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Background: Total knee arthroplasty is associated with a significant postoperative blood loss even without any form of perioperative anticoagulation. Methods: The potential role of QUIXIL, a fibrin sealant used in orthopaedic surgery to control blood loss and avoid blood transfusions in patients undergoing total knee arthroplasty was evaluated in a prospective randomized trial with twenty-four patients diagnosed with primary osteoarthritis of the knee. Results: Results showed that application of 2 ml QUIXIL adds costs to treatment without reducing the number of transfused red blood cell counts and postoperative haemoglobin loss. However, significant lower levels of postoperative fluid loss ( P = 0.026) was detected in QUIXIL treated patients. Conclusion: Regarding cost effectiveness and benefit no indication for the use of 2 ml QUIXIL fibrin sealant in standard knee arthroplasty could be proofed statistically. [ABSTRACT FROM AUTHOR]

Ankle joint affections and injuries are common problems in sports traumatology and in the daily routine of arthroscopic surgeons. However, there is little knowledge regarding intraarticular loads. Pressures on the ankle were determined in a dynamic model on 8 cadaver specimens, applying forces to tendons of the foot over the stance phase under vertical loading. A characteristic course of loading in the tibiotalar joint with a rapid increase upon heel contact was observed. It increased gradually to reach a maximum after 70% of the stance phase, during the push-off phase. The major torque in the ankle joint is located anterolaterally. A dynamic loading curve of the ankle joint can be demonstrated. These observations explain phenomena such as the appearance of osteophytes on the anterior tibia in the case of ankle osteoarthritis and the relatively low incidence of posterior tibial edge fragments in the case of trimalleolar ankle fracture. Furthermore, the medial side of the talus is less loaded compared to the lateral side, which appears relevant to the treatment of osteochondrosis dissecans. [ABSTRACT FROM AUTHOR]

Osteosarcoma is one of the most common primary malignant bone tumours in childhood, mainly affecting the metaphysis of long extremity bones. In rare cases, patients present at time of diagnosis with multiple bone lesions, sometimes in the absence of pulmonary metastases. The pathology pattern of these multifocal osteosarcomas occurring with a rare incidence of 0.5–4% is not yet clear, and in spite of investigations in diagnosis and therapy, the prognosis is still poor. We report two cases of multifocal synchronous osteosarcoma. The age of both children at the time of tumour detection was 14 years. A synchronous or metachronous occurrence of multiple bone lesions, initially in the absence of pulmonary metastases was seen. In both cases, treatment consisted of neoadjuvant chemotherapy, oncologic surgery and adjuvant chemotherapy. Tumour response to chemotherapy was good in one patient, and poor in the other case. In both patients initial R0-resection of the tumours was performed. The disease-free time was 1 year before detection of pulmonary metastases or relapse. By the combination of chemotherapy and aggressive surgery the prognosis in multifocal osteosarcoma has been improved over the last years. Nevertheless, the survival time is still short and seems to be correlated with the initial histological tumour response to chemotherapy. [ABSTRACT FROM AUTHOR]

Demographic changes create an expansion of the elderly population segment of society. Demands of mobility and quality of life have increased in this age group over the last decades. A rising number of elderly patients suffering from degenerative “de novo” lumbar scoliosis (DLS) may be eligible for surgical options to treat their spinal deformities. Therefore, we compared the clinical and radiographic results of conservative and surgical treatment. During 1990–2003, 55 patients with DLS were treated and followed up for a minimum of 24 months. Group 1 patients ( n = 26) underwent surgery (decompression and spondylodesis), group 2 patients ( n = 29) declined surgery and received conservative treatment (analgesics, physiotherapy). Clinical data, theatre records and X-rays were analysed. All patients were contacted and 73.1% of group 1 and 75.8% of group 2 patients were clinically re-evaluated and received standing radiographs on average 4.8 and 3.8 years after the initial procedure or consultation, respectively. We found a significantly higher rate of spinal stenosis and degenerative spondylolisthesis in group 1 patients ( P < 0.01). The procedure corrected the lumbar deformity in the frontal and sagittal planes. Three patients required revision for implant failure. Walking distance improved significantly during the postoperative course. Analgesic requirement decreased in comparison to group 2 patients. No significant difference was evident between the groups in terms of lumbar back pain after 3.8 and 4.8 years, respectively. Operative treatment of DLS with decompression in combination with a longer fusion improved walking ability and quality of life. Reduced need of analgesics can be anticipated. Benefits of surgery and risks of complications have to be considered carefully to avoid disappointment in expectations. [ABSTRACT FROM AUTHOR]

Problem: The purpose of the investigation was a comparison of two different digital X-ray techniques with conventional standing full spine films. Evaluation of dose area product, image quality and inter-observer error of Cobb-angle measurement in patients with scoliosis and kyphoscoliosis were studied. Methods: A consecutive series of 150 patients were prospectively randomized into three groups. Patients in group 1 (n=53) received a conventional standing postero-anterior full spine radiograph. All films were evaluated on the light box. Patients in group 2 (n=48) received a X-ray using the digital storage phosphor plate system (CR). For group 3 (n=49) digital pulsed fluoroscopy was used. In groups 2 and 3 images were exported to a picture archiving and communicating system (PACS) workstation and viewed on a monitor (Siemens SMM 21140P, Germany). Dose area product measurements were performed in all three groups (Diamentor-M, PTW, Freiburg). Three experienced investigators independently reviewed all pictures. Pedicles and endplates were counted. Cobb-angles of the main curves were measured. Results: The mean dose area product was 97.0 cGy cm(2) (37.0-380.0 cGy cm(2)) for conventional films, 31.5 cGy cm(2) (6.0-66.0 cGy cm(2)) for CR imaging and 5.0 cGy cm(2) (1.0-29.0 cGy cm(2)) for digital fluoroscopy. The differences of Cobb-angle measurements were not significantly different for the three methods. Differences in the count of pedicles and endplates between the investigators were significantly lower for the conventional film as an indicator for the best detail presentation. Conclusion: A significant reduction in dose area product is possible with modern digital X-ray methods. The inter-observer error of Cobb-angle measurement is not significantly altered. The detail information is decreased in comparison to conventional films. [ABSTRACT FROM AUTHOR]

Paralysis following scoliosis correction is a catastrophic situation. We report an unusual metabolic cause of neurological deficit after anterior thoracic release. A 15-year-old female developed proximal leg paralysis 1 day after surgery. Investigations disclosed severe serum hypokalaemia (2.8 mmol/l). After intravenous potassium substitution the neurological status completely normalized within a few hours. We assume that the condition was a manifestation of hypokalaemic paralysis since no further abnormalities could be disclosed. Spinal surgeons should bear in mind hypokalaemia as a benign and easily correctable cause of paresis following surgical scoliosis correction. [ABSTRACT FROM AUTHOR]

A correction to the article "Lactate modulates gene expression in human mesenchymal stem cells" that was published in the November 11, 2008 issue is presented.

Presents a letter to the editor about the early assessment of periprosthetic bone remodelling after total knee arthroplasty.