Zeitschrift für Orthopädie und Unfallchirurgie
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With regard to total replacement of the hip, revision arthroplasty poses a challenge especially for younger patients. In spite of substantial improvements, new materials and operation techniques are still not able to prevent a shorter running life of prostheses in this group. The present work aims at evaluating clinical and radiological mid-term results of the femoral neck prosthesis CUT (ESKA Orthodynamics Lübeck) to answer the question of whether this implant is recommendable for younger patients. ⋯ This study demonstrates the CUT prosthesis as a bone-preserving prosthesis with good functional and radiological results and therefore as an alternative joint replacement in younger patients.
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In spite of the cumulating evidence for the prognostic relevance of illness perceptions regarding the course of disease and recovery of hip and knee joint patients, there are still no studies that examine the effects of these perceptions on postoperative functioning as assessed by clinical ratings. The aim of this inception cohort study was to describe the course of functioning following a hip or knee joint replacement over a period of one year and to analyse moderator-type effects of illness perceptions in order to develop strategies for preoperative counselling and postoperative rehabilitation. ⋯ The results confirmed the prognostic relevance of illness perceptions for the functional outcome and indicate the importance of preoperative counselling and the potential benefit of patient-oriented education that is aimed at modifying illness perceptions.
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Comparative Study
[Medium-term results of anatomic straight-shaft IMAGE implantation in primary hip joint endoprosthetics--a prospective study].
The IMAGE prosthesis was developed with the objective of proximal load induction to avoid stress shielding and proximal bone resorption. In this study patients were followed clinically and radiologically with a special emphasis on osteointegration of the shaft in the proximal and distal regions. In addition, the reconstruction of the bony geometry of the proximal humerus was investigated. ⋯ Proximal stress transmission can be supported and the danger of stress shielding can be reduced by means of an appropriate design of a prosthetic stem. Distal corticoid hypertrophy was found in only 19% of the patients with the prosthesis model investigated as compared to 60% having prostheses with distal femoral anchoring. The medium-term clinical results are excellent, so that the shaft appears suitable for primary as well as secondary osteoarthritis of the hip joint.
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Precise placement of the sustentaculum tali screw is essential for fixation of calcaneus fractures to achieve the best fixation strength. In the clinical practice, this procedure is demanding due to the complex anatomic configuration of the calcaneus and the limited visualisation in the intraoperative fluoroscopic images. The aim of this study was an evaluation of the accuracy for the sustentaculum tali screw placement by using different navigation procedures compared to the standard procedure. The different navigation specific workflows were evaluated and the feasibility of each procedure proven in clinical applications. ⋯ Navigation procedures seem to be helpful for the precise placement of sustentaculum tali screws in cases of operative calcaneus fracture fixation. The kind of application to be used depends on the infrastructure of the department and the navigation-experience of the operating room team. Whereas the fluoro-free procedure is intuitive in use, the 2D-navigation does not justify the extra efforts. The 3D-procedure is the recommended application for surgeons familiar with navigation, providing the best orientation due to the slice image visualisation in all three dimensions.
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Volar locked plate fixation of distal radius fractures has become an established procedure in the past decade, although reports of flexor tendon injuries due to volar plating have been increasing. The aim of the present study is to identify the risk factors which produce irritations of flexor tendons using the locking palmar 3.5 mm T-plate, with special emphasis placed on the watershed line and the pronator quadratus muscle. ⋯ Stabilisation of distal radius fractures with dorsal and volar displacement by the locked palmar 3.5 mm T-plate produces positive results. A careful reconstruction of the pronator quadratus is more important than respecting the watershed line in that it achieves muscular coverage, and thus provides a greater distance of the plate to the tendon compartment. We recommend sonography after bony healing to identify functional plate prominence or tendon irritations under functional conditions (dorsal wrist flexion) and, if necessary, plate removal. Further systematic sonographic examinations should be undertaken including other locked plate systems.