[Sonographic screening of the newborn hip at the university hospital Marburg--a long-run analysis]. / Sonografisches Screening der Neugeborenenhüfte am Universitätsklinikum Marburg--eine Langzeitanalyse.

BACKGROUND: Since 1985 the hips of the newborns have been sonographically screened at the University Hospital Marburg by staff of the Orthopaedic Department. This study was conducted to collect data on the local incidence of DDH (developmental dysplasia of the hip). Moreover, the diagnostic findings were checked critically to detect weak points. Another aim was to analyse the influence of investigators' experience on the treatment recommendation. MATERIAL AND METHODS: In a retrospective study, 18 247 hip sonograms in a treatment period from 1985 to 2009 were analysed. The following parameters were evaluated: perinatal incidents (e.g., breech presentation, Caesarean section, premature delivery), orthopaedic findings (e.g., club foot, limitation of hip abduction). Bony roof, superior bony rim and cartilaginous roof were analysed; α- and ß-angles and hip type according to Graf were documented. Comparisons between variables were calculated by means of adequate statistic tests. χ(2)-values and coefficients of correlation were used to detect significance. RESULTS: All in all 55 physicians of our Orthopaedic Department conducted 350 measurements on average (min. 1; max. 1993). Accuracy of documentation improved over time. In particular in the beginning of the screening, the hip angles according to Graf were not completely determined and sonograms were classified by "visual diagnosis". The ß-angle was not measured at the outset. In the course of time we measured a decrease of the diagnosis hip type II a according to Graf. In the years 1985-1989 more than 40 % of the hips were described as physiologically immature. We evaluated a numerical regression of hip type II a to 16 % in time period 1990-1994 and 9 % in time period 2005-2009. There was a significant correlation between breech presentation and decentering and eccentric hips. Inexperienced physicians recommend more often therapeutic interventions (p ≤ 0.01). Treatment of hip type II a according to Graf was inconsistent over time. CONCLUSION: This study demonstrates the necessity of standardised hip sonography. Treatment according to measured hip type should be concise. Training programmes both for instructors and medical assistant staff is mandatory. "Bedside teaching" is not constructive.

[Paediatric hip sonography: current status at German university hospitals]. / Sonographie der Säuglingshüfte: Aktueller Status an den deutschen Universitätskliniken.

BACKGROUND: This study was conducted to evaluate the current status of pediatric hip sonography at German university hospitals. MATERIAL AND METHODS: A questionnaire was sent to all heads of orthopedic departments in Germany. They were asked to give details of the technique and instrumentation used for hip ultrasound examination, local organization of consultation and options for advanced training of students and staff. RESULTS: The return rate of the questionnaires was 93.9 %. Pediatric hip ultrasonography was performed at every university hospital by staff of the orthopedic and trauma departments (n = 31, 100 %). A well-established tradition of teaching both medical students and physicians on this topic was reported by many departments. Courses with a focus on pediatric hip sonography were organized in 25.8 % of the German university hospitals. In the majority of the responding orthopedic and trauma departments a 7.5 MHz linear transducer for ultrasound examination (93.5 %), a foot switch for rapid freezing of the ultrasound image (93.5 %) and a cradle for positioning the infant (100 %) were used. A guided probe device recommended by Graf was only used in 35.5 % of the departments. Evaluation of the sonograms was performed in 19 of the clinics (61.3 %) in the classical way on printed paper strips. CONCLUSIONS: This survey documented the high importance of pediatric hip sonography in German university hospitals. Quality controls in the orthopedic departments are carried out internally. For this reason both the implementation of standardized training courses and the schooling of well-trained instructors are mandatory.

NCB-plating in the treatment of geriatric and periprosthetic femoral fractures.

BACKGROUND: The aim of this study is the presentation of the polyaxial locking NCB-plate in the treatment of femoral fractures, especially in elderly patients and in proximity of a prosthetic implant. The reduction and fixation of these fractures is a challenging surgical procedure with high complication rates reported up to 40%. PATIENTS AND METHODS: A total of 72 patients with femoral fractures had polyaxial locking plate osteosynthesis. Indications included fractures of the shaft and around an implant. Concerning surgical procedures, three different standardized techniques were performed: (1) minimally invasive with percutaneous distal insertion using a targeting device; (2) mini-open with additional cerclage wire via the same approach and (3) a conventional open reduction and internal fixation. Data collection included intraoperative data and early complications at 6, 24 and 52 weeks. Fifty-two patients had an implant or prosthesis in situ. Thirty-three patients were treated by technique (1), 32 patients had mini-open surgery and seven patients conventional open surgery. RESULTS: Thirty-nine patients attended clinical follow-up after 52 weeks. Twenty-two patients were interviewed by telephone, two were untraceable and nine patients had died. Bony consolidation without secondary loss of reduction was confirmed after 52 weeks in all patients but two. Plate breakage occurred in these two at 25 and 31 weeks after surgery due to non-union. Implant related complications (17% in total) lead to surgical revision in five other cases: two deep wound infections as well as three minor revisions. When itemizing complications according to surgical technique used, most major complications occurred following open surgery. CONCLUSION: The availability of polyaxial locking implants widened the range of indications for plate fixation in femoral fractures. The advantages of the polyaxial locking implant combined with minimally invasive surgical technique contribute to successful management of this population category. Early revision rate is noticeably lower compared to similar procedures. LEVEL OF EVIDENCE: IV retrospective series.

[Measurement on printed paper strips or on the ultrasound device with computer assistance - which technique is more accurate in paediatric hip ultrasound?]. / Ausmessung auf Papier oder computergestützt am Ultraschallgerät - Welches Verfahren ist genauer in der Sonografie der Säuglingshüfte?

AIM: Two different measurement techniques of ultrasonograms of the infant hip were evaluated with respect to reproducibility of the Graf classification and variation of α- and ß-angles. MATERIAL AND METHODS: In a cross-sectional, blinded study, the hips of 207 consecutive newborn babies (101 male; 106 female) were sonographically screened at an average of 2.64 days after birth. Each hip was measured twice by three investigators with different levels of experience - a paediatric orthopaedic surgeon, a senior surgeon and a trained medical student. A mobile ultrasound system (SONOLINE G60S®, Siemens, Erlangen, Germany), equipped with a 7.5 MHz linear transducer, was used. Both hip joints were measured twice by all three investigators. The measurement was performed 6-8 weeks later in a blinded manner. The sonograms were initially printed out on high-quality paper strips and measured by pencil, ruler and goniometer. Finally, each investigator evaluated the same sonograms computer-assisted, using the trackball and dashboard of the ultrasound system. RESULTS: Concerning intraobserver reliability, we observed a significant reduction of variation both for α- and ß-angles in favour of the classic measurement on printed strips (p < 0.05). The interobserver calculation also detected a trend for higher angle variation when the angles were measured electronically. The reproducibility of Graf classification was not influenced by the kind of measurement technique. The outcome was not affected by investigator's level of experience (p > 0.05). CONCLUSIONS: This study demonstrated considerable advantages for the classic measurement of paediatric hip ultrasonograms with pencil and goniometer on printed paper strips compared to computer-aided measurement concerning variation of α- and ß-angles.

[Current Diagnostics and Treatment of FAI in Germany]. / Aktueller Stand der Behandlung des FAI in Deutschland.

AIM: Femoroacetabular impingement (FAI) is a recently proposed mechanical concept for the development of osteoarthritis of the hip. Aim of this nationwide survey is the description of the current status of diagnostics and therapy of FAI in Germany. MATERIAL AND METHODS: All orthopedic and traumatological hospitals listed in the "list of German hospitals 2006" were invited via e-mail to take part in this anonymous survey. RESULTS: The questionnaire was answered by 682 departments (50.5 %). 98 (14.3 %) of these departments treated FAI in 2007. CONCLUSION: In Germany, diagnostics and treatment of FAI were performed inconsistently in a small number of specialized hospitals.

Expression of vascular endothelial growth factor on chondrocytes increases with osteoarthritis - an animal experimental investigation.

OBJECTIVE: To evaluate the expression of VEGF by chondrocytes of hyaline cartilage during the course of osteoarthritis (OA). METHODS: In 12 white New Zealand rabbits the anterior cruciate ligament (ACL) was resected to create an anterior instability of the knee. In 12 control rabbits only a sham operation without resection of the ACL was done. Four animals of each group were killed at 3, 6, and 12 weeks. The load bearing area was evaluated histologically according to Mankin and by immunostaining for VEGF. RESULTS: In the experimental group, histological grades of OA showed a positive linear correlation with the time after surgery. Immunostaining showed an increased expression of VEGF in the control group after 3 weeks, which dropped to normal after 6 weeks. There was no difference in the progression of OA between control and experimental groups after 3 weeks, but a significant difference was seen after 6 (p=0,01) and 12 (p=0,05) weeks. A significant positive correlation between VEGF expression and the histological grade of OA was found (r = 0.767; p<0.01). CONCLUSIONS: An increase of VEGF expressing chondrocytes occurs during time course of OA.

Incorporation of osteoblasts (MG63) into 3D nanofibre matrices by simultaneous electrospinning and spraying in bone tissue engineering.

Nanofibre scaffolds are suitable tools for bone tissue engineering. Mimicking the extracellular matrix, they allow for cell growth and differentiation. However, in large 3D scaffolds, uniform cell colonisation presents an unsolved problem. Our aim was to design and analyse a method of colonising nanofibre scaffolds, combining electrospinning of fibres and electrospraying of cells, to determine its impact on cell survival, growth, and gene expression. The osteoblast-like cell line MG63 was suspended in medium and electrosprayed into growing scaffolds of poly-(l-lactic acid) (PLLA) or PLLA/Col-I blend nanofibres. Fluorescein diacetate (FDA) staining was used to determine survival and growth over a 22 d culture period. Expression of osteocalcin (OC) and type I collagen (Col-I) genes was determined by real time PCR. Fluorescence microscopy was used to analyse Col-I and OC deposition, as well as cell densities. While spraying distance and cell density in the spraying solution influenced survival and cell density, the combination of electrospinning and electrospraying did not negatively influence the maintenance of the osteoblast phenotype. Furthermore, VEGF induction in response to hypoxia was not suppressed, but modulated by polymer composition. Therefore, simultaneous electrospinning and electrospraying is a suitable tool in producing nanofibre based 3D cell seeded scaffolds.

Influence of hepatocyte growth factor on autologous osteochondral transplants in an animal model.

PURPOSE: Several studies have investigated the influence of different growth factors on hyaline cartilage regeneration. In a rabbit model, hepatocyte growth factor (HGF) was proven to increase the amount of hyaline-like chondrocytes in a mixed fibro-cartilaginous regenerate of small defects. The aim of the current study was to evaluate whether intra-articular administration of HGF influences the ingrowth of osteochondral grafts in a sheep model. TYPE OF STUDY: Animal experiment. METHODS: Both knee joints of eight sheep were opened surgically and osteochondral grafts were harvested and simultaneously transplanted to the opposite condyle of the same joint. The sheep were divided into two groups of four sheep, resulting in 16 grafts per group. In one group, HGF was administered by bilateral intra-articular injections given three times a week for 4 weeks. The control group received isotonic sodium chloride injections. The animals were killed after 3 months. RESULTS: Histological evaluation showed a complete ingrowth of the osseous part of the osteochondral grafts. A healing or ingrowth at the level of the cartilage could not be observed. Histological evaluation of the transplanted grafts according to the modified Mankin score revealed less degeneration in the cartilage of the HGF group, as compared to the control group. In the HGF group, less cloning of chondrocytes and less irregularities of the articular surface were observed. Importantly, no deleterious effects, such as osteophyte formation, cartilage thickening or synovial proliferation, were found. CONCLUSION: HGF positively influenced the cellularity of the transplanted osteochondral graft, but could not diminish the fissures in the marginal zone of the grafts. CLINICAL RELEVANCE: Marginal zone fissures and degeneration in the absence of HGF may undermine long-term results of autologous osteochondral grafts.

Increased glenohumeral translation and biceps load after SLAP lesions with potential influence on glenohumeral chondral lesions: a biomechanical study on human cadavers.

PURPOSE: The aim of the study was to evaluate the stabilizing function of the long head of biceps tendon (LHB) and its tension, both without and with the presence of SLAP lesion to analyze a potentially occurring humeral chondral print of LHB with consecutive glenohumeral chondral lesions in SLAP lesions. METHODS: Testings were performed on 21 fresh frozen human cadaver shoulders with intact shoulder girdle by a 5 axis industrial robot with a force/moment sensor and 20 N joint compression, 50 N force in anterior, posterior, anterosuperior, and anteroinferior direction, and 0°, 30°, 60° of abduction. LHB was connected over a force measuring sensor with 5 N and 25 N preload. A type IIC SLAP lesion was created arthroscopically. RESULTS: A significant increase in anterior and anteroinferior translation was evaluated, whereas the LHB tension increased significantly in at most anterior and anterosuperior direction. The highest increase in translation and LHB tension after SLAP lesion was measured in anterior translation in at most 60° of abduction. The glenohumeral translation was significantly higher in SLAP lesions without LHB tenotomy than after isolated LHB tenotomy. CONCLUSIONS: SLAP lesions lead to increased glenohumeral translation and concurrently LHB tension and load in at most anterior direction. The increased anterior glenohumeral instability and the increased LHB load pressing on the humeral head might cause glenohumeral chondral lesions with a typical chondral print-like lesion on the humeral head underneath the LHB.

[Anterior shoulder instability--the current situation]. / Vordere Schulterinstabilität--Aktueller Stand.

AIM: The aim of the study was to survey the current state of the conservative and operative treatment of anterior shoulder instability and its rehabilitation in German hospitals. METHODS: A previously evaluated online questionnaire was sent out to all German hospitals with orthopaedic or trauma surgery departments. The Federal Statistical Office's hospital list was the basis for the selection of hospitals. The questions referred to the year 2007. The survey, including 3 reminders, was conducted over 3 months. The questionnaire consisted of 6 response categories: always (100%), almost always (99-81%), predominantly (80-51%), rarely (50-21%), almost never (20-1%) and never (0%). RESULTS: The response rate was 41% and 67% of these had carried out shoulder stabilisations. In total, 99.2% of the 67% were evaluable. The proportion of shoulder surgery was 8.4% of the total number of operations. Shoulder stabilisations represented 10.6% of these operations. A specialised shoulder department existed in 22.9%. Conservative treatment was carried out with an immobilisation of the arm "predominantly", "almost always" and "always" for internal rotation in 70.8% and in 23.4% for external rotation. The shoulders were "predominantly", "almost always" and "always" stabilised in an arthroscopic technique in 68.2% and in an open one in 31.8% of the clinics. With 92.9%, the Bankart repair was the most common operation. Shoulder instability was principally treated with the arthroscopic technique, regardless of the care level and department and is considered the best surgical technique. Physiotherapy was prescribed "always" and "almost always" in 99.3%. The rate of reluxation after conservative treatment was estimated at 35.5%, after operative open anterior shoulder stabilisation at 9.1% and after arthroscopic shoulder stabilization at 10.6%. Nevertheless, 49.4% of respondents expected the best results after arthroscopic treatment. Participants, who mainly applied the arthroscopic technique, expected a lower rate of reluxation in comparison to other techniques (p<0.001). CONCLUSION: The operative shoulder stabilisation is most frequently carried out as arthroscopic Bankart repair. A standardised, subsequent treatment is well established.

CD44: survival and metastasis in chondrosarcoma.

OBJECTIVE: Recent studies have shown abnormal expression of CD44s and some of its isoforms in many human malignancies, but little is known about the presence of CD44 in chondrosarcoma. In this study the expression of CD44s and two variant isoforms was evaluated. It was assumed that abnormalities in these receptor proteins may be associated with clinical outcome of the patients. METHOD: Thirty paraffin-embedded chondrosarcoma samples were immunostained with monoclonal antibodies for CD44s, CD44v5 and CD44v6. Two independent examiners who were unaware of the clinical status of the patients evaluated the immunohistochemical results. The percentage of CD44-positive cells was scored semiquantitatively. A rate of higher than 10% was considered as overexpression. RESULTS: Among the 30 patients (median age 50 years) there were 22 conventional chondrosarcomas, two dedifferentiated chondrosarcomas, two extraskeletal chondrosarcomas, and one periostal, mesenchymal, clear cell and myxoid chondrosarcoma each. In the immunochemistry staining overexpression (>10% of cells) of CD44s was shown in 56.7% (17 of 30), of CD44v5 in 43.3% (13 of 30) and of CD44v6 in 6.7% (two of 30) of the tumors. Four grade III chondrosarcomas (80%) and 10 (71.4%) grade II chondrosarcomas showed overexpression for CD44s, whereas CD44s was overexpressed in only three (27.3%) grade I chondrosarcomas. Cox regression suggests overexpression of CD44s to be an additional prognostic marker for chondroid bone tumors independent of grading and other covariates. CONCLUSIONS: Overexpression of CD44s correlated significantly with metastatic potential and with poorer survival in patients with chondrosarcoma. CD44s might be an independent additional marker, but small sample size remains to be considered.

[From natural growth to artificial composition: the use of artificial materials in endoprosthetics from a cultural-historical perspective]. / Verwendung von Fremdmaterialien in der Endoprothetik: Ein medizinhistorischer Beitrag.

The use of artifical materials in joint replacement is not self-evident. A paradigm change can be observed. Beginning in the 18th century orthopedic surgery became possible because of a change of the idea of man. Natural growth was seen as ideal solution in orthopedic surgery until the 19th century. Yet in the aftermath the point of view changed to a more technical determined approach. Until the middle of the 20th century the terms "efficieny" and "ability" became more and more important. Joint replacement with artificial materials was generally accepted and led to an enormous accelaration in the development of new materials and surgical techniques.

[Incidence and mechanism of injuries in cable-wakeboarding: a prospective study]. / Verletzungsarten und Verletzungshäufigkeiten beim Cable-Wakeboard: eine prospektive saisonbegleitende Studie.

UNLABELLED: Cable-wakeboarding has become more and more popular in the last years in Germany and worldwide as well. The mechanism, frequency and severity of injuries is still unclear and not described in the literature yet. Thus to compare the injuries of cable-wakeboarding with similar sports we decided to perform this prospective study during a six months summer season. The study included 122 actives with a mean age of 25 years (15 - 42, +/- 5.876), 81,1 % male, sending an online questionnaire to us every month. 98 % of the participants suffered 277 injuries during 8647 hours of activity, 108 (39 % 12 / 1000 h) had to be treated medically. We found out most frequently mild injuries (61 % 19.5 / 1000 h), 15 % very severe injuries (4.8 / 1000 h), 14 % severe injuries (4.5 / 1000 h) and 10 % medium-severe injuries (3.2 / 1000 h). Injuries of the knee and the shoulder dominated in more than 20 % each with more than 70 % distorsions and contusions. CONCLUSION: Cable-wakeboarding is not more dangerous in regard to injuries than similar trendy sports even though the rate of mild injuries not treated medically is quite higher.

Primary stability of tibial components in TKA: in vitro comparison of two cementing techniques.

In spite of improvements in cementing technique, migration of tibial component remains a problem in total knee arthroplasty. This study compares the primary stability of tibial components using two different cementing techniques with roentgen stereophotogrammetric analysis (RSA) in vitro. A total of 20 tibia specimens were matched into two groups, 10 specimens per group. Cementing technique was randomized to each group. In the first group only the base and in the second group the base and stem were cemented. The implants and the tibial metaphysis were marked with markers for the RSA analysis. All specimens were tested with an axial load of 2,000 N for 1,000 and 10,000 cycles and RSA analysis was performed. Endpoints for radiosterometric analysis were maximum total point motion, maximum subsidence, lift off, rotation and translation along the x-, y-, and z-axes. After 1,000 and 10,000 cycles, no significant differences could be found, but two tibial components of the surface cementing group showed a migration of more than 2 mm defined as failure compared to six failed tibial components in the full cementing group (P = 0.068). This higher number of failed arthroplasties in the fully cemented prosthesis group demonstrates a disadvantageous load distribution in the tibia apophysis which can cause an early component loosening.

[Operative and follow-up treatment of rotator cuff tears--the current situation]. / Operative Therapie und Nachbehandlung der Rotatorenmanschettenruptur--Aktueller Stand.

AIM: The aim of this study was to evaluate the current situation of rotator cuff repair and follow-up treatment in German hospitals. METHODS: An evaluated survey, enquiring about the year 2006, was sent to all 777 German orthopaedic and/or trauma surgery departments. The hospitals were chosen using the official index of hospitals from the German Federal Statistical Office. RESULTS: 44 % of the surveys were sent back, whereby 40 % were of use. Within the 309 departments, 26 % of the total number of 59,957 shoulder operations were rotator cuff repairs. Mini-open was the operation method in 49 %, open in 29 % and arthroscopic in 22 % of cases. Regarding the operational methods, there were differences between the departments and level of care. The arthroscopic technique was used sometimes in 48 % of the departments, whereas 52 % never used it. Specialised shoulder departments employed the total arthroscopic procedure more often. A set follow-up treatment occurred in 79 % of departments. CONCLUSION: Rotator cuff repair is mainly carried out using the mini-open method, which is nowadays regarded as gold standard.

Lack of obvious influence of PLLA nanofibers on the gene expression of BMP-2 and VEGF during growth and differentiation of human mesenchymal stem cells.

Growth factors like bone morphogenetic protein 2 (BMP-2) and vascular endothelial growth factor (VEGF) play an important role in bone remodeling and fracture repair. Therefore, with respect to tissue engineering, an artificial graft should have no negative impact on the expression of these factors. In this context, the aim of this study was to analyze the impact of poly(L-lactic acid) (PLLA) nanofibers on VEGF and BMP-2 gene expression during the time course of human mesenchymal stem cell (hMSC) differentiation towards osteoblasts. PLLA matrices were seeded with hMSCs and cultivated over a period of 22 days under growth and osteoinductive conditions, and analyzed during the course of culture, with respect to gene expression of VEGF and BMP-2. Furthermore, BMP-2-enwoven PLLA nanofibers were used in order to elucidate whether initial down-regulation of growth factor expression could be compensated. Although there was a great interpatient variability with respect to the expression of VEGF and BMP-2, PLLA nanofibers tend to result in a down-regulation in BMP-2 expression during the early phase of cultivation. This effect was diminished in the case of VEGF gene expression. The initial down-regulation was overcome when BMP-2 was directly incorporated into the PLLA nanofibers by electrospinning. Furthermore, the incorporation of BMP-2 into the PLLA nanofibers resulted in an increase in VEGF gene expression. Summarized, the results indicate that the PLLA nanofibers have little effect on growth factor production. An enhancement in gene expression of BMP-2 and VEGF can be achieved by an incorporation of BMP-2 into the PLLA nanofibers.

Gait patterns after intraarticular treatment of patients with osteoarthritis of the knee--hyaluronan versus triamcinolone: a prospective, randomized, doubleblind, monocentric study.

OBJECTIVE: Evaluation of gait performance and muscle activity patterns as well as clinical efficacy and safety after single intraarticular injection with hyaluronan compared with triamcinolone in patients with knee osteoarthritis. MATERIALS AND METHODS: This trial evaluated the influence of a single injection of hyaluronan or triamcinolone on gait pattern and muscle activity. For clinical evaluation a visual analogue scale for pain, Lequesne index, and Knee Society Score were used. Quality of life was assessed with the SF-36. RESULTS: The complete analysis was performed in 50 of 60 patients. 26 patients were treated with triamcinolone and 24 with hyaluronan. Hyaluronan treatment led to significant improvement of range of motion at hip and knee. Significant improvement could be either demonstrated for the pain scale, Lequesne and Knee Society score in both groups. Quality of life showed greater improvement in the triamcinolone group. CONCLUSION: Single application of high-viscosity hyaluronan shows superior range of motion and pain reduction as well as improvement in clinical results. Even if there was a lack of significant differences compared to triamcinolone, this therapy classified as safe and effective in the short follow up.

[Matched pair analysis: Innex FIXUC vs. NexGen LPS]. / Matched-Pair-Analyse: Innex FIXUC vs. NexGen LPS.

AIM: The aim of the present retrospective matched pair study was to compare the clinical results of patients undergoing total knee arthroplasty (TKA) with 2 different operation strategies: tibia first vs. femur first for ligament balancing and rotational alignment of the femoral component. METHODS: In this study 30 patients underwent TKA with the fixed bearing prosthesis Innex FIXUC between 2003 and 2005. In the same period of time the posterior stabilised prosthesis NexGen LPS was implanted in 123 patients. Out of these, 30 patients were matched to the 30 patients of the Innex group based on the parameters age, gender, height, weight and BMI. All implants were cemented. Clinical examination was rated using UCLA score, Knee Society score, Lequesne score for knees, a visual analogue scale (VAS) for pain and the Feller patellar score. Three patients in the Innex group were lost to follow-up, and 27 matched pairs could finally be analysed. RESULTS: At a mean follow-up of 25 months (Innex) and 3 years (NexGen) statistically significant differences (p < 0.05) with advantages for the NexGen were found in the UCLA activity score (4.9 vs. 5.9, p = 0.013), in part A (knee score) of the Knee Society score (78.9 vs. 91.0, p = 0.002) as well as the total score (153.9 vs. 173.2, p = 0.012), VAS (2.1 vs. 0.6, p = 0.003) and in the Lequesne knee score (5.7 vs. 3.6, p = 0.024). No statistically significant differences (p < 0.05) were found in the function score of the Knee Society score and the patellar score (Feller). CONCLUSION: In the described setting there were functional advantages for the NexGen prosthesis (femur first) at a comparable revision rate. However, satisfactory results with the Innex FIXUC are possible, too.

[Parental enquiries before frequenting the outpatient paediatric orthopaedic consultation--focus Internet]. / Elterliche Recherche vor Aufsuchen der kinderorthopädischen Sprechstunde--Schwerpunkt Internetinformationen.

PURPOSE: Every day several million people are seeking for answers to medical problems via the internet. In particular parents, whose children are affected by systemic diseases, orthopaedic defective positions, anomalies or deformities, use the internet to increase their knowledge. Concerning this situation there is a lack of studies in the current literature. METHODS: We investigated parental preparation to the outpatient paediatric orthopaedic consultation at our University Hospital with respect to internet enquiries or further sources of information using a standardised questionnaire. We assessed age and educational background of the parents, local hardware equipment and general habits of internet use. In particular, we retrieved parental use of search machines (e.g., Google.de, Yahoo.de), general medical websites (e.g., netdoktor.de) and websites from self-help groups (e.g., klumpfusskinder.de). RESULTS: In total, 288 out of 300 questionnaires (96%) were evaluated. More than half of the parents (57%) were over 35 years of age and 78% were women. 82% of the study population had access to the internet at home and 70% used the internet regularly. More than 80% obtained information about the orthopaedic diseases of their child beforehand. Age and educational background of the parents were not significantly correlated with the extent of enquiries (p > 0.05). 90% of the parents, using the internet as source of information, frequented internet search machines; approximately one third used general medical websites. In particular in clubfeet we observed a highly significant (p < 0.001) tendency of parents to frequent websites from self-help groups. 60% of the study population assessed the internet information as useful; 92% will frequent the internet as source of information again. One third of the respondents is going to discuss the obtained internet information with the physician. CONCLUSIONS: The internet is an important source of information for parents in the field of paediatric orthopaedics. Treating physicians will be increasingly confronted with the results of parental internet enquiries.

[Patellofemoral arthroplasty--results of a nation-wide survey in Germany and review of the literature]. / Patellofemorale Endoprothetik in Deutschland - eine Standortbestimmung und Uberblick über die Literatur.

BACKGROUND: Isolated patellofemoral arthroplasty is discussed controversially. The aim of this nation-wide survey in Germany and review of the literature was to determine the current status of patellofemoral arthroplasty. METHODS: A standardised questionnaire was sent to 744 German departments of orthopaedic surgery, traumatology and general surgery. In the first part, surgeons were asked general questions about their department size, case numbers of knee arthroplasties per year and non-endoprosthetic treatment of isolated patellofemoral disorders. If patellofemoral arthroplasty was conducted, parameters concerning age, gender, duration of complaints, indication for surgery, surgical approach, type of endoprosthesis used, additional surgical treatments and failures were evaluated in the second part. Furthermore we asked for the reasons if no isolated patellofemoral arthroplasty was performed. A systematic review of the literature was done including studies published until October 2007. The main inclusion criterion was the presentation of results after the implantation of a patellofemoral prosthesis for isolated patellofemoral osteoarthritis. RESULTS: A total of 225 analysable questionnaires were returned. Of 53,420 knee arthroplasties performed per year, only 195 (0.37 %) were isolated patellofemoral arthroplasties. The majority of patients (91 %) were between 40 and 80 years old. The aetiology of isolated patellofemoral osteoarthritis was believed to be idiopathic in 41 % and traumatic in 8 %. Patellofemoral dysplasia was held to be responsible in 47 % and patellofemoral instability in 4 % of the cases. The main reason for failure and surgical revision was ongoing tibiofemoral osteoarthritis of the affected knee. Negative attitude and disbelief towards the success of isolated patellofemoral arthroplasty were stated by the majority (62 %) of non-users. A lack of appropriate indications was reported by 22 % and lacking know-how by 16 %. We analysed 12 studies (459 implantations; 390 patients) in the literature review. The treatment was considered successful in 67.8 % of cases. The overall revision rate was 30.3 %. The highest failure rates were in patients with progression of tibiofemoral osteoarthritis or malalignment. CONCLUSIONS: Isolated patellofemoral arthroplasty has only low significance among surgeons performing knee arthroplasty in Germany. The majority of surgeons do not believe in the success of the procedure. Almost one third of published cases in the literature needed to be revised.