Zeitschrift für Orthopädie und Unfallchirurgie
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Clinical Trial
[Metaphyseal fitting short-stem prosthesis - preliminary results of a prospective single-surgeon series].
Conventional uncemented femoral stems provide good long-term fixation in patients with a wide range of clinical function. However, preservation of bone stock, and minimally invasive approaches have led to exploration into various other implant designs. Short-stem prosthesis focusing on a stable metaphyseal fit have emerged to address these challenges in total hip arthroplasty. The purpose of this study was to evaluate the clinical and radiological results of a newly developed short-stem hip prosthesis AIDA® in context of a single surgeon study. ⋯ The newly developed "AIDA short stem" is a promising hip implant for the young and active patient with osteoarthritis of the hip. The short-term results are encouraging, but nevertheless mid- and long-term results must be further observed on a prospective basis as part of this collective study.
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Only 84 % of patients are satisfied with the operative result after total knee arthroplasty. A relevant reason is non-fulfilled preoperative expectations. Non-fulfilled preoperative expectations cannot be influenced postoperatively. So a knowledge of preoperative expectations and their influential factors is essential. The following study analyses the expectations and influential factors in patients before total knee arthroplasty in Germany. ⋯ For the first time this study determines expectations and influential factors of patients who undergo a total knee replacement in Germany. By knowing the interaction of satisfaction and preoperative expectations, this knowledge is an essential condition to increase satisfaction after total knee replacement in the German population. Collecting the preoperative expectations of patients has to be an indispensable feature of the clinical practice in orthopaedic surgery.
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Minimally invasive treatment of diaphyseal femur fractures (DFF) with closed reduction and intramedullary nailing is a well established procedure. However, a femoral malrotation after intramedullary nailing is considered to be a substantial problem. Studies have described femoral malrotation (FMR) in 17-35 % after this procedure. Computed tomography (CT) of both femora is accepted as an objective, reproducible measurement method to determine a postoperative femoral malrotation. An anatomic reposition of the centreline of the femur remains of high importance since a malrotation > 15° can lead to a significant limitation of the range of motion (ROM) and to clinical symptomatic constraints. ⋯ In spite of diligent attendance to the femoral torsion intraoperatively in DFF a significant femoral malrotation may result after closed reduction and intramedullary nailing. To prevent a limitation of ROM and clinical constraints a routinely performed postoperative CT scan with a adequate surgical correction is recommended.
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Even though arthroplasty of the ankle joint is considered to be an established procedure, only about 1,300 endoprostheses are implanted in Germany annually. Arthrodeses of the ankle joint are performed almost three times more often. This may be due to the availability of the procedure - more than twice as many providers perform arthrodesis - as well as the postulated high frequency of revision procedures of arthroplasties in the literature. In those publications, however, there is often no clear differentiation between revision surgery with exchange of components, subsequent interventions due to complications and subsequent surgery not associated with complications. The German Orthopaedic Foot and Ankle Association's (D. A. F.) registry for total ankle replacement collects data pertaining to perioperative complications as well as cause, nature and extent of the subsequent interventions, and postoperative patient satisfaction. ⋯ Covering less than 10 % of the approximately 240 providers in Germany and approximately 12 % of the annually implanted total ankle-replacements, the D. A. F.-register is still far from being seen as a national registry. Nevertheless, geographical coverage and inclusion of "high-" (more than 100 total ankle replacements a year) and "low-volume surgeons" (less than 5 total ankle replacements a year) make the register representative for Germany. The registry data show that the number of subsequent interventions and in particular the "true revision" procedures are markedly lower than the 20 % often postulated in the literature. In addition, a high level of patient satisfaction over the short and medium term is recorded. From the perspective of the authors, these results indicate that total ankle arthroplasty - given a correct indication and appropriate selection of patients - is not inferior to an ankle arthrodesis concerning patients' satisfaction and function. First valid survival rates can be expected about 10 years after the register's start.