The synthesis of brominated-boron-doped PAHs by alkyne 1,1-bromoboration: mechanistic and functionalisation studies.

The synthesis of a range of brominated-B n -containing (n = 1, 2) polycyclic aromatic hydrocarbons (PAHs) is achieved simply by reacting BBr3 with appropriately substituted alkynes via a bromoboration/electrophilic C-H borylation sequence. The brominated-B n -PAHs were isolated as either the borinic acids or B-mesityl-protected derivatives, with the latter having extremely deep LUMOs for the B2-doped PAHs (with one example having a reduction potential of E 1/2 = -0.96 V versus Fc+/Fc, Fc = ferrocene). Mechanistic studies revealed the reaction sequence proceeds by initial alkyne 1,1-bromoboration. 1,1-Bromoboration also was applied to access a number of unprecedented 1-bromo-2,2-diaryl substituted vinylboronate esters directly from internal alkynes. Bromoboration/C-H borylation installs useful C-Br units onto the B n -PAHs, which were utilised in Negishi coupling reactions, including for the installation of two triarylamine donor (D) groups onto a B2-PAH. The resultant D-A-D molecule has a low optical gap with an absorption onset at 750 nm and emission centered at 810 nm in the solid state.

[The S2k guideline: Indications for knee endoprosthesis : Evidence and consent-based indications for total knee arthroplasty]. / S2k-Leitlinie: Indikation Knieendoprothese : Evidenz- und konsensbasierte Indikationsstellung in der Knie-Endoprothetik (EKIT-Knie).

Total knee arthroplasty (TKA) is one of the most frequent surgical procedures in orthopaedic surgery. Until now there have not been any standardized indication criteria, which might contribute to the large geographical differences in the frequency of TKA. This guideline aims to consent minimal requirements (main criteria), additional important aspects (minor criteria), as well as relative and absolute contraindications for TKA. The following main criteria have been consented: knee pain, radiological confirmation of osteoarthritis or osteonecrosis, inadequate response to conservative treatment, adverse impact of knee disease on the patient's quality of life and the burden of suffering due to the knee disease. Relative contraindications have been consented as severe general disease with reduced life expectancy and a BMI ≥40; absolute contraindications are an active infection and if the patient is not able to undergo major surgery.

Assessment of butorphanol-azaperone-medetomidine combination as anesthesia for semen collection and evaluation of semen quality in white-tailed deer (Odocoileus virginianus).

The aim of this current study was to evaluate the level of anesthesia produced by a combination of butorphanol-azaperone-medetomidine (BAM) for semen collection by electroejaculation on captive white-tailed bucks (Odocoileus virginianus). Ten male white-tailed deer, weighing 68.2-115.9kg, ranging in age from one to four years were randomly selected from housing pens and anesthetized with the BAM drug combination at a dose volume of 2.0mL each. Semen was collected from each animal using a standard cervid electroejaculation protocol while under BAM anesthesia. Physiological data was recorded following induction of anesthesia and during semen collection. Collected ejaculates were prepared for analysis using a standard extender protocol for cryopreservation. Eleven sperm viability parameters were quantified for each sample using a Computerized Assisted Sperm Analysis system, including total seminal volume; sperm concentration and total sperm number. kinematic parameters of motile spermatozoa were also assessed. Results demonstrated that BAM provided an effective plane of anesthesia for successful collection of viable sperm. Measured physiological variables of heart rate, respiration and body temperature all remained within safe, normal limits. Data recorded on semen characteristics from all collected ejaculates correlated well with key traits determined to be important for successful fertilization through measurement of total semen volume; sperm concentration; total sperm number; and kinematic parameters of motile spermatozoa. There were no serious adverse events. This field study indicates that BAM anesthesia is suitable for semen collection in white-tailed deer.

[Validity and Reliability of the German Version of the HSS Expectation Questionnaire on Hip Joint Replacement]. / Validität und Reliabilität der deutschen Version des HSS-Erwartungsfragebogens zum Hüftgelenkersatz.

Background: Total hip arthroplasty is one of the most successful operations in medicine. The clinical result after surgery and compliance during rehabilitation are influenced by the patient's expectations. There is a lack of a validated German instrument to record these expectations in a standardised manner. Patients: 193 patients from the Dresden Hip Register with osteoarthritis of the hip were surveyed with respect to their expectations before the operation. The study sample consists of 108 women and 85 men. The average age of the patients was 59.7 years, with a standard deviation of 12.2 years. Methods: The Hospital for Special Patient Expectations Survey was translated into German and culturally adapted. In addition, the RKI demographic core data set, the HADS-D, LOT-R and the SCL-(K-)9 were collected to validate the instrument. In the statistical analysis, four main factors could be distinguished. These were "everyday activities", "pain relief and improvement in function", "medication and social participation" and "gait improvement". Results: Patients were predominantly married. 20 % of the women were widowed. 20 % had received higher education. Almost half of the patients were retired, 30 % were employed, 15.1 % self-employed and 7.3 % were unemployed. For most of the items, patients expected major improvements up to normalisation of their health. There were many different answers to several items, such as the question on occupation. For sporting and sexual activities no high expectations were given. The average expectation of the whole sample shows major differences to individual expectations. Men showed higher expectations for medication, social participation and gait improvement than did women. There were lower expectations for everyday activities, medication and social participation and gait improvement for older patients. Summary: The German version of the HSS patients expectation survey was validated. The instrument is useful in the preoperative setting to give the surgeon a first impression on the patient's expectations.

[Evidence-based trauma and orthopedic surgery : 20 years after Sackett]. / Evidenzbasierte Unfallchirurgie und Orthopädie : Zwanzig Jahre nach Sackett.

The article "Evidence based medicine: what it is and what it isn't" published in the BMJ in 1996, is regarded as the foundation of the evidence-based medicine (EbM) movement. Approximately 5 years later David L. Sackett, one of the leaders of the movement, requested all experts to voluntarily abandon their position to make way for young researchers and fresh ideas. Since the term was first coined and the establishment of organizations and platforms fostering the idea, EbM has polarized clinicians and scientists around the world. Clinical and methodological developments during recent years have, however, overtaken the original principles of EbM. This review highlights the core concepts of EbM which have remained unchanged and valid for the current practice of trauma and orthopedic surgery and where revision is needed.

Infundibula of equine maxillary cheek teeth. Part 1: Development, blood supply and infundibular cementogenesis.

There is increasing interest in diseases of infundibula of equine maxillary cheek teeth. Imperfect infundibular cementogenesis has been recognized as an aetiopathological factor for the onset of infundibular necrosis. In this article, infundibular development was examined with particular attention to infundibular blood vessels and cementogenesis. Forty-one deciduous maxillary premolars prior to eruption were investigated using routine histological and immunohistological methods to visualize blood vessels and the enamel organ. Selected specimens were scanned by micro-computed tomography to analyze the three-dimensional configuration of the developing infundibulum. Before eruption, the infundibula are supplied by a central infundibular artery entering the infundibulum from an occlusal direction and by arteries entering the mesial infundibulum from the mesial aspect, and the distal infundibulum from the distal aspect. The central infundibular artery is destroyed shortly after tooth eruption but the lateral arteries remain vital for a time after eruption. As the arteries of the distal infundibulum are located in a more apical position, blood is received for a longer period compared with the mesial infundibulum. Cementogenesis starts first at distinct enamel in-foldings in the occlusal part of the infundibula, advancing in an apical direction. The results suggest a distinct asymmetry between the infundibula with the mesial infundibulum prone to incomplete cementogenesis due to early blood supply cessation.

Similar stability and range of motion between cruciate-retaining and cruciate-substituting ultracongruent insert total knee arthroplasty.

PURPOSE: The use of an ultracongruent (UC) insert with a standard femoral component for substitution of the posterior cruciate ligament (PCL) is a bone-preserving and therefore interesting alternative to the established box and cam mechanism of posterior-stabilized total knee arthroplasty (TKA). Despite the regular use of these UC inserts, there is little evidence about stability and range of motion (ROM). METHODS: The aim of this study was to evaluate the stability and ROM in standard cruciate-retaining (CR) and cruciate-substituting UC inserts of the same TKA. In 39 patients, intraoperative measurements of stability and ROM were taken (1) before soft tissue release and bone cuts, (2) after implantation of a CR TKA and (3) after resection of the PCL and substitution with an UC insert. All measurements were taken using a navigation system. RESULTS: Stability measurements demonstrated no differences between CR (PCL intact) and UC TKA (PCL resected), but significantly increased anteroposterior translation at 60° and 90° of knee flexion compared with the preoperative condition. ROM measurements demonstrated improvement of knee flexion from preoperatively mean 105° (SD 14.1°) to intraoperative 120.2° (SD 6.7°) with the CR and 121.0° (SD 7.5°) with the UC insert and 113.5° (SD 14.0°) at the 1-year follow-up. CONCLUSION: This study demonstrates similar stability of an UC insert compared with a standard CR insert. UC inserts are therefore a bone-preserving solution if the PCL needs to be substituted. ROM was not improved after resection of the PCL and substitution with the UC insert. LEVEL OF EVIDENCE: II.

[Modular reconstruction in acetabular revision with antiprotrusio cages and metal augments : the cage-and-augment system]. / Modulare Defektrekonstruktion beim Pfannenwechsel mit Abstützschale und metallischen Augmenten : "Cage-and-Augment"-System.

OBJECTIVE: Restore primary center of rotation and reconstruct extensive bone defects in hip revision surgery with a modular off-label implant combined with antiprotrusion cage and metal augment, thus, achieving improved hip function. INDICATIONS: Large segmental acetabular defects with nonsupportive columns (Paprosky type 3a and 3b) in cup loosening or Girdlestone situation. In case of pelvic discontinuity posterior column-plating is possible. CONTRAINDICATIONS: Persisting hip infection and severe systemic disorders impairing achievement of secondary stability through bony integration of metal augment. SURGICAL TECHNIQUE: Posterolateral (if dorsal column plating) or other approach. Remove loose implant and granulation tissue with sufficient exposure of bleeding bone. Size acetabular defect with trial components of augment and appropriate antiprotrusio cage. Fixation of selected metal augment with screws. Fill additional acetabular defects with morsellized bone graft. Open a slot into the ischium to fix the distal flange of the cage. If necessary, bend both flanges according to patient's anatomy. Enter the ischium with distal flange and gradual impaction of the antiprotrusio ring. Final stabilization of the ring with several screws aiming at the posterior column or the acetabular dome. Inject cement between ring and augment to stabilize the construction and avoid metal wear. Final cement fixation of a polyethylene liner or a dual-mobility cup into the antiprotrusio ring. In pelvic discontinuity with major instability osteosynthesis of the dorsal column can be performed prior to cementation. POSTOPERATIVE MANAGEMENT: Prophylaxis of periprosthetic infection, DVT and heterotopic ossification. Physical therapy with partial weight bearing (20 kp) for 6 weeks; in discontinuity initial wheel chair mobilization. RESULTS: Since 2008, 72 off-label implantations of a combined antiprotrusio cage and a Trabecular Metal™ Augment were performed. A total of 44 patients (46 operations) were investigated at 38.8 (36-51) months postoperatively. In all, 36 patients had a bone defect according to Paprosky type 3a/b and in 3/4 patients with pelvic discontinuity additional osteosynthesis was performed. The WOMAC score increased from 39.8 (8.7-75) points preoperatively to 57.9 (16.7-97.9) points at follow-up. Migration or failure of implant components was not observed. In 11 % of dislocations and 11 % periprosthetic infections surgical revision was necessary.

[Endoprosthetic treatment of osteoporosis-related coxarthrosis : aspects of safe patient treatment]. / Endoprothetische Versorgung bei osteoporoseassoziierter Koxarthrose : Aspekte zur sicheren Patientenversorgung.

BACKGROUND: With increasing life expectancy the prevalence of osteoarthritis is also substantially rising. Patients aged between 65 and 75 years scheduled for total joint arthroplasty suffer from undetected osteoporosis in 20-25% of cases. OBJECTIVES: How to determine osteoporosis during preoperative workup? Which conclusions can be drawn for the operation treatment and the postoperative course? METHODS: The literature dealing with the prevalence of osteoporosis, perioperative complications of total hip arthroplasty, selected register informations, guidelines for diagnostics and treatment of osteoporosis and for the postoperative treatment are summarized and discussed. RESULTS: The fracture risk is determined according to the guidelines of the Dachverband Osteologie (DVO, Governing Body on Osteology). The implant and the anchorage are selected based on the risk of suffering from osteoporosis. An intraoperative fracture and early aseptic loosening are the main operative risk factors. For the postoperative course in addition to education about arthroplasty, adequate support for prevention of falls is mandatory. Continuous physiotherapy with muscular strengthening is advisable. The long-term medication should be checked for risks in the PRISCUS list of potentially inappropriate medication in the elderly and non-steroidal anti-inflammatory drugs (NSAIDs) should not be prescribed in patients with cardiac comorbidities. Patients with confirmed osteoporosis should be treated with antiresorptive agents.

[Complications of metal-on-metal tribological pairing]. / Komplikationen bei Metall-Metall-Gleitpaarungen.

BACKGROUND: Metal-on-metal (MoM) tribological pairing results in less volumetric abrasion than pairing with the conventionally used polyethylene and is associated with a lower risk of material failure compared to other hard-hard pairings. An increased frequency of problem cases in recent years has led to a great increase in uncertainty. Against this background in this article the current aspects of epidemiology, etiology, diagnostics and treatment of complications in MoM hip joint endoprostheses will be discussed. EPIDEMIOLOGY AND ETIOLOGY: Based on the results from national endoprosthesis registers and selected clinical studies an evaluation of the rate of local complications from MoM tribological pairings was undertaken. A differentiation was made between MoM pairings in pedicled small head prostheses (≤ 32 mm), large head (> 32 mm) and surface replacement (OFE) endoprostheses. Each year MoM endoprostheses release on average 10(12)-10(14) cobalt (Co) and chromium (Cr) nanoparticles per patient. This release of metal ions and particles can lead to a variety of tissue reactions. DIAGNOSTICS: A differentiation must be made between regular routine diagnostics within the framework of implant follow-up screening and specific investigations due to the occurrence of complaints. The diagnostics for patients treated with MoM hip endoprostheses consists of a standardized step-wise approach considering possible differential diagnoses and the utilization of modern laboratory chemical and radiological methods. When problems occur, a differentiation should preferentially be made between complaints not caused by metal and mechanical problems (e.g. prosthesis loosening and impingement) and symptoms due to periprosthetic infections. THERAPY OF COMPLICATIONS: The normal standards for hip endoprosthetics are also valid for periprosthetic infections, fractures and other general complications. Specific measures are, however, necessary for complications due to metal-specific risks.

[Minimally invasive surgery for knee total arthroplasty - evidence-based advantages?]. / Minimalinvasive Zugänge am Kniegelenk - evidenzbasierter Vorteil in der Knieendoprothetik?

The impact of minimally invasive surgical techniques for implantation of a total knee arthroplasty is evaluated according to evidence-based medicine criteria. The patient-relevant clinical question can be formulated as: Is the rehabilitation of osteoarthritis patients with minimally invasive implantation of total knee arthroplasty faster compared to those with the conventional approach. The available literature is sorted and critically appraised with regard to methodological quality and risk of bias. Following the results of the meta-analyses the clinical question can be positively answered. Following the aspect of a structured evolution for surgical techniques, the meaning of a minimally invasive technique for total knee arthroplasty cannot be answered finally. Under the impression of more frequent surgical complications, the rating of the procedure is conservative. A general advantage is not apparent. Further studies investigating surgical learning curves, proper patient selection and the selection of the patient for such techniques are required, before the final judgement on the use of this technique can be formed.

[Re-evaluation of the AOK hospital navigator with a focus on total knee replacement]. / Re-Evaluation des Krankenhausnavigators der AOK für das "QSR-Verfahren" unter besonderer Berücksichtigung des Themenschwerpunkts Knieendoprothetik.

BACKGROUND: One of the biggest health insurance companies in Germany (AOK, Allgemeine Ortskrankenkasse) has published new results focussing on process quality of total knee replacement in 2010. These results were published in the online portal "Weiße Liste", which is based on health insurance routine data. The German Association of Orthopeadic Surgery questions the credibility of the rating system of the "Weiße Liste". To prove the system an interdisciplinary task force was created. MATERIAL AND METHODS: The task force identified patient-specific parameters, which influence the outcome of total knee replacement based on the literature and expert opinions. Out of 907 orthopaedic departments, 4 above average and four below average were identified. The AOK was asked to provide 80 data sets for each department. These anonymised data sets could be converted into patient-specific data sets in the identified departments. Statistical analysis was performed to answer the question of whether there are differences between the below and the above average groups. RESULTS: 625 cases could be investigated. We found an increased rate of postoperative complications in the below average group. There are differences between both groups in terms of factors influencing the procedure. In the below average group an increased rate of patients with one or more comorbidities and a preoperative extension lag of over 10° was found. The above average group has a higher rate of operations before the knee replacement. CONCLUSION: The results need to be proven on a larger scale. Further, prospective investigations are planned.

[Femoral nerve palsy as delayed complication after total hip replacement: delayed hematoma formation in unexpected screw malpositioning]. / Femoralisparese als Spätkomplikation nach Hüftendoprothesenimplantation: Späte Hämatombildung bei unerwarteter Schraubenfehllage.

Nerve injury after total hip replacement is a rare but severe complication. If the nerve lesion becomes evident in the early postoperative phase the lesion is often due to an incorrect implant position, direct nerve injury or vascular injury with manifestation of a hematoma which results in nerve compression. Secondary nerve lesions are more often due to a chronic hematoma with nerve compression. Secondary nerve lesions in particular are often a diagnostic challenge and should lead to an early revision after comprehensive imaging diagnostics.

[Update on metal-on-metal hip joints]. / Update Metall-Metall-Gleitpaarungen.

Increasing data are available describing risk factors for the development of local and systemic adverse events following operations using metal-on-metal (MoM) hip implants. The prevalence and clinical relevance of metal-associated problems are, however, still under debate. They can be influenced by type and position of implant as well as patient-specific factors. Patients with small MoM heads (maximum diameter 32 mm) and subgroups of resurfacing arthroplasty can achieve good long-term survival. The use of large head MoM implants (diameters greater than 36 mm), however, is currently not advised due to the unsatisfactory results.

[Academic clinical medicine in orthopedic and trauma surgery: which route will the next generation choose?]. / Akademische klinische Medizin in Orthopädie und Unfallchirurgie: Welchen Weg geht der Nachwuchs?

BACKGROUND: An increasing clinical pressure forces academic surgeons in Germany to decide between private life and research activities. How do those people decide and how do they develop their individual career plan? MATERIAL AND METHODS: In an e-mail survey German orthopedic and trauma surgeons were interviewed on their way of reconciliation of private life, clinical duties and research. The survey included the same questions as the previous survey and a follow-up of 66 % was achieved. RESULTS: The number of consultants in the questioned cohort increased from 44 % to 66 %. More than 80 % reported that the workload had increased which was accompanied by a more clinical orientation of research activities. When asked about personal priorities and wishes leisure time was ranked first, surgical skills, research and income followed in that order. The majority were content with the current situation and career path. CONCLUSIONS: This is the first study on occupational conditions in orthopedic and trauma surgeons in a time-line based manner. It became evident that a more clinical orientation of research is needed to match the interests of clinically engaged surgeons in orthopedics and traumatology.

[Templating and radiological outcome monitoring for elective total hip arthroplasty. Applied quality management principles for safe patient care]. / Operationsplanung und Ergebniskontrolle in der elektiven Hüftendoprothetik. Angewandtes Qualitätsmanagement als Grundlage einer sicheren Patientenversorgung.

Implementation of total hip arthroplasty is a successful and reliable treatment for end-stage osteoarthritis. The biomechanics and components as well as the fixation were selected with the aid of templating. Based on a cohort of 114 patients the quality of digital X-rays and the operative results were determined. There was a slight leg lengthening and a good offset reconstruction in these patients. For the patients with replacement of the second hip the leg lengthening was smaller. The cup inclination was at 43° and 44° within the desired range. The prediction of the exact component size used was 40% for the cup and 29% for the stem.Through variation in scaling of the digital X-ray a diminishing prediction accuracy was found in our study. The correction of biomechanics and position of components showed good quality in patient care. Templating and assessment of the postoperative result in total hip arthroplasty is a model for continuous quality management and can be recommended for safe patient care.

[Avoidance, diagnostics and therapy of nerve lesions after total hip arthroplasty]. / Vermeidung, Diagnostik und Therapie von Nervenläsionen nach Hüftendoprothesenimplantation.

Nerve palsy following total hip arthroplasty is a rare complication. Developmental dysplasia of the hip, previous fracture treatment and medical comorbidities are characteristic risk factors. By accurate preparation of the patient and a careful operative technique nerve palsy can be avoided in most cases. Nerve palsy following poor patient positioning during the perioperative period should be avoided by close cooperation with anesthesiologists.In cases of postoperative nerve palsy correct diagnostics should be carried out immediately. Further treatment options should be considered to minimize the damage. For patients with definite nerve palsy, devices such as a foot drop splint are often necessary and should be carried out as soon as possible.

[The EbM Commentary at the Annual Meeting of the German Congress of Orthopaedics and Traumatology (DKOU): background, aims and vision]. / Der EbM-Kommentar auf dem DKOU: Hintergründe, Ziele und Vision.

The critical appraisal of clinical and scientific work to assure the effectiveness and to balance the risks of treatment are mandatory today. Recent innovations in medicine often lead only to minor improvement in patient benefit. For the better understanding of the presented study results, the EbM commentary was introduced in 2007 at the Annual Meeting of the German Society of Orthopaedics and Traumatology. The EbM commentary was developed within the Swiss Orthopaedic Society and is a vital part of the Annual Meetings. The EbM commentary is a carefully prepared critical appraisal of an orally presented study by a specially trained colleague. The commentary consists of three components and begins with a systematic analysis following the SPION principle. What kind of study was carried out? Which patients were enrolled in the investigation? What kind of interventions were compared? How was the outcome measured? What is the benefit of the study for my own practice and what is the benefit for the patient? The reporting and the evaluation of the patient benefit is of great interest. In the second step the strengths and weaknesses of the study were discussed and the study will be rated for their evidence. For the best case the presented study implies direct changes in the usual treatment of patients. In the worst case no changes are necessary and the study is rated "so what" because of methodological weaknesses making the drawn conclusions invalid. For the audience the EbM commentary may support their rating of the quality of the presented study. The congress team selects interesting presentations for the EbM commentary. The EbM commentators receive the oral presentation and in most cases additional information from the selected studies four weeks in advance of the meeting. The EbM commentary is focused on a precise analysis of the presented data in an open and pleasant discussion. The aim of the EbM commentary is to clearly point out the patient benefit and to disclose the biases and weaknesses. The best studies of the DKOU were awarded following the suggestion of the EbM jury. The experiences have shown some methodological improvement of the presentations. The pragmatic style of the EbM commentary has led to good acceptance at the Annual Meeting of the German Society of Orthopaedics and Traumatology.

Incidence of early postoperative cognitive dysfunction and other adverse events in elderly patients undergoing elective total hip replacement (THR).

In elderly patients cognitive dysfunction and other adverse events (AEs) can impair the outcome of surgical procedures. As THR is performed with increasing frequency in aging populations, it is important to know the impact of these problems on the postoperative result. In this prospective cohort study 60 patients older than 65 years (66.7% female, 33.3% male) who received THR were included. The cognitive function was measured preoperatively, one week and six months postoperatively by the mini-mental state test (MMSE). Shortly after surgery 4 patients (6.7%) developed postoperative cognitive dysfunction, which has recovered at six-months-follow-up. In 41 patients (68.3%) AEs were recorded. Postoperative anemia occurred as the most common AE (n=32; 53.3%). During hospital stay older patients are at an increased risk for AEs. The incidence of postoperative cognitive dysfunction was observed less often than expected. Further research is necessary to assess the effect of early interventions in case of cognitive dysfunction. With use of a simple and quickly performed test like the MMSE patients can be effectively screened for impaired cognitive function. Secure identification of those patients is mandatory to avoid complications with harmful long-term effects.

[Long-term results in total knee arthroplasty. A meta-analysis of revision rates and functional outcome]. / Langzeitergebnisse in der Knieendoprothetik : Metaanalyse zu Revisionsrate und funktionellem Ergebnis.

BACKGROUND: Total knee arthroplasty (TKA) is one of the most common procedures in orthopedic surgery and clinical success can be characterized by the revision rate and improvement of function. To quantify both characteristics two independent meta-analyses have been performed. MATERIALS AND METHODS: A search in Medline provided a total of 96 studies on revision rates and 63 studies with functional results with a minimum follow-up of 5 years. RESULTS: A total of 911 revisions among 20,873 TKAs were identified corresponding to a meta-revision rate of 4.4% after a mean follow-up of 10.7 years. Most common causes for revision were aseptic loosening (31%), infection (23%), polyethylene wear (16%) and patellar problems (14%). Revision rates were higher in younger patients (7.0% <60 years at time of operation, 5.0% between 60 to 70 years and 2.2% >70 years), after cementless TKA (8.3% cementless versus 3.6% cemented) and in studies with a higher rate of patients with rheumatoid arthritis. The second meta-analysis revealed a meta-improvement based on the Knee Society Knee Score of 51.3%, for the Knee Society Function Score of 30.6%, for the Hospital for Special Surgery Score of 36.1% and for the New Jersey Orthopedic Hospital Knee Evaluation System of 33.6%. CONCLUSION: TKA is a successful treatment for osteoarthritis of the knee with an expectable revision rate of less than 5% within 10 years and a long-lasting functional improvement of more than 30% in any assessment score.