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Background: Soft tissue sarcomas (STS) are a rare and heterogeneous group of malignant tumors that arise from the mesenchymal tissue. STS can form anywhere in the human body, with the extremities being preferred sites of predilection., Treatment: A fundamental pillar of treatment is the surgical resection of soft tissue sarcomas. The goal is always an R0 resection with a safety margin. There is no consensus in the literature about the desired tumor-free resection margin. The decisive factors for these resection margins are histopathology, presence of anatomical barriers (capsule, tendon, fascia, cartilage, periosteum) and possibilities of (neo-) adjuvant therapy., Discussion: References in the literature support the role of resection margins as a predictor of local recurrence. Regarding the role of resection margins in overall survival, available data is divergent. There are known prognostic factors that influence overall survival, such as histological subtype, tumor size, tumor grading, and presence of metastases. So far, several studies have attempted to quantify the margins of resection, but no consensus has been reached, and debates are ongoing. When analyzing all the results of the data in the literature, it seems appropriate to aim for a negative resection margin >1 mm including an anatomical border structure, if possible.

Background: Bone metastases are the most common malignant bone tumours and most commonly occur in the spine, pelvis, proximal femur and proximal humerus. Prostate and breast cancer most often metastasize to the bone., Diagnostics: In patients with a history of tumours and local unspecific pain in the back and extremities, further diagnostic examinations should be performed. For the initial diagnosis a conventional radiograph of the whole bone in two planes is sufficient. For further diagnostics, the imaging may be supplemented with CT, MRI, scintigraphy and a PET-CT (PET-MRI) if the findings are not inconspicuous on the x‑ray. An indication for biopsy exists if the tumor cannot be classified, especially in solitary findings with or without previous tumor anamnesis., Therapy: Surgical indications for bone metastases are a pathological fracture, an impending fracture, a solitary late metastasis, radiation-resistant osteolysis and therapy-resistant pain. In solitary metastases, the prognosis for patients can be significantly improved by a wide (R0 resection) depending on the primary tumour. For multiple metastases the restoration of mobility and improvement of the quality of life are in the foreground. Depending on the life expectancy and other factors, such as the location of the metastases osteosynthesis, implantations of dual head prothesis, total joint arthroplasty and tumor endoprostheses can be performed.

Background: Providing the hip with an endoprosthesis is one of the most common orthopedic interventions in Germany. The long-term success of such a procedure depends on the consideration of the loads due to muscle and joint forces in the planning and operative care. Patient-specific information of forces acting in vivo is not available to the surgeon in clinical routine today. This is where biomechanical modeling comes in., Procedures: A field of activity of biomechanical modeling is the development of methods and procedures for the precise analysis and simulation of endoprosthetic supplies. The aim was to show the possibilities of biomechanical modeling in total hip arthroplasty by means of two examples (sensitivity analysis and pre-/postoperative comparison of intervention outcome)., Results: The results of the sensitivity analysis showed that by modeling the position of an optimal reconstruction of the hip rotational center can be found and the forces acting on the hip joint minimized. In the case of the pre-/postoperative comparison, it can be analyzed whether there has been a decrease or increase of load postoperatively, respectively, or whether the conditions are considered to be approximately equal to the preoperative situation. In the future, biomechanical modeling will be able to significantly improve long-term function by reducing wear and optimizing muscular function of the joint. Therefore, the routine use of validated musculoskeletal analysis in the context of standardized preoperative planning and intraoperative navigation-based implementation should be considered. Thus, validated analyses of musculoskeletal loads not only contribute to the extension of basic knowledge but also to the optimization of endoprosthetic care through their integration into the clinical workflow.

Background: Instability is a common cause of failure in primary and, especially, revision total hip arthroplasty. The reasons for instability include implant malpositioning, impingement, inadequate offset reconstruction, and gluteal insufficiency. Impingement following THA and revision THA is divided into prosthetic and bony impingement, and in addition to instability also causes pain in the area of the hip joint. Offset reconstruction during revision THA is of particular biomechanical importance, since insufficient reconstruction leads not only to instability and pain but also to dislocation. Abductor deficiency often occurs after revision THA and leads to a change in gait pattern, instability and pain., Aim: Current diagnostic and treatment procedures for instability, impingement, insufficient offset reconstruction and abductor deficiency after THA and revision THA are summarized., Results and Discussion: Diagnosis of an instable THA and painful THA includes patient history, physical examination and medical imaging. Thus, in almost all cases, the cause can be determined and treated. Dislocation after primary THA in the early postoperative period can often be treated conservatively if accurate component placement is observed, while a late-onset and recurrent dislocation after primary and revision THA usually needs surgical procedures. To avoid bony and prosthetic THA impingement intraoperative control is absolutely necessary. If possible, the offset reconstruction is based on the condition of the native hip joint and can be achieved by using modular prostheses, neck adapters and different head lengths. Abductor deficiency also occurs frequently after revision THA and can be treated surgically if severe clinical symptoms and fatty degeneration of the abductors have been diagnosed.

Background: Avascular necrosis of the femoral head is a progressive perfusion disorder of the hip joint. Progress in avascular necrosis causes structural damage to the affected joint, often requiring total hip replacement., Aim: This article is intended to give the reader an overview of the current literature on total hip replacement of patients with an avascular necrosis of the femoral head., Results: Before 1990, patients with avascular necrosis of the femoral head had significantly higher revision rates after total hip replacement. Recent studies, however, showed no significant differences in clinical outcomes after total hip replacement in femoral head necrosis and primary osteoarthritis. Despite the young age of the patients, good long-term clinical results can be expected even in patients with an avascular necrosis of the femoral head after total hip replacement.

Morphological imaging of cartilage at high resolution allows the differentiation of chondral and osteochondral lesions. Nowadays, magnetic resonance imaging is the principal diagnostic tool in the assessment of cartilage structure and composition. Conventional radiography, computed tomography, ultrasound or optical coherence tomography are adjunct diagnostic modalities in the assessment of cartilage pathologies. The present article discusses the up-to-date diagnostic practice of cartilage imaging in terms of its scientific basis and current clinical status, requirements, techniques and image interpretation. Innovations in the field such as functional MRI are discussed as well due to their mid- to long-term clinical perspective.

Background: Cartilage defects around the knee joint frequently occur in the region of the medial femoral condyle and the retropatellar cartilage surface. The distinction between local cartilage defects and large area degenerative cartilage lesions is very important for both prognosis and surgical therapy. The size and position of the lesion, the underlying pathomechanism and the age of the patient are very important factors which should be considered in the therapy algorithm for optimal cartilage defect restoration. Important cofactors such as stability, long leg axis and muscle balance should be taken into account., Aim: Current procedures for cartilage repair of the knee joint and their results are summarized in this article. In addition, the necessity of precise and comprehensive preoperative clinical and radiological diagnostics is displayed to be able to treat co-pathologies in order to enable a successful repair of the cartilage defect., Results and Conclusions: Preoperative planning of cartilage-repair techniques usually includes x‑ray images and a magnetic resonance imaging (MRI) examination. If MRI is not available, an arthro-computed tomography could be an alternative. Modern and routinely used procedures for cartilage repair at the knee joint are microfracture, autologous matrix-induced chondrogenesis, autologous chondrocyte transplantation, matrix-induced autologous chondrocyte implantation and osteochondral transplantation. Successful surgical cartilage-repair surgeries require a correct and individualized indication, addressing of copathologies and a standardized rehabilitation that is adapted to the surgical procedure. Evidence-based criteria for an exact time point for the return to sports according to individually operative cartilage repair techniques currently do not exist.

Background: Cartilage is an avascular, alymphatic and non-innervated tissue with limited intrinsic repair potential. The high prevalence of cartilage defects and their tremendous clinical importance are a challenge for all treating physicians., Aim: This article provides the reader with an overview about current cartilage treatment options and their clinical outcome., Methods: Microfracture is still considered the gold standard in the treatment of small cartilage lesions. Small osteochondral defects can be effectively treated with the autologous osteochondral transplantation system. Larger cartilage defects are successfully treated by autologous membrane-induced chondrogenesis (AMIC) or by membrane-assisted autologous chondrocyte implantation (MACI)., Conclusion: Despite limitations of current cartilage repair strategies, such procedures can result in short- and mid-term clinical improvement of the patients. Further developments and clinical studies are necessary to improve the long-term outcome following cartilage repair.

Background: Pelvic and femoral osteotomies are frequently performed in patients with hip dysplasia. The aim of these surgeries are optimal biomechanical conditions of the hip joint thereby avoiding the occurrence of hip osteoarthritis or the delay of initial hip osteoarthritis progression., Therapy: Nevertheless even with good biomechanical conditions of the hip joint, progression of hip osteoarthritis can be recognized postoperatively. A total hip arthroplasty is indicated even more after a time period with conservative treatment. In preparation for the operation, a detailed documentation of the initial clinical situation, appropriate imaging, implant selection and preoperative planning are mandatory. In addition, a biomechanical model representing the desired pre- and postoperative situation can be included in the preoperative planning. According to the previous osteotomy, the size and shape of the acetabulum after the osteotomy and the current pivot centre of the hip joint should be considered. Depending on these observations the acetabular cup can be directly inserted into the bone stock of the acetabulum or an acetabular plasty is necessary before implantation of the acetabular cup. With respect to the previous osteotomy of the femur, it needs to be clarified wether hardware removal will be necessary before total hip replacement; moreover, the anatomy of the proximal femur is critical. In addition, if necessary, a re-osteotomy of the femur is required to enable a hip stem implantation., Conclusion: Cementless total hip replacement should be preferred due to the younger patient age. The load of the hip replacement depends on the osseous anchoring and primary stability of the acetabular and femoral component.

Background: Anterior knee pain is one of the most common complications after total knee arthroplasty. An incidence of up to 30 % has been reported in peer-reviewed studies., Target: The purpose of this study was to systematically review the literature and to identify determinants that have been analyzed with regard to anterior knee pain., Causes: Patient- and knee-specific characteristics, prosthetic designs and operative techniques are addressed as well as functional and neurologic determinants. Instability, increased contact pressure in the patellofemoral joint and patella maltracking due to malrotation of components, offset errors, ligament insufficiencies or patella baja are mechanical reasons for anterior knee pain. Functional causes include pathologic gait patterns, quadriceps imbalance and dynamic valgus. They have to be differentiated from infectious and inflammatory causes as well as soft tissue impingement, arthrofibrosis and neurologic diseases., Treatment: A differentiated treatment algorithm is recommended. Often conservative treatment options exist, however, particularly with most mechanical causes revision surgery is necessary.

Background: Scoliosis is a complex three-dimensional deformity of the spine, which usually occurs during childhood and adolescence. Up to now, whole spine X-rays have been the therapeutic gold standard in the diagnosis and follow-up of scoliosis., Aim: This review gives a brief overview of the history, technical background and possible fields of use for video-rasterstereography, Methods: Alternative measurement systems have been developed over the past few years for the treatment of scoliosis, because of the risk of radiation exposure of X-rays. The rasterstereographic system Formetric (Diers International GmbH, Schlagenbad) allows a radiation-free, three-dimensional analysis of the back surface and the spine., Outlook: Even dynamic measurements can now be conducted with this rasterstereographic system, which will help to further understand and analyze the human spine.

Scoliosis is a complex, three-dimensional spinal deformity with various causes. Adolescent idiopathic scoliosis (AIS) is the most common form. Surgical treatment is indicated for curves greater than 45-50° meaured using the Cobb method. We can distinguish among posterior, anterior or combined surgical procedures. Today, the posterior, transpedicular approach has revolutionized scoliosis surgery. This review gives an overview of current surgical options in scoliosis treatment.

Congenital vertical talus is a rare condition which presents as an isolated deformity or in association with neuromuscular and/or genetic disorders. Pathoanatomically the deformity shows a dislocated talonavicular and subtalar joint. The etiology and pathogenesis are still not finally determined although in some cases a genetic basis has been identified. The clinical picture is that of a flat, convex longitudinal arch with abduction and dorsiflexion of the forefoot and an elevated heel. Clinical diagnosis is confirmed by plain radiographic imaging. Congenital vertical talus should not be confused with other deformities of the foot, such as congenital oblique talus, flexible flat feet or pes calcaneus. The object of treatment of congenital vertical talus is to restore a normal anatomical relationship between the talus, navicular and calcaneus to obtain a pain-free foot. Major reconstructive surgery has been reported to be effective but is associated with substantial complications. Good early results of a modified non-operative treatment using serial manipulation, cast treatment and minimally invasive surgery may change therapeutic concepts.

Osteochondrosis is a heterogeneous group of self-limiting conditions characterized by disturbance of enchondral ossification caused by a lack of circulation. Foot pain is a relatively common problem in children and adolescents and may be due to osteochondrosis. Osteochondrosis of the growing foot shows painful radiological alterations including increased density, fragmentation and irregularity of the epiphyses, physes and apophyses. Lacking etiologic and pathophysiologic information, ostoechondroses have been documented in almost every bone of the foot and therefore should be considered in the differential diagnosis when evaluating pediatric foot pain. The most common localizations of osteochondroses of the growing foot include the navicular as Kohler's syndrome, the metatarsal as Freiberg's infraction and calcaneal apophysitis as Sever's disease. Prognosis and final outcome vary considerably between the different localizations. Physicians should therefore be informed about the etiology, clinical presentation and treatment options for osteochondroses of the growing foot.

Periprosthetic knee joint infection is a rare complication. However, patients as well as surgeons have to deal with severe problems. The past years have brought new knowledge on periprosthetic knee joint infections which have resulted in new classifications. The present manuscript evaluates the current literature on this topic and presents a new therapeutic algorithm.

Background: Isolated osteoarthritis of the patellofemoral joint occurs in 9% of patients over 40 years of age and women are more often affected. Options of treatment are varied and not sufficiently justified by the literature., Materials and Methods: A literature research with keywords in the field of femoropatellar osteoarthritis was carried out in the relevant databases. Studies were categorized into different treatment options and analyzed., Results: There are almost no level I studies comparing the different treatment options. In the literature there are indications that relief of pain can be achieved by conservative treatment, arthroscopic surgery, cartilage conserving surgery and isolated arthroplasty., Conclusion: In view of the fact that there are almost no prospective randomized controlled trials, none of the options for treatment can be highly recommended. There is still no gold standard for the treatment of isolated patellofemoral osteoarthritis.

Total knee arthroplasty (TKA) is an operation with a high gain in quality of life. However, some patients suffer from pain, limited range of motion, instability, infections or other postoperative complications. Patellofemoral pain (PFP) in particular is a common complication after TKA and is often responsible for revision surgery. In particular increasing and localized contact pressure and patella maltracking are held accountable for patellofemoral pain but the reasons are various. Diagnostics and therapy of patellofemoral pain is not easy to handle and should be treated following a clinical pathway. We suggest that patients with patellofemoral pain should be classified into four groups according to the suspected diagnosis after basic diagnostic measures as 1) tenidinosis, 2) mechanical reasons, 3) intraarticular non-mechanical reasons and 4) neurogenic psychogenic reasons. Efficient application of special diagnostic measures and further therapy is facilitated by this classification.