An interleukin-1 polymorphism additionally intensified by atopy as prognostic factor for aseptic non-mechanical complications in metal knee and hip arthroplasty.

Background: In contrast to infection or mechanical issues joint replacement failure following inflammatory adverse reactions is poorly understood. Objective: To assess the association of IL-1ß polymorphisms and history of allergy with aseptic non-mechanical complications following arthroplasty. Methods: In 102 patients with aseptic non-mechanically caused symptomatic knee or hip arthroplasty (SA) and 93 patients with asymptomatic arthroplasty (AA) questionnaire-based history, patch test with at least standard series, lymphocyte transformation test (LTT) with nickel, cobalt and chromium and interleukin-1 polymorphism analysis were done. Three polymorphisms of the IL1B gene [IL-1b -3954 (rs1143634), IL-1b -511 (rs16944) and IL-1b -31 (rs1143627)] and one polymorphism of the IL1RN gene [IL1RN intron 2, variable number of tandem repeats, VNTR (rs2234663)] were assessed by PCR and gel electrophoresis. Results: We found no significant difference in smoking history and atopy but 25% versus 10% of self-reported metal allergy in SA versus AA; the patch test (respective, LTT) for metal sensitivity was more often positive in SA patients. The allele 498 bp of the IL1RN polymorphism occurred significantly more often in the SA group (37% versus 11%; p < 0.0001). Upon additional presence of atopy, the difference was even greater (60% vs 10%) (p < 0.000001). There was no association of IL-1 polymorphisms with metal allergy. Conclusion: The IL1RN VNTR allele 498 bp was strongly associated with SA. In patients with a history of atopy, presence of the IL1RN VNTR allele 498 bp led to a four-fold higher SA prevalence compared to patients without this allele.

[Characteristics of 200 patients with suspected implant allergy compared to 100 symptom-free arthroplasty patients]. / Charakteristika von 200 Patienten mit Verdacht auf Implantatallergie im Vergleich zu 100 beschwerdefreien Endoprothesenträgern.

BACKGROUND: Data on implant allergies are incomplete; therefore, we compared the data on allergy history, patch test (PT) and lymphocyte transformation test (LTT) results in a patient series from the Munich implant allergy outpatient department with symptom-free arthroplasty patients. PATIENTS AND METHODS: In this study 200 arthroplasty patients with complaints involving the prosthesis (130 female, 187 knee and 13 hip prostheses) and in parallel 100 symptom-free patients (75 female, 47 knee and 53 hip prostheses) were investigated. A questionnaire-aided history including implant type, cementing, intolerance of dental materials, atopy, cutaneous metal intolerance (CMI) and PT, including a standard series with Ni, Co, Cr, seven bone cement components, including gentamicin and benzoyl peroxide and LTT for Ni, Co and Cr. RESULTS: In the knee arthroplasty patients with complaints 9.1% showed dental material intolerance, 23.5% atopy, 25.7% CMI, 18.2% metal allergies, 7.4% gentamicin allergy and 27.8% positive metal LTT (mostly to Ni). In symptom-free patients 0% showed dental material intolerance, 19.1% atopy, 12.8% CMI, 12.8% metal allergy, 0% gentamicin allergy and 17% positive metal LTT. CONCLUSIONS: Characteristics of the patients with complaints were increased intolerance of dental materials, higher rates of atopy, CMI, metal and gentamicin allergy and LTT reactivity.

[Long-term results with the Wagner metal-on-metal resurfacing prosthesis]. / Langzeitergebnisse mit der Wagner-Metall/Metall-Schalenprothese.

INTRODUCTION: Former failures of hip resurfacing arthroplasties in the 1980s were attributed to articulating materials and malpositioning of the implants. To solve these problems in the 1990s metal-on-metal articulations were developed. The purpose of this study was to depict the long-term results of the Wagner resurfacing prosthesis utilising a metal-on-metal surface articulation. PATIENTS AND METHOD: Between January 1991 and December 1995 40 Wagner resurfacing prostheses were implanted. All operations were performed via an anterior approach. 37 patients were able to be followed up after an average period of 13.1 years. For clinical evaluation the score according to Merle d'Aubigné was used. For radiological assessment X-rays in two planes were evaluated. RESULTS: On average, 1.45 (1 to 9) preliminary operations were performed on each patient prior to the implantation of the actual surface replacement prosthesis. In 32 cases a cementless femoral component was used, in the remaining 8 cases a cemented one. The score according to Merle d'Aubigné improved from a pre-operative average of 8.3 to a post-operative average of 17.3 points (p < 0.001). 17 of 40 (42.5 %) hip resurfacing arthroplasties have been revised. DISCUSSION: Taking all aspects into account, the high rate of revisions in this series was attributed to extreme indications for hip resurfacing which would not be considered as standard nowadays. Combined with a stricter indication and an exact, careful operative technique, the metal-on-metal surface replacement of the hip joint may offer an alternative replacement option.

Long-term results with the Wagner metal-on-metal hip resurfacing prosthesis.

The purpose of this study was to report the long-term results of the metal-on-metal Wagner resurfacing prosthesis. Between January 1991 and August 2004, 54 Wagner resurfacing prostheses were implanted in 52 patients. There were 45 female patients (1 bilateral case) and 7 male patients (1 bilateral case). All the operative procedures were performed using the anterior approach. Of those cases available, the average time to follow-up was nine years. The average Merle dAubign score improved from 8.3 preoperatively to 17.3 postoperatively (p-value < 0.001). Seventeen prostheses required revision. Radiographic evidence of femoral neck narrowing was seen in three prostheses that remained in situ. Combined with a stricter diagnosis and an exact operating technique, the Wagner metal-on-metal surface replacement of the hip joint may offer an alternative surface replacement option.

[Results of operative therapy of idiopathic clubfoot using a dorsomedial approach with soft tissue preparation "à la carte"]. / Ergebnisse der operativen Behandlung des idiopathischen Klumpfusses unter Verwendung eines dorsomedialen Zuganges mit Weichteilpräparation "à la carte".

INTRODUCTION: Several concepts have been published for therapy of idiopathic clubfoot. Actually the Cincinnati approach is the "gold-standard" in operative treatment of idiopathic clubfoot. Using this approach delayed wound healing and overcorrection are wellknown complications. During the last 30 years a dorsomedial approach is used in operative treatment of idiopathic clubfoot in our clinic. Using this approach a dorsal, medial and/or lateral release can be performed. Postoperatively a plaster cast is used. The following years a rigid therapy with orthosis and support is requested. PATIENTS AND METHOD: Between June 1986 and December 2000 130 clubfoot operations with soft tissue release were performed. 119/130 (91 %) patients could be clinically and radiologically followed-up after a mean of 4.5 years (min: 2, max: 17) including 65.5 % male and 34.5 % female patients. Average age at time of operation was 7.6 months. The findings were classified according to Dimeglio. To evaluate the clinical results the score according to Laaveg and Ponseti was used. X-rays with load (a. p. and lateral view) were evaluated preoperatively and at follow-up for a. p. and lateral talocalcaneal angle, talometatarsal-I-angle, calcaneometatarsal-V-angle and the angle of the first ray. Additionally complications and recurrences were documented. RESULTS: 21.8 % of the feet were classified IV degrees , 39.5 % III degrees and 38.7 % II degrees according to Dimeglio. Recurrent clubfoot was found in 7.6 % of all cases. All angles showed a significant improve. At latest follow-up 95.6 +/- 9.2 points according to the score of Laaveg and Ponseti were achieved. Flat top talus was found in 37 cases. CONCLUSION: The dorsomedial approach allows an excellent correction of clubfeet with a low rate of complications and recurrences in comparison to other studies.

[Experiences with the Butler procedure for overlapping fifth toe]. / Erfahrungen mit der Weichteilkorrektur nach Butler des Digitus quintus varus superductus.

UNLABELLED: Overlapping fifth toe is a finding in pediatric orthopaedics which rarely requires operative therapy. PATIENTS AND METHOD: Between Jan. 1, 1992 and Dec. 31, 2002 five operations of an overlapping fifth toe using the Butler procedure were performed at a mean patients age of 5.5 years (min: 3, max: 9). All patients were clinically evaluated after a mean follow-up of 6 years (min: 2, max: 10) according to the score of Black. We present the technique of the Butler procedure and discuss the relevant literature. RESULTS: An excellent result was achieved in all patients. Despite the extensive soft tissue release no complications could be found. CONCLUSION: The Butler procedure is a simple and safe procedure without any need of immobilisation.

[Results of fixation of osteochondral lesions of the talus using K-wires]. / Ergebnisse der Refixation der Osteochondrosis Dissecans des Talus mit Kirschnerdrähten.

INTRODUCTION: Etiology of osteochondral lesions of the talus remains uncertain, a myriad of treatment options exists. The purpose of this study is to evaluate the clinical and radiological results of fixation of osteochondral lesions of the talus using K-wires. An unstable osteochondral fragment or osteosclerotic changes in the bed of the talus were regarded as indications for the procedure. PATIENTS AND METHOD: We report a retrospective study of 20 patients who underwent fixation of osteochondritis dissecans of the talus between 1.1.1995 and 31.12.2000. There were 14 men and 6 women. The average age was 18 years (range, 11 to 52 years). The average duration of symptoms prior to surgery was 30 weeks (range, 8 to 100 weeks). RESULTS: The average duration of follow-up was 46 months (range, 18 to 93 months). The overall clinical result was rated good in 4 cases and excellent in 16 cases according to the Ogilvie-Harris score. There were no surgical complications. All osteochondral lesions healed. CONCLUSION: Using K-wires for fixation of osteochondral lesions of the talus repair of the articular surface and stability of the lesion can be achieved even in unstable chronic lesions.

[Impingement of the iliopsoas muscle after revision of a loosened acetabular cup with an acetabular reinforcement ring]. / Impingement-Syndrom des Iliopsoas nach Pfannenwechsel mit Stützringosteosynthese.

Impingement of the iliopsoas muscle due to a protruding acetabular component is an uncommon cause of pain after total hip arthroplasty. We report the case of a 59 year old female patient who developed groin pain one year after revision arthroplasty and reconstruction of the acteabular defect with an acetabular reinforcement ring due to a loosened cup. THERAPY AND FOLLOW UP: After revision of the right hip via an anterior approach we used bone cement to smooth the anterior edge of the acetabular reconstruction ring and created a smooth rim for the iliopsoas tendon. At follow up 2 years later the patient was satisfied with the result, she complained about very rare recurrent groin pain, without any need for further treatment.