Hansjoerg Heep

Digital templating in total hip arthroplasty with the Mayo stem

PatientsIn 40 patients undergoing total hip arthroplasty with the Mayo femoral stem we studied how preoperative digital templating corresponded to the actual intraoperative choice of implant size, position, offset and restoration of leg length.ResultsThe preoperatively planned sizes of the components showed a high rate of coincidence with the sizes used intraoperatively [Intraclass Correlation Coefficient (ICC) 0.661–0.810]. However, the agreements in offset and CCD correction were poor (ICC 0.476, 0.253). This could be statistically attributed to the change in the distance from the medial margin of the stem to the medial margin of the medial femoral cortex and the height of osteotomy. The agreement in leg length correction was moderate (ICC 0.583), which was attributed to the change in the hip rotation center and the height of osteotomy.ConclusionCareful preoperative planning was useful for accurate size choice of the Mayo prosthesis. Factors such as the height of osteotomy and the distance from the medial margin of the stem to the medial margin of the medial femoral cortex in relation to the position of the Mayo stem should be taken into account in order to restore ideal offset and leg length.

A simple and convenient method guide to determine the magnification of digital X-rays for preoperative planning in total hip arthroplasty

Scaling of anteroposterior digital pelvic X-rays with variable magnification is the premise for accurate preoperative planning of total hip replacement with digital templating. Conns method of placing a marker of known diameter beside the thigh at the level of the femur has been reproduced in many studies and confirmed as one of the most accurate methods. But in our experience, it is inconvenient for radiographers and is not well tolerated by some patients. We modified this method by placing a coin on the radiograph plate. One hundred patients who had undergone hip replacement were enrolled in the study and randomly divided into two groups. The actual diameter of the prosthesis head was taken as the gold standard for assessment of the magnification of the coin in Group A. The coin was within a mean of 117.95% (range 114.37–122.02%) of magnification for male, and 111.71% (range 114.37–120.93%) for female patients. The variation was small and limited, and had no correlation with body shape parameters (i.e. height, weight, BMI). Subsequently, the magnification of the coin was used to correct the measuring scale of the X-rays of the other 50 patients (Group B). Bias did not exceed 1.96 mm during measurement of the prosthesis with a diameter of less than 56 mm, and a range of absolute error of measurements of 56–66 mm (standard deviation, SD, 0.04–3.95 mm). Furthermore, in order to confirm the expressiveness of the modified method, CT scans of another 50 patients were randomly selected. The distance between the rotation center of the hip and the table, which is acknowledged to be a factor which influences magnification of the coin, changed little in response to body shape. Variation in magnification was caused by variation in distance between the rotation center of the hip and the table. The minimal change in distance for patients with different body shape led to easier and more convenient examination, and increased the feasibility of our modified coin method, except in cases where implantation of a very large-sized prosthesis is necessary.

Socioeconomic impact of e-Health services in major joint replacement: A scoping review

BACKGROUND e-Health is a widespread healthcare practice in the medical community, supported by technology-based applications aiming to deliver health services in an efficient manner, improving the quality of life and providing a wide range of health and socio-economic benefits to patients. OBJECTIVE To investigate the use of e-Health and mobile applications for the follow-up of major joint arthroplasty patients and the socio-economic impact of e-Health services on arthroplasty patients. METHODS Studies published after 2000 in English language, enrolling patients who underwent total knee or hip replacement, applying e-Health solutions and highlighting the economic benefits obtained by patients, doctors and healthcare systems were considered for inclusion in the present study. RESULTS Five studies satisfied our inclusion criteria and were included in qualitative analysis. In this paper, the use of e-Health for the follow-up of major joint arthroplasty patients and the positive impact in terms of cost, time and hospital visits reduction by applying e-Health solutions on arthroplasty patients are reviewed in detail as reported in the included studies. CONCLUSION The majority of the included studies reported a positive impact in terms of cost, time and hospital visits reduction.

Impact of Total Hip Resurfacing Arthroplasty on Health-Related Quality of Life Measures: A Systematic Review and Meta-Analysis

The aim of this study was to investigate the effect of total hip resurfacing arthroplasty (RA) on general health-related quality of life (HRQOL) and disease/hip-specific measures. Original studies published after 2000, enrolling at least ten skeletally mature patients with a minimum follow-up of 6 months were considered. The standardized mean difference (SMD) was obtained with a random effects model. The cumulative patient population encompassed 1898 patients (2123 RA). Mean follow-up duration was 4 years. The physical component score (P<0.001) and mental component score (P=0.05) of SF-12, and the EuroQol-5D (P<0.0001) improved significantly. WOMAC global score and the subscales (P<0.00001) were also improved. Harris Hip Score (P<0.00001), Oxford Hip Score (P<0.001) and UCLA (P<0.00001) were markedly improved and patient satisfaction was favorable.

Musculoskeletal Injuries in Auto Racing: A Retrospective Study of 137 Drivers

Abstract Background and Purpose: The effect of continuous exposure of a drivers bones and muscles to vibration and G forces to years of automobile racing and the effect on overall health have not yet been examined in detail. The goal of this study was to investigate via questionnaire the musculoskeletal injuries and influencing parameters in 130 amateur and 7 professional race car drivers. Materials and Methods: A questionnaire, translated in English and German, was used to investigate the parameters that influence the racing performance and the character of resulting injuries. Results: This investigation involved 137 drivers (133 men and 4 women) with a mean age of 42 years (standard deviation = 15). Approximately half of the drivers had < 10 years of experience in auto racing (49%). The drivers mainly complained about pains in the lumbar (n = 36; 26%), shoulder (n = 27; 20%), and neck regions (n = 25; 18%). The drivers posture and the comfort of the seat were statistically significant for causing lower back and upper legs pains. The race duration was relevant to neck and shoulder discomfort. Conclusion: The high incidence of musculoskeletal injuries in race car driving indicates the need for further improvements. Elimination of driver complaints about pain in the spine and upper extremities can be achieved through technical development, as already accomplished in Formula One racing.

No Adaptations in Bone of Leptin-Deficient ob/ob Mice in Response to Loading

Problemstellung: Das Hormon Leptin reguliert die Reifung und Entwicklung des Knochens. Jedoch nicht bekannt ist der Einfluß von Leptin auf das wachsende Skelett. Unsere Studie untersucht die Auswirkung der biomechanischen Belastung des Körpergewichtes von Leptin-defizienten ob/ob-Mäusen in der Pubertät. Methodik: Beginnend mit einem Alter von 5 Wochen wurden zwei Gruppen von je 20 weiblichen ob/ob-Mäusen untersucht. Mit einem Alter von 20 Wochen war das Körpergewicht der Gruppe A, die keine Einschränkung des Essverhaltens erfuhren, signifikant schwerer als in der Gruppe B unter kontrollierter Diät (p<0.05). Die trabekulären und kortikalen Strukturen des Knochens wurden mittels MikroCT untersucht. Ergebnisse: Unter Berücksichtigung, daß Leptin einen wichtiORIGINAL ARBEITEN Hansjoerg Heep: No Adaptations in Bone of Leptin-Deficient ob/ob Mice in Response to Loading Fig. 3: Plots of the correlation between the femoral, tibial and vertebral regions, respectively for trabecular parameters. The correlation between the femoral and tibial regions was represented by an open triangle ( ), between the femoral and vertebral regions by a filled square ( .