Steffen Brodt

Comparison of Calcaneal Fixation of a Retrograde Intramedullary Nail with a Fixed-Angle Spiral Blade Versus a Fixed-Angle Screw

Background: Retrograde intramedullary nailing is an established technique for tibiotalocalcaneal arthrodesis (TTCA). In poor bone stock (osteoporosis, neuroarthropathy), device fixation in the hindfoot remains a problem. Fixed-angle spiral-blade fixation of the nail in the calcaneus could be useful. Materials and Methods: In seven matched pairs of human below-knee specimens, bone mineral density (BMD) was determined, and TTCA was performed with an intramedullary nail (Synthes Hindfoot Arthrodesis Nail HAN Expert Nailing System), using a conventional screw plus a fixed-angle spiral blade versus a conventional screw plus a fixed-angle screw, in the calcaneus. The constructs were subjected to quasi-static loading (dorsiflexion/plantarflexion, varus/valgus, rotation) and to cyclic loading to failure. Parameters studied were construct neutral zone (NZ) and range of motion (ROM), and number of cycles to failure. Results: With dorsiflexion/plantarflexion loading, the screw-plus-spiral-blade constructs had a significantly smaller ROM in the quasi-static test (p = 0.028) and early in the cyclic test (p = 0.02); differences in the other parameters were not significant. There was a significant correlation between BMD and cycles to failure for the two-screw constructs (r = 0.94; p = 0.002) and for the screw-plus-spiral-blade constructs (r = 0.86; p = 0.014). Conclusion: In TTCA with a HAN Expert Nailing System, the use of a calcaneal spiral blade can further reduce motion within the construct. This may be especially useful in poor bone stock. Clinical Relevance: Results obtained in this study could be used to guide the operating surgeons TTCA strategy.

Preservation of the shoulder joint by the use of a hybrid-spacer after septic loosening of a reversed total shoulder joint arthroplasty: a case report

Infections of a total joint replacement (TJR) of the shoulder are rare complications. After revision surgery, the incidence rises dramatically. If infection occurs, it leads to a loss of function and may be devastating to the joint. Treatment options range from single- to multiple-staged revision programs, permanent resection arthroplasty or exarticulation. In this case, a reversed shoulder endoprosthesis, which was implanted after multiple revisions of a TJR due to a posttraumatic omarthrosis and rotator cuff insufficiency, got infected. A hybrid-spacer, made of a humeral nail and a custom-made PMMA spacer forming the humeral head, was used during the revision program. After two operations, clinical and paraclinical signs turned back to normal. The patient felt well and was satisfied with the result of the therapy. The hybrid-spacer was then left in situ as a definitive solution with a satisfying range of motion. This case report shows that a hybrid-spacer can be helpful in the treatment of an infected shoulder TJR.

Effects of Kinesio taping compared to arterio-venous Impulse System™ on limb swelling and skin temperature after total knee arthroplasty

PurposeIt is an established fact that post-operative (p.o.) soft-tissue swelling and lymphoedema after total knee arthroplasty (TKA) have a major influence on the p.o. early functional outcome. Kinesio taping has a proven clinical effect in increasing lymph drainage. Despite the decades of experience gained and the assumed positive effects, hardly any investigations have been conducted to date on the influence of Kinesio taping on the p.o. healing process after TKA. The objective of the present study was to test the hypothesis that Kinesio taping used as a lymph application leads to a reduction of p.o. soft-tissue swelling. As a secondary objective, it was to be tested whether there is an effect on skin temperature as a surrogate parameter for dermal micro-circulation.MethodsIn this prospective study with a historical control (A-V Impulse System™ group), 42 subjects were included and treated with Kinesio taping after implantation of a TKA. The patients of the study group were treated immediately p.o. with Kinesio® Tex Gold™ fan cut tape as a lymph application with a common base. A thermographic temperature determination of the knee joint operated on was performed on each patient in the supine position every day from the first to the seventh p.o. day. The leg circumference was documented daily at eight specified measuring points on both lower limbs. As a statistical analytical approach, the so-called principal component analysis was used. An analysis of variance was performed. The significance level was set at p < 0.001.ResultsThe course of soft-tissue swelling of the study group did not differ from that of the control group at any point in time. For the temperature course of the medial wound aspect, no difference was seen between the Kinesio taping study group and the A-V Impulse System™ group. In contrast, the temperature course of the lateral wound aspect showed a reproducibly higher temperature in the Kinesio tape group than in the control group (0.6 °C (0.5–0.8), p < 0.001).ConclusionThe hypothesis of the study that Kinesio taping as a lymph application induces a reduction of soft-tissue swelling after TKA must be rejected on the basis of the present data. Solely the temperature of the lateral wound aspect was higher in the Kinesio taping group than in the control group, so that an increased blood circulation can be assumed here. Considering that the actively working A-V Impulse System™ used in the control group also increases local blood circulation, the effect of the passive Kinesio tape is surprising. However, this was not reflected in a quicker wound healing, as the day of last wound secretion was the same in both groups. Kinesio taping as a lymph application represents an equivalent alternative to the A-V Impulse System™ for therapy after total knee arthroplasty with regard to soft-tissue swelling and wound healing.

Patient-Specific Contact Stress Does Not Predict Polyethylene Wear Rate in a Specific Pressfit Cup

BACKGROUND The most common reason for revision total hip arthroplasty remains polyethylene wear. Development dysplasia of the hip and revision situations requires a conscious compromise of implant position. The surgeon should know about the consequence on wear via a possible change in hip contact force. The objective of this study is to investigate whether annual wear is dependent on hip contact force. METHODS Forty-five inserts (DuraLoc, DePuy) that were explanted in our department were included. Three-dimensional gravimetric determination of the wear was performed by fluid displacement. Then, the hip contact force was determined using radiographs according to the Blumentritt model. RESULTS No correlation was found between patient-specific factors and the annual wear. The hip contact force estimated by the Blumentritt model also showed no correlation between hip contact force and annual wear. Two single model parameters correlated significantly with wear: VRECAB as a ratio of the lever length of the spinocrural and the pelvitrochanteric muscles and the angle Alpha as a measure of the position of the center of rotation in relation to the greater trochanter. The greater the ratio spinocrural/pelvitrochanteric lever arm (R = 0.408, P = .005) and the greater the Alpha angle (more valgus the femoral neck) (R = 0.377, P = .011) were, the greater was the wear. CONCLUSION These results lead to the conclusion that neither patient-specific factors nor the estimated hip contact force have a major influence on annual wear in the case of DuraLoc cups. Only a coxa valga and a small femoral offset contribute in a limited amount to an increase in wear.

Course of pelvic lift during total hip arthroplasty

IntroductionThe position of the cup makes a major contribution to the success of total hip arthroplasty (THA). In conventional implantation of the prosthesis without navigation, the surgeon relies on the spatial position of the pelvis. However, iatrogenic manipulation of the pelvis during different surgical steps constantly changes the position of the pelvis during the operation. The position of the pelvis is substantial for the correct placement of the cup. The objective of this study was to investigate and visualize the course of this pelvic lift and correlate it to certain surgical steps.Materials and methodsPelvic lift was measured in 67 patients during implantation of a THA. This was done by measuring acceleration using the SensorLog app on a smartphone. It was placed on the patient’s contralateral anterior superior iliac spine and recorded the movement of the pelvis throughout the whole surgical procedure. The position of the pelvis was allocated to each of eight relevant surgical steps during the operation. These surgical steps were normed over the time axis and transferred to a diagram.ResultsWe found an average pelvic lift displacement of up to 14.9° upon placement in the figure-of-four position. This lift is particularly critical when exposing the acetabulum, as the true cup position can be unconsciously influenced. Average values of between 5.6° and 6.9° were found here.ConclusionsWhen implanting a THA in supine position, the pelvis is not fixed on the operating table. Rather, the side to be operated on is lifted to a greater or lesser degree, depending on the surgical step to be performed. The retractor traction immediately before cup implantation should be minimized. Nevertheless, it should be taken into account that anteversion of the cup implant in relation to the table plane is systematically higher than in relation to the pelvic entry plane.

Morbidly Obese Patients Undergoing Reduced Cup Anteversion Through a Direct Lateral Approach

BACKGROUND The presence of obesity negatively affects the results after total hip arthroplasty. The influence of morbid obesity on cup positioning is investigated. METHODS A retrospective analysis of radiographs from 790 patients in 2013 and 2014 was performed. The correlation of cup inclination and anteversion with body mass index (BMI) was analyzed. Three groups were formed: 139 patients with normal weight (BMI of <25 kg/m(2)), 566 patients with moderate obesity (BMI between 25 and 34 kg/m(2)), and 85 patients with morbid obesity (BMI of ≥35 kg/m(2)). RESULTS Cup anteversion significantly correlated with BMI (R = -0.127, p < 0.001) and patient age (R = 0.115, p = 0.001). This corresponded with a reduction of anteversion by 3.4° (p < 0.001) in the morbidly obese group compared with the normal-weight group. Cup inclination was not influenced by BMI or patient age. CONCLUSIONS The precision of cup positioning declines with increasing obesity. In addition, significantly reduced anteversion is found in younger patients. We assume that this is due to iatrogenically changed pelvic tilt resulting from increased pressure exerted on the dorsal and ventral acetabular rim retractors. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Influence of Surgical Approach on Pelvic Lift in Hip Arthroplasty During Cup Insertion

The position of the acetabular cup is a major factor in the long-term outcome of total hip arthroplasty (THA). Malpositioning of the acetabular cup frequently has been reported with the use of a minimally invasive implantation technique. It remains unclear whether the limited visibility or the increased retractor traction and thus tilting of the pelvis during cup implantation is the cause. This study investigated the influence of iatrogenically related pelvic lift using an anterolateral minimally invasive THA technique. In a group of 30 consecutive patients who underwent THA via a minimally invasive anterolateral approach, iatrogenic lifting of the pelvis was measured with a smartphone using a 3-axis accelerometer and compared with patients in a historical age- and sex-matched control group who underwent THA using a transgluteal approach. Postoperatively, the inclination and anteversion of the cup was determined on pelvic radiographs. In the anterolateral group, the pelvis was lifted by a maximum of 6.3° and by an average of 3.9° when the acetabular cup was impacted; no difference was noted compared with the transgluteal group. In contrast, the cups in the anterolateral group showed significantly increased inclination and reduced anteversion. In both techniques, the iatrogenic tilting of the pelvis at the time of cup implantation occurred to a comparable extent. Therefore, the significant differences in postoperative radiographs cannot be attributed to increased retractor traction on exposure of the acetabulum, which means that the limited visibility must be responsible. [Orthopedics. 2017; 40(4):e589-e593.].

Erratum zu: Komplikationen und Kosten in der primären Knieendoprothetik in einem Endoprothetikzentrum – Einfluss des Weiterbildungsstandes

timierungeineswesentlichenFunktionsbereiches imKrankenhaus.ErfahrungenundAnsätzevonRoland Berger Strategy Consultants – 2014. https:// www.rolandberger.de/media/pdf/ Roland Berger Baustelle OP 20140501.pdf. Zugegriffen: 02. Mai 2016 14. Tan SC, Chan YH, Chong HC, Chin PL, Yew A, Chia SL, Tay D, Lo NN, Yeo SJ (2014) Association of surgeon factors with outcome scores after total kneearthroplasty. JOrthopSurg22:378–382 15. Thienpont E, Grosu I, Jonckheere S, Yombi JC (2013) C-reactive protein (CRP) in different types ofminimally invasive kneearthroplasty. KneeSurg SportsTraumatolArthrosc21:2603–2610 16. Vogt JC, Saarbach C (2009) LCS mobile-bearing total knee replacement. A 10-year’s follow-up study.OrthopTraumatolSurgRes95(3):177–182 17. von Lewinski G, Floerkemeier T, Budde S, Fuhrmann U, Schwarze M, Windhagen H, Radtke K (2015) Experience in establishing a certified endoprosthesis center.Orthopäde44:193–202 18. White J, Kelly M, Dunsmuir R (1998) C-reactive protein level after total hip and total knee replacement. JBoneJointSurgBr80:909–911 Orthopäde 2017 · 46:358 DOI 10.1007/s00132-017-3404-8 Online publiziert: 27. Februar 2017

Komplikationen und Kosten in der primären Knieendoprothetik in einem Endoprothetikzentrum

BACKGROUND This work examines the hypothesis that in endoprosthesis implantation there are differences between experienced primary and senior caregivers (S-Op) and less experienced follow-up assistants (T-Op) with respect to process-relevant parameters. The main hypothesis is that compared to S‑Op, T‑Op cause significantly longer surgery times and thus additional operating theatre costs. As sub-hypotheses, differences in various perioperative (p-o) parameters between T‑Op and S‑Op were examined. MATERIALS AND METHODS The status of the operator (senior and/or senior main operator [S-Op]) and/or postoperative CRP, perioperative blood loss, the amount of transfused erythrocyte concentrates, patient age, gender, ASA risk classification (American Society of Anesthesiologists), duration of surgery and blood transfusion, duration of inpatient stay, as well as the rates of early revision surgery and complications were recorded. A comparison of patients who had been operated by an S‑Op and those who had been operated by a T‑Op was made for all parameters. RESULTS Significant differences were found with respect to the duration of surgery, the duration of the hospital stay, and CRP on the third p‑o day. The T‑Op required an average of 11 min more than the S‑Op. CRP was significantly higher in the T‑Op group only on the third p‑o day, by 18 mg/l. In contrast, in the T‑Op group, a blood loss of 181 ml was lower than in the S‑Op group. This corresponded to a reduction of 0.26 transfused erythrocyte concentrates. There were no significant differences in complication rates between S‑Op and T‑Op. DISCUSSION In the setting of a certified endoprosthetics centre, the comparison of T‑Op with S‑Op showed that the use of the former with at a non-increased complication rate led to a significant extension of the operating time. This leads to additional training costs in the amount of an estimated 3% of the current DRG remuneration. These additional costs are not represented adequately in the current remuneration system.

Patient Obesity Influences Pelvic Lift During Cup Insertion in Total Hip Arthroplasty Through a Lateral Transgluteal Approach in Supine Position

BACKGROUND Movement of the pelvis during implantation of total hip arthroplasty (THA) has a major influence on the positioning of the acetabular cup. Strong traction caused by retractors leads to iatrogenic pelvic lift and can thus be partly responsible for cup malpositioning. The objective of this study was to investigate such factors that influence pelvic lift. METHODS The dynamic movement of the pelvis was measured during implantation of THA in 67 patients. This was done by measuring the acceleration using the SensorLog app on a smartphone. RESULTS At its maximum, the pelvis was lifted by an average of 6.7°. When impacting the press-fit cup, the surgical side was raised by 4.4° compared with the time of skin incision. This lift at the time of cup implantation correlates significantly with the body mass index and the patients abdominal and pelvic circumference. CONCLUSION Every surgeon performing THA must be aware of the pelvic lift during an operation. Especially in patients with a high body mass index, a large abdominal circumference, or a large pelvic circumference, there is an increased risk of malpositioning of the acetabular cup. When impacting the cup, we recommend releasing the traction of the retractor, so that the pelvis can tilt back into its natural position, and thus, the anticipated cup positioning can be implemented as exactly as possible.