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Distal humeral replacement (DHR) is a limb-salvage option for the endoprosthetic reconstruction of bone defects following the resection of a primary bone sarcoma. As primary bone sarcomas are only occasionally located around the distal humerus, there is a paucity of information regarding postoperative function, and patients' resumption of sporting activities. With advances in diagnostics and in surgical and oncological treatment leading to an increased patient life expectancy and higher quality of life, patients' functional outcome and return to sports activities are of increasing interest. Between 1997 and 2021, a total of 24 patients underwent DHR with a single-design modular implant at a tertiary sarcoma center. A total of 14 patients who died of their disease were excluded, leaving a study cohort of 10 patients, with a median age of 30 years on the day of surgery (IQR 20–37). At the last follow-up, after a median of 230 months (IQR 165–262), the median MSTS was 19 (IQR 13–24), the median TESS was 79 (IQR 66–87), the median SEV was 38% (IQR 24–53), the median TS was 6 (IQR 4–7), and the median WAS was 3 (IQR 1–8). Among the variables of gender, surgery on the dominant extremity, intraoperative nerve resection, extra-articular tumor resection, chemotherapy, radiotherapy, and revision surgeries, none were associated with a better/lower functional outcome score or return to sports activities. However, a higher level of sports performance prior to diagnosis (WAS > 10) was associated with a higher level of sports performance postoperatively (p = 0.044)., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Background: Prior to revision hip (THA) or knee arthroplasty (TKA), periprosthetic low-grade infection (PJI) should be ruled out. Despite advances in preoperative diagnosis, unsuspected positive cultures (UPCs) may occur in initially planned aseptic revisions. Particularly, single UPCs pose a diagnostic and therapeutic dilemma, as their impact on outcome is unclear and recommendations are heterogeneous. This review investigates the frequency of single UPCs and their impact on implant survivorship. Methods: In July 2022, a comprehensive literature search was performed using PubMed and Cochrane Library search. In total, 197 articles were screened. Seven retrospective studies with a total of 5821 cases were able to be included in this review. Results: Based on the cases included, UPCs were found in 794/5821 cases (14%). In 530/794 cases (67%), the majority of the UPCs were single positive. The most commonly isolated pathogens were coagulase negative Staphylococci and Cutibacterium acnes. Five of seven studies reported no influence on revision- or infection-free survival following a single positive culture. In two studies, single UPCs following THA revision were correlated with subsequent re-revision for PJI. Conclusions: Single UPCs of a non-virulent pathogen following presumed aseptic TKA revision may be interpreted as contaminants. A single UPC following THA revision may be a risk factor for subsequent PJI. The role of systemic antibiotic treatment remains unclear, but it should be considered if other risk factors for PJI are present., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Aims: This study aims to enhance understanding of clinical and radiological consequences and involved mechanisms that led to corrosion of the Precice Stryde (Stryde) intramedullary lengthening nail in the post market surveillance era of the device. Between 2018 and 2021 more than 2,000 Stryde nails have been implanted worldwide. However, the outcome of treatment with the Stryde system is insufficiently reported. Methods: This is a retrospective single-centre study analyzing outcome of 57 consecutive lengthening procedures performed with the Stryde nail at the authors’ institution from February 2019 until November 2020. Macro- and microscopic metallographic analysis of four retrieved nails was conducted. To investigate observed corrosion at telescoping junction, scanning electron microscopy (SEM) and energy dispersive x-ray spectroscopy (EDX) were performed. Results: Adjacent to the nail’s telescoping junction, osteolytic changes were observed in bi-planar radiographs of 20/57 segments (35%) after a mean of 9.5 months (95% confidence interval 7.2 to 11.9) after surgery. A total of 8/20 patients with osseous alterations (40%) reported rest and ambulation pain of the lengthened segment during consolidation. So far, 24 Stryde nails were retrieved and in 20 (83%) macroscopic corrosion was observed at the nail’s telescoping junction. Before implant removal 11/20 radiographs (55%) of lengthened segments with these 20 nails revealed osteolysis. Implant retrieval analysis by means of SEM showed pitting and crevice corrosion. EDX detected chromium as the main metallic element of corrosion. Conclusion: Patients are exposed to the risk of implant-related osteolysis of unclear short- and long-term clinical consequences. The authors advocate in favour of an early implant removal after osseous consolidation., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Background: In the treatment of tall stature, the reduction of excessive predicted final height can either be achieved by hormonal treatment or surgically by temporary (tED) or permanent (pED) epiphysiodesis. The present study evaluates the preliminary results of two novel devices for tED and pED around the knee to reduce the predicted final height. Materials and methods: A retrospective analysis was performed to evaluate the clinical and radiographic outcome after bilateral epiphysiodesis for the treatment of tall stature. A cohort of 34 patients (16 girls, 18 boys) who underwent either tED or pED between 2015 and 2020 were eligible for analysis based on the electronic patient records and picture archiving and communication system of our orthopaedic teaching hospital. tED was conducted in 11 patients (32%) through bilateral implantation of four RigidTacks™ (Merete, Berlin, Germany) around the knee. Twenty-three patients (68%) received pED, performed with an EpiStop™ trephine (Eberle, Wurmberg, Germany). The mean overall follow-up time was 2.9 years. Results: The mean age at surgery was 12.3 years in girls and 13.2 years in boys. Patients had a mean body height of 175.2 cm in girls and 184.7 cm in boys at surgery. The mean predicted final height was 191.4 cm in girls and 210.4 cm in boys. At the last follow-up, 26 patients (76.5%) had achieved skeletal maturity. The mean height of skeletally mature patients was 187.2 cm in girls and 198.5 cm in boys. A mean reduction of the predicted final height of 5.9 cm in girls and 8.7 cm in boys was achieved, corresponding to a reduction in remaining growth of 46% in girls and 38% in boys. Secondary frontal plane deformities of the knee were detected in 5/11 patients (45.5%) in the tED group and 1/23 treatments (4.3%) in the pED group. Conclusions: tED and pED have both proven to be efficient at achieving growth inhibition to reduce excessive predicted height. However, tED has been associated with an increased risk of secondary angular deformities of the knee. Furthermore, the risk of implant-related complications and the necessity of a subsequent surgical intervention for implant removal have led our study group to abandon tED when treating tall stature. Long-term results of both procedures are pending. Level of evidence: 4.

Fragestellung: Achondroplasier weisen häufig Achsfehlstellungen der Beine auf. Die alleinige Korrekturosteotomie gilt als Goldstandard bei Patient ohne Wunsch zur Extremitätenverlängerung. Um einen vergleichsweise großen Eingriff zu verhindern kann im Wachstumsalter das Verfahren [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Objectives: Reduction of excessive predicted final height may be achieved by hormonal treatment, or surgically by manipulating the growth plate around the knee through total epiphysiodesis (ED). Lately, hormonal therapy has been linked to adverse effects such as an overall increased cancer risk and [for full text, please go to the a.m. URL]

Fragestellung: Der Riesenzelltumor des Knochens (GCTB) ist ein gutartiger Tumor, der sich durch lokal-aggressives Wachstum, ein mögliches Rezidiv nach chirurgischer Behandlung und, wenn auch selten, durch Lungenmetastasen auszeichnet. Ein in der distalen Ulna lokalisierter GCTB ist selten. Die [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Der M. Perthes stellt die häufigste avaskuläre Osteochondronekrose im Kindesalter dar. Zur Verhinderung eines koxalen Containment-Verlustes und einer Verbesserung der Hüftbeweglichkeit kann bei ungünstigen Verläufen (Lateralisationstendenz, Herring Typ C, „head [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Die Diagnose der periprothetischen Infektion (PPI)basiert auf verschiedenen Serum-und Synoviamarkern, wobei in den gängigen Kriterien insbesondere Leukozytenzahl und Leukozytendifferenzierung sowie leukozytenabhängige Marker eine herausgestellte Rolle spielen. Vor dem Hintergrund, [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Alternativ zu externen Fixateuren können zur Distrakionsosteogenese (DO) intramedulläre Verlängerungsmarknägel (IMVN) angewendet werden Auch bei Patienten mit Achondroplasie kann das Verfahren zur Vergrößerung der Gesamtkörperlänge angewandt werden. [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Intramedulläre Verlängerungsmarknägel (IMVN) stellen eine etablierte Alternative zur Behandlung mit externen Fixateuren zur Kallusdistraktion dar. Bestehende Studien, welche die Behandlung mit einem IMVN ausgewertet haben, sind sehr heterogen in Bezug auf die angewandten [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Im Gegensatz zur Distraktionsosteogenese (DO) mit externen Fixateuren stellen intramedulläre Verlängerungsmarknägel (IMVN) eine komfortablere und sichere Alternative dar. Da bei einer antegraden femoralen (AF) Implantation von IMVN frontale und sagittale Deformitäten [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Der Riesenzelltumor des Knochens (RZT) stellt einen lokal aggressiven Tumor dar, der 4-5% aller primären Knochentumoren ausmacht. Er ist charakterisiert durch aggressives Wachstum, häufige Lokalrezidive nach chirurgischer Therapie und, in seltenen Fällen, Metastasen. [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Das Risiko einer periprothetischen Gelenkinfektion (PJI) steigt mit zunehmender Implantatoberfläche. Die Infektionsrate für Tumorprothesen beträgt etwa 20% und nach Revisionseingriffen bis zu 40% [ref:1]. Infektionen treten meist innerhalb der ersten [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Maligne Knochentumoren sind in langen Röhrenknochen überwiegend metaphysär lokalisiert. Seltener betroffen ist der diaphysäre Knochen. Nach Resektion können diese interkalaren Defekte endoprothetich rekonstruiert werden. Diese Arbeit untersucht das Implantatüberleben, [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Objectives: The occurrence of malignant bone tumors of the femur is extremely rare in children under the age of 8, but demands a challenging surgical treatment. In general, limb salvage approaches are preferable over ablative procedures. However, (extendable) tumor endoprostheses can often not be applied [for full text, please go to the a.m. URL]

Fragestellung: Die fibulare Hemimelie (FH) ist eine seltene Erkrankung, die mit einer Verkürzung sowohl des Unterschenkels als auch oftmals des Femurs einhergeht. Abhängig vom Schweregrad der Erkrankung kann das Ausmaß der Beinlängendifferenz (BLD) stark variieren. Bei einer BLD [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Die Resektion von muskuloskelettalen Tumoren und Rekonstruktion mit Tumorendoprothesen führt häufig zu einem relevanten Blutverlust, der eine hämodynamische Stabilisierung und (massive) Transfusion von Blutprodukten erfordert. Wir stellten die Hypothese auf, dass die kombinierte [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Objectives: Leg length discrepancies (LLD) are frequently associated with coronal angular deformities, in particular valgus deformity of the knee joint. Temporary hemiepiphysiodesis (HED) of the distal femur or proximal tibia represents a well-established procedure for valgus or varus deformity correction [for full text, please go to the a.m. URL]

Fragestellung: Aus medizinischen und organisatorischen Gründen kommt es in der täglichen Praxis vor, dass bei einem zweizeitigen Prothesenwechsel bei Protheseninfektionen die Spacer länger als ursprünglich geplant einliegen. Die Patienten sind in ihrer Mobilität stark eingeschränkt [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Der Nachweis einer Infektpersistenz (IP) vor Prothesenreimplantation bei Patienten mit zweizeitigem Hüft- oder Knieprothesenwechsel bei chronischer periprothetischer Infektion (PPI) ist eine Herausforderung in der Revisionsendoprothetik. Klinische Befunde sowie verschiedene serologische [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Ein positiver Effekt durch das Aufwärmen ist häufig aus dem Bereich des Sports, aber auch z.B. beim Spielen eines Musikinstruments bekannt. Bei arthroskopischen Operationen ist ein solches Auswärmen nur bedingt vorstellbar. Da ein Zusammenhang zwischen Videospiel-Kompetenz [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Der proximale Humerus ist die dritthäufigste Lokalisation primär maligner Knochentumore. Radiologische, onkologische und chirurgische Fortschritte haben in den vergangenen Jahrzehnten zu einem stetig verbesserten Langzeitüberleben und einer steigenden Lebensqualität [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Chronische periprothetische Infektionen werden häufig mit einem zweizeitigen Wechsel unter Verwendung eines Knochenzementspacers behandelt. Trotz des mehrzeitigen Vorgehens werden Reinfektionsraten von teils über 20% abhängig von patientenseitigen, prothesenabhängigen [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Der konservative und operative Containmenterhalt in der Frühphase des M. Perthes folgt einem bereits seit vielen Jahren etablierten Schema. Zwar können dadurch bis zu 80% der kurz- und mittelfristigen Schäden therapiert werden [ref:1], bei ausgeprägter [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Die temporäre Hemiepiphysiodese (HED) ist ein anerkanntes Verfahren zur Wachstumslenkung bei Kindern mit Genu valgum und varum. Historisch wurde diese mittels Blount-Klammern (BK) gemacht. Heutzutage werden mehrheitlich 8-plates (8P) verwendet. Beide Implantate bieten Vorteile, zeigen [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Infektkontrolle und Extremitätenerhalt sind eine große Herausforderung bei infizierter Knieendoprothese und begleitendem Weichteildefekt, insbesondere bei wiederkehrenden Revisionen. Der Gastrocnemiusschwenklappen zusätzlich zum Prothesenwechsel stellt eine mögliche [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Radiation therapy (RT) for extremity soft tissue sarcoma is associated with lymphedema risk. In this study, we analyzed the influence of lymph-sparing volume on the lymphedema occurrence in patients who received adjuvant extremity RT. The lymph-sparing quotient (LSQ) was calculated by dividing the lymph-sparing volume by the total extremity volume with double weightingfor the narrowest lymph-sparing region. A total of 34 patients were enrolled in this analysis. The median applied total radiation dose was 66.3 Gy in 36 fractions. Acute lymphedema appeared in 12 patients (35%). Most of them (n = 8) were lymphedema grade 1 and five patients had grade 2 to 3 lymphedema. Chronic lymphedema appeared in 22 patients (65%). 17 of these patients had at least a grade 2 lymphedema. In 13 of 14 patients with an LSQ ≤ 0.2 and 11 of 20 patients with an LSQ &gt, 0.2, an acute or chronic lymphedema ≥ grade 2 was observed. A Kaplan–Meier Analysis of the two groups with the endpoint of a two-year lymph edema-free survival (=2-YLEFS) was estimated with an univariate, significant result (2-YLEFS LSQ ≤ 0.2 vs. LSQ &gt, 0.2: 0% vs. 39%, p = 0.006, hazard ratio LSQ ≤ 0.2 vs. &gt, 0.2 2-YLEFS 2.822 (p = 0.013), 95% confidence interval (CI): 1.24–6.42). Maximizing the potential oncologically-justifiable lymph-sparing volume should be considered to reduce the risk of high-grade lymphedema when applying RT to extremities.

Aims This study aims to enhance understanding of clinical and radiological consequences and involved mechanisms that led to corrosion of the Precice Stryde (Stryde) intramedullary lengthening nail in the post market surveillance era of the device. Between 2018 and 2021 more than 2,000 Stryde nails have been implanted worldwide. However, the outcome of treatment with the Stryde system is insufficiently reported. Methods This is a retrospective single-centre study analyzing outcome of 57 consecutive lengthening procedures performed with the Stryde nail at the authors’ institution from February 2019 until November 2020. Macro- and microscopic metallographic analysis of four retrieved nails was conducted. To investigate observed corrosion at telescoping junction, scanning electron microscopy (SEM) and energy dispersive x-ray spectroscopy (EDX) were performed. Results Adjacent to the nail’s telescoping junction, osteolytic changes were observed in bi-planar radiographs of 20/57 segments (35%) after a mean of 9.5 months (95% confidence interval 7.2 to 11.9) after surgery. A total of 8/20 patients with osseous alterations (40%) reported rest and ambulation pain of the lengthened segment during consolidation. So far, 24 Stryde nails were retrieved and in 20 (83%) macroscopic corrosion was observed at the nail’s telescoping junction. Before implant removal 11/20 radiographs (55%) of lengthened segments with these 20 nails revealed osteolysis. Implant retrieval analysis by means of SEM showed pitting and crevice corrosion. EDX detected chromium as the main metallic element of corrosion. Conclusion Patients are exposed to the risk of implant-related osteolysis of unclear short- and long-term clinical consequences. The authors advocate in favour of an early implant removal after osseous consolidation. Cite this article: Bone Joint Res 2021;10(7):425–436.

The need for concomitant proximal fibular epiphysiodesis (PFE) when correcting leg length discrepancy (LLD) with temporary proximal tibial epiphysiodesis (PTE) in children is controversially discussed. This single center, retrospective cohort study analyzes proximal fibular growth in patients treated by PTE with and without concomitant PFE. Radiographic measurements were conducted before implantation and at implant removal. The position of the fibular head in relation to the tibia was assessed with recently established radiographic reference values. All patients (n = 58, 19 females) received PTE to treat LLD at a mean age of 12.2 years (range 7 to 15). In 27/58 (47%) concomitant PFE was performed. Mean follow-up was 36.2 months (range 14.2 to 78.0). The position of the proximal fibula at implant removal was within physiological range in 21/26 patients (81%) with PFE and in 21/30 patients (70%) without PFE. Proximal fibular overgrowth newly developed in 2/26 patients (8%) treated with PFE and in 5/30 patients (17%) treated without PFE (p = 0.431). Peroneal nerve injury or discomfort due to proximal fibular overlength was not reported. The position of the proximal fibula should be critically assessed preoperatively under consideration of reference values before PTE. In consequence of this study, the authors do not routinely perform PFE concomitantly with PTE for correction of moderate LLD in children if the proximal fibula is localized within physiological radiographic margins determined by the established reference values., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Background: Patient-reported outcome measures are gaining increasing importance in clinical research and quality control. Clinical impairment through limb deformities can appear in various forms. This study aimed at translating and culturally adaptating the Limb Deformity-Scoliosis Research Society (LD-SRS) patient-reported outcome measure (PROM) into German by following the scientific rigor of the cross-cultural adaptation process as well as ensuring the reliability of the translated version. The LD-SRS is applicable in children and adults. Methods: The translation was performed in accordance with the creators of the LD-SRS following the Professional Society for Health Economics and Outcomes Research (ISPOR) guidelines for translation and cultural adaptation. Two forward translations were performed, and after a consensus meeting, a professional translator translated the PROM back to English. The creators reviewed the back translation of the preliminary German version. Thirty patients with upper and lower limb deformities participated in cognitive debriefing interviews. The version was proofread and, finally, the test-retest reliability was estimated. Results: The mean age was 19 years (range 6–61). Twenty-six patients (87%) completed the retest after 6 days (range 3–26). The internal consistency was estimated with a Cronbach’s alpha of 0.96 (range 0.94–0.97), and the intraclass correlation was 0.92 (range 0.89–0.94), indicating an excellent reliability. The scores were normally distributed. Thereafter, the German version was proofread and finalized. Conclusions: The German translation and cross-cultural adaptation of the LD-SRS score resulted in a high reliability and internal consistency. The German LD-SRS score is readily usable and may be applied in future studies of German-speaking limb deformity patients., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Background and purpose — Temporary hemiepiphysiodesis for growth modulation in skeletally immature patients is a long-known technique. Recently the use of tension-band devices has become popular. This study compares 2 tensionband implants (eight-Plate and FlexTack) regarding their effects on the growth plate. Animals and methods — 12 pigs in 2 equally sized groups (A and B) were investigated. The right proximal medial tibia was treated with either eight-Plate or FlexTack. The left tibia of the same pig was treated with the opposite implant. After 9 weeks all implants were removed. Animals in group B were then hosted for another 5 weeks. Histomorphometric analysis of the growth plate was carried out after 9 and 14 weeks, respectively. Radiographs were taken at implantation, removal, and after 14 weeks. Results — Both tension-band devices achieved a statis- tically significant and clinically relevant growth inhibition, whereas the effect appeared to be more distinct after the use of FlexTack. Implant-related complications or physeal damage was not observed. After implant removal, rebound phenomenon was radiologically observed in all cases. The growth plates treated with eight-Plate showed a paradox reversal of the zonal distributions, with an increase of the proliferative zones at the previously arrested medial aspect of the physis and a decrease laterally. Interpretation — Both eight-Plate and FlexTack proved to be appropriate devices for growth-guiding treatment. The radiographic evaluation showed a change in angular axes after treatment with each implant, while the correction appeared to be faster with FlexTack. The paradox cartilaginous reaction observed after removal of the eight-Plate might be a histopathological correlate for rebound phenomenon., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

The accurate preoperative diagnosis of periprosthetic joint infection (PJI) of total knee arthroplasty (TKA) can be difficult despite the use of a combination of serum and synovial markers. In such inconclusive cases, incisional open biopsy might be considered. This study investigates the usefulness of biopsies in patients with inconclusive diagnostic findings. We retrospectively identified 63 patients who underwent incisional biopsy for chronic PJI in the operation theatre following TKA revision between 2010 and 2018 after inconclusive preoperative diagnostics for PJI. In all cases, 5 independent biopsies were taken. Results from open biopsy for PJI were analyzed for diagnostic accuracy using the intraoperative results from following revision surgery as gold standard. 27 patients (43%) had a positive culture taken during biopsy. 15 cases (24%) met the diagnostic criteria for a chronic PJI. Most common organisms were Coagulase-negative staphylococci (67%) and 'Cutibacterium acnes' (30%). Compared to the findings during revision surgery, biopsies showed a sensitivity of 47% and a specificity of 77% for PJI. Open incisional biopsy following inconclusive serum- and synovial diagnostics for low grade PJI may be considered for identification of microorganisms. Due to its low sensitivity and moderate specificity found in the present cohort, microbiological analysis should be combined with additional diagnostic markers and histological investigation., Finanziert über die DEAL-Vereinbarung mit Wiley 2019-2022.

Wide tumor resection is the local treatment of choice for patients with primary malignant bone tumors and a prerequisite for long-term survival. We present two patients that underwent total bone resection in the upper limb because of primary malignant bone tumors. The defects were then reconstructed by a 3D printed prosthesis, a procedure that, to our knowledge, has not been reported for bone defects of the upper extremity so far. Complete resection of the affected bone was required in a five-year-old girl with a high-grade osteoblastic osteosarcoma of the humerus and a 53-year-old man with a dedifferentiated leiomyosarcoma of the radius, due to the tumor’s extent. Following neoadjuvant chemotherapy, resection of the entire affected humerus including the axillary nerve took place in the first case and the entire affected radius including parts of the radial nerve in the second case. Approximately three years after surgery, both patients are alive and pain-free. Despite a postoperative drop hand that affected the now 56-year-old man, he is able to carry out everyday activities such as brushing his teeth, writing, and eating. The now eight-year-old girl is also able to engage in normal activities with her left arm such as eating and carrying lightweight objects. Both patients are tumor-free to date., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Tobias Kalisch,1 Frank Horst,2 Georg Gosheger,1 Christoph Theil,1 Leonie Seeber,1 Burkhard Moellenbeck1 1Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, 48149, Germany; 2Department of Orthopedics and Traumatology, St. Josef-Stift Sendenhorst, Sendenhorst, 48324, GermanyCorrespondence: Tobias KalischDepartment of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, Muenster, 48149, NRW, GermanyTel +49 251 8347984Email tobias.kalisch@ukmuenster.deBackground: Osteoarthritis (OA) is a frequent cause of pain and disability, affecting half of the world’s population aged 65 years or older. Due to experienced pain and limitations, OA patients generally spend most of their waking hours sedentary and fail to adhere to physical activity (PA) recommendations. As a result of living together with OA patients, their partners might adopt a sedentary lifestyle. This study investigates the change in habitual PA and sedentary behavior (SB) in patients and their partners one year after the patients’ total joint replacement (arthroplasty) and inpatient rehabilitation.Methods: This is a follow-up of a prospective cohort study including 24 older couples (69.3± 7.8 years, gender ratio 11:13) consisting of OA patients (17 hip OA, 7 knee OA) and their partners. The participants’ habitual PA and SB were assessed by means of synchronous accelerometry (16h per day, 4– 7 days) and additional self-report.Results: Although the partners (∼ 6300 steps per day) were significantly more active than the patients (∼ 4800 steps per day) before arthroplasty, their lifestyle was still classified “low active”. Irrespective of the method used, the PA and SB parameters of patients and partners were significantly correlated before arthroplasty (accelerometry: r≥ 0.333, p≤ 0.001; self-report: r≥ 0.569, p≤ 0.004). Following the patients’ arthroplasty, no improvement in PA or SB was observed either in the patients or their partners. A detailed evaluation of accelerometric data on hourly basis revealed no change in behavior for both groups. Furthermore, their everyday activities remained correlated (accelerometry: r≥ 0.418, p≤ 0.001; questionnaire: r≥ 0.554, p≤ 0.005).Conclusion: One year post-arthroplasty and inpatient rehabilitation neither the OA patients nor their partners had changed their PA or SB. Their everyday physical activity was still strongly intertwined. Further research is needed to determine why behavior change does not occur even though the prerequisites are in place.Keywords: osteoarthritis, dyads, physical activity, sedentary behavior, arthroplasty

Background and purpose — To date there is a lack of studies defining the anatomical position of the proximal fibula. This is especially relevant when planning surgical interventions affecting the knee joint such as permanent or temporary epiphysiodesis to correct leg length discrepancies or angular deformities in growing patients. The goal of this study is to establish a standardized measurement technique and radiological reference values for the position of the proximal fibula in children. Patients and methods — 500 measurements were performed in calibrated long standing anteroposterior radiographs of 256 skeletally immature patients (8–16 years; 233 female, 267 male legs). As a radiographic reference in the frontal plane, the distance between the center of the proximal tibial growth plate and a line tangential to the tip of the fibular head and horizontal to the imaging plane was measured (dPTFH). Results — The average value of dPTFH in the studied population (median age 12 years) was –2.7 mm (SD 3, CI –3.0 to –2.5) and normally distributed (p = 0.1). There were no clinically significant sex or age-dependent differences. The inter-rater reliability analysis showed excellent ICC values (ICC = 0.88; CI 0.77–0.93). Interpretation — This study provides a new radiographic reference value to assess the position of the proximal fibula in relation to the proximal tibia in children and adolescents. This reference can aid preoperative decision-making as to whether additional fibular epiphysiodesis is necessary when performing tibial epiphysiodesis to correct moderate leglength discrepancies., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Background: Objective sensor-based quantification of sedentary behavior is an important tool for planning and evaluating interventions for excessive sedentary behavior in patients with musculoskeletal diseases. Although waist-worn accelerometers are the standard for physical activity (PA) assessment, only thigh-worn inclinometers can clearly distinguish sedentary behavior from any light PA or standing activity. Methods: In this study, 53 adults (ages 20–85 years) wore two ActiGraph wGT3X-BT monitors, each containing an inclinometer and accelerometer (set for acquisition of slow movements in all three planes), attached to the right waist and thigh for a period of about 4 days. Both monitors recorded total sedentary time and continuous sedentary 10-min bouts by synchronous accelerometry and inclinometry. Differences and correlations between methods and wearing positions were evaluated against participant age, body mass index (BMI), and number of steps taken. Thigh-worn inclinometry was used as reference. Results: Data from thigh-worn inclinometry and waist-worn accelerometry were highly correlated for total sedentary time [rho = 0.888; intraclass correlation coefficient (ICC) = 0.937] and time in sedentary bouts (rho = 0.818; ICC = 0.848). Nevertheless, accelerometry at the waist underestimated sedentary time by ≈17% (p, Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Megaprosthetic reconstruction of segmental bone defects following sarcoma resection is a frequently chosen surgical approach in orthopedic oncology. While the use of megaprostheses has gained popularity over the last decades and such implants are increasingly used for metastatic reconstructions and in non-tumor cases, there still is a high risk of long-term complications leading to revision surgery. This article investigates current implant survivorship, frequency and types of complications as well as functional outcomes of upper and lower limb megaprosthetic reconstructions., Simple Summary: Malignant bone and soft tissue tumors are usually surgically removed with an envelope of healthy tissue as a barrier. If located in the long bones of the upper and lower extremity, this approach leads to a large bone defect commonly affecting a joint. One way to rebuild the bone defect and the neighboring joint is the use of a megaprosthesis that is anchored in the remaining bone comparable to a conventional joint replacement. In general this approach is popular as it provides early stability and allows the affected patient to begin rehabilitation early on. However, complications leading to long-term unplanned reoperation are common. This article provides an overview of current implant survival, types of complication and long-term outcomes of megaprostheses used following tumor resection., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Wir präsentieren den Fall einer 22-jährigen Patientin mit einem histopathologisch gesicherten Chondroblastom des rechten Humeruskopfes. Um bei der jungen und funktionell anspruchsvollen Patientin eine möglichst schonende und anatomische Rekonstruktion der humeralen Gelenkfläche zu erzielen, ohne dabei auf einen totalendoprothetischen Gelenkersatz zurückzugreifen, implantierten wir nach intraläsionaler Kürettage des Chondroblastoms eine HemiCAP®. Die sehr guten funktionellen Kurzzeitergebnisse zeigen, dass dieser Therapieansatz eine sehr gute Behandlungsoption darstellen kann. Video online Die Online-Version dieses Beitrags (10.1007/s00132-020-03958-w) enthält ein Video.

Reactive arthritis following infection with chlamydia is a rare but important differential diagnosis in atraumatic joint swelling. A delayed diagnosis often leads to prolonged periods of absence from physical activity. This can have serious consequences, especially for the career of competitive athletes.Recommendation for the clinical management of postinfectious reactive arthritis for rapid diagnosis and targeted treatment in the symptomatic clinical course.Review of the literature on the topics "chlamydia", "reactive arthritis", "postinfectious arthritis" and "sexually acquired reactive arthritis", including presentation of two clinical cases of postinfectious reactive arthritis after chlamydia infection from competitive sports.Reactive arthritis following chlamydia infection in competitive athletes is a rare entity. However, it can be accompanied by far-reaching individual consequences, especially with regard to possible downtime in sports. Long-term consequences such as chronic joint damage in maintained synovitis must also be considered. In order to make a diagnosis, a specific anamnesis and the direct detection of the pathogen in the specimen of synovial fluid by polymerase chain reaction is essential. This allows a reliable diagnosis to be made with immediate initiation of therapy. However, a prolonged course of the disease cannot be excluded even if therapy is started in due time.HINTERGRUND: Die reaktive Arthritis infolge einer Chlamydieninfektion ist eine seltene, aber wichtige Differenzialdiagnose der atraumatischen Gelenkschwellung. Eine verzögerte Diagnosestellung führt nicht selten zu langen Ausfallzeiten der sportlichen Aktivität, die gerade beim Leistungssportler weitreichende Konsequenzen haben kann.Darstellung des klinischen Managements der postinfektiösen reaktiven Arthritis zur schnellen Diagnosestellung und zielgerichteten Behandlung bei symptomatischem Krankheitsverlauf.Literaturrecherche zu den Themen „Chlamydien“, „reaktive Arthritis“, „postinfektiöse Arthritis“ und „sexually acquired reactive arthritis“ einschließlich Darstellung von zwei klinischen Fällen der postinfektiösen reaktiven Arthritis nach Chlamydieninfektion aus dem Leistungssport.Die reaktive Arthritis nach Chlamydieninfektion bei Leistungssportlern ist eine seltene Entität. Sie kann jedoch durchaus mit weitreichenden individuellen Folgen, insbesondere hinsichtlich möglicher Ausfallzeiten, im Sport einhergehen. Auch langfristige Folgen, wie chronische Gelenkschäden bei unterhaltener Synovialitis, müssen bedacht werden. Zur Diagnosestellung ist eine gezielte Anamneseerhebung und der direkte Erregernachweis im Gelenkpunktat durch die Polymerasekettenreaktion essenziell. Dies erlaubt eine sichere Diagnosestellung mit verzögerungsfreier Therapieeinleitung. Jedoch sind auch bei frühzeitigem Therapiebeginn protrahierte Krankheitsverläufe nicht ausgeschlossen.

The tenosynovial giant cell tumor is a rare disease of the joint mucosa, tendon sheaths and bursa. We report on the rare constellation of an intraosseous manifestation of the proximal tibia of a lower leg stump after Burgess amputation as a result of a locally uncontrollable tenosynovial giant cell tumor of the upper ankle. The curettage of the local findings and operative stabilization through an intramedullary composite osteosynthesis led to an early rehabilitation of the exoprosthesis care with regaining patient autonomy.Der tenosynoviale Riesenzelltumor (TSGCT) ist eine seltene gutartige Erkrankung von Gelenkschleimhäuten, Sehnenscheiden und Schleimbeuteln. Wir berichten über die ungewöhnliche Konstellation einer intraossären Manifestation der proximalen Tibia eines Unterschenkelstumpfes nach Burgess-Amputation infolge eines lokal nicht beherrschbaren tenosynovialen Riesenzelltumors des oberen Sprunggelenkes. Die Kürettage des Lokalbefundes und die operative Stabilisierung durch eine intramedulläre Verbundosteosynthese führten zu einer frühzeitigen Rehabilitation der Exoprothesenversorgung mit Wiedererlangung der Patientenautonomie.

Background and purpose — Facemasks play a role in preventing the respiratory spread of SARS-CoV-2, but their impact on the physician–patient relationship in the orthopedic outpatient clinic is unclear. We investigated whether the type of surgeons’ facemask impacts patients’ perception of the physician–patient relationship, influences their understanding of what the surgeon said, or affects their perceived empathy. Patients and methods — All patients with an appointment in the orthopedic outpatient clinic of a tertiary university hospital during the 2-week study period were included. During consultations, all surgeons wore a non-transparent (first study week) or transparent facemask (second study week). Results of 285 of 407 eligible patients were available for analysis. The doctor–patient relationship was evaluated using the standardized Patient Reactions Assessment (PRA) and a 10-point Likert-scale questionnaire ranging from 0 (strongly disagree) to 10 (strongly agree). Results — A non-transparent facemask led to more restrictions in the physician–patient communication and a worse understanding of what the surgeon said. Patients’ understanding improved with a transparent facemask with greatest improvements reported by patients aged 65 years and older (non-transparent: 6 [IQR 5–10] vs. transparent: 10 [IQR 9–10], p < 0.001) and by patients with a self-reported hearing impairment (non-transparent: 7 [IQR 3–7] vs. transparent: 9 [IQR 9–10], p < 0.001). The median PRA score was higher when surgeons wore a transparent facemask (p= 0.003). Interpretation — Surgeons’ non-transparent facemasks pose a new communication barrier that can negatively affect the physician–patient relationship. While emotional factors like affectivity and empathy seem to be less affected overall, the physician–patient communication and patients’ understanding of what the surgeon said seem to be negatively affected., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Fragestellung: Chondroblastome sind seltene gutartige knorpelzellhaltige Knochentumoren und stellen 1-2% aller gutartigen primären Knochentumore dar. Sie sind durch lokal aggressives Wachstum, die Neigung zu Lokalrezidiven und in selten Fällen durch Metastasierung gekennzeichnet. Die [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Die bei Videospielen benötigten psychomotorischen und visuell-räumlichen Fähigkeiten können Schnittpunkte zu arthroskopischen Basisfähigkeiten sein und damit Möglichkeiten zum Erlernen und Trainieren arthroskopischer Operationen darstellen. Hypothese 1: [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Die Rekonstruktion des proximalen Humerus mittels modularer Tumorendoprothese ist eine Behandlungsoption nach Resektion bösartiger Knochentumoren. Ein radiologisches Phänomen nach dieser Versorgung ist das Auftreten von periimplantärem "Stress-Shielding" (SS) [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Die aneurysmatische Knochenzyste (AKZ) ist ein benigner, lokal aggressiver Knochentumordes Kindes- und Jugendalters. Sie betrifft in der Regel die Metaphyse der langen Röhrenknochen, kann aber auch an der Wirbelsäule oder am Becken auftreten. Verschiedene Therapieoptionen werden [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Objectives: Neglected hip dislocation (NHD) can either be of congenital origin or occur secondary due to septic arthritis (SA) or trauma. If the dislocation has been present for years, closed or open reduction is generally not feasible, mainly because of soft tissue contractures. Leg length discrepancy [for full text, please go to the a.m. URL]

Fragestellung: Mund-Nasen-Schutz-Masken spielen eine essentielle Rolle in der Eindämmung der respiratorischen Ausbreitung von SARS-CoV-2, ihr Einfluss auf die Arzt-Patienten-Kommunikation ist jedoch bislang unklar. Ziel dieser Studie war es, den Einfluss einer klassischen, nicht-transparenten Mund-Nasen-Schutz-Maske [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Nach Sarkomresektion und tumorprothetischer Rekonstruktion kommt es regelmäßig zu Erst-, aber auch Folgekomplikationen, insbesondere Infektionen. Unser Ziel war es, die Rolle der Operationsdauer als möglichen Risikofaktor für ein Prothesenversagen zu untersuchen. [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Intramedulläre Verlängerungsmarknägel (IMVN) sind eine etablierte Alternative zu externen Fixateuren bei der Behandlung von Längendifferenzen und Deformitäten der Beine. Die Kallusdistraktion mit den bisher verfügbaren IMVN erfordert während der Verlängerung [zum vollständigen Text gelangen Sie über die oben angegebene URL]