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Large bone defects and losses play a crucial role in both tumour surgery and in complex primary and revision total knee replacement. The established options of cemented or uncemented long intramedullary stems are limited by large bone defects and are at risk from relatively high exposure to aseptic loosening. There is no general valid agreement on implant fixation of the distal femur. A further option is the cementless fixation method with compressive osseointegration, based on the so-called Wolff law of bone remodelling. This method was developed in order to reduce the high loosening rates in revision arthroplasty due to intense stress shielding and is intended to be applied in patients with huge bone losses. The so-called CompressA case report of two male patients aged 59/56 years with a 1-year follow-up is presented. Both patients had a complex post-traumatic femoral deformity with bone loss, prior surgery and an ipsilateral hip replacement. Implantation was performed of a modular total knee replacement, consisting of a cemented modular tibia base plate and distal femoral replacement with cementless implant fixation by compressive osseointegration. Both patients were clinically and radiologically evaluated prospectively.Good clinical and radiological results were demonstrated in both patients after distal femoral replacement by compressive osseointegration. There was no need for further or revision surgery. Both patients were rapidly able to resume their jobs. The survival rates for CPS were comparable to published values with conventional procedures. There are yet no long-term results or extensive data for revision arthroplasty or posttraumatic cases.Besides distal femoral replacement with compressive osseointegration in oncological arthroplasty, the indication of complex distal femoral settings with large bone defects can be evaluated for daily clinical routine. Especially if there is ipsilateral total hip replacement, this option might be used to avoid interprosthetic stress risers.Größere Knochendefekte und -verluste sind sowohl in der Tumorchirurgie als auch in der komplexen Primär- und Revisionsendoprothetik des Kniegelenks für die Rekonstruktion ausschlaggebend. Die gängige Option der zementierten wie auch zementfreien Implantation langstieliger Implantate gerät bei großen Knochendefekten oft an ihre Grenzen und ist des Weiteren aufgrund des relativ hohen Risikos der aseptischen Lockerung im Verlauf gefährdet. Eine allgemein gültige Festlegung auf die optimale Implantatfixierung im Bereich des distalen Femurs ist bisher noch nicht erfolgt. Eine weitere Verankerungsoption ist die Nutzung der auf dem Wolffʼschen Transformationsgesetz beruhenden zementfreien, kompressiven Osteointegration. Diese Methode wurde entwickelt, um die hohen aseptischen Lockerungsraten in der Revisionsendoprothetik zu senken und gleichzeitig bei großen Knochendefekten eingesetzt zu werden. Das sog. CompressEs werden 2 Fallberichte zweier männlicher Patienten (59 und 56 Jahre) mit 1-Jahres-Ergebnissen präsentiert. In beiden Fällen bestand der Zustand nach Polytrauma mit komplexer posttraumatischer Ausgangssituation am distalen Femur (Deformität, Knochendefekte, Voroperationen) und gleichseitig einliegender Hüftendoprothese. Es erfolgte die Implantation einer modularen KTP, bestehend aus einer zementierten modularen Tibiabasisplatte sowie einem distalen Femurersatz, mit zementfreier Implantatverankerung mittels kompressiver Osteointegration. Die beiden Fälle wurden prospektiv klinisch und radiologisch dokumentiert.Es zeigten sich gute klinisch-radiologische Ergebnisse nach distalem Femurersatz mittels kompressiver Osteointegration. Es waren keine Folge- oder Revisionseingriffe erforderlich. Die Patienten konnten ihre berufliche Tätigkeit in der Nachbeobachtungsphase wieder aufnehmen. Die Literatur zeigt vergleichbare Überlebensraten für das CPS im Vergleich zu den konventionellen Verfahren. Langzeitergebnisse und größere Daten für die Revisionsendoprothetik bzw. posttraumatische Fälle fehlen bisher.Neben der Anwendung in der Tumorendoprothetik kann auch die komplexe femorale Ausgangssituation mit großen Knochendefekten als Indikation für den distalen Femurersatz mittels Compress-System für den klinischen Alltag evaluiert werden. Gerade wenn gleichseitig eine HTP einliegt, kann diese Option interprothetische Stress-Riser vermeiden.

Fragestellung: Die Inzidenz periprothetischer Frakturen bei einliegender KTP (PpFxK) beträgt 0,3-5,5%. 40% der Fälle betreffen Revisionsendoprothesen. Es ist meist das distale Femur betroffen. Die Klassifikation erfolgt nach Rorabeck (I-III). In der Regel wird bei Rorabeck I-II Frakturen[zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017)

Fragestellung: In der Frühphase der Arthrose wird das Ausmaß des strukturellen Schadens als gering und theoretisch reversibel angesehen. Entwicklungen zur Frühdiagnose der Arthrose sind für unser Fachgebiet daher von großer Bedeutung. Ein relativ neues Charakteristikum der Knorpelarchitektur[zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2016)

In contrast to periprosthetic fractures of the femur, periprosthetic fractures of the acetabulum are rare complications - both primary fractures and fractures in revision surgery. This topic is largely under-reported in the literature; there are a few case reports and no long term results. Due to an increase in life expectancy, the level of patients' activity and the number of primary joint replacements, one has to expect a rise in periprosthetic complications in general and periprosthetic acetabular fractures in particular. This kind of fracture can be intra-, peri- or postoperative. Intraoperative fractures are especially associated with insertion of cementless press-fit acetabular components or revision surgery. Postoperative periprosthetic fractures of the acetabulum are usually related to osteolysis, for example, due to polyethylene wear. There are also traumatic fractures and fractures missed intraoperatively that lead to some kind of insufficiency fracture. Periprosthetic fractures of the acetabulum are treated conservatively if the implant is stable and the fracture is not dislocated. If surgery is needed, there are many possible different surgical techniques and challenging approaches. That is why periprosthetic fractures of the acetabulum should be treated by experts in pelvic surgery as well as revision arthroplasty and the features specific to the patient, fracture and prosthetic must always be considered.

Fragestellung: Die Arthrose führt zu strukturellen, zellulären und funktionellen Veränderungen des hyalinen Knorpelgewebes. Die Chondrozyten innerhalb und außerhalb einer Arthrose-Läsion unterscheiden sich in ihrer Genexpression, in ihrem Proliferationsverhalten und als Resultat[zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2015)

Between 1986 and 1994, 71 cases of open fractures of the lower leg were treated by transplantation of a free, microvascular flap. Of these, 68 flaps were successful and the complication rate was low. Because of better vascularity subsequent bone reconstruction was shown to be more effective.

Prospectively the levels of C-reactive protein (CRP) of 40 patients were studied twice within 6-12 hours in case of a suspected infection after different osteosynthetic and orthopedic procedures and compared with the levels of the erythrocyte sedimentation rate (ESR). 16 patients showed an increase of CRP in relation to a wound infection, hematoma or effusion in all but one case. 6 patients showed an increase of ESR, which also could be cleared in all but one case. Those patients with a proved wound infection demonstrated a CRP-rise in 8 cases, a CRP-plateau in 4 cases and no CRP-decrease. The same patients showed an ESR-rise in 3, an ESR-plateau in 7 and an ESR-decrease in even 2 cases. This study indicates that the determination of two CRP-levels with a short interval in case of a clinically suspected infection is another, meaningful criterion in making a decision for an operative revision.

Prospectively 70 male patients with elective arthroplasty of the hip (n = 34) and with operation of the anterior cruciate ligament (n = 36) were studied in respect of the postoperative screening of C-reactive protein (CRP), the erythrocyte sedimentation rate (ESR), the white blood cell count and the clinical signs of infection. There were 9 infectious postoperative complications, all with an increase of CRP. But also 6 other patients with no clear infection showed a rise or a plateau of CRP, which could only be explained by the presence of a hematoma, an effusion or a subclinical infection. The close postoperative screening of CRP appeared to be quite costly and laborious, especially in a population with a low infection rate. We therefore suggest a CRP-screening only on patients or operative procedures with wellknown high risk. In addition we studied the determination of two CRP-levels with a short interval following the clinical suspect of a postoperative infection (described in part II of this paper).

During an 8-year period, fifteen patients with subacute or chronic epidural haematoma were seen among 110 treated cases of extradural haematoma corresponding to a frequency of 13.6%. Increasing headache, nausea, vomiting, mild drowsiness and cranial nerve palsy were the symptoms resulting in the correct diagnosis in most cases. Clinical and pathological findings are described, and the factors influencing the course of events are discussed. The most important factors are cerebral atrophy, age, source of bleeding and location. By means of early CT (computed tomography) diagnosis of haematoma, fatal outcome could be prevented in most of the cases.