[What should be considered in the case of previous operations or injections prior to hip and knee replacement?].

Background: Patients who have had prior injections, surgeries such as arthroscopies, and have existing osteosynthetic implants in the hip and knee have an increased risk of periprosthetic infections when undergoing hip (THA) or total knee arthroplasty (TKA).

Osteosynthesis: For patients with osteosynthetic implants in the knee joint, a two-stage procedure (implant removal followed by TKA) is recommended based on the available literature and the high colonization rates. A two-stage procedure is also recommended for patients with hip implants.

[Perioperative management with consumption of alcohol and nicotine in patients with hip and knee arthroplasty].

Excessive consumption of nicotine and alcohol has been proven to effect the organ system. Both stimulants are consumed in the population to a not insignificant extent. The question therefore arises as to what effect the consumption of nicotine and alcohol has on the complication rates and to what extent this should be reduced or stopped before performing a joint arthroplasty? A literature search was carried out to answer these questions.

Best timing of bilateral total hip arthroplasty - an analysis of revision and mortality rates from the German Arthroplasty Registry (EPRD).

Background: The burden of osteoarthritis (OA) in multiple joints is high and for patients with bilateral OA of the hip there is no clear recommendation about the indication for simultaneous (one-stage) bilateral total hip arthroplasty (THA) versus two-staged procedures. The purpose of this study was therefore to compare revision and mortality rates after different strategies of surgical timing in bilateral hip OA from the German Arthroplasty Registry (EPRD).

Methods: Since 2012 22,500 patients with bilateral THA (including 767 patients with one-staged bilateral surgery and 11,796 patients with another separate procedures within one year after first THA) are documented in the registry.

Evidence-based and Patient-centered Indication for Knee Arthroplasty - Update of the Guideline.

Knee arthroplasty is one of the most frequently performed operations in Germany, with approximately 170000 procedures per year. It is therefore essential that physicians should adhere to an appropriate, and patient-centered indication process. The updated guideline indication criteria for knee arthroplasty (EKIT-Knee) contain recommendations, which are based on current evidence and agreed upon by a broad consensus panel.

Patients risk for mortality at 90 days after proximal femur fracture - a retrospective study in a tertiary care hospital.

Background: Despite improving the management of proximal femur fractures (PFF) with legal requirements of timing the surgery within 24 h, mortality rates in these patients remain still high. The objective of our study was to analyze potential cofactors which might influence the mortality rate within 90 days after surgery in PFF to avoid adverse events, loss of quality of life and high rates of mortality.

Methods: In this retrospective, single-center study all patients with PFF aged 65 years and older were included.

Girdlestone resection arthroplasty for femoral neck fractures has poorer outcomes than hemiarthroplasty in frail patients with increased risk for arthroplasty-related complications: a retrospective case study of 21 patients.

Background And Purpose: Hemiarthroplasty (HA) is the usual treatment for displaced femoral neck fractures (FNF) in elderly patients. Patients may be unsuitable for HA due to secondary conditions such as systemic infections or severe neurological conditions, which is why Girdlestone resection arthroplasty (GRA) may be an option. We aimed to determine (1) patient survival in matched patient groups treated with either GRA or HA and (2) functional outcomes.

[High revision rates and mortality after treatment of periprosthetic distal femur fractures with a distal femur replacement : An analysis from the EPRD].

Background: Periprosthetic distal femoral fractures (PDFF) are challenging injuries, as mostly geriatric patients with serious comorbidities are affected. Revision to a distal femoral replacement (DFR) is often the best option in very distal fractures, poor bone stock and/or loose total knee replacement. Data on outcome after these surgeries is limited.

No difference in patient reported outcome and inflammatory response after coated and uncoated total knee arthroplasty - a randomized controlled study.

Background: Allergies against implant materials are still not fully understood. Despite controversies about its relevance, some patients need treatment with hypoallergenic implants. This study compared coated and standard total knee arthroplasty (TKA) regarding inflammatory response and patient-reported outcome measures (PROMs).

Musculoskeletal Rehabilitation: New Perspectives in Postoperative Care Following Total Knee Arthroplasty Using an External Motion Sensor and a Smartphone Application for Remote Monitoring.

Background: The number of total knee replacements performed annually is steadily increasing. Parallel options for postoperative care are decreasing, which reduces patient satisfaction. External devices to support physical rehabilitation and health monitoring will improve patient satisfaction and postoperative care.

Better Flexion but Unaffected Satisfaction After Treatment With Posterior Stabilized Versus Cruciate Retaining Total Knee Arthroplasty - 2-year Results of a Prospective, Randomized Trial.

Background: Both the cruciate-retaining (CR) and posterior-stabilized (PS) implant systems are commonplace in modern total knee arthroplasty (TKA) practice. However, there is controversy regarding functional outcomes and survivorship. The aim of the underlying study was to evaluate differences between CR and PS TKA regarding knee function, patient-reported outcome measures (PROMs) as well as complication rates.

High revision rates and mortality after distal femoral replacement for periprosthetic distal femoral fractures: analysis from the German Arthroplasty Registry (EPRD).

Purpose: This study was initiated to analyze the outcome after distal femoral replacement (DFR) for periprosthetic distal femoral fractures (PDFF).

Methods: Data from the German Arthroplasty Registry (EPRD) were analyzed. A total of 626 patients could be identified with a DFR for PDFF.

When are patients with osteoarthritis referred for surgery?

Current treatment strategies in hip and knee osteoarthritis (OA) involve a combined approach that includes not only modification of risk factors and conservative treatment but also joint-preserving surgical therapy in the early stages, or joint replacement in late OA. With the recent development of new etiological concepts (i.e.

[Delirium in the context of intensive care medicine-Part 1: epidemiology, definitions, pathophysiology].

The prevalence of delirium syndromes is high, they are often underdiagnosed and therefore medically as well as economically highly relevant syndromes due to the long-term sequelae. In the majority of cases, delirium has a multifactorial etiology, which is why a comprehensive search for the cause is of highest priority. Surgery, administration of potentially proinflammatory drugs as well as the intensive care environment, including the underlying disease and drugs used, represent relevant etiological factors.

[Delirium in the context of intensive care medicine-Part 2: diagnosis, prevention and treatment].

Despite the high prevalence and the enormous medical and health economic impact, delirium syndromes are often underdiagnosed, which is mainly attributable to the high frequency of hypoactive delirium and to the frequently subtle and fluctuating psychopathology in the initial phase of delirium. These aspects also justify the need for a consequent and continuous application of standardized screening tools to detect delirium as early as possible. A multidimensional, nonpharmacological prevention of delirium is effective and still underutilized in the clinical practice.

Total knee arthroplasty in post-traumatic osteoarthritis is more challenging, but results in similar patient satisfaction - An analysis of 1646 cases.

Background: Patients with post-traumatic osteoarthritis (PTOA) present a variety of technical challenges to surgeons. Surgical parameters, complication rates and patient-reported outcomes (PROs) have been reported as detrimental in total knee arthroplasty (TKA) for PTOA. The purpose of this study was to compare these variables and satisfaction with the results of TKA in patients with post-traumatic osteoarthritis with a matched-pair cohort of primary osteoarthritis (POA).

A Novel Multilayer-Coating for Total Knee Arthroplasty Implants is Safe - 10-Year Results From a Randomized-Controlled Trial.

Background: This randomized-controlled trial was initiated to compare a new multilayer hypoallergenic coating system with the standard implant in total knee arthroplasty (TKA) in terms of serum metal ion levels, patient-reported outcomes (PROs), and implant survival.

Methods: A total of 120 patients were randomized to receive a coated or standard TKA of the same knee system. Serum metal ion levels (ie, cobalt, chromium, molybdenum, and nickel) as well as knee function (Oxford Knee Score, OKS), quality of life (SF-36), and physical activity (UCLA activity scale) were assessed before surgery and until the 10 year follow-up.

Indication Criteria for Total Hip Arthroplasty in Patients with Hip Osteoarthritis-Recommendations from a German Consensus Initiative.

Osteoarthritis of the hip (hip OA) is a leading cause of pain and disability in elderly people. If non-surgical therapies become ineffective, patients may consider total hip arthroplasty (THA). The biggest challenge in recommending a THA is identifying patients for whom the benefits of this procedure outweigh the potential risks.

Ask Patients What They Expect! A Survey Among Patients Awaiting Total Hip Arthroplasty in Germany.

Background: Total hip arthroplasty (THA) is an elective surgery. Therefore, patient satisfaction with the results of surgery is paramount. The association between fulfillment of patients' expectations and satisfaction is well known.

[The use of knee prostheses with a hypoallergenic coating is safe in the medium term : A randomized controlled study].

Background: In Germany, patients with contact allergy to implant components usually receive coated joint arthroplasties. Whether the treatment using these hypoallergenic implants achieves comparable results to standard treatment with implants consisting of cobalt-chromium alloy (CoCr) implants is controversially discussed internationally and has rarely been investigated in the mid-term.

Objectives: Are there differences in blood metal ion concentrations, knee function, and patient-reported outcomes (PROM) between coated and standard implants?

Material And Methods: 118 patients were randomized to receive either a coated or a standard implant.

Total Hip Replacement for Osteoarthritis-Evidence-Based and Patient-Oriented Indications.

Background: Total Hip Replacement (THR) belongs to the most common inpatient operations in Germany, with over 240 000 procedures performed per year. 90% of the artificial joints are still functional at 15 years, and up to 60% at 20 years after surgery. It is essential that the indications for such procedures should be uniform, appropriate, and patient-oriented.

[Decision for total hip arthroplasty-the surgeons' view].

Background: The decision for total hip arthroplasty (THA) is based on pain, loss of function, radiological changes and failed conservative therapy. These criteria are rarely based on systematic research and have not been integrated in generally accepted treatment guidelines. Aim of our study was, therefore, to analyse which decision criteria German orthopaedic and trauma surgeons use in order to recommend THA for patients with hip osteoarthritis.

Acetabular- and femoral orientation after periacetabular osteotomy as a predictor for outcome and osteoarthritis.

Background: Periacetabular osteotomy is a successful treatment for hip dysplasia. The results are influenced, however, by optimal positioning of the acetabular fragment, femoral head morphology and maybe even femoral version as well as combined anteversion have an impact. In order to obtain better insight on fragment placement, postoperative acetabular orientation and femoral morphology were evaluated in a midterm follow-up in regard to functional outcome and osteoarthritis progression.

Use of Physical Therapy in Patients With Osteoarthritis in Germany: An Analysis of a Linkage of Claims and Survey Data.

Objective: To examine the utilization of physical therapy (PT) and predictors for its use in individuals with osteoarthritis (OA) while focusing on sociodemographic and disease-related factors.

Methods: For this cross-sectional study, 657,807 patients (age 30-79 years) diagnosed with hip, knee, or polyarticular OA were identified in claims data. In 2016, a questionnaire including information on disease status, demography, and socioeconomics was sent to a random sample of 8,995 patients stratified by sex, age, and type of diagnosis.