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General principles of cartilage repair therapies have not changed in the last years. Recommendations for cartilage repair include symptomatic ICRS grade 3 and 4 classified cartilage defects. However, what has changed in the last years is a better understanding of underlying or concomitant pathologies. Since a more precise analysis and stringent therapy of concomitant pathologies has been performed, an increase in success rates especially in formerly difficult entities could be observed. The most important concomitant pathologies in cartilage therapies of the hip-, knee- and ankle joint are axis deviations, instabilities, meniscus pathologies or prearthrotic deformities like hip dysplasia and femuroacetabular impingement syndrome. To increase the efficiency of cartilage repair procedures these pathologies should be corrected either prior to, or at latest concomitant to any cartilage repair surgery. Therefore, this article is intended to give an overview of the most important concomitant pathologies in cartilage repair of the lower extremities and their possibilities of correction. [ABSTRACT FROM AUTHOR]

Der Verlust der Integrität und Funktion des oberen Sprunggelenkes hat für die betroffenen Patienten gravierende Auswirkungen auf die Mobilität und Lebensqualität, die vergleichbar sind mit den Einschränkungen bei Hüftgelenkarthrose. Die weitaus häufigste Ursache von Sprunggelenkarthrosen sind Folgezustände nach Sprunggelenkverletzungen, für die in fortgeschrittenen Stadien mit einer Arthrodese des oberen Sprunggelenkes ein schmerzfreies Gangbild mit guten Ergebnissen auch im mittel- und langfristigen Verlauf wiederhergestellt werden kann. Die alternative Therapieoption des künstlichen Gelenkersatzes mit einer Spunggelenkendoprothese bleibt trotz insgesamt sinkender Fallzahlen in Deutschland aktuell, zumal in den letzten Jahren Neuentwicklungen von Prothesen auf den Markt gekommen sind. Neuere Daten aus den verschiedenen Prothesenregistern zeigen signifikant bessere Ergebnisse in der Standzeit der Prothesen, die als „Ersatz“ des für die Fußfunktion essenziellen Gelenkes unbestritten auch Vorteile für die Gelenkbeweglichkeit, das Abrollverhalten und den Gangzyklus im Vergleich zur Arthrodese des oberen Sprunggelenkes bieten. Auch gibt es Hinweise, dass das Risiko von Anschlussarthrosen von Gelenken des Fußes geringer ist. Unverändert ist die Datenlage der wissenschaftlichen Literatur für die Entscheidung Prothese vs. Arthrodese bei posttraumatischer oberer Sprunggelenkarthrose nicht schlüssig und klar entschieden. Der folgende Beitrag soll einen Überblick über das Thema geben und eine Hilfe bei der Indikationsstellung Arthrodese vs. Prothese sein. [ABSTRACT FROM AUTHOR]

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Background: After experience of total ankle replacement over more than one decade, there is still no evidence that total ankle replacement is superior to fusion. Total ankle replacement: Functional results after total ankle replacement and ankle arthrodesis are very similar in the literature; however, the long-term revision rate after total ankle replacement is up to 30 % after 10 years. Unsolved problems after total ankle replacement include aseptic loosening, cyst formation, low-grade infection and heterotopic ossification. There is increasing evidence that the results after total ankle replacement are especially limited in younger and active patients. Ankle fusion: In contrast, there has been a remarkable development of the surgical techniques for ankle fusion. As long as there are no extensive bone defects or severe malalignment, ankle fusion can be performed arthroscopically with minimal soft tissue trauma. This has special advantages in posttraumatic patients with extensive scar tissue formation. Degenerative arthritis of adjacent joints is an increased problem in patients with persisting hind foot malalignment. Results: The majority of patients with posttraumatic arthritis are of a younger age and can be characterized by a high activity level. Especially for these patients arthrodesis of the ankle represents a reliable and stable treatment concept, particularly with respect to long-term results. Strong arguments in favor of arthrodesis are the significantly lower revision rate and rare severe complication rate compared to total ankle replacement while providing identical functional long-term results. [ABSTRACT FROM AUTHOR]

Background: Total ankle replacement (TAR) has gained more and more interest in the last decade and has become a reasonable treatment option for symptomatic ankle arthritis. Due to increasing number of TARs and a prolonged survival rate, periprosthetic fractures occur as a complication, which is already known from total hip and knee replacement. Objectives: The aim of this study was to develop a classification of periprosthetic ankle fractures, which can guide the surgeon's decision-making in treating these rare fractures. Methods: All TARs (including prosthesis replacement) were retrospectively collated and analyzed with respect to periprosthetic fractures. All fractures were classified according to the point in time (e.g. intraoperative or postoperative fracture), localization (e.g. tibia, fibula or talus), fracture morphology and prosthesis stability. Results: Retrospectively 21 patients (4.2 %) with periprosthetic fractures were identified. Of the patients 11 had an intraoperative fracture (type 1 fractures) and the remaining 10 fractures were postoperative fractures, which in turn were traumatic (type 2 fractures) in 2 and postoperative fatigue (type 3) fractures in 8 patients. Conclusion: Periprosthetic ankle fractures are a very rare complication. Nevertheless, a differentiated treatment algorithm is necessary depending on the cause of the fracture, localization and prosthesis stability. Based on more than 500 TARs this study offers for the first time a classification system for periprosthetic fractures following TAR. By systemically categorizing the different types of periprosthetic fracture this classification assists in therapeutic decision-making as it allows a differential causal analysis and guides indicated surgical or conservative treatment concepts. [ABSTRACT FROM AUTHOR]

Copyright of Der Orthopäde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Orthopäde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Orthopäde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Orthopäde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Orthopäde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Operative Orthopädie und Traumatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To revise one or both loosened prosthesis components, to achieve postoperative pain relief, and preserve ankle range of motion., Indications: Aseptic loosening of the tibial and/or talar ankle prosthesis components without substantial bone defect of the tibial or talar bone stock., Contraindications: General surgical or anesthesiological risks, infections, critical soft tissue conditions, nonmanageable hindfoot instability, neurovascular impairment of the lower extremity, neuroarthropathy (e. g. Charcot arthropathy), substantial nonreconstructable osseous defects with or without cysts on the tibial and/or talar side, non-compliance, patients with primary total ankle replacement (TAR) using intramedullary fixation (stem fixation), patients with severely reduced bone quality, insulin-dependent diabetes mellitus, smoking, unrealistic patient expectations, patients with high activity in sports., Surgical Technique: Exposure of the ankle joint using the previous incision (anterior or lateral transfibular approach). Mobilization and removal of loosened prosthesis component. Careful debridement of bone stock at bone-prosthesis interface. Determination of prosthesis component size. Implantation of definitive prosthesis components. Wound closure in layers., Postoperative Management: A soft wound dressing is used. Thromboprophylaxis is recommended. Patient mobilization starts at postoperative day 1 with 15 kg partial weight bearing using a stabilizing walking boot or cast for 6 weeks. Following clinical and radiographic follow-up at 6 weeks, full weight bearing is initiated gradually., Results: Between January 2007 and December 2012 a one-stage revision TAR was performed in 14 patients with a mean age of 52.7 ± 12.0 years (29.8-70.5 years). The indication for revision surgery was aseptic loosening of one or both prosthesis components. The mean time between the initial TAR and revision surgery was 5.9 ± 2.9 years (2.0-11.5 years). In 2 patients a tibiotalocalcaneal arthrodesis was performed due to painful aseptic loosening of revision TAR. In all patients a significant pain relief was observed.