Orthopadie (Heidelberg, Germany)最新文献

{"title":"Knee and ankle functional outcome after anterior cruciate ligament reconstruction with a peroneus longus tendon autograft : A prospective clinical study.","authors":"Ahmed Sayed Kotb, Mostafa AbdElnabee Abouzaid, Mohamed Amr Hemida, Ayman Abdelaziz Bassiony, Haitham E Sallam","doi":"10.1007/s00132-026-04892-z","DOIUrl":"https://doi.org/10.1007/s00132-026-04892-z","url":null,"abstract":"<p><strong>Background: </strong>An entire peroneus longus tendon (PLT) autograft has been introduced as an alternative graft for anterior cruciate ligament (ACL) reconstruction but concerns remain regarding donor-site effects on ankle and foot function.</p><p><strong>Objective: </strong>This study evaluated knee outcome, ankle/foot function and footprint changes after ACL reconstruction using the entire peroneus longus autograft.</p><p><strong>Methods: </strong>This non-randomized controlled clinical trial included 26 male patients (mean age 29.7 ± 5.8 years) with isolated ACL tears who underwent arthroscopic ACL reconstruction using an ipsilateral entire PLT autograft at Ain Shams University Hospitals and Dar Al-Shefa Hospitals. Patients were assessed preoperatively and at 6 months using the Foot Arch Index (FAI) from static footprint analysis, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Foot and Ankle Disability Index (FADI) and International Knee Documentation Committee (IKDC) score.</p><p><strong>Results: </strong>The FAI significantly increased from 0.26 ± 0.05 preoperatively to 0.27 ± 0.04 at 6 months (P = 0.027). Knee outcome improved, with the IKDC increasing from 68 ± 0.5 to 84.0 ± 0 (P = 0.017). Ankle/foot functional scores did not change significantly, with the AOFAS remaining at 98.8 ± 2.31 preoperatively versus 98.8 ± 2.45 postoperatively (P = 1) and the FADI showing no significant difference (99 ± 1.73 vs. 99.3 ± 1.41; P = 0.212).</p><p><strong>Conclusion: </strong>Reconstruction of the ACL using the entire PLT autograft was associated with improved knee outcome at 6 months without significant deterioration in ankle/foot function, alongside a small but statistically significant increase in FAI.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082457","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":"[Friction-assisted screw fixation after reorienting pelvic osteotomies : Current evidence and clinical implications].","authors":"Jens Richter, André Zahedi, Daniel Ciric, Ivan Zderic, Christian Lüring, Jens-Peter Stahl, Boyko Gueorguiev","doi":"10.1007/s00132-026-04887-w","DOIUrl":"https://doi.org/10.1007/s00132-026-04887-w","url":null,"abstract":"<p><strong>Background: </strong>Internal fixation of the reoriented acetabular fragment is essential to maintain correction until osseous union. However, the underlying biomechanical principles of fixation stability remain insufficiently understood.</p><p><strong>Objectives: </strong>To summarize the biomechanical evidence on fragment fixation following reorienting pelvic osteotomies and to derive clinically relevant fixation principles.</p><p><strong>Materials and methods: </strong>The results of a previously published biomechanical study using 12 synthetic hemipelvis models after triple pelvic osteotomy were combined with a structured literature review. A bidirectional construct with two axial screws and one transverse screw (group 1) was compared with a monoaxial construct using three long iliac screws (group 2).</p><p><strong>Results: </strong>No significant differences were found between the two fixation concepts. Construct stiffness in group 1 and in group 2 was 56.5 ± 17.8 and 41.2 ± 9.5 N/mm, respectively, and corresponding failure loads were 255.3 ± 40.7 and 255.6 ± 61.7 N. Medialization and changes in acetabular anteversion and inclination increased significantly in both groups during progressively increasing cyclic loading, without significant differences between them at the assessed time points. Six additional biomechanical studies showed substantial methodological heterogeneity. Recurrent determinants of stability were osteotomy geometry, fragment contact, spatial screw distribution, and intraosseous anchorage.</p><p><strong>Conclusions: </strong>Iliac screw fixation can be understood as a friction-assisted intraosseous interlocking construct. Long screws with favorable spatial distribution are more relevant than the isolated orientation of a single screw. In triple pelvic osteotomy, additional anterior fixation across the pubic osteotomy may further improve stability. Partial weight-bearing until radiographic consolidation and strict nicotine abstinence remain essential components of postoperative management.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018937","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":"[Biological age in orthopedics : Importance, assessment, and clinical recommendations].","authors":"Stefan Dalichau, Philip Meyer","doi":"10.1007/s00132-026-04886-x","DOIUrl":"https://doi.org/10.1007/s00132-026-04886-x","url":null,"abstract":"<p><strong>Background: </strong>Chronological age insufficiently reflects differences in physiological reserve, resilience, and regenerative capacity. Biological age (BA) estimates aging from molecular, physiological, and functional characteristics.</p><p><strong>Objectives: </strong>To describe BA concepts and assessment methods and evaluate their relevance for orthopedic rehabilitation.</p><p><strong>Materials and methods: </strong>Narrative review based on structured MEDLINE/PubMed and manual search, with a focus on reviews, meta-analyses, consensus papers, and key methodological studies.</p><p><strong>Results: </strong>Epigenetic, phenotypic, and laboratory-based models capture different dimensions of aging and are not directly comparable. Frailty, sarcopenia, gait speed, chair-rise performance, grip strength, endurance, and deficit accumulation have the greatest practical value. Frailty and sarcopenia predict complications, prolonged care, non-home discharge, and mortality after orthopedic procedures beyond chronological age.</p><p><strong>Conclusions: </strong>BA should be interpreted as a multidimensional risk profile. A staged assessment combining frailty screening, muscle strength, mobility, endurance, nutrition, and cognition is recommended. Molecular aging clocks are not currently recommended for routine care.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972780","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":"[Antimicrobial therapy of periprosthetic joint infection : Full version of the AE guidelines (2026)].","authors":"Susanne Feihl, S Meller, Y Gramlich, R von Eisenhart-Rothe, R Hube, P Radünzel, R Otchwemah, Gunnar Hischebeth","doi":"10.1007/s00132-026-04850-9","DOIUrl":"https://doi.org/10.1007/s00132-026-04850-9","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infections (PJI) are among the most severe and complex complications following joint arthroplasty and require a structured interdisciplinary treatment approach. In addition to an adequate surgical strategy, pathogen-directed and patient-specific anti-infective therapy plays a central role in successful management.</p><p><strong>Methods: </strong>Based on a comprehensive literature review and current guidelines, followed by a structured consensus process within the interdisciplinary working group of the \"German Society for Arthroplasty (Deutsche Gesellschaft für Endoprothetik e. V.)\", available treatment options were evaluated and consensus recommendations for the anti-infective management of PJI were developed.</p><p><strong>Results: </strong>The cornerstone of PJI treatment is surgical management combined with an initial empiric followed by targeted antibiotic therapy. Staphylococci represent the most frequently identified pathogens, with the biofilm-active antibiotic rifampin playing a key role in their treatment. Fluoroquinolones are primarily used for infections caused by gram-negative pathogens but are also employed in combination with rifampin for staphylococcal infections. For other clinically relevant pathogen groups, differentiated consensus-based treatment recommendations were established. The recommended total duration of antibiotic therapy is generally approximately 12 weeks.</p><p><strong>Conclusion: </strong>Anti-infective therapy represents a key component in the successful treatment of periprosthetic joint infections. An individualized therapeutic approach, tailored to the respective surgical treatment strategy, is essential.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946275","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":"[Total hip replacement or resistance training in advanced osteoarthritis of the hip? : Evidence-based comment on the PROHIP study].","authors":"Markus Weber, Tobias Renkawitz","doi":"10.1007/s00132-026-04880-3","DOIUrl":"https://doi.org/10.1007/s00132-026-04880-3","url":null,"abstract":"","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148882399","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":"Coronal plane alignment of the knee (CPAK) phenotypes and their relationship with gap patterns in robotic-assisted total knee arthroplasty: a clinical trial.","authors":"Filippo Migliorini, Luise Schäfer, Jens Schneider, Andrea Maria Nobili, Daniel Kämmer, Nicola Maffulli, Andreas Bell","doi":"10.1007/s00132-026-04797-x","DOIUrl":"10.1007/s00132-026-04797-x","url":null,"abstract":"<p><strong>Background: </strong>Achieving optimal soft-tissue balance remains a key challenge in total knee arthroplasty (TKA), even with robotic assistance. The coronal plane alignment of the knee (CPAK) classification provides a structured description of constitutional alignment phenotypes, yet its relationship with intraoperative gap behavior has not been fully defined.</p><p><strong>Methods: </strong>A prospective series of 285 patients undergoing robotic-assisted TKA with the CORI system was analyzed. Knees were categorized according to the CPAK classification and intraoperative medial and lateral gaps were automatically recorded in extension (0°) and flexion (90°). Gap configurations were defined as balanced, varus, or valgus. Associations between CPAK phenotypes and gap types were assessed using χ²and logistic regression analyses, with CPAK IV serving as the reference phenotype.</p><p><strong>Results: </strong>The CPAK I and CPAK II phenotypes showed a significantly higher likelihood of varus gaps in both extension (odds ratio, OR 5.41 and 3.38, respectively) and flexion (OR 1.58 and 2.20, respectively), whereas CPAK VII was protective in extension (OR 0.23). Even valgus-aligned phenotypes demonstrated varus-dominant behavior in flexion. These findings indicate that gap behavior is strongly influenced by CPAK phenotype rather than solely by surgical alignment.</p><p><strong>Conclusion: </strong>Intraoperative soft-tissue balance during TKA reflects the underlying CPAK phenotype. Integrating CPAK classification into robotic planning enables anticipation of gap tendencies and facilitates phenotype-driven balancing, bridging constitutional anatomy with functional alignment.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"719-726"},"PeriodicalIF":0.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517293","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":"Muskuloskelettale Tumorchirurgie.","authors":"Tilman Graulich, Max Ettinger","doi":"10.1007/s00132-026-04875-0","DOIUrl":"https://doi.org/10.1007/s00132-026-04875-0","url":null,"abstract":"","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":"55 9","pages":"683-684"},"PeriodicalIF":0.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148852099","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":"Association between breech presentation in twins and developmental dysplasia of the hip.","authors":"Beatrice Jung, J Hollfelder, V Zur Strassen, B Bodelle, M Schulz","doi":"10.1007/s00132-026-04867-0","DOIUrl":"10.1007/s00132-026-04867-0","url":null,"abstract":"<p><strong>Background: </strong>Breech presentation is considered one of the main risk factors for developmental dysplasia of the hip (DDH) in singleton pregnancies; however, data regarding twins are limited. The aim of this study was to evaluate whether breech presentation in twins is associated with abnormal hip ultrasound findings and to assess the influence of delivery mode, sex and gestational age.</p><p><strong>Methods: </strong>Obstetric and ultrasound data from twin births at Frankfurt University Hospital between 2010 and 2014 were retrospectively analyzed. A total of 130 twins in whom at least 1 infant with breech presentation and both infants underwent hip ultrasound according to Graf's technique within the first 14 days after birth were included. Twins were divided into breech-breech, breech-vertex and breech-transverse groups. Hip findings were categorized as normal (Graf type Ia/Ib) or abnormal/immature (Graf type IIa or higher). Statistical analysis was performed using Fisher-Freeman-Halton exact testing.</p><p><strong>Results: </strong>No infant demonstrated manifest DDH (Graf type IIc or higher). Overall, 5.4% of infants showed physiologically immature or abnormal hip ultrasound findings classified as Graf type IIa. No significant association was found between breech presentation and abnormal hip findings; however, abnormal findings were more common in the breech-transverse group compared to the breech-breech group (p = 0.037). Infants delivered via cesarean section demonstrated a higher rate of abnormal findings than vaginally delivered infants (p = 0.041).</p><p><strong>Conclusion: </strong>In this cohort, breech presentation in twins was not associated with an increased rate of abnormal hip ultrasound findings. The combination of breech and transverse presentation may represent a higher risk constellation. Due to the retrospective design and lack of a singleton control group, conclusions regarding a modifying effect of twin pregnancy on the occurrence of DDH cannot be drawn.</p><p><strong>Level of evidence: </strong>Retrospective cohort study. Level III evidence.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"727-731"},"PeriodicalIF":0.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148439119","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":"[Diagnosis of osteoporosis-importance of dual-energy X-ray absorptiometry].","authors":"Franca Genest, Lothar Seefried","doi":"10.1007/s00132-026-04878-x","DOIUrl":"10.1007/s00132-026-04878-x","url":null,"abstract":"<p><p>Dual-energy X‑ray absorptiometry (DXA) assessing the lumbar spine and bilateral proximal femurs is the current guideline-recommended standard method for quantitative measurement of bone density. The output of DXA-the T score-reflects the number of standard deviations by which the measured bone density differs from the average of a healthy young reference population. The operational World Health Organization (WHO) definition of osteoporosis is based on a T score ≤-2.5 at the femoral neck, although other measurement locations are interpreted analogously in clinical routine. Numerous studies have shown that a decrease in bone density is associated with an exponential increase in the fracture risk. However, consideration of the bone density in isolation is inadequate to predict the real fracture risk. Therefore, DXA results must always be interpreted within the context of other clinical risk factors. Additional DXA methods and further analyses can significantly improve the diagnostic accuracy.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"755-764"},"PeriodicalIF":0.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681363","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":"[Surgical management of spinal metastases].","authors":"Lars Wessels, Julia Onken, Peter Vajkoczy","doi":"10.1007/s00132-026-04856-3","DOIUrl":"10.1007/s00132-026-04856-3","url":null,"abstract":"<p><strong>Background: </strong>Spinal metastases from malignant tumors represent an increasingly relevant clinical problem due to improved systemic therapies, prolonged survival, and the growing prevalence of long-term survivors with metastatic disease. The spine is not only a central biomechanical component of the musculoskeletal system, but also protects the spinal cord and spinal nerves. Accordingly, the treatment of spinal metastases is complex and must always be embedded within an overarching oncological treatment concept.</p><p><strong>Basics: </strong>This review summarizes epidemiological and pathophysiological principles and presents contemporary indications and operative strategies for spinal metastases. The central goals of surgery are histological diagnosis, decompression of neural structures, restoration or preservation of mechanical stability, pain relief, and maintenance of neurological function and quality of life. Surgical decision-making should be interdisciplinary and should consider not only imaging findings and neurological status, but also tumor biology, radiosensitivity, systemic treatment options, prognosis, patient preference, and rehabilitation potential.</p><p><strong>Therapy: </strong>Modern surgical treatment of spinal metastases has undergone a paradigm shift: maximal tumor resection is no longer routinely the primary objective; instead, the focus has shifted toward function-preserving, low-morbidity interventions embedded within a multimodal treatment strategy. Concepts such as NOMS, SINS, and the Bilsky grading system support structured decision-making.</p><p><strong>Aims: </strong>Minimally invasive procedures, percutaneous instrumentation, navigation, intraoperative three-dimensional imaging, modern implant materials, and increasingly AI-based prognostic models allow a patient-specific calibration of surgical invasiveness. The overall aim is to preserve neurological function and quality of life, control local tumor progression, and minimize treatment-delaying morbidity.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"694-703"},"PeriodicalIF":0.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148364061","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}