Orthopade最新文献

{"title":"[Septic revision arthroplasty: how to confirm diagnosis, plan surgery and manage follow-up treatment].","authors":"Stephanie Kirschbaum, Carsten Perka","doi":"10.1007/s00132-021-04176-8","DOIUrl":"10.1007/s00132-021-04176-8","url":null,"abstract":"<p><strong>Background: </strong>Septic revision arthroplasty represents an interdisciplinary challenge in terms of diagnosis as well as surgical and follow-up treatment.</p><p><strong>Diagnosis: </strong>The implementation of a standardized diagnostic algorithm including anamnesis, clinic, imaging, blood sampling and joint aspiration is essential. Depending on the duration of the symptoms acute (< 3 weeks) and chronic (> 3 weeks) infections are distinguished.</p><p><strong>Therapy: </strong>While acute infections show an immature biofilm and can usually be addressed surgically via debridement and changing the mobile parts, chronic infections almost always require a complete change of the implant. This can be done in one or two stages, depending on the general condition of the patient, the pathogen, its resistances as well as the wound conditions. The surgical revision is always followed by a resistance-based antibiotic treatment.</p>","PeriodicalId":54669,"journal":{"name":"Orthopade","volume":"50 12","pages":"995-1003"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39520335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Strategic planning of revision total knee arthroplasty].","authors":"Georg Matziolis,&nbsp;Max Ettinger","doi":"10.1007/s00132-021-04188-4","DOIUrl":"https://doi.org/10.1007/s00132-021-04188-4","url":null,"abstract":"","PeriodicalId":54669,"journal":{"name":"Orthopade","volume":"50 12","pages":"969-971"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39688255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Posterior meniscus root tears].","authors":"Maurice Balke, Sebastian Metzlaff, Svea Faber, Thomas Niethammer, Philip P Roessler, Ralf Henkelmann, Theresa Diermeier, Alexander Kurme, Philipp W Winkler, Sebastian Colcuc, Ge Rald Zimmermann, Wolf Petersen","doi":"10.1007/s00132-021-04192-8","DOIUrl":"10.1007/s00132-021-04192-8","url":null,"abstract":"<p><p>Meniscus root tears are radial tears in the region of the posterior insertion zones. Medial root injuries usually occur in individuals > 50 years of age without adequate trauma and are associated with obesity and varus deformities. The root lesion leads to a loss of ring tension, which results in extrusion of the meniscus and a strong increase in joint pressure that is biomechanically equivalent to a complete meniscectomy. When indicating arthroscopic transosseous refixation of the medial root lesion, factors such as accompanying cartilage damage, osteoarthritis, obesity and varus deformity must be taken into account. Injuries to the root of the lateral meniscus are mostly observed in younger patients in combination with a rupture of the anterior cruciate ligament. Arthroscopic transosseous refixation in combination with cruciate ligament surgery is therefore also recommended for type I and type II lesions. In summary, both the medial and the lateral root lesions of the menisci are injuries with high biomechanical relevance.</p>","PeriodicalId":54669,"journal":{"name":"Orthopade","volume":"50 12","pages":"1039-1050"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39614784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Mega-prostheses in revision knee arthroplasty].","authors":"D Rak, M Weißenberger, K Horas, S von Hertzberg-Bölch, M Rudert","doi":"10.1007/s00132-021-04187-5","DOIUrl":"10.1007/s00132-021-04187-5","url":null,"abstract":"<p><strong>Background: </strong>Due to a predicted increase in primary total knee arthroplasty (TKA), revision TKA will gain importance over the following years. Because the average age of patients receiving a TKA is decreasing the possible need for multiple revisions might increase as well. Despite efforts to minimize bone and soft tissue damage, the resulting bone and soft-tissue loss increases with each revision and will make the use of megaprostheses indispensable in the future.</p><p><strong>Complications: </strong>The implantation of a mega-prosthesis must be carefully considered and planned, since mega-prostheses in particular are associated with an increased risk of infection and loosening. Mechanical complications, patient-specific problems and periprosthetic infections can be either the cause for or the result of revision surgery of a mega-prosthesis. In the case of a complication, only a salvage procedure, namely an arthrodesis, amputation or-if necessary-the installation of a permanent fistula is commonly recommended.</p>","PeriodicalId":54669,"journal":{"name":"Orthopade","volume":"50 12","pages":"1011-1017"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39846780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Extended access to revision knee replacement : Intraoperative possibilities for improved joint exposure in complex knee arthroplasty procedures].","authors":"Severin Langer, Igor Lazic, Maximilian Stephan, Rüdiger von Eisenhart-Rothe","doi":"10.1007/s00132-021-04184-8","DOIUrl":"10.1007/s00132-021-04184-8","url":null,"abstract":"<p><p>In most cases, a standard access via a medial parapatellar arthrotomy with a carefully performed release technique is sufficient for a good exposure of the knee joint in the revision situation. Crucial steps are targeted scar removal, sufficient soft tissue release and recreation of the shifting layers. Tuberosity osteotomy is an effective option for extended exposure at the distal joint region, facilitating a patella replacement to correct abnormalities in the patellofemoral joint. Extended exposure to the proximal joint is possible with the rectus snip and the VY plasty technique. Due to the rather poor results, a quadriceps turndown should be seen more historically and should no longer be used. In extreme cases, a femoral peel or an osteotomy of the medial epicondyle can help achieve the reconstruction of a joint. The latter techniques are reserved for selected cases and always require a linked implant.</p>","PeriodicalId":54669,"journal":{"name":"Orthopade","volume":"50 12","pages":"987-994"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39843727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Diagnosis of loosening after knee arthroplasty].","authors":"Christoph Stotter, Philipp von Roth","doi":"10.1007/s00132-021-04180-y","DOIUrl":"10.1007/s00132-021-04180-y","url":null,"abstract":"<p><strong>Background: </strong>Aseptic loosening is one of the most common reasons for revision in knee arthroplasty. Its pathogenesis is multifactorial, and early diagnosis is necessary to initiate appropriate therapy and to avoid serious complications, such as substantial bone loss or even periprosthetic fractures.</p><p><strong>Objectives: </strong>This paper describes the current standard in the diagnosis of aseptic loosening in total knee arthroplasty. Sensitivity and specificity of the individual diagnostic procedures are presented, and other causes for differential diagnoses of painful total knee arthroplasty (TKA) are discussed.</p><p><strong>Results: </strong>In the case of suspected loosening in TKA, infection diagnostics should be performed to rule out periprosthetic infection, as this is crucial in terms of surgical strategy. The gold standard in diagnosing aseptic loosening is conventional radiography. Radiolucent lines at the cement-bone or metal-cement interface of more than 2 mm or increasing in translucency, migration of components, and cement fractures are obvious signs of loosening. Artifact-reduced computed tomography can bring additional information regarding periprosthetic osteolysis. A single bone scan is not reliable in diagnosing aseptic loosening, especially in the first 2 years after surgery. Single photon emission computed tomography (SPECT-CT) could be a useful extension in loosening diagnosis in the future.</p><p><strong>Conclusions: </strong>The diagnosis of aseptic loosening poses a great challenge to the treating physician and requires a structured diagnostic algorithm. After exclusion of infection, conventional radiography is the basic examination, which should be supplemented by computed tomography and nuclear medicine examinations according to the clinical symptoms and the time course.</p>","PeriodicalId":54669,"journal":{"name":"Orthopade","volume":"50 12","pages":"972-978"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39558154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Typing and particle analysis of squeaking hip endoprostheses : First histopathological analysis to examine the squeaking pathogenesis of ceramic-on-ceramic bearings].","authors":"Stephanie Eiden, Therese Bormann, Jan Philippe Kretzer, Ralf Dieckmann, Veit Krenn","doi":"10.1007/s00132-021-04133-5","DOIUrl":"10.1007/s00132-021-04133-5","url":null,"abstract":"<p><strong>Background: </strong>Since the use of ceramic-on-ceramic (CoC) hip endoprostheses complications in the form of squeaking noises have occasionally occurred.</p><p><strong>Objectives: </strong>This is the first histopathological analysis of the synovia-like interface membrane (SLIM) of ceramic squeaking hip endoprostheses with the aim to gain new insights into the squeaking pathogenesis.</p><p><strong>Materials and methods: </strong>Seven CoC hip endoprostheses with squeaking pathogenesis are analyzed by SLIM consensus classification, particle algorithm, CD3 quantification, semiquantitative CD68 macrophages, Oil-Red positive macrophages, hemosiderin evaluation and in two cases by energy dispersive X‑ray spectroscopy (EDX).</p><p><strong>Results: </strong>In 1733 hip joint prosthesis pathology cases, a squeaking revision incidence of 0.40% was determined. In addition to SLIM type I (1/7), only SLIM type IV (6/7) was detected. 4/7 CoC cases showed combinations of micro, macro and, for the first time, supramacro (166.5 µm) ceramic wear particles. The EDX analysis confirmed the ceramic and an additional metallic abrasion. Increased focal concentrated low inflammatory markers (CD3/CD68) with hemosiderin (5/7) and lipid depositions (Oil-Red positive macrophages) (6/7) occurred.</p><p><strong>Conclusions: </strong>A pathogenetic connection between SLIM type I/IV and squeaking can be assumed. SLIM types showed a partly light microscopic ceramic particle-dependent, partly independent predominantly low-grade inflammation. Hemosiderin and Oil-Red positive macrophages are signs of synovial tissue damage and indicate biomechanical misload (impingement) and dysfunction as cause of the squeaking pathogenesis.</p>","PeriodicalId":54669,"journal":{"name":"Orthopade","volume":"50 12","pages":"1032-1038"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39178744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum zu: Ein klinisch-radiologischer Score für Femurkopftransplantate : Etablierung des Tabea-FK-Scores zur Sicherung der Qualität humaner Femurkopftransplantate.","authors":"Nicolaus Siemssen, Christian Friesecke, Christine Wolff, Gisela Beller, Katharina Wassilew, Bruno Neuner, Helge Schönfeld, Axel Pruß","doi":"10.1007/s00132-021-04191-9","DOIUrl":"10.1007/s00132-021-04191-9","url":null,"abstract":"","PeriodicalId":54669,"journal":{"name":"Orthopade","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39681994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Informed consent for surgery: clearly regulated by the patient rights law-significant uncertainty among medical students : Legal analysis and inventory of over 2500 medical students in Berlin as part of the Progress Test Medicine].","authors":"R J Seemann,&nbsp;P Melcher,&nbsp;C Eder,&nbsp;J Deckena,&nbsp;R Kasch,&nbsp;S Fröhlich,&nbsp;M März,&nbsp;M Ghanem","doi":"10.1007/s00132-021-04080-1","DOIUrl":"https://doi.org/10.1007/s00132-021-04080-1","url":null,"abstract":"<p><strong>Background: </strong>Obtaining informed consent is a challenging task and is part of the educational objectives in the German NKLM. Teaching formats are inconsistent and time-consuming, with little emphasis on legal aspects, although they have moved into the focus of attention since the implementation of patient rights laws and play an important role in legal proceedings.</p><p><strong>Objectives: </strong>The aim of this study was the evaluation of medical students' knowledge about the legal aspects of obtaining informed consent. A legal analysis was performed, and the patient rights laws were reviewed with reference to implications for undergraduate medical education.</p><p><strong>Materials and methods: </strong>After the analysis of laws and jurisdiction, multiple-choice questions regarding the legal aspects of obtaining informed consent were created and placed in the Progress Test Medicine (PTM). A statistical analysis of the results of Berlin medical students was performed descriptively.</p><p><strong>Results: </strong>The answers of 2625 (winter semester 2018/19) and 2409 (summer semester 2019) medical students in Berlin were analyzed. The rate of students who answered the questions about the procedures requiring informed consent and adequate time for consideration increased over time but did not reach comparable values to all PTM questions. Questions about required content were answered correctly by 30 to 60% of the students, regardless of their level of training; we did not see an increase along with the time of study.</p><p><strong>Conclusion: </strong>In our study, we were able to show that medical students of all educational levels show tentativeness when it comes to the legal aspects of obtaining informed consent. Yet, the legal framework offers room for new teaching formats like \"Co-Action\", introduced in this paper for the first time, where students acquire informed consent while being supervised by the medical doctor in charge.</p>","PeriodicalId":54669,"journal":{"name":"Orthopade","volume":"50 11","pages":"937-945"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00132-021-04080-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25433406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum zu: Wiederaufnahmeraten von Rückenschmerzpatienten an einer Universitätsklinik nach primär konservativer stationärer Therapie.","authors":"Florian Ihde,&nbsp;Robert Lenz,&nbsp;Wolfram Mittelmeier,&nbsp;Katrin Osmanski-Zenk","doi":"10.1007/s00132-021-04170-0","DOIUrl":"https://doi.org/10.1007/s00132-021-04170-0","url":null,"abstract":"","PeriodicalId":54669,"journal":{"name":"Orthopade","volume":"50 11","pages":"957-958"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8571213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39472543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}