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Objectives: Treatment of periprosthetic joint infections (PJIs) is based upon pathogen identification via microbiological culture. Empirical antimicrobial therapy is applied in culture-negative PJI. Treatment success is monitored via routine blood tests (CRP, leukocyte count) and clinical presentation. [for full text, please go to the a.m. URL]

Objectives: Intraoperative analgesia in patients undergoing periacetabular osteotomy (PAO) can be challenging due to the extensive approach and osteotomies associated with relevant pain. The aim of this study was to assess the effect of the transversus abdominis plane block (TAPb) on intraoperative [for full text, please go to the a.m. URL]

Objectives: Bone marrow (BM) is increasingly getting into focus in the course of investigating pathomechanisms of adverse effects related to periprosthetic inflammation induced by local exposure to particles released from arthroplasty implants. Particles released from cobalt-chromium-molybdenum (CoCrMo) [for full text, please go to the a.m. URL]

Fragestellung: Zur chirurgischen Therapie von Knorpelschäden des Kniegelenkes stehen verschiedene Operationsverfahren zur Verfügung. Gemäß aktueller Empfehlungen ist eine chirurgische Therapie insbesondere für begrenzte, traumatische Knorpelschäden empfohlen. Für Knorpeldefekte [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Hat die navigierte Implantation von Pedikelschrauben bei adoleszenter idiopathischer Skoliose (AIS) einen Vorteil gegenüber der Freihandtechnik? Um welchen Faktor erhöht sich die Strahlenbelastung und das Risiko zur Entwicklung sekundärer Malignome? Methodik: [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Fragestellung: Die Therapie symptomatischer irreparabler Rotatorenmanschettenrupturen (RMR) stellt eine Herausforderung dar. Neben einem arthroskopischen Debridement, einer Partialrekonstruktion, Muskeltransfers oder der Implantation einer inversen Prothese besteht seit einigen Jahren die Möglichkeit [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Hintergrund: Rückenschmerzen sind extrem häufig und bis zu 40% der Patienten die damit konsultieren erhalten eine Bildgebung. Querschnittsstudien zeigen nur einen geringen Zusammenhang zwischen Befunden in der Magnetresonanztomographie (MRT) der Wirbelsäule und Rückenschmerzen. [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Background: periacetabular osteotomy (PAO) is known as the gold standard surgical treatment in young adults with symptomatic hip dysplasia. With the aim of reducing soft tissue trauma, we developed a new rectus and sartorius sparing (RASS) approach. We hypothesized that this new PAO technique was equal regarding acetabular reorientation, complication rate, and short-term clinical outcome parameters, compared to our conventional, rectus sparing (RS) approach. Patients and Methods: we retrospectively assessed all PAO procedures performed by a single surgeon between 2016 and 2019 (n = 239 hips in 217 patients). The cases in which the new RASS technique were used (n = 48) were compared to the RS cases for acetabular orientation parameters, surgical time, perioperative reduction of hemoglobin level, and length of hospital stay (LOHS). Inclusion criteria were a lateral center-edge angle (LCEA) &lt, 25° and osteoarthritis Tönnis grade ≤1. Patients with acetabular retroversion or additional femoral osteotomy were excluded. Results: the mean patient age at the time of surgery was 29 years (14 to 50, SD ± 8.5). Females accounted for 79.5% in this series. The mean preoperative LCEA were 16° (7 to 24°, SD ± 4.4) and 15° (0 to 23°, SD ± 6) in the RASS and the RS group, respectively (p = 0.96). The mean preoperative acetabular index (AI) angles were 14° (2 to 25°, SD ± 4) and 14° (7 to 29°, SD ± 4.3), respectively (p = 0.67). The mean postoperative LCEA were significantly improved to 31° (25 to 37°, SD ± 3.5, p &lt, 0.001) and 30.2° (20 to 38°, SD ± 4, p &lt, 0.001), respectively. The mean postoperative AI angles improved to 2.8° (−3 to 13°, SD ± 3.3, p &lt, 0.001) and 3° (−2 to 15°, SD ± 3.3, p &lt, 0.001), respectively. There were no significant differences between the RASS and the RS group for surgical time, perioperative reduction in hemoglobin level, and LOHS. No blood transfusions were necessary perioperatively in either group. No major perioperative complication occurred in either group. We observed one surgical site infection (SSI) requiring superficial debridement in the RS group. Conclusion: the RASS approach for PAO showed to be a safe procedure with equivalent acetabular reorientation and equivalent clinical outcome parameters compared to the RS approach. Additionally, patients have fewer postoperative restrictions in mobilization with the RASS approach.

Background: Patients undergoing periacetabular osteotomy (PAO) may experience significant postoperative pain due to the extensive approach and multiple osteotomies. The aim of this study was to assess the efficacy of the transversus abdominis plane (TAP) block on reducing opioid consumption and improving clinical outcome in PAO patients. Patients and Methods: We conducted a two-group randomized-controlled trial in 42 consecutive patients undergoing a PAO for symptomatic developmental dysplasia of the hip (DDH). The study group received an ultrasound-guided TAP block with 20 mL of 0.75% ropivacaine prior to surgery. The control group did not receive a TAP block. All patients received a multimodal analgesia with nonsteroidal anti-inflammatory drugs (NSAID) (etoricoxib and metamizole) and an intravenous patient-controlled analgesia (PCA) with piritramide (1.5 mg bolus, 10 min lockout-time). The primary endpoint was opioid consumption within 48 h after surgery. Secondary endpoints were pain scores, assessment of postoperative nausea and vomiting (PONV), measurement of the quality of recovery using patient-reported outcome measure and length of hospital stay. Forty-one patients (n = 21 TAP block group, n = 20 control group) completed the study, per protocol. One patient was lost to follow-up. Thirty-three were women (88.5%) and eight men (19.5%). The mean age at the time of surgery was 28 years (18&ndash, 43, SD &plusmn, 7.4). All TAP blocks were performed by an experienced senior anaesthesiologist and all operations were performed by a single, high volume surgeon. Results: The opioid consumption in the TAP block group was significantly lower compared to the control group at 6 (3 mg &plusmn, 2.8 vs. 10.8 mg &plusmn, 5.6, p &lt, 0.0001), 24 (18.4 &plusmn, 16.2 vs. 30.8 &plusmn, 16.4, p = 0.01) and 48 h (29.1 mg &plusmn, 30.7 vs. 54.7 &plusmn, 29.6, p = 0.04) after surgery. Pain scores were significantly reduced in the TAP block group at 24 h after surgery. There were no other differences in secondary outcome parameters. No perioperative complication occurred in either group. Conclusion: Ultrasound-guided TAP block significantly reduces the perioperative opioid consumption in patients undergoing PAO.

(1) Background: Degeneration of the hip abductor mechanism, a well-known cause of functional limitation, is difficult to treat and is associated with a reduced health-related quality of life (HRQOL). The gluteus maximus muscle flap is a treatment option to support a severely degenerative modified gluteus medius muscle. Although several reports exist on the clinical outcome, there remains a gap in the literature regarding HRQOL in conjunction with functional results. (2) Methods: The present study consists of 18 patients with a mean age of 64 (53‒79) years, operatively treated with a gluteus maximus flap due to chronic gluteal deficiency. Fifteen (83%) of these patients presented a history of total hip arthroplasty or revision arthroplasty. Pre and postoperative pain, Trendelenburg sign, internal rotation lag sign, trochanteric pain syndrome, the Harris Hip Score (HHS), and abduction strength after Janda (0‒5) were evaluated. Postoperative patient satisfaction and health-related quality of life, according to the Short Form 36 (SF-36), were used as patient-reported outcome measurements (PROMs). Postoperative MRI scans were performed in 13 cases (72%). (3) Results: Local pain decreased from NRS 6.1 (0&ndash, 10) to 4.9 (0&ndash, 8) and 44% presented with a negative Trendelenburg sign postoperatively. The overall HHS results (p = 0.42) and muscular abduction strength (p = 0.32) increased without significance. The postoperative HRQOL reached 46.8 points (31.3&ndash, 62.6) for the mental component score and 37.1 points (26.9&ndash, 54.7) for the physical component score. The physical component results presented a high level of positive correlation with HHS scores postoperatively (R = 0.88, p &lt, 0.001). Moreover, 72% reported that they would undergo the operative treatment again. The MRI overall showed no significant further loss of muscle volume and no further degeneration of muscular tissue. (4) Conclusions: Along with fair functional results, the patients treated with a gluteus maximus flap transfer presented satisfying long-term PROMs. Given this condition, the gluteus maximus muscle flap transfer is a viable option for selected patients with chronic gluteal deficiency.