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ABSTRACT: Wrong alignment of hip and knee prosthesis is a known risk factor for early loosening and revision. Meta-analyses have shown that, by use of computer navigation, outliers can be reduced significantly. Our analysis of 200 implanted knee prostheses (100 navigated procedures, 100 conventional procedures) and 60 implanted hip resurfacings (30 navigated procedures, 30 conventional procedures) yielded the same result: In total knee arthroplasty and hip resurfacing, the numbers of outliers were significantly reduced by use of computer navigation. Furthermore, in total knee arthroplasty a significantly reduced blood loss and need for blood transfusions were noted if computer navigation was used. Long term studies are required to verify if computer navigation may be an economically cost-saving procedure. So far, in our clinic every navigated operation produced extra costs of 442 Euros. In our current healthcare system no reimbursement for these additional charges exist.
Versicherungsmedizin / herausgegeben von Verband der Lebensversicherungs-Unternehmen e.V. und Verband der Privaten Krankenversicherung e.V 03/2010; 62(1):16-9.
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ABSTRACT: Interspinous process distractors are an effective operative tool for treating patients with lumbar spinal stenosis. Lumbar stenosis with minor secondary instabilities due to degenerative changes in the segment can also be treated successfully with these devices. In case of failure, these devices can easily be revised or removed. As this operative procedure is not very time-consuming, it is a reasonable option for elderly patients with various medical problems and increased anaesthetic risk. There are reports of implanting these devices in certain cases under local anaesthetic. A prospective randomised trial has shown promising results for up to two years postoperatively. There are no long-term results available.
Versicherungsmedizin / herausgegeben von Verband der Lebensversicherungs-Unternehmen e.V. und Verband der Privaten Krankenversicherung e.V 01/2008; 59(4):176-8.
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Versicherungsmedizin / herausgegeben von Verband der Lebensversicherungs-Unternehmen e.V. und Verband der Privaten Krankenversicherung e.V 07/2007; 59(2):98-9.
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ABSTRACT: Low back pain is a major physical and socioeconomic problem. A significant percentage is attributable to internal disc disruption (IDD). The management of IDD has been limited to conservative treatment or to operative treatment. Intradiscal electrothermal therapy (IDET) is a new minimal-invasive therapy. In carefully selected patients, it could be an effective treatment alternative. Further studies with long-term follow-up are necessary.
Versicherungsmedizin / herausgegeben von Verband der Lebensversicherungs-Unternehmen e.V. und Verband der Privaten Krankenversicherung e.V 01/2006; 57(4):182-4.
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ABSTRACT: Non-specific enzyme therapy does not intend the catalysis of definite steps of metabolism, but claims to stimulate regenerative processes in general. Initially, non-specific enzyme therapy had been considered to be a promising approach. The growing knowledge in basic research and the lack of evidence for clinical effectiveness rendered the predominantly oral application of enzyme preparations for non-specific treatment outdated by the 1960s. In Germany, however, the absence of strict legal regulations prevented the deregistration of drugs designed for non-specific enzyme therapy. Furthermore, numerous clinical studies were initiated by the leading producer of enzyme preparations in Germany in order to provide the scientific confirmation missing so far. Our critical and systemic review of the published trials shows that neither the mechanism of action could be enlightened, nor the clinical benefit of non-specific enzyme therapy proven on an acceptable level of scientific standards.
Versicherungsmedizin / herausgegeben von Verband der Lebensversicherungs-Unternehmen e.V. und Verband der Privaten Krankenversicherung e.V 01/2004; 55(4):163-70.
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ABSTRACT: In view of the planned introduction of the DRG system in Germany, this paper gives the reader a guideline on how to analyse costs and productivity of medical procedures. Total knee replacement was chosen because it is one of the standard operations in orthopedic surgery with existing special calculations for this type of operation. By using the example of a total knee replacement, productivity phases are used and their costs are estimated. With these phases the clinician is able to analyse the efficiency of his department and a benchmarking is possible. Nevertheless, we should not forget that although cost reduction in hospitals is essential the patients' health is the main aim of treatment.
Versicherungsmedizin / herausgegeben von Verband der Lebensversicherungs-Unternehmen e.V. und Verband der Privaten Krankenversicherung e.V 07/2003; 55(2):87-91.
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ABSTRACT: The aim of this prospective study was to analyse the development of activities of daily living (ADL) as well as sports activities in patients suffering from osteoarthritis of the knee and undergoing total knee replacement. 40 patients with 42 operated knee joints were included in this study.
38 patients (40 knee replacements) recieved a PFC endoprosthesis, 2 patients recieved a GSB endoprosthesis. In 28 cases (71%) we found generalized degenerative joint changes, in 7 cases (17%) a varus deformity and in 2 cases (5%) a valgus deformity. Post-traumatic osteoarthritis was seen in 3 cases (7%). We used the PFC endoprosthesis in patients with stable ligaments, in unstable joints we used the GSB endoprosthesis. Patients were reviewed clinically and radiographically and answered a questionnaire with special reference to ADL (walking, gymnastics, bicycling, homework, swimming, gardening). For evaluation of the results we used the Ranawat & Shine score. Pain was determined with the VAS (visual analogue pain scale).
The activity level increased from preoperatively 62.5% up to 91.5% 2 years postoperatively. This was mainly due to walking and gymnastics. Overall sports activities decreased. There was a high uncertainty regarding activities due to patients' lack of knowledge about possible postoperative load capacity of the new joint. The average score according to Ranawat & Shine increased from preoperative 56.98 to 75.89 points out of 100. Most significantly we found an improvement in the pain rating. There was an improvement of 73% under resting and of 81% under activity conditions.
With this prospective study we can demonstrate the benefit for patients undergoing knee replacement surgery with respect to activities of daily living and especially pain reduction.
Versicherungsmedizin / herausgegeben von Verband der Lebensversicherungs-Unternehmen e.V. und Verband der Privaten Krankenversicherung e.V 06/2003; 55(2):82-6.
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ABSTRACT: Autologous chondrocyte transplantation (ACT) is a recently developed procedure for repairing chondral defects of the knee. An analysis of the literature provides no evidence so far for regular regeneration of hyaline cartilage, and no randomized controlled studies are available showing a long-term efficacy. Therefore, controlled randomized studies are urgently needed. At present, ACT cannot be recommended for extended application in clinical practice.
Versicherungsmedizin / herausgegeben von Verband der Lebensversicherungs-Unternehmen e.V. und Verband der Privaten Krankenversicherung e.V 01/2003; 54(4):168-71.
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ABSTRACT: Infection following total joint replacement remains a problem that has not been solved so far. The treatment options include removal of the implant and a delayed reconstruction or a direct exchange operation. Among patients with stable implants and short duration of infection as well as in patients who for certain reasons are inoperable, antibiotic therapy with a combination of rifampicin-ciprofloxacin may be a reasonable treatment option for curing staphyloccocal infection without removal of the implant. A case study of a Staphylococcus epidermidis (coagulase-negative) infection following delayed revision total knee replacement after septic loosening of a knee arthroplasty and its successful conservative treatment with rifampicin-ciprofloxacin is described. Alternative rifampicin combinations are discussed with respect to recently developed pharmacodynamical and pharmacokinetical findings of biofilm active drugs.
Archives of Orthopaedic and Trauma Surgery 06/2001; 121(5):297-9. · 1.37 Impact Factor
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ABSTRACT: Anhand einer Bundesligaringermannschaft werden die Überlastungsschäden, die akuten Verletzungen sowie die angeborenen und
anderweitig erworbenen Pathologien beschrieben mit denen der Mannschaftsarzt zu rechnen hat. Zahlenmäßig am häufigsten sind
Hautverletzungen und das Ringerohr gefolgt von Extremitätenverletzungen. Durch verbesserte Matten sind Verletzungen des AC-
und SC-Gelenkes zu vermeiden. Beim Freistilringen werden gehäuft Knieverletzungen festgestellt. Wirbelsäulenverletzungen sind
seltener, jedoch zumeist schwerwiegender Natur. Eine routinemäßige Untersuchung der Mannschaft lässt vorhandene Pathologien
aufdecken und einer Behandlung zuführen.
Wrestling injuries, overuse problems, and other pathologies of a league wrestling team are described. Most frequently the
team doctor has to deal with open wounds and ear injuries. Use of better equipment has reduced the incidence of injuries to
the AC and SC joint, but freestyle wrestling has a higher incidence of knee injuries. Spine injuries are less frequent but
more severe. A routine team check-up can reveal other pathologies needing treatment.
Manuelle Medizin 05/2001; 39(3):110-113.
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ABSTRACT: Incorrect alignment is a known risk factor for early loosening of implants. Computer-assisted joint replacement surgery (CAS) improves the positioning of the used implants. So far there is no study comparing the improvement of radiological implant position and the extra costs for the CAS.
We therefore analysed 200 (100 navigated procedures versus 100 conventional operations) total knee replacements and 60 (30 navigated procedures versus 30 conventional operations) hip resurfacing procedures. Evaluation criteria were radiological alignment and costs produced by using computer-assisted navigation tools.
In our series of total knee and hip resurfacing arthroplasties the number of outliers could be significantly reduced by using CAS. Patients receiving a navigated total knee replacement had a significantly lower blood loss and need for blood transfusion. The financial calculation for CAS for our specialised orthopaedic hospital showed that every CAS operation produced 442 euro extra costs per operation. So far these extra costs are not reimbursed.
By using CAS the implant positioning is significantly improved. Total knee replacements have a lower blood loss. Due to the prolonged operation time, the leasing costs and the single use navigation tools of every navigated operation produced costs for our hospital of 442 euro. As there is so far no reimbursement of these costs, long-term survival studies are needed to reveal the superiority of the navigation method and to show an impact on the medical budget.
Zeitschrift fur Orthopadie und Unfallchirurgie 147(6):669-74. · 0.52 Impact Factor
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ABSTRACT: Six weeks after spontaneous healing or suturing of standardized longitudinal lesions in zone II of the posterior horn of the rabbit medial meniscus there was no difference of any kind evident. After fibrin sealing, however, a significant higher stability of scar tissue was measured. Compared to intact menisci in all cases scar stability was diminished, hence in the elongation of the scar the tissue was also weakened. This region of weakness was significantly reduced in menisci that had been sealed. Due to these results it is of utmost necessity that the meniscus suture in zone II should be thoroughly reexamined; the application of fibrin sealant should be seriously considered.
Zeitschrift für Orthopädie 129(4):350-4. · 0.86 Impact Factor
