Sustainable treatment success of an Os naviculare syndrome using conservative measures, infiltration therapy, and shock waves.

Medial plantar foot pain can have various causes, and the painful Os tibiale externum should be considered in the differential diagnosis. A reliable diagnosis can be made through physical examination and multimodal imaging. We report on a 53-year-old man with severe, load-dependent pain consistent with an accessory navicular syndrome, caused by a pes planovalgus, which consecutively induced focal inflammation and tenosynovitis of the tibialis posterior tendon.

Serum albumin-to-globulin ratio and CRP-to-albumin ratio did not outperform serum CRP in diagnosing periprosthetic joint infections.

Aims: Serum inflammatory parameters are widely used to aid in diagnosing a periprosthetic joint infection (PJI). Due to their limited performances in the literature, novel and more accurate biomarkers are needed. Serum albumin-to-globulin ratio (AGR) and serum CRP-to-albumin ratio (CAR) have previously been proposed as potential new parameters, but results were mixed.

Cytokine-directed cellular cross-talk imprints synovial pathotypes in rheumatoid arthritis.

Introduction: Structural reorganisation of the synovium with expansion of fibroblast-like synoviocytes (FLS) and influx of immune cells is a hallmark of rheumatoid arthritis (RA). Activated FLS are increasingly recognised as a critical component driving synovial tissue remodelling by interacting with immune cells resulting in distinct synovial pathotypes of RA.

Methods: Automated high-content fluorescence microscopy of co-cultured cytokine-activated FLS and autologous peripheral CD4 T cells from patients with RA was established to quantify cell-cell interactions.

Serum Inflammatory Biomarkers in the Diagnosis of Periprosthetic Joint Infections.

Accurate preoperative diagnosis of periprosthetic joint infections (PJIs) can be very challenging, especially in patients with chronic PJI caused by low-virulence microorganisms. Serum parameters, such as serum C-reactive protein (CRP) or the erythrocyte sedimentation rate (ESR), are-among other diagnostic test methods-widely used to distinguish septic from aseptic failure after total hip or knee arthroplasty and are recommended by the AAOS in the preoperative setting. However, they are systemic parameters, and therefore, unspecific.

Distal femoral reconstruction following failed total knee arthroplasty is accompanied with risk for complication and reduced joint function.

Background: Substantial bone loss following failed total knee arthroplasty (TKA) represents a major challenge in revision arthroplasty, that can require distal femoral reconstruction (DFR). In this study, we aimed to assess the clinical outcome and the complication frequencies of individuals who underwent DFR with modular megaprostheses. Additionally, we aimed to compare functional outcome measures after DFR in these sophisticated cases to an age-matched control group of total knee prostheses to quantify the potential loss of function.

Sports activity after soft tissue sarcoma of the lower extremity.

The aim of this case series was to assess sports activity levels in long-term survivors of soft-tissue sarcomas after multimodal treatment including limb salvaging surgical resection and radio-chemotherapy. Thirty-two patients (17 f/15 m) with a mean age of 29 (range 10-44) years at the time of diagnosis and a mean follow-up time of 9 (range 3-21) years following sarcoma were included. Ten patients had been diagnosed with liposarcoma, seven with synovial sarcoma, four with fibrosarcoma, three with undifferentiated pleomorphic sarcomas and the remaining eight patients with different soft-tissue sarcoma entities.

Surgical and Functional Outcome after Endoprosthetic Reconstruction in Patients with Osteosarcoma of the Humerus.

Endoprosthetic reconstruction (EPR) is the most widely used reconstruction technique after humeral osteosarcoma (OSA). Complications are common and function is often compromised due to the premise of wide resection. In the current study we evaluated (1) the risk of complications after resection and EPR; (2) the functional outcome and how it is influenced by the preservation/resection of deltoid muscle (DM), rotator cuff (RC), axillary nerve or the type of resection (intra-/extraarticular) and (3) if the preservation/resection of DM, RC, axillary nerve or the type of resection has a negative influence on the oncological outcome.

Multiplex PCR Unyvero i60 ITI application improves detection of low-virulent microorganisms in periprosthetic joint infections.

Purpose: The aim of this study was to evaluate the pre-operative performance of an automated multiplex PCR (mPCR) system in patients with suspected periprosthetic joint infection (PJI).

Methods: Under sterile conditions, synovial fluid samples from patients with a suspected PJI were collected pre-operatively. One hundred eighty microliter of the aspirate was used for analysis in the mPCR.

Comparison of Plantar Pressure Distribution and Functional Outcome after Scarf and Austin Osteotomy.

Objective: To investigate the changes of plantar pressure distribution in patients who underwent either Austin or Scarf osteotomy and underwent a postoperative rehabilitation program.

Methods: Between September 2006 and December 2007, 50 participants who suffered from mild to moderate hallux valgus deformity were prospectively included in this study. An Austin osteotomy (Austin group) was performed in 25 patients and a Scarf osteotomy (Scarf group) in 25 patients.

The influence of antibiotic-loaded cement spacers on the risk of reinfection after septic two-stage hip revision surgery.

Purpose: The aim of this study was the evaluation of possible outcome differences of patients undergoing two-stage hip exchange with antibiotic-loaded spacers, compared to patients without an interim spacer implantation.

Methods: We evaluated 46 patients undergoing two-stage hip revision surgery. Twenty-five patients received an interim ALS.

Failed Two-Stage Exchange: Factors Leading to Unachievable Endoprosthetic Reconstruction After Multiple Revision Surgeries.

Background: Information about the outcome after failed 2-stage exchange is scarce. The aim of this study is to determine possible influencing factors leading to multiple revisions, resulting in a failed endoprosthetic joint reconstruction.

Methods: Medical records of patients (15 hip and 29 knee joints) who had undergone additional revision surgeries due to a failed 2-stage exchange were reviewed concerning infection parameters, number and type of procedure(s), current state of the revised joint, and whether failure of endoprosthetic reconstruction had occurred.

Surgical treatment of shoulder infections: a comparison between arthroscopy and arthrotomy.

Background: Management of bacterial shoulder infections includes antibiotic therapy and surgical joint decompression. Arthroscopy and open arthrotomy are recommended treatment options. Whether 1 of the 2 surgical options is superior remains unclear.

Preoperative MRI is helpful but not sufficient to detect associated lesions in patients with chronic ankle instability.

Purpose: The aim of this study was to determine the reliability and validity of preoperative magnetic resonance imaging (MRI) scans for the detection of additional pathologies in patients with chronic ankle instability (CAI) compared to arthroscopic findings.

Methods: Preoperative MRI images of 30 patients were evaluated regarding articular and periarticular comorbidities and compared to intraoperative findings. The reliability of MRI was determined by calculating specificity, sensitivity, as well as positive and negative predictive values.

Measurement considerations on examiner-dependent factors in the ultrasound assessment of developmental dysplasia of the hip.

Purpose: The standardized sonographic hip screening according to Graf has increased reliability and comparability of measurements in the screening of developmental dysplasia of the hip (DDH). However, examiner dependent factors have been discussed to influence sonographic measurements. The objectives of this study were to examine the tolerance of the transducer positioning and to analyse the impact of transducer inclinations on Graf's hip grading system.

Increased zinc accumulation in mineralized osteosarcoma tissue measured by confocal synchrotron radiation micro X-ray fluorescence analysis.

Abnormal tissue levels of certain trace elements such as zinc (Zn) were reported in various types of cancer. Little is known about the role of Zn in osteosarcoma. Using confocal synchrotron radiation micro X-ray fluorescence analysis, we characterized the spatial distribution of Zn in high-grade sclerosing osteosarcoma of nine patients (four women/five men; seven knee/one humerus/one femur) following chemotherapy and wide surgical resection.

Oncological and surgical outcome after treatment of pelvic sarcomas.

Background And Objectives: Treatment of pelvic tumors remains challenging due to complex anatomy, poor oncological outcome and high complication rates. We sought to investigate the long-term oncological and surgical outcome of these patients.

Methods: Between 1980 and 2012, 147 patients underwent surgical treatment for pelvic sarcoma.

Sonication culture improves microbiological diagnosis of modular megaprostheses.

Modular megaprostheses are known for high infection rates followed by high rates of revisions. Microbial biofilms growing adherently on prosthetic surfaces may inhibit the detection of the pathogens causing prosthetic joint infections. We sought to answer the following questions: Does sonication culture (SC) improve the microbiological diagnosis of periprosthetic infections of megaprostheses compared to conventional tissue culture (TC)? Which pathogens were detected on the surface of megaprostheses with either SC or TC and do the findings help to identify low-grade infections? Included were 31 patients with modular megaprostheses, whose implant had been explanted due to suspected joint infection or revision surgery.

LARS® band and tube for extensor mechanism reconstructions in proximal tibial modular endoprostheses after bone tumors.

Unlabelled: Wide tumor resections around the proximal tibia (pT) are related to compromised function and high complication rates. This retrospective study aims to present the technique employed as well as functional and surgical outcomes of patients undergoing a Ligament Advanced Reinforcement System (LARS®) reconstruction of the knee extensor apparatus after tumor resection and modular endoprosthetic reconstruction of the proximal tibia. Twenty-five patients who received an artificial ligament after pT resection (11 men and 14 women; mean age, 29years; range 11 to 75years, with a minimum follow-up of 24months) were analyzed regarding the ISOLS failure mode classification.

What Sport Activity Levels Are Achieved in Patients After Resection and Endoprosthetic Reconstruction for a Proximal Femur Bone Sarcoma?

Background: Limited information is available about sports activities of survivors after resection and reconstruction of primary malignant bone tumors with megaprostheses. Because patients often ask what activities are possible after treatment, objective knowledge about sports activities is needed to help assess the risks of sports participation and to help guide patients' expectations.

Questions/purposes: The aims of this study were to evaluate (1) what proportion of patients with proximal-femoral megaprostheses placed as part of tumor reconstructions can perform sports; (2) what activity levels they achieved; and (3) whether sports activity levels are associated with an increased likelihood of revision.

Interface Management between General Practitioners and Rheumatologists-Results of a Survey Defining a Concept for Future Joint Recommendations.

Objective: To measure the views of general practitioners (GPs) and rheumatologists in a nationwide evaluation, so as to optimise their cooperation in managing patients with inflammatory rheumatic diseases.

Methods: A questionnaire covering aspects of collaboration was sent, both by mail and/or by email, to all GPs and rheumatologists in Austria. Topics covered were (i) examinations and interventions to be performed before referral, (ii) the spectrum of diseases to be referred, and (iii) the role of GPs in follow-up and continuous management of patients.

Outcome after Reconstruction of the Proximal Tibia--Complications and Competing Risk Analysis.

Background And Objectives: The proximal tibia (pT) is a common site for bone tumors. Improvements in imaging, chemotherapy and surgical technique made limb salvage surgery the treatment of choice. Yet, reconstructions of the pT have been associated with less favorable outcome compared to other parts of the extremities.

Is the state of health of rheumatoid arthritis patients receiving adequate treatment, predictable? - Results of a survey.

Background: A survey was conducted to evaluate whether a steady improvement in the quality of life of Rheumatoid Arthritis (RA) patients as frequently reported in clinical studies, does actually occur. The focus of this study laid on the personal perception of RA patients. How do patients who have been treated along accepted guidelines see the state of their health and their joint pain at different points in time?

Methods: RA patients were asked to complete a questionnaire and return it to an opinion research centre.

Primary malignant tumours of the scapula--a review of 29 cases.

Purpose: Primary malignant bone tumours of the scapula are very rare. Apart from limited small series and some case reports, international literature on flat bone sarcoma is exiguous and not much is known about the oncological outcome.

Methods: A retrospective analysis of 29 patients diagnosed with a primary malignant tumour of the scapula was performed.

Incidence and management of hip dislocation in tumour patients with a modular prosthesis of the proximal femur.

Purpose: Little data is available about the incidence and especially the management of hip dislocation following the implantation of modular tumor prostheses of the proximal femur. In this retrospective single-centre study we assessed the incidence of hip dislocation following implantation of a proximal femoral modular prosthesis as well as the success of the subsequent surgical or non-surgical treatment in tumor patients.

Methods: Between 1982 and 2008, 166 tumor patients received a modular prosthesis of the proximal femur at our institution.