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Aims: This study aims to enhance understanding of clinical and radiological consequences and involved mechanisms that led to corrosion of the Precice Stryde (Stryde) intramedullary lengthening nail in the post market surveillance era of the device. Between 2018 and 2021 more than 2,000 Stryde nails have been implanted worldwide. However, the outcome of treatment with the Stryde system is insufficiently reported. Methods: This is a retrospective single-centre study analyzing outcome of 57 consecutive lengthening procedures performed with the Stryde nail at the authors’ institution from February 2019 until November 2020. Macro- and microscopic metallographic analysis of four retrieved nails was conducted. To investigate observed corrosion at telescoping junction, scanning electron microscopy (SEM) and energy dispersive x-ray spectroscopy (EDX) were performed. Results: Adjacent to the nail’s telescoping junction, osteolytic changes were observed in bi-planar radiographs of 20/57 segments (35%) after a mean of 9.5 months (95% confidence interval 7.2 to 11.9) after surgery. A total of 8/20 patients with osseous alterations (40%) reported rest and ambulation pain of the lengthened segment during consolidation. So far, 24 Stryde nails were retrieved and in 20 (83%) macroscopic corrosion was observed at the nail’s telescoping junction. Before implant removal 11/20 radiographs (55%) of lengthened segments with these 20 nails revealed osteolysis. Implant retrieval analysis by means of SEM showed pitting and crevice corrosion. EDX detected chromium as the main metallic element of corrosion. Conclusion: Patients are exposed to the risk of implant-related osteolysis of unclear short- and long-term clinical consequences. The authors advocate in favour of an early implant removal after osseous consolidation., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Fragestellung: Achondroplasier weisen häufig Achsfehlstellungen der Beine auf. Die alleinige Korrekturosteotomie gilt als Goldstandard bei Patient ohne Wunsch zur Extremitätenverlängerung. Um einen vergleichsweise großen Eingriff zu verhindern kann im Wachstumsalter das Verfahren [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Objectives: Reduction of excessive predicted final height may be achieved by hormonal treatment, or surgically by manipulating the growth plate around the knee through total epiphysiodesis (ED). Lately, hormonal therapy has been linked to adverse effects such as an overall increased cancer risk and [for full text, please go to the a.m. URL]

Fragestellung: Der Riesenzelltumor des Knochens (GCTB) ist ein gutartiger Tumor, der sich durch lokal-aggressives Wachstum, ein mögliches Rezidiv nach chirurgischer Behandlung und, wenn auch selten, durch Lungenmetastasen auszeichnet. Ein in der distalen Ulna lokalisierter GCTB ist selten. Die [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Der M. Perthes stellt die häufigste avaskuläre Osteochondronekrose im Kindesalter dar. Zur Verhinderung eines koxalen Containment-Verlustes und einer Verbesserung der Hüftbeweglichkeit kann bei ungünstigen Verläufen (Lateralisationstendenz, Herring Typ C, „head [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Die Diagnose der periprothetischen Infektion (PPI)basiert auf verschiedenen Serum-und Synoviamarkern, wobei in den gängigen Kriterien insbesondere Leukozytenzahl und Leukozytendifferenzierung sowie leukozytenabhängige Marker eine herausgestellte Rolle spielen. Vor dem Hintergrund, [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Alternativ zu externen Fixateuren können zur Distrakionsosteogenese (DO) intramedulläre Verlängerungsmarknägel (IMVN) angewendet werden Auch bei Patienten mit Achondroplasie kann das Verfahren zur Vergrößerung der Gesamtkörperlänge angewandt werden. [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Intramedulläre Verlängerungsmarknägel (IMVN) stellen eine etablierte Alternative zur Behandlung mit externen Fixateuren zur Kallusdistraktion dar. Bestehende Studien, welche die Behandlung mit einem IMVN ausgewertet haben, sind sehr heterogen in Bezug auf die angewandten [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Im Gegensatz zur Distraktionsosteogenese (DO) mit externen Fixateuren stellen intramedulläre Verlängerungsmarknägel (IMVN) eine komfortablere und sichere Alternative dar. Da bei einer antegraden femoralen (AF) Implantation von IMVN frontale und sagittale Deformitäten [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Der Riesenzelltumor des Knochens (RZT) stellt einen lokal aggressiven Tumor dar, der 4-5% aller primären Knochentumoren ausmacht. Er ist charakterisiert durch aggressives Wachstum, häufige Lokalrezidive nach chirurgischer Therapie und, in seltenen Fällen, Metastasen. [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Das Risiko einer periprothetischen Gelenkinfektion (PJI) steigt mit zunehmender Implantatoberfläche. Die Infektionsrate für Tumorprothesen beträgt etwa 20% und nach Revisionseingriffen bis zu 40% [ref:1]. Infektionen treten meist innerhalb der ersten [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Maligne Knochentumoren sind in langen Röhrenknochen überwiegend metaphysär lokalisiert. Seltener betroffen ist der diaphysäre Knochen. Nach Resektion können diese interkalaren Defekte endoprothetich rekonstruiert werden. Diese Arbeit untersucht das Implantatüberleben, [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Objectives: The occurrence of malignant bone tumors of the femur is extremely rare in children under the age of 8, but demands a challenging surgical treatment. In general, limb salvage approaches are preferable over ablative procedures. However, (extendable) tumor endoprostheses can often not be applied [for full text, please go to the a.m. URL]

Fragestellung: Die fibulare Hemimelie (FH) ist eine seltene Erkrankung, die mit einer Verkürzung sowohl des Unterschenkels als auch oftmals des Femurs einhergeht. Abhängig vom Schweregrad der Erkrankung kann das Ausmaß der Beinlängendifferenz (BLD) stark variieren. Bei einer BLD [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Die Resektion von muskuloskelettalen Tumoren und Rekonstruktion mit Tumorendoprothesen führt häufig zu einem relevanten Blutverlust, der eine hämodynamische Stabilisierung und (massive) Transfusion von Blutprodukten erfordert. Wir stellten die Hypothese auf, dass die kombinierte [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Objectives: Leg length discrepancies (LLD) are frequently associated with coronal angular deformities, in particular valgus deformity of the knee joint. Temporary hemiepiphysiodesis (HED) of the distal femur or proximal tibia represents a well-established procedure for valgus or varus deformity correction [for full text, please go to the a.m. URL]

Fragestellung: Aus medizinischen und organisatorischen Gründen kommt es in der täglichen Praxis vor, dass bei einem zweizeitigen Prothesenwechsel bei Protheseninfektionen die Spacer länger als ursprünglich geplant einliegen. Die Patienten sind in ihrer Mobilität stark eingeschränkt [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Der Nachweis einer Infektpersistenz (IP) vor Prothesenreimplantation bei Patienten mit zweizeitigem Hüft- oder Knieprothesenwechsel bei chronischer periprothetischer Infektion (PPI) ist eine Herausforderung in der Revisionsendoprothetik. Klinische Befunde sowie verschiedene serologische [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Ein positiver Effekt durch das Aufwärmen ist häufig aus dem Bereich des Sports, aber auch z.B. beim Spielen eines Musikinstruments bekannt. Bei arthroskopischen Operationen ist ein solches Auswärmen nur bedingt vorstellbar. Da ein Zusammenhang zwischen Videospiel-Kompetenz [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Der proximale Humerus ist die dritthäufigste Lokalisation primär maligner Knochentumore. Radiologische, onkologische und chirurgische Fortschritte haben in den vergangenen Jahrzehnten zu einem stetig verbesserten Langzeitüberleben und einer steigenden Lebensqualität [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Chronische periprothetische Infektionen werden häufig mit einem zweizeitigen Wechsel unter Verwendung eines Knochenzementspacers behandelt. Trotz des mehrzeitigen Vorgehens werden Reinfektionsraten von teils über 20% abhängig von patientenseitigen, prothesenabhängigen [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Der konservative und operative Containmenterhalt in der Frühphase des M. Perthes folgt einem bereits seit vielen Jahren etablierten Schema. Zwar können dadurch bis zu 80% der kurz- und mittelfristigen Schäden therapiert werden [ref:1], bei ausgeprägter [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Die temporäre Hemiepiphysiodese (HED) ist ein anerkanntes Verfahren zur Wachstumslenkung bei Kindern mit Genu valgum und varum. Historisch wurde diese mittels Blount-Klammern (BK) gemacht. Heutzutage werden mehrheitlich 8-plates (8P) verwendet. Beide Implantate bieten Vorteile, zeigen [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Infektkontrolle und Extremitätenerhalt sind eine große Herausforderung bei infizierter Knieendoprothese und begleitendem Weichteildefekt, insbesondere bei wiederkehrenden Revisionen. Der Gastrocnemiusschwenklappen zusätzlich zum Prothesenwechsel stellt eine mögliche [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Radiation therapy (RT) for extremity soft tissue sarcoma is associated with lymphedema risk. In this study, we analyzed the influence of lymph-sparing volume on the lymphedema occurrence in patients who received adjuvant extremity RT. The lymph-sparing quotient (LSQ) was calculated by dividing the lymph-sparing volume by the total extremity volume with double weightingfor the narrowest lymph-sparing region. A total of 34 patients were enrolled in this analysis. The median applied total radiation dose was 66.3 Gy in 36 fractions. Acute lymphedema appeared in 12 patients (35%). Most of them (n = 8) were lymphedema grade 1 and five patients had grade 2 to 3 lymphedema. Chronic lymphedema appeared in 22 patients (65%). 17 of these patients had at least a grade 2 lymphedema. In 13 of 14 patients with an LSQ ≤ 0.2 and 11 of 20 patients with an LSQ &gt, 0.2, an acute or chronic lymphedema ≥ grade 2 was observed. A Kaplan–Meier Analysis of the two groups with the endpoint of a two-year lymph edema-free survival (=2-YLEFS) was estimated with an univariate, significant result (2-YLEFS LSQ ≤ 0.2 vs. LSQ &gt, 0.2: 0% vs. 39%, p = 0.006, hazard ratio LSQ ≤ 0.2 vs. &gt, 0.2 2-YLEFS 2.822 (p = 0.013), 95% confidence interval (CI): 1.24–6.42). Maximizing the potential oncologically-justifiable lymph-sparing volume should be considered to reduce the risk of high-grade lymphedema when applying RT to extremities.

The need for concomitant proximal fibular epiphysiodesis (PFE) when correcting leg length discrepancy (LLD) with temporary proximal tibial epiphysiodesis (PTE) in children is controversially discussed. This single center, retrospective cohort study analyzes proximal fibular growth in patients treated by PTE with and without concomitant PFE. Radiographic measurements were conducted before implantation and at implant removal. The position of the fibular head in relation to the tibia was assessed with recently established radiographic reference values. All patients (n = 58, 19 females) received PTE to treat LLD at a mean age of 12.2 years (range 7 to 15). In 27/58 (47%) concomitant PFE was performed. Mean follow-up was 36.2 months (range 14.2 to 78.0). The position of the proximal fibula at implant removal was within physiological range in 21/26 patients (81%) with PFE and in 21/30 patients (70%) without PFE. Proximal fibular overgrowth newly developed in 2/26 patients (8%) treated with PFE and in 5/30 patients (17%) treated without PFE (p = 0.431). Peroneal nerve injury or discomfort due to proximal fibular overlength was not reported. The position of the proximal fibula should be critically assessed preoperatively under consideration of reference values before PTE. In consequence of this study, the authors do not routinely perform PFE concomitantly with PTE for correction of moderate LLD in children if the proximal fibula is localized within physiological radiographic margins determined by the established reference values., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Background and purpose — Temporary hemiepiphysiodesis for growth modulation in skeletally immature patients is a long-known technique. Recently the use of tension-band devices has become popular. This study compares 2 tensionband implants (eight-Plate and FlexTack) regarding their effects on the growth plate. Animals and methods — 12 pigs in 2 equally sized groups (A and B) were investigated. The right proximal medial tibia was treated with either eight-Plate or FlexTack. The left tibia of the same pig was treated with the opposite implant. After 9 weeks all implants were removed. Animals in group B were then hosted for another 5 weeks. Histomorphometric analysis of the growth plate was carried out after 9 and 14 weeks, respectively. Radiographs were taken at implantation, removal, and after 14 weeks. Results — Both tension-band devices achieved a statis- tically significant and clinically relevant growth inhibition, whereas the effect appeared to be more distinct after the use of FlexTack. Implant-related complications or physeal damage was not observed. After implant removal, rebound phenomenon was radiologically observed in all cases. The growth plates treated with eight-Plate showed a paradox reversal of the zonal distributions, with an increase of the proliferative zones at the previously arrested medial aspect of the physis and a decrease laterally. Interpretation — Both eight-Plate and FlexTack proved to be appropriate devices for growth-guiding treatment. The radiographic evaluation showed a change in angular axes after treatment with each implant, while the correction appeared to be faster with FlexTack. The paradox cartilaginous reaction observed after removal of the eight-Plate might be a histopathological correlate for rebound phenomenon., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

The accurate preoperative diagnosis of periprosthetic joint infection (PJI) of total knee arthroplasty (TKA) can be difficult despite the use of a combination of serum and synovial markers. In such inconclusive cases, incisional open biopsy might be considered. This study investigates the usefulness of biopsies in patients with inconclusive diagnostic findings. We retrospectively identified 63 patients who underwent incisional biopsy for chronic PJI in the operation theatre following TKA revision between 2010 and 2018 after inconclusive preoperative diagnostics for PJI. In all cases, 5 independent biopsies were taken. Results from open biopsy for PJI were analyzed for diagnostic accuracy using the intraoperative results from following revision surgery as gold standard. 27 patients (43%) had a positive culture taken during biopsy. 15 cases (24%) met the diagnostic criteria for a chronic PJI. Most common organisms were Coagulase-negative staphylococci (67%) and 'Cutibacterium acnes' (30%). Compared to the findings during revision surgery, biopsies showed a sensitivity of 47% and a specificity of 77% for PJI. Open incisional biopsy following inconclusive serum- and synovial diagnostics for low grade PJI may be considered for identification of microorganisms. Due to its low sensitivity and moderate specificity found in the present cohort, microbiological analysis should be combined with additional diagnostic markers and histological investigation., Finanziert über die DEAL-Vereinbarung mit Wiley 2019-2022.

Wide tumor resection is the local treatment of choice for patients with primary malignant bone tumors and a prerequisite for long-term survival. We present two patients that underwent total bone resection in the upper limb because of primary malignant bone tumors. The defects were then reconstructed by a 3D printed prosthesis, a procedure that, to our knowledge, has not been reported for bone defects of the upper extremity so far. Complete resection of the affected bone was required in a five-year-old girl with a high-grade osteoblastic osteosarcoma of the humerus and a 53-year-old man with a dedifferentiated leiomyosarcoma of the radius, due to the tumor’s extent. Following neoadjuvant chemotherapy, resection of the entire affected humerus including the axillary nerve took place in the first case and the entire affected radius including parts of the radial nerve in the second case. Approximately three years after surgery, both patients are alive and pain-free. Despite a postoperative drop hand that affected the now 56-year-old man, he is able to carry out everyday activities such as brushing his teeth, writing, and eating. The now eight-year-old girl is also able to engage in normal activities with her left arm such as eating and carrying lightweight objects. Both patients are tumor-free to date., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Background and purpose — To date there is a lack of studies defining the anatomical position of the proximal fibula. This is especially relevant when planning surgical interventions affecting the knee joint such as permanent or temporary epiphysiodesis to correct leg length discrepancies or angular deformities in growing patients. The goal of this study is to establish a standardized measurement technique and radiological reference values for the position of the proximal fibula in children. Patients and methods — 500 measurements were performed in calibrated long standing anteroposterior radiographs of 256 skeletally immature patients (8–16 years; 233 female, 267 male legs). As a radiographic reference in the frontal plane, the distance between the center of the proximal tibial growth plate and a line tangential to the tip of the fibular head and horizontal to the imaging plane was measured (dPTFH). Results — The average value of dPTFH in the studied population (median age 12 years) was –2.7 mm (SD 3, CI –3.0 to –2.5) and normally distributed (p = 0.1). There were no clinically significant sex or age-dependent differences. The inter-rater reliability analysis showed excellent ICC values (ICC = 0.88; CI 0.77–0.93). Interpretation — This study provides a new radiographic reference value to assess the position of the proximal fibula in relation to the proximal tibia in children and adolescents. This reference can aid preoperative decision-making as to whether additional fibular epiphysiodesis is necessary when performing tibial epiphysiodesis to correct moderate leglength discrepancies., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Background: Objective sensor-based quantification of sedentary behavior is an important tool for planning and evaluating interventions for excessive sedentary behavior in patients with musculoskeletal diseases. Although waist-worn accelerometers are the standard for physical activity (PA) assessment, only thigh-worn inclinometers can clearly distinguish sedentary behavior from any light PA or standing activity. Methods: In this study, 53 adults (ages 20–85 years) wore two ActiGraph wGT3X-BT monitors, each containing an inclinometer and accelerometer (set for acquisition of slow movements in all three planes), attached to the right waist and thigh for a period of about 4 days. Both monitors recorded total sedentary time and continuous sedentary 10-min bouts by synchronous accelerometry and inclinometry. Differences and correlations between methods and wearing positions were evaluated against participant age, body mass index (BMI), and number of steps taken. Thigh-worn inclinometry was used as reference. Results: Data from thigh-worn inclinometry and waist-worn accelerometry were highly correlated for total sedentary time [rho = 0.888; intraclass correlation coefficient (ICC) = 0.937] and time in sedentary bouts (rho = 0.818; ICC = 0.848). Nevertheless, accelerometry at the waist underestimated sedentary time by ≈17% (p, Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Megaprosthetic reconstruction of segmental bone defects following sarcoma resection is a frequently chosen surgical approach in orthopedic oncology. While the use of megaprostheses has gained popularity over the last decades and such implants are increasingly used for metastatic reconstructions and in non-tumor cases, there still is a high risk of long-term complications leading to revision surgery. This article investigates current implant survivorship, frequency and types of complications as well as functional outcomes of upper and lower limb megaprosthetic reconstructions., Simple Summary: Malignant bone and soft tissue tumors are usually surgically removed with an envelope of healthy tissue as a barrier. If located in the long bones of the upper and lower extremity, this approach leads to a large bone defect commonly affecting a joint. One way to rebuild the bone defect and the neighboring joint is the use of a megaprosthesis that is anchored in the remaining bone comparable to a conventional joint replacement. In general this approach is popular as it provides early stability and allows the affected patient to begin rehabilitation early on. However, complications leading to long-term unplanned reoperation are common. This article provides an overview of current implant survival, types of complication and long-term outcomes of megaprostheses used following tumor resection., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Background and purpose — Facemasks play a role in preventing the respiratory spread of SARS-CoV-2, but their impact on the physician–patient relationship in the orthopedic outpatient clinic is unclear. We investigated whether the type of surgeons’ facemask impacts patients’ perception of the physician–patient relationship, influences their understanding of what the surgeon said, or affects their perceived empathy. Patients and methods — All patients with an appointment in the orthopedic outpatient clinic of a tertiary university hospital during the 2-week study period were included. During consultations, all surgeons wore a non-transparent (first study week) or transparent facemask (second study week). Results of 285 of 407 eligible patients were available for analysis. The doctor–patient relationship was evaluated using the standardized Patient Reactions Assessment (PRA) and a 10-point Likert-scale questionnaire ranging from 0 (strongly disagree) to 10 (strongly agree). Results — A non-transparent facemask led to more restrictions in the physician–patient communication and a worse understanding of what the surgeon said. Patients’ understanding improved with a transparent facemask with greatest improvements reported by patients aged 65 years and older (non-transparent: 6 [IQR 5–10] vs. transparent: 10 [IQR 9–10], p < 0.001) and by patients with a self-reported hearing impairment (non-transparent: 7 [IQR 3–7] vs. transparent: 9 [IQR 9–10], p < 0.001). The median PRA score was higher when surgeons wore a transparent facemask (p= 0.003). Interpretation — Surgeons’ non-transparent facemasks pose a new communication barrier that can negatively affect the physician–patient relationship. While emotional factors like affectivity and empathy seem to be less affected overall, the physician–patient communication and patients’ understanding of what the surgeon said seem to be negatively affected., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Fragestellung: Chondroblastome sind seltene gutartige knorpelzellhaltige Knochentumoren und stellen 1-2% aller gutartigen primären Knochentumore dar. Sie sind durch lokal aggressives Wachstum, die Neigung zu Lokalrezidiven und in selten Fällen durch Metastasierung gekennzeichnet. Die [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Die bei Videospielen benötigten psychomotorischen und visuell-räumlichen Fähigkeiten können Schnittpunkte zu arthroskopischen Basisfähigkeiten sein und damit Möglichkeiten zum Erlernen und Trainieren arthroskopischer Operationen darstellen. Hypothese 1: [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Die Rekonstruktion des proximalen Humerus mittels modularer Tumorendoprothese ist eine Behandlungsoption nach Resektion bösartiger Knochentumoren. Ein radiologisches Phänomen nach dieser Versorgung ist das Auftreten von periimplantärem "Stress-Shielding" (SS) [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Die aneurysmatische Knochenzyste (AKZ) ist ein benigner, lokal aggressiver Knochentumordes Kindes- und Jugendalters. Sie betrifft in der Regel die Metaphyse der langen Röhrenknochen, kann aber auch an der Wirbelsäule oder am Becken auftreten. Verschiedene Therapieoptionen werden [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Objectives: Neglected hip dislocation (NHD) can either be of congenital origin or occur secondary due to septic arthritis (SA) or trauma. If the dislocation has been present for years, closed or open reduction is generally not feasible, mainly because of soft tissue contractures. Leg length discrepancy [for full text, please go to the a.m. URL]

Fragestellung: Mund-Nasen-Schutz-Masken spielen eine essentielle Rolle in der Eindämmung der respiratorischen Ausbreitung von SARS-CoV-2, ihr Einfluss auf die Arzt-Patienten-Kommunikation ist jedoch bislang unklar. Ziel dieser Studie war es, den Einfluss einer klassischen, nicht-transparenten Mund-Nasen-Schutz-Maske [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Nach Sarkomresektion und tumorprothetischer Rekonstruktion kommt es regelmäßig zu Erst-, aber auch Folgekomplikationen, insbesondere Infektionen. Unser Ziel war es, die Rolle der Operationsdauer als möglichen Risikofaktor für ein Prothesenversagen zu untersuchen. [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Intramedulläre Verlängerungsmarknägel (IMVN) sind eine etablierte Alternative zu externen Fixateuren bei der Behandlung von Längendifferenzen und Deformitäten der Beine. Die Kallusdistraktion mit den bisher verfügbaren IMVN erfordert während der Verlängerung [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Die Resektion und Rekonstruktion mittels modularer Tumorendoprothese ist eine mögliche Therapieoption bei Patienten mit Knochenmetastasen, insbesondere bei Patienten mit solitärer oder oligometastatischer Krankheitsmanifestation, bei pathologischer Fraktur oder bei fehlgeschlagener [zum vollständigen Text gelangen Sie über die oben angegebene URL]

We aimed to evaluate the functional outcome and endoprosthetic complications following the Bateman-type soft tissue reconstruction around proximal or total humeral replacements in patients undergoing resection of a primary malignant bone tumor. Between September 2001 and December 2018, a total of 102 patients underwent resection of a primary malignant bone tumor and subsequent reconstruction with a modular humeral megaprosthesis in our department. Fifteen (15%) of these patients underwent a Bateman-type soft tissue reconstruction and were included in this retrospective study. The median Musculoskeletal Tumor Society (MSTS) score was 21, the median Toronto Extremity Salvage Score (TESS) was 70, and the median American Shoulder and Elbow Surgeons (ASES) score was 72. Fifty-three percent (8/15) of all patients required a revision surgery after a median time of 6 months. There were 2 soft tissue failures, 3 infections and 3 tumor recurrences. The revision-free implant survivorship amounted to 53% (95% confidence interval (CI) 28–81) after 1 year and 47% (95% CI 22–73) at last follow-up. The Bateman-type reconstruction is a feasible option for soft tissue reconstruction but functional outcome is overall limited and the risk for revision surgery within the first postoperative year is high., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Introduction: The most common causative organism in periprosthetic joint infections (PJIs) is Gram-positive bacteria that are increasingly drug resistant. In these cases the use of linezolid may be warranted. However, there are conflicting reports regarding its role in antibiotic treatment of PJIs. The aim of this review is to gather and analyze clinical results and treatment details on linezolid in patients with PJIs. Methods: In August 2019, a comprehensive literature search using MEDLINE (Pubmed and Ovid) and Cochrane Library was performed. A total of 504 records were screened, and a total of 16 studies including 372 patients treated with linezolid for a PJI were included in this review based on the PRISMA criteria and after quality analysis using the MINOR score and Newcastle–Ottawa scale, as well as assessing level of evidence. Pooling analysis as well as descriptive analysis was performed. Results: Based on the results from the studies included, infection control was achieved in 80 % (range 30 %–100 %) of patients after a mean follow-up period of 25 (range 2–66) months. The mean duration of treatment was 58 d intravenous and orally at a median dose of 600 mg bis in die (b.i.d.) (range 400–900 b.i.d.). A combination therapy with rifampicin was used in 53 % of patients. MRSA (methicillin-resistant Staphylococcus aureus) infections were present in 29 % and resistant CoNS (coagulase-negative Staphylococcus) in 46 %. Adverse effects occurred in 33 % of cases, mostly anemia, thrombocytopenia and gastrointestinal complaints leading to treatment discontinuation in 9 %. However, great heterogeneity was found with respect to surgical treatment, diagnosis of infection and indication for linezolid. Discussion: Linezolid is an appropriate option for treatment of resistant Gram-positive organisms in PJIs. Most commonly 600 mg b.i.d. is used, and a combination with rifampicin appears feasible although one must consider individual increases in doses in these cases. However, adverse effects are common and there are limited data for long-term use and optimal antibiotic combinations or individual doses., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

BACKGROUND: Osteoarthritis (OA) is a frequent cause of pain and disability, affecting half of the world’s population aged 65 years or older. Due to experienced pain and limitations, OA patients generally spend most of their waking hours sedentary and fail to adhere to physical activity (PA) recommendations. As a result of living together with OA patients, their partners might adopt a sedentary lifestyle. This study investigates the change in habitual PA and sedentary behavior (SB) in patients and their partners one year after the patients’ total joint replacement (arthroplasty) and inpatient rehabilitation. METHODS: This is a follow-up of a prospective cohort study including 24 older couples (69.3± 7.8 years, gender ratio 11:13) consisting of OA patients (17 hip OA, 7 knee OA) and their partners. The participants’ habitual PA and SB were assessed by means of synchronous accelerometry (16h per day, 4– 7 days) and additional self-report. RESULTS: Although the partners (∼ 6300 steps per day) were significantly more active than the patients (∼ 4800 steps per day) before arthroplasty, their lifestyle was still classified “low active”. Irrespective of the method used, the PA and SB parameters of patients and partners were significantly correlated before arthroplasty (accelerometry: r≥ 0.333, p≤ 0.001; self-report: r≥ 0.569, p≤ 0.004). Following the patients’ arthroplasty, no improvement in PA or SB was observed either in the patients or their partners. A detailed evaluation of accelerometric data on hourly basis revealed no change in behavior for both groups. Furthermore, their everyday activities remained correlated (accelerometry: r≥ 0.418, p≤ 0.001; questionnaire: r≥ 0.554, p≤ 0.005). CONCLUSION: One year post-arthroplasty and inpatient rehabilitation neither the OA patients nor their partners had changed their PA or SB. Their everyday physical activity was still strongly intertwined. Further research is needed to determine why behavior change does not occur even though the prerequisites are in place., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Complications in megaprosthetic reconstruction following sarcoma resection are quite common. While several risk factors for failure have been explored, there is a scarcity of studies investigating the effect of the duration of surgery. We performed a retrospective study of 568 sarcoma patients that underwent megaprosthetic reconstruction between 1993 and 2015. Differences in the length of surgery and implant survival were assessed with the Kaplan–Meier method, the log-rank test and multivariate Cox regressions using an optimal cut-off value determined by receiver operating curves analysis using Youden’s index. 230 patients developed a first and 112 patients a subsequent prosthetic failure. The median duration of initial surgery was 210 min. Patients who developed a first failure had a longer duration of the initial surgery (225 vs. 205 min, p = 0.0001). There were no differences in the probability of infection between patients with longer and shorter duration of initial surgery (12% vs. 13% at 5 years, p = 0.492); however, the probability of mechanical failure was higher in patients with longer initial surgery (38% vs. 23% at 5 years, p = 0.006). The median length of revision surgery for the first megaprosthetic failure was 101 min. Patients who underwent first revision for infection and did not develop a second failure had a longer median duration of the first revision surgery (150 min vs. 120 min, p = 0.016). A shorter length of the initial surgery appears beneficial, however, the notion that longer operating time increases the risk of deep infection could not be reproduced in our study. In revision surgery for infection, a longer operating time, possibly indicating a more thorough debridement, appears to be associated with a lower risk for subsequent revision., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

D-dimer has been included in the criteria by the Musculoskeletal Infection Society in 2018 as a novel parameter to diagnose prosthetic joint infection (PJI). However, it is unclear how D-dimer levels change in between stages of a two-stage exchange. We prospectively investigated 30 patients who underwent a two-stage exchange using a spacer for PJI. D-Dimer, CRP and IL-6 were collected before first and second stage surgery and the difference (Δ) in between stages was calculated. The levels of plasma D-Dimer did not change from first to second stage surgery (2770 ng/ml (IQR, 1600–3770 ng/ml) versus 2340 ng/ml (IQR, 1270–4100 ng/ml); p = 0.8) while CRP (4.0 mg/dl (IQR, 1.7–5.5 mg/dl) versus 0.6 mg/dl (IQR, 0.5–0.8 mg/dl); p < 0.001) and IL-6 (21 pg/ml (IQR, 10–29 pg/ml) versus 6 pg/ml (4–9 pg/ml); p < 0.001) decreased. The ΔD-dimer between both stages was 300 ng/ml (range: − 2820 to 4280 ng/ml), the median ΔCRP was − 3.4 mg/dl (IQR, − 1.2 to − 4.8 mg/dl) and ΔIL-6 was − 13 pg/ml (IQR, − 4 to − 20 pg/ml). In 15 of 30 cases (50%) the D-dimer level increased between both stages, whereas the level of CRP (93%; 28/30) and IL-6 (96%; 28/29) decreased in most patients. As the level of serum D-dimers varies greatly, lacks a uniform decrease and does not identify persisting infection, surgeons should be cautious when using it at the timing of reimplantation., Finanziert über die DEAL-Vereinbarung mit Wiley 2019-2022.

The aim of this study was to evaluate the functional outcome of primary anterior cruciate ligament (ACL) repair using suture augmentation (SA) in 93 consecutive patients (67 female) with a minimum follow-up of 12 months. Patients&rsquo, outcomes were determined using International Knee Documentation Committee (IKDC) score, Lysholm score (LS) and Tegner score (TS). Knee-laxity was assessed using the KT-1000 arthrometer. Eighty-eight patients (67 female, mean age 42 years &plusmn, standard deviation (SD) 13) were available for follow-up after a mean time of 21 months (range 12&ndash, 39). Three patients (3%) underwent revision surgery and were excluded from functional analysis. The mean IKDC score was 87.4 &plusmn, 11, mean LS was 92.6 &plusmn, 11, mean pre-traumatic TS was 6 &plusmn, 2 and mean postoperative TS was 6 &plusmn, 2, with a mean difference (TSDiff) of 1 &plusmn, 1. The interval from injury to surgery had no significant impact on the postoperative IKDC (p = 0.228), LS (p = 0.377) and TSDiff (p = 0.572). Patients&rsquo, age (&gt, 40 years), BMI (&gt, 30) and coexisting ligament or meniscal injuries did not seem to influence postoperative functional results. Primary ACL repair using SA provides good to excellent functional outcomes with a low probability of revision surgery at a minimum of 12 months.

We present the case of a 55-year-old female patient with metamizole-induced agranulocytosis after total knee arthroplasty, leading to septic periprosthetic joint infections (PJIs). Owing to metamizole-induced agranulocytosis, the synovial leukocyte count was negative. Here, we discuss the diagnostic challenges evolving from sepsis and neutropenia in patients with suspected PJIs. We suggest an urgent surgical approach, mainly focusing on the clinical presentation preoperatively. Later, our patient developed candidemia and periprosthetic tissue samples were positive for Candida albicans. For fungal PJIs, long-term follow-up studies are lacking and therapeutic recommendations differ. Here, we present our therapeutic approach, including staged revision and 12 weeks of systemic antifungal therapy, and discuss recent findings regarding the therapy of fungal PJIs., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).

Background and purpose — Motorized intramedullary lengthening nails (ILNs) have been developed as an alter- native to external fixators for long bone lengthening. The antegrade approach represents the standard method for tibial ILN insertion. In patients with preexisting ankle and hindfoot fusion a retrograde approach provides an alternative technique that has not been evaluated so far. We report the outcome of this method in 10 patients. Patients and methods — This retrospective study included 10 patients (mean age 18 years [13–25]) with preexisting ankle and hindfoot fusion who underwent tibial lengthening with a retrograde ILN (PRECICE). The mean leg length discrepancy (LLD) was 58 mm (36–80). The underlying conditions were congenital (n = 9) and post tumor resection (n = 1). The main outcome measures were: ILN reliability, distraction achieved, distraction index (DIX), time to bone healing, consolidation index (CIX), complications, and functional results. Results — All patients achieved the goal of lengthening (mean 48 mm [26–80]). Average DIX was 0.6 mm/day (0.5– 0.7) and mean CIX was 44 days/cm (26–60). Delayed consolidation occurred in 2 patients and healed after ILN dynam- ization or nail exchange with grafting. Toe contractures in 2 other patients were resolved with physiotherapy or tenotomy. Until last follow-up (mean 18 months [12–30]) no true complications were encountered, knee motion remained unaffected, and full osseous consolidation occurred in all patients. Interpretation — In patients with LLD and preexisting ankle and hindfoot fusion distal tibial lengthening using a retrograde ILN is a reliable alternative to the standard approach with equivalent bone healing potential and low complication rates leaving the knee unaffected., Finanziert durch den Open-Access-Publikationsfonds der Westfälischen Wilhelms-Universität Münster (WWU Münster).