Zeitschrift fur Orthopadie und Unfallchirurgie最新文献

{"title":"Implementation of Outpatient Parenteral Antimicrobial Therapy (OPAT) in Patients with Complicated Periprosthetic Joint Infections.","authors":"Anne Strassburg, Andreas T Weber, Torsten Kluba","doi":"10.1055/a-2288-7187","DOIUrl":"10.1055/a-2288-7187","url":null,"abstract":"<p><p>Periprosthetic joint infections (PJI) are a serious complication of arthroplasty with high morbidity. With growing bacterial resistance and limited disposability of oral antibiotics with sufficient bioavailability, the need for intravenous antibiotic application is raising. This causes long-term hospital stays and rising costs. In the course of transferring procedures into an outpatient setting as well as coping with pressures on hospital capacity, outpatient parenteral antimicrobial therapy (OPAT) can build a bridge for the treatment of such infections.In a single centre analysis, 47 cases treated with OPAT were studied in relation to pathogen, antimicrobial resistance, indication for OPAT and follow up. Furthermore, the patients received an anonymised questionnaire with 4 clusters of interest in terms of internal quality assessment on the success and evaluation of this therapeutic procedure. Special attention was paid to the descriptive analysis of patients with periprosthetic joint infections (n = 30).Between May 2021 and October 2022 out of 47 patients with OPAT, 30 cases with periprosthetic joint infections were identified. For infected hip- and knee arthroplasties, a remarkable spectrum of pathogens was found. In hip infections highly resistant strains of Staphylococcus epidermidis and Enterococci were detected. In knee infections, the pathogens were more susceptible, but however highly virulent Staphylococcus aureus and Streptococci. Difficult to treat, mixed infections were found in both locations. The indication for OPAT was based in half of the cases on the high level of antimicrobial resistance, with availability of only parenteral applicable antibiotics. Further indications were mixed infections and difficult to treat pathogens, with flucloxacillin therapy as well as OPAT as the last therapeutic option. The questionnaire showed 96% patient satisfaction in terms of organisation and acceptance of this kind of therapy. Complications or unexpected outpatient/ hospital treatments were very rare in connection with OPAT. Two thirds of patients reported completion of the treatment. In the clinical follow up (average of 5.7 months), 96.6% of cases were declared free of infection. In one patient the infection persisted.OPAT is a safe and reliable therapeutic option for outpatients to continue parenteral antimicrobial treatment in joint infections. Due to increasing pressure on hospitals in terms of costs and capacity, this therapy offers an alternative to inpatient treatment. The indication for OPAT should be set individually, risk adjusted and not generalised for all patients. The outpatient sector needs financial and structural support for comprehensive roll-out of this treatment in Germany. A further focus should be on the prevention of periprosthetic joint infections. With the knowledge of the expected pathogens and the surgical resources, the standards should be adapted. The choice of the antibiotic should be specified and the interv","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"35-43"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141158739","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":"[Transtuberositary, Anterior Open Wedge High Tibial Osteotomy (TT-AOW-HTO) to Correct a Negative Slope].","authors":"Jörg Harrer, Felix Ferner, Christoph Lutter, Wolf Petersen, Mario Perl, Michael Simon","doi":"10.1055/a-2417-7957","DOIUrl":"10.1055/a-2417-7957","url":null,"abstract":"","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"91-93"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515736","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":"Evidence-based and Patient-centered Indication for Knee Arthroplasty - Update of the Guideline.","authors":"Jörg Lützner, Stefanie Deckert, Toni Lange, Anne Elisabeth Postler, Martin Aringer, Hendrik Berth, Hartmut Bork, Karsten E Dreinhöfer, Klaus-Peter Günther, Karl-Dieter Heller, Robert Hube, Stephan Kirschner, Bernd Kladny, Christian Kopkow, Rainer Sabatowski, Johannes Stoeve, Richard Wagner, Cornelia Lützner","doi":"10.1055/a-2288-7254","DOIUrl":"10.1055/a-2288-7254","url":null,"abstract":"<p><p>Knee arthroplasty is one of the most frequently performed operations in Germany, with approximately 170000 procedures per year. It is therefore essential that physicians should adhere to an appropriate, and patient-centered indication process. The updated guideline indication criteria for knee arthroplasty (EKIT-Knee) contain recommendations, which are based on current evidence and agreed upon by a broad consensus panel. For practical use, the checklist has also been updated.For this guideline update, a systematic literature research was conducted in order to analyse (inter-)national guidelines and systematic reviews focusing on osteoarthritis of the knee and knee arthroplasty, to answer clinically relevant questions on diagnostic, predictors of outcome, risk factors and contraindications.Knee arthroplasty should solely be performed in patients with radiologically proven moderate or severe osteoarthritis of the knee (Kellgren-Lawrence grade 3 or 4), after previous non-surgical treatment for at least three months, in patients with high subjective burden with regard to knee-related complaints and after exclusion of possible contraindications (infection, comorbidities, BMI ≥ 40 kg/m²). Modifiable risk factors (such as smoking, diabetes mellitus, anaemia) should be addressed and optimised in advance. After meeting current guideline indications, a shared decision-making process between patients and surgeons is recommended, in order to maintain high quality surgical management of patients with osteoarthritis of the knee.The update of the S2k-guideline was expanded to include unicondylar knee arthroplasty, the preoperative optimisation of modifiable risk factors was added and the main indication criteria were specified.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"79-86"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176903","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":"Correlation Analysis Between the Geriatric Nutritional Risk Index Hip Fracture in Male: Based on the National Health and Nutrition Examination Survey Database.","authors":"Fangfang Lan, Kuihong Jiang","doi":"10.1055/a-2504-4538","DOIUrl":"https://doi.org/10.1055/a-2504-4538","url":null,"abstract":"<p><p>Hip fractures (HFs) are common in elderly patients and are associated with high mortality rates and functional impairment. Malnutrition has been shown to negatively impact postoperative survival rates in HF patients. However, the relationship between the Geriatric Nutrition Risk Index (GNRI) and the risk of HF remains unclear. This study aims to evaluate the association between GNRI and HF risk, with a particular focus on the elderly male population.We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) for the periods 2007-2010, 2013-2014, and 2017-2018. Through multivariate regression analysis, we assessed the association between GNRI and HF and performed stratified and subgroup analyses to further explore this relationship. Additionally, we utilized restricted cubic splines (RCSs) to investigate the potential nonlinear relationship between GNRI and HF risk.The study found that gender significantly influenced the relationship between GNRI and HF (p for interaction = 0.002). In males, GNRI was significantly negatively associated with the risk of HF (OR < 1, p < 0.05). RCS analysis showed that the relationship between GNRI and HF risk in elderly males might be linearly negative. The critical threshold for GNRI was identified as 104.14, beyond which the risk of HF significantly decreased.This study demonstrates a linear negative correlation between GNRI and the risk of HF in elderly males, with a GNRI of 104.14 identified as the critical threshold for predicting the risk of hip fractures.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061924","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":"How Effective is Low-dose Radiotherapy (LD-RT) for Heberden's Osteoarthritis? An Analysis of the Current Literature.","authors":"Ute Schreiner, Helmut Huberti","doi":"10.1055/a-2489-5071","DOIUrl":"https://doi.org/10.1055/a-2489-5071","url":null,"abstract":"<p><p>Low-dose radiotherapy is an established treatment option for non-malignant skeletal disorders. It is used in the treatment of Heberden's osteoarthritis (HA), but the evidence of efficacy does not seem to be certain. This paper reviews current literature for scientific evidence of efficacy in the treatment of HA.The PubMed and Cochrane Library databases were searched for relevant publications.9 publications were identified that published data from 7 studies. Only one study was randomised, placebo-controlled and double-blinded. None of the studies exclusively investigated HA. The studies were all inhomogenous with regard to inclusion criteria, follow-up criteria, radiation mode and interpretation or treatment success. In the RCT, no difference was found between the verum and control groups.The study situation is currently weak. The researched publications are not sufficiently focused on the collective of Heberden's osteoarthritis and are generally too inhomogenous with regard to the criteria applied. Future targeted studies are therefore required to prove efficacy.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054657","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":"In Vitro Efficacy of Phage Therapy Against Common Biofilm-forming Pathogens in Orthopedics and Trauma Surgery.","authors":"Alberto Alfieri Zellner, Dieter Christian Wirtz, Frank Alexander Schildberg","doi":"10.1055/a-2436-7394","DOIUrl":"https://doi.org/10.1055/a-2436-7394","url":null,"abstract":"<p><p>Formation of biofilms by bacteria is a major challenge in a clinical setting. The importance of these biofilms increases in specialties where foreign bodies and prosthetic material are used. Orthopaedics is such a speciality and phage therapy could offer additional therapeutic options when dealing with biofilm infections.We conducted a systematic literature review using the PubMed database. We searched for phage activity against biofilms of the most common pathogens found in orthopaedics.The results of the systematic review were broken down into different categories and discussed accordingly. We concentrated on the time the biofilms were allowed to mature, and the surface they were grown on. In addition, we checked the efficacy of bacteriophages compared to antibiotics and when applied simultaneously with antibiotics. We also investigated the source of the phages, how they were tested for sensibility against the biofilms, as well the conditions (pH, temperature) under which they remained active and stable.The data suggests that the in vitro efficacy of phages does not change under a wide spectrum of temperature and pH. To further explore the use of bacteriophages in orthopaedics, we need further studies that test biofilms which matured for several weeks on surfaces that are common in arthroplasty and traumatology.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019441","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":"3D Printing as an Aid in Acetabular Defects Compared to Established Diagnostics - a Survey.","authors":"Mari Babasiz, Jonas Roos, Adnan Kasapovic, Robert Kaczmarczyk, Kristian Welle","doi":"10.1055/a-2486-9437","DOIUrl":"https://doi.org/10.1055/a-2486-9437","url":null,"abstract":"<p><p>The treatment of acetabular defects in revision arthroplasty is an increasing challenge. Different classifications have been introduced for preoperative planning to achieve the best possible result. 3D printing is a way to better visualize and understand these defects. The aim of this study was to facilitate classification, provide young doctors with a better understanding of complex defects, and ultimately improve preoperative planning and patient safety.The study was conducted at the 2022 BOUT congress, where health care professionals were provided with X-rays, a computed tomography (CT) scan, and a 3D print to classify acetabulums according to Paprosky and ADC. A questionnaire was administered to gather information on their familiarity with the classification systems and perception of 3D models in the clinic.The study involved 14 participants, mostly resident physicians, with some familiarity with the Paprosky and ADC classifications. The 3D printing method resulted in the highest rate of correct classifications for acetabular defects compared to X-ray and CT imaging. Participants found the 3D model useful for clinical applications and rated it higher than X-ray and CT imaging for classifying acetabular defects.Acetabular defects present a challenge in assessment, preoperative planning, and surgical management due to their complex anatomy. Overall, we were able to show that the use of a 3D model increases the accuracy in the classification of acetabular defects. The use of 3D printing in orthopedics and trauma surgery is showing more and more advantages and has opened up new methods for the education of medical students and young surgeons.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985418","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":"Comparison of Maximum Isometric Strength of the Hip Joint Abductor and Knee Joint Extensor Muscles between Knee Osteoarthritis Patients with and without Self-reported Instability.","authors":"Martin Alfuth, Alexander Stollenwerk, Jonas Klemp, Patrick René Diel","doi":"10.1055/a-2494-8497","DOIUrl":"https://doi.org/10.1055/a-2494-8497","url":null,"abstract":"<p><p>Patients with knee osteoarthritis (KOA) often have impaired muscle function of the weight-bearing muscles, particularly in the knee and hip joints. This can lead to a significant loss of strength and power and may play a role in the perceived instability of the knee joint. The purpose of this study was to compare the maximum isometric strength of the hip abductor and knee extensor muscles between patients with KOA with and without perceived instability.Nineteen patients with KOA participated in this cross-sectional study and were divided into two groups. The first group (n = 10; women = 4, men = 6, mean age = 67.4 ± standard deviation [SD] 6.4 years) consisted of patients with self-reported instability in the knee joint, and the second group (n = 9; women = 5, men = 4, mean age = 69.6 ± SD 6.7 years) consisted of patients without self-reported instability. Functional and activity limitations were quantified using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Maximum isometric strength of the hip abductors and knee extensors was measured using a belt-mounted handheld dynamometer and expressed as torque (Newton meters [Nm]) by multiplication with the determined lever arm. Torque was normalized to body weight and height.Patients with instability (median WOMAC score = 68) achieved a significantly lower mean torque in hip abduction than the patients without instability (median WOMAC score = 39) (p = 0.01; Cohen's d = 1.31). There was no significant difference in knee extension torque between the groups (p = 0.202; Cohen's d = 0.58).KOA patients with instability were able to develop significantly lower hip abductor strength than those without instability, suggesting that targeted strength training of this muscle group may be important for this group of patients.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960992","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":"Degenerative Shoulder Diseases: Shoulder Injuries, Epidemiology, ICD10, Coding.","authors":"Jasmin Azarderakhsh, Sebastian Siebenlist, Olaf Schneider, Frauke Beck, Johannes Flechtenmacher","doi":"10.1055/a-2437-0981","DOIUrl":"https://doi.org/10.1055/a-2437-0981","url":null,"abstract":"<p><p>Despite the increasing number of cases in recent years, there are currently no data available on the disease and care situation for degenerative shoulder diseases and shoulder injuries, as well as on the ICD-10 coding behaviour of the treating physicians. This paper presents, for the first time, a descriptive analysis based on billing data from 2022 of coded shoulder diseases affecting 4.9 million insured individuals of a statutory health insurance in Baden-Württemberg. The study distinguishes between accident-related shoulder injuries and diseases caused by degenerative changes in the shoulder. In ICD-10 coding, a distinction is made between specific codes (using key numbers of the underlying disease) and non-specific codes that only encode the symptom. According to billing data, women were slightly more affected by shoulder diseases than men (7.3% vs. 6.9%), with women being significantly older on average at the time of diagnosis. For fractures, the gender difference averaged 20 years. The analysis of coding behaviour revealed that general practitioners coded non-specific shoulder diseases, such as joint pain or impingement syndrome, more frequently than other specialist groups. The analysis of the claiming of benefits showed that only one-third of the evaluated patients received imaging, and only 40% received a prescription for physiotherapy due to a shoulder diagnosis. The investigation of comorbidities found that patients with degenerative shoulder diseases were more frequently affected by metabolic diseases and hypertension than those without shoulder diseases. These results regarding the frequency of coded shoulder diseases in various health sectors demonstrate their importance in the Federal Republic of Germany for both men and women. In summary, the evaluations-despite methodological limitations-suggest that there may be potential for more specific coding in the diagnosis and prescription of therapeutic measures. A more precise understanding of the actual cause of claiming health services can be helpful for the provider to initiate specific diagnostic and therapeutic measures and identify a potentially increased need for care within the health system in the Federal Republic of Germany.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142804243","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":"[Correction: Return to Sports After Arthroplasty].","authors":"Andreas M Halder, Corinna Di Michele","doi":"10.1055/a-2494-7677","DOIUrl":"https://doi.org/10.1055/a-2494-7677","url":null,"abstract":"","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782240","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}