und ohne retropatellare Denervierung.
    Der Orthopäde 01/2014; 43(2). · 0.51 Impact Factor
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    ABSTRACT: Aim: In a monocentric study, we investigated patient satisfaction, clinical outcome and isokinetic muscle torque in dependence on the body mass index (BMI) in the mid-term outcome after total knee arthroplasty.Patients and Methods: A group-matched study with two groups (each 40 knee arthroplasties in 40 patients) with a normal body mass index (BMI 20-25) and above 25 was conducted. The groups were matched for sex, diagnosis and age. Satisfaction, HSS score and isokinetic torque parameters with the Cybex 340 system were measured.Results: There were no differences in the demographic data except for BMI. The HSS score was significantly lower in the overweight group (p = 0.04). Also there were more patients with an HSS score below 60 (bad result) in the group with the higher BMI (0 vs. 9, p = 0.002). Only one patient was not satisfied in the normal weight group, whereas 9 patients in the group BMI > 25 were not satisfied (p = 0.014). No differences between the groups could be found in maximum torque, work and power.Conclusion: The patient satisfaction was much lower in patients with BMI higher than 25. There were no differences between the groups in isokinetic torque parameters.
    Zeitschrift fur Orthopadie und Unfallchirurgie 12/2012; 150(6):641-7. · 0.65 Impact Factor
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    ABSTRACT: Prosthesis loosening is becoming more and more important due to increasing numbers of primary arthroplasty. Especially in patients suffering from rheumatoid arthritis this is a major topic due to younger age and multiple affected joints. A carefully performed diagnostic regimen is essential for ruling out septic loosening of the prosthesis. Preoperative planning is crucial for revision surgery. Revision implants should be available as back-up. Revision arthroplasty is a technically and economically demanding procedure. Costs for revision surgery are much higher than for primary arthroplasty due to longer hospital stay, intensive care, microbiology, histology, diagnostic imaging, implants and antibiotics. Revision arthroplasty should be performed in highly specialized centers.
    Zeitschrift für Rheumatologie 11/2012; 71(9):785-97. · 0.45 Impact Factor
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    ABSTRACT: PURPOSE: The talonavicular joint is a central connection of the human foot. Symptomatic talonavicular arthritis can be adequately addressed by isolated talonavicular fusion. However, non-union remains a relevant clinical challenge to the orthopaedic surgeon. The aim of this study was to analyse the clinicoradiological outcome of talonavicular fusion using angle-stable mini-plates. METHODS: We performed 30 talonavicular fusions in 30 patients (12 male, 18 female) with a mean age of 58.8 years (range, 22-74) between 2005 and 2007. Osseous joint fusion was achieved using mono- and multidirectional angle-stable mini-plates. The patients followed a standardised immobilisation and weight bearing protocol. The mean postoperative follow up was 15.8 months (6.1-23.8). RESULTS: The American Orthopedic Foot and Ankle Society AOFAS score increased significantly from 31.7 (19-42) to 82.3 points (55-97) (p < 0.001). Neither age at operation nor gender influenced the score results significantly, while the aetiology of talonavicular degeneration showed a significant effect. Mean visual analogue scale (VAS) pain intensity (0-10) reduced from 8.6 to 1.7 (p < 0.001). Good or excellent results were achieved in 26 patients, while two patients reported fair and another two poor results. Complete osseous fusion was observed at a mean of 10.9 weeks (8-13) postoperatively. CONCLUSIONS: For the treatment of talonavicular arthritis, the application of mono- and multidirectional angle-stable mini-plates provided a strong fixation that led to high union rates and good to excellent overall outcome.
    International Orthopaedics 10/2012; · 2.32 Impact Factor
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    ABSTRACT: Key WordsHeterotopic ossification-Prevention of heterotopic ossification-Total hip replacement-NSAID-Irradiation
    Orthopaedics and Traumatology 04/2012; 8(4):302-313.
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    ABSTRACT: Survivin, the smallest member of the inhibitor of the apoptosis protein gene family (IAP) is a key molecule for mammalian cell cycle regulation and cellular survival. Of note these functions have been thought to be limited to embryonic and malignant tissues. However, a growing body of evidence indicates a limited expression of survivin in some highly specific adult tissues and cells. In the present study it has been demonstrated that the antiapoptotic protein survivin is re-expressed in osteoarthritic human cartilage and primary human chondrocytes. Furthermore, the data indicated that survivin significantly affects cell cycle regulation and cellular survival. The modulation of survivin expression and function in cartilaginous tissues might be important for understanding osteoarthritis and the development of regenerative strategies.
    Der Orthopäde 04/2012; 41(4):260-7. · 0.51 Impact Factor
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    ABSTRACT: Hallux valgus is a frequent condition of the forefoot, resulting in cosmetic deformity and pain. Chevron osteotomy (CO) is widely employed for the treatment of hallux valgus. Chevron-Akin double osteotomy (CAO) was previously described and superiority over an isolated Chevron procedure was assumed. The objective of this study was to compare the short-to-middle term outcomes of CO and CAO. This study included 72 patients with established diagnosis of mild-to-moderate hallux valgus, treated by either isolated CO or CAO. The CO group included 46 patients (mean 51.5 years) with a mean hallux valgus angle of 27°, while the CAO group included 26 subjects (mean 53.1 years) and a mean hallux valgus angle of 32° preoperatively. All patients were reviewed by physical examination, and standardized questionnaire, and pre- and postoperative standing X-rays were performed. Matched group analysis was carried out to analyze statistical differences of both techniques. The patients were assessed and group matched at a mean of 1.37 years for the CO group and 1.04 years for the CAO group, postoperatively. Mean improvement of HVA (hallux valgus angle) was 10.6° in the CO group and the CAO group improved by 17.5°. DMAA (distal metatarsal articular angle) improved in the CO group by 5.4° and in the CAO by 13.7°. Mean AOFAS score improved by 27.9 (CO) and 21.5 (CAO). Patient satisfaction was high in both groups, with a tendency towards higher values within the CAO group. These findings indicate that Chevron-Akin double osteotomy is a save and practicable procedure for the treatment of mild-to-moderate hallux valgus. Superiority of combined Chevron-Akin procedure over an isolated Chevron osteotomy might be limited to distinct clinical settings, but should not be generally assumed.
    Archives of Orthopaedic and Trauma Surgery 08/2011; 132(1):9-13. · 1.36 Impact Factor
  • J Götz, J Grifka, M Handel
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    ABSTRACT: Osteoarthritis of the first metatarsophalangeal joint is termed hallux rigidus. Clinical symptoms are expressed by a painful limitation of range of motion, finally leading to an eponymous total stiffness of the joint. Conservative treatment includes drug therapy, physical therapy and orthotic devices like insoles and footwear modification. After making use of the whole range of conservative treatment options, several surgical techniques are available, which should be considered depending on stage, patient's activity level and possible comorbid diseases. Open and arthroscopic techniques addressing the cartilage and cheilectomy can be chosen in early stages of hallux rigidus. Osteoarthritis at a higher stage requires further reaching techniques, e.g. Bonney-Kessel procedure or Watermann-Green procedure. When the complete clinical picture of hallux rigidus is present, arthrodesis is the gold standard. Nevertheless, alternative surgical treatments like arthroplasty and resection arthroplasty are being discussed.
    Der Orthopäde 08/2011; 40(9):819-34. · 0.51 Impact Factor
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    ABSTRACT: The treatment of unicompartmental arthritis in younger patients is challenging. The aim of this study is to report final safety and efficacy analysis results for the iForma patient-specific interpositional device, which is designed for the treatment of isolated medial or lateral compartment arthritis of the knee. From June 2005 to June 2008 78 subjects (42 men, 36 women) received an iForma implant. The mean age was 53 years, the mean Body Mass Index 29.0. We surveyed the WOMAC scores, the visual analog pain scale and the Knee Society Scores. The mean follow up was 16.4 months. The mean WOMAC knee scores increased from 48.3 before surgery to 71.3 after 24 months. A reduction in pain was achieved for all five pain measures using a standard visual analog scale (VAS). Knee Society Knee Score improved from 39.2 before to 61.9 24 month after surgery. The Knee Society Function Scores improved form preoperative 64.5 to 82.5 2 years postoperative. The preoperative range of motion could be restored. The overall revision rate was 24%. 15 implants were removed early, 4 knees were revised without implant removal. Within narrow indication of patients with unicompartmental disease, the iForma device can provide improvement in knee function and reduction in pain, however, with a significant higher risk of early revision compared to traditional arthroplasty. Respecting this limitation it may be an alternative option for arthritic patients with unicompartmental disease who have contraindications to High Tibial Osteotomy or are too young for knee replacement; the iForma device further has the distinct advantage of time and cost saving compared to those procedures.
    The Open Orthopaedics Journal 01/2011; 5:37-43.
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    ABSTRACT: To evaluate whether a further optimization of an existing accelerated clinical pathway protocol after total knee replacement is feasible and improves postoperative outcome. Prospective, parallel group design. Orthopaedic University Medical Centre. A total of 143 patients, scheduled for unilateral primary total knee replacement under perioperative regional analgesia. Sixty-seven patients received an optimized accelerated clinical pathway including patient-controlled regional analgesia pumps, ultra-early/doubled physiotherapy and motor-driven continuous passive motion machine units. Seventy-six patients received a standard accelerated clinical pathway. Feasibility was defined as the proportion of patients successfully completing the assigned pathway. Early postoperative pain on a visual analogue scale, consumption of regional anaesthetics, knee range of motion, time out of bed, non-stop walking distance/stair climbing, circumference measurement and Knee Society Score on the operated leg. Possible discharge according to an own discharge checklist. All patients assigned to both groups successfully completed this pathway. Patients in the optimized pathway showed significant benefits regarding stair climbing/walking distance/time out of bed/circumference measurements of the thigh/Knee Society function score on the fifth postoperative day and stair climbing/ circumference measurements of the thigh on the eighth postoperative day, and reduction of the consumption of regional anaesthetics. No significant reduction in length of stay was observed. Early postoperative functional process indicators tended to be higher within the optimized pathway group, but the main effects flattened over the course of the first eight postoperative days.
    Clinical Rehabilitation 02/2010; 24(3):230-9. · 2.19 Impact Factor
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    ABSTRACT: Local antiseptics are commonly used for perioperative skin and wound disinfection and as solutions for joint lavage. Therefore, we examined if an intra-articular use of these antiseptics is possible by using an IN VITRO chondrocyte model. Articular chondrocytes harvested from 7 patients were cultured. After reaching 80% confluency different concentrations (0%, 1%, 10%, 50%, 100%) of polyhexanide, hydrogen peroxide and povidone-iodine were added for 5 minutes. Afterwards, the solution was removed and the chondrocytes were cultured for 24 hours. Subsequently the vitality and proliferation rate (DNA synthesis) were analysed with the WST-1 and BrdU tests. 1% povidone-iodine and 1% hydrogen peroxide solutions significantly (p=0.001) decreased the chondrocyte vitality as compared to our control group. There was no significant difference (p=0.71) after the application of 1% polyhexanide in the vitality ratios. A significant decrease in vitality was also observed after the application of 10% polyhexanide solution (p=0.001). Application of 1% povidone-iodine solution, 1% hydrogen peroxide solution and 10% polyhexanide revealed a decrease in the metabolic cell activity of 80% compared to our control group, whereas the activity was 65% (p=0.026) compared to the control group after application of 1% polyhexanide solution. Our results demonstrate the chondrotoxic effect of the tested antiseptic solutions in clinical used concentrations within short time points. Polyhexanide in a low concentrated solution (1%) was the antiseptic with the lowest influence on the vitality and the DNA synthesis of chondrocytes. Thus, this antiseptic solution seemed to be the best choice for intra-articular application. But overall, our study showed general limitations for the intra-articular use of local antiseptics.
    Zeitschrift fur Orthopadie und Unfallchirurgie 01/2010; 148(1):39-43. · 0.65 Impact Factor
  • Physikalische Medizin Rehabilitationsmedizin Kurortmedizin - PHYSIK MED REHABIL KURORTMEDI. 01/2010; 20(04):207-212.
  • Zeitschrift Fur Orthopadie Und Unfallchirurgie - Z ORTHOP UNFALLCHIR. 01/2009; 147(06).
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    ABSTRACT: We report about a 44-year-old woman who presented at our Orthopaedic Department suffering from persisting pain and a tumor of the right knee after open articulosynovectomy. MRI did not clarify the entity at all. The X-ray examination could identify an inlying compress after a synovectomy in 1999. The intra-articular foreign body could be removed by open revision surgery.
    Zeitschrift fur Orthopadie und Unfallchirurgie 01/2009; 147(5):616-8. · 0.65 Impact Factor
  • Source
    Martin Handel, F. Köck
    Fuß & Sprunggelenk. 12/2008; 6(4).
  • F. X. Köck, M. Handel
    Fuß & Sprunggelenk. 12/2008; 6(4).
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    ABSTRACT: This study investigates the influence of pelvic tilt on conventional alignment of acetabular cups. Cementless cups were aligned into a synthetic replica of the pelvis 300 times at different pelvic tilts. At +10 degrees pelvic tilt, average cup inclination was 46.2 degrees (32 degrees to 65 degrees ; +/-7.0 degrees ), and average cup anteversion was 19.8 degrees (4 degrees to 37 degrees ; +/-9.1 degrees ). At neutral pelvic tilt, inclination was 44.5 degrees (28 degrees to 59 degrees ; +/-7.2 degrees ), and anteversion was 15.6 degrees (-5 degrees to 33 degrees ; +/-8.1 degrees ). At -10 degrees pelvic tilt, inclination was 42.6 degrees (25 degrees to 61 degrees ; +/-7.2 degrees ), and anteversion was 10.5 degrees (-10 degrees to 37 degrees ; +/-12.2 degrees ). Overall, 50% of the cups were positioned outside the safe zone: 46% in pelvic inclination, 42% in neutral position, and 63% in pelvic reclination (P = .007). This study shows the considerable inaccuracies of conventional cup implantation by experienced and trainee surgeons and shows the influence of pelvic tilt on acetabular cup alignment.
    The Journal of arthroplasty 11/2008; 24(1):152-7. · 1.79 Impact Factor
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    ABSTRACT: Degeneration of the meniscus and the articular cartilage in unicompartmental osteoarthritis of the knee results in progressive deformity of the leg axis. It is the aim of this study to evaluate if a leg axis correction can be achieved by implanting a customised metallic interpositional device for the knee (ConforMIS iForma). Before and after implanting a ConforMIS iForma knee implant, a radiological analysis of the leg axis deviation in the frontal plane was performed prospectively in 27 patients by evaluating anteroposterior single-leg stance radiographs. We achieved a sufficient leg axis correction with an average correction of 3.8 degrees and an averaged small under-adjustment of 0.9 degrees by inserting the ConforMIS iForma interpositional knee implant. Apart from the primary treatment objective of articular surface restitution the ConforMIS iForma knee implant can be reliably used to correct axis deformity occurring with unicompartmental osteoarthritis of the knee.
    International Orthopaedics 07/2008; 33(4):955-60. · 2.32 Impact Factor
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    ABSTRACT: Some of the systems marketed for pulsatile high-pressure lavage are clearly different in their mechanical pulse characteristics. To take the matter further we set up an experimental in vitro model to determine whether these different lavage systems might produce different cementation results because of their differing pulse characteristics, and whether the systems differed significantly in terms of cement depth penetration. A total of 48 femoral heads were obtained at operation from patients who had undergone endoprosthetic hip replacement. The specimens were subjected to manual rinsing or semiautomatic cleansing procedures with five different pulsatile lavage devices. After the cleansing procedures, polymethylmetacrylate bone cement was intruded into the cancellous bone under standardised conditions. Determination of cement penetration was done by computed tomography using an image processing software. Irrespective of the nature of the lavage system tested, superficial cement penetration, both up to 2 mm and up to 3 mm, was significantly better after pulsatile high-pressure lavage than it was after manual rinsing of the specimens with a bladder syringe (P < 0.001 in each case). Whereas our experimental model did not show any significant differences between the lavage systems as regards the cementation results to a depth of up to 2 mm (P = 0.996), there were significant differences at a target depth of 3 mm (P < 0.05). As compared with manual rinsing, pulsatile high-pressure lavage in vitro makes highly significant improvements in cement penetration into cancellous bone and should be regarded as an indispensable component of modern cementation techniques for endoprosthetic surgery. Up to the present we have not been able to ascertain what influence the different pulse characteristics of a pulsatile lavage system may have on the intended cementation result, whether it is impact force, pulse shape, pulse duration, flow rate or frequency. Appropriate investigations will be necessary.
    Archives of Orthopaedic and Trauma Surgery 01/2008; 127(10):873-7. · 1.36 Impact Factor

Publication Stats

301 Citations
38.84 Total Impact Points

Institutions

  • 2003–2012
    • Universität Regensburg
      • Department of Orthopaedics
      Regensburg, Bavaria, Germany
  • 2001–2012
    • Orthopädische Universitätsklinik Friedrichsheim
      Frankfurt, Hesse, Germany
    • Universitätsklinikum Tübingen
      • Department of Orthopaedic Surgery
      Tübingen, Baden-Württemberg, Germany
  • 2011
    • Klinikverbund Südwest
      Sindelfingen, Baden-Württemberg, Germany
  • 2002–2010
    • University Hospital Regensburg
      Ratisbon, Bavaria, Germany
  • 2005–2006
    • Asklepios Klinikum Bad Abbach
      Abach, Bavaria, Germany