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Question: The accuracy of ultrasound in the detection of histological changes is a point of discussion., Method: In an experimental study we examined on 58 explanted human patellar tendons the correlation between histological and sonographic changes., Results: Ultrasonographic measurements of length, width, thickness and circumference of the ligaments correlated highly to the explants' macroscopic evaluated dimensions. The sonographic lesions were distinguished in changes in form and echogenicity. Macroscopic visible changes in the explanted ligaments could be detected ultrasonographically. In histological aspect 2 tendons and in ultrasonographical aspect 16 tendons were found to be normal in the whole course of the tendons. 14 ligaments showed histological but not ultrasonographical abnormalities. 42 ligaments were conspicuous in both methods of examination. In the course of the tendons a very high correlation (up to 92%) between sonographical and histological findings was detected. At the insertion are of the patellar ligament the correlation was low., Conclusion: The performed study shows that ultrasonographically detected lesions of the patellar ligament point to histological changes but no conclusions to the kind of histological changes can be taken. However ultrasonographically found abnormalities correlate in a high proportion to histologically detectable changes in the ligaments. Ultrasonography is a good method to evaluate degenerative symptoms in the patellar ligament.

97 patients were treated with cementless custom-made total hip replacement of the Aldinger type for osteoarthritis of the hip. All were prophylactically treated by radiotherapy with 5 x 2 Gy. 10.3% showed heterotopic ossification. 8 patients showed ossification grade I by the Arcq scale and 2 of grade II. Clinical results according to the Merle d'Aubigné score were good or very good in over 90% at one year postoperatively. One patient showed loosening of the femoral stem caused by sinking-in of the custom-made implant. During the revision procedure there were no signs of radiation induced damage to the implant bed. Negative sequelae to the bony implant bed by prophylactic radiotherapy cannot be detected on radiological assessment. Side effects like delayed wound healing or alteration of local immune status with subsequent infection which are commonly discussed, were not seen. Fractionated irradiation is an effective means of prophylaxis of heterotopic ossification.

Periarticular ossification is one of the main problems of total hip replacement. Irradiation with megavolt photons is known to be a well recognized means of prevention of heterotopic ossification. So far only little scientific basis exists about the most favourable way of radiotherapy for prevention of ectopic ossification. In this study two theoretically equivalent doses are compared. Allogeneic bone matrix was implanted into both thighs of 50 adult male Wistar rats for experimental induction of heterotopic ossification. Immediately after operation the thigh implants were irradiated with a single dose of 7 Gy or a total dose of 10 Gy given in 5 fractions of 2 Gy each. In the model of matrix-induced osteogenesis in rats fractionated irradiation by 5 x 2 Gy leaded to a highly-significant (p = 0.001) better suppression of ectopic ossification compared to irradiation by 1 x 7 Gy. Once-only irradiation with 1 x 7 Gy leads to a reduction of the calcium contents by 27.5%, split irradiation by 5 x 2 Gy obtained a reduction by 66.9% compared to the calcium contents of thigh implants not exposed to radiation. In view of experimentally proven better effects, fractionated irradiation has to be preferred to single dose radiation also considering less side effects in split radiation.

A new measuring device has been developed at the Orthopedic Clinic of the University of Tübingen. Its task is to ensure that the right length of leg is selected intraoperatively. The method of measurement can be used in all approaches for alloplastic hip replacement when the patient is in the supine position. Measurement is quick, non-invasive, and can be carried out in a direct comparison to the contralateral leg, using measuring points at the iliac crest and the upper edge of the patella. In a prospective randomized study we were able to demonstrate on 53 patients that the use of this newly-developed measuring device improves the accuracy of the length of the operated leg as compared to the contralateral leg, so that the difference is only +/- 0.5 cm (post-operative difference in length of leg without use of the measuring device 1.1 cm on average, with the measuring device 0.5 cm; p < 0.05).

Between april 1985 and march 1989 183 individual hip prosthesis of the Aldinger type have been implanted at the university hospital of Tübingen. The time of follow up was 37.3 months. In the average the patients were 55.0 years old. In 39 patients one or several operations had be done at the same hip joint before the implantation of the individual hip. 7 hip prosthesis had to be removed. In two cases 1 respectively 1 1/2 years after the primary operation an infection of the prosthesis mad a replacement necessary. In five cases a aseptic loosening of the prosthesis occurred. 139 patients were painfree. In 13 patients there was an intensive femoral pain; 4 of these patients showed radiological signs of loosening. 159 Patients were satisfied with the result of the operation. In one case a fissure of the femoral shaft occurred; a fracture of the femoral shaft was not found. Our early results with an individual hip prosthesis are promising, but we have to wait for the long-term-results.

The membrana interossea natebrachii was investigated submacroscopically and microscopically in human cadaveric specimens. Stereomicroscopical and histological investigations under polarized and non-polarized light were performed. Due to the textological structure and due to its osseous insertion the membrana interossea antebrachii represents in its middle and proximal part all morphological features of an interosseous ligament with uniform direction of its fibers. In this middle and proximal part the membrana interossea has to be regarded as a strong ligament coordinating both radioulnar joints which act by the cardan shaft of the forearm as a functional unit.

In more than 15% of the homozygotic patients sickle-cell anemia coincides with severe changes of the skeleton. The skeletal manifestation of the disease is characterized by a generalized osteoporosis and--more typical--by destruction of the epi- and metaphysis caused by osseous infarction. The indication, effectiveness and technical problems of total joint replacement in bilateral destruction of the hipjoints due to sickle-cell anemia are demonstrated.

Among the great number of operative techniques for stabilization of the distal end of the ulna by grafts in recurrent inferior radioulnar dislocation 6 different methods were tested biomechanically and compared among each other. Those techniques which permit successful treatment of the dislocation are pointed out.

218 Patients, primary treated with total replacement of the hip joint were examined for ectopic ossifications. Frequency and Arcq-classification are described in relation to the transgluteal approach to the hip joint, age, sex an the technic of implantation. We found 3.5% more paraarticular ossifications in the group of cementfixed endoprotheses compared with the group of cementless CAT-endoprotheses type Heramed. In comparison men were affected more often with heterotopic ossifications than women. In both groups the overall incidence of paraarticular ossifications was 34.0%.

A Chiari osteotomy was performed in a macerated female pelvis specimen and the medialization of the distal pelvic segment bearing the hip joint was simulated within a range from 0-2.5 cm. In relation to the medialization different biomechanical hip-parameters were measured as well from the specimen as from the x-ray. For practical purpose the Wiberg CE angle towards the edge of the original acetabulum and the CE' angle towards the edge of the acetabular shelf are important parameters for preoperative calculation of the required amount of medialization.

The functional status of the new wrist joint after transnaviculo-lunate resectionarthroplasty is examined with a 12 year follow-up. The biomechanical and functional changes induced by total os lunatum and partial os navicularis resection are demonstrated. The resulting degenerative changes remain within tolerably acceptable limits after this long period. Clinically, we find a stable, almost completely pain free joint with good motion and good stress tolerance.

In 18 adult cats a wedge osteotomy in the middle of the radial shaft was performed and stabilized with plate fixation in 10 degrees axial deviation. After different times of survival forearm specimens were obtained. In a motion-simulator the elongation pattern of the interosseous membrane during pronation and supination was measured with strain gauges. Remarkable changes of the normal elongation pattern could be observed according to the deviation of the radius.

Among 13 patients with congenital proximal radioulnar synostosis the chromosomal analysis revealed a 47, XXY-constellation in an 8 years old boy and a 47, XXX-syndrome in a 12-year-old girl. The investigations show, that the congenital radio-ulnar synostosis may be combined with the chromosome aberration more often than it was commonly thought.

In 64 cadaveric forearm-specimens of different donorage the membrana interossea antebrachii was investigated macroscopically. The extension of the membrana interossea at the forearm was measured as well as its thickness. The direction of its fibers was also determinated in its different sections and prevalent fibrous structures reinforcing the membrana interossea were investigated. The results characterize the membrana interossea in its middle and proximal section as a taut, strong ligament, which stabilizes the forearm and coordinates pronation and supination in both radioulnar joints.