Orthopadie (Heidelberg, Germany)最新文献

{"title":"[The weight-loss injection : An orthopaedic overview].","authors":"Saif Al Basri, Wiebke K Fenske","doi":"10.1007/s00132-025-04609-8","DOIUrl":"https://doi.org/10.1007/s00132-025-04609-8","url":null,"abstract":"<p><strong>Background: </strong>The increasing prevalence of obesity represents a significant and growing challenge in orthopaedic surgery. This is particularly true for patients with morbid obesity, who have a significantly increased risk of postoperative complications. The newer incretin-based therapies (such as semaglutide and tirzepatide), these so-called \"weight loss injections\", offer promising potential for preoperative weight reduction and minimisation of peri- and postoperative complications.</p><p><strong>Study situation: </strong>However, the evidence regarding their influence on postoperative outcomes is inconsistent. Retrospective studies suggest that rapid weight loss immediately prior to orthopaedic surgery may increase the risk of complications, including septic shock and revision surgery. Meta-analyses, on the other hand, indicate potential protective effects in surgical outcomes with prior long-term weight reduction.</p><p><strong>Conclusion: </strong>There are currently no sufficiently qualitative studies on the safety and efficacy of these new drugs in the orthopaedic surgery sector. An individualised and multidisciplinary approach, therefore, remains relevant in order to achieve an optimal surgical outcome for the individual patient.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124163","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":"[Artificial intelligence in arthroplasty].","authors":"Vincent Lallinger, Florian Hinterwimmer, Rüdiger von Eisenhart-Rothe, Igor Lazic","doi":"10.1007/s00132-025-04619-6","DOIUrl":"https://doi.org/10.1007/s00132-025-04619-6","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence is very likely to be a pioneering technology in arthroplasty, with a wide range of pre-, intra- and post-operative applications. The opportunities for patients, doctors and healthcare policy are considerable, especially in the context of optimized and individualized patient care.</p><p><strong>Data availability: </strong>Despite these diverse possibilities, there are currently only a few AI applications in routine clinical practice, mainly due to the limited availability of analyzable health data. AI systems are only as good as the data they are trained with. If the data is insufficient, incomplete or biased, the AI may draw false conclusions. The current results of such AI applications in arthroplasty must, therefore, be viewed critically, especially as previous data bases were not designed a priori for AI applications.</p><p><strong>Prospects: </strong>The successful integration of AI, therefore, requires a targeted focus on the development of a specific data structure. In order to exploit the full potential of AI, comprehensive clinical data volumes are required, which can only be realized through a multicentric approach. In this context, ethical and data protection issues remain a further question, and not only in orthopaedics. Cooperative efforts at national and international levels are, therefore, essential in order to research and develop new AI applications.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124143","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":"[Diagnosis and treatment of perioperative anaemia in elective primary hip and knee arthroplasty : Consensus statement of the \"Committee for Perioperative Management\" of the Working Group for Endoprosthetics].","authors":"Julia M Reinke, Patrick Meybohm, Patrick Weber","doi":"10.1007/s00132-024-04602-7","DOIUrl":"10.1007/s00132-024-04602-7","url":null,"abstract":"<p><strong>Background: </strong>Hip and knee arthroplasty remain risk procedures for bleeding complications. The prevalence of preoperative anaemia prior to elective joint replacement is high. There are no standardized guidelines in Germany for the diagnosis and treatment of perioperative anaemia in elective hip and knee arthroplasty. The aim of this work, initiated by the \"Perioperative Management\" committee of the German Society for Endoprosthetics (AE), was to develop a treatment recommendation.</p><p><strong>Materials and methods: </strong>A systematic review of relevant publications between 2010 and 2023 was conducted. Medline, the Cochrane Library, existing national and international guidelines, and recommendations from other professional societies were considered. A total of 38 relevant articles were identified. Questions with clinical relevance were prepared in advance by the committee, and these were answered after studying and evaluating the literature. Finally, a recommendation was determined by expert consensus using the GRADE system.</p><p><strong>Consensus: </strong>All patients scheduled for elective joint replacement should undergo preoperative diagnostics. Preoperative anaemia is a risk factor for increased mortality and the likelihood of transfusions; therefore, the cause of anaemia should be investigated preoperatively and treated accordingly. The administration of iron should be considered in diagnosed iron deficiency and can be done either orally or intravenously. Oral substitution therapy should be started 3 months preoperatively. Intravenous therapy requires less time, causes fewer side effects and should be administered 4 weeks preoperatively. Persistent iron deficiency anaemia despite substitution, anaemia due to chronic inflammation and renal anaemia may indicate the need for erythropoietin substitution.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"115-121"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017920","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":"[Perioperative management of obese patients undergoing elective hip and knee arthroplasty].","authors":"P M Prodinger, C H Gruber, P Weber, N Böhler","doi":"10.1007/s00132-024-04597-1","DOIUrl":"10.1007/s00132-024-04597-1","url":null,"abstract":"<p><strong>Introduction: </strong>Obesity is a worldwide growing health crisis, affecting younger and younger age groups and posing new challenges for arthroplasty. Due to increased complication rates in this population, many authors are of the opinion that in patients with a body mass index (BMI) of over 40, the problems outweigh the benefits of surgery and that surgery should be postponed until significant weight reduction has been achieved.</p><p><strong>Materials and methods: </strong>A systematic review of electronic databases (PubMed, Embase, Web of Science and the Cochrane Library) was performed. 49 relevant articles were analyzed. Pre-defined questions were answered based on the literature. The level of evidence for the recommendation was defined in a consensus meeting.</p><p><strong>Results: </strong>Obese patients with a BMI ≥ 30 have an up to threefold increased perioperative risk, particularly for infections and mechanical complications. In addition, surgery in obese patients is technically demanding, which results in a higher risk of implant malpositioning. Despite these risks, obese patients benefit from surgery in a similar way compared to normal-weight patients, showing comparable improvements in function and quality of life. Preoperative weight loss can reduce the risk but should be long-term to avoid negative metabolic effects. Bariatric surgery and drug therapies can help, but their effects on perioperative risk are unclear. Besides the BMI, careful diagnosis and treatment of comorbidities is crucial.</p><p><strong>Conclusion: </strong>Obese patients benefit from arthroplasty in a similar way to normal-weight patients but have a higher risk of complications, particularly infection. Prior to joint replacement, patients with a BMI of 40 or more should undergo dietary counselling and weight reduction; their metabolic status should be checked, as malnutrition can increase the risk. If weight reduction is not achieved despite these measures, the operation can be performed with increased risks, whereby the patient should be fully informed and involved in the decision-making process.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"135-143"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017925","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":"[Transarterial periarticular embolization (TAPE) for treatment of achillodynia: initial results].","authors":"Marcus Katoh, Henrike Ziegler, Peter Schott, Bettina Touloumtzidis, Ludger Feyen, Clayton Kraft, Patrick Freyhardt","doi":"10.1007/s00132-024-04588-2","DOIUrl":"10.1007/s00132-024-04588-2","url":null,"abstract":"<p><strong>Background: </strong>In recent years, transarterial periarticular embolization (TAPE) has received increasing attention in the treatment of chronic joint pain, which can be caused by degenerative changes such as osteoarthritis but also by inflammatory changes in the capsule-ligament apparatus.</p><p><strong>Objectives: </strong>The aim of this study is to describe the method as well as preliminary results of TAPE in the treatment of therapy-resistant achillodynia.</p><p><strong>Material and methods: </strong>TAPE was used in the treatment of seven patients (female: 1, male: 6) with chronic achillodynia. The technical success rate and complication rates were analyzed. Furthermore, the changes in subjective pain were assessed using a visual analogue scale (VAS) and the load-bearing capacity using the Foot and Ankle Disability Index (FADI).</p><p><strong>Results: </strong>All procedures were performed successfully (technical success rate: 100%); no complications were observed. In the first postoperative week, pain was reduced from an initial average VAS of 8.2 to 4.2. After 12 months, there was a further reduction to 1.4. At the same time, based on the FADI, the Achilles tendon load capacity increased on average from 45.4 initially to 60.1 after 1 week and to 89.9 after 12 months.</p><p><strong>Conclusion: </strong>Our results suggest that TAPE may be a new, promising procedure in the treatment of therapy-resistant, chronic achillodynia. This technically demanding but minimally invasive procedure, performed only under local anesthesia, can significantly reduce pain and restore the patient's ability to bear weight.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"144-150"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782042","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":"Bilateral septic acromioclavicular arthritis in a farm worker with high suspicion of zoonotic disease: a case report.","authors":"K A Barlow, J Gütler","doi":"10.1007/s00132-024-04593-5","DOIUrl":"10.1007/s00132-024-04593-5","url":null,"abstract":"<p><strong>Introduction: </strong>We report the case of a 54-year-old male with the rare entity of bilateral septic acromioclavicular (AC) arthritis with osteomyelitis of the lateral clavicle with methicillin-susceptible Staphylococcus aureus (MSSA). The glenohumeral joint was affected as well. The patient was immunocompetent with no history of diabetes or intravenous drug abuse. There is a high possibility of a transmission from farm animals.</p><p><strong>Material and methods: </strong>The case files including laboratory measurements, imaging and documentation were used to reassess the case and complete the case report. Regular clinical follow-up was done in our outpatient clinic. We compared our case with the literature and existing guidelines.</p><p><strong>Results: </strong>We report this rare entity of bilateral septic AC arthritis to ensure early diagnosis and proper treatment in the future. In comparison to the existing guidelines, we followed similar treatment concepts. The outcome of our patient was satisfactory despite a pre-existing rotary cuff tear, which might need further treatment in the future.</p><p><strong>Conclusion: </strong>This report of a rare case can help to understand this infectious disease in the future and help establish treatment guidelines. In farm workers, one should be highly suspicious of transmission through animals and establish a quick and effective treatment as we did in this case.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"153-156"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11802618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Recommendations for perioperative skin care in total joint arthroplasty: antimicrobial wash lotion, precleaning and hair removal].","authors":"Thomas Klonschinski, Viktor Janz, David R Krüger","doi":"10.1007/s00132-024-04605-4","DOIUrl":"10.1007/s00132-024-04605-4","url":null,"abstract":"<p><strong>Introduction: </strong>Periprosthetic joint infection (PJI) is a serious complication in arthroplasty surgery. The preoperative preparation of the skin plays an important role in infection prevention.</p><p><strong>Methodology: </strong>A systematic literature review was conducted on the topic of antimicrobial wash lotion, precleaning, and shaving. Existing evidence was summarized by the committee of the German Arthroplasty Society and recommendations were formulated.</p><p><strong>Results: </strong>By applying a local antiseptic before the operation, the risk of wound infection and PJI can be significantly reduced. This causes a reduction in revision surgery and leads to a shorter average hospital stay. If hair removal is necessary, it is ideally performed shortly before the procedure using an electric clipper. The use of a razor is not recommended.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"102-107"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076413","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":"[Treatment of malnutrition in total joint arthroplasty : Consensus statement of the Perioperative Management Committee of the German Society for Endoprosthetics].","authors":"Alexander C Paulus, Viktor Janz","doi":"10.1007/s00132-024-04603-6","DOIUrl":"10.1007/s00132-024-04603-6","url":null,"abstract":"<p><p>Pre- and perioperative management of malnutrition is crucial for the success of hip and knee arthroplasties. Various studies indicate that malnutrition, particularly when associated with vitamin D deficiency, significantly increases the risk of postoperative complications such as periprosthetic fractures and infections, prolonged hospital stays, and higher mortality rates. Adequate preoperative nutritional intake, including vitamin D supplementation, can improve arthroplasty outcomes. Current literature emphasizes the importance of comprehensive nutritional optimization before surgery to minimize the risk of complications and promote recovery.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"122-128"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985723","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":"[What should be considered in the case of previous operations or injections prior to hip and knee replacement?]","authors":"Philipp von Roth, Anne Postler, Cornelia Lützner, Lukas Konstantinidis","doi":"10.1007/s00132-024-04601-8","DOIUrl":"10.1007/s00132-024-04601-8","url":null,"abstract":"<p><strong>Background: </strong>Patients who have had prior injections, surgeries such as arthroscopies, and have existing osteosynthetic implants in the hip and knee have an increased risk of periprosthetic infections when undergoing hip (THA) or total knee arthroplasty (TKA).</p><p><strong>Osteosynthesis: </strong>For patients with osteosynthetic implants in the knee joint, a two-stage procedure (implant removal followed by TKA) is recommended based on the available literature and the high colonization rates. A two-stage procedure is also recommended for patients with hip implants. If there is an increased risk of re-fracture between implant removal and THA, a one-stage procedure can also be used.</p><p><strong>Arthroscopy: </strong>An arthroscopy before THA or TKA increases the risk of complications and reoperations, in particular with short intervals. The interval should be at least 6 months, ideally 9 months.</p><p><strong>Preoperative injections: </strong>Preoperative injections before THA clearly increase the risk, while for TKA, there is a non-significant trend. The earliest time for a prosthesis after injection should be 6 weeks, preferably 3 months. The waiting period should be balanced against the patients' discomfort and high levels of suffering, and patients should be informed about the risks.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"108-114"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017928","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":"[Perioperative management with consumption of alcohol and nicotine in patients with hip and knee arthroplasty].","authors":"Anne Postler, Cornelia Lützner, Michael Müller","doi":"10.1007/s00132-024-04594-4","DOIUrl":"10.1007/s00132-024-04594-4","url":null,"abstract":"<p><p>Excessive consumption of nicotine and alcohol has been proven to effect the organ system. Both stimulants are consumed in the population to a not insignificant extent. The question therefore arises as to what effect the consumption of nicotine and alcohol has on the complication rates and to what extent this should be reduced or stopped before performing a joint arthroplasty? A literature search was carried out to answer these questions. An increased risk of impaired wound healing and periprosthetic infections with regard to smoking was shown. This was also proven regarding excessive alcohol consumption. Additionally, there is an alcohol related increased risk of bleeding and malnutrition. Accordingly, nicotine and alcohol consumption should be reduced at least 4 weeks before performing total joint arthroplasty.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"95-101"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900972","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}