[Patient safety during endoprosthetic training : Does the training of surgeons in primary hip arthroplasty at certified endoprosthesis centres lead to increased complications?] / Patientensicherheit in der endoprothetischen Weiterbildung : Führt die Weiterbildung von Operateuren in der primären Hüftgelenkendoprothetik in zertifizierten Endoprothesenzentren zu vermehrten Komplikationen?

BACKGROUND: The aim of the study was to investigate whether the perioperative outcome and the operation-specific process variables in patients with total hip arthroplasty (THA) significantly deteriorate when the operation is performed by an inexperienced surgeon assisted by an experienced one in the context of a certified endoprosthesis center. MATERIAL AND METHODS: 1480 patients who received primary THA for primary coxarthrosis between 2013 and 2016 were included. The relevant data were retrospectively documented from the hospital information system, the discharge letter and the EndoCert form. The surgeons were divided according to their qualifications into experienced (senior surgeon, > 50 THA per year) and inexperienced surgeons (junior surgeon, < 50 THA per year). The collected data and measured variables were then compared based on this subdivision. RESULTS: Inexperienced surgeons showed a significant increase in the duration of the operation by 20.7 min (senior 62.6 ± 20.4 min; junior 83.3 ± 19.5 min; p ≤ 0.001), as well as the length of hospital stay by 0.25 days (senior 8.8 ± 0.9 days; junior 9.0 ± 0.9 days; p ≤ 0.001). The frequency of transfusions of red cell concentrates was significantly increased with inexperienced surgeons (senior 0.6 ± 1.1 items; junior 0.9 ± 1.4 items; p ≤ 0.001). In contrast, there was no difference in perioperative complications (p = 0.682) or in perioperative blood loss (senior 1.3 ± 0.5 l; junior 1.3 ± 0.5 l; p = 0.097). However, there was a positive correlation between the duration of the operation and blood loss (senior r = 0.183; junior r = 0.214; each p ≤ 0.01). CONCLUSION: The training of inexperienced surgeons at a certified endoprosthesis center does not lead to a reduction in patient safety or increased complications when inexperienced surgeons are assisted by experienced surgeons. Due to the extended operating time, however, there is an additional burden on the clinics in competition with non-training clinics, which is not mapped in the DRG system.

[Recommendations for unicondylar knee replacement in the course of time : A current inventory]. / Empfehlungen zur unikondylären Schlittenendoprothetik im Wandel der Zeit : Eine aktuelle Bestandsaufnahme.

BACKGROUND: A higher patient satisfaction stands in contrast to higher revision rates of unicondylar knee joint endoprosthetics (UKE) compared to total knee joint endoprosthetics (TKE). Furthermore, old "dogmas" regarding indications and contraindications persist, which is still reflected in the significantly different case numbers. AIM: The aim of this article is to provide an overview of the current literature regarding 1. indication and contraindication (BMI, age, sport, arthrosis of other compartments, ligament status) and 2. the "eternal rival" fixed or mobile bearing for UKE. RESULTS: The choice of the right patient remains essential, even if all the old "dogmas" of contraindications have been relativized or even outdated. Arthroses of the contralateral (in medial UKE correspondingly lateral) compartment and advanced arthroses of the lateral patella facet remain the only persistent contraindications. In contrast, a high BMI, age, chondrocalcinosis, medial patella facet and a defective (but particularly functionally stable) ACL are not contraindications; however, severe obesity is responsible for a significantly higher complication rate and probably a higher rate of loosening. Rather, the experience and thus the number of UKEs of the individual surgeon is decisive for the outcome, to which the discussion about mobile or fixed inlays must also be completely subordinated. CONCLUSION: The indications for UKE can, therefore, be extended with a clear conscience on the basis of literature, and the current 1:10 UKE:TKE ratio in Germany can be shifted significantly.

Sodium hypochlorite is more effective than chlorhexidine for eradication of bacterial biofilm of staphylococci and Pseudomonas aeruginosa.

PURPOSE: Periprosthetic infection is a common reason for surgical revision. Given the increasing resistance of bacteria to antibiotics (e.g., VRE, 4-MRGN) local antiseptic treatment is gaining in importance. However, no standard guideline-based treatment recommendation is yet available. The aim of this study was to investigate the effectiveness of sodium hypochlorite and chlorhexidine against bacterial biofilms. Furthermore, the toxicity of both antiseptics towards human chondrocytes was examined. METHODS: Human chondrocytes were isolated, cultivated and treated with sodium hypochlorite and chlorhexidine. The viability of cultures was assessed by determination of cell count, XTT and MTT ELISAs, and fluorescent staining with propidium iodide. Bacterial strains of Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa were added to liquid media and incubated overnight. After determination of bacterial concentrations polyethylene (PE) devices were inoculated with bacteria for 48 h until biofilms formed. The devices were then washed, treated with antiseptics for 2 and 5 min and subsequently spread on agar plates. RESULTS: Sodium hypochlorite is more effective than chlorhexidine in penetrating biofilms of S. aureus, S. epidermidis and P. aeruginosa. Both antiseptics are chondrotoxic, but sodium hypochlorite damages human chondrocytes less than chlorhexidine in vitro. CONCLUSIONS: The findings confirm the effectiveness of sodium hypochlorite and chlorhexidine against bacterial biofilms. Both antiseptics can be recommended for the treatment of periprosthetic infections. The toxic effects of sodium hypochlorite and chlorhexidine towards chondrocytes may mean there is a risk of damage to cartilage tissue. LEVEL OF EVIDENCE: Controlled experimental study.

Gait Analysis before and after Cycle Training Using a 3D Pedal System.

PURPOSE OF THE STUDY In this pilot study, gait analysis was performed before and after training with a 3D pedal system (BIUS1), in order to clarify whether these differences are detectable by gait analysis after a short period of training. MATERIAL AND METHODS Two female and three male subjects were included in a prospective case-control pilot study. The patient and training characteristics were determined. Objective measurement data of the gait were obtained by using a three-dimensional motion analysis system with six infrared cameras and three force plates before and after training with the 3D pedal system. RESULTS The mean age was 36.7 ± 8.7 years and the subjects had a BMI of 21.8 ± 2.4 kg/m 2 . The training time per year was an average of 36.0 ± 11.2 days, with a training workload of 511.4 ± 36.7 km. For time-distance parameters, improvements for the left and right side were obtained for cadence and cycle time after training. In total, there was a reduction in hip abduction angle, and an increase in hip inward rotation, knee outward rotation, and range of the frontal knee angle. CONCLUSIONS Changes in parameters in the gait analysis after a short training interval demonstrate that a 3D pedal system is suitable to produce changes in the gait pattern detectable by gait analysis. Training effects on the supposedly weaker left side can be explained after a brief application of the BIUS1 system. Key words:cycle training, 3D pedal system, gait analysis.

Long-Term Effects of Intravenous Iloprost Therapy in Patients with Bone Marrow Oedema of the Knee Joint.

PURPOSE OF THE STUDY Bone marrow oedema (BMO) syndrome is a multifactorial condition. Various conservative treatment options include analgesic therapy, immobilisation of the affected joint and/or systemic intravenous iloprost therapy. Many studies have confirmed the positive effect of iloprost therapy, but only after short-term follow-up. The purpose of this study was to show that treatment with iloprost leads to positive long-term functional and radiological outcomes for BMO of the knee. MATERIAL AND METHODS Fifteen patients with BMO of the knee joint, ARCO stage 1-2, were included in this study. Various questionnaires, the Lysholm Score, the SF-36, WOMAC, Knee Society Score, and a visual analogue pain scale (VAS), were evaluated before and after iloprost therapy. All patients underwent MRI for radiological follow-up three months after treatment. RESULTS Significant improvements were found in the Lysholm Score, SF-36, WOMAC and KSS. In 80% of patients, follow-up MRI after three months showed complete regression of the oedema. Three patients received additional surgery after a follow-up period of 33 ± 7 months. CONCLUSIONS Based on the positive results of our study, we recommend treatment with iloprost for BMO of the knee in ARCO stage 1-2 patients. Key words:iloprost, bone marrow oedema, knee joint.

Calcaneal Displacement Osteotomies - Less Soft Tissue Irritation in Lateral Compression Plate than Screws.

PURPOSE OF THE STUDY With the concept of the lateral compression plate (LLCP) a technique has been available designed to combine the advantages of a fixed-angle fixation with a complete sinking of the implant into the proximal bone. The objective of the present study was to investigate the results of the LLCP compared with classical screw osteosynthesis (SO). MATERIAL AND METHODS 31 patients with pes planovalgus who received calcaneal displacement osteotomy and osteosyntheses with screws (n = 17) or LLCP (n = 14) between 2010 and 2015 were investigated retrospectively.The ankle-hindfoot scale, Kaikkonen score, VAS, and the SF-36 were determined preoperatively as well as at the last clinical follow-up. In addition, a radiological control of osseous integration was performed in all patients 12 weeks after surgery. RESULTS With regard to clinical scores both methods depicted significant improvement. In the overall cohort there were no pseudarthroses. In the SO group 5 cases (29%) showed hardware irritation, in the LLCP group there were none. Results in the LLCP group were significantly superior in the area of the physical section of the SF 36. CONCLUSIONS Based on the results of our study, surgical treatment of stage II pes planovalgus by means of calcaneal displacement osteotomy using the LLCP is equivalent to SO with a lower incidence of hardware irritation. Key words:pes planovalgus, lateral compression plate, osteosynthesis, screw, hardware irritation. LEVEL OF EVIDENCE: Level IV, retrospective case serie.

Establishing an Interdisciplinary Compulsory Elective Subject 'Spine' in the Curriculum of the University Study Course of Human Medicine.

PURPOSE OF THE STUDY Back pain and pathologies of the spine are among the main reasons why people consult a doctor, both general practitioners and paediatricians, as well as, specifically, orthopaedists, surgeons, and neurosurgeons. This involvement of different faculties calls for a high degree of interdisciplinary co-operation. In order to mediate these aspects of spine-specific diagnostics, therapy, and research to students during their studies and to promote up-and-coming specialists, the compulsory elective subject 'Spine' was established. MATERIAL AND METHODS From the winter semester of 2013 to the winter semester of 2014, the compulsory elective subject 'Spine' was offered to interested students in the 7th semester of their studies of human medicine. The maximum number of participants per course was 16. Each course lasted four weeks. The subjects taught covered the fields of degeneration, deformities, and destruction in the specialist disciplines of orthopaedics, traumatology, neurosurgery, and rehabilitation medicine. In addition, orthopaedic technology and the local musculoskeletal and biomechanical research institute were integrated into the course. Various teaching methods were applied, including problem oriented learning, seminars, observation or consultation, and internship. At the end, the course was evaluated with regard to subjective learning success, knowledge gain, satisfaction, and interdisciplinarity. Participants were compared with all students of the semester employing an objectively structured clinical examination (OSCE). RESULTS Forty-eight students took part in the compulsory elective subject 'Spine'. The compulsory elective subject was given a positive rating in all fields. In the learning success control, all of the students had good to very good results. Students attending the elective subject performed significantly better in the objective structured clinical examination (OSCE) (p ≤ 0.001). The compulsory elective course continues to be offered in the curriculum with a slightly altered schedule. CONCLUSIONS In view of the high prevalence of patients with back pain and its associated importance in terms of healthcare policy and social relevance, our experience leads us to recommend the general integration of such a compulsory elective subject in the study of human medicine. Key words:elective subject, spine, students, spinal disorders.

[Use of dual mobility cups for revision hip arthroplasty]. / Einsatz von Dual-Mobility-Pfannen beim Hüftprothesenwechsel.

The dual mobility cup (DMC) is an increasingly important tool not only in primary but also in revision total hip arthroplasty to prevent dislocation and eventually reduce postoperative complication rates. Various studies have shown survival rates with DMCs of up to 100% with an average dislocation rate of less than 1.5% after primary hip arthroplasty and a follow-up of 10 years. In revision surgery, survival rates of up to 99% were reported with dislocation rates between 0 and 10% after an average of 5 years after implantation. This article is intended to provide an overview of the principle and function of DMCs. Furthermore, indications as well as complications are presented.

[Complications and costs in primary knee replacement surgery in an endoprosthetics centre : Influence of state of training]. / Komplikationen und Kosten in der primären Knieendoprothetik in einem Endoprothetikzentrum : Einfluss des Weiterbildungsstandes.

BACKGROUND: This work examines the hypothesis that in endoprosthesis implantation there are differences between experienced primary and senior caregivers (S-Op) and less experienced follow-up assistants (T-Op) with respect to process-relevant parameters. The main hypothesis is that compared to S­Op, T­Op cause significantly longer surgery times and thus additional operating theatre costs. As sub-hypotheses, differences in various perioperative (p-o) parameters between T­Op and S­Op were examined. MATERIALS AND METHODS: The status of the operator (senior and/or senior main operator [S-Op]) and/or postoperative CRP, perioperative blood loss, the amount of transfused erythrocyte concentrates, patient age, gender, ASA risk classification (American Society of Anesthesiologists), duration of surgery and blood transfusion, duration of inpatient stay, as well as the rates of early revision surgery and complications were recorded. A comparison of patients who had been operated by an S­Op and those who had been operated by a T­Op was made for all parameters. RESULTS: Significant differences were found with respect to the duration of surgery, the duration of the hospital stay, and CRP on the third p­o day. The T­Op required an average of 11 min more than the S­Op. CRP was significantly higher in the T­Op group only on the third p­o day, by 18 mg/l. In contrast, in the T­Op group, a blood loss of 181 ml was lower than in the S­Op group. This corresponded to a reduction of 0.26 transfused erythrocyte concentrates. There were no significant differences in complication rates between S­Op and T­Op. DISCUSSION: In the setting of a certified endoprosthetics centre, the comparison of T­Op with S­Op showed that the use of the former with at a non-increased complication rate led to a significant extension of the operating time. This leads to additional training costs in the amount of an estimated 3% of the current DRG remuneration. These additional costs are not represented adequately in the current remuneration system.

Cementless Total Hip Arthroplasty in Primary Myelofibrosis - a Case Report.

There is a great deal of data available, in part contradictory, on the best fixation technique to use for total hip arthroplasty (THA) in hip osteoarthritis. Both the cementless and the cemented versions offer excellent long-term outcomes - if the respective technique is applied correctly. However, as far as we know, no recommendation has been made regarding cemented vs. cementless THA in primary myelofibrosis. The case described here concerns a very active 76-year-old patient with primary myelofibrosis. This is a rare hematological disease. It develops from clonal hematopoiesis with impaired blood formation and progressive bone marrow fibrosis. An MRI scan of the patients pelvis showed a marked spotted change over all of the imaged bone. Ultimately, in preoperative planning we decided in favor of a proven cementless implant (Allofit Alloclassic cup and the CLS Spotorno stem from Zimmer). Complication-free osseous integration of the cementless implants was observed. Histologic analysis of the bone showed a focally sclerotically altered bone structure. Neither osteoporosis nor osteopenia were found. In our opinion, taking into account all other indication criteria, there is no reason not to perform a cementless THA implantation in the presence of primary myelofibrosis. Key words: hip, primary myelofibrosis, cementless, THA, total hip replacement.

[Total knee arthroplasty in 2014 : Results, expectations, and complications]. / Knietotalendoprothese 2014 : Ergebnisse, Erwartungen und Komplikationen.

BACKGROUND: Aseptic loosening seems to have become a minor problem in total knee arthroplasty. In contrast to that, new challenges are defined by changing patients' expectations. Beside reduction of pain and improving mobility, modern implants should not be noticed as such and should not limit sports activities. OBJECTIVES: In this paper, a summary of the development and the current situation of total knee arthroplasty (e.g., implantation numbers, hospitality, operation time, and infection rates) are provided. The data are compared in an international context. In addition, current trends and developments from recent years are shown and rated according to the literature. MATERIALS AND METHODS: The paper is based on a literature search (PubMed) and analyses of published official statistical data and expert recommendations. RESULTS: Implantation numbers have been declining gradually in Germany since 2009. In 2013, 127,077 total knee arthroplasties were implanted. In contrast, the number of revision operations has increased gradually during the last decade. In addition, hospital stay and operation time have declined. CONCLUSION: The development of implants, instruments, and operation techniques results from changing patients' expectations. All innovations must be compared against the results of well-proven techniques. The arthroplasty register may be an instrument to evaluate the results of new techniques and implants in a broad clinical application in terms of survival.

Arthroscopic-Assisted Intraosseous Balloon-Assisted Repositioning of a Tibial Plateau Fracture: A Case Report.

This is the first description of an arthroscopic-assisted intraosseous balloon-assisted repositioning and defect filling of a tibial plateau fracture. The bone defect was filled with calcium phosphate cement in a liquid/paste form. The described technique was therefore introduced in order to allow an arthroscopic control of reposition and intra-articular cement escape during defect filling. X-rays showed an exact reposition without cement escape and the clinical outcome was satisfactory.

[Tibiocalcaneal arthrodesis with retrograde nails. Description of a hindfoot procedure after massive talus destruction]. / Tibia-Allograft-Kalkaneus-Arthrodese mit retrogradem Nagel: Beschreibung eines Rückzugsverfahrens nach massiver Talusdestruktion.

Following loss of the talus, tibiocalcaneal fusion is often the only available means of obtaining weight-bearing ability in the lower limb. Length discrepancy may be managed with an allograft. This casuistic describes 6 patients with tibiocalcaneal fusion (mean age 64 years) who had received a structural femoral head allograft fusion for failed total ankle arthroplasty (3 cases), Charcot arthropathy (2 cases) and osteomyelitis (1 case). The mean follow-up was 33 months and all limbs could be salvaged. There were two cases of non-union (one with infection). The mean AOFAS score was 51 and the mean Mazur score was 37. In the SF-36 the mean PCS was 34.4 and the mean MCS was 48.4. It was shown that in the hindfoot, as at other sites, allografts may be used for the filling of major bone defects; however, the patient function will still be massively impaired. Therefore, the procedure should be confined to cases where less complex and less invasive techniques are unlikely to be of benefit.

[More muscle mass in men: explanatory model for superior outcome after total hip arthroplasty]. / Mehr Muskelmasse bei Männern : Erklärungsmodell für bessere Ergebnisse nach Hüfttotalendoprothesenimplantation.

BACKGROUND: Men show better functional results after total hip arthroplasty (THA). The aim of this study was a patient-specific analysis of the hip joint muscles in comparison to the joint geometry. METHODS: In this study 93 computed tomography (CT) scans of the pelvis (45 men, 48 women) were analyzed to determine hip joint geometry and the volume of the gluteus medius (GMV), gluteus maximus (GXV) and tensor fasciae latae (TFL) muscles. The abduction muscle volumes were analyzed with respect to patient-specific adduction moments. RESULTS: The absolute total volume of the hip muscular system (TMV) was larger in men than in women (1913 ccm vs. 1479 ccm; p <0.0001). Men exhibited a more progressive increase of muscle volume as the adduction moment increases. CONCLUSIONS: Men have a greater abduction muscle mass in order to balance adduction moments occurring in the hip joint and therefore have more muscle mass to compensate the inevitable intraoperative muscle damage during THA. This argument supports the extraordinary importance of muscle sparing surgical techniques in women.

[Early results of gender-specific posterior stabilized total knee arthroplasty without patella resurfacing]. / Konventionelle und geschlechtsspezifische kreuzbandersetzende Knietotalendoprothesenimplantation. Vergleich frühfunktioneller Ergebnisse.

INTRODUCTION: To address anatomical gender differences in total knee arthroplasty (TKA) specific total knee prostheses have been developed for women. Potential benefits of these modified prostheses are currently under debate. The present study investigated whether the modified design features bring benefits compared to uni-sex TKA. METHODS: A total of 80 prospectively blinded and randomized patients underwent implantation of unilateral TKAs with NexGen LPS Gender Solutions (Zimmer, Warsaw, USA, group gender-specific GS prosthesis, n = 40) or NexGen LPS Flex (Zimmer, Warsaw, USA, control group standard prosthesis ST, n = 40) The follow-up was carried out 10 days and 6 weeks postoperatively. Clinical data and the subjective assessment of quality of life were evaluated using the Knee Society Clinical Rating System (KSS), the short form 36-item health survey (SF-36) and the Western Ontario and McMaster Universities OA Index (WOMAC). RESULTS: The two groups showed equal values in KSS, SF-36 and WOMAC preoperatively and ten days postoperatively the GS group reached an average KSS knee score of 62.6 ± 16.1 points (ST group 56.9 ± 14.7, p = 0.184) and a functional score of 28.5 ± 12.1 (ST group 24.3 ± 15.3, p = 0.082). In the overall score the GS group reached 91.1 ± 24.1 points (ST group 81.0 ± 27.1, p = 0.104). The GS group reached a knee score of 85.5 ± 14.4 points (ST group 77.8 ± 16.8, p = 0.03) and a functional score of 68.1 ± 20.7 points (ST group 62.3 ± 18.5, p = 0.185) 6 weeks postoperatively. In the overall score the GS group reached 153.7 ± 30.7 points (ST group 139.6 ± 32.4, p = 0.048). The analysis of SF-36 and WOMAC showed no significant differences at all time points. No evidence of loosening or migration was observed in both groups. CONCLUSIONS: Based on the data presented, gender-specific TKA type NexGen LPS Gender Solutions has advantages in terms of early functional outcome. This result is not reflected in the patient satisfaction and is not considered to be clinically relevant.

[Synovialitis of the arthrofibrotic type: criteria of a new synovialitis type for the diagnosis of arthrofibrosis]. / Synovialitis vom arthrofibrotischen Typ: Kriterien eines neuen Synovialitis-Typus für die Diagnose der Arthrofibrose.

After rheumatologic conservative medical therapy has been exhausted in degenerative and inflammatory joint diseases, arthroplastic operations are an important option to restore quality of life. Endoprosthesis-associated arthrofibrosis is a severe fibrosing disease of the synovial membrane after endoprosthetic operations. Neither the morphological substrate nor histopathological criteria have been described. The aim was to describe the histopathological substrate of arthrofibrosis and to define histological and immunohistochemical criteria of arthrofibrosis on the basis of tissue samples derived from revision. In histopathological analyses arthrofibrosis revealed a synovialitis with varying fibrosis, without detectable ossification and without minimal wear particle reaction (so-called synovialitis of arthrofibrotic type, SAT). A 3-stage grading was determined based on the cellular density of the fibrous tissue (fibroblast cellularity). In 191 cases with SAT, grade 1 was found in 24.1 % (n = 46), grade 2 was found in 51.8 % (n = 99) and grade 3 was found in 24.1 % (n = 46). The control group consisted of 29 cases with synovialitis of indifferent type (type IV membrane). If SAT grades 2 and 3 are summed together, i.e. the distance between the fibroblasts was less than two cell lengths, the difference of the fibroblast cellularity compared with the type IV membrane was significant (p < 0.001). Above SAT grade 2 the diagnosis of arthrofibrosis could be made with a sensitivity 0.7592 and specificity 0.8276. The SM-alpha-actin cytoplasmic positivity of fibroblasts indicates a myofibroblast phenotype and the ß-catenin positivity suggests a resemblance to fibromatosis or a keloid-like process. In the quantitative evaluation of the ß-catenin positive fibroblasts, there was a significant difference (p < 0.001) between type IV membrane and SAT. A threshold value of 20 beta-catenin positive cells per microscopic high power field (HPF) was determined, which represents in conjunction with the clinical information a new histopathological diagnosis component (sensitivity 0.720, specificity 0.867).

[Revised consensus classification. Histopathological classification of diseases associated with joint endoprostheses]. / Erweiterte Konsensusklassifikation. Histopathologische Klassifikation von Gelenkendoprothesen-assoziierten Erkrankungen.

The revised classification of the periprosthetic membrane (synovial-like interface membrane SLIM) encompasses all pathological alterations which can occur as a result of endoprosthetic replacement of major joints and lead to a reduction in durability of prostheses. This also includes the established consensus classification of SLIM by which aseptic and septic prosthetic loosening can be subdivided into four histological types and histopathological criteria for additional pathologies: endoprosthesis-associated arthrofibrosis, immunological/allergic alterations and osseous pathologies. This revision represents the foundation for the histopathological diagnostics of the total spectrum of diseases associated with joint prostheses, is a suitable basis for a standardized diagnostic procedure and etiological clarification of endoprosthesis failure and also as a data standard for endprosthesis registers, in particular for registers based on routine data (e.g. German endoprosthesis register).

Wound drainage in primary knee arthroplasty--a prospective randomized study.

UNLABELLED: PURPOUSE OF THE STUDY: Wound drainage in surgical interventions has a long tradition. Regarding the primary TKA there are no valid data concerning the ideal point of time for removal. The objective of this prospective randomized study was to investigate which drainage procedure should be given preference with regard to wound healing, blood loss, development of intraarticular hematomas and early postoperative function. MATERIAL AND METHODS: We documented the ROM, the knee circumference at the upper patellar pole preoperatively and on days 2, 4 and 6 postoperatively. The blood volume and loss was calculated. As surrogate parameter for wound healing we counted the amount of days until no residual secretion was observed via the wound/drainage site. RESULTS: The results of our investigation do not show any significant difference with regard to the mentioned parameters. CONCLUSIONS: In our investigation, we were unable to find any significant advantage of intraarticular drainage for 48 hours over 24 hours after primary total knee arthroplasty. After uncomplicated total knee arthroplasty we recommend removing drainage after 24 hours.

[The bicompartmental knee joint prosthesis Journey Deuce: failure analysis and optimization strategies]. / Die bikompartimentelle Kniegelenkendoprothese Journey Deuce: Fehlschlaganalyse und Optimierungsstrategien.

BACKGROUND: The Journey Deuce bicompartmental knee system is intended for patients with medial and patellofemoral arthritis of the knee and is aimed at diversifying the treatment options for knee arthritis. The prosthesis consists of a combined femoral shield with a medial condylar resurfacing component and a fixed bearing unicondylar tibial knee prosthesis. The advantages of the Journey Deuce system compared to total knee arthroplasty (TKA) are the bone sparing and cruciate retaining implantation. Outcome studies and investigation with respect to success and revision rates are rare. Thus the aim of this study was to investigate the early functional outcome as well as the revision and complication rates in patients with a Journey Deuce prosthesis within the first 2 years. METHODS: In this study 43 patients (25 female/18 male, average age 62.4 ± 8 years and mean body mass index27.3 ± 4.5 kg/m(2)) underwent bicompartmental knee arthroplasty using the Journey Deuce prosthesis between March 2008 and March 2009. Inclusion criteria were clinically and radiographically confirmed patellofemoral arthritis, ligament stability and flexion > 90°. Exclusion criteria were extension deficits > 5°, axis deviation > 10° and patellofemoral malalignment. Patients were followed up for 6, 12 and 24 months postoperatively. Follow-up consisted of clinical and radiographical examination as well as a survey of the Knee Society score (KSS), a pain score (visual analog scale VAS, range 0-10) and a satisfaction score. RESULTS: Of the patients 35 (82%) patients reached the 2-year follow-up and of these 35 patients 26 (75%) had a good to very good satisfaction, a mean KSS of 93 (range 65-100) and a minimal pain score of 1.2 (range 0-4). After 12 months all patients had a knee flexion of more than 90° (mean 116°, range 95°-140°). Loosening was not detected but 8 (18%) patients had to undergo revision within the first year due to persistent knee pain and instability. CONCLUSIONS: Under clear indications and exact anatomical positioning the Journey Deuce prosthesis enables a good functional outcome; however, a high revision rate occurred in this study caused by technical complexity and insufficient variety of implant sizes which led to malalignment and instability. Additional positional guidance and a higher variability in implant sizes are required to enable an adequate treatment with anatomically correct positioning. The Journey Deuce prosthesis would then be a reasonable diversification of the endoprosthesis spectrum in knee arthroplasty and would allow a more individual and selective treatment of patients with knee arthritis.