Indications and technique of arthrodesis of the knee joint (author's transl)

The indications of an arthrodesis of the knee joint have changed and seem to be rare in a century of total arthroplasty. However, even nowadays the arthrodesis of the knee joint is still carried out with good results in: postinfectious gonarthrosis, irreparable posttraumatic instability, Charcots knee, Neoplastic destructions in special cases, for patients with a severe painful and deforming arthrosis of any reason, which are too young for an arthroplasty and in a century of arthroplasty for all patients after failure of arthroplasty. Within a period of 11 years from 1969-1980, 105 patients underwent an arthrodesis of the knee joint at BG Unfallklinik Tübingen. Indications and technique are given, the value of an individual postoperative care is pointed out.     

Gonarthrosis following persisting knee joint instability (author's transl)

It is frequently assumed that persisting instability of the knee joint leads to gonarthrosis. We have reviewed recent and primary radiograms of 32 patients with old knee trauma resulting in prolonged capsular and ligamentous instability in order to study the eventual development of secondary gonarthrosis. Our results were as follows: All primarily intact joints developed gonarthrosis after an average of 46 months of permanent instability. Primarily existing gonarthrosis increased with exception of 3 cases. The tendency to develop an arthrosis seems to be proportional to the duration of instability; the type of instability apparently has no influence on the development of an instability gonarthrosis. Operative procedures having been performed prior to final stabilysing surgery obviously do not cause the development of secondary gonarthrosis. The persisting instability of the knee joint after combined discontinuation of capsule and ligaments therefore may be regarded as a prearthrotic factor.     

Posttraumatic recurrent luxation of knee joint (author's transl)

A posttraumatic, recurrent luxation of the knee joint is presented. The cause for the first luxation was a severe trauma. As the treatment of the ligament and capsule ruptures of the first luxation was inadequate, the effect was a completely unstable knee joint. By hyperextension trauma or hyperextension following weakness of the muscles of the thigh recurrent luxations of the knee were caused. The importance of a sufficient treatment of ligament and capsule damage following a knee luxation is emphasized.     

Arthrodesis of the knee joint (author's transl)]

Arthrodesis of the knee joint was performed in 75 patients. Solid fusion was achieved in 74 out of them. Average time for union was basically dependent upon type of pathological process and not upon fusion technique employed. In the last years compression arthrodesis with internal fixation by plates was used in all cases of degenerative, posttraumatic and rheumatoid arthrosis; in cases of tuberculosis and other infections of the knee joint external osteosynthesis by fixateur externe was the preferred procedure.     

Knee joint prosthesis with the geomedic knee joint (author's transl)]

Thirty-one cases of plastic knee joint operations were reported. Twenty-one patients were treated with the geomedic knee. The advantage of this joint is that only a small amount of bone must be sacraficed. The range of movement is better than that with a complete knee prosthesis with axis.     

Intraosseous osteotomy in arthrosis of the knee joint (author's transl)]

The article describes a surgical method in which removal of the spongiosa is effected in the region of the upper tibia and the lower femur after fenestration of the cortex. Results are reported on the surgical treatment of 24 knee joints with painful arthrosis without any deformation worth mentioning. Worthwhile pain relief was achieved in 22 cases. In these cases, no osteotomy with correction was indicated.     

Cartilage repair in the knee joint

Full thickness defects of the articular cartilage in the knee joint have lower regenerative properties compared to chondral lesions of the ankle. In order to avoid early osteoarthritis, symptomatic articular cartilage defects in younger patients should undergo biological reconstruction as early as possible. There are different surgical procedures available to achieve a biological resurfacing of the articular joint line. Numerous animal experiments and clinical studies have shown that early biological reconstruction of circumscribed cartilage defects in the knee is superior to a conservative or delayed operative treatment. This effect refers not only to the defect healing but also to the elimination of changes following secondary osteoarthritis. The different surgical procedures can be differentiated concerning the various indications and the final outcome. Additional malalignment, meniscus tears, and/or ligament instabilities should be treated simultaneously together with the cartilage resurfacing. The mid- and long-term results of the different current techniques are promising, but further modifications and improvements are needed.     

Primary operative repair of acute knee joint ligament injuries; results (author's transl)

From 1978 to 1980 43 patients suffering from ligament injuries of the knee-joint immediately underwent definitive surgical repair. The follow-up of 31 patients showed 8 patients with excellent results, 13 with good results, 7 with satisfactory results, 2 with poor results, and 1 with a bad one. Instability could be found in the antero-medial compartment of 15 patients, in the antero-lateral compartment of 7 patients, in the postero-medial compartment of 2 patients. There was 1 case of instability in the postero-lateral compartment. We recommend to perform the repair as soon as possible and in the postoperative period as well as early mobilisation under supervision of an experienced physiotherapist.     

Progress in transplantation of the pancreas (author's transl)

In the field of pancreas transplantation great progress has been made in recent years. While the transplantation of the whole organ has lost importance, success could be reached with the transplantation of isolated islets of Langerhans and with the segmental pancreas transplantation in experiments and in clinical practice. The present-day research is focused particularly on influencing the antigenicity of the endocrine pancreas tissue and on methodical problems of segmental pancreas transplantation.     

Haemarthros of the upper ankle joint (author's transl)

34 patients with isolated, non-dislocated fractures of the medial malleolus and consecutive haemarthros of the upper ankle joint were followed up at an average of 8 years after the trauma. Special attention was given to arthrotic deformities and complaints. The results of this study seem to point to the conclusion that postraumatic haemarthros itself is of no special importance in the development of arthrotic changes of the upper ankle joint in man. This was judged from the pathophysiological reactions of articular cartilage due to haemarthros as shown in animal experiments.     

Experiences gained with knee endoprostheses (author's transl)

Authors report on their experiments and observations with knee endoprostheses. On reason of the high price of imported prostheses the home production of implantates is urged. They reported in a preliminary paper in 1977 on the insertion of the first knee prosthesis made in Hungary. Since this time in 36 instances have been inserted without complication their titanium-polyamid and stainless steel-polyamid sledge type prostheses (a total of 42 pairs of 32 patients). After 2 years follow up the results can be classified as "very good". A new improved model of knee prosthesis is under elaboration.     

Long-term results following synovectomy of the knee joint in rheumatoid arthritis (author's transl)]

Late synovectomy of the knee joint in rheumatoid arthritis is considered by many authors as a positive influencing factor with regard to the local development of the disease at that particular site. Since this assumption is based on evaluation criteria which are by no means uniform, it has so far not been possible to compare the individual results achieved by different authors. For this reason, we conducted follow-up examinations of 57 knee joints in 44 patients with rheumatoid arthritis in whom the synovectomy had occurred at least five years ago, using the standardised follow-up scheme devised by Gschwent et al. Most of these cases represented a late synovectomy, as was evident from the duration of the disease and from Steinbrocker's stages. An analysis of the results showed that in our patients, pain and swelling were most impressively improved, in accordance with the reports made by other authors. Less impressive was the improvement of mobility following synovectomy. Despite increasing instability, it was usually possible to improve the ability of the patients to walk, especially in cases where this ability had been severely restricted. X-ray films showed in almost one-half of the cases that the objective finding had deteriorated, whereas in the other half of the patients the status was largely unchanged or even improved. We can sum up these results by stating that, taking into consideration the comparable results published in the literature regarding late synovectomy of the knee joint in rheumatoid arthritis, a positive influence exercised by late synovectomy on the local pathology can be assumed.     

"Example of clinic rehabilitation" (author's transl)

After ten years' activities of a working group for rehabilitation in an orthopedic clinic, the actual success as reported by the rehabilitated persons, is checked and evaluated in a questionnaire operation. The aim of this inquiry was to assess the work done by such a group within the general framework of clinical activities. Particular emphasis was places on the results in respect of rehabilitation, i.e., the extent to which the patient was able to resume his normal professional or employment activities.     

Results of orthopedic and radiological investigations on the knee joint of old age patients (author's transl)

Orthopedic and radiological investigations were performed on the knee joint of 200 old age patients. The majority of them had no or minute signs, and were free of symptoms. The X-ray characteristics of the degenerative changes of the old age patient's knee joints, and their relationship with the clinical findings are discussed too. The authors point to the relevance of prearthritic conditions in the pathogenesis of those serious osteo-arthritic changes, which become evident in advanced ages.