Orthopadie (Heidelberg, Germany)最新文献

{"title":"[Antiresorptive therapies in osteoporosis].","authors":"Konstantin Horas, Andreas Kurth","doi":"10.1007/s00132-025-04725-5","DOIUrl":"https://doi.org/10.1007/s00132-025-04725-5","url":null,"abstract":"<p><p>Osteoporosis is a systemic skeletal disorder that is characterised by low bone mineral density (BMD) and deterioration of bone tissue. Eventually, this leads to disruption of bone microarchitecture, a compromised bone strength and an increase risk of fracture. Antiresorptive therapies are used to increase bone strength and reduce the risk of fracture in individuals with osteoporosis. The most common antiresorptives are bisphosphonates, estrogens, selective estrogen receptor modulators (SERM) and the human monoclonal antibody against RANKL (Denosumab).</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066682","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":"[Patients benefit from information : Pain neuroscience education in an outpatient setting].","authors":"Markus Schneider","doi":"10.1007/s00132-025-04702-y","DOIUrl":"https://doi.org/10.1007/s00132-025-04702-y","url":null,"abstract":"<p><strong>Background: </strong>In the past 20-30 years, there has been a significant paradigm shift in understanding the causes of pain. Historically, the biomedical model, which emphasized a direct relationship between tissue damage and pain intensity, was dominant. However, it is increasingly recognized that pain perception is a highly complex system involving biological, psychological, and social factors, challenging the earlier understanding.</p><p><strong>Patent education: </strong>While intensive multimodal therapy provides sufficient time for patient education, this aspect is often neglected in outpatient settings. Key elements of outpatient pain neuroscience education (PNE) include improving the understanding of pain, differentiating between acute and chronic pain, explaining central and peripheral sensitization, addressing fear and avoidance behaviors, and demonstrating strategies to support endogenous pain inhibition.</p><p><strong>Goal: </strong>The goal of education is to convey these highly complex pain physiology concepts in simple language, using images and metaphors that are accessible to the patient. PNE can positively influence not only the treatment of chronic pain but also preoperative education, thereby improving postoperative outcomes.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042449","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":"[Complications after dynamic in-situ fixation of the femoral head in patients with slipped capital femoral epiphysis].","authors":"Daniël Kuijpers, Jürgen Forst, Andreas Podgurski, Albert Fujak","doi":"10.1007/s00132-025-04721-9","DOIUrl":"https://doi.org/10.1007/s00132-025-04721-9","url":null,"abstract":"<p><strong>Background: </strong>Slipped capital femoral epiphysis (SCFE) requires surgical treatment. In German-speaking countries, dynamic in-situ fixation is commonly used for mild SCFE lenta. Various implants are available for this purpose.</p><p><strong>Objective: </strong>High complication rates have been reported for the removal of titanium gliding screws. In this retrospective study, we analyzed the complications in the treatment of SCFE, particularly focusing on the removal of sliding screws made of stainless steel and K‑wires.</p><p><strong>Materials and methods: </strong>A total of 111 patients with SCFE were treated, including 96 fixations using stainless steel sliding screws, 93 wire pinning procedures, and 69 hips treated with a combination of both techniques. Additionally, 43 Imhäuser osteotomies were performed. Complications arising from these treatments were analyzed.</p><p><strong>Results: </strong>In 14 patients, 23 complications were observed. Avascular necrosis of the femoral head occurred in three cases. Two patients sustained a fracture of the proximal femur. One patient presented with soft tissue irritation following fixation with both sliding screws and K‑wires. Infections occurred in three patients. Due to implant misplacement or breakage, 6 patients required a total of 12 revision surgeries. Two patients developed postoperative hematomas, which were surgically evacuated. No complications were observed related to implant removal.</p><p><strong>Discussion: </strong>The issues described in the literature regarding the removal of titanium screws were not observed with stainless steel screws. This difference can be attributed to material properties: titanium screws have lower torsional strength and require higher torque for removal.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042357","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":"[Idiopathic anterior knee pain-what is the problem?]","authors":"Gerhard Opitz","doi":"10.1007/s00132-025-04715-7","DOIUrl":"https://doi.org/10.1007/s00132-025-04715-7","url":null,"abstract":"<p><p>Idiopathic anterior knee pain is a common and often serious clinical condition. The challenge of this condition lies in its complexity. Therapeutic outcomes are frequently disappointing and show a high tendency for recurrence. Risk factors are less about biometric data and more about prolonged pain duration and functional deficits. Malalignment and maltracking are predisposing factors that exert their effects within the context of dysfunctional musculature, central and peripheral sensitization, as well as emotional disturbances. Treatment should not only address the local problem but also consider systemic factors such as core musculature, trigger points, and psychovegetative state.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066748","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":"[Type D personality style and back pain : A narrative overview of the relevance of psychosocial factors in orthopedic pain therapy].","authors":"Christian Riediger, Mark Ferl, Christoph H Lohmann, Maria Schönrogge","doi":"10.1007/s00132-025-04718-4","DOIUrl":"https://doi.org/10.1007/s00132-025-04718-4","url":null,"abstract":"<p><strong>Background: </strong>The Type D personality (\"distressed personality\") is characterized by a combination of negative affectivity and social inhibition. While this personality style was originally researched in the context of cardiovascular disease, recent studies also show a significant association with chronic pain disorders, especially back pain.</p><p><strong>Objectives: </strong>This narrative review examines the current state of knowledge on the relationship between type D personality and back pain. The aim is to analyze possible psychological, behavioral, and biological mechanisms and to derive clinical implications for orthopedic pain therapy.</p><p><strong>Materials and methods: </strong>A selective literature search was conducted in the PubMed, PsycINFO and Google Scholar databases. Original studies, systematic reviews and meta-analyses from the last 20 years focusing on psychosomatic aspects of chronic back pain were included.</p><p><strong>Results: </strong>Several studies show that individuals with Type D characteristics have an increased risk of developing and chronicizing back pain. Possible mediating mechanisms include maladaptive stress processing, somatisation, reduced social support and changes in neuroendocrine and inflammatory processes.</p><p><strong>Conclusions: </strong>Type D personality is a relevant psychosocial risk factor in the development and persistence of chronic back pain. Early detection may contribute to improving multidisciplinary therapeutic approaches.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024838","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 knee arthroplasty with simultaneous triplanar osteotomy of the distal femur using patient-specific instrumentation : A case report.","authors":"Witold Szerksznis, Ewa Tramś, Rafał Kamiński, Dariusz Grzelecki","doi":"10.1007/s00132-025-04719-3","DOIUrl":"https://doi.org/10.1007/s00132-025-04719-3","url":null,"abstract":"<p><strong>Purpose: </strong>Performing a one-stage periarticular osteotomy in conjunction with total knee arthroplasty (TKA) constitutes a technically complex procedure. In such demanding cases, a personalized approach utilizing patient-specific instrumentation (PSI) may serve as an advantageous option to achieve optimal precision in bone cuts, thereby enhancing both clinical and radiological postoperative outcomes.</p><p><strong>Methods: </strong>We present a case report of a 22-year-old man with multiple epiphyseal dysplasia (MED) resulting in knee osteoarthritis with complex femoral deformity and restricted (passive at 30-120° and active at 80-120°) range of movement (ROM). Simultaneous TKA and triplanar osteotomy with the use of PSI stabilized with the prosthesis stem was performed.</p><p><strong>Results: </strong>The treatment resulted in correct limb and implant positioning. The functional improvement and bone union were confirmed 1 year after TKA. The patient did not report any pain in the operated joints and achieved passive 0-120° and active 10-120° ROM of the operated right knee.</p><p><strong>Conclusion: </strong>Although the latest reports do not demonstrate improved clinical outcomes for PSI in periarticular osteotomies and TKAs separately, we highlight the benefits of PSI in complex deformities, particularly in patients requiring a combination of these two methods.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002109","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":"[The literary patient file-How Galen of Pergamum documented his diseases : On the discussion about the introduction of the electronic patient record].","authors":"Werner Golder","doi":"10.1007/s00132-025-04698-5","DOIUrl":"https://doi.org/10.1007/s00132-025-04698-5","url":null,"abstract":"<p><p>Galen of Pergamon described his own illnesses in several of his works. The course was always favourable, although sometimes after invasive or time-consuming treatment. The author derived a number of measures for recurrence prophylaxis from the evolution of the illnesses. The reports are to be regarded as credible due to their attention to detail and self-critical commentary. With the documentation of his diseases, Galen created the first literary patient file.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994570","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":"[AI in instrumental gait analysis : Challenges and solution approaches].","authors":"Dominik Raab, Falko Heitzer, Christine Kocks, Wojciech Kowalczyk, Andrés Kecskeméthy, Marcus Jäger","doi":"10.1007/s00132-025-04712-w","DOIUrl":"https://doi.org/10.1007/s00132-025-04712-w","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) is considered a key technology for alleviating the burden on the healthcare system. For instrumental gait analysis, AI-based evaluations promise a direct and intuitive access to clinically relevant information in orthopaedics and trauma surgery, avoiding the challenging and time-consuming manual evaluations of large amounts of patient data.</p><p><strong>Objective: </strong>The objective of this work is to investigate the specific challenges and limitations of using AI for clinical evaluation of gait analysis data and to propose effective solutions to address these limitations.</p><p><strong>Method: </strong>This work combines a systematic literature review on AI in gait analysis with practical experiences from applications of AI in the authors' own published research projects.</p><p><strong>Results: </strong>Six key challenges have been identified. While AI methods work best when extensive training data, a limited number of influencing factors, and a clearly defined target variable are available, instrumental gait analysis is characterised by opposite conditions (little training data, multiple influencing factors, and fuzzy target variables). To address these contradicting characteristics, a catalogue of possible solution approaches focusing on integrating clinical expert knowledge into AI development and operation is outlined.</p><p><strong>Conclusion: </strong>It is shown that AI offers significant potential for improving the efficiency and quality of gait data exploitation. However, current AI approaches from other fields are only partially transferable to gait analysis due to insufficient fitting. By addressing the specific challenges for AI in gait analysis, it can be expected that specialized procedures and best practices can be developed, which will boost AI assistance in IGA clinical evaluation.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981238","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":"[Medial pivot, bicruciate retaining and co: Evidence of modern insert and implant designs].","authors":"Johanna-Maria Simon, Philipp von Roth","doi":"10.1007/s00132-025-04694-9","DOIUrl":"10.1007/s00132-025-04694-9","url":null,"abstract":"<p><strong>Background: </strong>In the context of rising numbers in primary total knee arthroplasty, alternative insert designs are being established, which are supposed to show superior results in terms of knee joint kinematics, clinical results and long-term survival in comparison to the traditional cruciate retaining or posterior stabilized insert designs.</p><p><strong>Medial pivot: </strong>The medial pivot design presents equivalent results to the cruciate retaining design with presumed superiority combined with kinematic alignment.</p><p><strong>Dual pivot: </strong>Current data for the dual pivot design is still very limited. A benefit in comparison to traditional insert designs has not yet been demonstrated.</p><p><strong>Ultracongruent: </strong>Forthe ultracongruent design, similar clinical results and revision rates as for the posterior stabilized design have been shown so far, but a superiority in this respect cannot be indicated.</p><p><strong>Bicruciate retaining: </strong>The bicruciate retaining design does not present as a meaningful alternative to the traditional insert designs due to a more challenging surgical technique and significantly increased revision rates based on aseptic partial loosening.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"693-699"},"PeriodicalIF":0.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796329","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 comparison between robotic-assisted and freehand total knee arthroplasty : A quasi-randomized controlled trial.","authors":"Filippo Migliorini, Luise Schäfer, Jens Schneider, Andrea Maria Nobili, Daniel Kämmer, Nicola Maffulli, Andreas Bell","doi":"10.1007/s00132-025-04709-5","DOIUrl":"https://doi.org/10.1007/s00132-025-04709-5","url":null,"abstract":"<p><strong>Background: </strong>The advent of navigation, followed by robotics in knee prosthetic surgery aims, among other things, to enhance the alignment of components and to improve the control of stress forces (i.e., weight, gravity, and static and dynamic stabilizers) on the bearing surface throughout the range of motion; however, the benefits of robotic-assisted total knee arthroplasty (TKA) are debated.</p><p><strong>Objective: </strong>This quasi-randomized controlled trial (RCT) compares robotic-assisted and conventional TKA, focusing on surgical duration, hospital stay and serum markers. It aims to address current gaps in the literature and clarify potential advantages.</p><p><strong>Material and methods: </strong>All patients who received a TKA at the Department of Orthopedic Surgery of the Eifelklinik St. Brigida in Simmerath, Germany, between 2021 and 2025 were prospectively invited to participate in the present clinical trial. All patients followed the same clinical, imaging, and anesthesiological presurgical and postsurgical pathways irrespective of their allocation. All surgeries were performed using a standard medial parapatellar approach and a functional alignment philosophy. Both groups received the same implants, and patients followed the same postoperative physiotherapy program. Deviation from the planned surgical procedure and rehabilitation protocol warranted exclusion from the study. For patients allocated to robotic-assisted TKA, the CORI system (Smith & Nephew plc, Watford, United Kingdom) was used.</p><p><strong>Results: </strong>A total of 1099 patients completed the study, 59% (649 of 1099) of the patients were women and 50% (547 of 1099) of TKAs were performed on the left side. The mean body mass index (BMI) was 30.2 ± 4.9 kg/m^2, and the mean age was 66.9 ± 8.2 years. Comparability was found between the two cohorts regarding the number of women, side of surgery, mean BMI, age, hemoglobin, hematocrit and leucocyte count at admission. Robotic-assisted TKA was associated with a longer surgical time of 1.6 min (p = 0.04) and a lower C‑reactive protein level at both the first (p = 0.0003) and fifth (p = 0.003) postoperative days. No other difference between groups was found.</p><p><strong>Conclusion: </strong>Robotic-assisted TKA was associated with lower serum C‑reactive protein levels. No difference was found in the length of hospitalization and erythropoietic function in serum. Although the surgical execution of conventional TKA was statistically significantly faster, the clinical relevance of the endpoint surgical duration is negligible.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981629","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}