[Comparison of medium-term clinical and radiological outcome between cemented and cementless medial unicompartmental knee arthroplasty]. / Mittelfristiger, klinischer und radiologischer Vergleich von zementierten und zementfreien, medialen, unikompartimentellen Knieendoprothesen.

AIM: Cementation of tibial implants in total knee arthroplasty is the gold standard considering the high loosening rates of cementless implants. In contrast, only sparse data exist regarding unicondylar arthroplasty due to its lesser use. In this study, we compare cemented with cementless unicondylar knee arthroplasty and aim to define both clinical and radiological differences in treatment outcome. MATERIALS AND METHODS: In a retrospective study, 106 patients who had undergone a medial unicondylar replacement were examined after a mean postoperative period of 8 years. Of these, 42 patients (median age 81 +/- 7 years) had received a cemented and 64 (median age 73 +/- 7 years) a cementless knee arthroplasty by the same surgeon while 7 patients were deceased or could not be reached. Well-established clinical (VAS, HSS, KSS, UCLA, WOMAC) and quality of life (SF-36) scores were used to evaluate treatment outcome. X-rays were performed to evaluate periprosthetic loosening zones, according to Ewald's criteria. RESULTS: The cementless patient group presented significantly better clinical scores (HSS, KSS, UCLA, WOMAC), except in the visual analogue scale (VAS) for pain assessment. The quality of life was significantly better in the cementless group except in the subgroups for physical function, vitality and social role, in that it resembles the normal population. Moreover, radiographic analysis using antero-posterior X-rays revealed significantly more and larger periprosthetic loosening areas in tibial zone 2 in the cementless group. CONCLUSION: The inferior clinical results characterising the cemented group could be attributed to the higher mean age. Regarding the radiological loosening zones, we did not detect any differences in the techniques of fixation, although physical activity and accordingly mechanical stresses were higher in the cementless group.

[The ochronosis disease picture and conservative and operative therapy. Presented in relation to a case report]. / Das Krankheitsbild der Ochronose sowie konservative und operative Therapie. Dargestellt anhand einer Kasuistik.

Ochronosis leads very early, already in the fourth decade, to osteoarthritic alterations, mainly of the large joints. As the treatment has to be symptomatic, joint prosthesis is often inevitable. We report about a case history of a patient with coxarthrosis and basic alterations by ochronosis. In spite of a bone structure similar those of osteomalacia, we were able to implant a cementless total hip prosthesis in the left hip joint.

[Primary and secondary arthrodeses following talus fractures]. / Primäre und sekundäre Arthrodesen nach Talusfrakturen.

In 18 cases out of 55 patients, who had been operated on talus fractures in our clinic, a primary or secondary arthrodesis of one or both adjacent joints had been necessary. We carried out a follow-up examination on those 18 patients. In 4 cases a primary or early secondary arthrodesis had been performed; the attempt to reconstruct the joint surfaces after the trauma would have been not promising. The indication of the secondary arthrodesis in the 14 patients is discussed. In all the patients there had been a bony healing of the arthrodesis in an adequate time, the gait pattern of the patients had been improved and they complained less pain. We conclude that in case of a not solvable complication after talus fracture like destroyed joint surfaces, secondary severe arthritis or bone necrosis early secondary arthrodesis should be considered as a measurement to avoid long periods of insufficient conservative treatment.

[Posttraumatic extensor rigidity of the knee joint]. / Die posttraumatische Kniestrecksteife.

Arthrolysis is indicated in an extensor rigidity of the knee joint after failure of conservative treatment. The value of the method is demonstrated by several reports about clinical results in the literature. Preoperatively detailed clinical and X-ray investigation of the knee is necessary to determine the adequate operating procedure (intraarticular, extraarticular or combined arthrolysis). In this therapy preoperative preparation and exercises of the patient are decisive for the result.

[Conservative and early functional therapy of fractures of the thoracic and lumbar spine (author's transl)]. / Konservative und frühfunktionelle Therapie der Brust- und Lendenwirbelbrüche.

A series of follow-up examinations in patients treated in our clinic by conservative functional therapy for fractures of the thoracic and lumbar spine without neurologic symptoms is reported. Pathological anatomy and mechanical findings are described, with the distinction between primary stable and primary unstable fractures being emphasized. Because of the preponderance of good late results in both stable and unstable conditions this methodology is recommended.

[Experiences with the contrast medium metrizamid in lumbar and thoracolumbar myelographies (author's transl)]. / Erfahrungen mit dem Kontrastmittel Metrizamid bei lumbalen und thorakolumbalen Myelographien.

At the orthopaedic clinic in Ratingen we investigated between November 1976 and May 1977 60 patients who were suffering from low back pain by means of myelography in order to verify the type of pathology. As contrast medium we used Metrizamid. All X-rays showed a clear outline of the spinal canal and the roof sheat. In 39 cases out of 60 a prolapsed disk was found. In 9 cases the result was uncertain and the rest was negative. Operation was carried out on 42 patients and the findings in 37 cases were conclusive. No severe side effects were found which were due to the contrast medium.