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Aim Two different measurement techniques of ultrasonograms of the infant hip were evaluated with respect to reproducibility of the Graf classification and variation of α- and β-angles. Material and methods In a cross-sectional, blinded study, the hips of 207 consecutive newborn babies (101 male; 106 female) were sonographically screened at an average of 2.64 days after birth. Each hip was measured twice by three investigators with different levels of experience - a paediatric orthopaedic surgeon, a senior surgeon and a trained medical student. A mobile ultrasound system (SONOLINE G60S®, Siemens, Erlangen, Germany), equipped with a 7.5 MHz linear transducer, was used. Both hip joints were measured twice by all three investigators. The measurement was performed 6-8 weeks later in a blinded manner. The sonograms were initially printed out on high-quality paper strips and measured by pencil, ruler and goniometer. Finally, each investigator evaluated the same sonograms computer-assisted, using the trackball and dashboard of the ultrasound system. Results Concerning intraobserver reliability, we observed a significant reduction of variation both for α- and β-angles in favour of the classic measurement on printed strips (p 0.05). Conclusions This study demonstrated considerable advantages for the classic measurement of paediatric hip ultrasonograms with pencil and goniometer on printed paper strips compared to computer-aided measurement concerning variation of α- and β-angles.

AIM The aim of the study was to survey the current state of the conservative and operative treatment of anterior shoulder instability and its rehabilitation in German hospitals. METHODS A previously evaluated online questionnaire was sent out to all German hospitals with orthopaedic or trauma surgery departments. The Federal Statistical Office's hospital list was the basis for the selection of hospitals. The questions referred to the year 2007. The survey, including 3 reminders, was conducted over 3 months. The questionnaire consisted of 6 response categories: always (100%), almost always (99-81%), predominantly (80-51%), rarely (50-21%), almost never (20-1%) and never (0%). RESULTS The response rate was 41% and 67% of these had carried out shoulder stabilisations. In total, 99.2% of the 67% were evaluable. The proportion of shoulder surgery was 8.4% of the total number of operations. Shoulder stabilisations represented 10.6% of these operations. A specialised shoulder department existed in 22.9%. Conservative treatment was carried out with an immobilisation of the arm "predominantly", "almost always" and "always" for internal rotation in 70.8% and in 23.4% for external rotation. The shoulders were "predominantly", "almost always" and "always" stabilised in an arthroscopic technique in 68.2% and in an open one in 31.8% of the clinics. With 92.9%, the Bankart repair was the most common operation. Shoulder instability was principally treated with the arthroscopic technique, regardless of the care level and department and is considered the best surgical technique. Physiotherapy was prescribed "always" and "almost always" in 99.3%. The rate of reluxation after conservative treatment was estimated at 35.5%, after operative open anterior shoulder stabilisation at 9.1% and after arthroscopic shoulder stabilization at 10.6%. Nevertheless, 49.4% of respondents expected the best results after arthroscopic treatment. Participants, who mainly applied the arthroscopic technique, expected a lower rate of reluxation in comparison to other techniques (p

PURPOSE Every day several million people are seeking for answers to medical problems via the internet. In particular parents, whose children are affected by systemic diseases, orthopaedic defective positions, anomalies or deformities, use the internet to increase their knowledge. Concerning this situation there is a lack of studies in the current literature. METHODS We investigated parental preparation to the outpatient paediatric orthopaedic consultation at our University Hospital with respect to internet enquiries or further sources of information using a standardised questionnaire. We assessed age and educational background of the parents, local hardware equipment and general habits of internet use. In particular, we retrieved parental use of search machines (e.g., Google.de, Yahoo.de), general medical websites (e.g., netdoktor.de) and websites from self-help groups (e.g., klumpfusskinder.de). RESULTS In total, 288 out of 300 questionnaires (96%) were evaluated. More than half of the parents (57%) were over 35 years of age and 78% were women. 82% of the study population had access to the internet at home and 70% used the internet regularly. More than 80% obtained information about the orthopaedic diseases of their child beforehand. Age and educational background of the parents were not significantly correlated with the extent of enquiries (p > 0.05). 90% of the parents, using the internet as source of information, frequented internet search machines; approximately one third used general medical websites. In particular in clubfeet we observed a highly significant (p < 0.001) tendency of parents to frequent websites from self-help groups. 60% of the study population assessed the internet information as useful; 92% will frequent the internet as source of information again. One third of the respondents is going to discuss the obtained internet information with the physician. CONCLUSIONS The internet is an important source of information for parents in the field of paediatric orthopaedics. Treating physicians will be increasingly confronted with the results of parental internet enquiries.

AIM The aim of this study was to evaluate the current situation of rotator cuff repair and follow-up treatment in German hospitals. METHODS An evaluated survey, enquiring about the year 2006, was sent to all 777 German orthopaedic and/or trauma surgery departments. The hospitals were chosen using the official index of hospitals from the German Federal Statistical Office. RESULTS 44 % of the surveys were sent back, whereby 40 % were of use. Within the 309 departments, 26 % of the total number of 59,957 shoulder operations were rotator cuff repairs. Mini-open was the operation method in 49 %, open in 29 % and arthroscopic in 22 % of cases. Regarding the operational methods, there were differences between the departments and level of care. The arthroscopic technique was used sometimes in 48 % of the departments, whereas 52 % never used it. Specialised shoulder departments employed the total arthroscopic procedure more often. A set follow-up treatment occurred in 79 % of departments. CONCLUSION Rotator cuff repair is mainly carried out using the mini-open method, which is nowadays regarded as gold standard.

Background Isolated patellofemoral arthroplasty is discussed controversially. The aim of this nation-wide survey in Germany and review of the literature was to determine the current status of patellofemoral arthroplasty. Methods A standardised questionnaire was sent to 744 German departments of orthopaedic surgery, traumatology and general surgery. In the first part, surgeons were asked general questions about their department size, case numbers of knee arthroplasties per year and non-endoprosthetic treatment of isolated patellofemoral disorders. If patellofemoral arthroplasty was conducted, parameters concerning age, gender, duration of complaints, indication for surgery, surgical approach, type of endoprosthesis used, additional surgical treatments and failures were evaluated in the second part. Furthermore we asked for the reasons if no isolated patellofemoral arthroplasty was performed. A systematic review of the literature was done including studies published until October 2007. The main inclusion criterion was the presentation of results after the implantation of a patellofemoral prosthesis for isolated patellofemoral osteoarthritis. Results A total of 225 analysable questionnaires were returned. Of 53,420 knee arthroplasties performed per year, only 195 (0.37 %) were isolated patellofemoral arthroplasties. The majority of patients (91 %) were between 40 and 80 years old. The aetiology of isolated patellofemoral osteoarthritis was believed to be idiopathic in 41 % and traumatic in 8 %. Patellofemoral dysplasia was held to be responsible in 47 % and patellofemoral instability in 4 % of the cases. The main reason for failure and surgical revision was ongoing tibiofemoral osteoarthritis of the affected knee. Negative attitude and disbelief towards the success of isolated patellofemoral arthroplasty were stated by the majority (62 %) of non-users. A lack of appropriate indications was reported by 22 % and lacking know-how by 16 %. We analysed 12 studies (459 implantations; 390 patients) in the literature review. The treatment was considered successful in 67.8 % of cases. The overall revision rate was 30.3 %. The highest failure rates were in patients with progression of tibiofemoral osteoarthritis or malalignment. Conclusions Isolated patellofemoral arthroplasty has only low significance among surgeons performing knee arthroplasty in Germany. The majority of surgeons do not believe in the success of the procedure. Almost one third of published cases in the literature needed to be revised.

AIM The aim of the present retrospective matched pair study was to compare the clinical results of patients undergoing total knee arthroplasty (TKA) with 2 different operation strategies: tibia first vs. femur first for ligament balancing and rotational alignment of the femoral component. METHODS In this study 30 patients underwent TKA with the fixed bearing prosthesis Innex FIXUC between 2003 and 2005. In the same period of time the posterior stabilised prosthesis NexGen LPS was implanted in 123 patients. Out of these, 30 patients were matched to the 30 patients of the Innex group based on the parameters age, gender, height, weight and BMI. All implants were cemented. Clinical examination was rated using UCLA score, Knee Society score, Lequesne score for knees, a visual analogue scale (VAS) for pain and the Feller patellar score. Three patients in the Innex group were lost to follow-up, and 27 matched pairs could finally be analysed. RESULTS At a mean follow-up of 25 months (Innex) and 3 years (NexGen) statistically significant differences (p < 0.05) with advantages for the NexGen were found in the UCLA activity score (4.9 vs. 5.9, p = 0.013), in part A (knee score) of the Knee Society score (78.9 vs. 91.0, p = 0.002) as well as the total score (153.9 vs. 173.2, p = 0.012), VAS (2.1 vs. 0.6, p = 0.003) and in the Lequesne knee score (5.7 vs. 3.6, p = 0.024). No statistically significant differences (p < 0.05) were found in the function score of the Knee Society score and the patellar score (Feller). CONCLUSION In the described setting there were functional advantages for the NexGen prosthesis (femur first) at a comparable revision rate. However, satisfactory results with the Innex FIXUC are possible, too.