T. Kappe

Effektivitätsanalyse einer klinikinternen allogenen Knochenbank

Hintergrund Die EU-Richtlinien 2004/23/EG und 2006/17/EG mit der entsprechenden nationalen Umsetzung definieren die Rahmenbedingungen fur das Fuhren einer Knochenbank und die allogene Knochentransplantation neu. Vor diesem Hintergrund untersuchten wir die abteilungsintern etablierte Knochenbank (allogen, „fresh frozen“, −70°C) hinsichtlich der Effektivitat den Eigenbedarf zu decken und ihrer Wirtschaftlichkeit im Vergleich mit alternativen Verfahren.

[Minimally invasive total hip arthroplasty - trend or state of the art?: A meta-analysis].

ZusammenfassungMinimalinvasive Zugänge in der Hüftendoprothetik haben sich weltweit verbreitet und erfreuen sich zunehmender Popularität. Obwohl früh auf teilweise katastrophale Fehlschläge hingewiesen wurde, nimmt die Zahl der Publikationen zu diesem Thema ebenso wie die Anzahl der Operateure, die minimalinvasive Hüftendoprothetik anbieten, weiter zu. Anhand einer systematischen Literaturübersicht werden potenzielle Vorteile und Risiken der minimalinvasiven Hüftendoprothetik gegenüber gestellt. Während ein kürzerer Hautschnitt, ein geringeres Muskeltrauma, eine schnellere Rehabilitation und ein klinisch irrelevant geringerer Blutverlust für die Anwendung minimalinvasiver Techniken sprechen, liefern die potenzielle Beeinträchtigung der Wundkosmetik, periprothetische Frakturen, Implantatmalpositionierungen und die ausstehenden Langzeitergebnisse Argumente dagegen, die minimalinvasive Hüftendoprothetik als Standardtechnik einzusetzen.AbstractMinimally invasive approaches in total hip arthroplasty are being used worldwide and continue to grow in popularity. Despite early reports of catastrophic failures, both the number of scientific publications as well as the number of orthopaedic surgeons practicing minimally invasive techniques in total hip arthroplasty are steadily increasing. By means of a systematic review of the literature, the current article weighs the potential advantages and disadvantages of minimally invasive techniques. A shorter skin incision, potentially less muscle damage, a faster rehabilitation and a clinically irrelevant lower blood loss may support the use of minimally invasive techniques. However, the potential impairment of wound cosmetics, the increased risk of periprosthetic fractures, implant malpositioning and lack of long-term results contradict the use of minimally invasive total hip arthroplasty as a standard treatment.Minimally invasive approaches in total hip arthroplasty are being used worldwide and continue to grow in popularity. Despite early reports of catastrophic failures, both the number of scientific publications as well as the number of orthopaedic surgeons practicing minimally invasive techniques in total hip arthroplasty are steadily increasing. By means of a systematic review of the literature, the current article weighs the potential advantages and disadvantages of minimally invasive techniques. A shorter skin incision, potentially less muscle damage, a faster rehabilitation and a clinically irrelevant lower blood loss may support the use of minimally invasive techniques. However, the potential impairment of wound cosmetics, the increased risk of periprosthetic fractures, implant malpositioning and lack of long-term results contradict the use of minimally invasive total hip arthroplasty as a standard treatment.

Minimalinvasive Hüftendoprothetik – nur Trend oder schon Standard?

ZusammenfassungMinimalinvasive Zugänge in der Hüftendoprothetik haben sich weltweit verbreitet und erfreuen sich zunehmender Popularität. Obwohl früh auf teilweise katastrophale Fehlschläge hingewiesen wurde, nimmt die Zahl der Publikationen zu diesem Thema ebenso wie die Anzahl der Operateure, die minimalinvasive Hüftendoprothetik anbieten, weiter zu. Anhand einer systematischen Literaturübersicht werden potenzielle Vorteile und Risiken der minimalinvasiven Hüftendoprothetik gegenüber gestellt. Während ein kürzerer Hautschnitt, ein geringeres Muskeltrauma, eine schnellere Rehabilitation und ein klinisch irrelevant geringerer Blutverlust für die Anwendung minimalinvasiver Techniken sprechen, liefern die potenzielle Beeinträchtigung der Wundkosmetik, periprothetische Frakturen, Implantatmalpositionierungen und die ausstehenden Langzeitergebnisse Argumente dagegen, die minimalinvasive Hüftendoprothetik als Standardtechnik einzusetzen.AbstractMinimally invasive approaches in total hip arthroplasty are being used worldwide and continue to grow in popularity. Despite early reports of catastrophic failures, both the number of scientific publications as well as the number of orthopaedic surgeons practicing minimally invasive techniques in total hip arthroplasty are steadily increasing. By means of a systematic review of the literature, the current article weighs the potential advantages and disadvantages of minimally invasive techniques. A shorter skin incision, potentially less muscle damage, a faster rehabilitation and a clinically irrelevant lower blood loss may support the use of minimally invasive techniques. However, the potential impairment of wound cosmetics, the increased risk of periprosthetic fractures, implant malpositioning and lack of long-term results contradict the use of minimally invasive total hip arthroplasty as a standard treatment.Minimally invasive approaches in total hip arthroplasty are being used worldwide and continue to grow in popularity. Despite early reports of catastrophic failures, both the number of scientific publications as well as the number of orthopaedic surgeons practicing minimally invasive techniques in total hip arthroplasty are steadily increasing. By means of a systematic review of the literature, the current article weighs the potential advantages and disadvantages of minimally invasive techniques. A shorter skin incision, potentially less muscle damage, a faster rehabilitation and a clinically irrelevant lower blood loss may support the use of minimally invasive techniques. However, the potential impairment of wound cosmetics, the increased risk of periprosthetic fractures, implant malpositioning and lack of long-term results contradict the use of minimally invasive total hip arthroplasty as a standard treatment.

Erkennung von Hüftschaftsinterungen am Röntgenbild

BACKGROUND In Germany, more than 150,000 total hip arthroplasties (THA) are performed annually. Early implant migration is supposed to be the best indicator for mechanical failure of femoral stems. Therefore, radiological evaluation of hip stems is routinely done by analyzing plain radiographs of THA. OBJECTIVES The purpose of this study was to evaluate the accuracy of implant migration measurement on plain radiographs. MATERIAL AND METHODS Two observers analyzed 44 anterior-posterior radiographs of the pelvis in 22 pain-free patients at least 2 years after implantation of an anatomical hip stem. The evaluation was performed on digital as well as conventional plain radiographs. Intraobserver reliability was analyzed by double measurements of each radiograph and the evaluation of the consecutive series of each patient. The anatomical structures of interest were the greater trochanter and the minor trochanter. Furthermore, the tip of the prosthesis, the shoulder of the implant, and the center of rotation were determined. RESULTS The conventional measurement technique proved higher accuracy compared to the digital measurement technique. The best anatomical structure was the greater trochanter in the conventional technique and the minor trochanter in the digital technique. The best reference structure with regard to the implant was the shoulder of the prosthesis for both techniques. CONCLUSION The recommended reference structures for the evaluation of implant migration on plain radiographs are the greater trochanter and the shoulder of the implant for the conventional measurement technique and the minor trochanter and the shoulder of the implant for the digital technique. Migration of an implant should not assumed before a determined difference of 2 mm.

[Accuracy of hip stem migration measurement on plain radiographs: reliability of bony and prosthetic landmarks].

BACKGROUND In Germany, more than 150,000 total hip arthroplasties (THA) are performed annually. Early implant migration is supposed to be the best indicator for mechanical failure of femoral stems. Therefore, radiological evaluation of hip stems is routinely done by analyzing plain radiographs of THA. OBJECTIVES The purpose of this study was to evaluate the accuracy of implant migration measurement on plain radiographs. MATERIAL AND METHODS Two observers analyzed 44 anterior-posterior radiographs of the pelvis in 22 pain-free patients at least 2 years after implantation of an anatomical hip stem. The evaluation was performed on digital as well as conventional plain radiographs. Intraobserver reliability was analyzed by double measurements of each radiograph and the evaluation of the consecutive series of each patient. The anatomical structures of interest were the greater trochanter and the minor trochanter. Furthermore, the tip of the prosthesis, the shoulder of the implant, and the center of rotation were determined. RESULTS The conventional measurement technique proved higher accuracy compared to the digital measurement technique. The best anatomical structure was the greater trochanter in the conventional technique and the minor trochanter in the digital technique. The best reference structure with regard to the implant was the shoulder of the prosthesis for both techniques. CONCLUSION The recommended reference structures for the evaluation of implant migration on plain radiographs are the greater trochanter and the shoulder of the implant for the conventional measurement technique and the minor trochanter and the shoulder of the implant for the digital technique. Migration of an implant should not assumed before a determined difference of 2 mm.

Aktueller Stellenwert der minimalinvasiven Knieendoprothetik

Minimally invasive approaches are increasingly being used in total knee arthroplasty. By means of a review of the literature the pros and cons of minimally invasive approaches for total knee arthroplasty were analyzed. The potential advantages of reduced postoperative pain and improved early range of motion and mobility are opposed by the risks of malpositioning of the prosthetic components and impaired wound healing. Long-term improvement of knee function and quality of life should not be compromised by techniques promising temporary or secondary advantages.ZusammenfassungDie Implantation von Knietotalendoprothesen erfolgt zunehmend über minimalinvasive Zugänge. Anhand eines aktuellen Literaturüberblicks werden die Vor- und Nachteile minimalinvasiver Zugänge zur Implantation von Knietotalendoprothesen analysiert. Den potenziellen Vorteilen geringerer postoperativer Schmerzen, einer besseren Beweglichkeit und Mobilität in der frühen postoperativen Phase stehen die Risiken der Fehlpositionierung der Komponenten und der beeinträchtigten Wundheilung gegenüber. Langfristige Verbesserungen der Kniefunktion und der Lebensqualität sollten nicht durch Techniken gefährdet werden, die nur vorübergehende oder sekundäre Vorteile erbringen.AbstractMinimally invasive approaches are increasingly being used in total knee arthroplasty. By means of a review of the literature the pros and cons of minimally invasive approaches for total knee arthroplasty were analyzed. The potential advantages of reduced postoperative pain and improved early range of motion and mobility are opposed by the risks of malpositioning of the prosthetic components and impaired wound healing. Long-term improvement of knee function and quality of life should not be compromised by techniques promising temporary or secondary advantages.

Erkennung von Hüftschaftsinterungen am Röntgenbild@@@Accuracy of hip stem migration measurement on plain radiographs: Reliabilitätsuntersuchung knöcherner und prothetischer Landmarken@@@Reliability of bony and prosthetic landmarks

BACKGROUND In Germany, more than 150,000 total hip arthroplasties (THA) are performed annually. Early implant migration is supposed to be the best indicator for mechanical failure of femoral stems. Therefore, radiological evaluation of hip stems is routinely done by analyzing plain radiographs of THA. OBJECTIVES The purpose of this study was to evaluate the accuracy of implant migration measurement on plain radiographs. MATERIAL AND METHODS Two observers analyzed 44 anterior-posterior radiographs of the pelvis in 22 pain-free patients at least 2 years after implantation of an anatomical hip stem. The evaluation was performed on digital as well as conventional plain radiographs. Intraobserver reliability was analyzed by double measurements of each radiograph and the evaluation of the consecutive series of each patient. The anatomical structures of interest were the greater trochanter and the minor trochanter. Furthermore, the tip of the prosthesis, the shoulder of the implant, and the center of rotation were determined. RESULTS The conventional measurement technique proved higher accuracy compared to the digital measurement technique. The best anatomical structure was the greater trochanter in the conventional technique and the minor trochanter in the digital technique. The best reference structure with regard to the implant was the shoulder of the prosthesis for both techniques. CONCLUSION The recommended reference structures for the evaluation of implant migration on plain radiographs are the greater trochanter and the shoulder of the implant for the conventional measurement technique and the minor trochanter and the shoulder of the implant for the digital technique. Migration of an implant should not assumed before a determined difference of 2 mm.

Minimalinvasive Hüftendoprothetik – nur Trend oder schon Standard?@@@Minimally invasive total hip arthroplasty – trend or state of the art?: Eine Metaanalyse@@@A meta-analysis

ZusammenfassungMinimalinvasive Zugänge in der Hüftendoprothetik haben sich weltweit verbreitet und erfreuen sich zunehmender Popularität. Obwohl früh auf teilweise katastrophale Fehlschläge hingewiesen wurde, nimmt die Zahl der Publikationen zu diesem Thema ebenso wie die Anzahl der Operateure, die minimalinvasive Hüftendoprothetik anbieten, weiter zu. Anhand einer systematischen Literaturübersicht werden potenzielle Vorteile und Risiken der minimalinvasiven Hüftendoprothetik gegenüber gestellt. Während ein kürzerer Hautschnitt, ein geringeres Muskeltrauma, eine schnellere Rehabilitation und ein klinisch irrelevant geringerer Blutverlust für die Anwendung minimalinvasiver Techniken sprechen, liefern die potenzielle Beeinträchtigung der Wundkosmetik, periprothetische Frakturen, Implantatmalpositionierungen und die ausstehenden Langzeitergebnisse Argumente dagegen, die minimalinvasive Hüftendoprothetik als Standardtechnik einzusetzen.AbstractMinimally invasive approaches in total hip arthroplasty are being used worldwide and continue to grow in popularity. Despite early reports of catastrophic failures, both the number of scientific publications as well as the number of orthopaedic surgeons practicing minimally invasive techniques in total hip arthroplasty are steadily increasing. By means of a systematic review of the literature, the current article weighs the potential advantages and disadvantages of minimally invasive techniques. A shorter skin incision, potentially less muscle damage, a faster rehabilitation and a clinically irrelevant lower blood loss may support the use of minimally invasive techniques. However, the potential impairment of wound cosmetics, the increased risk of periprosthetic fractures, implant malpositioning and lack of long-term results contradict the use of minimally invasive total hip arthroplasty as a standard treatment.Minimally invasive approaches in total hip arthroplasty are being used worldwide and continue to grow in popularity. Despite early reports of catastrophic failures, both the number of scientific publications as well as the number of orthopaedic surgeons practicing minimally invasive techniques in total hip arthroplasty are steadily increasing. By means of a systematic review of the literature, the current article weighs the potential advantages and disadvantages of minimally invasive techniques. A shorter skin incision, potentially less muscle damage, a faster rehabilitation and a clinically irrelevant lower blood loss may support the use of minimally invasive techniques. However, the potential impairment of wound cosmetics, the increased risk of periprosthetic fractures, implant malpositioning and lack of long-term results contradict the use of minimally invasive total hip arthroplasty as a standard treatment.

[Current role of minimally invasive total knee arthroplasty. A meta-analysis].

Minimally invasive approaches are increasingly being used in total knee arthroplasty. By means of a review of the literature the pros and cons of minimally invasive approaches for total knee arthroplasty were analyzed. The potential advantages of reduced postoperative pain and improved early range of motion and mobility are opposed by the risks of malpositioning of the prosthetic components and impaired wound healing. Long-term improvement of knee function and quality of life should not be compromised by techniques promising temporary or secondary advantages.ZusammenfassungDie Implantation von Knietotalendoprothesen erfolgt zunehmend über minimalinvasive Zugänge. Anhand eines aktuellen Literaturüberblicks werden die Vor- und Nachteile minimalinvasiver Zugänge zur Implantation von Knietotalendoprothesen analysiert. Den potenziellen Vorteilen geringerer postoperativer Schmerzen, einer besseren Beweglichkeit und Mobilität in der frühen postoperativen Phase stehen die Risiken der Fehlpositionierung der Komponenten und der beeinträchtigten Wundheilung gegenüber. Langfristige Verbesserungen der Kniefunktion und der Lebensqualität sollten nicht durch Techniken gefährdet werden, die nur vorübergehende oder sekundäre Vorteile erbringen.AbstractMinimally invasive approaches are increasingly being used in total knee arthroplasty. By means of a review of the literature the pros and cons of minimally invasive approaches for total knee arthroplasty were analyzed. The potential advantages of reduced postoperative pain and improved early range of motion and mobility are opposed by the risks of malpositioning of the prosthetic components and impaired wound healing. Long-term improvement of knee function and quality of life should not be compromised by techniques promising temporary or secondary advantages.

Aktueller Stellenwert der minimalinvasiven Knieendoprothetik@@@Current role of minimally invasive total knee arthroplasty: Eine Metaanalyse@@@A meta-analysis

Minimally invasive approaches are increasingly being used in total knee arthroplasty. By means of a review of the literature the pros and cons of minimally invasive approaches for total knee arthroplasty were analyzed. The potential advantages of reduced postoperative pain and improved early range of motion and mobility are opposed by the risks of malpositioning of the prosthetic components and impaired wound healing. Long-term improvement of knee function and quality of life should not be compromised by techniques promising temporary or secondary advantages.ZusammenfassungDie Implantation von Knietotalendoprothesen erfolgt zunehmend über minimalinvasive Zugänge. Anhand eines aktuellen Literaturüberblicks werden die Vor- und Nachteile minimalinvasiver Zugänge zur Implantation von Knietotalendoprothesen analysiert. Den potenziellen Vorteilen geringerer postoperativer Schmerzen, einer besseren Beweglichkeit und Mobilität in der frühen postoperativen Phase stehen die Risiken der Fehlpositionierung der Komponenten und der beeinträchtigten Wundheilung gegenüber. Langfristige Verbesserungen der Kniefunktion und der Lebensqualität sollten nicht durch Techniken gefährdet werden, die nur vorübergehende oder sekundäre Vorteile erbringen.AbstractMinimally invasive approaches are increasingly being used in total knee arthroplasty. By means of a review of the literature the pros and cons of minimally invasive approaches for total knee arthroplasty were analyzed. The potential advantages of reduced postoperative pain and improved early range of motion and mobility are opposed by the risks of malpositioning of the prosthetic components and impaired wound healing. Long-term improvement of knee function and quality of life should not be compromised by techniques promising temporary or secondary advantages.