Verwendungsraten von Prothesen der unteren Extremität in Deutschland und der Schweiz: Ein Vergleich der Jahre 2005-2008

Zusammenfassung: Hintergrund: In den USA hat die Verwendung der totalen Hüftprothese innerhalb der letzten Dekade stark zugenommen. Es ist jedoch nicht bekannt, ob sich dieser Trend auf andere Länder übertragen lässt. Ziel dieser Untersuchung war daher der detaillierte Vergleich der Verwendungsraten von Hüft-, Knie- und OSG-Prothesen in der BRD und der Schweiz im Zeitraum 2005-2008 und ein Sekundärvergleich mit den USA. Patienten und Methoden: Aus Daten der beiden statistischen Bundesämter wurden die Einwohnerzahl, Geschlechts- und Altersverteilung sowie die Anzahl von Primär- und Revisionseingriffen ermittelt. Aus diesen Kennzahlen konnte die Anzahl von Primär-, Revisions- und Gesamteingriffen, der Revisionslast, von Primär- und Revisionsraten pro 100.000 Einwohner und Jahr sowie geschlechts- und altersspezifische Primär- und Revisionsraten berechnet werden. Ein im Vergleich dazu reduzierter Datensatz aus den USA stammt direkt vom Autor der entsprechenden Auswertungen. Ergebnisse: In Deutschland, der Schweiz und den USA stieg die Anzahl der Voll- und Teilhüftprothesenimplantationen pro 100.000 Personen von 235,8, 238,2 und 116,8 im Jahr 2005 auf 254,7, 262,7 und 127,3 an. Für Voll- und Teilknieprothesen lagen die Raten bei 156,3, 140,1 und 178,2 Implantationen in 2005 und 188,3, 176,8 und 213,6 in 2008. Die Revisionslast für Hüftprothesen lag in der BRD in 2005 mit 13,6% um 3,6% höher als in der Schweiz und betrug 11,2% in den USA. In 2008 lag sie mit 15,1% um 4,6% höher als in der Schweiz und betrug wiederum 11,2% in den USA. Für Knieprothesen lag die Last in der BRD in 2005 bei 11,1% und damit 3,5% höher als in der Schweiz; in den USA betrug sie 7,4%. In 2008 lag sie bei 12,8% und somit 4,2% höher als in der Schweiz und betrug 8,9% in den USA. In allen 3 Ländern lag die Revisionslast für Knieprothesen stets unter derjenigen für Hüftprothesen. Schlussfolgerung: In allen 3 Ländern stiegen die Primärraten für Hüft- und Knieprothesen an, diejenigen für Knieprothesen stärker. Die Revisionslasten lagen in 2008 für beide Prothesentypen in der BRD am höchsten. In der Schweiz gab es eine vorübergehende Senkung der Revisionslasten und erst ab 2007 wieder einen Anstieg. Die Verwendungsrate von Hüftprothesen pro 100.000 Einwohner lag in den USA stark unter den Raten der BRD und der Schweiz, für Knieprothesen lag sie leicht darübe

A European spine registry

Abstract.: New joint replacement registries are being widely implemented across national and international organizations. The need for a continuous long-term post-market surveillance of implants has been recognized, and has become increasingly important to ensure the quality of prosthetic components. Registry data with large case numbers represent an acceptable alternative to controlled randomized clinical trials, which are often difficult to conduct in orthopedic surgery. The variety of implants and procedures in spinal surgery not only induces the same need for long-term monitoring of post-surgical product performance as in the joint replacement subspecialties, but also renders essential the establishment of a comprehensive spine registry for all major pathologies and interventions. In cooperation with the M.E. Müller Institute for Evaluative Research in Orthopedic Surgery (MEM-CED) at the University of Berne, Switzerland, the Spine Society of Europe (SSE) has launched Spine Tango: the first modular and multilevel European online registry for spinal surgery. Within Spine Tango, the major challenge in registry design and structure is the definition of and agreement upon a core set of questions as a common European dataset. Additional questions for national or individual interest can also be dynamically added to the core dataset. An automated implant tracking system has also been setup, which allows highly precise product documentation without additional work for clinical staff member

Benchmarking with Spine Tango: potentials and pitfalls

The newly released online statistics function of Spine Tango allows comparison of own data against the aggregated results of the data pool that all other participants generate. This comparison can be considered a very simple way of benchmarking, which means that the quality of what one organization does is compared with other similar organizations. The goal is to make changes towards better practice if benchmarking shows inferior results compared with the pool. There are, however, pitfalls in this simplified way of comparing data that can result in confounding. This means that important influential factors can make results appear better or worse than they are in reality and these factors can only be identified and neutralized in a multiple regression analysis performed by a statistical expert. Comparing input variables, confounding is less of a problem than comparing outcome variables. Therefore, the potentials and limitations of automated online comparisons need to be considered when interpreting the results of the benchmarking procedur

Hall-Effect Sign Anomaly and Small-Polaronic Conduction in (La_{1-x}Gd_x)_{0.67}Ca_{0.33}MnO_3

The Hall coefficient of Gd-doped La_{2/3}Ca_{1/3}MnO_3 exhibits Arrhenius behavior over a temperature range from 2T_c to 4T_c, with an activation energy very close to 2/3 that of the electrical conductivity. Although both the doping level and thermoelectric coefficient indicate hole-like conduction, the Hall coefficient is electron-like. This unusual result provides strong evidence in favor of small-polaronic conduction in the paramagnetic regime of the manganites.Comment: 11 pages, 4 figures, uses revtex.st

Carbon Ion irradiation in the treatment of grossly incomplete or unresectable malignant peripheral nerve sheaths tumors: acute toxicity and preliminary outcome

Background: To report our early experience with carbon ion irradiation in the treatment of gross residual or unresectable malignant peripheral nerve sheath tumors (MPNST). Methods: We retrospectively analysed 11 patients (pts) with MPNST, who have been treated with carbon ion irradiation (C12) at our institution between 2010 and 2013. All pts had measurable gross disease at the initiation of radiation treatment. Median age was 47 years (29-79). Tumors were mainly located in the pelvic/sacral (5 pts) and sinunasal/orbital region (5 pts). 5 pts presented already in recurrent situation, 3 pts had been previously irradiated, and in 3 pts MPNST were neurofibromatosis type 1 (NF1) associated. Median cumulative dose was 60 GyE. Treatment was carried out either as a combination of IMRT plus C12 boost (4 pts) or C12 only (7 pts). Results: Median follow-up was 17 months (3-31 months). We observed 3 local progressions, translating into estimated 1- and 2-year local control rates of 65%. One patient developed distant failure, resulting in estimated 1- and 2-year PFS rates of 56%. Two patients have died, therefore the estimated 1- and 2-year OS rates are 75%. Acute radiation related toxicities were generally mild, no grade 3 side effects were observed. Severe late toxicity (grade 3) was scored in 2 patients (trismus, wound healing delays). Conclusion: Carbon ion irradiation yields very promising short term local control and overall survival rates with low morbidity in patients suffering from gross residual or unresectable malignant peripheral nerve sheath tumors and should be further investigated in a prospective trial

Polarons and bipolarons in strongly interacting electron-phonon systems

The Holstein Hubbard and Holstein t--J models are studied for a wide range of phonon frequencies, electron--electron and electron--phonon interaction strengths on finite lattices with up to ten sites by means of direct Lanczos diagonalization. Previously the necessary truncation of the phononic Hilbert space caused serious limitations to either very small systems (four or even two sites) or to weak electron--phonon coupling, in particular in the adiabatic regime. Using parallel computers we were able to investigate the transition from `large' to `small' polarons in detail. By resolving the low--lying eigenstates of the Hamiltonian and by calculating the spectral function we can identify a polaron band in the strong--coupling case, whose dispersion deviates from the free--particle dispersion at low and intermediate phonon frequencies. For two electrons (holes) we establish the existence of bipolaronic states and discuss the formation of a bipolaron band. For the 2D Holstein t--J model we demonstrate that the formation of hole--polarons is favoured by strong Coulomb correlations. Analyzing the hole--hole correlation functions we find that hole binding is enhanced as a dynamical effect of the electron--phonon interaction.Comment: 23 pages (Revtex) with 13 figures (ps, uuencoded

SSE Spine Tango - content, workflow, set-up: www.eurospine.org - Spine Tango

The Spine Tango registry is now accessible via the SSE webpage under www.eurospine.org - Spine Tango. Links to the Swiss/International, German and Austrian modules are provided as well as information about the philosophy, methodology and content. Following the links, the users are taken to the respective national modules for registration or log-in and data entry. The Swiss/International module, also accessible under www.spinetango.com, is used by all Swiss and international users, who do not have a separate national module. The physician administered forms for surgery, staged surgery and follow-up can be downloaded as PDFs.The officially recommended Spine Tango patient forms are also available. All forms were implemented in an online version and as scannable optical mark reader forms which can be ordered from the corresponding autho

Electron-impact ionization of atomic hydrogen at 2 eV above threshold

The convergent close-coupling method is applied to the calculation of fully differential cross sections for ionization of atomic hydrogen by 15.6 eV electrons. We find that even at this low energy the method is able to yield predictive results with small uncertainty. As a consequence we suspect that the experimental normalization at this energy is approximately a factor of two too high.Comment: 10 page

Phonons from neutron powder diffraction

The spherically averaged structure function \soq obtained from pulsed neutron powder diffraction contains both elastic and inelastic scattering via an integral over energy. The Fourier transformation of \soq to real space, as is done in the pair density function (PDF) analysis, regularizes the data, i.e. it accentuates the diffuse scattering. We present a technique which enables the extraction of off-center phonon information from powder diffraction experiments by comparing the experimental PDF with theoretical calculations based on standard interatomic potentials and the crystal symmetry. This procedure (dynamics from powder diffraction(DPD)) has been successfully implemented for two systems, a simple metal, fcc Ni, and an ionic crystal, CaF$_{2}$. Although computationally intensive, this data analysis allows for a phonon based modeling of the PDF, and additionally provides off-center phonon information from powder neutron diffraction