Zeitschrift fur Orthopadie und Unfallchirurgie最新文献

{"title":"Bearing Materials in Hip Arthroplasty - What Do the Arthroplasty Registries Say?","authors":"Michael M Morlock","doi":"10.1055/a-2785-6312","DOIUrl":"10.1055/a-2785-6312","url":null,"abstract":"<p><strong>Abstract: </strong>In the early days of artificial joint replacement, the choice of bearing material was a decisive factor for the long-term success of an artificial joint. Through intensive research and development over more than three decades, the materials and their processing and sterilisation have been continuously improved. The materials used today all offer a high degree of safety and durability. As a result - In combination with the strict approval guidelines - the choice of a specific material is no longer as important as it was when artificial joint replacement was first introduced.This article focuses on the results of primary hip arthroplasty in eight established registries. In all of the registries examined, ceramic-ceramic bearings and bearings with cross-linked polyethylene cups or liners in combination with heads made of all common head materials, show very good long-term results with a low revision risk. The choice of head size varies considerably in the individual registries. In America, large (36 mm diameter) or very large ceramic heads (over 36 mm) tend to be used, even though the country's own registry warns against very large heads. In Australia, also mainly large heads are used. However, recent analyses indicate that large heads (36 mm) have a higher risk of revision in the long term. In Scandinavian countries, the Netherlands, and New Zealand, smaller heads (32 mm diameter) tend to be predominantly used. The situation in the other countries whose registries were analysed lies somewhere in between, with each country having its own special features. In England, the results of surface replacement are being closely monitored. The results are inconspicuous for the recommended patient population. The further performance of the newly introduced ceramic surface replacement is being followed with great interest. In Germany, the proportion of heads with a diameter of 36 mm is growing continuously, which should be critically questioned when considering the results from Australia. Ceramic-ceramic bearings are being used less and less frequently, even though they perform similarly well overall to hard-soft bearings and even better in some settings. Switzerland is the only country where this bearing still accounts for more than 10 % of treatments. Sweden no longer differentiates between materials in its annual report, but instead provides a ranking of the 74 Swedish clinics in terms of revision risk. In the Netherlands, the 32 mm head diameter is still the most frequently chosen. The German registry has the highest granularity of all registries. The use of dual mobility systems in primary endoprosthetics varies greatly between registries.Despite the differences in head materials and diameters, the results for hip replacements using HXLPE or ceramic cup inlays, show a comparable overall survival rate of approximately 96 % to 98 % after 5 years. What is noteworthy is the approach taken by the Swedish mother of all endoprosthesi","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"321-330"},"PeriodicalIF":0.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147392261","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":"Geriatric Trauma Centres - Effects on Quality of Care?","authors":"Bastian Pass, Carsten Schoeneberg, Carl Neuerburg","doi":"10.1055/a-2778-1819","DOIUrl":"10.1055/a-2778-1819","url":null,"abstract":"<p><strong>Abstract: </strong>With the aging population in Germany, the incidence of fragility fractures is increasing significantly. To improve the care of these patients, geriatric trauma centres (ATZ-DGU) have been established by the German Society for Trauma Surgery (DGU). These centres differ from pure orthogeriatric co-management (OGCM) by more comprehensive requirements regarding process quality, outcome quality, prevention, and continuity of care.The evidence is strongest for hip fractures: studies demonstrate significantly reduced mortality, improved mobility, and increased prescription rates of osteoporosis medication in ATZs. For other fracture types-such as distal radius, pelvic ring, spinal, and proximal humerus fractures-the evidence base is weaker and more heterogeneous. Although improvements in process indicators, including early mobilisation, complication detection, and osteoporosis treatment, have been observed, a clear mortality benefit has generally not been confirmed.Health insurance claims data suggest advantages of both OGCM and ATZs, such as lower rates of nursing home admission, longer fracture-free intervals, and reduced rehospitalisation rates. At the same time, higher costs and longer hospital stays are reported. Overall, ATZs demonstrate clear qualitative improvements in care, although there are no robust prospective multicentre studies to confirm patient-relevant outcomes beyond hip fractures.Geriatric trauma centres improve quality of care primarily through structured processes, prevention, and interdisciplinary collaboration. A proven mortality benefit has so far been demonstrated unequivocally only for hip fractures. Further research is needed for other fracture types, particularly to delineate the differences between OGCM and certified ATZs.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"315-320"},"PeriodicalIF":0.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146109571","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":"„Bunter Blumenstrauß“ an wissenschaftlicher Evidenz.","authors":"Dieter C Wirtz, Ulrich Stöckle","doi":"10.1055/a-2878-6445","DOIUrl":"https://doi.org/10.1055/a-2878-6445","url":null,"abstract":"","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":"164 4","pages":"309-310"},"PeriodicalIF":0.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671777","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":"Clinical Long-term Outcomes after Modified Pemberton Acetabuloplasty for Developmental Dysplasia of the Hip: a 25-Year Follow-up.","authors":"Pavlos Sampatakakis, Christian Lüring","doi":"10.1055/a-2775-3706","DOIUrl":"10.1055/a-2775-3706","url":null,"abstract":"<p><strong>Background: </strong>Developmental dysplasia of the hip (DDH) is among the most common congenital musculoskeletal disorders and may lead to early hip osteoarthritis if left untreated. Modified Pemberton acetabuloplasty is an established, growth-preserving osteotomy technique for surgical correction in childhood. However, robust clinical long-term outcomes with follow-up periods exceeding two decades have not yet been published. The aim of this study was to retrospectively evaluate functional and patient-reported outcomes after an average follow-up of 25.6 years.</p><p><strong>Methods: </strong>In this monocentric retrospective cohort study, 63 patients (92 hips) were included from an original cohort of 331 patients with 507 operated hips who had undergone modified Pemberton acetabuloplasty between 1990 and 1995. In 2018, clinical follow-up was performed in 54 patients; all participants completed standardised questionnaires, including the Harris Hip Score (HHS), WOMAC, and EQ-5D. Data analysis was descriptive.</p><p><strong>Results: </strong>The mean follow-up period was 25.6 years. The average HHS was 95.8 points, the mean WOMAC index 7.2 points, and the EQ-5D-VAS 89.3/100. A total of 81% of patients were free of symptoms, and 83.3% achieved excellent functional results. Overall, 96.8% rated the surgical outcome as good or very good, and 92% would choose to undergo the procedure again. No patient required total hip arthroplasty. No major postoperative complications occurred.</p><p><strong>Conclusion: </strong>Modified Pemberton acetabuloplasty demonstrates stable functional outcomes, low symptom levels, and high health-related quality of life more than 25 years after surgery. The very high patient satisfaction and the absence of secondary procedures underscore the long-term clinical effectiveness of this growth-preserving technique.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"331-338"},"PeriodicalIF":0.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146196324","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":"Chronic Hamstring Tendon Ruptures.","authors":"Christiane Kruppa, Maria A Bernstorff, Silvia J Hufnagel, Thomas A Schildhauer","doi":"10.1055/a-2803-6608","DOIUrl":"10.1055/a-2803-6608","url":null,"abstract":"<p><strong>Abstract: </strong>Hamstring tendon injuries are common, accounting for up to 30% of all injuries in athletes. Delayed diagnosis, failed initial conservative therapy, or repetitive injuries can lead to chronicity. This, in turn, is associated with persistent pain, loss of strength, and potentially neurological symptoms, often resulting in surgical intervention. Current literature is heterogeneous and focuses primarily on surgical treatment. Direct anchor suture repairs are described, as well as restoration of continuity using allograft or autograft interposition. Clinical outcomes are difficult to compare due to differing definitions, approaches, assessments, and postoperative treatments. However, functional results suggest that surgical treatment can achieve satisfactory outcomes, often improving the postoperative condition compared to the preoperative state. This applies to activities of daily living as well as the return to athletic activity. The latter, however, is expected to take longer than with the surgical treatment of acute injuries and is not guaranteed in all cases. Due to the chronic condition with adhesions of scar tissue around the tendon and the sciatic nerve, the rate of postoperative complications, particularly neurological ones, as well as the rate of re-ruptures, is increased. Individualized decision-making and planning of the surgical approach, taking into account the injury and patient's age, subjective and objective complaints including neurological symptoms, imaging findings, and functional demands, are necessary to achieve a satisfactory outcome.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"365-375"},"PeriodicalIF":0.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147701328","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 Epidural Fibrosis after Lumbar Disc Herniation Surgery: Our Experience.","authors":"Keyvan Mostofi, Morad Peyravi, Ali Shirbacheh, Kamran Shirbache","doi":"10.1055/a-2778-1914","DOIUrl":"10.1055/a-2778-1914","url":null,"abstract":"<p><strong>Purpose: </strong>Postoperative epidural fibrosis (PEF) is a significant complication following lumbar disc herniation surgery. It is characterised by the formation of non-physiological scar tissue that may lead to recurrent radicular pain and contribute to failed back surgery syndrome (FBSS). Despite its clinical relevance, the exact incidence and effective management strategies for LPEF have not been adequately quantified in the existing literature.</p><p><strong>Methods: </strong>This study analyses a cohort of 2673 patients who underwent surgical intervention for herniated lumbar discs between September 2010 and August 2023, focusing on 1974 patients monitored for up to one year post surgery.</p><p><strong>Results: </strong>The study reports on the incidence of postoperative fibrosis, with 97 patients diagnosed with this condition. Over 61% of these patients experienced inadequate relief following various treatment modalities, including epidural steroid injections and anti-neuropathic medications.</p><p><strong>Conclusion: </strong>The findings indicate that while corticosteroid injections provided relief for a minority (23.61%) of patients, a substantial proportion continued to experience pain, necessitating referral to pain management centres. This research contributes to the understanding of LPEF's impact on patient outcomes and underscores the need for further investigation into effective preventive and therapeutic strategies during postoperative care.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"339-346"},"PeriodicalIF":0.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146095424","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":"Adolescent Idiopathic Scoliosis - Current S2k AWMF Guideline.","authors":"Kiril Mladenov, Bernd Wiedenhöfer, Tobias L Schulte","doi":"10.1055/a-2766-4986","DOIUrl":"10.1055/a-2766-4986","url":null,"abstract":"<p><strong>Abstract: </strong>The adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity of unknown etiology and onset between 10 and 18 years of life. The current AWMF S2k guideline was elaborated with participation of the specialty associations in Germany aiming at improving and unifying the standard of care in AIS patients. The purpose of this review is to present a compact synopsis of the results of the expert consensus.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":"376-380"},"PeriodicalIF":0.9,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069491","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":"Gender Inequality in Surgery - a Narrative Review.","authors":"Lena Walfisch, Alice Wermke, Christina Pempe, Andreas Roth","doi":"10.1055/a-2896-7725","DOIUrl":"https://doi.org/10.1055/a-2896-7725","url":null,"abstract":"<p><strong>Abstract: </strong>This narrative review summarises structural, cultural, psychosocial, and organisational factors associated with gender-specific disadvantages in surgical training and career progression. The analysis highlights differences in surgical exposure, access to mentoring and sponsorship, hierarchical power structures, work-family compatibility, and the conditions of institutional framework. The available evidence suggests that unequal career trajectories in surgery are not solely attributable to individual choices, but are shaped by modifiable structural conditions. Transparent training structures, documented allocation processes, structured support measures, and family-compatible training models may help promote more equitable career opportunities.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148633272","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: Waste Management and Recycling in the Operating Theatre - A Sustainability-oriented Approach.","authors":"Annika Steinmeier, Nicole Feder, Oliver Birkelbach, Robert Mahlow, Ulrich Stöckle, Robert Karl Zahn","doi":"10.1055/a-2919-2878","DOIUrl":"10.1055/a-2919-2878","url":null,"abstract":"","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551989","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":"Anterior Cruciate Ligament Graft Failure: An Update on Failure Analysis, Risk Factors, and Surgical Strategies.","authors":"Anja M Wackerle, Sebastian Siebenlist, Knut Beitzel, Andrea Achtnich","doi":"10.1055/a-2862-8960","DOIUrl":"https://doi.org/10.1055/a-2862-8960","url":null,"abstract":"<p><strong>Abstract: </strong>Revision reconstruction of the anterior cruciate ligament (ACL) presents a considerable challenge - due to its technical complexity, variable clinical presentations, and the interplay of multiple risk factors and concomitant pathologies. Optimal treatment requires a thorough analysis of the causes of failure. The preoperative evaluation should include full-leg radiographs, lateral X-rays of the entire lower leg, magnetic resonance imaging (MRI) to assess soft tissue pathologies, and computed tomography (CT) to evaluate tunnel position and tunnel widening. Graft failure is usually multifactorial and may be related to technical, biological, demographic, or biomechanical causes. Technical issues include malpositioning of the tunnels, unaddressed primary instabilities, fixation failure, or inadequate graft tensioning. Biological factors comprise impaired graft incorporation and infections. Biomechanical and anatomical factors-such as increased posterior tibial slope (PTS), coronal plane malalignment, or persistent peripheral or rotational instabilities-must also be recognised and addressed. For this purpose, additional surgical techniques are available - such as slope-reducing osteotomy, varus and valgus osteotomies, as well as lateral extra-articular tenodesis. A successful revision ACL reconstruction is based on a comprehensive analysis of the underlying causes, individually tailored surgical strategies, correction of modifiable predisposing factors, and realistic patient counseling. These measures are crucial for achieving good functional outcomes and long-term stability, while enabling a safe return to the desired level of activity without recurrent injury.</p>","PeriodicalId":94274,"journal":{"name":"Zeitschrift fur Orthopadie und Unfallchirurgie","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552005","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}