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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.

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. Cite this article: Bone Joint Res 2021;10(7):425–436.

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: Patient-reported outcome measures are gaining increasing importance in clinical research and quality control. Clinical impairment through limb deformities can appear in various forms. This study aimed at translating and culturally adaptating the Limb Deformity-Scoliosis Research Society (LD-SRS) patient-reported outcome measure (PROM) into German by following the scientific rigor of the cross-cultural adaptation process as well as ensuring the reliability of the translated version. The LD-SRS is applicable in children and adults. Methods: The translation was performed in accordance with the creators of the LD-SRS following the Professional Society for Health Economics and Outcomes Research (ISPOR) guidelines for translation and cultural adaptation. Two forward translations were performed, and after a consensus meeting, a professional translator translated the PROM back to English. The creators reviewed the back translation of the preliminary German version. Thirty patients with upper and lower limb deformities participated in cognitive debriefing interviews. The version was proofread and, finally, the test-retest reliability was estimated. Results: The mean age was 19 years (range 6–61). Twenty-six patients (87%) completed the retest after 6 days (range 3–26). The internal consistency was estimated with a Cronbach’s alpha of 0.96 (range 0.94–0.97), and the intraclass correlation was 0.92 (range 0.89–0.94), indicating an excellent reliability. The scores were normally distributed. Thereafter, the German version was proofread and finalized. Conclusions: The German translation and cross-cultural adaptation of the LD-SRS score resulted in a high reliability and internal consistency. The German LD-SRS score is readily usable and may be applied in future studies of German-speaking limb deformity patients., 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).

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).

Tobias Kalisch,1 Frank Horst,2 Georg Gosheger,1 Christoph Theil,1 Leonie Seeber,1 Burkhard Moellenbeck1 1Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, 48149, Germany; 2Department of Orthopedics and Traumatology, St. Josef-Stift Sendenhorst, Sendenhorst, 48324, GermanyCorrespondence: Tobias KalischDepartment of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, Muenster, 48149, NRW, GermanyTel +49 251 8347984Email tobias.kalisch@ukmuenster.deBackground: 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.Keywords: osteoarthritis, dyads, physical activity, sedentary behavior, arthroplasty

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).