[Update: endoprosthetics on the ankle joint]. / Update: Endoprothetik am oberen Sprunggelenk.

The ankle joint has to bear the entire body weight on a relatively small joint surface. Incongruities, instabilities and deformities lead to painful arthrosis and considerable restrictions in everyday life. For many years, arthrodesis has proven to be the gold standard for end stage arthrosis; however, considering modern endoprostheses for the ankle joint it is no longer appropriate to offer only arthrodesis. The very good results of the 3rd generation 3­component prostheses and the 4th generation 2­component prostheses show how much the surgical treatment options for the ankle joint are currently changing. The simplified implantation techniques enable access to arthroplasty of the ankle joint for a broader spectrum of surgeons and explain the increasing implantation rates in recent years. Decisive for postoperative success are correct planning with knowledge of the leg axes and foot position, correct patient selection and exact surgical placement of the components.

[Fast track in hip and knee arthroplasty]. / Fast-Track in der Hüft- und Kniegelenkendoprothetik.

Fast-track treatment concepts were developed decades ago in general and abdominal surgery and have been adapted in recent years for the special requirements of hip and knee arthroplasty. In this field, Hendrik Husted in particular was able to demonstrate scientific evidence for the components of fast-track concepts. The primary aim is not so much to shorten the patient's hospital length of stay (LOS) but rather to effectively increase the quality of medical treatment for the patient and to reduce complications. The optimization of organizational processes as well as intraoperative and perioperative surgical approaches are essential components regarding the introduction of fast track into the clinical routine. This article gives a comprehensive overview of fast-track treatment concepts and explains the scientific principles for the approach.

[Discrepancy between radiographic and true cup position after total hip arthroplasty : Are we interpreting our radiographic quality indicators correctly? Video article]. / Diskrepanz zwischen radiographischer und tatsächlicher Pfannenstellung bei der Hüft-TEP-Versorgung : Interpretieren wir unsere radiologischen Qualitätsindikatoren richtig? Videobeitrag.

BACKGROUND: After total hip arthroplasty (THA), objective postoperative quality control is done via X­rays by as component position assessment. The cup position is defined by its version and inclination. However, there is a discrepancy between radiographically measured and true (anatomic) cup position, which may lead to misinterpretation. METHODS: To visualize the discrepancy between true and radiographically measured cup position, in this video, a cup holder was used to set the angular cup version and inclination. Hereby, the cup position (anteversion and inclination) can be characterized in its radiographic and anatomic definition in greater detail. The viewer of this video should receive an impression as to when radiographically measured cup angles must be considered with caution. RESULTS: In a simultaneous X­ray and image sequence, this video shows decreased radiographic inclination measurement with increasing anterior rotation of the cup exceeding 20° of anteversion, yet with unchanged true inclination on the cup holder. Isolated consideration of the radiographic angles of anteversion and inclination may cause misinterpretation of true cup position. In pectoral illustration we show that variations in cup version and inclination may remain undetected when considering isolated the radiographic cup parameters. CONCLUSION: True cup position in its anatomical definition can be calculated from the radiographically measured position. For this purpose, both cup parameters (radiographic anteversion and radiographic inclination) have to be taken into account.

[Hand surgery in the rheumatic hand-novel and established aspects]. / Handchirurgie an der Rheumahand ­ Neues und Bewährtes.

BACKGROUND: Hand surgery of the rheumatoid hand has undergone significant changes mostly as a result of biologicals and biosimilars. OBJECTIVE: The significance of established and innovative operative procedures in the modern treatment of the rheumatoid hand is elaborated and a subsumption of local interventional options in this context is carried out. METHODS: The analysis, evaluation and discussion of the literature and expert recommendations are presented. RESULTS: With the consistent use of modern antirheumatic drugs the destruction and deformation of the wrist and hand occur more slowly and less severely. The hand surgeon can therefore operate more selectively and focus on less pathologies at the same time. Up to the present many of the operative techniques described by the pioneers of modern hand surgery are still powerful tools. Most of the considerations about the correction of the disturbed biomechanics and about the reconstitution of stability and the range of motion are still valid. The combination of arthroscopic synovectomy and radiosynoviorthesis of the wrist seems to show promising results. CONCLUSION: Modern treatment of the rheumatoid hand is a multidisciplinary challenge. Rheumatologists, nuclear medicine physicians and hand surgeons together can achieve excellent results. A consistent medication, an early operative intervention if necessary and systematic integration of nuclear medicine physicians into the therapeutic process enable preservation of the long-term function of the hand as the main tool in daily life.

[The knee joint in rheumatoid arthritis-current orthopaedic surgical treatment options]. / Kniegelenk bei rheumatoider Arthritis ­ aktuelle orthopädisch-chirurgische Therapieoptionen.

The knee joint is often involved in rheumatoid arthritis. Despite ever-improving medical antirheumatic therapies, surgical treatment continues to play an important role in optimal multidisciplinary care. The aim of the present work is to process current orthopedic surgical therapy procedures on the knee joint according to disease stage. In the early phase, joint-preserving arthroscopic procedures for synovectomy are used. In advanced joint destruction, joint function can be restored by total knee arthroplasty. Of central importance for optimal patient care are individual treatment and good interdisciplinary coordination of all involved specialist groups.

Implementing a benchmarking and feedback concept decreases postoperative pain after total knee arthroplasty: A prospective study including 256 patients.

Perioperative pain reduction, particularly during the first two days, is highly important for patients after total knee arthroplasty (TKA). Problems are not only caused by medical issues but by organization and hospital structure. The present study shows how the quality of pain management can be increased by implementing a standardized pain concept and simple, consistent benchmarking. All patients included into the study had undergone total knee arthroplasty. Outcome parameters were analyzed by means of a questionnaire on the first postoperative day. A multidisciplinary team implemented a regular procedure of data analyzes and external benchmarking by participating in a nationwide quality improvement project. At the beginning of the study, our hospital ranked 16th in terms of activity-related pain and 9th in patient satisfaction among 47 anonymized hospitals participating in the benchmarking project. At the end of the study, we had improved to 1st activity-related pain and to 2nd in patient satisfaction. Although benchmarking started and finished with the same standardized pain management concept, results were initially pure. Beside pharmacological treatment, interdisciplinary teamwork and benchmarking with direct feedback mechanisms are also very important for decreasing postoperative pain and for increasing patient satisfaction after TKA.

[Total hip replacement in developmental dysplasia: anatomical features and technical pitfalls]. / Hüftgelenkendoprothetik bei kongenitaler Dysplasie: Anatomische Besonderheiten und technische Stolpersteine.

Total hip arthroplasty is the procedure of choice for most patients with advanced, symptomatic osteoarthritis due to congenital dysplasia of the hip. However, the complexity of arthroplasty is significantly increased because of anatomic abnormalities associated with dysplasia of the hip. In addition the relatively young age of patients may affect survival of the implant. From a biomechanical standpoint the primary surgical objective is reconstruction of the anatomical center of rotation. Independent of the pelvic bone stock the socket should be located as near as possible to the anatomical acetabular location. There are various operative strategies to ascertain sufficient stability of the socket. The anterolateral deficiency of the acetabulum can be reconstructed by bulk femoral autografting or bone impaction grafting. Furthermore controlled perforation of the medial wall or implantation of reinforcement rings and oval sockets have been described. Cementless, biological socket fixation shows superior long-term results compared to cemented cups, especially in these young patients. The location of the reconstructed acetabulum and the desired leg length influence the type of femoral reconstruction and in some cases femoral shortening is required. In this article endoprosthetic reconstructive options for developmental dysplasia of the hip are discussed depending on the femoral and acetabular deformity.