INTRODUCTION: Although humeral head resurfacing with a cap is relatively common in clinical practice, clinical studies about the changes of the bone are rare. The aim of this study was to analyse qualitative and quantitative changes of the bone after cup arthroplasty. Our hypothesis is that the implant leads to a new functional load with remarkable changes of the bone underneath the cap. MATERIAL AND METHODS: Overall, 12 explanted caps with adherent bone tissues, retrieved at the revision surgery, were collected for histological examination. None of these implants were revised for loosening. Afterwards, there was a qualitative evaluation of the bone as well an assessment of established quantitative bone tissue parameters. Results were analyzed in correlation to the time to revision surgery, as well as to patient's age. RESULTS: A significant decrease of the bone volume and trabecular architecture underneath the cap was already observed after a relatively short lifetime. The quantitatively measured bone loss does not depend on the patient's age, but correlates significantly with the lifetime of the implants. In contrast to these findings within the central areas, an increased bone remodeling with bone densifications and microcallus formations was noticed at the edge of the cap in most cases. DISCUSSION: A significant reduction of the bone volume underneath the cap and remarkable changes of the trabecular architecture confirm our hypothesis. Even if these changes did not lead to a clinically relevant loosening in our series, they might influence revision surgeries. Thus, these findings might be of interest, especially when a non-stemmed reversed or anatomical revision arthroplasty with a central metaphyseal press-fit fixation is chosen. LEVEL OF EVIDENCE: IV - retrospective or historical series.
Humeral Head/surgery , Osteoarthritis/surgery , Shoulder Joint/surgery , Aged , Aged, 80 and over , Arthroplasty, Replacement/methods , Female , Germany , Humans , Humeral Head/physiopathology , Male , Middle Aged , Osteoarthritis/physiopathology , Postoperative Complications , Prostheses and Implants , Reoperation/methods , Retrospective Studies , Shoulder Joint/physiopathology
This article presents the spectrum of indications for the use of hyaluronic acid (HA) based on the recommendations of the European League Against Rheumatism (EULAR), the American College of Rheumatology (ACR), the Osteoarthritis Research Society International (OARSI), the International Institute for Health and Clinical Excellence (NICE) and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) taking the reality of patient care in Europe into account.
Hyaluronic Acid/administration & dosage , Hyaluronic Acid/standards , Practice Guidelines as Topic , Rheumatic Diseases/drug therapy , Rheumatology/standards , Adjuvants, Immunologic/administration & dosage , Adjuvants, Immunologic/standards , Antirheumatic Agents/administration & dosage , Antirheumatic Agents/standards , Dose-Response Relationship, Drug , Drug Monitoring/standards , Europe , Humans , Injections, Intra-Articular/methods , Injections, Intra-Articular/standards , Injections, Intralesional/methods , Injections, Intralesional/standards , Rheumatic Diseases/diagnosis , United States , Viscosupplements/administration & dosage , Viscosupplements/standards
The short stem designs currently available are significantly different and can be differentiated into neck containing, partial containing and neck resection designs. In this article, the differences in the design features are presented. These include the differences in the technique of implantation, the significant differences in the reproducibility of the given anatomy of the patient and also concerning their osteologic competence.
Arthroplasty, Replacement, Hip/instrumentation , Arthroplasty, Replacement, Hip/methods , Hip Joint/surgery , Hip Prosthesis/classification , Joint Instability/surgery , Technology Assessment, Biomedical , Equipment Design , Equipment Failure Analysis , Humans
PURPOSE: In over-head motion athletes a dysfunction of the suprascapular nerve has been described. In the literature a relation between the spinoglenoid ligament and the dysfunction of the suprascapular nerve is mentioned. An appreciable variability of this ligament is described. The purpose of the present study was the anatomic documentation of the spinoglenoid ligament and its relation to the suprascapular nerve. MATERIAL AND METHODS: In 36 shoulder specimen the suprascapular nerve, the spinoglenoid and bony parameter of the scapula were documented. The statistic evaluation was performed with SPSS12.0. RESULTS: In all but one specimen a spinoglenoid ligament was present. In 20 cases (56 %) the infraspinatus muscle inserted at the spinoglenoid ligament. In five cases (14 %) the spinoglenoid ligament reached the glenohumeral joint capsule. In two cases the suprascapular nerve was completely fixed with the ligament, in four cases the perineural soft tissue had a close connection to the ligament. In four cases a branch of the nerve passed through the ligament. All together in 28 % of the specimen there were mechanical conflicts. In one case a ganglion compressed the nerve. CLINICAL RELEVANCE: Our anatomic study showed in a significant number of cases a possible entrapment of different origins. These findings have implications both for diagnostics and treatment.
Ligaments, Articular/pathology , Models, Anatomic , Nerve Compression Syndromes/pathology , Shoulder Impingement Syndrome/pathology , Humans
INTRODUCTION: Posterior calcaneal exostosis treatment modalities have given rise to many controversial opinions. After failure of the conservative treatment, surgical bursectomy and resection of the calcaneal exostosis are indicated by many authors. But clinical studies also show a high rate of unsatisfactory results with a relative high incidence of complications. The minimally invasive surgical technique by an endoscopic calcaneoplasty (ECP) could be an option to overcome some of these problems. MATERIAL AND METHOD: Between 1999 und 2010 we operated 164 patients with an age range between 16 and 67 years, 81 males and 83 females. The radiological examination prior to surgery documented in all cases a posterior superior calcaneal exostosis that showed friction to the Achilles tendon. All patients included in the study had no clinical varus of the hind foot, nor cavus deformities. All patients had undergone a trial of conservative treatment for at least 6 months and did not show a positive response. The average follow-up was 46.3 (range: 8-120) months. RESULTS: According to the Ogilvie-Harris score 71 patients presented good and 84 patients excellent results, while 5 patients showed fair results, and 4 patients only poor results. All the post-operative radiographs showed sufficient resection of the calcaneal spur. In 61 patients the preoperative MRI showed a partial rupture of the Achilles tendon close to the insertion side. In no case could we observe a complete tear at the time of follow-up. Only minor postoperative complications were observed. In many patients we could observe a chondral layer at the posterior aspect of the calcaneus. Close to the intersion the Achilles tendon showed also in many patients a chondroide metaplasia. CONCLUSION: ECP is an effective and minimally invasive procedure for the treatment of patients with calcaneal exostosis. After a short learning curve the endoscopic exposure is superior to the open technique, has less morbidity, less operating time, and nearly no complications. Moreover, the pathology can be better differentiated.
Calcaneus/surgery , Endoscopy/methods , Heel Spur/surgery , Adolescent , Adult , Aged , Exostoses , Female , Humans , Male , Middle Aged , Syndrome , Treatment Outcome , Young Adult
AIM: The purpose of the study was to analyse different parameters before and after implantation of a modern short-stem hip design. MATERIAL AND METHODS: In this prospective radiological study 250 consecutive hips with degenerative hip osteoarthritis were included (246 patients). The patients were operated by five different surgeons at 4 different hospitals and a metadiaphysial fixed short-stem prothesis (Mini Hip, Corin) was used. Standardised X-rays were performed with the same technique pre- and postoperatively in all patients. Different anatomic parameters of the hip were documented by using the pre- and postoperative Xrays (ofset, CCD angle, length of leg). All measurements were performed by an independent examiner. The 246 patients included 129 females and 117 males. The average age of the patients was 59.7 years (range: 27-82 years). RESULTS: The offset only changed by + 0.28 cm (SD: 0.45 cm) after surgery. We could document only a small decrease of -0.51° (SD: 4.10°) of the CCD angle. The length of the leg increased on average by + 0.09 cm (SD: 0.34 cm). We found no difference between the measurements of female and male patients. Conspicuous was also the increasing use of small protheses (size 2) for hips with a small CCD angle and the increasing implantation of large protheses (size 9) in hips with a high CCD angle. CONCLUSION: Our results showed that we could reconstruct the individual geometry of the hip quite well by using the metadiaphysial short-stem prothesis. The tendency of an increasing CCD angle and a decrease of the offset seems not to be existent with the design of this kind of short-stem prothesis.
Hip Prosthesis , Models, Anatomic , Osteoarthritis, Hip/diagnostic imaging , Osteoarthritis, Hip/surgery , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Radiography , Reproducibility of Results , Sensitivity and Specificity , Treatment Outcome
PURPOSE: The purpose of the present study was to evaluate the MRI of the hip musculature as well as specific blood parameters on comparison of the Bauer approach with the minimally invasive ALMI approach. MATERIAL AND METHODS: We compared two patient groups after total hip replacement, which were operated either via the Bauer or the ALMI approach. All 47 patients had the same cementless hip design. All surgeries were performed by two experienced hip surgeons with experience of more than 1200 ALMI approaches. The patient groups did not differ concerning age, sex or side which was operated on. All MRI were performed in a standardised technique with a Philips Outlook Proview (0.23 Tesla). Patients were scanned preoperatively, within 2 weeks after surgery and at time of follow-up 14 months after surgery. The evaluation of the MRI findings was performed by two independent and blinded examiners. In order to document the muscle damage we documented myoglobin (the day before surgery, 6 hours postoperatively and at the first postop. day) und troponin (6 hours postoperatively). RESULTS: Preoperatively the male patients showed a significantly larger diameter of the gluteus medius muscle. We also could demonstrate in many patients a fatty degeneration even before surgery. At time of follow-up there was no significant difference between the two patient populations concerning the fatty degeneration. There was also no significant difference concerning the muscle atrophy. Muscle oedema, that was present before surgery, however, was no longer present at the time of follow-up. Two patients even preoperatively showed a lesion of the gluteus medius tendon. The range of the postoperative myoglobin level was high (118-5411 µg/L), in the ALMI group the standard deviation was 1445 µg/L, in the Bauer group it was 738 µg/L. There was no significant difference between both groups. Similar findings were documented for the troponin levels. CONCLUSION AND CLINICAL RELEVANCE: Even before THR many patients show significant degeneration in the hip muscles. Muscle oedema that was present before surgery had disappeared at the time of follow-up. The fatty degeneration was still present at the time of follow-up. There was no difference concerning the muscle atrophy between the ALMI and the Bauer groups.
Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Hip/methods , Magnetic Resonance Imaging/methods , Muscle Proteins/blood , Muscle, Skeletal/injuries , Muscular Atrophy/blood , Muscular Atrophy/diagnosis , Aged , Biomarkers/blood , Female , Humans , Male , Muscle, Skeletal/metabolism , Muscular Atrophy/etiology , Prospective Studies , Treatment Outcome
The presently available short hip stem designs show significant differences and can be differentiated into those containing the neck, those partially containing the neck and neck resection designs. In this article the currently available designs will be presented. Except for the Mayo stem there are no long-term results available. There are significant differences between the the systems especially with respect to reproducibility of the individual anatomy of patients therefore DEXA and DSA studies are needed in order to identify problematic stem designs early before clinical failures are produced in a large number of patients.
Arthroplasty, Replacement, Hip/instrumentation , Arthroplasty, Replacement, Hip/trends , Hip Prosthesis/trends , Equipment Failure Analysis , Humans , Prosthesis Design
During the last decade there have been significant changes in the perioperative management of total hip replacement patients. This process begins in the preoperative phase. Many patients are much better informed and standardized preoperative patient programs improve patient outcome and optimize the clinical pathways. The techniques in perioperative pain management have also significantly improved. The surgeon should not only rely on the anesthesiologist but should also use the options available during surgery. Postoperative weight bearing is handled in a much more progressive way than previously. In a standard primary hip replacement pain-adapted full weight bearing is possible if there are no patient-specific problems. There has also been a shift in the postoperative capability of performing athletic or recreational activities. In general patients can perform those activities that were performed before the surgery, which also includes, for example downhill skiing.
Arthroplasty, Replacement, Hip/adverse effects , Exercise Therapy/methods , Joint Instability/rehabilitation , Joint Instability/surgery , Pain, Postoperative/prevention & control , Patient Education as Topic/methods , Perioperative Care/methods , Combined Modality Therapy/methods , Germany , Humans , Patient Care Team/standards
OBJECTIVES: The primary objective was to compare a single, 6 ml, intra-articular injection of hylan G-F 20 with placebo in patients with symptomatic knee osteoarthritis. The safety of a repeat injection of hylan G-F 20 was also assessed. METHODS: Patients with primary osteoarthritis knee pain were randomly assigned to arthrocentesis plus a 6 ml intra-articular injection of either hylan G-F 20 or placebo in a prospective, double-blind (one injector/one blinded observer) study. RESULTS: were evaluated at 4, 8, 12, 18 and 26 weeks post-injection. The primary outcome criterion was change from baseline over 26 weeks in Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index A pain. Secondary outcome measures included WOMAC A1 and C, patient global assessment (PGA) and clinical observer global assessment (COGA) and Outcome Measures in Rheumatology, Osteoarthritis Research Society International responder rates. A 4-week, open, repeat treatment phase evaluated safety only. Results: A total of 253 patients (Kellgren-Lawrence grade II or III) was randomly assigned. Patients receiving hylan G-F 20 experienced statistically significantly greater improvements in WOMAC A pain scores (-0.15, SE 0.076, p = 0.047), and several of the secondary outcome measures (WOMAC A1, PGA and COGA), than patients receiving placebo. There was no difference between the safety results of the two groups. No increased risk of local adverse events was observed in the open, repeat treatment phase. CONCLUSIONS: This placebo-controlled study demonstrated that, in patients with knee osteoarthritis, a single 6 ml intra-articular injection of hylan G-F 20 is safe and effective in providing statistically significant, clinically relevant pain relief over 26 weeks, with a modest difference versus placebo.
Hyaluronic Acid/analogs & derivatives , Osteoarthritis, Knee/drug therapy , Viscosupplementation/methods , Viscosupplements/administration & dosage , Aged , Biocompatible Materials/administration & dosage , Biocompatible Materials/adverse effects , Double-Blind Method , Drug Administration Schedule , Female , Humans , Hyaluronic Acid/administration & dosage , Hyaluronic Acid/adverse effects , Injections, Intra-Articular , Male , Middle Aged , Osteoarthritis, Knee/physiopathology , Severity of Illness Index , Treatment Outcome , Viscosupplementation/adverse effects , Viscosupplements/adverse effects
INTRODUCTION: Viscosupplementation by repeated intra-articular injections of hyaluronic acid (HA) is used widely in the treatment of symptomatic knee osteoarthritis (OA). The number of injections required can limit the availability of treatment and affect patient compliance. The aim of this study was to assess different dosing regimens of hylan G-F 20, a high molecular-weight cross-linked derivative of HA, in the treatment of pain due to knee OA. MATERIALS AND METHODS: Pilot, prospective, multi-centre, open-label, randomised trial in 100 patients with unilateral, symptomatic, tibio-femoral OA (Kellgren-Lawrence grade II or III), aged > or =40 years. Patients were randomised to receive varying dosing regimens of hylan G-F 20 (1 x 6 mL, 1 x 4 mL, 2 x 4 mL 2 weeks apart, 3 x 4 mL 1 week apart, or 3 x 2 mL 1 week apart). Adverse events (AE's) were monitored throughout the study. The primary efficacy endpoint was the change from baseline in the patient-rated knee OA pain assessment (100 mm visual analogue scale (VAS)) at 24 weeks. The secondary efficacy criteria included the WOMAC index, patient and physician global assessments using a 100 mm VAS, and knee OA pain assessment at all other visits. Concomitant use of permitted rescue medications (paracetamol) was also assessed. RESULTS: The treatment was well tolerated overall. Patients in the 3 x 4 mL group reported the highest percentage of device-related local AE's (30%) while patients in the 1 x 6 mL and 3 x 2 mL groups reported only 10%. There were no serious device-related AEs. There was a statistically significant improvement from baseline at week 24 in all efficacy endpoints for all treatment regimens. The 1 x 6 and 3 x 4 and 3 x 2 mL treatment groups showed the greatest mean improvements (-34.9, -32.6 and -36.7 mm respectively) in the patient-rated knee OA pain assessment VAS. CONCLUSION: This study suggests that a single 6 mL injection of hylan G-F 20 may be as efficacious, and as well tolerated, as 3 x 2 mL one week apart. A double-blind, controlled trial is needed to confirm these data.
Biocompatible Materials/administration & dosage , Hyaluronic Acid/analogs & derivatives , Osteoarthritis, Knee/drug therapy , Viscosupplementation , Adult , Aged , Aged, 80 and over , Arthralgia/drug therapy , Arthralgia/etiology , Dose-Response Relationship, Drug , Female , Humans , Hyaluronic Acid/administration & dosage , Injections, Intra-Articular , Male , Middle Aged , Osteoarthritis, Knee/complications , Pilot Projects , Prospective Studies , Treatment Outcome
INTRODUCTION: Glenohumeral arthritis with a massive rotator cuff tear is a devastating condition that seriously compromises the comfort and function of the shoulder. Cuff tear arthropathy presents a unique surgical challenge and many arthroplasty options were used for its treatment. The purpose of this study was to evaluate the clinical and radiological results of Copeland cementless surface replacement arthroplasty (CSRA) applied in patients with cuff tear arthropathy and intact subscapularis function. PATIENTS AND METHODS: The study was conducted on twenty-five shoulders in twenty-five patients with cuff tear arthropathy with the subscapularis tendon still intact. The patients were prospectively followed-up clinically and radiologically for a mean of 26 months (range: 15 - 38 months). There were 16 female and 9 male patients. The mean age was 69.04 years (range: 53 - 83 years). The mean operative time was 38 minutes (range: 28 - 56 minutes). The clinical assessment was performed with the Constant score. RESULTS: The Constant score significantly improved from a mean of 14.04 points preoperatively to 53.17 points postoperatively. Of the patients, 88 % considered the shoulder to be much better or better as a result of the operation. Radiologically, the humeral offset, the lateral glenohumeral offset (coracoid base to the greater tuberosity), height of centre of instant rotation and the acromiohumeral distance were significantly increased. No intra- or postoperative complications were encountered. CONCLUSION: Our early results with the use of Copeland surface replacement in selected cases with cuff tear arthropathy are encouraging. The patients showed significant clinical (pain and range of motion) and radiological improvements. Moreover, if the surface replacement were to fail for any reason, it can be revised to a reverse prosthesis type as there is no lack of bone stock.
Arthroplasty, Replacement/methods , Osteoarthritis/surgery , Rotator Cuff Injuries , Shoulder Impingement Syndrome/surgery , Shoulder Joint/surgery , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Middle Aged , Osteoarthritis/diagnostic imaging , Postoperative Complications/diagnostic imaging , Prospective Studies , Prosthesis Design , Radiography , Rotator Cuff/diagnostic imaging , Rotator Cuff/surgery , Shoulder Impingement Syndrome/diagnostic imaging , Tendons/surgery
The purpose of the study was to evaluate the effect of suprascapular nerve block (SSNB) in shoulder surgery. The study group consisted of 260 patients, which were subjected to shoulder operations. The patients were divided into two equal groups: group I with nerve block compared to a control group II without a nerve block. The mean age of the patients in group I was 56.2 +/- 6.86 years and that in group II was 54.5 +/- 7.06 years. The female to male ratio was 71:59 in group I and was 69:61 in group II. Surgical procedures were arthroscopic rotator cuff repair, arthroscopic subacromial decompression, arthroscopic acromioclavicular resection, arthroscopic removal of calcific tendonitis, arthroscopic reconstruction of instability, arthroscopic capsular release and shoulder replacement. In all cases the pain was documented by the visual analogue scale (VAS) preoperative, at the first, the second as well as at the third day after surgery. In order to evaluate the amount of fluid, which is needed for infiltration of the area of the supraspinatus fossa, we injected different amount of local anesthetic in combination with contrast dye in five patients. In this study to document the fluid distribution, after injecting with different milliliters, 10 ml is proved to be more than enough to have sufficient local anesthetic to block the SSN. Pre-operatively the mean VAS was comparable between both groups. We documented a significant difference in favour of SSNB from day 1 to day 3 after surgery. No specific complications due to this nerve block procedure were found in any patient post-operatively.
Nerve Block/methods , Pain, Postoperative/prevention & control , Shoulder Joint/surgery , Anesthetics, Local/therapeutic use , Arthroscopy , Bupivacaine/therapeutic use , Case-Control Studies , Female , Humans , Male , Middle Aged , Pain Measurement , Shoulder/innervation
AIM: Prosthetic replacement in the hand must address such unique challenges as preservation of the collateral ligaments, tendon balancing,and Stability. Surface replacement arthroplasty can be an alternative to other current implants. The purpose of this study was to evaluate the metacarpophalangeal joint kinematics after surface replacement arthroplasty. METHOD: The kinematics of pyrolytic carbon as a surface replacement implant for the metacarpophalangeal joint (MCP) was compared with the intact MCP joint in eight fresh cadaver long fingers by means of an electromagnetic tracking system (Polhemus, Colchester, VT). The eight human cadaver MCP joints were tested before implantation, after implantation, after collateral ligaments resection, and after collateral ligaments reconstruction. RESULTS: The kinematics of the MCP joint is reproduced by the joint surface replacement arthroplasty when normal ligament tension was present. The maximum angular displacement of the pyrocarbon implant was 378 for lateral deviation and 338 for rotation during the passive flexion and extension motion. The instantaneus center of rotation (ICR) after implant insertion was nearly identical to the center of rotation of the normal joint. The results also indicated that the collateral ligaments provide the primary stability of the MCP joint. No significant differences in lateral and rotational stability after surface replacement arthroplasty were noted. While collateral ligaments resection significantly affected the stability of the MCP joint. CONCLUSION: The ICR of the pyrocarbon implant most closely matched that of the intact MCP joint. The pyrocarbon implant provides suitable stability to radio-ulnar deviation and rotational stresses as a resurfacing implant and it simulates the kinematics of the intact MCP joint. By using new materials and taking the anatomical and biomechanical requirements into consideration, the endoprosthesis of the finger joints has created an option to achieve good long-term results. The inadequate results of earlier and current prostheses are a consequence of their mechanical construction and their materials. The success of the new implants could be proven by preferably long-term, controlled studies.
Arthroplasty, Replacement, Finger/instrumentation , Arthroplasty, Replacement, Finger/methods , Awards and Prizes , Joint Instability/physiopathology , Metacarpophalangeal Joint/physiopathology , Metacarpophalangeal Joint/surgery , Biomechanical Phenomena/history , Cadaver , Elasticity , Equipment Design , Equipment Failure Analysis , Germany , History, 21st Century , Humans , In Vitro Techniques , Joint Instability/etiology , Minnesota , Orthopedics/history , Range of Motion, Articular , Stress, Mechanical , Treatment Outcome
Organized orthopaedic pain management is a major part of successful patient treatment. Therefore pain management should start before surgery. Patients need to be informed about the operation and the subsequent procedures. Clinical pain management is based on continuous pain documentation with pain as the fifth vital sign. Surgery should be minimally invasive bewaring a peripheral modulated nociceptive sensitization. In order to prevent chronic pain preemptive analgesia should be employed followed by an individually tailored regimen of post-operative analgesia. In consideration of the documented pain levels post-operative pain therapy consisting of a standing medication and a rescue medication should by adjusted daily. Due to the fact that the highest pain levels after surgery were reported within the first 48 h pain medication should be reduced in the ensuing days, again taking the documented pain levels into account. Supportive treatment approaches such as cryotherapy or transcutaneous electrical nerve stimulation (TENS) are useful in the post-operative period. Physiotherapy after surgery should be extended stepwise regarding the operative device and it is of particular importance to respect pain intensities. The post-hospital regimen for a continuous pain medication should be given to the orthopaedic specialist.
Analgesics/therapeutic use , Orthopedic Procedures/adverse effects , Pain, Postoperative/etiology , Pain, Postoperative/prevention & control , Perioperative Care/methods , Physical Therapy Modalities , Humans , Pain, Postoperative/diagnosis , Pain, Postoperative/drug therapy , Practice Guidelines as Topic , Practice Patterns, Physicians'
Ankle arthrodesis is performed for the treatment of unstable, arthritic, painful, and deformed ankle joints. A wide variety of surgical options and approaches exist to treat the difficult problem of an ankle arthrodesis. In patients with only minor ankle deformity and minor bone loss arthroscopically assisted fusion is the treatment of choice. The risk for the development of a pseudarthrosis depends on clinical factors like corticoid medication, nicotine, incorrect alignment and improper mobilization. With adequate shoes the patients can remain asymptomatic for long time. Adjacent joints may show radiological degenerative changes in the long-term follow-up; however, they do not need to be clinically symptomatic. Nowadays total ankle replacement is a valid alternative. The surgical technique is demanding. Implants of the 1st and 2nd generation did not show satisfying results. The newer 3rd generation total ankle arthroplasties show promising medium-term and long-term results.
Ankle Joint/surgery , Arthrodesis/methods , Arthroplasty, Replacement/instrumentation , Arthroplasty, Replacement/methods , Joint Diseases/therapy , Joint Prosthesis , Osteotomy/methods , Humans
The purpose of this study was to present the technique of arthroscopic capsule release in patients with early and midstage degenerative joint disease of the hip. In 22 patients we performed an arthroscopic capsular release of the hip joint capsule with simultaneous synovectomy and percutaneous drilling of areas of bone edema. The age of the patient ranged from 28 to 65 years (mean 52 years). There were 14 male and 8 female patients. All patients had suffered from a significant reduction of quality of life. In 15 of the 22 patients hip arthroplasty was already indicated in another institution. The preoperative Harris hip Score of 12 patients was below 69 points, 8 patients had a score between 70 and 79 points and 2 patients had a score between 80 and 89 points. At the time of follow-up (mean 26 months after surgery) 1 patient scored below 69 points, 3 patients scored between 70 and 79 points in the Harris hip score. Two patients scored between 80 and 89 points and 16 patients reached a score between 90 and 100 points. Subjective and objective 18 of 22 patients showed clinical relevant improvement. There was no complication in this series. Four patients underwent hip arthroplasty between 6 months and 2 years after the arthroscopic procedure. Minimal invasive arthroscopic treatments seem to decrease the subjective and objective complaints in early and midstage degenerative arthritis of the hip.
Arthroscopy , Osteoarthritis, Hip/surgery , Activities of Daily Living , Adult , Aged , Female , Hip Joint/surgery , Humans , Joint Capsule/surgery , Male , Middle Aged , Quality of Life , Treatment Outcome
Fusion of the ankle is an established option for end-stage degenerative joint disease. The purpose of this paper is to present the surgical technique as well as our own results. AAA starts with removal of all the remaining cartilage and joint detritus. For this we routinely use a posterolateral portal. When opening the subchondral plate one must be careful not to remove too much bone. In our hands a small chisel is very helpful for this step. Fixation is performed with two screws. In 31 out of 35 patients, we were able to obtain a solid bony fusion. AAA of the ankle can be performed in patients without significant malalignment or bony defect. It is an "in-situ" fixation of the destroyed painful joint, which is not suitable for patients with neuropathic joints. Patients with secondary joint destruction due to rheumatoid arthritis can also be treated with AAA.
Ankle Joint/surgery , Arthrodesis/instrumentation , Arthrodesis/methods , Arthroscopy/methods , Bone Screws , Internal Fixators , Osteoarthritis/surgery , Adult , Aged , Arthroscopes , Female , Humans , Male , Middle Aged , Prognosis , Treatment Outcome
