K. Weise’s research while affiliated with University of Tübingen and other places

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Publications (328)


Long-Term Results Using the Straight Tapered Femoral Cementless Hip Stem in Total Hip Arthroplasty: A Minimum of Twenty-Year Follow-Up
  • Article

August 2014

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85 Reads

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50 Citations

The Journal of Arthroplasty

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Kuno Weise

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Siegfried Weller

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[...]

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Björn Gunnar Ochs

We report the first long-term results of a prospective cohort study after total hip arthroplasty using the cementless Bicontact hip stem. Between 1987 and 1990, 250 total hip replacements in 236 patients were performed using the cementless Bicontact hip stem. The average follow-up was 22.8 years (20.4 to 24.8) and average age at index surgery 58.1 years. 81 patients deceased and 9 were lost to follow-up. We noted 11 stem revisions revealing an overall Kaplan Meier survival rate of 95,0% (CI 95%: 91,1-97,2%). The average Harris Hip Score revealed 81 points (range 24 to 93). The Bicontact hip stem demonstrated high survival rates despite high ages and osteopenic changes, which are equivalent to other long-term reports of cementless stem fixation.


[Treatment of proximal humeral fractures in Germany : Influence of the level of hospital care and the frequency of treatment.]

March 2014

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53 Reads

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3 Citations

Die Unfallchirurgie

Various treatment options exist for displaced proximal humeral fractures. The impact of the level of hospital care and frequency of treatment on current treatment regimens in Germany was analyzed. A total of 576 hospitals were included. The survey covered questions on frequency, diagnostics, classification, therapy, complications, and clinical scenarios. In all, 48% of the hospitals returned the questionnaire: 73% treat more than 60% of the fractures surgically, mainly with angle-stable implants. The angle-stable plate is the treatment of choice for young patients, but older patients are treated using other treatment options. Problems and complications included malreduction, secondary displacement, screw perforation, avascular necrosis, and impingement. According to treatment indication, implant choice, and common complications, no significant differences between the level of hospital care and frequency of treatment were observed. Independent of the level of hospital care and frequency of treatment, there is a trend for head-preserving angular-stable surgery with a homogenous level of treatment in Germany.



Figure 1 Flow-chart of literature inclusion/exclusion process.
Flow-chart of literature inclusion/exclusion process.
Complication rates and outcomes stratified by treatment modalities in proximal humeral fractures: A systematic literature review from 1970-2009
  • Article
  • Full-text available

November 2013

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99 Reads

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41 Citations

Patient Safety in Surgery

The optimal treatment of complex, displaced proximal humeral fractures is controversial. A systematic literature review of the time period from 1970 to 2009 was conducted. The purpose was to evaluate the clinical success and complications of the available treatment modalities to determine specific treatment recommendations for the different fracture patterns. The databases (PubMed/EMBASE) were searched for the time period (01/1970--09/2009). Study quality, treatment modalities, classification, outcome scores and complications of 200 publications including 9377 patients were analyzed. Interventions were compared by analysis of variance with subsequent Tukey's-test. Complication rates among methods were compared by using Pearson's-chi-square-test and pairwise comparisons using Fisher's-two-tailed-exact-test. Hemiarthroplasty, angle-stable plate and non-operative treatment were used for 63% of the follow-up-patients. For 3- and 4-part fractures, patients with hemiarthroplasty [3-Part: 56.4 (lower/upper 95% confidence interval (CI): 43.3-68.7); 4-Part: 49.4 (CI: 42.2-56.7)] received a lower score than different surgical head-preserving methods such as ORIF [3-Part: 82.4 (CI: 76.6-86.9); 4-Part: 83.0 (CI:78.7-86.6)], intramedullary nailing [3-Part: 79.1 (CI:74.0-83.4)] or angle-stable plates [4-Part: 66.4 (CI: 59.7-72.4)].The overall complication rate was 56%. The most common complications were fracture-displacement, malunion, humeral head necrosis and malreduction. The highest complication rates were documented for conventional plate and hemiarthroplasty and for AO-C, AO-A, for 3- and 4-part fractures. Only 25% of the data were reported with detailed classification results and the corresponding outcome scores. Despite the large amount of patients included, it is difficult to determine adequate recommendations for the treatment of proximal humeral fractures because a relevant lack of follow-up data impaired subsequent analysis. For displaced 3- and 4-part fractures head-preserving therapy received better outcome scores than hemiarthroplasty. However, a higher number of complications occurred in more complex fractures and when hemiarthroplasty or conventional plate osteosynthesis was performed. Thus, when informing the patient for consent, both the clinical results and the possibly expected complications with a chosen treatment modality should be addressed.

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The complexity of proximal humeral fractures is age and gender specific

February 2013

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46 Reads

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33 Citations

Journal of Orthopaedic Science

Background: Studies that investigated possible associations between the complexity of proximal humeral fractures and patient characteristics are rare. We hypothesized that the grade of fracture complexity may correlate with age and gender of hospitalized, adult patients. Methods: Based on the Neer classification, we defined four radiological grades of fracture complexity. The data of adult patients that were treated during a 9-year period at a German hospital serving a town of 80,000 inhabitants was reviewed. Results: Seven hundred and eighty fractures were evaluated [518 female/262 male (66.41/33.59 %), average age 64.2 years (range 17.4-99.2)]. During the study period, the number of fractures increased to 167 %. Almost two-thirds of the patients were females and older than 60 years. Of all fractures, 86 % were displaced fractures. In patients younger than 60 years, 1.99-fold more complex fractures occurred in males (32.4 %) than in females (16.2 %). In contrast, in patients older than 60 years, 1.72-fold more complex fractures occurred in females (54.1 %) than in males (31.5 %). There was a significant association between low-energy trauma and female gender older than 60 years. Conclusions: Our study demonstrated an overall increase of displaced proximal fractures. The vast majority of patients with more complex fractures consisted of female patients older than 60 years.


Current strategies for the treatment of proximal humeral fractures: An analysis of a survey carried out at 348 hospitals in Germany, Austria, and Switzerland

July 2012

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94 Reads

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72 Citations

Journal of Shoulder and Elbow Surgery

Background: The therapeutic spectrum for the treatment of displaced proximal humeral fractures ranges from conservative therapy to head-preserving surgical interventions and joint replacement. This study initiated a survey on the current treatment options with regard to diagnostics, choice of therapy, and complications that are encountered at trauma surgeries and orthopedic hospitals in Germany, Austria, and Switzerland. Materials and methods: The survey included 743 hospitals. The questionnaire covered information on demographics, diagnostics, classification, therapy, and complications of proximal humeral fractures. Results: The questionnaire was completed by 348 hospitals. Five of 6 hospitals treat more than 40% of the fractures surgically. The percentage distribution of the available implants is at 63.4% for angular stable plates, 30.9% for intramedullary nails, and 10.1% for fracture prostheses. The 5 complications reported most frequently were nonanatomic reduction (83%), implant perforation (73%), secondary displacement of the fracture (71%), avascular necrosis (67%), and implant-related impingement (59%). Conclusions: A preference for surgical treatment of proximal humeral fractures was found, with stabilization predominantly being attempted by the use of angle-stable implants. The 2 most common complications were "nonanatomic reduction of fractures" and the more specific problem of "implant perforation" when fixed-angle implants were used for treatment.


High Success Rate for Augmentation Compression Plating Leaving the Nail In Situ for Aseptic Diaphyseal Tibial Nonunions

May 2012

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130 Reads

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16 Citations

Journal of Orthopaedic Trauma

OBJECTIVES:: To evaluate adjunctive compression plating leaving the previously unreamed inserted intramedullary nail (URIMN) in situ for treating a resultant diaphyseal tibial nonunion. DESIGN:: Retrospective study. SETTING:: Level 1 trauma center (University Hospital). PATIENTS/PARTICIPANTS:: Patients treated by URIMN for diaphyseal tibial fractures that developed an aseptic hypertrophic nonunion. INTERVENTION:: Dynamization of the nail and compression plating leaving the URIMN in situ. MAIN OUTCOME MEASUREMENTS:: Radiographic and clinical parameters Results: The mean follow up was 3.8 years (range 2-7 years). Mean time for healing was 15 weeks with a mean operation time of 63 minutes. Union occurred in 27/28 (96.4%). There were no infections. CONCLUSIONS:: This simple technique appears to have a high success rate and should be considered when a nonunion occurs after URIMN. The need for an additional incision and removal of symptomatic implants remains a disadvantage.


Funktionelle Behandlungsergebnisse nach Durchflechtungsnaht bei Rupturen der langen Bizepssehne

April 2012

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27 Reads

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1 Citation

Die Unfallchirurgie

Operative treatment for ruptures of the long biceps tendon still is discussed controversially. In the present literature the keyhole-technique is recommended according to favourable biomechanical conditions. In recent years refixation to the short biceps tendon was preferred. Now it is supposed that this technique may provocate subacromial impingement considering the loss of depression function of the long biceps tendon to the humeral head. Between 1980 to 1991 83 patients with rupture of the long biceps tendon were treated operatively by refixation to the short head. 28 patients were investigated after an average follow-up of 6,5 years. Due to the criterias of the Constant-Score 85% of patients achieved very good, 15% good results. At our patients provocation of a subacromial impingement could not be observed. The subacromial space was not reduced in the postoperative x-ray control. Compared with the non-operated shoulder isokinetic determination of isometric maximal peak torque for elbow-flexion, shoulder-abduction and shoulder-flexion yield to almost identical results for the operated shoulder. Refixation to the short head can be advised for treatment of ruptures of the long biceps tendon due to the certain technique with a low complication rate and very good functional outcome.


Behandlungsergebnisse nach primärer und sekundärer Radiusköpfchenresektion

April 2012

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48 Reads

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17 Citations

Die Unfallchirurgie

Apart from comminuted fractures of the radial head the indication for resection of the radial head is discussed controversially. To evaluate our own results, the hospital notes of 113 patients treated between 1.1.1984–31.12.1994 in our clinic by posttraumatic primary or secondary radial head resection were examined retrospectively. 79 patients were controlled by clinical and radiological examination with an average follow-up of 37,8 months. We examined at 46 patients the influence of additional lesions of the elbow joint on the functional outcome. In 33 patients follow up was done with special regard to the time of resection. Poor results due to the score from Radin and Riseborough especially followed secondary radial head resection (>14 days after trauma) and in case of additional elbow lesions. We could not observe problems of the wrist joint after radial head resection as described by other authors. According to our own experience primary resection is recommended in case of doubtful reconstruction of the radial head. In these fracture types radial head resection should not be seen as an alternative treatment because of the worse results following secondary resection.


Figure 1 of 1
Biomechanical analysis of a new expandable vertebral body replacement combined with a new polyaxial antero-lateral plate and/or pedicle screws and rods

March 2012

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105 Reads

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16 Citations

European Spine Journal

Restoration of the anterior spinal profile and regular load-bearing is the main goal treating anterior spinal defects in case of fracture. Over the past years, development and clinical usage of cages for vertebral body replacement have increased rapidly. For an enhanced stabilization of rotationally unstable fractures, additional antero-lateral implants are common. The purpose of this study was the evaluation of the biomechanical behaviour of a recently modified, in situ distractible vertebral body replacement (VBR) combined with a newly developed antero-lateral polyaxial plate and/or pedicle screws and rods using a full corpectomy model as fracture simulation. Twelve human spinal specimens (Th12-L4) were tested in a six-degree-of-freedom spine tester applying pure moments of 7.5 Nm to evaluate the stiffness of three different test instrumentations using a total corpectomy L2 model: (1) VBR+antero-lateral plate; (2) VBR, antero-lateral plate+pedicle screws and rods and (3) VBR+pedicle screws and rods. In the presented total corpectomy defect model, only the combined antero-posterior instrumentation (VBR, antero-lateral plate+pedicle screws and rods) could achieve higher stiffness in all three-movement planes than the intact specimen. In axial rotation, neither isolated anterior instrumentation (VBR+antero-lateral plate) nor isolated posterior instrumentation (VBR+pedicle screws and rods) could stabilize the total corpectomy compared to the intact state. For rotationally unstable vertebral body fractures, only combined antero-posterior instrumentation could significantly decrease the range of motion (ROM) in all motion planes compared to the intact state.


Citations (47)


... Despite the small absolute number of additional treatment variants, trends over time and across variants do confirm the adoption of innovative developments. However, a comparison of the coded and imbursed number of cases with the literature and reported advances in surgical technique shows that the real world lags behind specialized trauma centers and the optimal treatment choices, as recommended in current reviews [42]. ...

Reference:

Treatment Reality of Proximal Humeral Fractures in the Elderly—Trending Variants of Locking Plate Fixation in Germany
Behandlung proximaler Humerusfrakturen in Deutschland: Einfluss von Krankenhausversorgungsstufe und Behandlungsfrequenz
  • Citing Article
  • January 2014

... 6 However, exporting results and methods in different geographic and socioeconomic contexts raises some critical issues that were not always properly considered in the past, leading to delay of some projects. 7 A national data collection is mandatory to evaluate the national clinical practice and build a local reference, including implants not used in the countries where a registry is available, to stimulate a quality improvement process in the interest of patients, surgeons, and device manufacturers. [8][9][10] Currently, several countries have national joint arthroplasty registries with a high level of completeness both in Europe and worldwide (http://www. ...

The German Endoprosthesis Register - A Never-Ending Story?
  • Citing Article
  • March 2009

Zeitschrift fur Orthopadie und Unfallchirurgie

... The number of practising physicians in Germany is likely to decrease, due to the expected increase in the average age of the German population [1][2][3]. In addition, the physicians themselves are ageing, and a large proportion of them will retire soon [1,[4][5][6]. Furthermore, according to the Association of German Surgeons (Bund Deutscher Chirurgen), the rate of students selecting surgery for their postgraduate specialty is declining [7][8][9]. ...

On the Lack of Young Physicians in Trauma Surgery and Orthopaedics
  • Citing Article
  • February 2010

Zeitschrift fur Orthopadie und Unfallchirurgie

... Die Ähnlich wie in anderen Rodelstudien aus dem alpenländischen Bereich [4,5,10,11] ist in der vorliegenden Untersuchung die untere Extremität am häufigsten von Verletzungen betroffen. Wie in einer älteren Studie von Gröbner et al. [10] bereits festgestellt, wurden Knieverletzungen auch in dieser Studie am häufigsten genannt, welche möglicherweise durch eine Distorsion des Kniegelenks beim Lenken oder Bremsen der Rodel (besonders bei vorhandenen Bodenunebenheiten) verursacht wurden. ...

Verletzungen beim Schlittenfahren
  • Citing Article
  • September 2008

Sportverletzung · Sportschaden

... Implan-implan yang sesuai diperlukan semasa melakukan proses tersebut. Implan ini direka khas supaya besi sentiasa bergesel pada plastik dan menyebabkan pergerakan yang lembut dan hakisan yang minimum ( Ilchman et al. 2006). ...

Femoral Subsidence Assessment After Hip Replacement

Upsala Journal of Medical Sciences

... Az általuk behelyezésre került implantátumok közel 90%-a szögstabil rendszer volt. A protézis beültetés aránya a nagy diszlokációval járó 11 AO A3, B3, C3-as típusú töréseknél elérte a 40%-ot (13). Utánvizsgálatunk alapján megállapítható, hogy a szögstabil implantátumok alkalmazása osteoporotikus csontokon kevesebb redislocatióval, implantátum kilazulással jár, mint a hagyományos lemezek vagy csavarok esetében, azonban az avascularis necrosis kialakulására nincs befolyása. ...

[Treatment of proximal humeral fractures in Germany : Influence of the level of hospital care and the frequency of treatment.]
  • Citing Article
  • March 2014

Die Unfallchirurgie

... In addition, further research is warranted to evaluate the role of potential HO prophylaxis, additional associations with HO formation (such as patient comorbidities or additional complications including intraoperative and postoperative bleeding), and treatment for clinically significant cases. Ateschrang et al. [13] Not provided Busch et al. [14] Not provided Chémaly et al. [4] Not provided Choy et al. [15] Single surgeon Edwards et al. [16] Single surgeon Fischer et al. [17] Not provided Gofton et al. [18] Four surgeons Hartford and Bellino. [19] Single surgeon (reconstruction fellow) Hayashi et al. [20] Single surgeon Hürlimann et al. [21] Four consultant surgeons Kutzner et al. [22] 18 surgeons (residents in training, fellows, and senior surgeons) Lavernia et al. [23] Single surgeon Leunig et al. [24] Six surgeons Malhotra and Guatam. ...

Long-Term Results Using the Straight Tapered Femoral Cementless Hip Stem in Total Hip Arthroplasty: A Minimum of Twenty-Year Follow-Up
  • Citing Article
  • August 2014

The Journal of Arthroplasty

... 18 A study by Tepass et al. suggests displaced three-part fractures and four-part fractures of proximal humerus fractures have better outcomes with head-preserving therapy but with high rates of complications. 19 One of the least explored options is the usage of a titanium mesh cage and a plating system. However, it is not FDA-approved, and Chen et al. did not provide adequate studies on this option. ...

Complication rates and outcomes stratified by treatment modalities in proximal humeral fractures: A systematic literature review from 1970-2009

Patient Safety in Surgery

... There is no consensus on when to initiate knee mobilization or weight bearing, with a high heterogeneity about full weight bearing timing and stairs climbing (12). Up to now, early rehabilitation is being tested also in basic science studies, it seems that early passive motion after surgical treatment of ruptured tendons improves the healing process and enhances tendon tensile strength, and gives a greater joint mechanics when compared to immobilization (13)(14)(15). Immobilization can be potentially counterproductive and increase the risk of complications, such as deep vein trombosis, linked to the restricted weight bearing (16). ...

Quadrizepssehnenruptur nach arthroskopischem lateralem Retinakulumrelease
  • Citing Article
  • June 2010

Die Unfallchirurgie

... The literature knows a wide variety of treatment options for distal radius fractures, such as conservative plaster treatment or reduction and stabilisation with K-wires, locking plates, nail or external fixator variants. Following response to the work of Altisimmi et al. [8] as well as Cooney and colleagues [9] and the increasingly surgical management of distal radius fractures, the majority are currently fixed using locking plates [10][11][12]. This usually allows immediate release for functional postoperative treatment without weightbearing. ...

Irritation der Beugesehnen nach palmarer winkelstabiler Plattenosteosynthese des distalen Radius mit der 3,5-mm-T-Platte: Erarbeitung von Risikofaktoren
  • Citing Article
  • June 2010

Zeitschrift fur Orthopadie und Unfallchirurgie