[Injection treatment for cervical and lumbar syndromes : Special infiltration techniques]. / Injektionstherapie bei Zervikal- und Lumbalsyndromen : Spezielle Infiltrationstechniken.

Minimally invasive injection treatment is indicated particularly in cases of treatment-resistant, painful degenerative alterations of the cervical and lumbar spine, intervertebral disc displacement and radicular syndrome. Through the injections and the supplementation with further conservative, e.g., physical therapy and activating measures, the vicious circle of neural irritation and muscle tension and sympathetic nerve reactions can be interrupted.

[Injection treatment for cervical and lumbar syndromes: principles, indications and general performance]. / Injektionstherapie bei Zervikal- und Lumbalsyndromen: Grundlagen, Indikationen und allgemeine Durchführung.

An intensive conservative treatment that exhausts all treatment options should fundamentally be carried out before every surgical intervention in the region of the spinal column. The therapeutic measures are determined by the extent of the cervical or lumbar syndrome. As a rule, in cases of local complaints symptomatic measures with physiotherapy or digital healthcare applications are indicated. In cases of referred cervical and lumbar syndromes targeted injections can be employed. Before targeted injection treatment a detailed orthopedic clarification with respect to the intensity of local, radicular or pseudoradicular complaints must be carried out. When carrying out minimally invasive injection treatment specific prerequisites with respect to spatial, personnel and technical conditions must be fulfilled. The indications and contraindications must be strictly controlled.

[Achilles tendon pathologies]. / Achillessehnenpathologien.

Achilles tendon pathologies are a frequent problem in the clinical practice. A distinction must be made between insertional and noninsertional tendinopathies. In addition to intrinsic risk factors, such as diabetes mellitus, there are also extrinsic risk factors, such as overuse and running. Sonography, X­ray imaging and magnetic resonance imaging (MRI) are established imaging methods, depending on the question. The primary treatment includes a conservative approach. First-line treatment includes administration of nonsteroidal anti-inflammatory drugs (NSAID), physical rest and the use of assistive devices. Established conservative treatment procedures include eccentric stretching, shockwave therapy and infiltration with, e.g., platelet-rich plasma. There are numerous other conservative treatment options. After exhausting the conservative treatment options, a surgical approach can be considered. The surgical procedure depends on the clinical symptoms and findings. Established procedures are minimally invasive or endoscopic procedures or even open debridement.

[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.

[Surgical treatment of focal cartilage defects in the knee : Indications, techniques, modifications and results]. / Chirurgische Therapie fokaler Knorpelschäden am Knie : Indikationen, Techniken, Modifikationen, Ergebnisse.

The treatment strategies for focal cartilage damage in the knee are multifarious. For established procedures, such as microfracturing (MFX), autologous matrix-induced chondrogenesis (AMIC), osteochondral transplantation (OCT) and autologous chondrocyte transplantation (ACT), well-founded, partly comparative long-term studies and overlapping size-dependent differential indications are available. Innovative cell sources, the utilization of biological scaffolds as well as biologic agents and various combinations, have recently become the focus of scientific attention; however, high regulatory demands are restricting their use in Germany. The success of every procedure is dependent on the appropriate indications, the treatment of comorbidities, such as axis deviations or ligamentous instability, the surgeon's experience and an adequate follow-up treatment.

[Surgical treatment of focal cartilage defects in the knee : Indications, techniques, modifications and results]. / Chirurgische Therapie fokaler Knorpelschäden am Knie : Indikationen, Techniken, Modifikationen, Ergebnisse.

The treatment strategies for focal cartilage damage in the knee are multifarious. For established procedures, such as microfracturing (MFX), autologous matrix-induced chondrogenesis (AMIC), osteochondral transplantation (OCT) and autologous chondrocyte transplantation (ACT), well-founded, partly comparative long-term studies and overlapping size-dependent differential indications are available. Innovative cell sources, the utilization of biological scaffolds as well as biologic agents and various combinations, have recently become the focus of scientific attention; however, high regulatory demands are restricting their use in Germany. The success of every procedure is dependent on the appropriate indications, the treatment of comorbidities, such as axis deviations or ligamentous instability, the surgeon's experience and an adequate follow-up treatment.

[Infected endoprosthesis in patients with rheumatism]. / Infizierte Endoprothese des Rheumatikers.

Infections are a severe complication after an artificial joint replacement. The clinical symptoms are highly variable, particularly in patients with inflammatory rheumatic diseases, which often makes the diagnosis difficult. In addition to clinical and laboratory findings, joint puncture is an essential component of the diagnostics and enables the identification of pathogens. Treatment of periprosthetic infections in patients with rheumatism should be an interdisciplinary cooperation between surgeons, rheumatologists and specialists for infectious diseases. The two essential pillars of treatment are surgical intervention and antibiotics. For acute joint infections an attempt at preservation of the artificial joint can be carried out, whereas for chronic infection situations only replacement of the prosthesis is possible as a curative treatment. In order to reduce the probability of occurrence of a joint infection, modifiable risk factors should be preoperatively identified and specifically treated.

[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.

[Nerve compression syndromes of the upper extremities]. / Nervenkompressionssyndrome der oberen Extremität.

Nerve compression syndromes of the upper extremities are relatively frequent diseases, the timely detection and treatment of which can prevent irreversible damage in the sense of muscle atrophy and subsequent paresis. The medical history and clinical examination play an important role in determining the suspected diagnosis. The subsequent neurological examination then serves to confirm the suspected diagnosis. This article provides a comprehensive overview of the etiology, pathogenesis, symptoms and treatment of the disease.

[Gluteal insufficiency]. / Gluteale Insuffizienz.

Gluteal insufficiency or hip abductor mechanism deficiency mainly following (revision) total hip replacement is associated with highly painful complaints and severe suffering of patients. It represents a great diagnostic and therapeutic challenge. Differentiated conservative treatment pathways, open surgical and endoscopic anatomic repair techniques with intact gluteal musculature and muscle transfer are available as salvage procedures for chronic not anatomically reconstructable mass ruptures. A stepwise diagnostic and therapeutic approach is required for restoration of the quality of life and painless or almost painless mobility of affected patients in occupation and daily life.

[Application of image-guided injection for cervical and lumbar syndromes]. / Anwendung Bildwandler-gestützter Injektionen bei Zervikal- und Lumbalsyndromen.

The X­ray image-guided injection methods are an important tool for the treatment of cervical and lumbar pain syndromes. For the application of these methods it is necessary to have a differentiated consideration of cervical and lumbar pain syndromes. This leads to a decoding of complaints to assignable pain generators, which enables a targeted injection method. Depending on the origin of pain, injections are placed at the nerve root or the joints. Thus, the vicious cycle of pain can be stopped. A correct technical procedure is of enormous importance. Particular attention must be paid to the pharmacological effects and special complications. A monitoring and precautionary measures are mandatory.

[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.

[Clinical examination of the foot]. / Klinische Untersuchung des Fußes.

A systematic clinical examination of the foot, including a structured medical history, is essential for the diagnostics of foot disorders. The foot and ankle, with a total of 28 bones and numerous joints, require a variety of musculotendinous and neuromuscular structures for stabilization and faultless gait. Almost all anatomical structures of the foot are easily accessible for a manual clinical examination due to the sparse soft tissue covering. This requires differentiated and well-founded anatomical knowledge as well as examination experience to be able to distinguish a normal finding from a pathological abnormality. The examination of the contralateral foot is always necessary. A targeted supplementary imaging examination completes the diagnosis.

[Degenerative forefoot : Diagnostics and treatment]. / Degenerativer Vorfuß : Diagnostik und Therapie.

The hallux valgus deformity is the most common toe deformity of the forefoot and is often associated with a splayfoot. Malpositioning of the small toes may be isolated but are more common in other foot deformities. The understanding of the complex pathoanatomy of the foot is necessary for orthopedic treatment. Conservative treatment is reserved for the early stages. The indications for surgery should be based on clinical and radiographic findings. Countless surgical procedures are available and minimally invasive surgical techniques are also increasingly being used.

[Lumbar spinal stenosis : From the diagnosis to the correct treatment]. / Lumbale Spinalkanalstenose : Von der Diagnose bis zur richtigen Therapie.

The number of patients with the diagnosis of lumbar spinal stenosis (LSS) is steadily increasing and simultaneously, the patients' expectations are also increasing. Nevertheless, evidence from studies for the appropriate treatment is still lacking. Treatment options mainly result from the practitioner 's experience and the clinical focus. The findings described in magnetic resonance imaging (MRI) often do not correlate with the patient's symptoms. Basically, the treatment should be started with a conservative treatment and preferably with a multimodal approach. Severe pain with extensive neurogenic claudication symptoms and unsuccessful conservative treatment should be treated surgically. Absolute indications for surgery, such as a conus-cauda syndrome are rare. The goal of all surgical procedures is to decompress the spinal canal without compromising the stability of the motion segment. Instability can also make an additional fusion necessary.

[Biomechanical aspects of preoperative planning: What is really important?] / Biomechanische Aspekte der präoperativen Planung: Was ist wirklich wichtig?

BACKGROUND: Sagittal balance is dependent on a complex interplay of the spinal curves, shape and setting of the pelvis, but also the position of the joints of the lower limb. Degenerative processes such as stiffening of the spine, aging of musculature, or reduction of the range of motion of the joints lead to imbalance of the spine after all compensatory mechanisms have been exhausted. OBJECTIVES: Based on standardized imaging, compensation mechanisms must be identified within a biomechanical analysis of the spine, the original sagittal spine profile anticipated and included in the planning of the corrective intervention. RESULTS: This review presents the most important global and spinopelvic parameters for the biomechanical analysis of the spine. In addition, normal variations of the sagittal alignment are discussed, compensation mechanisms are shown, and the planning of the rebalancing of the sagittal alignment is shown according to the full balance integrated model.

[Rheumatism operations in a state of flux-"Foot"]. / Rheumaoperationen im Wandel ­ "Fuß".

Surgical management of rheumatic feet has dramatically changed over the last decades influenced by the development of new pharmacological drugs and tissue-preserving surgical procedures. It has switched from joint resection to joint-sparing procedures as the method of choice. Nevertheless, the surgical interventions commonly used for non-rheumatic patients cannot be applied to rheumatic patients without reflection: in addition to the basic treatment, comorbidities, degree of mobilization of the patient, orthopedic shoe engineering and orthotic treatment play a major role. Due to the decreasing incidence of the classical rheumatic foot, it has become even more important for physicians, physiotherapists and ergotherapists to recognize the development of such a disease as early as possible and immediately start the appropriate treatment.