Orthopadie (Heidelberg, Germany)最新文献

{"title":"[Biomechanics of the intervertebral disc : Consequences of degenerative changes].","authors":"Bastian Welke, Dorothea Daentzer, Cornelia Neidlinger-Wilke, Christian Liebsch","doi":"10.1007/s00132-024-04578-4","DOIUrl":"10.1007/s00132-024-04578-4","url":null,"abstract":"<p><p>The intervertebral disc represents the flexible connection between two adjacent vertebral bodies. Intervertebral discs, therefore, give the spine its enormous range of motion. At the same time, intervertebral discs distribute the load evenly over the bony vertebral bodies to ensure load transfer from the upper body to the pelvis, provide sufficient stability, and absorb shocks during everyday movements as well as under extreme loads. The two tissue regions of the intervertebral disc, the central fluid-rich core (nucleus pulposus) and the lamellae of the outer fibrous ring (annulus fibrosus) experience different stresses under load and movement. This article summarizes current knowledge on the biomechanical properties of the intervertebral disc and explains how these are altered by degeneration and which surgical treatment options for degenerated and herniated discs are advisable from a biomechanical perspective.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"912-917"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583757","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":"[Prehabilitation before total knee arthroplasty].","authors":"Christina Valle, Philipp von Roth","doi":"10.1007/s00132-024-04544-0","DOIUrl":"10.1007/s00132-024-04544-0","url":null,"abstract":"<p><strong>Background: </strong>Prehabilitation before knee joint replacement surgery is gaining increasing importance due to the rising prevalence of knee osteoarthritis. The aim is to optimize the preoperative condition to improve postoperative recovery and reduce complications.</p><p><strong>Materials and methods: </strong>This review is based on a systematic literature search in the databases Medline, Cochrane Library, and Web of Science on the topic of prehabilitation in knee joint replacement.</p><p><strong>Results: </strong>The current evidence shows heterogeneous results regarding the effectiveness of prehabilitation before knee joint replacement; some studies report improved postoperative outcomes such as reduced pain, increased function, and shorter hospital stays through preoperative training measures, while others found no significant differences. Additional preoperatively modifiable risk factors such as reduced physical fitness, substance abuse, nutritional status, comorbidities, and psychological factors should already be addressed during prehabilitation. Digital therapy and education measures offer a promising solution for the implementation of prehabilitation programs and are well received by patients.</p><p><strong>Conclusion: </strong>Overall, the evidence for preoperative training before knee joint replacement remains heterogeneous. Despite positive indications, evidence on exercise content, duration, frequency, and setting remains incomplete, requiring a critical review of current meta-analyses and systematic reviews. Modern prehabilitation before knee joint replacement should include musculoskeletal training and address preoperative risk factors to improve postoperative outcomes.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"819-823"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142074667","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":"[Medical practice in Ancient Greece : The orthopaedic and trauma surgery case reports of the Hippocratic Corpus].","authors":"Werner Golder","doi":"10.1007/s00132-024-04563-x","DOIUrl":"10.1007/s00132-024-04563-x","url":null,"abstract":"<p><strong>Objectives: </strong>Which theoretical and practical competences do the orthopaedic and trauma surgery reports of the Hippocratic Corpus reveal?</p><p><strong>Materials: </strong>The 431 Hippocratic case histories have been studied for reports and communication on diagnostics, therapy and prognosis of orthopaedic diseases and traumatic lesions.</p><p><strong>Results: </strong>The seven books of the Hippocratic \"Epidemics\" describe a total of 26 patients with orthopaedic diseases and traumatic lesions. In the field of orthopaedic diseases, arthritis, myo- and tenopathia and gangrene play a prominent role, among the consequences of injury the fracture of the skull (n = 10) is in first place. Mainly individuals, but also groups of patients are reported. The clients' information on the course of the disease was often cautious. Diagnostics were limited to inspection and palpation. In addition to the measures of conservative treatment, four trepanations are described. The majority of traumatic brain lesions resulted in death.</p><p><strong>Discussion: </strong>The Hippocratic doctor was faced with a variety of orthopaedic disases and traumatic lesions. Within the case reports, the subjective complaints, the objective findings and the course of the treatment are described in detail. Among the ailments of the musculoskeletal system, spinal disorders, especially hypercyphosis and scoliosis play an important role. The variety of reduction techniques reported suggests that most of the fractures detected were dislocated. Post-traumatic tetanus can be readily identified in several followup observations due to the development of opisthotonus. No other surgical intervention is discussed by Hippocrates as often and as variously as trepanation. It can be concluded with some certainty that perforating injuries of the skull were a common challenge in the life of a surgeon of classic antiquity.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"876-882"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302845","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 and fast track in knee arthroplasty].","authors":"Christina Valle, Sandro Valle, Clemens Baier","doi":"10.1007/s00132-024-04569-5","DOIUrl":"10.1007/s00132-024-04569-5","url":null,"abstract":"<p><strong>Background: </strong>Knee arthroplasty is an established surgical treatment for advanced osteoarthritis of the knee. In view of the rising number of surgical procedures, increasing costs in the healthcare system with a parallel increase in patient age and comorbidities, an evidence-based perioperative management is gaining importance. Fast Recovery concepts comprise a range of evidence-based strategies for optimizing the perioperative course. By reducing perioperative risks and optimizing pre-, peri- and postoperative processes, complications can be reduced, as well as perioperative morbidity, while comprising faster convalescence.</p><p><strong>Material and methods: </strong>This review is based on a systematic literature search in the PubMed, Cochrane Library and Web of Science databases on the topic of perioperative optimization and evidence for Fast Recovery programs in knee resurfacing.</p><p><strong>Results: </strong>In knee arthroplasty, Fast Recovery protocols lead to a significant reduction in the length of stay in hospital without an increase in complication rates. Patients also benefit from a faster return to mobility and a reduced level of postoperative pain. The involvement of multidisciplinary teams, the optimization of pain therapy, the minimization of blood loss and early mobilization are key elements of these protocols. The implementation of Fast Recovery protocols in the perioperative care of patients is an effective strategy to improve surgical outcomes. Essential for the success of such programs is individualized multidisciplinary patient care with preoperative risk assessment, optimized pain management and early physiotherapeutic mobilization. Future research should focus on the long-term effects of these approaches and their adaptation to different patient populations.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"833-839"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382679","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":"[Blood flow restriction training (BFRT) in patients before and after total knee arthroplasty].","authors":"Arthur Praetorius","doi":"10.1007/s00132-024-04543-1","DOIUrl":"10.1007/s00132-024-04543-1","url":null,"abstract":"<p><strong>Background: </strong>In healthy individuals, blood flow restriction training (BFRT) has shown positive effects on muscle mass, strength, fatigue resistance, as well as tendon and bone metabolism. BFRT reduces blood flow in the extremities using inflatable cuffs, creating local muscular hypoxia, which produces an anabolic metabolic environment. This promotes significant muscular and cardiovascular adaptations even at low mechanical training loads.</p><p><strong>Knee endoprostheses: </strong>BFRT also shows promising initial results in pre- and postoperative applications for knee endoprostheses (KTEP). Both preoperative and postoperative BFRT can improve muscle strength and joint function, accelerate recovery, and alleviate pain. Although the method is generally safe, potential risks such as discomfort and rare side effects must be considered. Clear application protocols are still lacking, necessitating further research and individualized programs to achieve optimal training effects. BFRT thus offers an innovative way to effectively rehabilitate patients despite their low load tolerance.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"853-857"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908543","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":"[Low UKA implantation volume, comorbidities, male sex, and implantation of constrained TKA are risk factors for septic revision after knee arthroplasty implantation : A register-based study from the German Arthroplasty Register].","authors":"Dominik Szymski, Nike Walter, Josina Straub, Yinan Wu, Oliver Melsheimer, Alexander Grimberg, Volker Alt, Arnd Steinbrück, Markus Rupp","doi":"10.1007/s00132-024-04562-y","DOIUrl":"10.1007/s00132-024-04562-y","url":null,"abstract":"<p><strong>Aim: </strong>Periprosthetic joint infection (PJI) is one of the main causes of revision surgeries after total knee arthroplasty (TKA) and unicondylar knee replacement. Patient- and hospital-related risk factors must be evaluated to prevent PJI. This study identifies influencing factors and differences in infection rates between various types of implant.</p><p><strong>Methods: </strong>The basis for the data is the German Arthroplasty Register (EPRD). Septic revisions were calculated with the aid of Kaplan-Meier estimates, with septic revision surgery defined as the primary endpoint. Patients with constrained and unconstrained TKA or UKA were analysed using the Holm multiple log-rank test and the Cox proportional hazard model. The 300,998 cases of knee arthroplasty analysed included 254,144 (84.4%) unconstrained TKA, 9993 (3.3%) constrained TKA and 36,861 (12.3%) UKA, with a maximum follow-up of 7 years.</p><p><strong>Results: </strong>After 1 year, the PJI rate was 0.5% for UKA and 2.8% for TKA, whereas after 7 years it was 4.5% for UKA and 0.9% for TKA (p < 0.0001). In constrained TKA, the PJI rate was significantly increased compared with unconstrained TKA (p < 0.0001). After 1 year, the PJI rate was 2.0% for constrained TKA and 0.8% for unconstrained TKA, as well as 3.1% and 1.4% respectively after 7 years. Implantation of a constrained TKA (HR = 2.55), male sex (HR = 1.84), an increased Elixhauser Comorbidity Index score (HR = 1.18-1.56) and an implantation volume of less than 25 UKA per year (HR = 2.15) were identified as risk factors for revision surgeries; an Elixhauser Comorbidity Index score of 0 (HR = 0.80) was identified as a preventive factor.</p><p><strong>Conclusions: </strong>A reduced implantation volume and constrained knee arthroplasty are linked to a higher risk of PJI. Comorbidities (increased Elixhauser Comorbidity Index score), male sex and a low UKA-implantation volume were identified as risk factors for PJI. Patients who fulfil these criteria need specific infection prevention measures. Further analyses are required to investigate the potential influence of prevention and risk factor modification.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"883-892"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302836","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":"[Postoperative rehabilitation after knee arthroplasty].","authors":"Christina Valle, Sebastian Stemmler, Clemens Baier, Georg Matziolis","doi":"10.1007/s00132-024-04560-0","DOIUrl":"10.1007/s00132-024-04560-0","url":null,"abstract":"<p><strong>Background: </strong>Postoperative rehabilitation after knee arthroplasty plays a decisive role in restoring the function and mobility of the affected joint. However, there is still disagreement regarding the setting, structure and content of rehabilitation after knee arthroplasty, and the evidence on the individual measures is largely unclear. The aim of this article is to provide an evidence-based overview of the current status of rehabilitation after knee arthroplasty and to critically discuss the points that are still unclear. In view of the increasing prevalence of knee osteoarthritis and the rising number of knee endoprosthesis implantations, the optimization and scientific processing of postoperative rehabilitation is more important than ever in order to be able to offer scientifically sound, practice-oriented and cost-effective rehabilitation measures in the future.</p><p><strong>Material and methods: </strong>This review is based on a systematic literature search in Medline, Cochrane Library and Web of Science databases on the topic of postoperative rehabilitation after knee arthroplasty.</p><p><strong>Results: </strong>Regarding specific treatment components, duration and frequency after knee arthroplasty, the evidence is unclear. Passive therapies should only be used supportive to active interventions. Educational programmes before and after knee arthroplasty can play a crucial role in outcome and patient satisfaction. Regular strength training should always be combined with centrally oriented components, such as motor imagery, to achieve better movement visualization and central anchoring. There is still a frequent lack of scientific evidence regarding individual therapeutic measures, their intensity, frequency, duration, exercise selection and their specific implementation in rehabilitation after knee arthroplasty. In the future, digital diagnostic and training tools will become established in both inpatient and outpatient therapy, supporting the urgently needed data collection for the scientific analysis of individual therapeutic measures.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"824-832"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302846","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":"[Return to activity and return to sports after total knee replacement].","authors":"Jochen Bellerich, Sebastian Stemmler, Alexander Franz","doi":"10.1007/s00132-024-04545-z","DOIUrl":"10.1007/s00132-024-04545-z","url":null,"abstract":"<p><strong>Background: </strong>Total knee arthroplasty (TKA) is one of the most common and successful operations in the field of orthopaedics, with a steadily increasing number of patients. However, as the patient population becomes younger, expectations regarding the outcome of the surgery are also changing. In addition to pain reduction and improved mobility, the longevity of the implant and the recovery of (everyday) activity in general (return-to-activity, RtA) and sporting activity in particular (return-to-sports, RtS) are becoming increasingly important.</p><p><strong>State of the study: </strong>RtS with a tendency towards low-impact sports seems generally possible but is highly dependent on the individual characteristics of the patient. Despite comprehensive studies on treatment with TKA, there are no systematic studies and reliable conclusions on the key factors that enable patients to return to sports after TKA. Any recommendation by the responsible surgeons remains dependent on their subjective experience due to the lack of standardized implementation of an RtA/RtS assessment and the necessary long-term follow-up observation under control of patient-related confounding factors.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"840-844"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141984088","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":"[Three-dimensional individual joint reconstruction through the Mako robotic arm-assisted surgical technique : Possibilities and limitations of the surgical technique].","authors":"Severin Langer, Vincent Lallinger, Niels Heine, Julian Zapf, Claudio Glowalla","doi":"10.1007/s00132-024-04554-y","DOIUrl":"10.1007/s00132-024-04554-y","url":null,"abstract":"<p><strong>Background: </strong>Although knee arthroplasty represents a very successful treatment for osteoarthritis or joint destruction, a relevant number of patients is still not completely satisfied with the outcome. Higher satisfaction and faster rehabilitation seem to be achievable through patient-individualized alignment of the prosthesis and especially through reproducible robotic-assisted implantation.</p><p><strong>Importance of robotics: </strong>The topic of robotics in orthopedics and especially in knee endoprosthesis is not new and began in the 1990s with the Robodoc system. The resurgence of robotics with new systems can be referred to as an innovation in the orthopedic operating room. Interest in this has risen significantly, not only among surgeons, but especially among patients, primarily because it seems to offer better joint function and patient satisfaction, as well as faster rehabilitation.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"845-852"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115668","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":"[Dupuytren's disease : Epidemiology, diagnosis, treatment, outcome].","authors":"A Harbrecht, P Honigmann, S Löw, L P Müller, F Unglaub, C K Spies","doi":"10.1007/s00132-024-04553-z","DOIUrl":"10.1007/s00132-024-04553-z","url":null,"abstract":"<p><p>Dupuytren's contracture is a fibroproliferative systemic disease that cannot be stopped by medication. The overall prevalence is 7-8%. Men are affected 3-4 times more frequently. The cause of the disease is not known. A genetic disposition and thus familial clustering are being discussed. Risk factors for the development of a Dupuytren's contracture are work-related stress (microtrauma), nicotine and alcohol consumption, epilepsy and diabetes mellitus as well as advanced age. The prognosis is poor in cases with a positive family history, bilateral involvement, age < 50 years and male gender. Several treatment options are available. Conservative therapy has no lasting benefit. Minimally invasive procedures include partial needle aponeurectomy or the injection of collagenase. Surgical procedures range from partial aponeurectomy to dermatoaponeurectomy. The recurrence risk of the gold standard treatment of surgery (partial aponeurectomy) is 20.9%.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"893-902"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333963","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}