Hans-Michael Klinger

Universitätsmedizin Göttingen, Göttingen, Lower Saxony, Germany

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Publications (32)41.35 Total impact

  • Sportverletzung · Sportschaden 09/2006; 20(3):123-126. DOI:10.1055/s-2006-927001 · 0.28 Impact Factor
  • Zeitschrift für Orthopädie 07/2006; 144(4):357-361. DOI:10.1055/s-2006-942125 · 0.86 Impact Factor
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    ABSTRACT: Infection after total knee arthroplasty (TKA) can be a challenging and difficult problem to treat. In selected patients, knee arthrodesis is a well-recognized salvage procedure after infected TKA. The authors retrospectively reviewed their experience with this treatment option, presenting 20 patients (8 women, 12 men), performed between 1990 and 2002. The average age was 67 years (range: 47-81 years) and the mean number of previous surgical procedures was 6 (range: 4-11 procedures). There were multiple indications for knee arthrodesis, including extensive bone or soft tissue loss, poor bone stock, and recurring infections. One-stage fusion was done in 7 knees while, on the other 13, arthrodesis was performed as two-stage fusions. The average clinical follow-up was 4.5 years (range: 2-11 years). 18 of the 20 patients were interviewed and graded using the Visual Analogue Scale (VAS) for pain, the Short Form-36 Health Survey (SF-36), and the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire that has knee-related quality of life items. According to the VAS, the mean intensity was 3.4 points. 6 (33%) of the patients had no difficulty with the knee and 9 (50%) of them had mild or moderate difficulty. The SF-36 scores were similar to those for normative data for patients after TKA, with only the social functioning, role emotional, and physical functioning scores being lower and the role physical and social functioning scores being higher. Three of 20 fusions failed, whereas two knees became non-infected non-unions. In one, the knee infection persisted and required above-knee amputation. The two-stage arthrodesis gave the most predictable rate of fusion. Persistent infection and extensive bone stock losses led to failure even under the best circumstances. In our opinion, arthrodesis of the knee is a satisfactory salvage procedure following a failed TKA, and can provide reliable expectation for a stable, painless extremity for high-functioning patients who are able to walk.
    Knee Surgery Sports Traumatology Arthroscopy 06/2006; 14(5):447-53. DOI:10.1007/s00167-005-0664-3 · 2.84 Impact Factor
  • Zeitschrift für Orthopädie 03/2006; 144(2):212-217. DOI:10.1055/s-2006-921415 · 0.86 Impact Factor
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    ABSTRACT: The purpose of this study was to investigate the outcome of arthroscopy in painful knee arthroplasty without evidence of infection, fracture, wear, and component loosening or malposition that had been refractory to conservative treatment. In addition, a literature review of 498 cases (MEDLINE 1966 to 2002) was performed. Case series. From 1997 to 2000, 27 patients (20 women, 7 men) had undergone arthroscopies because of poor results following total knee arthroplasty. Before the operation, the patients had suffered symptoms for an average of 11 months (range, 3 to 41 months). The average onset of symptoms after knee arthroplasty was 26 months (range, 3 to 59 months). The average patient age was 70 years (range, 42 to 81 years) and the average follow-up was 34 months (range, 24 to 52 months). At the initial operation, 19 patients had received total condylar surface replacement and 8 had received hemireplacement. Patients were evaluated using the Knee Society rating system. A review of the literature was performed by initial identification of the articles from a MEDLINE database followed by the use of cross references. All of the patients were available for follow-up. Eighteen of the 27 procedures resulted in an improvement in the patient's knee score. The average Knee Society ratings increased from 71 points before arthroscopy to 85 at follow-up for the knee score. The average functional scores were 69 and 83 points, respectively. The Knee Society pain score improved from 32 to 41 points. Nine patients underwent a subsequent open revision after arthroscopic diagnosis or treatment. Operative diagnoses included arthrofibrosis, impinging hypertrophic synovitis, impinging posterior cruciate ligament stump, prosthesis loosening or wear, symptomatic pseudomeniscus, an infrapatellar spur, and meniscal rupture. There was 1 infection as a complication associated with the arthroscopic procedure. Arthroscopic treatment of painful knee arthroplasty provides reliable expectations for improvement in function, decrease in pain, and improvement in knee scores for most patients. Level IV, Case Series.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 07/2005; 21(6):731-8. DOI:10.1016/j.arthro.2005.03.012 · 3.19 Impact Factor
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    ABSTRACT: The purpose of this study was to identify the factors that may lead to poor outcomes after arthroscopic debridement in massive rotator cuff tears. Thirty-three patients (10 women and 23 men) with massive, irreparable rotator cuff tears underwent arthroscopy by a single surgeon. The preoperative diagnosis was based on the clinical examination and MRI. Their mean age was 69 years (range 62-79 years), and the average follow-up was 31 months (range 24-46 months). If indicated, the performed arthroscopic debridement included acromioplasty, debridement of the cuff, resection of the distal part of the clavicle or tenotomy of the long head of the biceps. In 28 cases (85%) acromioplasties and in 6 cases (18%) biceps tenotomies were performed, 2 of which were a single tenotomy without any associated acromioplasty. One patient had been managed with concomitant resection of the distal part of the clavicle. The Constant and Murley Score improved by a mean of 30 points, from a mean of 37 points (range 21-52) preoperatively to a mean of 67 points (range 31-82) at the time of follow-up. Some 82% of the patients were satisfied with the procedure. The result was considered unsatisfactory because of inadequate pain relief in 4 shoulders, because of limited active abduction in 1 and because of limited external rotation in 1. A poor outcome was associated with a complete tear of the subscapularis tendon in 6 patients. The radiological study showed no significant narrowing of the subacromial space. Our early results suggest that arthroscopic debridement is an excellent treatment for elderly patients with modest functional demands. However, its long-term consequences remain to be evaluated by studies with lengthy follow-up. Prognostic factors that may lead to a negative outcome are preoperative superior migration of the humeral head, presence of subscapularis tear, presence of glenohumeral arthritis and decreased range of motion.
    Archives of Orthopaedic and Trauma Surgery 06/2005; 125(4):261-6. DOI:10.1007/s00402-004-0738-6 · 1.31 Impact Factor
  • Hans-Michael Klinger, Mike H Baums, Stephanie Otte, Hanno Steckel
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    ABSTRACT: The purpose of this prospective study was to evaluate the results of simultaneous anterior cruciate ligament (ACL) reconstruction and osteochondral autograft transplantation performed in patients suffering an anterior instability associated with symptomatic full-thickness cartilage defects. Our clinical report includes the first 21 patients (six women, 15 men) who have been followed up for 32 months or longer. The average patient age was 29 years (range 22-44 years), and mean time from injury to the combined reconstructive surgery was 10 months (range 4-27 months). The cartilage defects had a mean area of 3.5 cm2 (range 2.0-5.0 cm2). All patients were evaluated according to the IKDC, Lysholm and Tegner scoring scales by an independent observer. A visual analogue scale (VAS) reflecting patient pain was evaluated. Assessment using the IKDC knee scoring scale revealed 81% of the patients with a normal or nearly normal knee joint. There was a significant improvement in subjective discomfort, and the KT-1000 arthrometric evaluation showed a reduction of the ventral tibial translation (5.9 to 1.9 mm). All but two patients had returned to full activities without restriction and were asymptomatic. The results of this study suggest that symptomatic full-thickness articular cartilage defects associated with ACL instability can be effectively treated by performing ACL reconstruction and osteochondral autologous grafts in one procedure. However, only the years which follow will show the long-term outcome of the patients.
    Knee Surgery Sports Traumatology Arthroscopy 12/2003; 11(6):366-71. DOI:10.1007/s00167-003-0422-3 · 2.84 Impact Factor
  • Hans-Michael Klinger, Stephanie Otte, Mike H Baums, Frank Lorenz
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    ABSTRACT: Arthroscopy for failed total knee arthroplasty (TKA) is a well-documented and accepted procedure for diagnosis of component and soft tissue problems. Fortunately, infection is a rare complication of arthroscopy. To our knowledge, we present the second report of acutely infected TKA after arthroscopy. Two days after arthroscopic treatment because of painful TKA, a 72-year-old woman developed an acutely infected TKA. The patient underwent immediate arthroscopic irrigation and debridement, and treatment with intravenous antibiotics. The cultures from knee joint aspirates were positive for infection with the organism Staphylococcus aureus. Three days later, repeat open debridement with exchange of the tibial polyethylene insert was performed because of persistent fever and fluctuation. The patient was treated with antibiotics for 6 weeks postoperatively. At the latest follow-up evaluation, 26 months after revision, the patient was pain free, had full activities of daily living, and had no clinical or radiographic signs of infection. However, despite the success of arthroscopy in treating and evaluating painful TKA, this potential complication should be considered when performing arthroscopy of symptomatic TKA.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 12/2003; 19(9):E111-13. DOI:10.1016/j.arthro.2003.09.010 · 3.19 Impact Factor
  • Mike Herbert Baums, Hans-Michael Klinger, Stephanie Otte
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    ABSTRACT: Morbus Teutschländer is a benign metabolic disorder involving soft-tissue masses near large joints and a rarely observed form of extraskeletal calcifications. For example, it is seen in patients with chronic renal failure, but in most cases it remains clinically silent. In a minority of patients, this soft-tissue calcification is responsible for complications. Various locations of calcium deposits have been characterized. Advanced age and increased calcium x phosphate product are some of the underlying reasons, but local factors are involved as well. Prevention should be preferred because the treatment is generally difficult. We describe the case of a morbus Teutschländer in a 58-year-old woman with chronic renal failure on hemodialysis presenting with a massive soft-tissue calcification of the foot with a compression of a cutaneous nerve secondary due to uremic tumoral calcinosis. The tumoral masses was successfully excised, and at the 1-year follow-up, the patient had no discomfort. Clinical and radiological features and treatment are discussed, and a review of soft-tissue calcifications is given.
    Archives of Orthopaedic and Trauma Surgery 03/2003; 123(1):51-3. DOI:10.1007/s00402-002-0447-y · 1.31 Impact Factor
  • Stephanie Otte, Hans-Michael Klinger, Juergen Beyer, Mike H Baums
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    ABSTRACT: Biodegradable implants were introduced in the middle 1990s as a new technique for the arthroscopic treatment of reparable meniscal tears. We have used these implants since 1999 and present two cases of failure of biodegradable meniscal repair implants. One foreign-body reaction with granuloma and one fresh meniscus tear after renewed trauma in the case of receding meniscus arrows with a chondral lesion. We also performed a review of the literature with the Medline database. Meniscus refixation with bioabsorbable arrows is considered reliable but shows various other complications that must be borne in mind.
    Knee Surgery Sports Traumatology Arthroscopy 08/2002; 10(4):250-3. DOI:10.1007/s00167-002-0283-1 · 2.84 Impact Factor
  • Hans-Michael Klinger, Stephanie Otte, Mike H Baums, Thomas Haerer
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    ABSTRACT: Frozen shoulder is still an enigma in shoulder surgery. It is reported that at 2 years after onset most patients will have recovered whether treated or not. To decrease time to recovery and improve the results of this condition, a number of different treatment modalities have been used. In our unit, all patients with frozen shoulder were selected for the arthroscopic release technique if a conservative program of physical therapy had failed to restore motion after 6 months and if they had no known extra-articular contractures. A prospective study was undertaken of 36 patients with refractory frozen shoulder who were treated with an arthroscopic capsulotomy between November 1997 and October 1999. There were 22 women and 14 men with an average age of 49 years (range 32-63 years). All of the patients were assessed for pain, function, and range of motion before surgery. Five patients were diabetic. An arthroscopic capsular release improved motion in all patients, with substantial relief of pain. Follow-up averaged 18 months (range 10-26 months). The median preoperative Constant score rose from 29 to 66 at the time of follow-up. By a mean of 8 weeks after treatment, 75% of the patients had returned to work. One patient developed recurrent refractory stiffness. There were no complications related to the procedure. This study demonstrates that arthroscopic capsular release can be a safe and effective tool in the management of refractory shoulder stiffness and is an effective way of shortening the course of an apparently self-limiting disease.
    Archives of Orthopaedic and Trauma Surgery 06/2002; 122(4):200-3. DOI:10.1007/s00402-001-0355-6 · 1.31 Impact Factor
  • Stephanie Otte, Hans-Michael Klinger, Frank Lorenz, Thomas Haerer
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    ABSTRACT: Closed rupture of the tibial anterior tendon is a rare clinical entity. Case reports in the literature reveal a total of only 49 cases up to the year 2000. According to these reports, the age group affected is 50 to 70 years old, and there are more men than women affected. Although the functional limitation is quite considerable, late diagnosis is common. An appropriate clinical examination, including an exact history taking, should lead to the right diagnosis. Ultrasound examination and magnetic resonance imaging (MRI) may be helpful. 'Restitutio ad integrum' can only be achieved by operative treatment. If technically possible, reinsertion of the tendon directly into bone or direct tendon repair is preferred. After delayed diagnosis, a secondary reconstruction through tendon transfer or transplantation is often necessary. A 64-year-old woman presented with pain and swelling in the area of the ankle joint 5 months after falling. She showed insecurity in walking, and the heel-walk could not be demonstrated. The distal neurovascular function was intact. The area of the retinaculum showed a swelling, and the tendon was not palpable in comparison with the other forefoot. An intact tendon could not be seen by ultrasound, and MRI confirmed these findings. A complete rupture was noted during the operative revision. The proximal and the distal tendon stumps were found to be thickened and knotted, the proximal stump was also atrophic. An augmented tenoplasty was performed. Afterwards, the tendon was tense in the neutral position. The lower leg was put in a plaster cast for 6 weeks, followed by physiotherapy. Ten months after the operation, the tendon was palpable in the correct position, the dorsal extension was powerful, and the patient did not experience any difficulty. Rupture of the anterior tibial tendon is a rare clinical entity and should be considered in the differential diagnosis of pain in the area of the ankle joint. An early operative treatment is advantageous.
    Archives of Orthopaedic and Trauma Surgery 05/2002; 122(3):188-90. DOI:10.1007/s004020100346 · 1.31 Impact Factor

Publication Stats

246 Citations
41.35 Total Impact Points

Institutions

  • 2008–2014
    • Universitätsmedizin Göttingen
      • Division of Orthopedics
      Göttingen, Lower Saxony, Germany
  • 2003–2012
    • Georg-August-Universität Göttingen
      • Centre for Medical Law
      Göttingen, Lower Saxony, Germany
  • 2002
    • Justus-Liebig-Universität Gießen
      Gieben, Hesse, Germany