[Clinical and radiological results of individual hip stems of the type Adaptiva(R) without cement]. / Klinische und radiologische Ergebnisse der zementfreien individuellen Hüftendoprothese vom Typ Adaptiva(R).

AIM: Long-term anchorage of foreign material in vital bone has proven to be the main problem in hip arthroplasty. Bone cement, a material for filling and fitting, allows an excellent solution for older people. Many failures have been blamed on the use of polymethylmethacrylate in younger patients. In our opinion, modelling a stem to the individual anatomic needs of younger patients and to implant it without cement but with a stable press-fit is a good way to transmit stress harmoniously from the prosthesis to the bone and to obtain a long-lasting function. This individual hip stem is now available in the third generation under the name Adaptiva(R). We would like to present our first results. METHOD: Between October 1993 and September 1995 150 individual hip prosthesis of the Adaptiva(R) type have been implanted. In the average the patients were 53,2 years old. The average time of follow-up was 19.9 (12 to 44) months. RESULTS: The Merle d'Aubigné score showed excellent absolute and relative results for pain, mobility and ability to walk. No aseptic loosening of the stem occurred. CONCLUSION: Our early results are promising, but we have to wait for the long-term results, which are part of a current study.

A surprising cause of paresis following scoliosis correction.

Paralysis following scoliosis correction is a catastrophic situation. We report an unusual metabolic cause of neurological deficit after anterior thoracic release. A 15-year-old female developed proximal leg paralysis 1 day after surgery. Investigations disclosed severe serum hypokalaemia (2.8 mmol/l). After intravenous potassium substitution the neurological status completely normalized within a few hours. We assume that the condition was a manifestation of hypokalaemic paralysis since no further abnormalities could be disclosed. Spinal surgeons should bear in mind hypokalaemia as a benign and easily correctable cause of paresis following surgical scoliosis correction.

[The course of inflammatory mediators after elective orthopedic interventions]. / Entzündungsparameterverlauf nach elektiven orthopädischen Eingriffen.

PURPOSE OF THE STUDY: The aim of the study was to characterize the changes of C-reactive protein, erythrocyte sedimentation rate, white blood count and body temperature by serial measurements after different types of uncomplicated orthopedic surgery. METHODS: The uncomplicated course of 180 patients after elective total hip and knee arthroplasties, ventral and dorsal spinal fusions and diagnostic knee and shoulder arthroscopies were analyzed. RESULTS: The maximal CRP-values were recorded on the second or third day after operation. The peak levels correlated with the extent of the procedures and reached 1.28-17.71 mg/dl. The ESR increased to maximal rates five to six days after surgery and remained elevated during the 14 days of the investigation period. WBC and body temperature showed a slow and uncharacteristic increase followed by a slow and irregular decrease. CONCLUSION: Awareness of the typical pattern of CRP, ESR, WBC and body temperature may help to evaluate the early postoperative course. The CRP is a sensitive marker. ESR, WBC and body temperature are less costly but a poor diagnostic aid for the early detection of postoperative complications especially infections.

Metastatic spine disease in renal cell carcinoma--indication and results of surgery.

Metastatic spine disease is frequent in renal cell carcinoma and 50% of osseous metastases are already found at the time of primary diagnosis. Therefore patient mobility and quality of life are threatened early in the course of disease. Surgery is able to relieve pain and to regain or to preserve mobility. Indication and technique of surgery (anterior decompression, vertebral replacement and transpedicular fixation) are explained and treatment results of eleven cases are reported. All patients with paraparesis or cord compression preoperatively were mobile when leaving our hospital after surgery. There were no severe complications, especially no neurological deteriorations or deaths. Postoperative survival time was ten months approximately in cases with multiple osseous lesions and it was several years in cases with solitary metastases. Mobility was preserved for most of the survival time. In conclusion, restabilisation of the spine proved to be a worthwhile treatment option in well-selected cases suffering from malignant spinal involvement.

[Treatment of osteoid osteoma with CT-guided drilling and ethanol instillation]. / Therapie des Osteoidosteoms durch CT-gesteuerte Bohrung und Aethanolinstillation.

HISTORY AND CLINICAL FINDINGS: For 6 months a 25-year-old man had been suffering from intermittent pain in the left upper leg, alleviated by aspirin. Physical examination was unremarkable: local pain was not elicited. INVESTIGATIONS: Routine radiology and computed tomography confirmed the clinically suspected diagnosis of intracortical osteoid osteoma of the femur. Skeletal scintigraphy showed distinctive local concentration of the contrast material. DIAGNOSTIC PROCEDURE, TREATMENT AND COURSE: The lesion's central area was identified by CT and under general anaesthesia drilled into (5 mm diameter drill bit). As the lesion's edges remained partially intact, the cavity was sterilized with 1-2 ml of 96% ethanol. The patient was mobilized after six hours. He has remained free of pain in the subsequent 7 months. CONCLUSIONS: Minimally invasive, CT-guided percutaneous treatment of an osteoid osteoma can be achieved by a combined radiological and percutaneous orthopaedic procedure as an alternative to open surgery.

Magnetic susceptibility in the vertebral column.

A magnetic resonance method is described which provides good-quality field-mapping images of the spine, although the in vivo signals from red bone marrow of the vertebral bodies exhibit similar fractions of lipid and water protons with their chemical-shift difference of 3.4 ppm. The susceptibilities of bone marrow and intervertebral disks were examined in 20 cadaveric human spines, 9 healthy volunteers, and 9 patients with degenerative disk alterations. The influence of geometrical properties was studied in cylindrical spine phantoms of different size and contents with different susceptibility. The measurements reveal interindividual differences of the susceptibility of the intervertebral disks in healthy subjects. Three out of nine degenerated disks with low signal in T2-weighted spin-echo images showed irregularities of the field distribution within the nucleus pulposus.

Kinematics of the Zielke procedure (VDS) in scoliosis. Intraoperative measurements.

The Zielke correction technique (VDS) has two parts, derotation and ventral convex-side compression. Both were studied by measurements made during and after the operation. Ventral derotation always creates lordosis. Lordosis can be maintained during compression by insertion of intervertebral bone blocks, or kyphosis created by omitting them.

Correction of the sagittal plane in idiopathic scoliosis using the Zielke procedure (VDS).

This paper reports a retrospective review of 91 patients with idiopathic thoracic scoliosis corrected by Zielke VDS instrumentation. The results were analysed to demonstrate the correction in all three planes. Satisfactory correction was obtained, and was particularly good in the sagittal and horizontal planes. There were no disadvantages from the thoracotomy.

Stabilization of the lumbosacral spine in postlaminectomy syndromes. Technique and 2-year results.

A 2-year follow-up study is presented using transpedicular stabilization with USIS (Universal Spinal Instrumentation System) and dorsoventral fusion for failed back syndrome. Eighty-four % excellent and good results at 3 to 6 months have decreased to 56% at 1 to 2 years. Complications are few if the anatomic landmarks are respected. Many psychological and social factors also modify the final outcome of salvage surgical procedures. Only the relief of pain determined our subjective evaluation by the patient himself, without regard to sensory or motor deficiencies.

[Surgical scoliosis therapy using VDS and Harrington instrumentation (ventral derotation spondylodesis)]. / Operative Skoliosetherapie mit der VDS- und der Harrington-Instrumentation.

The VDS-method in accordance to Zielke and the Harrington-distraction-spondylodesis are proved as methods for correction of scoliosis lasting for decades, which late results are world-wide analysed and published. The both diametrical corrective principles and the fundamental different operative techniques settle their different indications, which doubtless depend on the experience of the surgeon. Both methods complete each other in operative spectrum of the spinal surgeon. A careful study of the bending properties and the general situation is the supposition for adequate differential indication, which details and results are reported.

[The natural history of scoliosis]. / Der natürliche Verlauf (natural history) der Skoliose.

Adequate treatment of scoliosis requires from the managing doctor a detailed knowledge about the natural history of the disease for correct indication of the various possibilities for treatment and favourable influence of the spontaneous history. Essential prognostic factors of idiopathic scoliotic forms and congenital or neuromuscular scolioses will be demonstrated.

[Zielke ventral derotation spondylodesis]. / Die ventrale Derotationsspondylodese nach Zielke.

There are several procedures in the operative treatment of scoliosis. Zielke-instrumentation has proven to be a safe and effective method for many years. Biomechanics, the operative technique, indications and complications are presented as well as long-term results after 5-10 years. VDS really proves a superior correction of all the three dimensions of a curve, major complications are very rare. Special regard is given to rotation correction, the cosmetic improvement and to the behavior of compensatory curves: a full correction is not an ideal result.