Incidence of perioperative complications in total hip and knee arthroplasty in patients with Parkinson disease.

INTRODUCTION: The aim of this study is to evaluate the difference in perioperative complication rate in total hip, bipolar hemiarthroplasties and total knee arthroplasty in patients with Parkinson disease in trauma and elective surgery in our Musculoskeletal Center during a period of 10 years. MATERIAL AND METHOD: Between 2006 and 2016, 45 bipolar hemiarthroplasties in trauma surgery, 15 total knee and 19 total hip arthroplasties in patients with Parkinson's disease were performed. We divided the patients in two groups. Group I included trauma cases (45) and group II elective surgery cases (34). Complications were documented and divided into local minor and major complications and general minor and major complications. Fisher's exact test was used for statistical evaluation. RESULTS: In both groups, there was one local major complication (p > 0.05): In group I, there was one case of loosening of a K-wire which was removed operatively. In group II, there was one severe intraarticular bleeding requiring puncture of the hematoma. In group I, there were 38 general complications; in group II, there were 17 general complications. There was no statistical difference in complication rate (p > 0.05). CONCLUSION: Total hip arthroplasty, bipolar hemiarthroplasties and knee arthroplasty in patients with Parkinson disease is possible in elective and trauma surgery. Complication rate is higher in comparison with patients not suffering from Parkinson disease, but there is no difference in complication rate in elective and trauma surgery. Nevertheless, early perioperative neurological consultation in patients with Parkinson disease is recommended to minimize complications and improve early outcomes after arthroplasty.

Long-term results of total knee arthroplasty following high tibial osteotomy according to Wagner.

PURPOSE: There is relatively little information available about the long-term results of total knee arthroplasty (TKA) following high tibial osteotomy. The aim of our study was to share our experiences and long-term results of TKA after a previous closing wedge high tibial osteotomy according to Wagner. METHODS: In a retrospective study we identified 48 consecutive patients who had undergone TKA after a previous closing wedge high tibial osteotomy according to Wagner with a follow-up of over ten years. The average duration of follow-up after the TKA was 13.3 years (min 10.0, max 15.5). X-rays were taken in two planes before TKA, one week after TKA and at the latest follow-up. Tibio-femoral alignment was measured on weightbearing long-leg anteroposterior radiographs. Radiolucent lines at the latest follow-up were documented. Functional evaluations were performed preoperatively and postoperatively (at the time of latest follow-up). RESULTS: The mean Knee Society function score increased from 63.1 points preoperatively to 90.0 points postoperatively. The mean overall Knee Society score increased from 93.2 points preoperatively to 160.8 points postoperatively. The mean average femoro-tibial angle was corrected from varus 0.8° (varus 14°-valgus 8.0°) preoperatively to valgus 7.6° (valgus 2-9°) at the last follow-up. CONCLUSIONS: The closing wedge high tibial osteotomy according to Wagner does not compromise subsequent total knee replacement and leads to good clinical and radiological results.

Long-term results of intertrochanteric varus osteotomy for dysplastic osteoarthritis of the hip.

The beneficial role of intertrochanteric varus or valgus osteotomy in the treatment of hip osteoarthrosis has been recognised since the 1920s. Even today, it has an important role to delay the need for hip replacement in younger patients. The purpose of this study was to evaluate the long-term results of intertrochanteric varus osteotomy for dysplastic osteoarthritis of the hip. Between 1980 and 1995, 52 hips with dysplastic osteoarthritis underwent an intertrochanteric varus osteotomy. All patients could be followed up after 17.8 years. Radiographic assessment included centre-edge (CE) angle of Wiberg and collodiaphyseal (CCD) angle. Dysplastic hip dislocation was classified according to Crowe. Osteoarthritis was graded according to Tönnis. Preoperative osteoarthritis was Tonnis grade 1 in 19 hips, grade 2 in 28 and grade 3 in five. Complications were also documented. Clinical evaluation included score according to Merle d'Aubigné, Harris Hip Score and range of motion. Six of 52 patients underwent total hip replacement (THR) within five years after intertrochanteric osteotomy. In these cases, preoperative osteoarthritis was grade 3 in four cases and grade 2 in one case according to Tönnis. Twenty-five of 52 patients underwent THR after an interval of five to ten years after intertrochanteric osteotomy. In these cases, preoperative osteoarthritis was grade 3 in one case and grade 2 in 24 cases according to Tönnis. Sixteen of 52 patients underwent THR after an interval of ten to 15 years after intertrochanteric osteotomy. In these cases, preoperative osteoarthritis was grade 2 in four cases and grade 1 in 12 cases according to Tönnis. In five patients the hip was functioning well after a period longer than 15 years. In all these cases osteoarthritis was grade 1 according to Tönnis. In 40.4% of patients, THR was delayed longer than ten years. The osteotomy performed well at a mean time of 9.7 years after the procedure (range 3-21). Intertrochanteric varus osteotomy for dysplastic osteoarthritis of the hip should be considered in early or mild osteoarthritic changes of the hip. Good prognosis with delay of THR of more than ten years can be expected to exceed 40%, even when indications are less than optimum.

Long-term results of the standard Wagner cup.

Cementless acetabular components gained popularity because of the increased rate of loosening associated with cemented cups after intermediate and long-term follow-up. There are few long-term follow-up studies of cementless acetabular components. This study aims to evaluate the clinical and radiological long-term results of the press-fit standard Wagner Cup. Between January 1, 1994 and June 30, 1994, 118 implantations of a standard Wagner Cup were performed, and 102 implants were clinically and radiographically followed-up after a mean of 12.0 years. The Merle d'Aubigné score improved from a preoperative mean of 9.5 to 17.2 at latest follow-up. Early postoperative complications included two deep haematomata requiring needle aspiration, two deep vein thromboses, one pulmonary embolism, two temporary lesions of the sciatic nerve, one single event of THR dislocation and one recurrent dislocation. Two isolated cup revisions and five more complete total hip replacements were performed for aseptic loosening. The overall survival rate at 12 years was 93.1% (95/102). The standard Wagner cup yields very good long-term results.

Long-term results of surgical release of de Quervain's stenosing tenosynovitis.

The management of de Quervain's disease (DD) is nonoperative in the first instance, but surgery should be considered if conservative measures fail. We present the long-term results of operative treatment of DD. From July 1988 to July 1998, 94 consecutive patients with DD were treated operatively by a single surgeon. There were 80 women and 14 men. Average age at the time of operation was 47.4 years (range 22-76). The right wrist was involved in 43 cases, the left in 51 cases. All operations were done under tourniquet control with local infiltration anaesthesia using a longitudinal incision and partial resection of the extensor ligament. There were six perioperative complications, including one superficial wound infection, one delayed wound healing, and four transient lesions of the radial nerve. A successful outcome was achieved in all cases with negative Finkelstein's test. Simple decompression of both tendons and partial resection of the extensor ligament with a maximum of 3 mm can be recommended in operative treatment of DD with excellent long-term results.

Osteochondrosis dissecans of the medial malleolus: a case report.

Osteochondrosis dissecans of the ankle accounts for approximately 4% of all osteochondrosis dissecans. Most osteochondrosis dissecans in the ankle is found in the talar dome. We report the case of osteochondrosis dissecans of the medial malleolus in a 46-year-old patient which has not been described yet.

Long-term results of surgical release of trigger finger and trigger thumb in adults.

INTRODUCTION: Trigger finger and thumb are amongst the most common hand disabilities seen by orthopaedic surgeons. Surgical release of the first annular pulley (A1) is generally indicated when non-operative treatment fails. We present the long-term results of open operative treatment of trigger finger or trigger thumb in adults performed by a single surgeon. METHOD: From July 1988 to 1998, 305 trigger fingers or thumbs in 276 consecutive patients were treated operatively, including 179 women and 97 men. The average age at operation time was 46.2 years. RESULTS: Two hundred and ten (76%) of the operations were performed for a single trigger digit release, 76 (24%) for multiple trigger digits in individual patients. All operations were done under tourniquet control with local infiltration anaesthesia under outpatient conditions using a transverse incision just distal to the distal palmar crease or on the flexor crease of the thumb at the metacarpophalangeal joint. At latest follow-up after an average of 14.3 years (min: 10, max: 20) 234 patients could be evaluated and were out of complaints, there were no serious complications such as nerve transection or bowstringing or recurrencies. CONCLUSION: We recommend open surgery of trigger finger and trigger thumb.

[Are There any Differences in Quality or Complication Rate in Total Knee Arthroplasty after Establishing a Centre for Endoprosthesis?] / Gibt es Veränderungen in der Qualität bzw. Komplikationshäufigkeit in der Knieendoprothetik durch die Etablierung eines Endoprothesenzetrums?

BACKGROUND: The aim of the study is to show whether there are any changes in quality or incidence of complications in total knee arthroplasty (TKA) after establishing a centre for endoprothesis (EPZ). MATERIAL AND METHODS: We conducted a retrospective study comparing 100 TKAs one year before establishing an EPZ (Group I) with 100 TKAs one year after establishing an EPZ (group II). Data were collected by analysing our electronic documentation system, and the report of the rehabilitation hospital. The following parameters were documented which are necessary to establish an EPZ: existence of X-rays before and after operation. Existence of full length weight bearing X-ray before operation or using a navigation device. Existence of preoperative planning, duration of TKA below 100 minutes. The following complications were documented: Periprosthetic infections, occurrence of periprosthetic fissures/fractures, thrombembolism, neurologic complications, patients' satisfaction rate with the hospital stay and mortality rate. Additionally femorotibial angle, femoral angle, tibial angle and tibial slope were measured. Statistical analysis was performed with SPSS 22.0. using the Kolmogorov-Smirnov test, the Qui-Square test and the Mann-Whitney U test. RESULTS: There were no statistical differences in local or systemic complications. The mean duration of operation was 82.9 min in group I (min.: 55, max.: 141) und 81.5 min in group II (min.: 57, max.: 129; p > 0.05). In group I, there were 20/100 cases (20%) with operation time longer than 100 minutes, in group II 13/100 cases (13%; p < 0.001). Analysis of anatomical femorotibial angle, femur angle, tibial angle and tibial slope showed no significant differences. The rate of documented survey of patients' satisfaction rate improved from 62% in group I to 98% in group II (p < 0.001). CONCLUSION: By establishing an EPZ, we achieved a significant improvement in the parameters operation time > 100 minutes and documented survey of patients' satisfaction rate, but not in complication rate.

Osteoarthritis in a symptomatic coracoclavicular joint.

Coracoclavicular joint (CCJ) is a rare cause of shoulder pain. CCJ is not described in most orthopaedic textbooks, leading to lack of awareness in the general orthopaedic community. In that way the incidence of symptomatic cases is underestimated. We present the case of a symptomatic osteoarthtritic CCJ in a 46-year-old male patient with nearly complete relief of pain after therapeutic injection of the CCJ. The radiological signs of CCJ are briefly discussed to increase awareness of this very rare entity.