Orthopaedic Hospital Speising

Synovial fluid specific gravity (SG) was evaluated as a rapid, inexpensive test for periprosthetic joint infection (PJI) diagnosis in revision arthroplasties. High diagnostic accuracy (area under the curve 0.89; threshold 1.007) with high specificity (100 %) and moderate sensitivity (65 %) was found, supporting its use as an adjunctive point-of-care (POC) tool for PJI.

Existing classification systems for lateral clavicle fractures have low interobserver reliability and provide limited information for treatment decisions. The aim of this study was to introduce a new classification system and to evaluate its comprehensiveness, inter- and intraobserver reliability, and concordance of associated treatment strategy for lateral clavicle fractures compared with existing classifications. Four raters, all experienced in shoulder surgery, independently assessed routine radiographs of 100 patients with lateral clavicle fractures. They were asked to classify the fractures according to the Neer and Jäger/Breitner classification systems, as well as a new classification system, and to determine appropriate treatment for each case based on the new classification system. The assessment was performed at 2 different time points 6 weeks apart. The new classification divides the fractures into 3 zones according to the attachment of the coracoclavicular (CC) ligaments, as well as displacement (1: lateral to the CC ligament attachment; 2: at the attachment of the CC ligaments; 3: medial to the CC ligament attachment; a: nondisplaced, b: displaced). Furthermore, 30 orthopedic surgeons were surveyed about their knowledge regarding the Neer and Jäger/Breitner classification systems. Inter-rater reliability was moderate for the Neer classification (κ = 0.565), substantial for the Jäger/Breitner classification (κ = 0.781) and for the new classification system (κ = 0.798). Although 28 cases with the Neer classification and 28 cases with the Jäger/Breitner classification could not be classified by at least 1 of the raters, 99% of the cases could be classified with the new classification. Intrarater reliability was moderate for the Neer classification (κ = 0.693) and for the Jäger/Breitner classification (κ = 0.660) and substantial for the new classification system (κ = 0.762). The inter- and intrarater reliability of treatment choice was regarded as substantial (κ = 0.659, κ = 0.738, respectively). Although the raters would treat 94%-99% of all cases classified as subgroup b surgically, only 0%-26% of cases classified as subgroup a were classified as requiring surgery. The knowledge of Jäger/Breitner and Neer classification among the surgeons surveyed was relatively poor: None of the 30 surgeons was able to describe the fracture types of Neer classification, while 2 of 30 surgeons could detail all types of Jäger/Breitner classification. Our study demonstrated a high inter- and intrarater reliability of the new classification system and the associated treatment choices. Furthermore, the new classification system appears capable of categorizing the vast majority of lateral clavicle fractures.

The presence of acetabular dysplasia or femoro-acetabular impingement increases the chance of an earlier total hip arthroplasty (THA). Surprisingly, the influence of femoral and acetabular parameters on the age at which THA is required remains poorly investigated. The aim of this study was to evaluate the radiographic hip morphotype at the time of THA using an artificial intelligence-based analysis to assess potential differences. Overall, 6,767 patients (mean age 66 years [range, 16 to 99]; women: 60.6%; men: 39.4%) from a single orthopaedic center were included in the final analysis. Images were analyzed using artificial intelligence-powered software. The lateral-center-edge angle and the neck-shaft angle (caput-collum-diaphyseal) were used to determine the nine different hip morphotypes based on the coronal plane alignment of the hip (CPAH, I to IX). Patients who had valgus-aligned femoral necks (CPAH, I, IV, and VII) were significantly younger at the time of THA compared to patients who had femoral varus necks (CPAH, III, VI, and IX), suggesting a potential negative effect of valgus and a protective effect of varus alignment independent of acetabular coverage. Type I hips, defined as acetabular undercoverage in combination with femoral valgus alignment, were on average 16.2 years younger at the time of THA compared to type IX hips with acetabular overcoverage and varus alignment. The hip morphotype had a major impact on the timing of THA. Femoral varus neck alignment demonstrated a protective effect across all age groups, whereas acetabular undercoverage and femoral valgus necks were associated with an earlier need for THA.

Painful, degenerative stiffening of the first metatarsophalangeal (MTP-1) joint, as seen in hallux rigidus, is common among athletic individuals due to repetitive microtrauma. While arthrodesis of the MTP-1 joint is considered the gold standard for advanced degeneration, the resulting loss of motion may impair sports and recreational activities. Implant arthroplasty, by preserving joint mobility, may offer functional benefits for active patients. In accordance with PRISMA guidelines, a comprehensive literature search was conducted using PubMed, LIVIVO, the Cochrane Controlled Trials Library, Science Direct, CINHAL and Scopus. Studies reporting on sports function after MTP-1 arthrodesis or implant arthroplasty for degenerative arthritis were included. Fifteen studies with 1,103 procedures met the inclusion criteria. Sport-specific outcomes and functional scores were extracted and analyzed. Data on sports function following MTP-1 arthrodesis and implant arthroplasty are heterogeneous, limiting direct comparison. Arthrodesis studies reported return-to-sport rates of up to 100%, with a shift from high-impact to in-line activities. Implant arthroplasty showed similar return-to-sport rates, with potential short-term functional benefits. However, long-term superiority could not be demonstrated, and higher complication rates must be considered. MTP-1 arthrodesis remains a reliable treatment for end-stage hallux rigidus, offering satisfactory long-term sports function. Implant arthroplasty may provide short-term advantages in active patients but carries a higher risk of complications and has not shown superior long-term outcomes in sports participation.

Background/Objectives: The Chiari pelvic osteotomy (CPO) creates a bony roof by medialization of the acetabulum, thus improving the biomechanics of dysplastic hip joints. Long-term results have already been examined in various studies. However, the impact on the axis of the lower limb has not been investigated yet. The aim of this study was the analysis of changes in the alignment of the lower limb and leg length caused by a CPO and, consecutively, the impact on conversion total hip arthroplasty and primary knee arthroplasty. Methods: A total of 85 patients with 111 CPOs were clinically examined, patient reported outcome measures collected, and long leg standing radiographs analysed according to Paley. Results: The patients were examined an average of 34 years (±7.8; 23–53) after CPO. Unilaterally operated patients (N = 59 hips) showed a pathological MAD in 71% (N = 42) on the operated side (90% valgus, 10% varus). On the unaffected side, we could identify 56% (N = 33 hips) pathological cases (70% valgus, 30% varus). When patients underwent CPO bilaterally (N = 52 hips), the MAD was abnormal in 34 operated hips (65%; 97% valgus, 3% varus). If a leg length discrepancy occurred after the operation, the pelvis and the femur contributed the most to the total leg length discrepancy. Conclusions: Shifts in the mechanical axis following a CPO must be considered in order to inform patients appropriately preoperatively and quantified postoperatively by performing long leg standing radiographs in order to plan following joint replacement therapy adequately and maximize the chance of a successful long-term outcome on a functional level as well as for the patient’s satisfaction.

Introduction: The purpose of this study was to ascertain the primary ex vivo biomechanical stability of a novel bioabsorbable magnesium alloy (ZX00: Mg–Zn–Ca) bone anchor in human cadaveric proximal humeri, indicated in the reconstruction of the rotator cuff. Methods: Twenty human Thiel-embalmed cadaveric humeri were prepared and freed from soft tissue. One [Formula: see text]5.7 × 20.5-mm ZX00 anchor and one [Formula: see text]5.5 mm × 16.3 mm Arthrex Titanium FT Corkscrew (ATC) control anchor were inserted into the footprint of the supraspinatus tendon, 15 mm apart. The humeri were mounted onto a material testing machine and following a 40 N preload, cyclic loading was performed over 400 cycles. If the construct remained intact, ultimate load to failure (ULTF) was measured using an increasing axial load of 1 mm/s, ULTF and mode of failure were recorded. Results: No difference was found in the ability to withstand cyclic loading, mode or load-to-failure strengths between ZX00 and control anchors. The maximum tractional force loaded for the ZX00 anchors had a median of 257.4 N (range 165.3–328.2). The corresponding value for the ATC anchors averaged 239.9 N (range 118.9–306.7). Conclusion: ZX00 alloy anchors appear to provide adequate initial biomechanical stability when compared to an industry-standard control in a cadaveric rotator cuff repair model.

Achondroplasia is the most common skeletal dysplasia. With the development of new growth-promoting drug treatment for children and adolescents with achondroplasia, multidisciplinary care has become increasingly more important. In addition to orthopedic care, aspecialized team comprised of pediatrics/endocrinology, radiology, neurosurgery, otorhinolaryngology, anesthesiology, physiotherapy, psychology and other disciplines is necessary to develop and implement aholistic concept to improve the quality of life for individuals affected by achondroplasia. The orthopedic management of achondroplasia has become even more complex and multidisciplinary due to these new medical and surgical developments. These new developments herald anew era of orthopedic and multidisciplinary care for achondroplasia.