Jochen Paul

Hannover Medical School, Hanover, Lower Saxony, Germany

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Publications (42)53.95 Total impact

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    ABSTRACT: Purpose: Limited literature reports on internal and external rotation of the distal fragment in the context of valgus open wedge (OW) high tibial osteotomy (HTO). In the authors clinical observation, the distal fragment was always rotated internally in relation to the proximal fragment by the end of the surgical procedure. The purpose was to evaluate the influence of valgus OW-HTO on post-operative tibial torsion. Study design: Prospective case series. Methods: Fifty patients (10 female, 40 male; mean age 42.1 ± 9.4 years) underwent valgus OW- HTO. The osteotomy was spread and fixed with a locking plate at the posteromedial aspect of the proximal tibia. The osteotomy of the tibial tuberosity was performed either proximally or distally dependent on the patello-femoral findings. Two independent observers measured axial tibial rotation using K-wires placed into the anterior margin of the tibia proximal and distal to the osteotomy. Results: An overall mean of 4.4 ± 2.8° internal rotation of the distal tibia has been shown. In four patients with additional single step double bundle ACL-replacement after harvesting ipsilateral autologous hamstring grafts, the distal tibia rotated internally by 0.1 ± 0.3°, accordingly in the other 46 patients by 4.8 ± 2.6°. Conclusions: Valgus OW-HTO produces significant internal axial rotation of the distal tibia. This might be caused by soft tissue tension of the medial hamstrings/soft tissue structures and the location of the lateral tibial hinge. Clinical relevance: Surgeons have to take into consideration that valgus OW HTO might result in significant 3D changes of the tibia. Higher degrees of internal torsion of the tibia might influence overall gait mechanics and specifically alternate patellofemoral kinematics.
    No preview · Article · Jan 2016 · International Orthopaedics
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    ABSTRACT: We analyzed the histopathologic findings in end-stage osteoarthritic ankle joint tissue that display increased uptake of bone-seeking radiotracer in single-photon emission computed tomography-computed tomography (SPECT-CT) imaging. Six consecutive patients with end-stage osteoarthritis undergoing total ankle replacement received preoperative SPECT-CT imaging using (99m)Technetium dicarboxypropane diphosphonate ((99m)Tc-DPD). Using imaging data for stratification, osteochondral tissue sections were prepared from SPECT-positive (+) and -negative (-) areas of tibial and talar resection specimens. Histomorphometric analyses of osteoblast numbers, collagen deposition, and cartilage degeneration were performed on hematoxylin and eosin, van Gieson's and Safranin-O stained tissue sections. Osteoclast activity was visualized using tartrate-resistant acid phosphatase (TRAP) staining. Increased (99m)Tc-DPD uptake was observed exclusively subjacent to the subchondral bone plate of tibial and talar joint compartments. SPECT(-) tissues displayed typical fatty marrow morphology containing mainly collagen-positive blood vessels and few marrow and bone-lining cells. SPECT(+) tissues were characterized by increased numbers of active bone-lining osteoblasts depositing collagen fibers. Collagen area fraction of subchondral bone marrow was significantly increased in SPECT(+) (0.52 ± 0.21) compared with SPECT(-) (0.29 ± 0.13) tissues (P = .30). Multinucleated TRAP(+) osteoclasts were absent from bone formation sites, but associated with vascular structures invading articular cartilage through the subchondral bone plate. Increased (99m)Tc-DPD uptake was specifically and strongly correlated with increased osteoblast numbers (P = .011), and with collagen area fraction (P = .030) but not with Mankin score (P = .202), or with osteoclast number (P = .576). Subchondral bone tissues in SPECT(+) areas of end-stage ankle osteoarthritis were histologically characterized by increased osteoblast-mediated bone formation in the absence of functional osteoclasts, and increased cellularity and collagen deposition in marrow tissues. Our findings suggest a pathologic bone-remodeling process in end-stage ankle OA areas with increased (99m)Tc-DPD uptake. Level IV, case series. © The Author(s) 2015.
    No preview · Article · Jul 2015

  • No preview · Article · Apr 2015
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    ABSTRACT: Joint-preserving, realignment surgical procedures have gained increasing popularity as treatment of asymmetric early- and mid-stage ankle osteoarthritis. The aim of the present study was to quantify bilateral gait biomechanics in patients who underwent ankle realignment surgery by supramalleolar osteotomies. Eight patients, a minimum of 7 years after realignment surgery, and 8 healthy controls were included in this study. Three-dimensional instrumented gait analysis was used to assess spatiotemporal parameters, bilateral joint angles, and moments. Furthermore, a clinical evaluation on pain, ankle function, and quality of life was performed. Compared with the healthy controls, the patients walked more slowly, had a smaller sagittal hindfoot range of motion on their affected leg, and had a lower peak ankle dorsiflexion moment (P < .05). There were no significant differences compared with controls for the ranges of motion in the foot segments of the nonaffected foot and for the knee and hip joint ranges of motion and peak moments of both legs. Additionally, patients and controls did not differ in the quality of life score. However, in the pain subscore, the patients reported significantly more pain than the healthy persons. Despite different gait biomechanics of the affected foot after ankle realignment surgery, the quality of life for patients was comparable to that of healthy controls. Therefore, supramalleolar osteotomies should be considered as a promising treatment option in patients with asymmetric non-end-stage ankle osteoarthritis. Prognostic level III, comparative study. © The Author(s) 2015.
    No preview · Article · Mar 2015
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    ABSTRACT: Aktuell sind Sportverletzungen immer noch die häufigste Ursache für eine Instabilität des oberen Sprunggelenks (OSG). Obwohl die meisten Fälle der akuten OSG-Instabilität (AI [engl. Ankle Instability]), nach initialer konservativer Therapie komplikationslos heilen, können doch auch schwerwiegende Komplikationen entstehen. Die relevanten Komplikationen bei einer akuten AI sind (1) die chronische OSG-Instabilität (CAI [engl. Chronic Ankle Instability]), (2) die Entstehung einer osteochondralen Läsion (OCL) des Talus und (3) die Arthrose des OSG. Um diese schwerwiegenden Komplikationen zu vermeiden, sind eine adäquate Diagnostik und Therapie der AI nötig, jedoch können dennoch nicht alle Komplikationen vermieden werden.
    No preview · Article · Mar 2015 · Sport-Orthopädie - Sport-Traumatologie - Sports Orthopaedics and Traumatology
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    ABSTRACT: Osteochondral lesions (OCL) of the talus are being recognized as an increasingly frequent sports 7 injury. They can be found as a concomitant injury in up to 50 % of all ankle sprains (Saxena and 8 Eakin 2007). Damage to articular cartilage at the ankle can lead to osteoarthritis in midterm or long 9 term, which can significantly affect quality of life and restrict sports and recreation activities. 10 The management of OCL of the talus remains a challenge to the treating physician. The etiology 11 and pathophysiology of OCL of the talus are not clearly known yet. Even though trauma seems to be 12 the most common cause, it is likely that a variety of etiological factors may play a substantial role in 13 the development of OCL. MRI is the gold standard imaging tool for radiographic diagnostic of OCL 14 of the talus. However, conventional weight-bearing radiographs should routinely be done for 15 standard diagnostics, exclusion of fractures, and evaluation of biomechanical alignment. Symptom- 16 atic and/or deep OCL on the talus should be treated surgically, because these lesions rarely improve 17 clinically with conservative treatment. There are several different surgical treatment strategies, 18 which are described in this chapter. Advantages and disadvantages are discussed and indications 19 for the surgical treatment are described.
    No preview · Chapter · Feb 2015
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    ABSTRACT: CT-osteoabsorptiometry (CT-OAM) has been used to visualize subchondral bone plate density distribution regarding to its mineralization. The purpose of this study was to display and analyze the density distribution of the subchondral bone plate before and after supramalleolar realignment osteotomies. We retrospectively analysed pre- and postoperative CT images of nine consecutive patients with post-traumatic unilateral valgus ankle OA. The distribution charts of CT-OAM scans were quantitatively analyzed for subchondral bone plate density distribution. VAS for pain and the Tegner activity scale were used to assess clinical outcome. At a mean follow-up of 20 ± 5.6 months (range 13–27), we observed a significant pre- to postoperative decrease of the mean high-density area ratio in tibia (lateral and posterior area) (p ≤ 0.05) and the talus (lateral area) (p ≤ 0.05). Pairwise comparison between the pre- and postoperative mineralization at the articular surface showed a significant decrease of the high-density area ratio for the tibia and the talus. The VAS decreased from 6.2 ± 0.9 pre- to 2.8 ± 0.9 postoperatively (p = 0.027), and the Tegner score inclined from 4.5 ± 1.1 preoperatively to 5.3 ± 0.7 after surgery (p = 0.082). The tibial and talar subchondral bone plate density, regarding to its mineralization, decreased after supramalleolar medial closing wedge osteotomy in patients with valgus ankle OA. The results of this study suggest that realignment surgery may decrease peak bone density areas corresponding to the alignment correction and contribute to a homogenization of the subchondral bone plate mineralization. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop ResLevel of evidence Level IV, Case series.
    No preview · Article · Oct 2014 · Journal of Orthopaedic Research
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    ABSTRACT: Synovialbiopsien werden üblicherweise im Rahmen einer Arthroskopie durchgeführt. Die Indikationen hierfür sind vielfältig und beinhalten die Abklärung von metabolischen, entzündlichen und infektiösen Ursachen der Arthritis, die teilweise auch Sportverletzungen oder Überlastungsreaktionen imitieren können. Wir haben kürzlich ein neues Instrument zur retrograden Synovialbiopsie mitentwickelt (Retroforce, KARL STORZ GmbH, Tuttlingen, Germany). In dieser Studie wurde die Anwendung dieses Instrumentes während der uniportalen Arthroskopie mit der alleinigen Anwendung unter Lokalanästhesie verglichen. Insgesamt wurden zwölf Patienten eingeschlossen, bei denen die Indikation zur Synovialbiopsie gestellt wurde. Bei sechst Patienten wurde die Arthroskopie durchgeführt, bei den anderen sechs Patienten nur die blinde retrograde Synovialbiopsie. Bei allen Patienten konnte genug representatives Material für eine histologische und gegebenenfalls mikrobiologische Diagnose gewonnen werden. Der Zugang erfolgte entweder über den Softspot oder lateralen suprapatellären Rezessus. Komplikationen wie Blutung oder Infektionen sind nicht aufgetreten. Zusammenfassend erscheint die retrograde Synovialbiopsie sowohl im Rahmen einer uniportalen Arthroskopie als auch unter Lokalanästhesie verlässlich und sicher durchführbar.
    No preview · Article · Aug 2014 · Sport-Orthopädie - Sport-Traumatologie - Sports Orthopaedics and Traumatology
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    ABSTRACT: Background Posterior ankle and hindfoot arthroscopy finds an increasing acceptance as treatment option for intraarticular and extraarticular pathologies. The purpose of this study was to address the efficacy of posterior ankle and hindfoot endoscopy in athletes. Materials and Methods Seventeen patients with a mean age of 27.9 ± 4.3 years treated by posterior ankle and hindfoot endoscopy were included into this retrospective study. The average duration of follow-up was 5.4 ± 1.3 years. Clinical outcomes were assessed with use of a visual analogue scale (VAS) for pain and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Furthermore, preoperative and postoperative levels of sports activity were analyzed. Results The preoperative diagnoses were painful os trigonum, posterior ankle impingement, flexor hallucis longus tendinits and peroneal tendon impingement in 9, 4, 3, and 1 cases, respectively. There were no intraoperative complications. The average VAS score for pain decreased significantly from 5.6 ± 0.9 (range, 4 – 7) preoperatively to 0.6 ± 1.0 (range, 0 – 4) postoperatively (p < 0.001). The average AOFAS hindfoot score increased significantly from 60.7 ± 11.1 (range, 36 – 72) preoperatively to 92.4 ± 10.3 (range, 61 – 100) postoperatively (p < 0.001). All patients had sports activities at the latest follow-up, 13 patients (76.5%) returned to their sports activity level they had before onset of hindfoot symptoms. Conclusions Posterior ankle and hindfoot arthroscopy in athletes is associated with a low risk of intraoperative and postoperative complications and leads to significant pain relief, good functional results, and return to sports activities. Level of Evidence IV
    Full-text · Article · Aug 2014 · Sport-Orthopädie - Sport-Traumatologie - Sports Orthopaedics and Traumatology
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    ABSTRACT: Introduction: The most frequent posttraumatic malunions of the fibula are shortening and malrotation, occurring in up to 33%. It has been demonstrated that substantial fibular displacement may substantially increase the contact pressures in the ankle joint. Therefore distal fibular malunion is a risk factor for development of posttraumatic ankle osteoarthritis. The objectives of this study were to (1) describe our treatment algorithm and surgical technique in patients with posttraumatic fibula malunions; (2) determine intra- and postoperative complications rates, and (3) to describe mid-term clinical and radiological outcomes and quality of life. Methods: 19 consecutive patients (11 male, 8 female, mean age 42 years, range 19–68) with symptomatic fibular malunions were included into this prospective study. The initial injury was Weber B and C fracture in 7 and 12 ankles, respectively. The mean time between the injury and reconstructive surgery was 17 months (range 6–101). In all patients a z-shaped osteotomy of the fibula was performed to achieve the appropriate length/rotation of the fibula. All patients were evaluated pre- and postoperatively (mean follow-up 4.9 years, range 3.2–6.7). Radiological outcomes were assessed using standardized weightbearing radiographs. Clinical outcomes were assessed using visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale, and SF-36 questionnaire. Results: There were no intraoperative complications. In two patients early wound healing problems were observed, and resolved with i.v. antibiotics. Osseous healing was observed in all ankles within 10 weeks after surgery. The length and rotation of the fibula was improved in all patients, according to Weber criteria. All patients experienced significant pain relief (VAS: 6.5 ± 1.1 to 0.9 ± 0.8, P <0.001) and functional improvement (AOFAS hindfoot scale: 48.4 ± 14.5 to 85.7 ± 7.4, P <0.001; ROM:37° ± 6° to 46° ± 5°, P <0.001). The SF-36 score also significantly increased in all 8 subgroups. In 11 patients hardware was removed due a discomfort after a mean of 11.8 months (range 7.2–22.8). Conclusion: A z-shaped osteotomy is an efficient and successful method to restore fibula length and rotation in patients with posttraumatic malunion. Our findings in this series of 19 ankles confirm that this realignment surgery results in significant pain relief and functional improvement.
    No preview · Article · Jun 2014 · Swiss medical weekly: official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology
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    ABSTRACT: Introduction: Single photon emission computed tomography (SPECT)/CT enables accurate non-invasive and simultaneous acquisition of information on tissue morphology and biological processes in disease. SPECT/CT imaging using a radiographic bone tracer, such as 99mTechnetium-dicarboxypropane diphosphanate (99mTc-DPD), is frequently applied for differential diagnosis of foot and ankle pathologies that pose a diagnostic challenge due to their complex anatomy. Uptake of bone-seeking radiotracers is primarily determined by the degree of bone perfusion and chemisorption to the hydroxyapatite structure of bone tissue and can be influenced by environmental factors, such as pH. In this study we sought to identify the cellular and morphological changes that associate with increased 99mTc-DPD uptake in ankle joint osteoarthritis (OA). Methods: Six consecutive patients with end-stage ankle OA scheduled for total ankle replacement received preoperative 99mTechnetium-dicarboxypropane-diphosphanate (99mTc-DPD) SPECT/ CT scanning. The American Orthopedic Foot and Ankle Society (AOFAS) and visual analog scale (VAS) were used for clinical evaluation of preoperative function and pain. Tissue morphology of tibial and talar resection specimens from SPECT/CT-positive and negative areas was evaluated using histology. Osteoclast activity was visualized using tartrate-resistant acid phosphatase (TRAP) staining. Results: Preoperative AOFAS and VAS were 40 ± 15 points and 7.5 ± 0.84. Accumulation of 99mTc-DPD was located beneath the subchondral bone plate of both tibial and talar resection specimens and exclusively found in areas displaying subchondral bone sclerosis. Hematoxylin and eosin staining revealed marked infiltration of subchondral marrow spaces by fibrovascular tissue and abundant bone-lining osteoblasts in SPECT/CT-positive tissues. Active osteoblasts were surrounded by randomly organized collagen fibers. De novo and pre-existing bone tissues were devoid of TRAP-positive osteoclasts. Osteoblast presence was significantly correlated with 99mTc-DPD uptake, collagen deposition and severity of cartilage degeneration Conclusion: SPECT/CT is a valuable imaging modality for human OA. Histological evaluation of SPECT/CT-positive ankle OA revealed subchondral intramembranous bone formation rather than increased bone remodeling through coupled activities of osteoclasts and osteoblasts.
    No preview · Article · Jun 2014 · Swiss medical weekly: official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology
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    ABSTRACT: Synovial biopsies of the knee joint are commonly performed arthroscopically with the patient under full or regional anesthesia. To overcome the effort, costs, and potential risks of surgery, we developed an office-based technique for retrograde synovial biopsy using a designated novel biopsy forceps. Using this technique, no arthroscopic or radiologic control is needed to perform rapid synovial biopsies of the knee joint. Concomitant aspiration of synovial fluid can be performed. A technical description of the procedure is given.
    Full-text · Article · Jun 2014 · Arthroscopy Techniques
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    ABSTRACT: Nonunion of hindfoot arthrodesis can be difficult to successfully treat and will often require bone graft techniques. Large amounts of autogenous bone graft can be difficult to procure and will be associated with donor site morbidity. The use of porous metal implants has been shown to satisfactorily bridge segmental bone defects and to work in conjunction with allogeneic bone graft material, without the risks associated with autogenous bone graft donor site morbidity. The purpose of the present report is to describe the use of a perforated, porous metal implant combined with an intramedullary nail for revision surgery of failed subtalar joint fusion in an adult female patient.
    No preview · Article · May 2014 · The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons
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    ABSTRACT: Fußball stellt eine hohe Anforderung an den Bewegungsapparat, ist sehr kompetitiv und weist eine hohe Verletzungsrate auf. Der Fuß und das Sprunggelenk sind besonders verletzungsanfällig. Risikofaktoren für Fuss- und Sprunggelenk-Verletzungen im Fußball sind: Fehlen eines strukturierten Aufwärmtrainings, neuromuskuläre Defizite, inadäquates Training, chronische Ermüdung, vorangehende Verletzungen, Fouls, Kunstrasen u.a. Die häufigste Verletzung ist mit Abstand das Distorsionstrauma des oberen Sprunggelenkes. Komplexe Verletzungen mit Frakturen, ligamentären Verletzungen und Knorpelschäden können auftreten. Solche Verletzungen haben einen großen Einfluss auf die Karriere des Fußballers, da er sowohl den Erwartungen der Medien als auch der Vereine gerecht werden muss. Ein Großteil der Verletzungen kann konservativ behandelt werden. Bei komplexen Verletzungen ist ein operativer Eingriff oft unumgänglich. Das Ziel ist eine zügige Rehabilitation mit der baldigen Rückkehr in den Wettkampfsport.
    No preview · Article · May 2014 · Sport-Orthopädie - Sport-Traumatologie - Sports Orthopaedics and Traumatology
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    ABSTRACT: Retrograde tibiotalocalcaneal nailing arthrodesis has proved to be a viable salvage procedure; however, extended bone loss around the ankle has been associated with high rates of nonunion and considerable shortening of the hindfoot. We present the surgical technique and the first 2 cases in which a trabecular metal™ interpositional spacer, specifically designed for tibiotalocalcaneal nailing arthrodesis, was used. The spacer can be implanted using either an anterior or a lateral approach. An integrated hole in the spacer allows a retrograde nail to be inserted, which provides excellent primary stability of the construct. Trabecular metal™ is a well-established and well-described material used to supplement deficient bone stock in surgery of the spine, hip, and knee. It has shown excellent incorporation and reduces the need for auto- and allografts. The trabecular metal™ interpositional ankle spacer is the first trabecular metal spacer designed specifically for ankle surgery. Its shape and variable size will make it a valuable tool for reconstructing bone loss in tibiotalocalcaneal nailing arthrodesis.
    No preview · Article · May 2014 · The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons
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    ABSTRACT: Tibiotalocalcaneal arthrodesis with an intramedullary hindfoot nail is an established procedure for fusion of the ankle and subtalar joints. In cases involving ankle bone loss, such as in failed total ankle replacement, it can be difficult to salvage with sufficient bone restoration stability and a physiologic leg length and avoiding below the knee amputation. In addition to the alternatives of using a structural allograft or metal bone substitution, we describe the use of autologous ipsilateral circular pillar fibula augmentation in tibiotalocalcaneal retrograde nail arthrodesis combined with a ventral (anterior) plate in a prospective series of 6 consecutive cases with a mean follow-up duration of 26 ± 9.95 (range 12 to 34) months. The 6 patients (3 female and 3 male), with a mean age of 55 ± 13.89 (range 38 to 73) years were treated with revision surgery of the ankle (1 after talectomy, 5 [83.33%] after failed ankle replacement). The visual analog scale for pain and the American Orthopaedic Foot and Ankle Society hindfoot score were used to assess functional outcome, and radiographs and computed tomography scans were used to determine the presence of fusion. All patients improved clinically from pre- to postoperatively in regard to the mean pain visual analog scale score (from 7.5 to 2.0) and American Orthopaedic Foot and Ankle Society hindfoot score (from 29 to 65 points, of an 86-point maximum for fused joints). Radiologically, no loss in the reduction or misalignment of the hindfoot was detected, and all cases fused solid. One patient (16.67%) required hardware removal. The fixation construct provided good clinical and radiologic outcomes, and we recommend it as an alternative to structural allografts or metallic bone grafts for revision ankle surgery with severe bone loss.
    No preview · Article · Apr 2014 · The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons
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    ABSTRACT: Tibiotalocalcaneal arthrodesis with an intramedullary hindfoot nail is an established procedure for fusion of the ankle and subtalar joints. In cases involving ankle bone loss, such as in failed total ankle replacement, it can be difficult to salvage with sufficient bone restoration stability and a physiologic leg length and avoiding below the knee amputation. In addition to the alternatives of using a structural allograft or metal bone substitution, we describe the use of autologous ipsilateral circular pillar fibula augmentation in tibiotalocalcaneal retrograde nail arthrodesis combined with a ventral (anterior) plate in a prospective series of 6 consecutive cases with a mean follow-up duration of 26 ± 9.95 (range 12 to 34) months. The 6 patients (3 female and 3 male), with a mean age of 55 ± 13.89 (range 38 to 73) years were treated with revision surgery of the ankle (1 after talectomy, 5 [83.33%] after failed ankle replacement). The visual analog scale for pain and the American Orthopaedic Foot and Ankle Society hindfoot score were used to assess functional outcome, and radiographs and computed tomography scans were used to determine the presence of fusion. All patients improved clinically from pre- to postoperatively in regard to the mean pain visual analog scale score (from 7.5 to 2.0) and American Orthopaedic Foot and Ankle Society hindfoot score (from 29 to 65 points, of an 86-point maximum for fused joints). Radiologically, no loss in the reduction or misalignment of the hindfoot was detected, and all cases fused solid. One patient (16.67%) required hardware removal. The fixation construct provided good clinical and radiologic outcomes, and we recommend it as an alternative to structural allografts or metallic bone grafts for revision ankle surgery with severe bone loss.
    No preview · Article · Jan 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Nonunion of hindfoot arthrodesis can be difficult to successfully treat and will often require bone graft techniques. Large amounts of autogenous bone graft can be difficult to procure and will be associated with donor site morbidity. The use of porous metal implants has been shown to satisfactorily bridge segmental bone defects and to work in conjunction with allogeneic bone graft material, without the risks associated with autogenous bone graft donor site morbidity. The purpose of the present report is to describe the use of a perforated, porous metal implant combined with an intramedullary nail for revision surgery of failed subtalar joint fusion in an adult female patient.
    No preview · Article · Jan 2014
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    ABSTRACT: The posttraumatic osteoarthritis is the most common etiology of degenerative changes in the ankle joint. More than 50% of all patients with end-stage ankle osteoarthritis present with concomitant valgus or varus deformity of the hindfoot. Valgus deformity is less common than varus deformity with 8% and 55%, respectively. Malunited fractures but also ligamental instability can end up in end-stage ankle arthritis. Furthermore, pes planovalgus deformity is another risk factor for arthritic valgus ankle. Total ankle replacement is a well promising therapeutic option in patients with end-stage ankle osteoarthritis. However, all concomitant deformities and instabilities should be sufficiently addressed by additional surgical procedures.
    No preview · Article · Dec 2013 · Fuß & Sprunggelenk
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    ABSTRACT: Asymmetric ankle osteoarthritis may develop in patients with varus or valgus deformities. Pathologically altered load distribution in the tibiotalar joint leads to medial (varus) or lateral (valgus) tibiotalar joint degeneration. However, as more than half of the tibiotalar joint surface remains preserved, joint sacrificing procedures including total ankle replacement or ankle arthrodesis may not be the most appropriate treatment options. The short- and mid-term results following realignment surgery, published in the current literature, are very promising with substantial pain relief and functional improvement observed post-operatively.
    No preview · Article · Dec 2013 · Fuß & Sprunggelenk

Publication Stats

361 Citations
53.95 Total Impact Points

Institutions

  • 2015
    • Hannover Medical School
      • Laboratory for Biomechanics and Biomaterials (LBB)
      Hanover, Lower Saxony, Germany
  • 2013-2015
    • Universitätsspital Basel
      • Institut für Pathologie
      Bâle, Basel-City, Switzerland
    • Orthopädische Universitätsklinik Friedrichsheim
      Frankfurt, Hesse, Germany
  • 2012-2014
    • Universität Basel
      • Institute of Anatomy
      Bâle, Basel-City, Switzerland
  • 2008-2011
    • University of Technology Munich
      • Abteilung für Sportorthopädie
      München, Bavaria, Germany