Total knee replacement requires follow-up treatment. This can take place on an outpatient basis as part of health insurance coverage, but also as outpatient or inpatient rehabilitation. Outpatient rehabilitation provides comparable results to inpatient rehabilitation, but only for those patients who are suitable for outpatient rehabilitation. Inpatient rehabilitation should be indicated depending on general health status, general physical fitness, housing situation, accessibility of rehabilitation facilities and possibilities of social support in the home environment, as well as age and comorbidities. Physiotherapeutic procedures should focus on exercise therapy. Passive reactive measures complement the therapy. For patients of working age, the activity profile should be considered as part of the rehabilitation process. Patient education, with information on prosthesis-appropriate behavior, represents an important component in follow-up treatment. Demographic change requires increasing consideration of orthogeriatric aspects. Fast-track programs will not make follow-up treatment superfluous, but with accelerated processes they represent anew challenge for sectoral cooperation.

The quadriceps tendon often ruptures spontaneously without trauma, frequently following an eccentric load on the tendon (walking down stairs) in the case of aprevious degenerative injury. Rupture after endoprosthetic knee replacement is aspecial etiological case. Predominantly men between 50 and 65years of age are affected. Clinical signs are suprapatellar hematoma and the inability to actively straighten the knee. Atypical examination finding is the "suprapatellar gap sign". Ultrasonography is the diagnostic imaging modality of first choice as it can be reliably visualize the rupture and the resulting hematoma. Magnetic resonance imaging has ahigh sensitivity and specificity for detecting quadriceps tendon ruptures. However, its limited availability should not delay therapy. The treatment of choice is surgical transosseous refixation of the tendon at the upper patellar pole. Following surgery, a straight splint, partial weight bearing and limited mobility are required for 6-8weeks.

The reintegration into the social and professional environment and the achievement of the best possible quality of life after multiple injuries can often only be achieved after alengthy rehabilitation process and belongs in the hands of experienced doctors, therapists, and rehabilitation managers. Rehabilitation after serious accidents must be differentiated from "normal" orthopedic rehabilitation after elective surgery. The challenges of trauma rehabilitation require coordinated rehabilitation phases. This is the only way to avoid the so-called "rehab hole" between discharge from the acute clinic and the start of post-acute rehabilitation. A6-phase model is described. After acute treatment (phaseA) and any necessary early rehabilitation (phaseB), phaseC of post-acute rehabilitation places special demands on the rehabilitation facility. PhaseD of the follow-up rehabilitation is established. The further rehabilitation (phaseE) provides measures specifically tailored to the consequences of the accident, such as pain rehabilitation or activity-oriented procedures. Long-term follow-up care for previously severely injured patients is necessary (phaseF). An integration of trauma rehabilitation centers into the existing trauma network remains the goal to improve the outcome after polytrauma.

HintergrundDie Behandlung von Knochen- und Protheseninfektionen bleibt trotz moderner Behandlungskonzepte mit interdisziplinärem Therapieansatz schwierig und weitere Maßnahmen zur Verbesserung des Behandlungsergebnisses sind wünschenswert. Präklinischen Studien liefern ein vielversprechendes Bild der Wirksamkeit von Bakteriophagen zur Behandlung von Knochen- und Protheseninfektionen.Ziel der ArbeitDie vorliegende Arbeit gibt eine systematische Übersicht über die klinische Anwendung von Bakteriophagen zur Behandlung von Knochen- und Protheseninfektionen.Material und MethodenEine systematische Suche wurde in PubMed zur Identifikation von primären klinischen Daten zur Anwendung der Phagentherapie bei Patienten mit Knochen- und Protheseninfektion durchgeführt.ErgebnisseElf Studien wurden eingeschlossen, bestehend aus 8 Fallberichten und 3 Fallserien. Indikationen der Phagentherapie waren periprothetische Infektionen (n = 12, 52,2 %), frakturassoziierte Infektionen (n = 9, 39,1 %), Osteomyelitis (n = 1, 4,4 %) und eine Iliosakralgelenkinfektion nach Zementaugmentation einer Metastase (n = 1, 4,4 %). Die Interventionen waren heterogen, Phagen wurden intravenös verabreicht, intraoperativ ins Gelenk injiziert, intraoperativ lokal angewendet oder über Drainagen appliziert. In Kombination mit Antibiotikatherapie konnte eine vollständige Infekteradikation bei 18 Patienten (78,3 %) erreicht werden. Bei 91,3 % der Patienten wurden keine Nebenwirkungen berichtet.SchlussfolgerungBakteriophagen sind eine vielversprechende Behandlungsmethode von Knochen- und Protheseninfektionen in Kombination mit einer Antibiotikatherapie. Zukünftige klinische Studien mit höherem Evidenzgrad werden benötigt, um eine erfolgreiche Translation der Bakteriophagentherapie in die klinische Praxis weiter zu etablieren.

Stress reactions and fractures represent an important differential diagnostic entity, especially in patients active in sports. The lower extremities have predilection sites for stress fractures, which require special treatment in the context of the underlying risk factors. Clinically, patients usually complain of stress-dependent pain in the affected region and sport activities are mostly limited or even impossible. The detection of acute stress fractures is usually missed by conventional X‑ray within the first 4-6weeks. The gold standard diagnostic tool is magnetic resonance imaging (MRI). Depending on the location, adistinction must be made between low-risk and high-risk stress fractures. Low-risk fractures show ahigh healing rate after conservative treatment including load and stress reduction as well as avoiding risk factors. High-risk fractures can take acomplicated course under conservative treatment measures and in some cases, surgical intervention is required.

As part of the underlying condition, neuromuscular scoliosis occurs in early childhood. Compared to idiopathic scoliosis, neuromuscular scoliosis shows amore rapid progress of deformity, which continues even after the end of growth. This progress and the associated complications can only be prevented by surgical treatment. Depending on the patient's age and the extent of the deformity, different strategies have been established: in early childhood, so-called "growing implants" are used, while between the ages of 10 to 12, definitive treatment by reposition and fusion of the deformity is the treatment of choice. In this review, we present different surgical strategies as well as indications for surgery and discuss challenges in the treatment of these complex deformities.

Unicompartmental knee arthroplasty, especially for both femorotibial compartments of the knee, is an established partly joint-saving treatment option for osteoarthritis of the knee if the disease is limited to one compartment. Even smaller implants or resurfacing of the patellofemoral joint have been shown-in smaller patient collectives-to have the potential to yield good clinical results.

Pathologies of the hip, spine and the lower extremity are often concomitant due to their three-dimensional anatomic and physiological interrelation. The real challenge liesin definingwhich of the pathologies is most relevant for the patient in terms of clinical symptoms and which organ should be treated first. The purpose of this review article is two-fold: Firstly, to explain the treatment dilemma of hip-spine syndrome to the treating physician. Secondly, to highlight the significance of spinal pathology in this context.