Long-term results of reconstructing the joints' articular surface in the knee and ankle with the surgical diamond instrumentation (SDI).

PURPOSE: The surgical diamond instrumentation (SDI), a precise wet-grinding technology, promised contact healing of press-fit inserted bone and even hyaline cartilage, lacks medium- and long-term results. This retrospective study was conducted to identify risk factors associated with the failure of the technique and the subjective patient outcome. METHODS: All patients treated for cartilage defects of the knee or ankle joint using the SDI technology between 2000 and 2012 with a follow-up > 1 year were included. Patients with general joint diseases or joint-related procedures, except for corrective osteotomies, were excluded. A standardized questionnaire (EQ-5D) and a questionnaire-based patient-reported outcome survey were used. Descriptive statistics were applied. A multivariate analysis examining risk factors for joint failure was performed. A p value < 0.05 was considered to indicate significant differences. RESULTS: 87 patients with autologous osteochondral transplantation (68 knee, 19 ankle) were included. The median age was 53 years (IQR 37.5-63.0 years) for knee and 36 years (IQR 27.5-54.0 years) for ankle joints. 57.9% of knee and 55.6% of ankle patients were female. Nine patients (8 knee, 1 ankle) had received arthroplasty. 93.3% of knee and 83.3% of ankle patients had an excellent function or minor disabilities. 73.3% of knee and 64.7% of ankle patients did not require pain medication. The mean EQ-5D score was 0.84 for knee and 0.77 for ankle. Patients with higher age were more likely to receive arthroplasty (p = 0.022). CONCLUSIONS: The SDI technique provides promising results with excellent joint survival rates and satisfying patient-reported outcomes. Failure of the technique might be associated with higher age.

Development of a dynamic fall risk profile in elderly nursing home residents: A free field gait analysis based study.

Falls in nursing home residents are associated with a significant individual and socioeconomic burden of disease. To trigger and tailor individual intervention programs, solid early detection measures of residents at risk are needed. Aim of this study was thus to test the capability of a free field gait analysis insole to determine its usefulness in determining fall risk. In an observational study gait data of 22 nursing home residents over the age of 75 years was collected over one week with a measuring insole. Clinical scores were performed at baseline (POMA; DGI, TUG). For 6 months before and after the insole measurement, the fall events per resident were recorded. Correlation analysis as well as receiver operating characteristic curve analysis were performed. The average resident age was 88.2 years (range 78-99), 15 had at least one fall event. There was no significant correlation between clinical assessment and fall risk. Moderate correlations between different temporospatial parameters and fall risk were seen. Pressure distribution during gait was markedly changed in fallers. Differences between fallers and non-fallers as well as cut off values for increased fall risk in the ROC analysis could be determined. The introduced measurement protocol suggests that patients at risk for falling can be detected without any additional office visits. Based on the introduced protocol in a limited patient setting, further large scale studies should now determine the effect of prevention measures triggered by gait analysis, the specific risk reduction and the associated personal and socioeconomic advantages.