Orthopadie (Heidelberg, Germany)最新文献

{"title":"[The brain today is yesterday's psyche].","authors":"Paul Nilges","doi":"10.1007/s00132-025-04691-y","DOIUrl":"https://doi.org/10.1007/s00132-025-04691-y","url":null,"abstract":"<p><p>Despite scientific advances, chronic pain remains difficult to diagnose and treat. For a long time, a dualistic understanding prevailed: pain without an identifiable organic cause was considered psychological in origin, leading to stigmatization and conflict-laden doctor-patient relationships. Imaging techniques often reveal abnormalities even in pain-free individuals, and surgical interventions are frequently unnecessary. Modern pain research understands pain as a complex interplay of biological, psychological, and social factors-not as a simple stimulus-response mechanism. Pain is learned, shaped by experience, and constructed by the brain, influenced by context and expectation. Pain is not the same as nociception; it is not a direct indicator of tissue damage, but rather a perception of potential threat. The new diagnosis of primary pain in ICD-11 integrates biological, psychological, and social factors and expands our treatment framework.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Long-term sports medical care of soldiers : Relevance of trunk strength and performance].","authors":"Christoph Schulze, Sabrina Fehrmann, Claudia Bünzen, Daniel Geißler","doi":"10.1007/s00132-025-04677-w","DOIUrl":"https://doi.org/10.1007/s00132-025-04677-w","url":null,"abstract":"<p><strong>Background: </strong>Soldiers are exposed to physical strain with increased risk of developing overload injuries. Measures to preserve physical performance are of great preventive importance.</p><p><strong>Purpose: </strong>Does a long-term sports medical support based on strength and performance parameters help to maintain physical performance capacity?</p><p><strong>Methods: </strong>Data from isokinetic trunk strength measurements, lactate performance diagnostics, 50 m sprint tests, as well as anthropometric and laboratory parameters were retrospectively evaluated in 115 soldiers over 6 years and analysed using ANOVA and Pearson correlation analysis.</p><p><strong>Results: </strong>There were no relevant changes in anthropometric parameters. HDL cholesterol and trunk extension strength increased significantly. Performance in the sprint test also improved significantly. The maximum speed in the performance diagnostics remained constant.</p><p><strong>Conclusion: </strong>Long-term sports medical care for soldiers is suitable for preventing a loss of performance capacity and offers potential for further improvement.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Patient-specific instrumentation in total knee arthroplasty - current concepts and clinical implications].","authors":"Ricarda Stauss, Peter Savov, Hendrik Pott, Max Ettinger","doi":"10.1007/s00132-025-04689-6","DOIUrl":"https://doi.org/10.1007/s00132-025-04689-6","url":null,"abstract":"<p><strong>Background: </strong>In total knee arthroplasty (TKA), there is a trend towards personalized concepts, and the implementation of innovative technologies is crucial for the precise execution of modern alignment strategies.</p><p><strong>Patient-specific instrumentation: </strong>Patient-specific instrumentation (PSI) enables a detailed preoperative analysis of the patient's bony anatomy, and optimal component placement is determined in the virtual implant planning stage. PSI-guided execution of the surgical plan enables an improved precision and reproducibility of the surgical results. Despite the use of 3D-printed cutting guide instruments in standard TKA cases, PSI is increasingly being used in surgically complex cases that require an individualized surgical plan.</p><p><strong>Current situation of studies: </strong>With the increasing utilization of modern technologies in TKA and the expansion of the indications for PSI-TKA to complex cases, a thorough understanding of the potential benefits and limitations of this technology is crucial to determine the cases that will benefit most from the procedure. Therefore, the purpose of this article is to provide an overview on the current evidence and clinical implications of PSI-guided TKA.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Update 2025: Biomechanics and kinematics after total knee arthroplasty (TKA)].","authors":"Markus Heinecke, Leandra Bauer, Benjamin Jacob, Julia Kirschberg, Arnd Steinbrück, Georg Matziolis, Matthias Woiczinski","doi":"10.1007/s00132-025-04687-8","DOIUrl":"https://doi.org/10.1007/s00132-025-04687-8","url":null,"abstract":"<p><strong>Background: </strong>In order to optimise clinical outcomes after primary total knee arthroplasty (TKA), research has refocused on the knee joint's biomechanical characteristics. Beyond implant design and alignment philosophy, the restoration of natural joint kinematics, functional range of motion, and stability critically depends on patient-specific anatomical conditions.</p><p><strong>Biomechanics: </strong>Instrumented TKA systems have demonstrated the significance of coronal alignment and mediolateral load distribution. Furthermore, patellofemoral joint alignment has gained attention as a determinant of postoperative success. While static radiographic assessments remain the gold standard, they can be meaningfully complemented by instrumented gait analysis to capture dynamic leg alignment and quantify the influence of the external knee adduction moment. Furthermore, computational simulations facilitate a more precise analysis of implant-specific loading conditions and kinematic behaviour.</p><p><strong>New methods: </strong>In combination with experimental approaches, such as in vitro kinematic testing, these tools facilitate a detailed evaluation of complex movement and load scenarios, thereby supporting the development of personalised therapeutic and rehabilitative strategies. Furthermore, the development of novel classifications of kinematic phenotypes holds great potential for the systematic categorisation of patients and the personalisation of interventions, with the aim of enhancing functional outcomes and satisfaction. The use of subject-specific musculoskeletal models and finite element analysis (FEA) permits the simulation of joint mechanics under individual anatomical constraints, thus contributing to the optimisation of implant positioning and the reduction of biomechanical load. In the future, the integration of artificial intelligence and machine learning into preoperative planning is expected to refine patient-specific treatment algorithms.</p><p><strong>Prospect: </strong>The clinical translation of these biomechanical insights will ultimately require validation in larger patient cohorts in order to substantiate their efficacy and long-term benefit.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Hydraulically controlled isokinetic strength testing].","authors":"Jan Schröder, Miriam Knauer, Gunnar Liedtke","doi":"10.1007/s00132-025-04670-3","DOIUrl":"https://doi.org/10.1007/s00132-025-04670-3","url":null,"abstract":"<p><strong>Background: </strong>Hydraulically controlled strength test devices provide a constant predetermined movement velocity, and as such may be specified as (quasi‑)isokinetic dynamometry. There are limited literature reporting comparisons with other strength testing modes. This work presents reference values and reliability analyses for trunk and knee maximum torques and their respective flexion-extension ratios for hydraulically controlled isokinetic dynamometry in comparison to isometric strength testing.</p><p><strong>Materials and methods: </strong>In a cross-sectional design, reference values (M, SD, percentiles) of 45 healthy adults (21 females, age 26.1 ± 3.9 years, BMI 23.2 ± 2.5 kg/m²) were assessed (trunk, knee: flexion, extension and their functional ratios) for the Factum® test devices (Frei medical) including, comparisons of the isometric or isokinetic test mode (Bland-Altman). For a sub-sample of 20 persons (50% females), time economy and reliability (ICC3.k) were assessed.</p><p><strong>Results: </strong>The (quasi‑)isokinetic test protocol was less time consuming (50%) and demonstrated higher reliability coefficients (ICC3.k 0.736-0.933) compared to isometric testing (ICC3.k 0.550-0.899). Flexion-extension ratios (isokinetic 68%, isometric trunk 63%) revealed a relation nearby 2:3, except for the isometric knee ratio (55% ≈ 1:2), due to smaller proportions of knee flexion forces.</p><p><strong>Conclusion: </strong>Results indicated mode specific differences and are not directly comparable with clinical implications especially for the flexion-extension ratios. Each protocol showed to be sufficiently reliable with time economy advantages for the (quasi‑)isokinetic protocol. Distributions of body weight-adjusted peak torques and functional ratios may serve as device-specific benchmark values for strength testing in clinical environments.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Orthopaedics/trauma surgery in military aviation medical assessment].","authors":"Torsten M Pippig","doi":"10.1007/s00132-025-04674-z","DOIUrl":"https://doi.org/10.1007/s00132-025-04674-z","url":null,"abstract":"<p><strong>Background: </strong>The article describes the important role of orthopaedics and, in particular, the spine in military (and civilian) aviation medicine. This concerns both the selection for use as a military pilot and crewmember and the regular and long-term specialised orthopaedic/aeromedical care of pilots.</p><p><strong>Diagnostics: </strong>In modern orthopaedics/traumatology, MRI imaging of the spine is an important diagnostic tool. We handle the image findings with care. Our decision on military aeromedical fitness to fly is always a synthesis of the medical history, physical examination, imaging (MRI) and consideration of the occupational stresses and hazards in the military aircraft.</p><p><strong>Assessment: </strong>If a candidate, active pilot or crew member does not fulfil the medical requirements in accordance with the Central Service Regulation of the German Air Force A1/831/0-4008, they have the possibility to apply for an aeromedical waiver. In a case-by-case assessment and re-assessment, what speaks for aeromedical fitness and what speaks against it are weighed up. The application for an aeromedical waiver can be rejected or granted, in orthopaedics often with restrictions on the aeromedical fitness, e.g. no use on jets with ejection seats, no use in helicopters.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Return to work-return to duty : The importance of rehabilitation in peace and armed conflict].","authors":"Andreas Lison, S Simmel, C Reimertz, J Meyer","doi":"10.1007/s00132-025-04680-1","DOIUrl":"https://doi.org/10.1007/s00132-025-04680-1","url":null,"abstract":"<p><p>The MEDEVAC chain and acute treatment of severely injured patients is ensured in peacetime through the establishment of the DGU® Trauma Network and the three-link Network for Care after Work and Commuting Accidents (DGUV), even for a temporary mass incident. Due to the expected number of wounded and injury patterns, an armed conflict on German soil represents a considerable resource commitment of the health system to military and civilian war victims in Germany. Even in peacetime, there is a far-reaching gap in the rehabilitation care of severely injured patients with complex rehabilitation needs (\"rehabilitation gap\"). The considerable efforts to develop a resilient rehabilitation system in Ukraine make it clear that uninterrupted, phase-based and cross-sectoral rehabilitation is indispensable for maintaining the operational readiness of the armed forces, as well as for social resilience.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Tibial derotation osteotomy for knee joint pathologies : Indications, surgical technique and overview of the current literature].","authors":"Michael Liebensteiner, Clelia Appel-Ersek, Gerhard Kaufmann, Markus Neubauer, Johannes Neugebauer, Dietmar Dammerer","doi":"10.1007/s00132-025-04675-y","DOIUrl":"https://doi.org/10.1007/s00132-025-04675-y","url":null,"abstract":"<p><p>Pathological torsions of the femur and tibia are common. The negative effects on the knee are evident and do not only affect the patellofemoral joint. The suspected diagnosis of maltorsion is generated by physical examination and verified by tomographic imaging (MRI or CT). The literature review regarding tibial derotation osteotomies conducted by the authors yielded 35 studies (1562 osteotomies). Almost all of the studies reported a significant improvement compared to preoperatively based on patient-reported outcomes (Kujala, SF-36, Lysholm, KOOS, VAS and general patient wellbeing). Due to the lack of comparative studies, the best surgical technique for tibial derotation osteotomy is still undetermined. For complex cases in which deformities in several body planes are to be corrected (e.g., maltorsion and valgus varus deformity), three-dimensional planning and implementation using patient-specific incision blocks seems promising.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Skeletal dysplasias-Multidisciplinary orthopedics].","authors":"B Kraler, C Chiari, S Farr, A Kranzl, T Kainz, J Patsch, G Mindler","doi":"10.1007/s00132-025-04676-x","DOIUrl":"https://doi.org/10.1007/s00132-025-04676-x","url":null,"abstract":"<p><p>Skeletal dysplasias (SD) are a heterogeneous group of rare hereditary diseases with pronounced skeletal involvement and include over 750 phenotypes, which are associated with disease-triggering variants in more than 550 genes. In addition to orthopedic treatment, a network of various disciplines is necessary to ensure high-quality diagnostics and treatment for SD. This is ideally carried out at a center specialized in the treatment of rare bone diseases (European Reference Network on Rare Bone Diseases). The close networking of orthopedics with pediatrics and other disciplines is important to enable a state-of-the-art treatment and to monitor the influences of new forms of pharmacotherapy on the musculoskeletal apparatus.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Implementing quality management successfully : Experiences from the Bundeswehr Medical Service].","authors":"Doerthe Lison, N D Ferreira Sa Marques, M Haunhorst, A Lison","doi":"10.1007/s00132-025-04672-1","DOIUrl":"https://doi.org/10.1007/s00132-025-04672-1","url":null,"abstract":"<p><p>The Bundeswehr's medically and service-oriented rehabilitation for wounded and seriously injured soldiers serves the operational readiness of the armed forces even in peacetime. In addition to the employer's duty of care, it is based on legal requirements, the professional standards of civilian professional societies and cooperation with civilian rehabilitation facilities. In the case of national and collective defence, a QM system geared to military needs is an indispensable basis for sustainable rehabilitation measures under extreme conditions. The experience of a medical facility with a complex rehabilitative mission in the implementation of a QM system, under unfavourable conditions such as staff shortages, training deficits and limited material resources, can be helpful for civilian institutions with regard to public services in crisis and war.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}