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Methods: From January 2003 to July 2005 a total of 50 St Georg medial knee monosleds with metal-backed tibial components in stably seated form and Uniglide prostheses (Alphanorm/Corin) with mobile bearing onlays were implanted in minimally invasive operations. Postoperatively the alignment-especially of the tibial components-was investigated, to check whether we had achieved the dorsal slope we had been aiming at, i.e. 5-7 degrees , in the region of these knee replacements., Results: Before surgery there were initial malalignments of up to 10 degrees varus and 3 degrees valgus. All leg axes were restored to between -3 degrees and +3 degrees . The desired dorsal slope of 5-7 degrees for the knee monosleds relative to the tibial component was realized, the average slope being 5.3 degrees . The a-p alignment of the tibial component and of the femoral component was correct., Conclusions: Use of the navigation system leads to more accurate and reproducible results in terms of tibial dorsal slope, which is extremely important when these monosleds are used. Overcorrection of the leg axis is generally avoided. The use of too-high medial onlays is also reliably avoided by the navigation system's monitoring of the level of the cut.

The success and risks of spinal surgery depend on a correct diagnosis and detailed knowledge of anatomy. This report provides information on relevant structures of the lumbar spine and possible surgical complications. Anatomical topography and different surgical approaches are described step by step.

Background: To compare the in vitro effects of selective COX-2 inhibitors (L-745,337, NS-398 and DFU) and of COX-unspecific diclofenac on release of PGE(2 )and 6-keto-PGF(1alpha) from inflamed bursa subacromialis tissue (IBST) obtained from a total of 35 patients with shoulder impingement syndrome (SIS)., Patients and Methods: Bursal specimens were incubated in the presence of drugs (0.01-1000 microM) for 20 min and 16 h., Results: After 20 min 10 microM diclofenac significantly inhibited formation of PGE(2) and 6-keto-PGF(1alpha), whereas L-745,337 and NS-398 (10-1000 microM) induced significant inhibition only at concentrations > or =100 microM. In contrast to equimolar diclofenac, DFU (0.01-10 microM) induced no inhibition of bursal PGE(2) release but a dose-dependent, although statistically not significant inhibition after 16 h. The inhibitory potency of diclofenac (0.01-10 microM) was even more increased during long-term incubation showing greater inhibition than DFU at all concentrations studied., Conclusion: The data suggest that in IBST in SIS in vitro the majority of PG is generated via the COX-1 pathway.

With the progression of rheumatoid arthritis (RA),more than half of the patients develop an affliction of the elbow.Cub arthritis has to be regarded as a part of systemic rheumatoid disease. Thus, the indication for operative treatment depends not only on local changes but is determined by the pattern of all affected joints, the activity of the basic rheumatic disease as well as the effect of physical therapy and medication. The complexity of the rheumatic disease, which typically affects many joints, demands an individual therapeutic plan that can only be developed and accomplished successfully when rheumatologists, rheumatoid surgeons and other specialists cooperate. In cases of recurrent cub arthritis,in spite of adequate medication, synoviorthesis or synovectomy should be performed. This may relieve pain and swelling,however if lesions of the cartilage already exist,progressive joint destruction cannot be prevented. Arthroscopic surgery of the elbow provides all of the known advantages of minimal traumatisation. In RA,it is used mainly when there is ligament laxity in late synovectomies eventually combined with arthroscopically assisted resection of caput radii. In contrast to monoarticular diseases in RA,the adjoining bursa olecrani, neighbouring joints and nerve entrapment syndromes also require treatment. The treatment for advanced cub arthritis is arthroplasty. Due to progress in the development of elbow endoprotheses, the range of indications for resection (interposition) arthroplasty has increased. It is now preferred mainly in younger patients with ankylosing arthritis. Rheumatoid changes in the bone and soft tissue impede the implantation of artificial joints and require time consuming and precise preparation techniques. When choosing either an unconstrained or semi-constrained prosthesis,one has to bear in mind the actual ligament stability and its often unpredictable changes during the course of the disease.Perioperative measures, postoperative care and therapy is made even more difficult due to the involvement of several joints, often extensive permanent medication, secondary lesions such as ldquo;corticoid skin" and in most cases the multimorbidity of patients after many years of chronic disease. When comparing elbow surgery in osteoarthritis and RA,we found that patients with RA clearly required more elaborate surgery and more extensive perioperative and postoperative care.

Omarthritis occurs frequently during the early course of rheumatoid arthritis. Many rheumatoid patients ignore omarthritis because of the good compensation mechanism of the shoulder. Sonography and tomography enable early diagnosis of omarthritis before deterioration is radiologically visible. Arthroplasty gives better results when the musculotendinous rotator cuff is still intact. Therefore, arthroplasty should be performed before severe damage develops. Early indication for cup arthroplasty of the humeral head is justified because of better options in revision surgery. Glenoid components show a high incidence of radiolucency and loosening in rheumatoid patients. Cemented hemiarthroplasties show the lowest rate of loosening.

Video-laparoscopic transperitoneal ventral fusion of the lumbar spine using the Bagby-and-Kuslich (BAK) interbody fusion system combines the advantages of the conventional transperitoneal approach with the well-known advantages of minimally invasive surgery. According to our experience it is a safe procedure with an acceptable operating time, little postoperative pain, fast recovery and a short postoperative stay in hospital. Long term results need to be observed and further studies made.