Pneumatic compression with foot pumps facilitates early postoperative mobilisation in total knee arthroplasty.

Deep-vein thrombosis (DVT) and pulmonary embolism (PE) represent life-threatening postoperative complications frequently responsible for in-hospital mortality following total knee arthroplasty (TKA). Mechanical prophylaxis in the form of a foot pump offers an alternative to pharmacological and physical therapy. The aim of this prospective and randomised study was to examine the clinical efficacy of the A-V Impulse (AVI) system in reduction of soft-tissue swelling of the lower limb following a TKA.

In vivo measurement of polyethylene wear in cementless total hip arthroplasty.

Purpose Of The Study: Recent years have seen an increase in cementless total hip endoprosthesis (THP) implantations. Easy radiological measurement of wear in cups coated with X-ray dense material, such as metal or ceramics, is not applicable. An alternative technique has thus been developed to radiographically measure wear on cementless spherical implants.

Gelatin-based haemostyptic Spongostan as a possible three-dimensional scaffold for a chondrocyte matrix?: an experimental study with bovine chondrocytes.

The gelatin-based haemostyptic compound Spongostan was tested as a three-dimensional (3D) chondrocyte matrix in an in vitro model for autologous chondrocyte transplantation using cells harvested from bovine knees. In a control experiment of monolayer cultures, the proliferation or de-differentiation of bovine chondrocytes was either not or only marginally influenced by the presence of Spongostan (0.3 mg/ml).

[Development of a catalogue of undergraduate learning objectives for orthopaedics and traumatology].

Background: The development towards a combined speciality of orthopaedic and trauma surgery requires not only consolidation and revision of the postgraduate education training programme but also the development of a catalogue of learning objectives as a uniform basis for undergraduate medical training in the new speciality at German medical schools and teaching hospitals.

Materials And Methods: Based on the Frankfurt catalogue of learning objectives for trauma surgery and the Ulm catalogue of learning objectives for orthopaedics, a task force of experts developed a combined catalogue of learning objectives for the new speciality. Experts from both specialities classified the learning objectives into two levels of knowledge and four grades of skills competence, in addition to objectives for attitudes and social competence.

[Development of a catalogue of undergraduate learning objectives for orthopaedics and traumatology].

Background: The developments towards a combined specialty of orthopaedic and trauma surgery requires not only the consolidation and revision of the postgraduate education training programme but also the development of a catalogue of learning objectives as a uniform basis for undergraduate medical training in the new specialty at German medical schools and teaching hospitals.

Materials And Methods: Based on the Frankfurt Catalogue of Learning Objectives for Trauma Surgery and the Ulm Catalogue of Learning Objectives for Orthopaedics, a task force of experts has developed a combined catalogue of learning objectives for the new specialty. The experts of both specialties classified the learning objectives into 2 levels for knowledge, into 4 grades of competence for skills, as well as attitudes and social competence.

[Autologous chondrocyte transplantation in the ankle joint. Rational or irrational?].

Ankle sprains are one the most common injuries of the lower limb. Fractures, ligamentous lesions, and cartilaginous damage are often associated. Nevertheless the injury is often misjudged and concomitant chondral lesions are assessed late.

[Radiological and clinical functional examinations 36 months after anterior cruciate ligament repair by a patellar tendon graft].

Aim: The aim of this study was to examine radiological and functional outcome measurements after anterior cruciate ligament (ACL) reconstruction with a bone-tendon-bone (BTB) graft. Investigations included assessment of bony integration conditions regarding the use of bioabsorbable cross pins or a lateral screw for femoral graft fixation. A description of radiological parameters in contrast with IKDC findings is also given.

Total hip replacement through a minimally invasive, anterolateral approach with the patient supine.

Objective: Early postoperative mobilization and restoration of pain-free joint function by implantation of a total hip replacement through a standardized, minimally invasive approach regardless of the type of implant with the patient in the supine position.

Indications: Primary and secondary coxarthrosis. Femoral head necrosis.

[Intra-articular pain during gonarthrosis: a case report about an extremely increased cathepsin expression in chondrocytes].

Aim And Background: Cysteine proteases as cathepsins K and L as well as matrix metalloproteases are considered to be basically involved in collagen turnover. Degenerative joint diseases such as gonarthrosis are characterised by massive cartilage degradation mediated by increased activities of these proteases. These enzymes are, therefore, interesting targets for the treatment of painful arthritic joint diseases.

Proprioceptive skills and functional outcome after anterior cruciate ligament reconstruction with a bone-tendon-bone graft.

Several studies have shown that patients with anterior cruciate ligament (ACL) reconstruction have an improved proprioceptive function compared to subjects with ACL-deficient knees. The measurement of functional scores and proprioception potentially provides clinicians with more information on the status of the ACL-reconstructed knees. To evaluate proprioception in patients following ACL reconstruction with a bone-tendon-bone (BTB) graft, we used the angle reproduction in the sitting, lying and standing positions and the one-leg hop test.

[Autologous chondrocyte transplantation by the sandwich technique. A salvage procedure for osteochondritis dissecans of the knee].

The case presented is that of a 23-year-old man suffering from osteochonditis dissecans (OCD) of the medial femoral condyle, in whom a free piece of cartilage had separated off and there was a large osteochondral defect despite numerous operations. After refixation of the fragment failed, an autologous chondrocyte transplantation (ACT) was performed using the sandwich technique. Three years after the operation the patient is very satisfied with the result.

[The subacromial impingement syndrome].

The subacromial impingement syndrome describes the pathological contact between the rotatory cuff and the acromion. It is only a symptom and not a generic term for the different pathological diseases of the subacromial region. It is the diagnostical aim to verify the pathogenesis of the impingement syndromes and it is essential to differentiate structural versus functional causes.

[Transgluteal mini-incision. Technique and our own results].

Background: A transgluteal mini-incision technique according to the approach of Bauer et al. is described.

Material And Methods: Altogether 194 patients were supplied with a cementless primary total hip endoprosthesis using this approach.

Press fit fixation of cementless cups: how much stability do we need indeed?

Introduction: Using screws for a better primary and secondary fixation has been discussed in the literature of the recent years, although the principle of press fit has been explained as the principle of a push-button. The authors wanted to compare their own results in patients using X-rays from the postoperative course to decide if it is really safer to use screws or not.

Materials And Methods: Two hundred and twenty one consecutive, not selected patients were treated with total hip arthroplasty using a cementless cup type Duraloc.

Osteointegration of hydroxyapatite-titanium implants coated with nonglycosylated recombinant human bone morphogenetic protein-2 (BMP-2) in aged sheep.

Osteointegration of metal implants into aged organisms can be severely compromised due to reduced healing capacity of bone, lack of precursor cells for new bone formation, or osteoporosis. Here, we report on successful implant healing in a novel model of aged sheep in the presence of nonglycosylated bone morphogenetic protein 2 (BMP-2). Ewes of 8 to 12 years with significant radiologic and histologic signs of osteoporosis and adipocytic bone marrow received a cylindrical hydroxyapatite-titanium implant of 12 x 10 mm.

[Metatarsalgia. Differential diagnosis and therapeutic algorithm].

Metatarsalgia is explained as localized or more diffuse tenderness beneath the metatarsal heads. The pain may be attributed to various etiologies. Pathological changes affecting the positional relationship of the metatarsals in the sagittal plane can cause increased pressure and friction forces during weight bearing.

[The acquired buckling-flatfoot. A foot deformity due to obesity?].

Flatfoot deformity is characterized by a multiplanar hindfoot malalignment. Although the etiology remains unclear, the deformity is mainly attributed to ligamentous laxity and dysfunction of the posterior tibial tendon. Obesity is thought to be a risk factor that additionally impairs hindfoot stability.

Intra-articular injections of high-molecular-weight hyaluronic acid have biphasic effects on joint inflammation and destruction in rat antigen-induced arthritis.

To assess the potential use of hyaluronic acid (HA) as adjuvant therapy in rheumatoid arthritis, the anti-inflammatory and chondroprotective effects of HA were analysed in experimental rat antigen-induced arthritis (AIA). Lewis rats with AIA were subjected to short-term (days 1 and 8, n = 10) or long-term (days 1, 8, 15 and 22, n = 10) intra-articular treatment with microbially manufactured, high-molecular-weight HA (molecular weight, 1.7 x 10(6) Da; 0.

Radiological changes around the stem after cementless hip implantation in case of the anatomic medullary locking hip system -- five years results.

Introduction: We present radiological results regarding the development of stress shielding around the stem of the AML hip endoprosthesis and discuss the clinical significance of it and preventive measures against stress shielding.

Material And Methods: 391 patients (216 female and 122 male) with an AML-hip-endoprosthesis between 1991 and 1992 were followed clinically and radiologically during 5 years postoperatively. It was searched for a statistical correlation of stress shielding with a pre-existing osteoporosis of the proximal femur (Barnett-Nordin index), the diameter of the stem, a varus position of the stem and thigh pain.

Prophylaxis of heterotopic bone formation by radiotherapy -- a comparison between pre- and postsurgical activity.

Introduction: Heterotopic bone formation after total hip replacement is estimated to occur in about 30% of all patients. It may develop into restriction of mobility and persisting pain.

Material And Methods: From 1991 to 1998, 90 patients with uncemented total hip replacement and known risks to develop heterotopic bone formation were treated by radiotherapy (14 patients received 5 x 3 gy between the first and the fifth postoperative day, 13 patients received 1 x 7 gy between 24 hours postoperative, 63 Patients received 1 x 7 gy between 24 hours preoperative) using gamma ray or high-energy photons.

[Periprosthetic bone loss after total hip endoprosthesis. Dependence on the type of prosthesis and preoperative bone configuration].

The changes of the periprosthetic bone density were examined with DEXA in 81 patients over a period of 1 year after implantation of cementless total hip endoprosthesis. Four types of endoprostheses (Vision 2000/Duraloc, ALPHA-Fit/ALPHA-Lock Plus, CLS/Allofit, Mayo/Trilogy) were implanted. Information on the changes of the periprosthetic bone density depending on the type of the prosthesis and the bony situation at the femur before operation was expected from these measurements.

[Radiological evaluation of polyethyelene wear of cementless total hip endoprosthesis].

During the last years increasingly cementless hip endoprostheses have been implanted. Radiological wear measurement of cemented hip endoprostheses for the material couples polyethylene cup-ceramic- or metal head has been established in the literature. However, for cups encased by metal (screwing or pressfit cups), this method of measurement is not applicable.

Overwhelming septic infection with a multi-resistant Staphylococcus aureus (MRSA) after total knee replacement.

Introduction: The incidence of early deep infection after arthroplasty of the knee is very low but could represent a serious future problem.

Material And Methods: The authors report on a 71-year-old woman with gonarthritis who was supplied with a total knee endoprosthesis and developed a local infection followed by septic shock.

Results: The infection was evidently caused by a multiresistant Staphylococcus aureus (Staph.

[5-year follow-up study of total knee arthroplasty by means of EMG mapping].

Aim: The objective of the present study was to evaluate the long-term functional results after implantation of a total knee arthroplasty (TKA) objectively and quantitatively.

Method: Functional parameters (muscular coordination, strength and range of motion) and the subjective satisfaction of the patients were measured by means of EMG mapping, isokinetics, ultrasound and a questionnaire in 21 patients with TKA 5.1 years after implantation of the TKA.