[Update: endoprosthetics on the ankle joint].

The ankle joint has to bear the entire body weight on a relatively small joint surface. Incongruities, instabilities and deformities lead to painful arthrosis and considerable restrictions in everyday life. For many years, arthrodesis has proven to be the gold standard for end stage arthrosis; however, considering modern endoprostheses for the ankle joint it is no longer appropriate to offer only arthrodesis.

[Interpretation of systematic review articles and meta-analyses : Clinical trials in trauma surgery and orthopedics].

Clinical trials must be planned and interpreted in the context of current best clinical and scientific evidence, undoubtedly provided by systematic reviews and meta-analyses, especially Cochrane Reviews. While many clinicians feel overwhelmed by this complex data source, few visualElements (e.g.

Therapy of chronic extensor mechanism deficiency after total knee arthroplasty using a monofilament polypropylene mesh.

Introduction: Lesions of the quadriceps or patellar tendon after total knee arthroplasty (TKA) are a rare but serious complication which, if left untreated, can lead to loss of function of the knee joint. While acute and subacute extensor mechanism disruptions may have several causes, chronic deficiencies are often related to multiple prior revision surgeries for joint infection or aseptic TKA failure. Up to date, biological allograft reconstruction showed unsatisfying results.

[Treatment of hip dysplasia in young adults].

Developmental dysplasia of the hip (DDH) is one of the most common disorders of hips in children. The deformity can remain asymptomatic into adolescence and adulthood; however, it is considered to be a form of prearthritis and is the main cause of premature osteoarthritis of the hip. The deformity affects the acetabulum but can also be accompanied by changes in the shape of the proximal femur.

[Contemporary indications for aseptic revision total hip arthroplasty].

Background: Hip arthroplasties and revision procedures will continue to rise over the next decades. In 2020 in Germany, 75% of all revision surgeries involved an exchange of at least one component; exchanges of all components were carried out in 27.5% of the revisions.

[Established classification systems of posterior malleolar fractures : A systematic literature review].

Background: Posterior malleolar fractures are found in almost 50% of all ankle fractures. The high clinical relevance of these joint fractures is explained by the significantly worse clinical and functional outcome. There is still a lack of unified opinion regarding the classification and treatment of these fractures.

[Revision TKA due to instability: diagnostics, treatment options and outcomes].

Background: Instability after primary TKA is a frequent reason for revision surgery. Other mechanisms of failure must be ruled out before an in-depth analysis of instability.

Diagnostics: Diagnostic tools for instability consist of medical history, clinical examination, and imaging.

[Osteoporotic fractures of the pelvic ring and their minimally invasive treatment options].

The routine care of osteoporotic fractures of the pelvic ring requires a well-structured treatment algorithm in order to start a stage-appropriate treatment without delay. Nowadays, minimally invasive treatment methods are the gold standard. The minimally invasive dorsal techniques primarily include percutaneous sacroiliac screw osteosynthesis and internal spinopelvic fixation.

[Ventral support in dorsal lumbar fusion surgery : A case report with many incidents].

Anterior column support in posterior lumbar fusion surgery is essential for the outcome of the operation, particularly in the case of unstable pathologies such as spondylolisthesis or spondylodiscitis. The complicated case of a patient with simultaneous spondylolisthesis and spondylodiscitis is presented and reevaluated based on the literature and our own treatment algorithm. In the case of spondylodiscitis alone, iliac crest interposal is sufficient as a support.

[Physiotherapeutic and rehabilitative options for neuromuscular scolioses : Areas of physiotherapy techniques in the field of tension between hypertonic and hypotonic forms of neuromuscular scoliosis].

Conservative treatment and physiotherapy (PT) of neuromuscular scoliosis and its underlying systemic causes is dominated by a pragmatic approach. In the choice of treatment, the observance of the underlying muscle tone sets the essential course to select an appropriate PT technique. Hypertonic forms need the reflex-modulation techniques included in Bobath or Vojta programmes.

[Orthopaedic technology and neuromuscular scoliosis : Orthotics, wheelchair seating shells and positioning aids].

Children and adolescents with neuromuscular scoliosis usually undergo severe challenges with their respiratory and locomotor systems during growth. Early onset scoliotic deformities take a whole team of specialists to ease the problematic side effects associated with poor posture and seating abilities. Wheelchairs and seating shells need to be adjusted as does suitable bracing for the collapsing spine.

[Difficulties in diagnosing an osteoid osteoma of the big toe : A case report with review of the literature].

Background: Osteoid osteomas belong to the benign osseous neoplasia and can occur on the entire skeleton. The prolonged diagnosis of an osteoid osteoma of the great toe prompted us to prepare a case report with a literature review to identify possible sources of error and to contribute to a more expeditious diagnosis and therapy.

Literature: Currently, only two case reports on osteoid osteomas of the toes are known in the German literature.

[Unstable injuries of the deltoid ligament complex in ankle fractures : How to diagnose, how to treat?].

Unstable injuries of the deltoid ligament complex can have a substantial negative effect on the prognosis and treatment of ankle injuries. Lesions of the deltoid ligament are often overlooked at the initial presentation, both as isolated ruptures and in combination with more complex injuries of the ankle. Neglected unstable injuries of medial ankle ligaments may result in chronic instability, especially following correct treatment of fractures and lateral ligament injuries.

A Prospective, Randomized Study Evaluating Clinical and Radiographic Efficacy of Lumbar Interbody Fusion Performed Using a Truss Technology-Based Interbody Fusion Device With Homologous Bone or Bone Marrow Aspirate.

Background: Our group used vertebral bone marrow aspirate (BMA) with an anterior truss-based interbody implant to promote fusion. This implant has biomechanical characteristics that may enhance bone on-growth and through-growth and allow for the use of BMA clot alone. The primary end point was comparison of the proportion of patients who achieved fusion with the implant packed with either crushed cancellous homologous bone chips (CCB) alone or with BMA clot alone.

Management of Deep Spinal Wound Infections Following Instrumentation Surgery with Subfascial Negative Pressure Wound Therapy.

Background And Study Aims:  The treatment of infections following a spine surgery continues to be a challenge. Negative pressure wound therapy (NPWT) has been an effective method in the context of infection therapy, and its use has gained popularity in recent decades. This study aims to analyze the impact of known risk factors for postoperative wound infection on the efficiency and length of NPWT therapy until healing.

[Early assessment of the risk of later implantloosening using Roentgen Sterophotogrammetric Analysis (RSA)].

Background: Aseptic implant loosening is the most common cause of implant revisions in total hip and total knee arthroplasty. Roentgen Stereophotogrammetric Analysis (RSA) represents the current gold standard for the in-vivo assessment of implant fixation.

Present Situation: Long-term clinical trials have shown that continuous implant migration within the first two postoperative years correlates strongly with a later aseptic loosening.

Evaluation of the standard procedure for the treatment of periprosthetic joint infections (PJI) in Germany - results of a survey within the EndoCert initiative.

Background: The periprosthetic joint infection (PJI) is a severe complication in the field of arthroplasty. Despite the rising number of primary joint replacements, no unified therapeutic standard has been established for the treatment of PJI yet.

Methods: A survey on the principles of treatment of PJI in Germany was conducted.

Development and current use of local antibiotic carriers in spondylodiscitis : Pilot study on reduction of duration of systemic treatment.

Background: The current study situation regarding the duration of systemic antibiotic treatment for spondylodiscitis is inhomogeneous and varies between 4-12 weeks. Due to the many undesirable side effects the aim is to achieve complete healing without recurrence or hematogenous scatter within the shortest possible period of time. The present pilot study investigated whether the additional application of a local antibiotic carrier to the surgically treated intervertebral disc space can contribute to a further reduction of treatment duration.

[Gluteal insufficiency].

Gluteal insufficiency or hip abductor mechanism deficiency mainly following (revision) total hip replacement is associated with highly painful complaints and severe suffering of patients. It represents a great diagnostic and therapeutic challenge. Differentiated conservative treatment pathways, open surgical and endoscopic anatomic repair techniques with intact gluteal musculature and muscle transfer are available as salvage procedures for chronic not anatomically reconstructable mass ruptures.

[Peripheral truncal blocks-Overview and assessment].

By implementation of sonography for regional anesthesia, truncal blocks became more relevant in the daily practice of anesthesia and pain therapy. Due to visualized needle guidance ultrasound supports more safety and helps to avoid complications during needle placement. Additionally, complex punctures are possible that were associated with higher risk using landmarks alone.

Intra- and postoperative assessment of femoral component rotation in total knee arthroplasty: an EKA knee expert group clinical review.

Purpose: Malrotation of the femoral component after primary total knee arthroplasty (TKA) is one of the most important problems leading to painful TKA requiring revision surgery.

Methods: A comprehensive systematic review of the literature was performed to present current evidence on how to optimally place the femoral component in TKA. Several landmarks and techniques for intraoperative determination of femoral component placement and examination of their reliability were analyzed.