Eine neuartige Kniegelenksendoprothese mit physiologischer Gelenkform

The human medial tibial plateau is concave, whereas the lateral tibial plateau is convex. In a normal knee, the convex femoral condyles roll and glide on the tibia during the standing phase of walking. The designs of most commercially available knee prostheses do not take this morphological feature into consideration. The novel design of the AEQUOS G1 knee replacement prosthesis is based on the natural anatomy of the knee joint, with a convex lateral tibia plateau and a sagittal offset of the medial and lateral compartments. Following extensive development and testing, initial clinical results of the AEQUOS G1 prosthesis in a mulitcenter study are presented. From Mai 2005 to March 2007, 158 patients in 4 clinics underwent total knee arthroplasty with the AEQUOS G1 and agreed to participate in the study. Patients were evaluated preoperatively and at 3, 6 and 12 months of follow-up using a standardized protocol that included the American Knee Society Score (AKSS), the Oxford Knee Score (OKS) and the Visual Analog Scale (VAS) for pain. After 3 months, 151 patients appeared for follow up appointments, after 6 months, 134, and after 12 months, 127. The mean range of motion preoperatively was 97.0° (±19.9°) and 107.5° (±15.9°) 12 months after surgery. The AKSS, as well as the modified OKS, significantly improved (p<0.0001) from preoperative scores of 98.8 (±35.8) and 37.3 (±6.9) points, respectively, to 165.8 (±34.1) and 21.9 (±7.8) points, preoperatively, and 12 months postoperatively. The VAS score significantly decreased (p<0.001) from 7.4 (±1.8) points preoperatively to 1.9 (±2.2) points 12 months postoperatively. One implant was revised because of arthrofibrosis and another due to patellar luxation. Two patients required revision because their implants revealed malalignement with ligamentous instability. No infections, aseptic loosening or other implant-specific complications were observed at this early follow-up. Good clinical results were observed at early follow-up with the AEQUOS G1 knee arthroplasty. However, longer follow-up is necessary for a general evaluation of the implant.     

182.Eine neuartige Gallengangsendoprothese - Indikation und Ergebnisse

Zusammenfassung Bei nicht resektablen Carcinomen des proximalen Hepato-Choledochus, geringfügigem intrahepatischem Aufstau und niedrigen Bilirubinwerten bietet die endlose Drainage gegenüber der HepatoEnterostomie mehr Sicherheit. In den letzten 5 Jahren sind 8 Patienten mit einer endlosen Drainage versorgt worden. 2 Patienten sind während des stationären Aufenthaltes verstorben. 2 Patienten sind nach 81/2 bzw. 91/2 Monaten ihrem Grundleiden erlegen. 4 Patienten sind zwischen 5 und 11 Monaten p. o. noch am Leben. Bei häufigen Spülungen mit steriler NaCI-Lösung und Wechsel der Drainage alle 2–3 Monate ist die Funktion stets gut.     

182.Eine neuartige Gallengangsendoprothese - Indikation und Ergebnisse

Ohne Zusammenfassung     

Periprothetische Frakturen bei Knieendoprothese

Periprosthetic fractures after total knee arthroplasty continue to increase due to the demographic changes. Despite improvements of therapy morbidity and mortality rates up to 46% are still very high. Implant innovations offer better options for periprosthetic osteosynthesis and have led to good functional and radiographic outcome. Surgical therapy should be performed within 48?h, while emergency interventions remain the exception. Detailed preoperative planning and use of special implants and revision systems are essential. Management of these patients demands an interdisciplinary approach and should be performed in specialized centers. In the present article classifications, indications, techniques and results of periprosthetic osteosynthesis after total knee arthroplasty are presented.     

Eine neue Armprothese mit Sauerbruchhand

Ohne Zusammenfassung Mit 5 Textabbildungen.     

Verriegelungsarthrodese bei implantierter Knieendoprothese

Ohne Zusammenfassung      

Zweizeitiger Prothesenwechsel bei infizierter Knieendoprothese

OBJECTIVE: Treatment of deep infection of total knee arthroplasty by two-stage reimplantation. Using an articulating spacer may reduce the disadvantages of a static spacer (ligament contracture, muscle atrophy, muscle contraction, arthrofibrosis, and bone loss). Restoration of pain-free loading and ability to walk. INDICATIONS: Late deep infection after total knee arthroplasty. Definition: infection occurring at least 6 weeks after the initial arthroplasty. CONTRAINDICATIONS: Large metaphyseal bony defects of the distal femur and proximal tibia. Missing or insufficient extensor mechanism. SURGICAL TECHNIQUE: The articulating spacer is made intraoperatively by cleaning and autoclaving the explanted femoral component and the tibial polyethylene insert. These components are reinserted by "press-fit cementing" without cement interdigitation into the trabecular bone. The cement is loaded with antibiotic during the same operation (2-4 g antibiotics per 40 g of cement powder). POSTOPERATIVE MANAGEMENT: With the articulating spacer in place, partial weight bearing with crutches and continuous passive motion daily up to a flexion of 90 degrees are allowed. Usually, reimplantation with a standard revision system is scheduled for 6-12 weeks after spacer implantation. RESULTS: In a prospective study 33 consecutive patients were treated from February 2000 to July 2003. The average period of hospitalization after spacer implantation was 14 days (8-26 days). Three patients had recurrent infection (success rate 91%) after a mean follow-up period of 28 months (12-48 months). The average Hospital for Special Surgery Knee Score could be increased from 67 points (44-84 points) preoperatively to 87 points (53-97 points) after reimplantation. The complications were one temporary peroneal palsy, one dislocation of the spacer due to the absence of the extensor ligaments, and one fracture of the tibia due to substantial primary metaphyseal bone loss.     

Eine vierfingerige Hand mit Verbildung der Handwurzel

Ohne Zusammenfassung (Mit 3 Textbildern.)     

Eine Arbeitsklaue mit Kugelgelenk und doppelter Arretierung

Zusammenfassung Beschreibung einer Arbeitsklaue mit beweglichem Kugelgelenk und doppelter Feststellung. Mit 1 Textabbildung.     

Eine Myomotomie mit Versenkung des Stiels und der Kautschukligatur

Ohne Zusammenfassung     

Patellarsehnenruptur nach vorderer Kreuzbandrekonstruktion mit autologem Patellarsehnen-Knochen-Transplantat Eine Kasuistik

Patellar ligament ruptures due to a complication after usage of bone-tendon autograft for an anterior cruciate ligament reconstruction happens seldom. During surgeries to restore continuity a fascia-lata-strip may be wrapped in and fixated to secure the primary tendon suture. This may be done in addition to the usually employed patella-tibial wiring cerclage. Whether a matrix for the scarred healing tendon will be created in addition to the construction of a support for the primary tendon seam without a foreign body reaction has to be left to further histological clarifications that cannot be implemented in the present casuistry.     

Eine neue Technik des vorderen Kreuzbandersatzes mit dem Patellarsehnendrittel

Operationsprinzip Der endst?ndige Knochenblock eines Patellarsehnendrittels wird an der Innenfl?che des lateralen Femurkondylus unter Sicht des Auges mit einer Knochenklammer fixiert. Tibial wird das andere kn?cherne Ende des Transplantats in einem Bohrkanal mit einer kopflosen Schraube gehalten.      

Madelung-Krankheit Eine Fallbeschreibung mit besonderer Berücksichtigung der Therapie

Zusammenfassung. Die Madelung-Launois-Bensaude-Lipomatose ist eine seltene Erkrankung, die durch ausgedehnte Fettansammlungen haupts?chlich in der Halsregion charakterisiert ist. Anhand einer Fallbeschreibung werden die klinischen Besonderheiten und der Verlauf dieser Erkrankung aufgezeigt. Eine bilaterale funktionelle „neck dissection“ konnte im speziellen Fall ein erneutes Rezidiv verhindern.      

Eine einfache Checkliste als Hilfsmittel zur Vorsichtung mit dem mSTaRT-Algorithmus

Background

In a mass casualty incident triage algorithms seem to help to identify patients with an acute life-threatening injury. Algorithms which include the vital functions breathing, circulation and consciousness seem to be superior to others because of their simplicity.

Material and methods

A checklist was developed according to the mSTaRT algorithm (mSTaRT test). In an exercise 12 teams simulated 480 pretriage procedures situated in 4 different sections each staffed with 10 actors. Triage results were analyzed using means, standard deviation, confidence interval (CI), sensitivity/specificity, as well as positive and negative likelihood ratios (LR±).

Results

The rate of critical undertriage (false negative red) was 1.0?% (95 % CI 0.3–2.4?%). The sensitivity of the mSTaRT test for category red was 96.8?% (95?% CI 92.6–98.9?%), the specificity was 98.2?% (95?% CI 96.0?–99.3?%), LR +?52.3 (95?% CI 23.7–115.6) and LR ??0.03 (95?% CI 0.01–0.08).

Conclusion

The results of this simulation study indicate that the mSTaRT test can be successfully used for a rapid identification of patients with life-threatening injuries (red patients).     

Lebensqualit?tsgewinn (SF-36) nach Implantation einer Knieendoprothese

Aus einem Gesamtkollektiv von 41 nacheinander operierten Patienten konnten bei 35 Daten hinsichtlich der allgemeinen Lebensqualit?t im kurzfristigen Verlauf dokumentiert werden. Bei der Untersuchung der pr? und post-operativen Lebensqualit?t mit Hilfe des SF-36-Scores zeigten sich auf dem 5-%-Niveau eine signifikante Verbesserung in den Kategorien “K?rperliche Schmerzen” und “psychisches Wohlbefinden”. Mit einem P-Wert von p = 0,0616 kann eine fast signifikante Verbesserung in der k?rperlichen Funktionsf?higkeit konstatiert werden. Weitere 5 untersuchte Unterpunkte zeigten keine signifikante Verbesserung, jedoch bessere Werte bei den errechneten Mittelwerten. Zusammenfassend ist festzustellen, da? die Implantation einer Knieendoprothese zu einem deutlichen Gewinn in der Lebensqualit?t des kranken Menschen führt.     

CT-Analyse der Beinachse nach konventioneller vs. navigierter Knieendoprothese

INTRODUCTION: Correct alignment of the leg is one of the significant factors for the outcome after TKA. Previous studies have shown that the use of a navigation system can improve the alignment. However, for the positioning of the femoral component no validated data are available. This article presents the first results of a controlled, prospective and randomised trial comparing navigation versus free-hand implantation in TKA with special reference to the rotation of the femoral component. METHODS: Since January 2003, all patients with primary arthrosis of the knee admitted to our hospital for TKA have been followed prospectively. For this first analysis, data were collected over a period of 5 months. Apart from the usual clinical evaluations, all patients had CT of the leg prior to the operation and 1 week postoperatively. Measurement of axis and rotation was performed by staff members of the X-ray department who had no knowledge of the operation technique (navigation vs. free-hand). RESULTS: Twenty five sets of CT scans have been analysed, from 12 navigated operations and 13 freehand procedures. All 12 of the navigated knees were within the interval of +/-3 degrees varus/valgus deviation, but only 8 of the 13 non-navigated knees met this criteria. The analysis of the rotation position of the femoral component revealed no difference between the two groups. CONCLUSION: By using an intraoperative navigation system, the accuracy of the alignment in TKA can be improved. Long-term studies will have to be carried out to verify whether this will lead to a lasting benefit for the patient. Concerning the rotation position of the femoral implant, no conclusion can be made regarding the recommended rotation position at this point of the study.     

Interne Kallusdistraktion im Epiphysenfugendefektein physiologischer Weg der Spontankorrektur

For this experimental study we removed with a trephine in small (rabbit) and larger (pigs) animals cylinders of 2 mm respectively 8 mm diameter from the central growth plate area of proximal tibia. The direction of burring is in the axial line of the femur proximo-distally; the insertion point of the trephine is chosen on the cheek of the medial femoral condyle. As common reaction to that kind of trauma the defects in growth plates of rabbits become filled with a bone bridge that joins the epiphyseal core to the metaphyseal trabeculae, leading to gross growth disturbances. In pigs a similar solid bridging as first reaction develops, interrupted later by a zone of longitudinal collagen fibre bundles within a non-mineralized matrix. The distending pressure of sorrounding intact growth cartilage continuously brakes fracture callus formation and its calcification. Such so-called internal callus distraction leads to unaltered longitudinal bone growth.