Orthopadie (Heidelberg, Germany)最新文献

{"title":"[Atraumatic necrosis of the femoral head].","authors":"Stefan Landgraeber, Lorenz Büchler, Andreas Roth","doi":"10.1007/s00132-025-04666-z","DOIUrl":"10.1007/s00132-025-04666-z","url":null,"abstract":"<p><p>The incidence of atraumatic necrosis of the femoral head (ATN) has increased in recent years. The pathogenesis is complex and has a multifactorial etiology. In order to find the best possible treatment option for the often young patients, a well-coordinated evaluation, including differential diagnoses, is required. In particular, the decision whether to attempt to preserve the joint or to proceed with joint replacement is important. Knowledge of relevant classification systems is helpful in making this decision. This CME article aims to provide the necessary knowledge for the optimal treatment of ATN.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"733-744"},"PeriodicalIF":0.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499780","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":"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":"675-681"},"PeriodicalIF":0.5,"publicationDate":"2025-09-01","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":"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":"664-674"},"PeriodicalIF":0.5,"publicationDate":"2025-09-01","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":"[Innovation and evidence in knee arthroplasty].","authors":"Philipp von Roth, Max Ettinger","doi":"10.1007/s00132-025-04699-4","DOIUrl":"https://doi.org/10.1007/s00132-025-04699-4","url":null,"abstract":"","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":"54 9","pages":"661-663"},"PeriodicalIF":0.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981564","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":"[Cost reduction in robot-assisted knee arthroplasty can currently be achieved primarily through volume effects : A comparative cost analysis between 2018 and 2024].","authors":"Carlo Theus-Steinmann, Tilman Calliess, Bernhard Christen, Lars-René Tuecking","doi":"10.1007/s00132-025-04696-7","DOIUrl":"10.1007/s00132-025-04696-7","url":null,"abstract":"<p><strong>Introduction: </strong>Robot-assisted technologies in total knee arthroplasty (TKA) have been introduced to increase implantation accuracy, minimize revisions, and ideally improve patient outcomes. However, concerns remain regarding increased costs and extended operating time. The aim of this study was to analyze the development of the cost structure of robot-assisted image-based knee arthroplasty in a specialized center over a 6-year period.</p><p><strong>Methods: </strong>A retrospective cost analysis of image-based robot-assisted TKA based on data from 2024 was conducted and compared with results from a similar analysis from 2018. Specific parameters such as operating time, number and cost of surgical instrument trays, technology costs (leasing and service costs of the robot system), costs for robot-specific disposable materials, and preoperative CT imaging were considered. All costs were adjusted for inflation, converted to US dollars, and standardized to both a fixed case volume (n = 125 from 2018) and the actual case volume in 2024 (n = 457).</p><p><strong>Results: </strong>The fixed costs for the robotic technology itself (leasing and service fees per year) showed a slight increase between 2018 and 2024 (USD 151,000 vs. USD 225,620). However, due to the significant volume expansion achieved during this period, case-related technology costs were reduced by 60% (USD 1210 to USD 490). In addition, the costs for disposable materials were reduced by 27% (USD 600 to USD 440), and costs for preoperative CT imaging were reduced by 29% (USD 420 to USD 300). The average operating time was significantly reduced between 2018 and 2024 (73 min to 54 min) and was ultimately 5 min shorter than the comparable time for the manual technique (59 min). Overall, the average case-related total costs were reduced by 50% (USD 2600 to USD 1320) within 6 years.</p><p><strong>Conclusion: </strong>The total case-related costs of robotic-assisted knee arthroplasty have been reduced by 50% over the past years. This was achieved mainly due to increased case volume and resulting cost efficiencies, shortened operative time, and reductions in disposable material costs. The technology itself has not become cheaper over the years.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"708-714"},"PeriodicalIF":0.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12396978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790953","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":"[The importance of individual knee arthroplasty].","authors":"Peter Buschner, Christian Benignus, Johannes Rieger, Carsten O Tibesku, Johannes Beckmann","doi":"10.1007/s00132-025-04688-7","DOIUrl":"10.1007/s00132-025-04688-7","url":null,"abstract":"<p><strong>Background: </strong>Conventional knee arthroplasty offers excellent long-term durability. However, when it comes to patient satisfaction, it occasionally falls short of expectations. This is where customized knee arthroplasty comes into play: by utilizing patient-specific implant designs tailored to an individual's unique anatomy, it aims to address some of the limitations associated with standard implants.</p><p><strong>Advantage: </strong>In addition to an optimized fit, modern customized arthroplasty also enables implant positioning based on the patient's constitutional alignment, thereby taking the concept of personalization one step further. A particularly noteworthy design feature in this context is the \"decoupling\" of the patellofemoral and tibiofemoral joints, which helps mitigate the potential drawbacks of individualized alignment philosophies. Unlike other technologies such as robotics or navigation, customized arthroplasty relies on preoperative, image-based analysis and planning, followed by surgical execution using patient-specific instruments (PSI). This approach enables a unique combination of standardization and individualization.</p><p><strong>Prospects: </strong>Despite its theoretical advantages, customized arthroplasty must still demonstrate its clinical benefits in practice-and, in light of rising healthcare costs, justify its economic viability.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"700-707"},"PeriodicalIF":0.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144801135","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 future of robotic surgery in joint arthroplasty : Current platforms, emerging technologies and outlook for 2035.","authors":"David G Deckey, Max Ettinger, Peter Savov, Christopher Klifto, Thorsten M Seyler, Michael P Ast","doi":"10.1007/s00132-025-04695-8","DOIUrl":"https://doi.org/10.1007/s00132-025-04695-8","url":null,"abstract":"<p><p>Robotic-assisted total joint arthroplasty shows clear evidence of improved component positioning across all applications with modest functional improvements at early to mid-term follow-up. The strongest economic value proposition exists for partial knee arthroplasty (PKA), with emerging evidence for total hip arthroplasty (THA) and complex primary total knee arthroplasty (TKA). Growing concerns about cybersecurity, data protection, and energy consumption must be addressed through systematic approaches and industrial standards. The integration of artificial intelligence (AI), augmented reality/mixed reality (AR/MR) and advanced sensing technologies promises further enhancements, with a projected evolution towards more autonomous capabilities by 2035, although significant challenges remain in cost barriers, evidence gaps and equitable access.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":"54 9","pages":"682-692"},"PeriodicalIF":0.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981559","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":"[Ability to drive after surgery and trauma to the lower limb : When can I drive again?]","authors":"Stefan Simmel, Eike Benning","doi":"10.1007/s00132-025-04671-2","DOIUrl":"10.1007/s00132-025-04671-2","url":null,"abstract":"<p><strong>Background: </strong>The ability to drive after lower limb injuries or operations is usually temporarily impaired. Before deciding when a patient can safely drive again, legal, medical and safety-related issues must be clarified.</p><p><strong>Methods: </strong>The current literature was reviewed and summarized.</p><p><strong>Study situation: </strong>The study situation is heterogeneous; often only individual aspects of the complex ability to drive a car are examined. Many factors have an influence on this, including the type of injury or operation, the affected limb, the use of aids, immobilization or the use of painkillers and central medication.</p><p><strong>Advice: </strong>It is, therefore, important that doctors inform and advise affected patients individually, with the patient ultimately taking responsibility for the decision. The information provided by the doctor and any recommendations given on how to return to driving safely must be documented in the medical records. Missed or undocumented information can have legal consequences, for example in the event of an accident. In cases of doubt or for professional drivers, a formal driving test may be required. In the case of permanent restrictions, a traffic medical assessment is required. The driving license authority decides whether and when this is necessary.</p><p><strong>Recommendation: </strong>The patient must ensure that they are sufficiently functionally recovered to be able to control the vehicle without being restricted by pain or medication. Our recommendations, based on an extensive literature review, support orthopaedic and trauma surgeons in advising their patients, who ultimately have to make the decision to drive again independently.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"725-732"},"PeriodicalIF":0.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478090","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":"Local antibiotic carriers in the surgical management of pyogenic spondylodiscitis : First comparative evaluation of gentamicin-loaded versus vancomycin-loaded efficacy.","authors":"Yu Xiao, Vincent Heck, Long Hao, Michael Rauschmann, Andrei Slavici","doi":"10.1007/s00132-025-04657-0","DOIUrl":"10.1007/s00132-025-04657-0","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy of intraoperative gentamicin versus vancomycin-loaded PerOssal (Osartis, Münster, Germany) carriers on interbody fusion rates and infection control in patients undergoing surgery for pyogenic spondylodiscitis.</p><p><strong>Methods: </strong>This retrospective study included 29 patients with pyogenic spondylodiscitis who underwent surgical debridement, interbody fusion, and pedicle screw fixation between February 2018 and March 2023. Patients received PerOssal carriers loaded with either gentamicin (Group A, n = 14) or vancomycin (Group B, n = 15). Clinical outcomes, including fusion rates, infection control, complications, and inflammatory markers, were analyzed.</p><p><strong>Results: </strong>Baseline characteristics between groups were comparable. Fusion rates at 3-6 months' follow-up were 92.8% (13/14) in Group A and 80.0% (12/15) in Group B, without significant differences (P > 0.05). Both groups showed significant reductions in white blood cell counts and C‑reactive protein levels postoperatively, without inter-group differences (P > 0.05). Complications included cerebrospinal fluid leakage, hematoma, pulmonary embolism, and wound infections, all managed successfully with no recurrent infections observed.</p><p><strong>Conclusion: </strong>In the short term, PerOssal carriers loaded with either gentamicin or vancomycin demonstrated effective infection control for pyogenic spondylodiscitis and high interbody fusion rates. Moreover, no apparent adverse effects on bone healing were associated with the local administration of high-concentration antibiotics.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"715-724"},"PeriodicalIF":0.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055100","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":"[Orthopaedics of the future : AI meets motion analysis: opportunities and risks].","authors":"Falko Heitzer, Dominik Raab, Wojciech Kowalczyk, Marcus Jäger","doi":"10.1007/s00132-025-04708-6","DOIUrl":"https://doi.org/10.1007/s00132-025-04708-6","url":null,"abstract":"<p><strong>Background: </strong>With the progress of digitalization and the rapid development of portable measurement systems, the integration of new technologies into clinical practice is inevitable. Considering the demographic change, the current healthcare system needs exactly this integration to appropriately address the growing challenges. Regarding orthopaedic patient care, the objective analysis of the musculoskeletal system represents an increasingly important aspect. Innovative key technologies are necessary to handle the amount of instrumental data and create new opportunities. While an enormous increase in efficiency, effectiveness and quality of care can be realized, potential risks from the application of artificial intelligence (AI) need to be considered.</p><p><strong>Methods: </strong>Based on a literature review using the PRISMA-method, specific opportunities for clinical integration are identified and potential risks are discussed.</p><p><strong>Results: </strong>A total of 188 publications were included, of which 54 were analyzed in detail.</p><p><strong>Conclusion: </strong>While the application of AI methods for the use of objective measurement systems opens a variety of opportunities in orthopaedic patient care, it is also associated with relevant risks. In order to address specific problems and achieve the primary goal of optimized healthcare, the appropriate use and the proper integration of AI methods are essential. It must be acknowledged that artificial intelligence can only play a supporting role, with transparency being the main criterion for trustworthy use in the healthcare sector.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981618","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}