Orthopadie (Heidelberg, Germany)最新文献

{"title":"[Bacteriophages for the treatment of musculoskeletal infections-An overview of clinical use, open questions, and legal framework].","authors":"Markus Rupp, Tristan Ferry, Mohammadali Khan Mirzaei, Volker Alt, Li Deng, Nike Walter","doi":"10.1007/s00132-025-04690-z","DOIUrl":"https://doi.org/10.1007/s00132-025-04690-z","url":null,"abstract":"<p><strong>Background: </strong>Bacteriophages, or simply phages, are viruses that specifically infect and lyse bacteria. As antibiotic resistance becomes a growing global concern, phage therapy is gaining renewed attention as a targeted and effective treatment option. In orthopedics and trauma surgery-disciplines characterized by high rates of chronic and implant-associated infections-phages offer promising new therapeutic avenues, particularly in cases involving multidrug-resistant pathogens or when conventional surgery is limited.</p><p><strong>Current developments: </strong>Originally developed in the early 20th century, phage therapy lost prominence with the rise of antibiotics. Today, case studies and emerging clinical protocols-especially in the context of periprosthetic joint infections-demonstrate the potential of personalized phage cocktails and advanced delivery systems, such as hydrogels or intra-articular injections. Their specificity enables bacterial eradication while sparing the host microbiome.</p><p><strong>Regulatory situation: </strong>However, the regulatory landscape in the European Union poses significant challenges. Phages are classified as biological medicinal products, requiring comprehensive preclinical and clinical evaluation. While magistral production and compassionate use permit individual applications, broad clinical integration demands standardized protocols, accessible phage libraries, and robust quality control. Furthermore, safety concerns, including immunogenicity and systemic distribution, must be addressed through structured research.</p><p><strong>Conclusion: </strong>To fully realize the potential of phage therapy in orthopaedic infection management, interdisciplinary collaboration, targeted funding, and clinical trials are essential. Responsible implementation within expert centers can ensure efficacy and safety, paving the way for a controlled and evidence-based adoption of phages as a complementary strategy alongside traditional surgical and antibiotic treatments.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762578","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 brain today is yesterday's psyche].","authors":"Paul Nilges","doi":"10.1007/s00132-025-04691-y","DOIUrl":"https://doi.org/10.1007/s00132-025-04691-y","url":null,"abstract":"<p><p>Despite scientific advances, chronic pain remains difficult to diagnose and treat. For a long time, a dualistic understanding prevailed: pain without an identifiable organic cause was considered psychological in origin, leading to stigmatization and conflict-laden doctor-patient relationships. Imaging techniques often reveal abnormalities even in pain-free individuals, and surgical interventions are frequently unnecessary. Modern pain research understands pain as a complex interplay of biological, psychological, and social factors-not as a simple stimulus-response mechanism. Pain is learned, shaped by experience, and constructed by the brain, influenced by context and expectation. Pain is not the same as nociception; it is not a direct indicator of tissue damage, but rather a perception of potential threat. The new diagnosis of primary pain in ICD-11 integrates biological, psychological, and social factors and expands our treatment framework.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700626","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":"[Skeletal dysplasias-Multidisciplinary orthopedics].","authors":"B Kraler, C Chiari, S Farr, A Kranzl, T Kainz, J Patsch, G Mindler","doi":"10.1007/s00132-025-04676-x","DOIUrl":"https://doi.org/10.1007/s00132-025-04676-x","url":null,"abstract":"<p><p>Skeletal dysplasias (SD) are a heterogeneous group of rare hereditary diseases with pronounced skeletal involvement and include over 750 phenotypes, which are associated with disease-triggering variants in more than 550 genes. In addition to orthopedic treatment, a network of various disciplines is necessary to ensure high-quality diagnostics and treatment for SD. This is ideally carried out at a center specialized in the treatment of rare bone diseases (European Reference Network on Rare Bone Diseases). The close networking of orthopedics with pediatrics and other disciplines is important to enable a state-of-the-art treatment and to monitor the influences of new forms of pharmacotherapy on the musculoskeletal apparatus.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621449","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":"[A stem fracture rarely comes in pairs].","authors":"Hanno Schenker, Julius Michael Wolfgart, Ulf Krister Hofmann","doi":"10.1007/s00132-025-04660-5","DOIUrl":"10.1007/s00132-025-04660-5","url":null,"abstract":"","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"503"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096095","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":"[Short-stem THA-complications and therapy options].","authors":"Karl Philipp Kutzner","doi":"10.1007/s00132-025-04663-2","DOIUrl":"10.1007/s00132-025-04663-2","url":null,"abstract":"<p><p>Short stems in total hip arthroplasty are increasingly being established and offer several advantages in terms of minimal invasiveness and bone preservation compared to standard implants. The rounded design and shorter stem length facilitate better adaptation to natural anatomy, at the same time also posing specific risks and complications. When transitioning to short stems, a learning curve must be considered. Careful patient selection and preoperative planning are crucial, and intraoperative imaging is recommended. The most common implant-specific complications include insufficient osseointegration, leading to subsidence and aseptic loosening, as well as periprosthetic fractures. The risk instability and dislocations as well as periprosthetic infections can potentially be reduced with short stems. This article discusses the frequency, causes, and treatment options for these types of complications and highlights current evidence-based treatment approaches.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"530-536"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236155","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":"[Why does a total hip replacement dislocate? : Diagnosis and management].","authors":"Raphael Trefzer, Franz Reichel, Mustafa Hariri, Timo Nees, Tobias Reiner, David Spranz, Tilman Walker","doi":"10.1007/s00132-025-04662-3","DOIUrl":"10.1007/s00132-025-04662-3","url":null,"abstract":"<p><strong>Background: </strong>Dislocations represent one of the leading complications and the most common cause of early surgical revision in primary total hip arthroplasty (THA). Patient-, implant- and procedure-related factors can contribute causally by impairing soft tissue tension and/or impingement-free mobility.</p><p><strong>Influencing factors: </strong>Patient-specific factors, such as underlying neurological disorders or reduced spinopelvic mobility, should be carefully considered by the surgeon when selecting implants and devising a treatment strategy. Furthermore, the range of market-approved implants offers a broad spectrum of preventive measures for dislocation in both primary and revision settings.</p><p><strong>Therapy: </strong>Central to prevention is the precise and appropriate positioning of the implant, tailored to the patient's individual joint biomechanics. While tripolar acetabular systems are utilized in specific patient groups during primary surgery and revision procedures, constrained liners, should be reserved as a fallback strategy in exceptional cases. The occurrence of a THA dislocation constitutes a medical emergency, necessitating immediate radiographic evaluation and early reduction. In cases of a first-time dislocation, additional imaging may be warranted during follow-up, whereas recurrent dislocations mandate tomographic imaging to exclude malpositioning or loosening of the implant. This review summarizes the underlying causes and preventive strategies for THA instability, as well as the diagnostic and therapeutic algorithms for managing THA dislocations.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"506-512"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192584","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 malpractice in primary total hip arthroplasty : Why is there a medical malpractice clause?]","authors":"Moritz Innmann, Marcus Schiltenwolf","doi":"10.1007/s00132-025-04664-1","DOIUrl":"10.1007/s00132-025-04664-1","url":null,"abstract":"<p><p>The provision of a hip endoprosthesis for coxarthrosis is one of the most common medical procedures associated with treatment errors. These errors are most frequently identified in the surgical execution. The most crucial prerequisite for preventing treatment errors is correct and guideline-compliant indication. Additionally, proper execution and documentation of both risk disclosure and precautionary disclosure are essential. Patient-specific factors, such as comorbidities or anatomical peculiarities, must be taken into account, as they are identified during mandatory preoperative planning. For postoperative radiological measurement parameters (e.g., implant positioning and leg length), clear and universally valid target values with acceptable deviations have not been definitively established. However, recommended values help assess whether an implantation error is present. Furthermore, a causal relationship between damage (e.g., dislocation, muscle weakness) and implantation errors must be established.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"537-542"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236154","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":"[Influence of macromastia on cervical spine and thoracic spine].","authors":"Alexander Schuh, Maria Dietrich, Liudmilla Bragina, Philipp Koehl","doi":"10.1007/s00132-025-04646-3","DOIUrl":"10.1007/s00132-025-04646-3","url":null,"abstract":"<p><p>Macromastia refers to an excessively large breast volume, which can occur on one or both sides and is disproportionate to the patient's body proportions. Patients with macromastia often suffer from chronic pain of the breasts, shoulders, back and neck, degenerative changes of the spine, increased kyphosis of the thoracic spine, increased lordosis of the cervical and lumbar spine, headache, neurological problems such as dysesthesia of the ulnar nerve and carpal tunnel syndrome. Reduction mammoplasty is the gold standard in the treatment of symptomatic macromastia. A resection weight of more than 500 g per side is considered a medically indicated breast reduction by most health insurance companies if weight loss and comprehensive conservative treatment have not led to the desired success. Reduction mammoplasty results in a significant reduction of pain, improved posture and gait with a low complication rate.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"573-582"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009131","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":"[Literature review on kyphoplasty as a treatment for osteoporotic fractures of the spine].","authors":"Celine Zöllinger, Franz Landauer, Klemens Trieb","doi":"10.1007/s00132-025-04648-1","DOIUrl":"10.1007/s00132-025-04648-1","url":null,"abstract":"<p><strong>Background: </strong>Osteoeporotic vertebral fractures are one of the most common injuries in the elderly, with a prevalence of 10 to 15% in the population over 50 years of age. This type of fracture can be treated with minimally invasive surgery using kyphoplasty. The aim of this analysis is to show the advantages and disadvantages of treatment with kyphoplasty and to weigh up the different ways of performing this operation.</p><p><strong>Methods: </strong>The systematic literature search included randomized controlled trials and clinical studies in the period from 01/09/2018-31/08/2024. The updated 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used for evaluation.</p><p><strong>Results: </strong>A total of 16 studies from 4347 datasets were included. The most relevant outcome indices showed that the sole choice of surgical side (surgery from the symptom-dominant side) positively influences the VAS. In addition, the unilateral approach is recommended, as this is associated with a shorter operation time, as well as reduced cement volume and radiation exposure. Furthermore, bone density, different scores and certain biomarkers, such as NMID, beta-CTX and P1NP, can be positively influenced by the intravenous administration of zoledronic acid. PMMA bone cement loaded with gentamicin should be used as cement. Finally, drug treatment for osteoporosis and physical therapy are essential for postoperative recovery.</p><p><strong>Conclusion: </strong>Surgical treatment of an osteoporotic vertebral fracture by means of kyphoplasty leads to improved results, even with the inclusion of additional therapies.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"566-572"},"PeriodicalIF":0.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788868","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":"[Periprosthetic fracture in hip replacement-risk factors and treatment].","authors":"Matthias Luger, Tobias Gotterbarm, Clemens Schopper","doi":"10.1007/s00132-025-04658-z","DOIUrl":"10.1007/s00132-025-04658-z","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic acetabular fractures primarily pose a problem with cementless implantation techniques and occur in approximately 3.6% of primary and up to 20.9% of revision cases. When a fracture situation exists that affects the integrity of the pelvic columns, stabilization using plate osteosynthesis is necessary, in addition to the implantation of a revision cup. Periprosthetic femoral fractures also primarily occur with cementless techniques and account for 0.4-6.8% of revisions after primary total hip arthroplasty. In addition to the cementless technique, the most common risk factors for the development of PFF are a minimally invasive, ventral approach, female gender, poor bone quality, age > 75 years, and revision surgery.</p><p><strong>Treatment: </strong>Depending on the degree of risk to the stability of the implant, conservative or surgical treatment can be carried out using osteosynthesis, stem replacement or a combination of both procedures.</p>","PeriodicalId":74375,"journal":{"name":"Orthopadie (Heidelberg, Germany)","volume":" ","pages":"522-529"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121599","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}