[Show abstract][Hide abstract]ABSTRACT: Persistent pain after ankle sprains can be triggered by chondral lesions of the talus and tibia or impingement due to protruding capsular and ligament structures and secondary bony changes.
Differential diagnoses include extra-articular causes triggered from adjacent structures and stabilizing tendons.
This article summarizes methods for the identification and treatment of impingement causes and cartilage defects of the talus in the context of ankle instability.
[Show abstract][Hide abstract]ABSTRACT: The purpose of this study consisted in examining the effects of fit and fill ratio of the Metha (®) prosthesis (BBraun, Aesculap, Tuttlingen, Germany) on radiological and clinical outcomes at a follow-up of 1 year.
40 patients were included. Fit and fill ratio measurements, radiological and clinical examinations were performed preoperatively and postoperatively. Correlations were established between fit and fill ratio, and potential factors like sex, age, body mass index, Harris Hip Score and changes of radiological signs.
The whole cohort (100 %) had a tight fit and fill ratio (>0.8) at the proximal level and at each follow-up. "Champagne-flute" configuration provoked high distal tight-fit and fill ratio. Poor distal fit and fill ratio compared to the proximal and the mid-stem level was measurable at each follow-up (p < 0.05). Correlations between fit and fill ratio and preoperative femur configurations were detectable.
Implanting the Metha(®) prosthesis induces tight fit and fill ratio at the proximal and coated sections. Preoperative femur configuration should be considered to achieve best fit and fill situation and therefore excellent primary stability. In most cases "normal" and "stove-pipe" configurations provide good proximal fit and fill. Since "champagne-flute" configuration induces undesirable tight distal fit and fill ratio the size of the Metha (®) stem should be adequately increased to achieve a more proximal load transmission.
Full-text · Article · Aug 2015 · Archives of Orthopaedic and Trauma Surgery
[Show abstract][Hide abstract]ABSTRACT: Purpose
Matrix-induced autologous chondrocyte implantation (MACI) has demonstrated effectiveness in treating isolated cartilage defects of the knee but medium- and long-term evidence and information on the management of postoperative complications or partially successful cases are sparse. This study hypothesised that MACI is effective for up to 5 years and that patients with posttreatment problems may go on to obtain clinical benefit from other interventions.
A follow-on, prospective case series of patients recruited into a previous controlled, randomised, prospective study or newly enroled. Patients were followed up 6, 12, 24 and 60 months after surgery. Outcome measures were Tegner (activity levels) and Lysholm (pain, stability, gait, clinical symptoms) scores. Zone-specific subgroups were analysed 6, 12 and 24 months postoperatively.
Sixty-five patients were treated with MACI. Median Tegner score improved from II to IV at 12 months; an improvement maintained to 60 months. Mean Lysholm score improved from 28.5 to 76.6 points (±19.8) at 24 months, settling back to 75.5 points after 5 years (p > 0.0001). No significant differences were identified in the zone-specific analysis. Posttreatment issues (N = 12/18.5 %) were resolved with microfracture, debridement, OATS or bone grafting.
MACI is safe and effective in the majority of patients. Patients in whom treatment is only partially successful can go on to obtain clinical benefit from other cartilage repair options. This study adds to the clinical evidence on the MACI procedure, offers insight into likely treatment outcomes, and highlights MACI’s usefulness as part of an armamentarium of surgical approaches to the treatment of isolated knee defects.
Level of evidence
Prospective case control study with no control group, Level III.
[Show abstract][Hide abstract]ABSTRACT: Introduction
Silicone injection is a common procedure in cosmetic surgery. Granuloma formation and migration are the most commonly observed complications.
We report an unusual case of avascular necrosis of the hip in a 41-year-old woman from Thailand presenting with hip pain. Subcutaneous nodules were observed in the clinical examination. A pelvic X-ray revealed necrosis of the right femoral head and histological analysis of the punctuated nodules showed a reaction of foreign body granulomas. During surgical treatment with a hip replacement solitary silicone cysts were removed.
This case report emphasizes that orthopedic surgeons treating patients with necrosis of the hip joint in combination with palpable granulomas in the gluteal region have to be aware of silicone augmentation and its potential complications before planning a hip replacement.
Full-text · Article · May 2014 · Journal of Medical Case Reports
[Show abstract][Hide abstract]ABSTRACT: Fresh subtotal ACL tears have been reported to have the ability to heal with the help of subchondral bleeding spontaneously or by provoked bleeding in the avulsion of the notch. Within an orienting prospective study, 55 fresh partial (50–80%) ACL injuries were treated with arthroscopic primary repair to demonstrate the effect of provoked healing. The torn ACL bundles were re-adapted and the anatomical onsets at the bone were perforated in order to provoke a healing response from a super clot with mesenchymal stem cells. If re-insertion and reduction was difficult, an additional arthroscopic fixation with a suture anchor had to be performed. The knee rehabilitation was performed mainly in extended position and limited range of motion within the first 3 weeks, providing unloading for the ACL. Clinical and MRI follow-ups were performed at 6, 12, and 24 months. The median Tegner activity score performed from 2 to 5 points after 24 months. The mean Lysholm knee-score improved from 41 to 92 points after 24 months. The MRI showed morphological changes, with unorganized ligament fibers changing to continuous end-to-end appearance – mostly with a normal thickness and with hypertrophy or atrophy in a few cases. The KT-1000 measurement showed an improvement in stability from 3.4 to 2 mm mean value. Eleven (17%) cases showed failures within the first 12 months with inadequate stability (four) or recurrent trauma (seven) during sports activity. In mid-term time response, arthroscopic primary repair is a minimally invasive, easy, and inexpensive procedure that shows an 83% success rate if applied in fresh partial ACL tears.
[Show abstract][Hide abstract]ABSTRACT: Implant positioning and knee alignment are two primary goals of successful unicompartmental knee arthroplasty. This prospective study outlines the radiographic results following 32 patient-specific unicompartmental medial resurfacing knee arthroplasties. By means of standardized pre- and postoperative radiographs of the knee in strictly AP and lateral view, AP weight bearing long leg images as well as preoperative CT-based planning drawings an analysis of implant positioning and leg axis correction was performed.The mean preoperative coronal femoro-tibial angle was corrected from 7° to 1° (p<0.001). The preoperative medial proximal tibial angle of 87° was corrected to 89° (p<0.001). The preoperative tibial slope of 5° could be maintained. The extent of the dorsal femoral cut was equivalent to the desired value of 5mm given by the CT-based planning guide. The mean accuracy of the tibial component fit was 0mm in antero-posterior and +1mm in medio-lateral projection. Patient-specific fixed bearing unicompartmental knee arthroplasty can restore leg axis reliably, obtain a medial proximal tibial angle of 90°, avoid an implant mal-positioning and ensure maximal tibial coverage.
[Show abstract][Hide abstract]ABSTRACT: Four years after primary implantation of an ESKA Cut short-stemmed prosthesis, a 61-year-old patient suffered fracture of the implant. The combination of missing proximal support of the prosthesis as well as enormous strain on the distal third of the stem can be considered as main reason for the fatigue failure. The special design of the modular implant with a small diameter and a spongy metal surface can be regarded as a contributing factor. This unique case demonstrates a possible failure mechanism of short- and ultra short-stemmed prostheses.
No preview · Article · Jun 2011 · The Journal of arthroplasty
[Show abstract][Hide abstract]ABSTRACT: Hintergrund
Die hüftendoprothetische Versorgung von Patienten unter 50 Jahren ist angesichts steigender Versorgungsnotwendigkeit heute kein Ausnahmeeingriff mehr. Ziel der vorliegenden Studie war es zu analysieren, ob das metaphysär verankernde Prothesenkonzept der Druckscheibenendoprothese (DSP) bei unter 50-jährigen Patienten zu gleichwertigen Ergebnissen führt wie bei Patienten über 50 Jahren.
Patienten und Methoden
Die Untersuchung beinhaltete 465 DSP-Implantationen, davon 149 DSP bei Patienten ≤50 Jahre (Gruppe A) und 316 DSP bei Patienten >50 Jahre (Gruppe B). Neben einer klinischen und radiologischen Verlaufsevaluation erfolgte eine differenzierte Standzeitanalyse nach definierten Endpunkten.
Es ergaben sich signifikant bessere Standzeiten der Gruppe A (96%/13,2 Jahre) gegenüber der Gruppe B (86%/12,5 Jahre). Das Risiko einer Prothesenlockerung bzw. radiologischer Lockerungszeichen war in Gruppe A ebenfalls signifikant niedriger als in Gruppe B (p
[Show abstract][Hide abstract]ABSTRACT: Die hüftendoprothetische Versorgung von Patienten unter 50 Jahren ist angesichts steigender Versorgungsnotwendigkeit heute kein Ausnahmeeingriff mehr. Ziel der vorliegenden Studie war es zu analysieren, ob das metaphysär verankernde Prothesenkonzept der Druckscheibenendoprothese (DSP) bei unter 50-jährigen Patienten zu gleichwertigen Ergebnissen führt wie bei Patienten über 50 Jahren.Die Untersuchung beinhaltete 465 DSP-Implantationen, davon 149 DSP bei Patienten ≤50 Jahre (Gruppe A) und 316 DSP bei Patienten >50 Jahre (Gruppe B). Neben einer klinischen und radiologischen Verlaufsevaluation erfolgte eine differenzierte Standzeitanalyse nach definierten Endpunkten.Es ergaben sich signifikant bessere Standzeiten der Gruppe A (96%/13,2 Jahre) gegenüber der Gruppe B (86%/12,5 Jahre). Das Risiko einer Prothesenlockerung bzw. radiologischer Lockerungszeichen war in Gruppe A ebenfalls signifikant niedriger als in Gruppe B (p Bei vergleichbar langfristigen Standzeiten zu denen zementfreier Standardprothesen wird die DSP der Grundidee eines knochensparenden, metaphysär verankernden Schenkelhalsimplantats insbesondere für den jungen Patienten gerecht.
[Show abstract][Hide abstract]ABSTRACT: Hip replacement in patients younger than 50 years old is no longer an exception in view of the increasing necessity for care. The aim of the present study was to analyze whether the results after implantation of thrust plate prosthesis (TPP) with metaphyseal anchorage are equal for patients below 50 years compared to older patients.
The investigation comprised 465 TPP implantations. In 149 TPP the patient age was below 50 years (group A) und in 316 TPP cases above 50 years (group B). Clinical and radiological evaluation of the results for both groups was carried out as well as a differentiated survival analysis with defined endpoints.
Survival analysis of group A (96%/13.2 years) showed a significantly improved survival rate compared to group B (86%/12.5 years). Additionally, the risk of prosthesis and/or radiological signs loosening of was significantly lower in group A than in group B (p <0.05).
Comparison of long-term results of prostheses with intramedullary fixation shows that the anchorage principle of TPP with bone-saving implantation to the proximal femur is justified especially for patients below 50 years of age.
[Show abstract][Hide abstract]ABSTRACT: Cartilage defects occur in approximately 12% of the population and can result in significant function impairment and reduction in quality of life. Evidence for the variety of surgical treatments available is inconclusive. This study aimed to compare the clinical outcomes of patients with symptomatic cartilage defects treated with matrix-induced autologous chondrocyte implantation (MACI or microfracture (MF). Included patients were >or= 18 and <or= 50 years of age with symptomatic, post-traumatic, single, isolated chondral defects (4-10 cm2) and were randomised to receive MACI or MF. Patients were followed up 8-12, 22-26 and 50-54 weeks post-operatively for efficacy and safety evaluation. Outcome measures were the Tegner, Lysholm and ICRS scores. Sixty patients were included in a randomised study (40 MACI, 20 MF). The difference between baseline and 24 months post-operatively for both treatment groups was significant for the Lysholm, Tegner, patient ICRS and surgeon ICRS scores (all P < 0.0001). However, MACI was significantly more effective over time (24 months versus baseline) than MF according to the Lysholm (P = 0.005), Tegner (P = 0.04), ICRS patient (P = 0.03) and ICRS surgeon (P = 0.02) scores. There were no safety issues related to MACI or MF during the study. MACI is superior to MF in the treatment of articular defects over 2 years. MACI and MF are complementary procedures, depending on the size of the defect and symptom recurrence. The MACI technique represents a significant advance over both first and second generation chondrocyte-based cartilage repair techniques for surgeons, patients, health care institutions and payers in terms of reproducibility, safety, intraoperative time, surgical simplicity and reduced invasiveness.
[Show abstract][Hide abstract]ABSTRACT: Within a prospective case group study, two hamstring fixation techniques, a pin fixation with RigidFix (RF) and an anchor fixation with EndoButton (EB), were compared.
67 patients were followed clinically and by MRI preoperatively (t0), at six months (t6) and at twelve months (t12). In one group (N = 21), EB was used for representing a juxta-articular graft fixation. The second group (N = 46) with RF was used to represent the ab-articular fixation. KT-1000 stability measurement, IKDC, Lysholm and Tegner scores were used to determine the clinical outcomes. Reflux and tunnel widening (TW) were investigated by MRI.
The KT-1000 values were slightly more stable at t6 (EB: 2.1 +/- 4.1 mm, RF: 1.0 +/- 2.5 mm) in the RF group (p = 0.044) but equalised later at t12 (EB: 0.5 +/- 3.1 mm, RF 1.0 +/- 2.4 mm). The median Tegner score at t6 (EB: 4.3 +/- 1.2, RF 4.1 +/- 1.7) and t12 (EB: 5.9 +/- 1.8, RF 5.4 +/- 2.0) were comparable (p = 0.692). The mean Lysholm score at t6 (EB: 90 +/- 11, RF: 91 +/- 8.9) and t12 (EB: 95 +/- 7.5, RF: 95 +/- 7.4) was comparable in each group (p = 0.589). The same was valid in the median of the IKDC score at t6 (EB: II, RF III) and t12 (EB: II, RF III). The category "femoral reflux" showed slight minimal fringe in the EB group at t6 but aligned to "no reflux" together with the RF group at t12 (NS, p = 0.550). A tunnel widening was not detectable in either of the groups.
No preview · Article · Feb 2010 · Zeitschrift fur Orthopadie und Unfallchirurgie
[Show abstract][Hide abstract]ABSTRACT: The press-fit fixation of the conical Balgrist expansion cup (Allo Pro, Baar, Schweiz) is realised by the help of a (titanium alloy) split ring and a metal-backed inlay. The results and fixation principles of the cement-free Balgrist hip socket are analysed within a clinical and radiological long-time study and compared with those of the conical Zweymüller-Alloclassic CFS (Zimmer-GmbH, Winterthur, Schweiz) screw cup for a concluding evaluation.
Between 1993 and 2003, 277 Balgrist hip sockets and between 1994 and 2000 130 Alloclassic-Zweymüller screw cups were performed consecutively in 364 patients considering similar indications with an average age of 54.6 years and 51.9 years, respectively. The clinical investigation was carried out with the Harris hip score (HHS). Radiological evaluation included a manual migration analysis according to Sutherland et al., Nunn et al. and Effenberger et al.; radiolucent lines were registered according to the zones of DeLee and Charnley. The survival rate of both cups was calculated on the basis of the Kaplan-Meier and the life-table analyses.
Besides 4 (1.4%) aseptic loosenings, 5 Balgrist cups (1.8%) had to be replaced because of infection and another 1 (0.8%) because of persisting pain. Three Balgrist sockets (1.1%) showed a migration > 2 mm. In the Alloclassic group 1 cup (0.8%) was considered as being migrated, another cup (0.8%) had to be replaced due to infection. Considering aseptic loosening and radiological migration as an end point, the cumulative survival of the Balgrist cup at 13 years was 97.3%, that of the Zweymüller-Alloclassic cup at 10 years was 99.2%. In comparison with the Alloclassic group, the Balgrist hip sockets showed increased radiolucent lines of zone 1 (p < 0.001), without any effects on the survival time or the clinical result however. Both cups resulted in good to excellent clinical results in the HHS (91 points).
The long-term analysis of the Balgrist hip socket proved that the concept of the retightening conical expansion cup leads to good clinical results and fulfils the minimum survival rate of 95% at 10 years as demanded by Delaunay and Kapandji. The good results obtained with the aid of this concept are comparable to those of the Alloclassic screwing cup.
Full-text · Article · Nov 2009 · Zeitschrift fur Orthopadie und Unfallchirurgie
[Show abstract][Hide abstract]ABSTRACT: Different approaches for the hip have been developed for minimally invasive surgery in total hip arthroplasty. The goal of minimally invasive surgery is to reduce invasiveness to skin, muscles, and bone and improve recovery time after total hip arthroplasty. This article describes the technique of a minimally invasive approach to the hip from the anterolateral direction step by step and includes preoperative settings and pitfalls.
No preview · Article · Oct 2009 · Orthopedic Clinics of North America
[Show abstract][Hide abstract]ABSTRACT: With the help of a clinical and radiological follow-up evaluation 8 years after implantation of the femoral neck prosthesis CUT (ESKA Implants, Lübeck Germany), the question of whether this metaphyseal anchoring implant is recommendable in young patients will be answered.
Between 2000 and 2001 82 CUT-prosthesis procedures were performed in 79 patients (38 female, 41 male patients; average age 51.3 years) and evaluated prospectively. The clinical investigation was carried out according to the criteria of the Harris Hip and Merle d'Aubigné scores. Radiological periprosthetic bone changes were registered and a measurement of the CCD angle and femoral offset was performed. The survival rate was calculated according to both the Kaplan-Meier and the life-table analyses.
During the 12-month follow-up examination the HHS (48.4 preop.) as well as the Merle d'Aubigné score (10 preop.) increased significantly to an average value of 85.1 and 15.8, respectively (p < 0.000). Cumulative survival with replacement of the prosthesis as an end point at 8 years was 49.6 %. Due to 25 aseptic loosenings, three periprosthetic infections and three cases of persisting thigh pains, 31 replacements of the femoral neck prosthesis became necessary up to June 2008. The implantation of the CUT prosthesis led to a significant valgisation (p < 0.001) of 17.4 degrees degrees with a consecutive reduction of the femoral offset of 5 mm. Radiologically periprosthetic progressive radiolucencies, hypertrophic cortical bone changes as well as atrophy of the calcar femoris were often evaluated and interpretated as a sign of a stress shielding and migration process.
The analysis of the eight-year follow-up of 82 CUT prostheses shows that the implant does not fulfil our expectations of a femoral neck prosthesis, in spite of the possibility of a less invasive and bone-saving implantation technique. In view of unacceptable survival rates, valgisation changes of the joint geometry and critical changing procedures, from our point of view the femoral neck prosthesis CUT does not represent a recommendable alternative implant in young, active patients.
No preview · Article · Mar 2009 · Zeitschrift fur Orthopadie und Unfallchirurgie
[Show abstract][Hide abstract]ABSTRACT: The aim of this study was to analyse and evaluate comparatively loosening mechanisms, failure frequency, surgical changing strategies and results after replacement of thrust plate prostheses (TPP) and ESKA Cut prostheses.
Between 1993 und 2007, 465 TPP and in the years 2000 and 2001 82 ESKA Cut prostheses were performed and evaluated prospectively. Until 2007 46 change interventions of the TPP and 35 of the CUT prosthesis became necessary. All patients who received a stem revision procedure in our hospital were included within this study. Besides the evaluation of clinical results according to the criteria of the Harris Hip Score on the average at 15.6 months (+/- 14.4) postoperatively, radiological loosening processes and surgical difficulties were registered. Furthermore, an analysis of perioperative data was performed according to some criteria of the German Federal Office of Quality Assurance (BQS), such as duration of the surgery, intraoperative blood loss and complications. Statistical investigations for comparative analysis as well as survival analysis of both groups were calculated using SPSS for Windows 13.0.
The mean age of the 46 patients who had to undergo revision surgery after TPP was 60.1 years, that of 35 patients in whom revision surgery was necessary after receiving an ESKA Cut femoral neck stem was 56.6 years. The survival rate analysis according to Kaplan-Meier at 13 years was 89.4 % (TPP) and 53.6 % at 66 months (ESKA Cut). In all cases the partial osteointegration of the tripod surface of the loosened Cut prosthesis complicated the explantation. It led on the one hand to a significant difference of the surgery duration and on the other hand to an increased frequency of fractures of the trochanteric region. The conversion of the TPP on standard type stems was usually free of problems. The HHS increased significantly to the averages of 86.6 (TPP) or, respectively, 91.69 (ESKA Cut) after revision.
In comparison with the usually problem-free changing procedure of the TPP to a standard type stem, the revision surgery of the Cut prosthesis becomes substantially more complex and leads frequently to complications. In view of unacceptable survival rates, the Cut prosthesis does not represent an alternative implant in young patients. Except for the implantation technique, which does not allow a less invasive surgical procedure, the TPP fulfils the requirements of femoral neck prosthesis due to acceptable survival rates and good convertibility.
No preview · Article · Jan 2009 · Zeitschrift fur Orthopadie und Unfallchirurgie
[Show abstract][Hide abstract]ABSTRACT: Iliac bone grafting and matrix-guided autologous chondrocyte implantation (MACI) can be combined to treat large osteochondral defects of the knee. In this prospective study, we evaluated clinical and magnetic resonance imaging (MRI) findings after one and two years of this treatment method.
The study included 12 patients who completed a follow-up period of two years. Preoperative arthroscopic and MRI studies revealed grade 3 or 4 osteochondritis dissecans in all the cases. In the first operation, a deep debridement of the sclerotic subchondral bone was performed, followed by press-fit filling of the defect with cancellous bone. In the second operation, a double-layer MACI was fixed within the defect with fibrin glue. The clinical outcomes were evaluated using clinical scores.
The clinical outcomes before and 24 months after surgery were as follows: the mean Meyers score increased from 10.2 to 18, Lysholm-Gillquist score increased from 56.6 to 100, and Tegner-Lysholm score increased from 1.8 to 4. These scores did not show notable changes after 12 months. On MRI images, subchondral edema within the bone graft disappeared until the sixth month. Within a year, MRI signal intensity of the cartilage repair tissue well approximated to that of the healthy surrounding cartilage. The thickness of the cartilage repair tissue increased from 1 mm to 1.8 mm within 6 to 12 months.
Matrix-guided autologous chondrocyte implantation combined with bone grafting may be successfully used in remodeling the joint surface, without causing donor site morbidity within the knee joint. In addition, subchondral pathologic alterations may be effectively treated. Magnetic resonance imaging is a reliable technique to evaluate the repair process.
Preview · Article · Jan 2007 · acta orthopaedica et traumatologica turcica