Search

Abstract: The present investigation studied whether or not ventral derotation spondylodesis (VDS) screw fixation strength can be estimated preoperatively by means of radiology. Furthermore, comparison of the techniques applied was done to show which of them is most appropriate. The bone mineral density of human cadaveric lumbovertebral bodies was assessed by both dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT). Trabecular structure was characterised by T2*-relaxation time magnetic resonance imaging (MRI). After ventral instrumentation of vertebral bodies with VDS screws, their axial pullout force was assessed as a reference value for initial stability of the implant. Data from each radiological method were correlated with it. The highest correlation with pullout force was registered for density of cancellous bone by QCT (r = 0.72; P > 0.001), immediately followed by DXA (r = 0.70; P < 0.001). T2*-relaxation time (MRI) correlated moderately (r = 0.55), whereas cortical bone density (QCT) showed a negligible correlation (r = 0.2). Results reveal that absorptiometrical techniques like DXA and QCT (cancellous bone) are the most appropriate ones to assess initial screw fixation strength in vertebral bodies preoperatively.

Fragestellung: Mit der vorliegenden Studie sollte die Wirksamkeit, Patientenakzeptanz und das Nebenwirkungsprofil von Oxaprozin im Vergleich zu Diclofenac retard bei Patienten mit aktivierter primärer Arthrose geprüft werden. Methode: 80 ambulante Patienten mit aktivierter primärer Arthrose Grad II oder III (Krankheitsdauer im Mittel 4 Jahre) im Hüft- oder Kniegelenk wurden gleichmäßig randomisiert jeweils mit Oxaprozin oder Diclofenac retard behandelt. Das Alter der Patienten betrug 40–66 Jahre (im Mittel 51 Jahre). Nach einer Auswaschphase wurde das jeweilige Präparat über einen Zeitraum von 6 Wochen verabreicht. Die Wirksamkeitsprüfung beinhaltete Schmerzen, schmerzbedingte Schlafstörungen, eine individuelle und eine generelle funktionelle Beeinträchtigungsskala, Laborparameter und die Gesamtbewertung der Patienten. Zur statistischen Analyse wurde der Mann-Whitney-U-, der Wilcoxon- und der χ2-Test angewandt. Ergebnisse: 74 Patienten beendeten die Studie erfolgreich, 3 Patienten jeder Therapiegruppe brachen sie aufgrund von Nebenwirkungen auf eigenen Wunsch vorzeitig ab. Zur Abschlußuntersuchung nach 6 Wochen zeigte sich ein signifikanter Unterschied zugunsten von Oxaprozin bzgl. der individuellen und der generellen Beeinträchtigungsskala sowie der Gesamtbewertung durch die Patienten. Auch innerhalb beider Patientenkollektive war die Beschwerdeminderung zur Abschlußuntersuchung statistisch signifikant. Schlußfolgerungen: Die Resultate sprechen für die Wirksamkeit und mögliche Therapieoptimierung durch Oxaprozin im Vergleich zu Diclofenac retard als einem anerkannten Standardtherapeutikum bei aktivierter Arthrose. Aim: The present study should elucidate the efficacy, patient acceptability, and side effect profiles of Oxaprozin and Diclofenac retard when given to patients with active primary osteoarthrosis. Methods: 80 outpatients with active primary osteoarthrosis with a radiological grade of II or III in the hip or knee joint (mean duration 4years) were distributed randomly and equally to each treatment group. Patients age ranged from 40–66 years (mean age 51 years). After a washout period, they received one of the preparations for 6 weeks. Efficiency assessments consisted of pain, disturbance of sleep, individual and general functional impairment scales, laboratory determinations, and patients global evaluation. For statistical analyses Mann-Whitney-U-, Wilcoxon-, and χ2-tests were applied. Results: 74 Patients completed the study successfully, whereas 3 patients of each group withdrew due to adverse events. Significant differences favoring Oxaprozin were found for the individual and functional impairment scale and the patients‘ global evaluation of treatment at the final visit (6 weeks). Improvement compared to baseline visit was significant for both treatment groups. Conclusions: The results suggest that Oxaprozin is more effective than Diclofenac retard, a recognized standard therapy, when given for 6 weeks to patients with active osteoarthrosis.

We aimed to determine whether extracorporeal shock waves of varying intensity would damage the intact tendo Achillis and paratenon in a rabbit model. We used 42 female New Zealand white rabbits randomly divided into four groups as follows: group a received 1000 shock-wave impulses of an energy flux density of 0.08 mJ/mm2, group b 1000 impulses of 0.28 mJ/mm2, group c 1000 impulses of 0.60 mJ/mm2, and group d was a control group.Sonographic and histological evaluation showed no changes in group a, and transient swelling of the tendon with a minor inflammatory reaction in group b. Group c had formation of paratendinous fluid with a significant increase in the anteroposterior diameter of the tendon. In this group there were marked histological changes with increased eosin staining, fibrinoid necrosis, fibrosis in the paratenon and infiltration of inflammatory cells.We conclude that there are dose-dependent changes in the tendon and paratenon after extracorporeal shock-wave therapy and that energy flux densities of over 0.28 mJ/mm2should not be used clinically in the treatment of tendon disorders.

Abstract: The present investigation aims to evaluate periprosthetic bone remodelling after total knee arthroplasty by the use of dual-energy X-ray absorptiometry (DXA). Twelve patients affected by osteoarthrosis of the knee joint underwent primary total knee arthroplasty at an average age of 70.5 years. None of them had received a knee prosthesis before on the contralateral side. Anteroposterior and lateral DXA measurements of the femur, tibia and total knee (both sides) were taken 2 weeks, 3 and 9 months postoperatively. The 2-week measurement was used as an individual reference value to be compared with the 3- and 9-month findings. In addition, the contralateral knee was investigated also in order to estimate how far bone mineral loss was due to implantation or to an individual decline in bone mineral density (BMD). The comparison of BMD values after knee arthroplasty revealed a conspicuous decrease of bone density within 9 months. Bone mineral loss amounted to an average of 9.2% in anteroposterior and 17.8% in lateral DXA measurements. Lateral femur shots showed an average decrease of density of even 21.5%. In contrast, the BMD values of the contralateral knees remained almost unchanged. DXA, especially lateral shots of the femur, promises to be a suitable method for early assessment of periprosthetic bone remodelling after total knee arthroplasty.

Abstract: This re-investigation presents our experience with revision resurfacing knee arthroplasty caused by aseptic failure. The evaluation of the results should elucidate the benefit of revision, its complications as well as the impact of the implant type used. The study involved 36 patients whose primary resurfacing knee prostheses failed by aseptic loosening. The rather elderly patients (average 68.3 years) underwent revision 6 years later on average. In 30 cases (83.3%), arthroplasty could be repeated with resurfacing implants, whereas the use of hinge prostheses was unavoidable in 6 knees (16.7%). After an average of 7 years later, 30 knees were re-investigated according to the Hospital for Special Surgery (HSS) scoring system. Results were compared with the HSS values prior to revision. Complications and revised implant survivorship were reported chronologically. The revision knees had a 80% incidence of improved HSS score. In 73.3% the outcome was graded as good or even excellent. In contrast, scoring values before revision were dissatisfying without exception. The early complication rate after operation was 25%. Persisting pain, instability and limited mobility led to repeated revision in two cases and arthrodesis of one of the knees. The outcome of revision after 7 years revealed a remarkable early complication rate. Nevertheless, good or excellent results could be scored after implantation of PFC, PFC-modular, TC and TCIII prostheses.

The development of symptomatic hallux valgus deformities at an early age is rather uncommon and usually treated non-operatively. However, if surgical treatment is indicated, only so-called physiological procedures, especially e.g. McBride's soft-tissue realignment, should be considered. From 1970 to 1990, 11 patients aged 12–20 years underwent McBride's procedure, giving a total of 21 feet. For 9 of these patients (17 feet), the average follow-up was 14 years and consisted of patient's history, radiographs and physical examination. All in all, the outcome was judged as good in 10 of 17 feet, satisfying in 2 of 17 feet and dissatisfying in 5 of 17 feet by both patients and surgeon. This conspicuous variation in successrate will be discussed by means of two examples.