Arthrofibrosis after TKA - Influence factors on the absolute flexion and gain in flexion after manipulation under anaesthesia

<p>Abstract</p> <p>Background</p> <p>Stiffness with decreased range of motion (ROM) has been described as a frustrating complication after TKA. If all methods of physiotherapeutic treatment have been exhausted trying to develop ROM, manipulation under anaesthesia (MUA) can be discussed. The aim of the present study was to show the effect of MUA and to determine the influence of BMI, number of previous surgical procedures, pre-MUA ROM and timing of MUA for the results after MUA in regard to absolute flexion and gain in flexion.</p> <p>Methods</p> <p>858 patients underwent TKA at our institution between 2004 and 2009. 39 of these patients underwent MUA because of postoperative knee stiffness. The data were retrospective analysed for the influence of BMI, pre-MUA flexion (</≥ 70°), timing of MUA (>/≤ 30 days after TKA) and number of previous surgery on the results after MUA (absolute Flexion/gain in flexion).</p> <p>Results</p> <p>The prevalence for stiffness after TKA was 4.54%. There was a statistically significant improvement in flexion not only directly after MUA but also 6 weeks after MUA. Patients with two or more previous operations before TKA showed statistically significant worse results six weeks after MUA in absolute flexion and gain in flexion</p> <p>(p = 0.039) than patients with one or two previous operations. No statistical significance in absolute flexion (p = 0.655) and gain in flexion (p = 0.328) after MUA between "early" and "late" was detected. The stiffer knees with a flexion below 70° showed significantly worse results (p = 0.044) in absolute flexion six weeks after MUA, but they also had statistical statistically better results with regard to gain in flexion (p ≤ 0.001).</p> <p>Conclusion</p> <p>MUA is a good instrument for improving ROM after TKA. The time between TKA and MUA seems less important, so different types of physiotherapeutic treatment could be tried before the procedure is started. MUA in patients with many previous operations and a flexion of less than 70° before MUA is not as effective as in other patients, but they also benefit from MUA.</p

Radiographic signs for detection of femoroacetabular impingement and hip dysplasia should be carefully used in patients with osteoarthritis of the hip.

During the last years, terms like acetabular retroversion, excessive overcoverage, and abnormal head-neck-junction with the so called "pistol-grip-deformity" has been added to the classical description of hip dysplasia. These anatomical changes could lead to a femoroacetabular impingement (FAI). Both kinds of FAI has been indentified as a main reason for hip pain and progressive degenerative changes leading to early osteoarthritis of the hip. A lot of radiographic criteria on pelvic views have been established to detect classical dysplasia and FAI. The present study was initiated to assess the hypothesis that age and severity of osteoarthritis affect measurements of different radiographic parameters.The pelvic radiographs of 1614 patients were measured for head-ratio, CE-angle, roof obliquity, extrusion-index, depth-to-width ratio, CCD-angle, sharp's angle. To evaluate the severity of osteoarthritis of the hip the classification by Kellgren and Lawrence was used. Associations between age and radiographic parameters or severity of osteoarthritis were assessed by Spearman's (?) or Kendall's (r) rank correlation coefficient, respectively.366 (22.7%) patients presented no sign of osteoarthritis, 367 (22.7%) patients presented I° osteoarthritis, 460 (28.5%) patients presented II° osteoarthritis, 307 (19%) III° osteoarthritis and 114 (7.1%) IV° osteoarthritis of the hip. The mean head-ratio of all patients was 1.13 ± 0.26 (0.76 - 2.40), the mean CE-angle 40.05° ± 10.13° (0° - 70°), the mean roof obliquity was 35.27° ± 4.96° (10° - 55°), the mean extrusion-index was 12.99 ± 9.21 (6.20 - 95.2), the mean depth-to-width ratio was 59.30 ± 8.90 (6.30 - 100), the mean CCD-angle was 127.68° ± 7.22° (123° - 162°) and the mean sharp's angle was 9.75° ± 5.40° (1° - 34°) There was a weak association between age and the severity of osteoarthritis of the hips (left: r= 0.291; right: r=0.275; both P<0.001) with higher osteoarthritis levels observable for elderly patients).Severity of osteoarthritis has a negative impact on measurements of different radiographic parameters. Therefore - in our opinion - epidemiological studies on prearthrotic deformities should only be performed in healthy adults with no signs of osteoarthritic changes

The influence of Ibandronat on the bone density and bone markers on patients with osteogenesis imperfecta

Eine Vielzahl von Erkrankungen die das Knochensystem betreffen, haben hormonelle Dysregulationen übergeordneter Zentren als Ursachen und den Knochen als Manifestationsort. Es gibt aber auch einige Krankheiten die vom Knochengewebe selbst ausgehen. Bei der Osteogenesis imperfecta kommt es auf Grund verschiedener Ursachen zu einer verminderten Knochenfestigkeit und als Folge zu einer erhöhten Frakturrate. In letzter Zeit wurden verstärkt Bisphosphonate in der Therapie der Osteogenesis imperfecta eingesetzt und es zeichneten sich erste Erfolge ab. In dieser Arbeit betrachten wir den Einfluss des Bisphosphonats Ibandronat (Handelsname: Bondronat) auf den Knochenstoffwechsel und die Knochendichte bei Patienten mit Ostegenesis imperfecta. Es konnte gezeigt werden, dass es bei den Patienten zu einem Anstieg der Knochendichte kam, und sich somit auch die Stabilität der Knochen erhöhte. Ein zweiter Schwerpunkt wurde auf die verschieden Parameter des Knochenstoffwechsels gelegt. Unter der Therapie kam es zu einer Regulierung des Knochenstoffwechsels. Das Ergebnis dieser Studie war, dass alle Patientin von einer Therapie mit Ibandronat profitieren, dabei kam es zu einer deutlichen Regulation des zu Beginn gesteigerten Knochenstoffwechsels. Es konnte, wie in den anderen Studien zuvor gezeigt, auch Bondronat wirkungsvoll als ein Pfeiler der Therapie der OI eingesetzt werden.A lot of bone deases have there reason in hormonelle dysregulation. But there are also some deaseas caused directly from bone tissues. Because of different reasons Patients with Osteogenesis imperfecta have reduced bone stiffnes and so an increase in bone fragility. During the passed years, bisphosphonates are used in the therapy of Osteogenesis imperfecta and there has be shown beneficial effects. In our case the bisphosphonat Ibandronat is used an the beneficial effects of the therapy is shown. It has been shown that there is an increase in bone density and decrease of bone fragility. It has also been shown that there is a normalisation in bone markers. The result of this study was, that there are beneficial effects in all patients with osteogenesis

Arthroscopic modified Broström operation versus open reconstruction with local periosteal flap in chronic ankle instability

Introduction!#!The modified Broström operation (MBO) has found widespread use in the therapy of lateral chronic ankle instability (CAI). However, alternative surgical techniques like the open reconstruction using a periosteal flap (RPF) are still an important part of the surgical treatment of lateral CAI. Both procedures differ in terms of the reconstruction material used and the surgical procedure. Comparative studies on the surgical therapy of CAI are limited and generally refer to similar surgical procedures. Aim of this study was to compare the arthroscopic MBO and the RPF.!##!Materials and methods!#!We retrospectively analysed 25 patients with lateral CAI after a tear of the anterior talofibular ligament (ATFL). 14 patients received arthroscopic MBO and 11 patients received RPF. We compared the postoperative outcome between both groups with respect to subjective instability, the number of ankle sprains, pain, complications and follow-up operations as well as the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.!##!Results!#!Both surgical procedures resulted in a significant improvement in pain, in subjective instability, in the reduction in the frequency of ankle sprains and improvement in the AOFAS ankle-hindfoot score one year postoperatively. Three months postoperatively, the values for pain and instability of the MBO group were significantly better compared to the RPF. One year after the operation, these differences were evened out. Also in terms of complications and follow-up operations, no significant difference was found between the two procedures.!##!Conclusions!#!Both surgical procedures give very good results one year postoperatively in terms of pain, instability, function and complication rate. With significantly better results regarding pain and instability three months postoperatively, the MBO allows a faster recovery in patients operated with this technique

Quality of life, physical and mental status and contentment of patients with localized soft tissue or bone sarcoma: a questionnaire analysis

Extremity soft tissue and bone sarcomas represent a rare group of bone and connective tissue cancers. In literature, there is little information about psycho-emotional status and impact on quality of life after the diagnosis and treatment of this kind of tumors. The aim of this survey was to define the profile of the patients at risk and their need for psychooncological care. Our self-created questionnaire consists of 71 items related to the individual emotional, mental and physical situation after the diagnosis of soft tissue and bone sarcoma. Sixty-six patients, surgically treated at our department, were included. Only 37.5% of the patients considered themselves to be completely emotional stable. Psychooncological treatment was accepted mostly by female patients, by patients with higher education level and by married patients. Emotional stability and confidence in future were associated with a strong familiar background, with numerous consultations of psychooncological service and also to gender and physical condition. Current quality of life was strongly correlated to physical condition. Thanks to our questionnaire, we disclosed few risk factors for negative emotional outcome after therapy, such as higher age, social isolation, female gender and poor physical status

Oncological outcome and prognostic factors in the therapy of soft tissue sarcoma of the extremities

Uniform conclusions about therapeutic concepts and survival time of bone and soft tissue sarcoma patients are difficult due to the heterogeneity of histological subtypes as well as the different responses to neoadjuvant therapy. The subject of this retrospective study was the analysis of tumour free survival, risk and prognostic factors of sarcoma patients treated by limb sparing techniques or amputation. We included 118 patients with soft tissue sarcoma of the extremities treated primarily or secondarily at our institution between 1990 and 2008 with a minimum follow-up of 12 months. Data about the tumour free survival time, operative techniques and potential prognostic factors were analysed. The tumour-specific and overall survival were significantly influenced by two factors: the grading and distant metastases present at time of diagnosis. Optimal multimodal therapeutic concepts at a specialized Cancer Center decreased the risk of local recurrence. The importance of optimal preoperative and surgical course concerning the oncological long term outcome was investigated. The decrease in local recurrence as a result of multimodal therapeutic concepts at a specialized Cancer Center was confirmed. To evaluate the individual prognosis of a patient, multiple factors have to be considered. Factors for a poor prognosis are primary metastasis, high-grade tumours and several histological entities (e.g. synovial sarcoma, not other specified)