[6-year-old/male-limping gait and restrictions in sports : Preparation for the medical specialist examination-Part 1].
PMID: 32930808 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - September 15, 2020 Category: Orthopaedics Authors: Harrasser N, Schikora N Tags: Orthopade Source Type: research

[Biomechanical compensatory mechanisms of hips and spine : The essentials for spine and hip surgeons].
YP Abstract Spinal alignment changes with age and degeneration. Different compensatory mechanisms of the spine are necessary to preserve spinal balance. The capacity of compensation of the spine decreases with age. Thus, the pelvis and the lower limbs become involved in the compensatory mechanism. Concomitant osteoarthritis of the hip could impair this capacity. The biomechanical principles of compensation are described with respect to planning reconstructive hip and spine surgery. PMID: 32926204 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - September 14, 2020 Category: Orthopaedics Authors: Wiedenhöfer B, Matschke S, Pitzen T, Ruf M, Ostrowski G, Charles YP Tags: Orthopade Source Type: research

[Intraoperative assessment of pelvic tilt and cup position in total hip arthroplasty: the relevance of navigation and robotics].
r M Abstract The optimal 3D positioning of the prosthesis components is of great importance for the stability and function of a total hip endoprosthesis. Pelvic tilt has a particular influence on the position of the implant. In order to use intraoperatively the knowledge on pelvic kinematics gained through preoperative imaging procedures and movement analyses, "image-based" and "image-free" robotic and navigation procedures are available. With the "image-based" procedures, a 3D CT scan serves as the surgeon's basis for operative planning. The "image-free" procedure...
Source: Der Orthopade - September 9, 2020 Category: Orthopaedics Authors: Renkawitz T, Meyer M, Völlner F, Weber M Tags: Orthopade Source Type: research

[Hip joint contractures, leg length discrepancies, and spinopelvic alignment: impact on the development of osteoarthritis of the hip?]
n S Abstract Hip joint problems are common in every-day orthopedic practice. At the age of 60, approximately 5% of the German population suffer from symptomatic osteoarthritis of the hip. One of the main trigger is the morphological abnormality of the joint. Causes may also be overloading of the joint, developmental dysplasia of the hip with reduced coverage, as well as femoral or acetabular malpositioning, for example. The impact of hip joint contractures, leg length discrepancies, and the spinopelvic alignment and their prophylactic treatment in childhood, adolescence and early adulthood are discussed here. ...
Source: Der Orthopade - September 9, 2020 Category: Orthopaedics Authors: Götze M, Hagmann S Tags: Orthopade Source Type: research

[Battle: Total hip arthroplasty or spine surgery first in patients with hip-spine-syndrome? : The arthroplasty surgeon's point of view].
Abstract BACKGROUND: Frequently, patients with hip complaints also report lower back pain, and elective surgery may be indicated due to end-stage hip osteoarthritis and degenerative disc disease. Thus, we aim to answer the question of whether total hip arthroplasty (THA) or lumbar spine surgery should be performed first in patients with hip-spine-syndrome, from an arthroplasty surgeon's point of view. DECISION-MAKING: The present review demonstrates that in patients with an acute neurological deficit, lumbar spine surgery should be performed first. However, in patients without these symptoms, several argument...
Source: Der Orthopade - September 8, 2020 Category: Orthopaedics Authors: Clarius M, Farweez M, Innmann MM Tags: Orthopade Source Type: research

[Surgical challenges with spinal balance in adult spinal deformities-the forgotten coronal plane].
This article gives a brief overview of the importance, planning and correction of coronal spinal imbalance in patients with adult and pediatric spinal deformity. PMID: 32880703 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - September 3, 2020 Category: Orthopaedics Authors: Koller H, Koller J, Stengel F, Meyer B Tags: Orthopade Source Type: research

[News from the German Arthroplasty Registry].
PMID: 32885287 [PubMed - in process] (Source: Der Orthopade)
Source: Der Orthopade - September 1, 2020 Category: Orthopaedics Authors: Windhagen H, von Eisenhart-Rothe R Tags: Orthopade Source Type: research

[Revision procedures in hand surgery].
PMID: 32885288 [PubMed - in process] (Source: Der Orthopade)
Source: Der Orthopade - September 1, 2020 Category: Orthopaedics Authors: Spies CK, Unglaub F Tags: Orthopade Source Type: research

[Influence of institutional experience on results in hip and knee total arthroplasty : An analysis from the German arthroplasty registry (EPRD)].
n V Abstract BACKGROUND: The German Arthroplasty Registry, EPRD, has the ability to examine early factors influencing the probability of failure of total hip arthroplasty (THA) and knee arthroplasty (TKA). The study analyses the influence of the overall experience of a hospital, as well as the change in supplier on the revision rate. MATERIALS AND METHODS: A total of 164,903 cementless THA and 155,577 cemented TKA were in follow-up from 656 hospitals from 2012 to 2019. The number of arthroplasties performed per hospital per year was used as a surrogate parameter for institutional experience. This nu...
Source: Der Orthopade - September 1, 2020 Category: Orthopaedics Authors: Steinbrück A, Grimberg A, Melsheimer O, Jansson V Tags: Orthopade Source Type: research

[Revision surgery for carpal and cubital tunnel syndrome].
CK Abstract BACKGROUND: Carpal tunnel syndrome, a compressive neuropathy of the median nerve at the wrist and cubital tunnel syndrome, a compressive neuropathy of the ulnar nerve at the elbow, are the two most common peripheral nerve compression syndromes. Chronic compressive neuropathy of peripheral nerves causes pain, paraesthesia and paresis. Treatment strategies include conservative options, but only surgical decompression can resolve the mechanical entrapment of the nerve with proven good clinical results. However, revision rates for persistent or recurrent carpal tunnel syndrome is estimated at ar...
Source: Der Orthopade - August 28, 2020 Category: Orthopaedics Authors: Ayache A, Unglaub F, Tsolakidis S, Schmidhammer R, Löw S, Langer MF, Spies CK Tags: Orthopade Source Type: research

[Hip-spine syndrome-current developments and state of the evidence].
Abstract The movements between the spine, pelvis and hip joints are coordinated to allow for a physiological balance of the upper body and the pelvis during sitting and standing. Degenerative changes or spondylodesis of the spine result in decreased pelvic mobility and can lead to increased rates of instability in the presence of total hip arthroplasty (THA). To reduce the risk of THA dislocation several authors have recently recommended functional radiographs of the spine and pelvis, as well as individual safe zones for THA components. The aim of this article is to summarize the current body of knowledge reg...
Source: Der Orthopade - August 28, 2020 Category: Orthopaedics Authors: Zimmerer A, Hoffmann M, Hofer A, Janz V, Wassilew GI Tags: Orthopade Source Type: research

[Tumor-like bony lesions of the skeleton].
This article presents the aneurysmal bone cyst (ABC), solitary bone cyst (SBC), fibrous dysplasia, osteofibrous dysplasia Campanacci and non-ossifying fibroma (NOF). Many tumor-like bony lesions are often incidental findings. The combination of X‑ray imaging specifically supplemented by magnetic resonance imaging (MRI) or computed tomography (CT) enables a diagnostic classification in the majority of cases. PMID: 32840666 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - August 25, 2020 Category: Orthopaedics Authors: Uhl M, Herget GW Tags: Orthopade Source Type: research

Short to mid-term outcome of total hip arthroplasty with cementless implants in patients younger than 25  years old.
Short to mid-term outcome of total hip arthroplasty with cementless implants in patients younger than 25 years old. Orthopade. 2020 Aug 21;: Authors: Shakya H, Zhou K, Yao SY, Dahal S, Zhou ZK Abstract BACKGROUND: Total hip arthroplasty (THA) was once reserved for old patients with hip arthritis but has become more common in very young patients (≤25 years old) diagnosed with various joint disease that were not relieved with conservative treatment. The purpose of this study was to evaluate short to mid-term outcome of THA in patients younger than 25 years old. METHOD: This retrospecti...
Source: Der Orthopade - August 21, 2020 Category: Orthopaedics Authors: Shakya H, Zhou K, Yao SY, Dahal S, Zhou ZK Tags: Orthopade Source Type: research

[Erratum to: Low-grade-infections after spondylodeses-A chameleon? : Current findings and therapeutic strategies].
PMID: 32813068 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - August 19, 2020 Category: Orthopaedics Authors: Akbar M, Lehner B, Ryang YM, Pepke W Tags: Orthopade Source Type: research

[Kinematic alignment-management of deformities and flexion contractures].
Abstract BACKGROUND: Kinematic alignment (KA) total knee arthroplasty (TKA) has proven to be a viable alternative to mechanical alignment (MA) TKA. Like any technique, its validity has to encounter challenges. Two of these are flexion contracture and large deformities of the knee. FLEXION CONTRACTURE: Flexion contracture is commonly treated with posterior capsular release. Often, however, this technique is not sufficient. Many surgeons accustomed to MA techniques and guided by traditional femoral instruments manage the problem by proximalizing the distal femoral cut. However, this has proven to be a ...
Source: Der Orthopade - August 18, 2020 Category: Orthopaedics Authors: Malavolta M, Kley K Tags: Orthopade Source Type: research

[Revision surgery after failed (partial-) arthrodesis of the wrist].
glaub F Abstract (Partial) arthrodeses of the wrist have been proven cornerstones to treat many lesions for decades, especially in the case of revision surgery. Four-corner, scapho-trapezo-trapezoidal (STT), radio-scapho-lunate (RSL) and total wrist fusions are very common techniques in hand surgery. However, even these proven surgical procedures have significant non-fusion rates. Prior to revising a failed arthrodesis, it is essential to analyse the latter failure precisely. A technically adequate revision is only feasible when based on a correct and meticulous analysis. The understanding of the bi...
Source: Der Orthopade - August 18, 2020 Category: Orthopaedics Authors: Spies CK, Ayache A, Löw S, Langer MF, Hohendorff B, Müller LP, Oppermann J, Unglaub F Tags: Orthopade Source Type: research

[Revision surgery after total wrist arthroplasty].
Abstract BACKGROUND: Wrist arthroplasty is still an exceptional indication in the field of hand surgery. In recent years, it has become increasingly accepted as an alternative to wrist arthrodesis as the ultima ratio for panarthrosis or similar destruction of the wrist. In particular, the patient's desire for functional integrity also plays an important role. COMPLICATIONS: While there were often complications with earlier prosthesis designs of the older generations and only a short survival rate could be achieved, this has improved, if the indication of the so-called fourth generation prostheses is done...
Source: Der Orthopade - August 10, 2020 Category: Orthopaedics Authors: Damert HG, Kober M, Mehling I Tags: Orthopade Source Type: research

[Tenolysis of extensor and flexor tendons of the hand].
CONCLUSIONS: Tenolysis of extensor and flexor tendons in the hand is a demanding surgical procedure, and in addition to detailed knowledge of anatomy and biomechanics, it requires sufficient experience-especially following the primary repair of tendon injuries. The earliest indication for tenolysis can occur at about 3 months, usually after 6 months, if continuous intensive hand therapy and splinting have not been successful. General and individual benefits and risks must be carefully weighed. The key to successful tenolysis is the patient's access to and unrestricted participation in competent postoperative treatment...
Source: Der Orthopade - August 10, 2020 Category: Orthopaedics Authors: Hohendorff B, Kaya H, Spies CK, Unglaub F, Müller LP, Ries C Tags: Orthopade Source Type: research

[The talometatarsal-index  ("TMT-Index") : A valuable X-ray parameter for differentiating between normal feet and planovalgus deformity in children and adolescents].
CONCLUSION: Compared to conventional radiological parameters, the TMTInd shows the highest validity in the distinction between normal and planovalgus feet and can provide valuable information in clinical decision-making with regard to therapy specification. PMID: 32761421 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - August 6, 2020 Category: Orthopaedics Authors: Hamel J, Hörterer H, Harrasser N Tags: Orthopade Source Type: research

Efficacy of intravenous tranexamic acid administration in  revision hip arthroplasty.
This study aimed to evaluate the efficiency of constant dose intravenous administration of tranexamic acid (TXA) in reducing postoperative blood loss, hemoglobin (Hb) concentration, and the number of transfusions in revision hip arthroplasty (RHA). METHODS: The study included 145 consecutive patients who had undergone RHA: a TXA group (75 patients) who received two doses of TXA (1.0 g 15 min before skin incision and 1.0 g during wound closure) and a no-TXA group (70 patients). Percentage blood loss and quantitative blood loss were calculated. RESULTS: The percentage blood loss (23.82 &...
Source: Der Orthopade - August 6, 2020 Category: Orthopaedics Authors: Grzelecki D, Dudek P, Okoń T, Marczak D, Kordasiewicz B, Sibiński M, Kowalczewski J Tags: Orthopade Source Type: research

[Revision surgery after resection arthroplasty of the thumb saddle joint].
CK Abstract BACKGROUND: Resection arthroplasty still is the gold standard for the treatment of basal thumb arthritis. In most patients, satisfactory results can be expected. However, the few patients with persisting problems are a challenge for the hand surgeon. They may complain of neuromas, tendinitis of the flexor carpi radialis (FCR) tendon, impingement and/or proximalization of the first metacarpal, arthritis of the scaphotrapezoidal joint or carpal collapse in the case of pre-existing scapholunate instability. DIAGNOSIS: This includes subtle clinical examination. Radiography may be completed by a ...
Source: Der Orthopade - August 5, 2020 Category: Orthopaedics Authors: Löw S, Kiesel S, Spies CK Tags: Orthopade Source Type: research

[Both measurement parameters are needed to assess cup orientation: cup inclination and cup anteversion].
PMID: 32757032 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - August 5, 2020 Category: Orthopaedics Authors: Widmer KH Tags: Orthopade Source Type: research

Podcasts as a  teaching tool in orthopaedic surgery : Is it beneficial or more an exemption card from attending lectures?
CONCLUSION: Students in the age of digitalization use a variety of learning materials and are no longer bound to classical analog teaching methods. The use of online podcasts had no negative impact on examination performance. Most students perceived lecture podcasts as a useful supplement to lecture attendance. The students praised the expansion of the teaching curriculum to include additional digital offers with positive comments in the evaluations, but without achieving an improvement in these student evaluations. PMID: 32749511 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - August 4, 2020 Category: Orthopaedics Authors: Schöbel T, Zajonz D, Melcher P, Lange J, Fischer B, Heyde CE, Roth A, Ghanem M Tags: Orthopade Source Type: research

[Treatment of chondroblastoma of the humeral head : A  tumour- and shoulder-orthopaedic challenge].
We present the case of a 22-year-old female patient with chondroblastoma in the right humeral head. To allow a gentle and anatomic resurfacing of the humeral joint surface and to avoid total joint arthroplasty in our young patient with high functional requirements, we implanted a HemiCAP® after intralesional curettage of the chondroblastoma. Our patient's excellent short-term functional outcome shows that our approach can be considered a very good therapeutic option. PMID: 32748105 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - August 3, 2020 Category: Orthopaedics Authors: Oenning S, Schneider KN, Gosheger G, Theil C, Müller F, Deventer N, Lübben T Tags: Orthopade Source Type: research

[Septic arthritis of the native joint and after ligamentoplasty : Diagnosis and treatment].
Abstract BACKGROUND: Septic arthritis is an acute emergency. It occurs more frequently in patients with pre-existing degenerative or chronic inflammatory joint diseases than in the general population. The causative microorganisms can be introduced in various ways. DIAGNOSTICS: A rapid diagnosis is of great importance for the success of the therapy. In the clinical examination, the typical signs of inflammation are noticeable. The gold standard is the aspiration of synovial fluid and the subsequent laboratory and microbiological investigation. THERAPY: A prerequisite for successful therapy is the early in...
Source: Der Orthopade - July 31, 2020 Category: Orthopaedics Authors: Margaryan D, Renz N, Gwinner C, Trampuz A Tags: Orthopade Source Type: research

[Radiographic inclination and anteversion do not correspond to the actual cup slope and forward rotation].
PMID: 32734455 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - July 30, 2020 Category: Orthopaedics Authors: Schwarz TJ, Weber M, Renkawitz T, Greimel F, Leiss F, Grifka J, Schaumburger J Tags: Orthopade Source Type: research

Development and current use of local antibiotic carriers in spondylodiscitis : Pilot study on reduction of duration of systemic treatment.
CONCLUSION: The results of the present pilot study show that with the additional use of absorbable local antibiotic carriers in the surgical treatment of bacterial spondylodiscitis it is possible to shorten the duration of systemic antibiotic treatment to 3 weeks. This can reduce the side effects and incompatibility of treatment and still achieve similar healing results. PMID: 32719918 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - July 27, 2020 Category: Orthopaedics Authors: Fleege C, Rauschmann M, Arabmotlagh M, Rickert M Tags: Orthopade Source Type: research

[Gluteal insufficiency].
Abstract 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...
Source: Der Orthopade - July 24, 2020 Category: Orthopaedics Authors: Banke IJ, Prodinger PM, Weber M, Harrasser N, Hauschild M, Grifka J, Burgkart R, Gollwitzer H, von Eisenhart-Rothe R Tags: Orthopade Source Type: research

[Low-grade-infections after spondylodeses-A  chameleon? : Current findings and therapeutic strategies].
DISCUSSION: An algorithm for clinical decision-making in terms of diagnostic and therapeutic options is suggested. PMID: 32676718 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - July 16, 2020 Category: Orthopaedics Authors: Akbar M, Lehner B, Ryang YM, Pepke W Tags: Orthopade Source Type: research

[Fracture-related infections in traumatology : Current standards and new developments in diagnostics and treatment].
Abstract BACKGROUND: The high demands that fracture-related infections put on patients, physicians and the healthcare system have led to the establishment of a international group of experts called the Fracture-Related Infection (FRI) Consensus Group, whose aim is to develop evidence-based treatment recommendations. DIAGNOSIS: Fracture-related infections are classified according to the time of occurrence, extent and treatment options. The diagnostic algorithm distinguishes between confirmatory and suggestive diagnostic criteria. If there are indications of an infection, tissue biopsy with microbiological...
Source: Der Orthopade - July 15, 2020 Category: Orthopaedics Authors: Baecker H, Frieler S, Schildhauer TA, Gessmann J, Hanusrichter Y Tags: Orthopade Source Type: research

[Prevention of infections following open fractures].
Abstract Open fractures involve a high risk of open fracture-associated infections (OFAIs), and the treatment can often be protracted and complicated. Thus, prevention of OFAIs in the acute and perioperative management of open fractures is of great importance. Through vigilance and thorough treatment planning, between the day of injury and the hospital discharge, the risk of OFAIs can be considerably reduced. PMID: 32671415 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - July 15, 2020 Category: Orthopaedics Authors: Maleitzke T, Eckerlin P, Winkler T, Trampuz A Tags: Orthopade Source Type: research

[Diagnosis of periprosthetic joint infection : Development of an evidence-based algorithm by the work group of implant-associated infection of the AE-(German Society for Arthroplasty)].
CONCLUSION: The detection of PPI is of tremendous importance prior to revision arthroplasty and determines its success or failure. The diagnosis "prosthetic joint infection" requires a substantial change with respect to treatment concepts. The algorithm summarizes current literature and specialized expert opinions in a modern standardized format for a transparent diagnostic approach. PMID: 32666142 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - July 14, 2020 Category: Orthopaedics Authors: Mühlhofer H, Renz N, Zahar A, Lüdemann M, Rudert M, Hube R, Frommelt L, Ascherl R, Perka C, von Eisenhart-Rothe R Tags: Orthopade Source Type: research

Knee arthrodesis as last resort for persistent knee joint infections : Comparison of extramedullary and intramedullary treatment.
CONCLUSION: The study showed that no arthrodesis procedure is obviously superior with respect to the postoperative outcome. The IMA combines advantages especially in the early phase after surgery in terms of function as well as patient comfort and is therefore currently the procedure of choice. The attending physician should be familiar with the advantages and disadvantages of the various procedures in order to be able to make an individual decision and thus maximize the chance of treatment success. PMID: 32666143 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - July 14, 2020 Category: Orthopaedics Authors: Zajonz D, Zimmerlich B, Möbius R, Edel M, Przybyl J, Höch A, Fakler JKM, Roth A, Ghanem M Tags: Orthopade Source Type: research

[Evidence-based implant choice in infections of the spine : Is it a gut thing, after all?]
Abstract The choice of implant in an infection of the spine depends on what type of infection it is: discitis, spondylodiscitis, early infection after spinal surgery, or a late infection. The appropriate treatment strategies vary. In spondylodiscitis, a titanium implant may be necessary. In implant-associated early infections, surgical sanitization is often sufficient without changing the implant. In late infections, implant exchange is necessary because of biofilm. PMID: 32661896 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - July 13, 2020 Category: Orthopaedics Authors: Bullmann V Tags: Orthopade Source Type: research

[Infections after hip and knee replacement surgery and after spinal fusion: a comparison].
Akbar M PMID: 32642940 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - July 8, 2020 Category: Orthopaedics Authors: Dapunt U, Bürkle C, Günther F, Pepke W, Hemmer S, Akbar M Tags: Orthopade Source Type: research

[A  clinical radiological score for femoral head grafts : Establishment of the Tabea FK score to ensure the quality of human femoral head grafts].
[A clinical radiological score for femoral head grafts : Establishment of the Tabea FK score to ensure the quality of human femoral head grafts]. Orthopade. 2020 Jul 08;: Authors: Siemssen N, Friesecke C, Wolff C, Beller G, Wassilew K, Neuner B, Schönfeld H, Pruß A Abstract INTRODUCTION: Transplantation of cancellous tissue from human femoral heads (FK) is an established method in the reconstruction of bony defects in orthopedic and trauma surgery. Standardized rating systems with respect to the morphological quality of this tissue are not available. MATERIALS AND METHODS: In 91/1...
Source: Der Orthopade - July 8, 2020 Category: Orthopaedics Authors: Siemssen N, Friesecke C, Wolff C, Beller G, Wassilew K, Neuner B, Schönfeld H, Pruß A Tags: Orthopade Source Type: research

[Periprosthetic joint infections : Latest developments, strategies and treatment algorithms].
Abstract BACKGROUND: Due to their multidimensional consequences, periprosthetic joint infections are a serious complication in arthroplasty. There are disagreements in the literature regarding their classification. At the same time, a consequence for the practical procedure cannot always be derived. THERAPEUTIC PROCEDURES: In addition to debridement with antibiotics and implant retention, there are options for a one or two-stage change in the therapeutic procedure. Although the preservation of implants is only possible in the case of acute infections with a short duration of symptoms, pros...
Source: Der Orthopade - July 8, 2020 Category: Orthopaedics Authors: Lehner B, Omlor GW, Schwarze M Tags: Orthopade Source Type: research

[Pyogenic spondylodiscitis: symptoms, diagnostics and therapeutic strategies].
Abstract BACKGROUND: Pyogenic spondylodiscitis is a rare disease that is being diagnosed with increasing frequency in recent years. It is associated with a high morbidity and mortality. DIAGNOSIS: Often, because of its nonspecific symptoms, pyogenic spondylodiscitis is diagnose with some delay. In addition to pathogen detection, MRI is the gold standard to diagnose pyogenic spondylodiscitis. Also, x-ray imaging and CT can be carried out for surgical planning and for subsequent follow-up imaging. If blood or tissue cultures are negative, open surgical biopsies should be preferred over CT-guided biopsies. ...
Source: Der Orthopade - July 8, 2020 Category: Orthopaedics Authors: Ryang YM, Akbar M Tags: Orthopade Source Type: research

[Acute appendicitis after bone grafting from the right anterior iliac crest-difficult differential diagnosis].
This article reports the case of a young patient with acute appendicitis after bone grafting from the right iliac crest. Because of the preceding operation, the correct diagnosis was difficult and was only possible by a differentiated clinical examination followed by machine-aided diagnosis. PMID: 32632650 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - July 6, 2020 Category: Orthopaedics Authors: Förch S, Ritter B, Mayr E Tags: Orthopade Source Type: research

[Kinematic Alignment].
PMID: 32613294 [PubMed - in process] (Source: Der Orthopade)
Source: Der Orthopade - July 1, 2020 Category: Orthopaedics Authors: Windhagen H, Ettinger M Tags: Orthopade Source Type: research

[Imminent fracture of the tibia due to an osteolytic lesion caused by an intraosseous tenosynovial giant cell tumor : An unusual clinico-histopathological constellation].
We report on the rare constellation of an intraosseous manifestation of the proximal tibia of a lower leg stump after Burgess amputation as a result of a locally uncontrollable tenosynovial giant cell tumor of the upper ankle. The curettage of the local findings and operative stabilization through an intramedullary composite osteosynthesis led to an early rehabilitation of the exoprosthesis care with regaining patient autonomy. PMID: 32588099 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - June 25, 2020 Category: Orthopaedics Authors: Klingebiel S, Mühl S, Gosheger G, Hartmann W, Schneider KN, Budny TB, Rickert C, Schorn D, Deventer N, Lübben T Tags: Orthopade Source Type: research

[Rationale of kinematic alignment].
Abstract BACKGROUND: Kinematic alignment is a philosophy for individual knee prosthesis implantation in a three-dimensional view. The key of the concept is to understand the femoral flexion-extension axis as the centre of a cylinder within the posterior condyles. This axis defines the knee in three dimensions over the entire range of motion. The tibia follows the femur, is balanced on the knee in extension and flexion, and shows individual laxities in flexion and deep flexion. IMPACTS: As a consequence, limbs will be reconstructed along their constitutional leg axis, which in most patients...
Source: Der Orthopade - June 25, 2020 Category: Orthopaedics Authors: Windhagen H Tags: Orthopade Source Type: research

[Postinfectious reactive arthritis after chlamydia infection in competitive sports : Clinical management and current literature review].
CONCLUSION: Reactive arthritis following chlamydia infection in competitive athletes is a rare entity. However, it can be accompanied by far-reaching individual consequences, especially with regard to possible downtime in sports. Long-term consequences such as chronic joint damage in maintained synovitis must also be considered. In order to make a diagnosis, a specific anamnesis and the direct detection of the pathogen in the specimen of synovial fluid by polymerase chain reaction is essential. This allows a reliable diagnosis to be made with immediate initiation of therapy. However, a prolonged course ...
Source: Der Orthopade - June 24, 2020 Category: Orthopaedics Authors: Klingebiel S, Rieger H, Gosheger G, Theil JC, Rickert C, Schneider KN Tags: Orthopade Source Type: research

[PSI-technique for kinematic alignment].
DISCUSSION: With the aid of the 3D-printed PSI cutting blocks the preoperative plan of kinematic alignment can be implemented in a precise manner. It is a simple tool and does not require any great expense. Compared with the conventional instrumentation, the operating time is shortened. However, because of the purely CT-based design, no information about the state of the soft tissue is obtained. PMID: 32542426 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - June 15, 2020 Category: Orthopaedics Authors: Savov P, Ettinger M, Tuecking LR Tags: Orthopade Source Type: research

[Conservative and surgical treatment of idiopathic scoliosis].
k J Abstract Idiopathic scoliosis is the largest group of all forms of scoliosis in the growth phase accounting for 80-90%. A distinction is made between idiopathic infantile (0-3 years), juvenile (4-10 years) and adolescent scoliosis (>10 years), depending on the age when scoliosis appears. The treatment depends on the skeletal age, the Cobb angle and the progression behavior of scoliosis. Mild cases are treated conservatively using physiotherapy, exercises and bracing but in advanced stages scoliosis should be surgically treated. With existing growth potential various techniques, such as t...
Source: Der Orthopade - June 15, 2020 Category: Orthopaedics Authors: Völlner F, Dingeldey E, Schmitz S, Grifka JC, Matussek J Tags: Orthopade Source Type: research

[PJI-TNM as new classification system for periprosthetic joint infections : An evaluation of 20  cases].
CONCLUSIONS: The principles of the TNM classification from oncology can also be used for the classification of PJIs. Despite the limited number of cases in this study, a considerable heterogeneity of the evaluated PJIs is shown, which is a phenomenon that is also known from clinical practice. This heterogeneity can be adequately addressed by this new classification, which might be beneficial in decision-making in the future. PMID: 32533215 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - June 12, 2020 Category: Orthopaedics Authors: Rupp M, Kerschbaum M, Freigang V, Bärtl S, Baumann F, Trampuz A, Alt V Tags: Orthopade Source Type: research

[Trochleoplasty: Surgical technique : Video article].
Abstract A 29-year-old physically active patient presented with recurrent right-sided patellar dislocation. Clinical and radiological investigation showed patellar instability with stable cruciate and collateral ligaments, excess internal rotation of the right femur, as well as trochlear dysplasia. Treatment consisted of trochleoplasty in combination with medial patellofemoral ligament reconstruction. PMID: 32518980 [PubMed - as supplied by publisher] (Source: Der Orthopade)
Source: Der Orthopade - June 9, 2020 Category: Orthopaedics Authors: Wurm A, Riechelmann F, Dammerer D, Putzer D, Lair J, Liebensteiner M Tags: Orthopade Source Type: research

Current evidence base for kinematic alignment.
Abstract BACKGROUND: Kinematic alignment recently became an alternative alignment option for total knee arthroplasty (TKA). Beside previous studies assessing mechanical alignment in comparison to unintentional malalignment of TKA in terms of implant survival and clinical outcome, more and more studies have focused on the direct comparison of intentional kinematic alignment with mechanical alignment of the prosthesis. In the past 5 years the number of studies with respect to kinematic alignment has risen from 11 to 91 studies. AIM: The aim of this review article is to give a narrative overview o...
Source: Der Orthopade - June 7, 2020 Category: Orthopaedics Authors: Tuecking LR, Savov P, Windhagen H, Ettinger M Tags: Orthopade Source Type: research

[Alignment techniques for implantation of a total knee endoprosthesis with particular focus on kinematic alignment].
;re C Abstract BACKGROUND: This review introduces various techniques for implantation of a total knee endoprosthesis and scrutinizes the "mechanical alignment" of a total knee endoprosthesis, whereby the various alignment concepts are examined. In particular, kinematic alignment, in terms of its significance, the individual steps of the implantation technique and the data collected, will be examined in more detail. METHODS: Improvement in the clinical results after implantation of a total knee endoprosthesis can be achieved by a personalized, individualized, physiological implantation...
Source: Der Orthopade - June 4, 2020 Category: Orthopaedics Authors: Wiart Y, Kuntz J, Bergdolt C, Villet L, Rivière C Tags: Orthopade Source Type: research

[Adjusted mechanical alignment: operative technique-Tips and tricks].
CONCLUSION: The technique presented combines a measured-resection technique with individual ligament tension. The maximum deviation of the femoral alignment in the coronal plane from the neutral alignment is 2.5°. In order to avoid problems, it is recommended, as with the described technique, to achieve a component alignment based on the patient anatomy by adjusting the femoral component. The measured-resection technique carries the risk of flexion instability. With the gap-balancing technique symmetrical ligament tension can be achieved, assuming precise proximal tibial cuts. When aligning the femoral c...
Source: Der Orthopade - June 3, 2020 Category: Orthopaedics Authors: Hommel H, Tsamassiotis S, Falk R, Fennema P Tags: Orthopade Source Type: research