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We reviewed 80 patients (87 hips) who were older than 80 years of age at the time of cementless t... more We reviewed 80 patients (87 hips) who were older than 80 years of age at the time of cementless total hip arthroplasty. An Alloclassic SL stem had been implanted in all patients. A variety of cementless acetabular components was used. After a mean follow-up of 69.3 months (39.2 to 94.1) 48 hips in 43 patients were analysed clinically and radiologically. One patient had sustained a traumatic periprosthetic fracture of the femur with subsequent exchange of the stem 73 months after operation. Thirty-two patients (34 hips) had died and five patients (five hips) were unavailable for follow-up because of health reasons (four patients) or lack of co-operation (one patient). If the endpoint is defined as removal of the prosthesis because of aseptic loosening, the survival rate was 100% for the cup and stem after 78 months. The mean Harris hip score was 81.9 points. Radiolucent lines and osteolysis were seldom found.
Zeitschrift für Orthopädie
Since 1981, annual four-week holidays have been arranged for children with juvenile rheumatic art... more Since 1981, annual four-week holidays have been arranged for children with juvenile rheumatic arthritis, during which the children are cared for by a team of pediatricians, orthopedists, ergotherapists, physiotherapists and assistants trained in psychology. With systematic splint therapy, physiotherapy, and by enhancing drug awareness during these therapeutic holidays significant improvements in joint mobility and subjective wellbeing were achieved. Of the 103 children treated (209 places were available), the majority spent several holidays, with a resulting improvement in joint mobility lasting several years. Through systematic training, adaptation to splints, and physiotherapy acceptance was also enhanced, with a preventive effect for the rest of the year. The success of these measures has encouraged the authors to continue the project.
Zeitschrift für Orthopädie
The efficacy of low energy extracorporeal shock wave treatment (ESWT) for chronic plantar fasciit... more The efficacy of low energy extracorporeal shock wave treatment (ESWT) for chronic plantar fasciitis is discussed controversially. It is unclear whether the simultaneous application of local anesthesia (LA) interferes with clinical outcome. 60 patients with a chronic plantar fasciitis were enrolled in a triple-arm (20 patients per group), prospective randomized and observer-blinded pilot trial. The patients were randomly assigned to receive either active ESWT without LA (;3 x 1 500 shocks, total energy flux density [EFD] per shock 0.09 mJ/mm(2) [Group A]), ESWT with LA (3 x 1 500 shocks, EFD 0.18 mJ/mm(2) per shock [Group B]) or ESWT with LA (3 x 1 500 shocks, EFD 0.09 mJ/mm(2) [Group C]). Main outcome measures were: pain during first stepps in the morning (measured on a 0-10 point visual analogue scale) and number of patients with > 50 % reduction of pain and no further therapy needed, measured at 6 weeks after the last ESWT. Group A improved in the VAS from 6.4 (SD: 1.7) to 2.2 (SD: 2.6) points, group B from 6.7 (SD: 1.5) to 4.1 (SD: 2.4) points, group C from 6.2 (SD: 1.6) to 3.8 (SD: 2.5) points. A reduction of pain of at least 50 % was achieved in 60 % of group A, in 36 % of group B and in 30 % of group C. Group A without LA showed a significantly higher improvement in the VAS and subjective evaluation than groups B (p = 0.007) and C (p = 0.016). At 6 weeks success rates after low-energy ESWT with local anesthesia were significantly lower than after identical low-energy ESWT without local anesthesia. Higher energy levels could not balance the disadvantage of this effect. LA significantly influenced the clinical results after low energy ESWT in a negative way. Blinding patients by LA in ESWT studies must therefore be considered a systematic error in study design.
Zeitschrift für Orthopädie
The radiological appearance of the cementless ALLOCLASSIC SL-stem, implanted in patients with pri... more The radiological appearance of the cementless ALLOCLASSIC SL-stem, implanted in patients with primary osteoarthritis of the hip and aged at least 80 years at time of surgery, was investigated. 66 hips in 58 patients were analysed. 17 patients (19 hips) died in the interim, 5 patients (5 hips) were not available for follow-up because of health reasons (4) or lack of co-operation (1). 1 stem had to be explanted after a periprosthetic fracture of the femur. Finally, 41 total hip arthroplasties in 35 patients could be analysed after an average of 67.9 months (39.2-93.4). Bone atrophy - especially in the proximal Gruen zones - was frequently found. In contrast, radiolucent lines and osteolyses were rare occurrences. The Harris Hip score was preoperatively on average 33.0 points, at time of follow-up 81.7 points. The survival rate (endpoint aseptic loosening) was 100 % after a mean follow-up of 5.7 years. Also in very old patients the implantation of a cementless stem is possible and provides very good results.
Monatsschrift für Unfallheilkunde
Aktuelle Gerontologie
We evaluated the effect of a 6 months trial with synthetic human calcitonin in 10 symptomatic pat... more We evaluated the effect of a 6 months trial with synthetic human calcitonin in 10 symptomatic patients with polyosseous Paget's disease of bone. All patients reported a distinct clinical improvement which correlated with a significant decrease of alkaline phosphatase in the plasma and hydroxyproline and calcium excretion in the urine. Though no changes in skeletal x-rays were observed, the bone lesions showed a significant decrease of activity in tho bone scintigrams. Histologically there was a marked decrease of bone turn-over calcitonin therapy. No patient revealed the formation of autoantibodies against exogenous calcitonin after treatment.
Zeitschrift fur Orthopadie und Unfallchirurgie
Zeitschrift für Orthopädie
There is a difference in the use of redon drainage following hip arthroplasty worldwide. The aim ... more There is a difference in the use of redon drainage following hip arthroplasty worldwide. The aim of the study was to find the best version. In a prospective randomized study including 158 patients with coxarthrosis we implanted cementless Alloclassic hip-endoprostheses and registered consumption of blood, blood loss, hemoglobin level, subcutaneuos hematoma, swelling of the proximal thigh, bleeding and exsudation of the wound in four groups supplied with three, two (subcutaneously and subfascial) and one (subcutaneously or subfascial) drainage with compression bandage and one group with two redons (subcutaneously and subfascial) without compression bandage. For prophylaxis of deep vein thrombosis we used low dose heparin. We could demonstrate, that the application of two redons one subcutaneously and one subfascial gave the best result. Compared to the conventional procedure with three redons we achieved a reduction of 47% of blood units, a significant reduction of exsudation and ble...
Zeitschrift für Orthopädie, 2005
Zeitschrift für Orthopädie, 2004
Zeitschrift für Orthopädie und Unfallchirurgie, 1998
European Instructional Lectures, 2009
ABSTRACT National Arthroplasty Registers in Scandinavia have proved to be an important and valid ... more ABSTRACT National Arthroplasty Registers in Scandinavia have proved to be an important and valid instrument to assess the long-term performance of joint arthroplasty procedures and to lead to an improvement in the long-term outcome of arthro-plasty [1–8]. Improved quality of joint arthroplasty effects a reduction of costs in public health care by avoiding revision surgery [9]. Starting with the Swedish National Knee Register (Lund, 1975) [10] and the Swedish National Hip Register (Gothenburg, 1979) they have had a high impact on Orthopaedic procedures in Scandinavia and worldwide. In Sweden, for instance, the revision burden as an essential indicator could be substantially reduced. Due to data in the register, products with inferior performance such as Boneloc bone cement were rapidly detected [11]. The product was taken from the market wordwide in 1995. Moreover, the effects of procedures such as the mini-invasive approach, of operating experience [12] or the administration of antibiotics could be evaluated and, as a consequence, standardised improvements could be suggested.
Fortbildung Orthopädie · Traumatologie, 2005
Zeitschrift für Orthopädie und Unfallchirurgie
In Scandinavia national arthroplasty registers are accepted instruments in the assessment of join... more In Scandinavia national arthroplasty registers are accepted instruments in the assessment of joint implants. They have contributed essentially to the rapid detection of inferior products and, by encouraging a continuous process of quality improvement through feedback, have helped to avoid revision operations. However, national registers have a limited significance with regard to other countries and rarely used implants. In recent years, a great number of registers have been founded. The European Arthroplasty Register (EAR), an EFORT project, aims at supporting these projects, enhancing cooperation within a network, realising further benefit through registers, and fostering scientific activities. The registers have been conceived according to the successful Scandinavian model. It is, however, necessary to adapt the concept to the individual national circumstances. In order to increase the value of register publications for other countries, it makes sense to achieve a minimum of stard...
Der Orthopäde, 2003
Medial unicompartmental knee replacements have been used for more than 40 years. Due to increased... more Medial unicompartmental knee replacements have been used for more than 40 years. Due to increased experience in determining the indication for use and improvements in design of the prosthesis and tribology, the long-term results have now reached a high level. The advantages of these systems are less bone loss and better proprioception. The disadvantage is the risk of panarthrosis, which might be reduced by accurate indications for operations. Good indications are patients older than 60 years with normal weight and normal sports activity. Well-functioning collateral and cruciate ligaments are mandatory. Due to the fact that during implantation eversion of the patella is not necessary, a minimally invasive approach might be used. Overcorrection of the mechanical axis of the leg should be avoided. By observing these principles, very good long-term results can be achieved with medial unicompartmental arthroplasty. Better proprioception and better mobility of the knee are advantages of t...
Yonsei Medical Journal, 2013
We reviewed 80 patients (87 hips) who were older than 80 years of age at the time of cementless t... more We reviewed 80 patients (87 hips) who were older than 80 years of age at the time of cementless total hip arthroplasty. An Alloclassic SL stem had been implanted in all patients. A variety of cementless acetabular components was used. After a mean follow-up of 69.3 months (39.2 to 94.1) 48 hips in 43 patients were analysed clinically and radiologically. One patient had sustained a traumatic periprosthetic fracture of the femur with subsequent exchange of the stem 73 months after operation. Thirty-two patients (34 hips) had died and five patients (five hips) were unavailable for follow-up because of health reasons (four patients) or lack of co-operation (one patient). If the endpoint is defined as removal of the prosthesis because of aseptic loosening, the survival rate was 100% for the cup and stem after 78 months. The mean Harris hip score was 81.9 points. Radiolucent lines and osteolysis were seldom found.
Zeitschrift für Orthopädie
Since 1981, annual four-week holidays have been arranged for children with juvenile rheumatic art... more Since 1981, annual four-week holidays have been arranged for children with juvenile rheumatic arthritis, during which the children are cared for by a team of pediatricians, orthopedists, ergotherapists, physiotherapists and assistants trained in psychology. With systematic splint therapy, physiotherapy, and by enhancing drug awareness during these therapeutic holidays significant improvements in joint mobility and subjective wellbeing were achieved. Of the 103 children treated (209 places were available), the majority spent several holidays, with a resulting improvement in joint mobility lasting several years. Through systematic training, adaptation to splints, and physiotherapy acceptance was also enhanced, with a preventive effect for the rest of the year. The success of these measures has encouraged the authors to continue the project.
Zeitschrift für Orthopädie
The efficacy of low energy extracorporeal shock wave treatment (ESWT) for chronic plantar fasciit... more The efficacy of low energy extracorporeal shock wave treatment (ESWT) for chronic plantar fasciitis is discussed controversially. It is unclear whether the simultaneous application of local anesthesia (LA) interferes with clinical outcome. 60 patients with a chronic plantar fasciitis were enrolled in a triple-arm (20 patients per group), prospective randomized and observer-blinded pilot trial. The patients were randomly assigned to receive either active ESWT without LA (;3 x 1 500 shocks, total energy flux density [EFD] per shock 0.09 mJ/mm(2) [Group A]), ESWT with LA (3 x 1 500 shocks, EFD 0.18 mJ/mm(2) per shock [Group B]) or ESWT with LA (3 x 1 500 shocks, EFD 0.09 mJ/mm(2) [Group C]). Main outcome measures were: pain during first stepps in the morning (measured on a 0-10 point visual analogue scale) and number of patients with > 50 % reduction of pain and no further therapy needed, measured at 6 weeks after the last ESWT. Group A improved in the VAS from 6.4 (SD: 1.7) to 2.2 (SD: 2.6) points, group B from 6.7 (SD: 1.5) to 4.1 (SD: 2.4) points, group C from 6.2 (SD: 1.6) to 3.8 (SD: 2.5) points. A reduction of pain of at least 50 % was achieved in 60 % of group A, in 36 % of group B and in 30 % of group C. Group A without LA showed a significantly higher improvement in the VAS and subjective evaluation than groups B (p = 0.007) and C (p = 0.016). At 6 weeks success rates after low-energy ESWT with local anesthesia were significantly lower than after identical low-energy ESWT without local anesthesia. Higher energy levels could not balance the disadvantage of this effect. LA significantly influenced the clinical results after low energy ESWT in a negative way. Blinding patients by LA in ESWT studies must therefore be considered a systematic error in study design.
Zeitschrift für Orthopädie
The radiological appearance of the cementless ALLOCLASSIC SL-stem, implanted in patients with pri... more The radiological appearance of the cementless ALLOCLASSIC SL-stem, implanted in patients with primary osteoarthritis of the hip and aged at least 80 years at time of surgery, was investigated. 66 hips in 58 patients were analysed. 17 patients (19 hips) died in the interim, 5 patients (5 hips) were not available for follow-up because of health reasons (4) or lack of co-operation (1). 1 stem had to be explanted after a periprosthetic fracture of the femur. Finally, 41 total hip arthroplasties in 35 patients could be analysed after an average of 67.9 months (39.2-93.4). Bone atrophy - especially in the proximal Gruen zones - was frequently found. In contrast, radiolucent lines and osteolyses were rare occurrences. The Harris Hip score was preoperatively on average 33.0 points, at time of follow-up 81.7 points. The survival rate (endpoint aseptic loosening) was 100 % after a mean follow-up of 5.7 years. Also in very old patients the implantation of a cementless stem is possible and provides very good results.
Monatsschrift für Unfallheilkunde
Aktuelle Gerontologie
We evaluated the effect of a 6 months trial with synthetic human calcitonin in 10 symptomatic pat... more We evaluated the effect of a 6 months trial with synthetic human calcitonin in 10 symptomatic patients with polyosseous Paget's disease of bone. All patients reported a distinct clinical improvement which correlated with a significant decrease of alkaline phosphatase in the plasma and hydroxyproline and calcium excretion in the urine. Though no changes in skeletal x-rays were observed, the bone lesions showed a significant decrease of activity in tho bone scintigrams. Histologically there was a marked decrease of bone turn-over calcitonin therapy. No patient revealed the formation of autoantibodies against exogenous calcitonin after treatment.
Zeitschrift fur Orthopadie und Unfallchirurgie
Zeitschrift für Orthopädie
There is a difference in the use of redon drainage following hip arthroplasty worldwide. The aim ... more There is a difference in the use of redon drainage following hip arthroplasty worldwide. The aim of the study was to find the best version. In a prospective randomized study including 158 patients with coxarthrosis we implanted cementless Alloclassic hip-endoprostheses and registered consumption of blood, blood loss, hemoglobin level, subcutaneuos hematoma, swelling of the proximal thigh, bleeding and exsudation of the wound in four groups supplied with three, two (subcutaneously and subfascial) and one (subcutaneously or subfascial) drainage with compression bandage and one group with two redons (subcutaneously and subfascial) without compression bandage. For prophylaxis of deep vein thrombosis we used low dose heparin. We could demonstrate, that the application of two redons one subcutaneously and one subfascial gave the best result. Compared to the conventional procedure with three redons we achieved a reduction of 47% of blood units, a significant reduction of exsudation and ble...
Zeitschrift für Orthopädie, 2005
Zeitschrift für Orthopädie, 2004
Zeitschrift für Orthopädie und Unfallchirurgie, 1998
European Instructional Lectures, 2009
ABSTRACT National Arthroplasty Registers in Scandinavia have proved to be an important and valid ... more ABSTRACT National Arthroplasty Registers in Scandinavia have proved to be an important and valid instrument to assess the long-term performance of joint arthroplasty procedures and to lead to an improvement in the long-term outcome of arthro-plasty [1–8]. Improved quality of joint arthroplasty effects a reduction of costs in public health care by avoiding revision surgery [9]. Starting with the Swedish National Knee Register (Lund, 1975) [10] and the Swedish National Hip Register (Gothenburg, 1979) they have had a high impact on Orthopaedic procedures in Scandinavia and worldwide. In Sweden, for instance, the revision burden as an essential indicator could be substantially reduced. Due to data in the register, products with inferior performance such as Boneloc bone cement were rapidly detected [11]. The product was taken from the market wordwide in 1995. Moreover, the effects of procedures such as the mini-invasive approach, of operating experience [12] or the administration of antibiotics could be evaluated and, as a consequence, standardised improvements could be suggested.
Fortbildung Orthopädie · Traumatologie, 2005
Zeitschrift für Orthopädie und Unfallchirurgie
In Scandinavia national arthroplasty registers are accepted instruments in the assessment of join... more In Scandinavia national arthroplasty registers are accepted instruments in the assessment of joint implants. They have contributed essentially to the rapid detection of inferior products and, by encouraging a continuous process of quality improvement through feedback, have helped to avoid revision operations. However, national registers have a limited significance with regard to other countries and rarely used implants. In recent years, a great number of registers have been founded. The European Arthroplasty Register (EAR), an EFORT project, aims at supporting these projects, enhancing cooperation within a network, realising further benefit through registers, and fostering scientific activities. The registers have been conceived according to the successful Scandinavian model. It is, however, necessary to adapt the concept to the individual national circumstances. In order to increase the value of register publications for other countries, it makes sense to achieve a minimum of stard...
Der Orthopäde, 2003
Medial unicompartmental knee replacements have been used for more than 40 years. Due to increased... more Medial unicompartmental knee replacements have been used for more than 40 years. Due to increased experience in determining the indication for use and improvements in design of the prosthesis and tribology, the long-term results have now reached a high level. The advantages of these systems are less bone loss and better proprioception. The disadvantage is the risk of panarthrosis, which might be reduced by accurate indications for operations. Good indications are patients older than 60 years with normal weight and normal sports activity. Well-functioning collateral and cruciate ligaments are mandatory. Due to the fact that during implantation eversion of the patella is not necessary, a minimally invasive approach might be used. Overcorrection of the mechanical axis of the leg should be avoided. By observing these principles, very good long-term results can be achieved with medial unicompartmental arthroplasty. Better proprioception and better mobility of the knee are advantages of t...
Yonsei Medical Journal, 2013