Marienhospital Arnsberg

Restoring stability after total knee arthroplasty (TKA) and improving joint function using acemented rotating hinge system. Ligament instability and/or osseous defects (including Anderson Orthopaedic Research Institute [AORI] classification typeII defects) after primary TKA or TKA revision surgery. Distal femoral or proximal tibial bowing requiring implant systems that provide femoral or tibial offset stems. Persistent periprosthetic infection. Poor therapeutic compliance. AORI typeIII defects. Medial arthrotomy. Femoral and tibial component removal with small saw blades and chisels. Intramedullary alignment for the tibial and femoral cuts. Debridement and removal of membranes and cement remnants. Reconstruction of joint line and correct TKA alignment. Trial reduction. Cement fixation. Unrestricted range of motion, partial weight bearing for 4weeks. Between 2012 and 2013, 18patients suffering from ligament insufficiency after TKA were revised using the described system and included in aprospective study protocol. The mean follow-up was 37months (range 30-46months). There was asignificant improvement of the Oxford Knee Score (OKS) from 19 (range 7-29) preoperatively to 29 (range 10-45) postoperatively (p = 0.004). The Knee Society Score (KSS) knee assessment subscore improved from 35 (range 9-70) to 67 (range 35-97) (p = 0.002) and the pain score from 7 (range 0-50) to 24 (range 0-50) (p = 0.008).

Survivorship and survival rate of shoulder prostheses can be affected by a large number of possible complications. An evaluation of the current literature and the prosthesis register, however, shows an overall low revision (1.39 revisions per 100 observation years) and loosening rates (implant-related 10-year survival rate up to 99%), comparable to that of hip and knee endoprostheses. It must be emphasized that cementless stems more often cause problems than cemented components (4.34 compared to 0.77 revisions per 100 observation years) and that secondary rotator cuff rupture (4.6%; functional deficit up to 30%) occurs more frequently than was generally assumed and is often not diagnosed or treated adequately. The infection rate amounts to approximately 1% and according to latest literature the dislocation rate is regressive and is estimated to be approximately 5%.The low complication and revision rates do not justify the replacement of stemmed prostheses by stemless implants and short stem prostheses and the preference given to the new implants is attributed more to the better revision possibilities and easier convertibility into inverse prostheses.

Under the supposition that retrovirus is inactivated by heating at 56 degrees C, we explored what time was necessary to reach 65 degrees C as a central temperature in a femoral head by heating (14 femoral heads). We found that at a stove temperature of 85 degrees C and a femoral head volume of 81 ml the average central temperature was 66.1 degrees C after 1 hour. After 1.5 hours of heating a sufficient security should be guaranteed to avoid Aids-transmission by bone grafts.

In an eight years old boy we operated an intramedullary astrocytoma grade I and reimplanted the laminae C4-7 en bloc. A good stability was achieved. Ten years later only one segment remained intact, the others showing spontaneous fusion as a major draw back. This is possibly due to subperiostal dissection and bracing. No spinal stenosis occurred. An overuse of the remaining disc C4/5 might lead to a secondary degenerative stenosis. The operation is simple and might avoid swan neck deformity in children after large decompression of dorsal structures.

The bifurcate ligament is a central stabilizer of the carpus. It is the one of the structures concerned in chain of fibular injuries in supination traumas. Damage to the bifurcate ligament is often missed in clinical and radiological diagnosis. Hints are given on the mechanism of injury, staging and graded treatment of this ligamentous injury.

A total of 272 normal persons (109 men, 163 women) between the age of 14 and 84 years was studied for age, body weight, height, neck circumference and neck length. For evaluation of performance, a lifting test and an isometric extension force test showed sex- and age-specific differences in this group. A reliability test with two independent observers showed a good correlation of two consecutive measurements. The lifting test (PILE) and the isometric neck extension force test (IMPET) have been shown to be easy to administer, inexpensive and reliable. The data presented can be used as a data base for European persons for clinical research.