G. Heers

Proximal interphalangeal joint replacement with an unconstrained pyrocarbon prosthesis (Ascension®): a long-term follow-up

There have been limited publications that report long-term outcomes of pyrocarbon implants. This report describes both clinical and radiographic long-term results for patients who have been treated with pyrocarbon proximal interphalangeal implants. Thirteen implants in ten patients are reported for an average follow-up of 8.3 years (range 6.2–9.3). All patients were suffering from degenerative joint disease. Five of the 13 digits were free of pain, the remaining eight digits had mild to moderate pain (visual analogue scale 2–5). The average active range of motion was 58° (SD 19°) at latest examination. X-ray results were unremarkable in six digits with an acceptable position of the prosthesis. However, in seven patients significant radiolucent lines (≥ 1 mm) were observed. Three prostheses demonstrated a migration of the proximal component, and one a subsidence of the distal component. Our study does not support the use of this implant for treatment of osteoarthritis of the finger joint owing to high complication rates and limited range of motion.

Development and evaluation of an image-free computer-assisted impingement detection technique for total hip arthroplasty.

Periprosthetic or bony impingement in total hip arthroplasty (THA) has been correlated to dislocation, increased wear, reduced postoperative functionality with pain and/or decreased range of motion (ROM). We sought to study the accuracy and assess the reliability of measuring bony and periprosthetic impingement on a virtual bone model prior to the implantation of the acetabular cup with the help of image-free navigation technology in an experimental cadaver study. Impingement-free ROM measurements were recorded during minimally invasive, computer-assisted THA on 14 hips of 7 cadaveric donors. Preoperatively and postoperatively the donors were scanned using computed tomography (CT). Impingement-free ROM on three-dimensional CT-based models was then compared with corresponding, intraoperative navigation models. Bony/periprosthetic impingement can be detected with a mean accuracy limit of below 5° for motion angles, which should be reached after THA for activities of daily living with the help of image-free navigation technology.

The impact of hypoxia on mesenchymal progenitor cells of human skeletal tissue in the pathogenesis of heterotopic ossification

PurposeMesenchymal progenitor cells (MPCs) are capable of differentiating into osteo/chondrogenic cells to contribute substantially to heterotopic ossification (HO). This study aimed to examine the impact of hypoxia on MPCs in the aetiology of HO.MethodsMPCs from human normal and HO skeletal tissue were cultivated under normoxia and hypoxia. Gene expression of factors which have a key role in HO aetiology (BMPs, COX-1 and COX-2, etc.) were examined by real-time PCR. Tissue of both groups was analysed by immunohistochemistry.ResultsUnder hypoxia, COX-1, -2 and SOX-9 gene expression was elevated in HO MPCs, whereas in normal muscle tissue only COX-2 was upregulated. MPCs from HO had a significantly elevated gene expression of BMP-4 and decreased expression of BMP-1 and HIF-1 under hypoxia compared to normal MPCs. Immunohistochemistry detected no significant differences between normal and HO tissue.ConclusionsHypoxia causes an enhanced gene expression of factors, which have a key role in HO pathophysiology. A better understanding of this entity will possibly allow reducing HO rates in orthopaedic and trauma surgery.

Gait Analysis after Tibialis Anterior Tendon Rupture Repair Using Z-Plasty

Other than limited reports regarding surgical outcomes, little information is available regarding whether Z-plasty of the tibialis anterior results in normal gait kinematics. We included 5 patients with spontaneous ruptures in the present retrospective study. The mean interval between rupture and operative treatment was 2.6 ± 2.6 months (standard deviation). The mean age of the patients was 63 (range 40 to 80) years. All patients were treated operatively with Z-plasty. Gait analysis was used to study the outcome, comparing the operated and nonoperated limbs. The patients were tested after a mean follow-up of 22 (range 12 to 33) months. No repeat ruptures were noted. Plantarflexion was significantly diminished during the preswing phase and initial swing phase in the operated limbs compared with the uninjured limbs. Plantarflexion was significantly increased during the terminal swing phase on the operated side. Knee flexion was nearly symmetrical. No significant differences regarding the temporospatial parameters were noted. We recommend Z-plasty for ruptures of the tibialis anterior tendon as a safe and effective procedure. However, this technique does not fully restore a physiologic gait pattern.

Update Rheumaorthopädie – Aufgabe und therapeutische Optionen

ZusammenfassungDie orthopädischen Therapieoptionen zur Versorgung des Rheumatikers sind in den letzten Jahren maßgeblich fortentwickelt worden. Neben den konservativen Behandlungsmethoden der Orthopädie mit speziellen Schienen und Hilfsmitteln sowie lokalen Injektionen im Gelenk- und Sehnenbereich wird das Therapiespektrum wesentlich von den operativen Interventionsmöglichkeiten geprägt. Grundsätzlich können hierbei gelenkerhaltende, gelenkersetzende und gelenkversteifende Eingriffe unterschieden werden. Aufgrund apparativer Möglichkeiten und ausgefeilter technischer Vorgehensweisen haben sich auch bei Rheumatikern minimal-invasive Techniken zunehmend etabliert. Dadurch konnte die postoperative Morbidität deutlich reduziert werden. Zu den vorrangigen orthopädischen Therapiezielen gehören die Funktionsverbesserung und Schmerzreduktion sowie die Prävention der erneuten lokalen Entzündungssymptomatik. Unter diesen Therapiemaximen hat die Arthrodese nur noch in einzelnen Bereichen Bedeutung. Gelenkerhaltende und -ersetzende Maßnahmen stehen heute ganz im Vordergrund und werden in diesem Beitrag für den internistischen Rheumatologen dargestellt.AbstractOrthopaedic treatment options for rheumatological patients have been further developed over recent years. For orthopaedic treatment, a range of different interventions are offered: orthoses and special technical aids as well as injections for joints and tendons, or surgery. Surgical interventions cover joint preservation, restitution and arthrodeses. Improvements in equipment and surgical procedures also make minimally invasive interactions possible for rheumatoid diseases. Thus, postoperative morbidity has been reduced significantly. Improvement in function, reduction of pain and prevention of recurrent local inflammation are primary. Considering these aims, arthrodeses are restricted to special indications. Joint preservation and restitution are the predominant measures used. The various procedures are discussed.

[Update on rheuma-orthopedics - role and therapeutic options].

ZusammenfassungDie orthopädischen Therapieoptionen zur Versorgung des Rheumatikers sind in den letzten Jahren maßgeblich fortentwickelt worden. Neben den konservativen Behandlungsmethoden der Orthopädie mit speziellen Schienen und Hilfsmitteln sowie lokalen Injektionen im Gelenk- und Sehnenbereich wird das Therapiespektrum wesentlich von den operativen Interventionsmöglichkeiten geprägt. Grundsätzlich können hierbei gelenkerhaltende, gelenkersetzende und gelenkversteifende Eingriffe unterschieden werden. Aufgrund apparativer Möglichkeiten und ausgefeilter technischer Vorgehensweisen haben sich auch bei Rheumatikern minimal-invasive Techniken zunehmend etabliert. Dadurch konnte die postoperative Morbidität deutlich reduziert werden. Zu den vorrangigen orthopädischen Therapiezielen gehören die Funktionsverbesserung und Schmerzreduktion sowie die Prävention der erneuten lokalen Entzündungssymptomatik. Unter diesen Therapiemaximen hat die Arthrodese nur noch in einzelnen Bereichen Bedeutung. Gelenkerhaltende und -ersetzende Maßnahmen stehen heute ganz im Vordergrund und werden in diesem Beitrag für den internistischen Rheumatologen dargestellt.AbstractOrthopaedic treatment options for rheumatological patients have been further developed over recent years. For orthopaedic treatment, a range of different interventions are offered: orthoses and special technical aids as well as injections for joints and tendons, or surgery. Surgical interventions cover joint preservation, restitution and arthrodeses. Improvements in equipment and surgical procedures also make minimally invasive interactions possible for rheumatoid diseases. Thus, postoperative morbidity has been reduced significantly. Improvement in function, reduction of pain and prevention of recurrent local inflammation are primary. Considering these aims, arthrodeses are restricted to special indications. Joint preservation and restitution are the predominant measures used. The various procedures are discussed.

Operative gelenkerhaltende Therapie der Gonarthrose

The guiding principle of operative joint-preserving therapy of gonarthrosis is the search for a safe, minimally invasive, efficient and ultimately reasonably priced therapeutic procedure to preserve or restore joint integrity. A comprehensive analysis and treatment of pathologies adjacent to and distant (axis deviations) from the joint are prerequisites for success of treatment. A comparison of results from the current literature with respect to the operative treatment of arthritis is limited due to the divergence of indications, terminologies used, techniques of the therapeutic procedure, inhomogeneity of patient collectives and the different follow-up and control schemes (scores). Conclusive, prospective, randomized double blind studies with large case numbers are associated with a high degree of organizational effort in planning, patient recruitment and execution and remain a rarity. Long-term prognosis depends on the stage of arthritis at the time of the arthroscopic intervention. Operative measures, such as correction osteotomy can be effective in the early stages. A short duration of symptoms, mechanical blocking and low-grade cartilage damage are factors which have a favorable prognosis. Cell-based cartilage repair techniques can reduce secondary degenerative alterations only in cases of local cartilage damage representing a prearthritic condition. Advantages of autologous chondrocyte transplantation compared to microfracturing have been found depending on the size of the defect and the follow-up time period. Furthermore, preservation and replacement of primary knee stabilizers, such as the anterior cruciate ligament and meniscus, have an important function for secondary prevention. A one-for-all therapy for joint-preserving operative treatment of gonarthrosis is lacking.

[Operative joint-preserving therapy of gonarthrosis].

The guiding principle of operative joint-preserving therapy of gonarthrosis is the search for a safe, minimally invasive, efficient and ultimately reasonably priced therapeutic procedure to preserve or restore joint integrity. A comprehensive analysis and treatment of pathologies adjacent to and distant (axis deviations) from the joint are prerequisites for success of treatment. A comparison of results from the current literature with respect to the operative treatment of arthritis is limited due to the divergence of indications, terminologies used, techniques of the therapeutic procedure, inhomogeneity of patient collectives and the different follow-up and control schemes (scores). Conclusive, prospective, randomized double blind studies with large case numbers are associated with a high degree of organizational effort in planning, patient recruitment and execution and remain a rarity. Long-term prognosis depends on the stage of arthritis at the time of the arthroscopic intervention. Operative measures, such as correction osteotomy can be effective in the early stages. A short duration of symptoms, mechanical blocking and low-grade cartilage damage are factors which have a favorable prognosis. Cell-based cartilage repair techniques can reduce secondary degenerative alterations only in cases of local cartilage damage representing a prearthritic condition. Advantages of autologous chondrocyte transplantation compared to microfracturing have been found depending on the size of the defect and the follow-up time period. Furthermore, preservation and replacement of primary knee stabilizers, such as the anterior cruciate ligament and meniscus, have an important function for secondary prevention. A one-for-all therapy for joint-preserving operative treatment of gonarthrosis is lacking.

Operative Therapie bei rheumatoider Arthritis der Hand

ZusammenfassungDurch den vermehrten Einsatz der Biologika sinkt die Häufigkeit von ausgeprägten rheumatischen Deformitäten der Hand und des Handgelenks. Bei Patienten, bei denen aus unterschiedlichen Gründen die medikamentöse Therapie nicht ausreichend anschlägt oder vertragen wird, kommt es bei rheumatoider Arthritis häufig zu einer Beteiligung der Hand und im Spätstadium zur ausgeprägten Deformität mit Verlust der Funktion. Ziel dieses Artikels ist es, die Prinzipien der Chirurgie der Rheumahand zu erläutern. Zu Beginn der Therapie steht hierbei die sorgfältige Synovialektomie oder Tenosynovialektomie der betroffenen Gelenke bzw. der Sehnen im Vordergrund. Bei fortgeschritteneren Stadien müssen Rettungsoperationen durchgeführt werden, die die bestmögliche Funktion erhalten sollen.AbstractThe need for operative treatment of severe rheumatic deformities of the hand and wrist is decreasing due to the increased use of disease-modifying drugs; however, some patients do not tolerate or do not sufficiently respond to these drugs, which often results in the hands being affected and in advanced stages to severe deformity and loss of function. In these cases operative surgery can help to slow the progression of rheumatic destruction and restore the function of the patient’s hand. This article describes the principles of surgery for rheumatoid arthritis of the hand. A meticulous synovectomy or tenosynovectomy is the first stage of treatment. With progression of rheumatic destruction various salvage procedures are necessary to preserve the best possible functional state.

Operative therapy for rheumatoid arthritis of the hand

ZusammenfassungDurch den vermehrten Einsatz der Biologika sinkt die Häufigkeit von ausgeprägten rheumatischen Deformitäten der Hand und des Handgelenks. Bei Patienten, bei denen aus unterschiedlichen Gründen die medikamentöse Therapie nicht ausreichend anschlägt oder vertragen wird, kommt es bei rheumatoider Arthritis häufig zu einer Beteiligung der Hand und im Spätstadium zur ausgeprägten Deformität mit Verlust der Funktion. Ziel dieses Artikels ist es, die Prinzipien der Chirurgie der Rheumahand zu erläutern. Zu Beginn der Therapie steht hierbei die sorgfältige Synovialektomie oder Tenosynovialektomie der betroffenen Gelenke bzw. der Sehnen im Vordergrund. Bei fortgeschritteneren Stadien müssen Rettungsoperationen durchgeführt werden, die die bestmögliche Funktion erhalten sollen.AbstractThe need for operative treatment of severe rheumatic deformities of the hand and wrist is decreasing due to the increased use of disease-modifying drugs; however, some patients do not tolerate or do not sufficiently respond to these drugs, which often results in the hands being affected and in advanced stages to severe deformity and loss of function. In these cases operative surgery can help to slow the progression of rheumatic destruction and restore the function of the patient’s hand. This article describes the principles of surgery for rheumatoid arthritis of the hand. A meticulous synovectomy or tenosynovectomy is the first stage of treatment. With progression of rheumatic destruction various salvage procedures are necessary to preserve the best possible functional state.