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Introduction: Transcutaneous Osseointegrated Prosthetic Systems (TOPS) offer a good alternative for patients who cannot be satisfactorily rehabilitated by conventional suspension sockets. The Endo-Exo-Prothesis (EEP, ESKA Orthopaedic Handels GmbH®, Deutschland) is the most implanted TOPS in Germany. Previous studies have shown that cortical thickness increases after implantation of TOPS. The aim of this study is to determine changes of cortical thickness in relation to the time after implantation of the Endo-Fix-Stem. Patients and methods: All transfemoral amputees treated by EEP from 2007 to 2013 were operated by the last author of this study. X-ray images of 4 follow-up intervals (postoperative, 3 months, 12 months, 3 years) were analyzed retrospectively. The femoral residuum was divided into 3 sections (proximal, middle, distal) with 2 measuring points in each section: medial and lateral. Cortical thickness was measured at these 6 points and compared at regular intervals using the Friedman test for non-parametric dependent variables. Results: Thirty-seven patients with 40 implants were included. The average age was 52.2 years (30–79 years). 83.7% of the patients were male. No statistical significance could be shown for any of the measuring points of the femoral residual (proximal medial, proximal lateral, middle medial, middle lateral, distal medial, distal lateral) among the mean values of the cortical thickness at the different follow-up times (p > 0.05 for all measuring points). Cortical remodeling processes (> 1 millimeter (mm)) occurred in all implants despite a missing statistical significance. Hypertrophy could be confirmed for 42.5% and atrophy for 37.5%. Twenty percent of the cases showed a parallel occurrence of both entities. Cortical changes greater than 5 mm were only observed at the distal end of the femur. Conclusion: Even if our results did not show any significant difference, it can be deduced that the osseointegration process leads to a remodeling of the bone structure, both in terms of increased bone formation and bone resorption. However, it has not yet been conclusively clarified which processes lead to hyper- or atrophy. The force transmission between prosthesis and bone and the facultative bacterial colonization of the stoma are still the main factors which may be responsible for the bone remodeling processes. [ABSTRACT FROM AUTHOR]

Background: Exposure to medical ionizing radiation has been increasing over the past decades and constitutes the largest contributor to overall radiation exposure in the general population. While occupational exposures are generally monitored by national radiation protection agencies, individual data on medical radiation exposure for the general public are not regularly collected. The aim of this study was to determine the feasibility of assessing lifetime medical ionizing radiation exposure from diagnostic and therapeutic procedures retrospectively and prospectively within the framework of the German National Cohort study., Methods: Retrospective assessment of individual medical radiation exposure was done using an interviewer-based questionnaire among 199 participants (87 men and 112 women) aged 20-69 randomly drawn from the general population at two recruitment locations in Germany. X-ray cards were distributed to 97 participants at one recruitment center to prospectively collect medical radiation exposure over a 6-month period. The Wilcoxon-Mann-Whitney test was used to test differences in self-reported median examination frequencies for the variables age, sex, and recruitment center. To evaluate the self-reported information on radiological procedures, agreement was assessed using health insurance data as gold standard for the time period 2005 to 2010 from 8 participants., Results: Participants reported a median of 7 lifetime X-ray examinations (interquartile range 4-13), and 42% (n = 83) reported having had a CT scan (2, IQR = 1-3). Women reported statistically significant more X-ray examinations than men. Individual frequencies above the 75th percentile (≥15 X-ray examinations) were predominantly observed among women and in individuals >50 years of age. The prospective exposure assessment yielded a 60% return-rate of X-ray cards (n = 58). 16 (28%) of the returned cards reported radiological examinations conducted during the 6-month period but generally lacked more detailed exposure information. X-ray examinations reported for the period for which health insurance data were available provided a moderately valid measure of individual medical radiation exposure., Conclusions: The assessment of more recent medical examinations seems in the German National Cohort study feasible, whereas lifetime medical radiation exposure appears difficult to assess via self-reports. Health insurance data may be a potentially useful tool for the assessment of individual data on medical radiation exposure both retrospectively and prospectively.