Georg Göbel

Scoring systems in total knee arthroplasty.

For assessment of total knee arthroplasty outcome, various scoring systems have been introduced. The current study assessed the interobserver correlation of four commonly used total knee arthroplasty outcome scores. One hundred eighteen total knee arthroplasties were investigated by two independent observers, using the Hungerford score, the Hospital for Special Surgery score, the Knee Society score, and the Bristol score. Each score consisted of three subscores: pain, knee, and function. For the highest interobserver correlation was computed for the Bristol score (interobserver correlation coefficient, 0.88). For knee range of motion, flexion contracture, and extension lag there was high interobserver correlation (interobserver correlation coefficient > 0.8 each). For walking distance and walking aids, there also was a high interobserver correlation (interobserver correlation coefficient > 0.7 each). For clinical assessment of total knee arthroplasty, pain should be measured on a four-step system, the knee should be assessed by measurement of range of motion, extension lag, and flexion contracture, and function should be measured on a separate score assessing walking distance and walking aids.

No functional impairment after Robodoc total hip arthroplasty

The Robodoc total hip replacement procedure requires a wider exposure of the proximal femur, especially of the greater trochanter, than the standard procedure. Moreover, the leg must be placed in a rigid leg-holder apparatus to obtain fixation in maximal hip adduction and external rotation. This may impair the hip abductors and reduce hip abduction in the mid- and terminal stance phase of the cycle. In this study we compared patients after Robodoc and conventional total hip arthroplasty with three-dimensional gait analysis (VICON System, Oxford Metrics, Oxford, U.K.) to assess the kinematics of the pelvis and hip. 25 patients underwent total hip replacement by means of the Robodoc total hip arthroplasty system, 25 patients were treated with conventional total hip replacement, and 40 healthy volunteers served as controls. None of the patients undergoing total hip replacement, robotic or conventional, obtained normal kinematic gait patterns 6 months after surgery. However, the reduction in hip abduction did not differ significantly in patients undergoing robotic or conventional total hip arthroplasty, which suggests that the robotic procedure did not impair hip abductor function more than the conventional method. n

A MeSH based intelligent search intermediary for Consumer Health Information Systems.

GIN AUSTRIA (Gesundheitsinformationsnetz AUSTRIA) offers patients and consumers reliable medical knowledge about diseases, wellness and disease management in an easy understandable way and enables them to quick and incessant access to informations about the Austrian health system and Austrian health organizations. To achieve full customer (patients, citizens) satisfaction to find relevant information we propose a concept of a vector-model oriented IR-Tool based on the controlled vocabulary of the MeSH Thesaurus (german version). By this approach users who are often not used to scientific terms and expressions are supported to build up their own query with MeSH Main Headings. In a second step broader and narrower Main Headings are added to the query-vector by the system. The tool is part of the GIN Search Modul, which will ease gathering health information from different heterogenous internet datasources.

Fully vaccinated children are rare: Immunization coverage and seroprevalence in Austrian school children

Vaccination coverage for vaccine-preventable diseases in Austria as well as in many Central European countries has been reported to be too low to eradicate such diseases and prevent further outbreaks. Austria lacks an adequate surveillance system to monitor prevalence of the diseases, the vaccination coverage and seroconversion. School children aged 10–14 years (n = 1077) were recruited in all four schools in the city of Schwaz, Austria, to present their vaccination documents and to give blood for serological testing (diphtheria, pertussis, measles, mumps, rubella, varicella). All participants received a report with a personal guideline for (re-) vaccination. Overall vaccination coverage was 86.4% for measles, 85.5% for mumps and 35.0% for rubella. Tetanus vaccination coverage was 98.4% for the first, 97.8% for the second and 96.7% for the third dose, while 55.4% of the study subjects received the recommended two booster injections. For diphtheria the corresponding vaccination coverage was found to be almost identical. Pertussis coverage was lower in general (first dose: 90.9%; second dose: 89.0%; third dose: 86.5%). Oral poliomyelitis vaccination showed a coverage of 98.6, 96.5, 95.3%, with 78.7% receiving the fourth dose. Overall 38.7% were classified as fully vaccinated. Seropositivity for measles was found in 90.4%, for mumps in 61.8%, for rubella in 82.3%, for diphtheria in 65.8%, for pertussis in 35.6% and for varicella in 95.0%. In summary, fully vaccinated children are rare and intensive public health efforts will be necessary to reach higher levels of immunity and prevent further outbreaks.

Significance of talar distortion for ankle mobility in idiopathic clubfoot.

The abnormal bony feature found most consistently in clubfeet is talar distortion. The significance of the talar distortion for mobility of the tibiotalar joint was investigated. Twenty-seven congenital clubfeet in 19 patients were examined at a minimal followup of 20 years. In all patients Turco’s posteromedial release was done because of idiopathic clubfoot. Radiographic assessment of the feet included measurement of the talocalcaneal angle and index, and the tibiocalcaneal angle. The degree of talar flattening was estimated by the ratio of the curvature of the talar dome to the length of the talar bone (radius to length ratio). Three-dimensional gait analysis was done to assess the dynamic range of ankle motion. The static range of motion was measured with a goniometer. The degree of talar flattening correlated significantly with the dynamic range of ankle motion but not with the static mobility. For assessment of idiopathic clubfoot, evaluation of talar flattening should be done because of its significance for dynamic ankle mobility.

Categorization Diminishes the Reliability of Hip Scores

Scoring systems frequently are used to assess the outcome of total hip arthroplasty. The result may be presented as a numeric value, or in descriptive terms such as excellent, good, fair, and poor (category system). The current study was done to investigate the influence of descriptive and numeric outcomes for interobserver reliability and interscore correlation of five different hip scores. Sixty-four patients (83 hips) were included in the study. The average age of the patients at followup was 70 years (range, 48–88 years). The average followup was 6.2 years (range, 2–17 years). For the numeric outcome a higher interobserver reliability (correlation coefficient, 0.71–0.81) and interscore correlation (correlation coefficient, 0.81–0.92) were found compared with the category system (interobserver reliability[correlation coefficient, 0.57–0.72]; interscore correlation [correlation coefficient, 0.46–0.62]). Findings from the study suggest that categorization of the results of total hip arthroplasty reduces interobserver reliability and interscore correlation.

Bonding porcelain laminate veneer provisional restorations: An experimental study.

STATEMENT OF PROBLEM Minimal tooth preparation is required for porcelain laminate veneers, but an interim restoration is anticipated by patients to protect their teeth against thermal insult, chemical irritation, and to provide esthetics. Cement remaining after the removal of the provisional restoration can impair the etching quality of the tooth surface and the fit and final bonding of the porcelain laminate veneer. PURPOSE This in vitro study inspected the tooth surface for remaining debris from cement after removal of a provisional restoration. MATERIAL AND METHODS Seventy-two extracted natural anterior teeth were prepared for porcelain laminate veneers. For half of the teeth, the smear layer was removed before luting provisional restorations. Veneer provisional restorations were fabricated and luted to teeth with 3 bonding methods: temporary eugenol-free cement, spot etching combined with dual-curing luting cement, and polyurethane adhesive combined with dual-curing luting cement. After removal of provisional restorations 1 week later, the tooth surface was examined for residual luting material with an SEM. RESULTS Traces of cement debris were found on provisionally prepared teeth for all 3 material methods. CONCLUSION The use of polyurethane adhesive combined with the dual-curing cement revealed significantly less teeth with debris than the other methods. This difference was less distinct when the smear layer was removed.

Demand for intelligent search tools in medicine and health care

The high demand for medical knowledge poses a big challenge for information technology to offer user-friendly systems which help healthy citizens, patients and health professionals to find proper data, information and knowledge.