Orthopadie (Heidelberg, Germany)最新文献

{"title":"Abstractband KKOU 2025.","authors":"","doi":"10.1007/s00132-025-04633-8","DOIUrl":"10.1007/s00132-025-04633-8","url":null,"abstract":"","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"1-35"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598451","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":"[Fast-track arthroplasty and patient apps].","authors":"Ulrich Nöth, Frederic Braun, Michael Clarius, Lars Rackwitz","doi":"10.1007/s00132-025-04617-8","DOIUrl":"10.1007/s00132-025-04617-8","url":null,"abstract":"<p><strong>Background: </strong>Fast-track arthroplasty is on the rise in Germany. In comparison to established fast-track countries, such as Denmark and the USA, Germany is only at the beginning of its implementation. The biggest challenges include increasing staff shortages and cost pressure as, well as the slow progress of digitalization.</p><p><strong>Fields of application: </strong>The use of app-based patient management systems offers the opportunity to prepare the patient extensively for the surgical procedure, to rehabilitate them according to a standardized schedule, to avoid unnecessary doctor's visits, to save staff and, thus, reduce healthcare costs. Patient apps will also play an important role in collecting patient data and abnormalities in rehabilitation. By correlating intraoperative data from robotics, predictive statements about the surgical strategy, such as implant positioning or axis alignment may be possible. In this review, the essential contents of an app-based patient management system for fast-track arthroplasty are listed and discussed, and the possibilities for using patient data are presented.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"169-176"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392617","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 treatment strategies for periprosthetic femoral fractures of type Vancouver B].","authors":"Christian Ries, Patrick Gerhardt, Peter Helwig, Holger Bäthis, Stephan Kirschner, Tim Rolvien, Frank Timo Beil","doi":"10.1007/s00132-025-04613-y","DOIUrl":"10.1007/s00132-025-04613-y","url":null,"abstract":"<p><strong>Background: </strong>The demographic shift is expected to lead to a further increase in the number of hip joint replacements. Accordingly, as has already been observed in recent years, a further increase in periprosthetic femoral fractures (PPF) is to be expected. PPF is now the third most common reason for revision surgery after hip arthroplasty.</p><p><strong>Objectives: </strong>Taking into account the known risk factors for PPF, fracture treatment strategies are evaluated based on current evidence in order to make recommendations for practice.</p><p><strong>Methods: </strong>Narrative review.</p><p><strong>Results: </strong>Overall, the literature is very heterogeneous and evidence is lacking for many aspects. Numerous recommendations are based on non-randomized studies with low patient count. Mortality after PPF is high regardless of the treatment chosen. Age and bone quality influence the partly heterogeneous results and play a role in the treatment strategy. The use of both cemented and uncemented stems in revision surgery due to proximal PPF is frequently described in the literature. There are no significant differences in terms of outcome. The advantage of uncemented modular stems is currently not supported by the literature.</p><p><strong>Conclusions: </strong>An individualized approach to the treatment of PPF is recommended, considering environmental factors and comorbidities. In geriatric patients, full weight-bearing of the lower extremity should be aimed for postoperatively to avoid complications.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"205-217"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11868169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450402","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":"[Pain around the first ray of the hand: differential diagnoses and treatment].","authors":"R Meier, C K Spies, U Hug, P Honigmann, A Harbrecht, C Engler","doi":"10.1007/s00132-025-04616-9","DOIUrl":"10.1007/s00132-025-04616-9","url":null,"abstract":"<p><p>Pain around the first ray of the hand, particularly in the thumb area, is a frequent clinical problem that can have various causes. This article explores the most important differential diagnoses, including thumb carpometacarpal (CMC-I) osteoarthritis (rhizarthrosis), de Quervain's stenosing tenosynovitis, carpal tunnel syndrome and Wartenberg's syndrome. A detailed medical history, targeted clinical examination and if necessary the use of modern imaging techniques are crucial for making the diagnosis. The therapeutic approaches range from conservative measures to surgical interventions, depending on the severity and underlying cause of the disease. This article provides an overview of current diagnostic and treatment strategies.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"227-239"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061716","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":"[New technologies in total knee arthroplasty : Current concepts and personalized treatment strategies].","authors":"Ricarda Stauss, Peter Savov, Max Ettinger","doi":"10.1007/s00132-025-04618-7","DOIUrl":"10.1007/s00132-025-04618-7","url":null,"abstract":"<p><strong>Background: </strong>In total knee arthroplasty (TKA), there is a trend towards personalized concepts. This includes the implementation of new technologies and the increasing popularity of individualized alignment strategies.</p><p><strong>Targets: </strong>The purpose of personalized TKA is to restore the patient's bony anatomy and constitutional alignment, as well as the physiological soft tissue balance and joint kinematics. Modern technologies facilitate a thorough, three-dimensional analysis of the bony structures and the patient's constitutional alignment. Virtual planning enables a simulation component placement, gap balancing and postoperative alignment. After approval of the surgical plan, the technology-aided execution shows a greater accuracy, precision and reproducibility of implant alignment compared to conventional manual instrumentation.</p><p><strong>Overview: </strong>This article focuses on novel technologies in total knee arthroplasty, including patient-specific instrumentation (PSI), custom implants, navigation and robotics. The purpose of this article is to summarize current evidence, including radiological and functional outcomes, as well as economic aspects. Furthermore, the implementation of novel technologies in the context of personalized alignment strategies will be discussed.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"190-198"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442816","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":"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":"199-204"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","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":"[Innovations in orthopaedics-traditions and future united].","authors":"Stephan Kirschner, Georgi Wassilew","doi":"10.1007/s00132-025-04621-y","DOIUrl":"https://doi.org/10.1007/s00132-025-04621-y","url":null,"abstract":"","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":"54 3","pages":"167-168"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517331","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":"Intra-articular injections of hyaluronic acid versus plasma rich in growth factors (PRGF) for knee osteoarthritis: a meta-analysis of randomised controlled trials : A meta-analysis.","authors":"Filippo Migliorini, Nicola Maffulli, Gennaro Pipino, Madhan Jeyaraman, Swaminathan Ramasubramanian, Naveen Jeyaraman","doi":"10.1007/s00132-025-04615-w","DOIUrl":"10.1007/s00132-025-04615-w","url":null,"abstract":"<p><strong>Introduction: </strong>The present meta-analysis compared intra-articular injections of hyaluronic acid (HA) versus plasma rich in growth factors (PRGF) in patients with knee osteoarthritis (OA). The outcome of interest was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).</p><p><strong>Methods: </strong>This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses: the 2020 PRISMA statement. All the head-to-head randomised controlled trials (RCT) comparing intra-articular HA injections versus PRGF were accessed and included in the present study. Only studies that clearly stated that injections were performed in patients with knee OA, irrespective of the severity of OA, were considered. Data concerning the WOMAC index were retrieved at baseline and last follow-up. The endpoint of interest was to investigate whether intra-articular HA injections are associated with WOMAC score improvement compared to PRGF injections at 4-6 months follow-up.</p><p><strong>Results: </strong>Data from 432 patients were collected and 76.3% (330 of 432) of the patients were women. The mean age of the patients was 58.2 ± 1.5 years and the mean body mass index (BMI) was 28.0 ± 0.5 kg/m². At baseline, comparability in mean age, BMI, male:female ratio, WOMAC and related subscales were documented. The PRGF group evidenced lower values of the function subscale of the WOMAC index (P = 0.03). No difference was found in the overall WOMAC index (P = 0.05) and its stiffness (P = 0.4) and pain (P = 0.07) subscales.</p><p><strong>Conclusion: </strong>The current level I evidence suggests that the use of PRGF might be associated with more favorable clinical outcomes than using HA.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"218-226"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442822","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":"[EPRD update-scientific development and health policy classification].","authors":"Arnd Steinbrück, Klaus-Peter Günther, Jörg Lützner, Alexander Grimberg, Carsten Perka, Bernd Kladny","doi":"10.1007/s00132-025-04623-w","DOIUrl":"10.1007/s00132-025-04623-w","url":null,"abstract":"<p><strong>Background: </strong>Since its foundation in 2010 by the German Society for Orthopaedics and Orthopaedic Surgery (DGOOC) and its establishment together with industry representatives (Bundesverband Medizintechnologie e. V.-BVMed) and the health insurance companies (AOK-Bundesverband eGbR, Verband der Ersatzkassen e. V. (vdek)), the German Arthroplasty Registry (EPRD) has developed rapidly in terms of size and quality of results. With over 3 million data records of hip and knee prostheses, it is now the world's third largest registry for arthroplasty. The product database of the EPRD and National Joint Registry (NJR) is becoming the global standard. 2023 was a record year in terms of recorded operations and scientific publications. The results of the EPRD are increasingly analysing and influencing everyday clinical practice in hip and knee arthroplasty in Germany.</p><p><strong>Prospects: </strong>From 2025, all EPRD clinics will be able to use the Oxford Hip and Oxford Knee Score free of charge for their patients as Patient Reported Outcome Measures (PROMs). In 2025, the recording parameters will be expanded to include surgical approaches to the hip, navigation and robotics on the knee joint, as well as an optional infection module. In 2026, voluntary registration of the surgeon with surgeon level reporting will be possible. The EPRD and the Implantateregister Deutschland (IRD) are expected to exist in parallel from 2025, and cooperation is still being sought. Data collection should be as streamlined as possible without duplicate data entries. However, the EPRD will continue to work independently of the IRD with its more than 12 years of experience and over 3 million data sets and will continue to provide clinics and specialists with its analyses and publications in the future.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"185-189"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411951","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}