Patient-specific instrumentation improved three-dimensional accuracy in total knee arthroplasty: a comparative radiographic analysis of 1257 total knee arthroplasties.

Background: The purpose of this study was to compare restoration of mechanical limb alignment and three-dimensional component-positioning between conventional and patient-specific instrumentation in total knee arthroplasty.

Methods: Radiographic data of patients undergoing mobile-bearing total knee arthroplasty (n = 1257), using either conventional (n = 442) or patient-specific instrumentation (n = 812), were analyzed. To evaluate accuracy of axis restoration and 3D-component-positioning between conventional and patient-specific instrumentation, absolute deviations from the targeted neutral mechanical limb alignment and planned implant positions were determined.

[The MyKnee® patient-specific system. Rationale, Technique and Results].

Background: Adequate three-dimensional component positioning and restoration of overall limb alignment are primary goals in total knee arthroplasty. Patient-specific instrumentation (PSI) is a potential way to improve accuracy of knee reconstruction surgery. However, currently available literature regarding the reliability of PSI shows inconsistent results for limb alignment restoration and component positioning.

Patient-specific instrumentation improved mechanical alignment, while early clinical outcome was comparable to conventional instrumentation in TKA.

Purpose: The aim of this prospective study was to compare early clinical outcome, radiological limb alignment, and three-dimensional (3D)-component positioning between conventional and computed tomography (CT)-based patient-specific instrumentation (PSI) in primary mobile-bearing total knee arthroplasty (TKA).

Methods: Two hundred ninety consecutive patients (300 knees) with severe, debilitating osteoarthritis scheduled for TKA were included in this study using either conventional instrumentation (CVI, n = 150) or PSI (n = 150). Patients were clinically assessed before and 2 years after surgery according to the Knee-Society-Score (KSS) and the visual-analog-scale for pain (VAS).

Intensified Adjuvant IFADIC Chemotherapy for Adult Soft Tissue Sarcoma: A Prospective Randomized Feasibility Trial.

Purpose. The present prospective randomized adjuvant trial was carried out to compare the toxicity, feasibility and efficacy of augmented chemotherapy added to hyperfractionated accelerated radiotherapy after wide or marginal resection of grade 2 and grade 3 soft tissue sarcoma (STS).Patients and methods.

[Prevention of heterotopic ossification after THA with indomethacin: analysis of risk factors].

Aim: Several risk factors are associated with heterotopic bone formation following total hip replacement. All these risk factors were defined in cohorts without any treatment against postoperative ectopic bone. The aim of this prospective study was to reveal risk factors for the development of postoperative ossifications in patients who underwent a 7-day course of indomethacin therapy.

Chondrosarcoma of the hand: is a wide surgical resection necessary?

Chondrosarcomas of the hand are rare and generally treated with surgical resection. Thirteen patients with Grade 1 chondrosarcoma of the small bones of the hand were followed up for a mean of 99.8 months (range, 26-293 months).

Radiation synovectomy with (166)Ho-ferric hydroxide: a first experience.

Unlabelled: Radiation synovectomy (RS) is indicated when conventional pharmacologic treatment of chronic synovitis has not relieved its symptoms. The use of radionuclides that are bound to ferric hydroxide (FH) particles has been shown to be effective and safe for this procedure. (166)Ho-FH macroaggregates offer promising properties for RS but there is a lack of clinical data.

Reconstruction of the pelvis after tumor resection in children and adolescents.

Thirty patients younger than 19 years with malignant bone tumors of the pelvis were treated by limb salvage surgery between 1970 and 1998. Functional and oncologic results were reviewed retrospectively. In 10 patients the defect was reconstructed by an endoprosthesis and in 20 patients reconstruction by autologous grafts (n = 7), allograft and prosthesis combinations (n = 2), bone cement reconstruction (n = 1), iliosacral arthrodesis (n = 1), modified Girdlestone procedure (n = 3), or resection without reconstruction (n = 6) was done.

Revision of the Kotz type of tumour endoprosthesis for the lower limb.

In 251 patients over a period of 15 years an uncemented Kotz modular femoral and tibial reconstruction mega prosthesis was implanted after resection of a malignant tumour of the lower limb. Twenty-one patients (8.4%) underwent revision for aseptic loosening, again using an uncemented prosthesis, and five of these required a further revision procedure.

Growth prediction in extendable tumor prostheses in children.

Limb salvage procedures for malignant bone tumors of the lower limb in children usualy involve resection of at least one growing physis. To achieve equal leg length, reconstruction relies on accurate prediction of the remaining growth potential of the child. The current authors present the results of predicted growth versus actual prosthetic elongation observed in a group of 15 children fitted with extendable tumor endoprostheses of the lower limb who subsequently have reached skeletal maturity.

[Diagnostic-therapeutic procedure in benign bone tumors].

The indications of surgical treatment of benign bone tumours are strongly related to the clinical behaviour, the patient's complaints and the activity in Tc-bone scan. Some lesions--like the nonossifying fibroma--that can safely be diagnosed by conventional x-rays may not be treated surgically--as long as the patients are free of pain, and there is no risk of pathologic fracture. In case of clinically relevant lesions, activity in Tc-bone scan, or a risk of fracture, biopsy and curettage combined with autologous or homologous bone grafting is indicated.

Long-term followup of uncemented tumor endoprostheses for the lower extremity.

Between 1982 and 1989, 100 primary lower limb reconstructions were done using the Kotz Modular Femur Tibia Reconstruction System after resection of a malignant tumor. In 32 patients a proximal femur prosthesis was implanted, in 40 patients a distal femur prosthesis was implanted, in 19 patients a proximal tibia component was implanted, in four patients a total femur prosthesis was implanted, and in five patients a total knee prosthesis was implanted. The Kaplan-Meier estimate of the overall survival rate of the prostheses was 85% after 3 years, 79% after 5 years, and 71% after 10 years.

Radiation synovectomy using 165Dy ferric-hydroxide and oxidative DNA damage in patients with different types of arthritis.

Unlabelled: Radiation synovectomy is an effective treatment for chronic synovitis refractory to pharmacological treatment in patients with rheumatoid or seronegative arthritis. Concerns persist about possible radiation-induced cytogenetic damage after radiation synovectomy leading to recommendations to use this technique only in the elderly. Micronucleus (MN) frequency in lymphocytes and urinary excretion of 8-hydroxy-2'-deoxyguanosine (8OHdG) as an indicator of cellular oxidative DNA base damage are biomarkers of radiation-induced cytogenetic damage.

[Early weight bearing after uncemented total hip prostheses--an analysis of acetabulum cup migration].

Purpose: The postoperative mobilisation after cementless total hip arthroplasty is usually non-weight bearing within the first six weeks to achieve bony ingrowth for the implant. Since 1995 weight bearing mobilisation is performed at our clinic even after cementless implantation of the Alloclassic (Zweymüller-Sulzer) system. The aim of the presented study was the detection of any negative influence of weight bearing mobilisation on the stability of this cementless implant.

Influence of radiation synovectomy on articular cartilage, synovial thickness and enhancement as evidenced by MRI in patients with chronic synovitis.

Unlabelled: Radiation synovectomy is a safe and effective treatment for chronic synovitis that is refractory to the repetitive, intra-articular application of glucocorticosteroids in patients with rheumatoid or seronegative arthritis. Short-term and long-term effects of radiation synovectomy on articular cartilage, synovial enhancement and thickness were assessed in a prospective, clinical trial by MRI.

Methods: Thirteen patients (mean age 39+/-13 y) were treated with a median activity of 8.

Six-year results of a cementless stem with prophylaxis against heterotopic bone.

The hypothesis of a possibly diminished bony ingrowth revealed by the development of radiolucency or a radiodense line with time around a cementless femoral stem subsequent to indomethacin administration for prevention of heterotopic ossification was investigated. Eighty prospective patients with indomethacin prophylaxis were compared with 82 patients without indomethacin prophylaxis chosen retrospectively. The same cementless implant was used in all cases, and patients were observed clinically and radiologically for a minimum of 6 years.

Teicoplanin in the prevention of infection in total hip replacement.

Perioperative antibiotic prophylaxis has been shown to be effective in reducing postoperative wound infections. The rising incidence of infections secondary to methicillin-resistant strains of Staphylococcus aureus. S.

[Surgical therapy of spinal metastases].

Bone metastases of the vertebral spine occur frequently after breast cancer, hypernephroma or thyroid carcinoma. Located commonly in the lumbar and thoracic spine, half of the lesions are found in the vertebral body, but in many cases lamina and pedicles are also involved. Pain resistant to conservative treatment, vertebral compression fracture and segmental instability, together with progredient neurologic deficits and para- or tetraplegia, all make operative intervention mandatory.

Management of serious staphylococcal infections in the outpatient setting.

Patients with serious staphylococcal infections, e.g. endocarditis and osteomyelitis, need prompt and prolonged parenteral antibiotic treatment to ensure eradication of the causative pathogen.

[Osteomyelitis. Clinical aspects, diagnosis and therapy].

In this paper the basic features of acute, subacute and chronic types of osteomyelitis, skeletal tuberculosis and some special forms of osteomyelitis are described. The diagnosis of osteomyelitis is established using clinical signs and symptoms, culture studies, laboratory studies and radiological signs. The common conservative and surgical treatments are discussed.

Prevention of chemotherapy-induced anemia by the use of erythropoietin in patients with primary malignant bone tumors (a double-blind, randomized, phase III study).

Background: Patients undergoing chemotherapy for treatment of malignancy frequently experience clinically significant anemia. Myelosuppressive chemotherapy impairs erythropoiesis, which may not fully recover between treatment cycles. Recombinant human erythropoietin (rHuEPO) has been effectively introduced in anemic patients suffering from chronic renal failure.