AIM: This study aims to establish the indication for a pre- and postoperative MRI examination with an intravenous contrast agent in patients with an osteochondral lesion of the talus. METHODS: 20 patients with an osteochondral lesion of the talus in the different stages according to DiPaola were prospectively examined preoperatively and 6 months postoperatively by an MRI investigation with an i. v. contrast agent. The Weber ankle score was determined pre- and postoperatively. A correlation was calculated between MRI and arthroscopic findings of an osteochondral lesion (Spearman-rho). RESULTS: There was a significant correlation among the radiological, the MRI and the arthroscopically determined locations. With regard to staging only 12 out of 20 lesions were staged correctly by MRI using arthroscopy as a gold standard. Due to metal artifacts and morphological changes the postoperative MRI could not be used for staging. CONCLUSION: A preoperative MRI investigation is indicated in patients with ankle pain of unknown origin, a normal radiograph and a suspected osteochondral lesion of the talus. MRI is not indicated to determine the localization and the stage of an osteochondral lesion. A postoperative MRI is only necessary for the exclusion of a secondary pathology.

Adolescent↗

PubMedDate not supplied

[Nail-patella syndrome. A 4-generation family study].

Five cases of hereditary onycho-osteodysplasie are reported. All of the family members presented dysplastic nails. Hypoplastic patella, elbow dysplasia or iliac horns were shown in variable expression. We've seen no other anomalies especially nephropathy did not occur.

Adult↗

PubMedDate not supplied

[Comparison between low-molecular and unfractionated heparin in the prevention of thrombosis in patients with total endoprosthetic replacement of hip and knee joint].

PURPOSE: Thrombosis-prophylaxies with heparins after total hip arthroplasty (THP) and total knee arthroplasty (TKA) is well accepted. The aim of this study was to compare the low molecular weight heparin (Enoxaparin) with PTT adjusted unfractionated heparin (Na-heparin). METHODS: In a prospective study of 226 patients after THA and TKA, we performed physical examination and ultrasound in compression and duplex technique one day before surgery and at the 7th and 14th day after surgery. 120 patients received Enoxaparin 1 x 40 mg per day in fixed dosage. 106 patients received Na-heparin 3 x 5000 IE. Since PTT did not reach 40 seconds, Na-heparin dosage was increased to 3 x 7500 IE. RESULTS: The overall thrombosis rate was 4% (n = 9), in the Enoxaparin group 2.9% for the 70 THA and 10% for the 50 TKA. Thrombosis occurred in the group of unfractionated heparin (PTT adjusted) in 1.8% after THA and in 2% after TKA. In TKA, there is statistical difference between the two heparin groups. CONCLUSION: In the thrombosis prophylaxis of TKA, PTT adjusted unfractionated heparin is superior to low molecular weight heparin in fixed dosage.

Aged↗

PubMedDate not supplied

[Results of hip joint boring in femur head necrosis in the adult--4 to 18 years follow-up].

INTRODUCTION: Without primary fracture of femoral cortex in femoral head necrosis, 85% of cases have a collapse of the femoral head without treatment after 2 years. It was the aim of this retrospective study to examine the long term outcome of patients having undergone femoral head decompression. METHODS: The clinical evaluation was done by the Harris Score. A.p. pictures of the pelvis as well as Lauenstein X-rays were taken as radiographic evaluation. These were compared to the preoperative radiographs, computer-tomographies, szintigrams and MRIs according to the classification of Ficat et al. (1980) and to that of Steinberg et al. (1984). RESULTS: 62 cases of femoral head necrosis in 52 patients were followed. 12 cases received a varic osteotomy in addition to the decompression of the femoral head. The average follow up period was 90 months postoperatively. 11 cases had received a total hip arthroplasty (THA) and in three cases there was an indication for a THA after follow up examination. The mean interval between femoral head decompression and THA was 7.1 years. 40 cases (65%) ha a Harris Score over 75 points corresponding to a good to excellent clinical result. CONCLUSION: Femoral head decompression remains an important operation to preserve the structural integrity. It is indicated in cases without subchondral.

Adult↗

PubMedDate not supplied

[Is use of the Knee Society Roentgenographic Evaluation and Scoring System for radiologic control of knee prostheses reliable?].

PURPOSE: To follow the radiographic parameters of prosthetic loosening of the Knee Society Roentgenographic Evaluation and Scoring System (KSRESS) and to test their clinical relevance. METHODS: This prospective study documents the use of the KSRESS and clinical rating system in 333 primary posterior cruciate retaining PFC total knee arthroplasties preoperatively, at 3 month and at yearly intervals postoperatively. The average follow-up period was 3.2 years (range 2-5.5 y). RESULTS: The average component position and alignment angles remained unchanged at biomechanically correct angles during the follow-up period. Radiolucent lines were observed regularly at the edges of the tibial and femoral components. The average total radiolucent lines score decreased for the tibial component. Patellar and femoral lucencies remained unchanged. The total radiolucent lines scores did not correlate with postoperative pain, body-mass-index, alignment, stability, knee and function score. Four revisions, one with relevant radiolucent lines, had to be performed. CONCLUSIONS: The KSRESS is a useful tool. Standardisation of roentgenograms is mandatory. The PFC arthroplasty, the operative technique and the instruments ensure a biomechanically correct implantation.

Adult↗

PubMedDate not supplied

[Clinical aspects and treatment of arthrogryposis multiplex congenita. Lower extremity].

This is a report about 25 patients of 28 AMC patients with affected lower limbs. From distal to proximal the joints are less attacked. The club-foot is most frequent. It nearly always needs operative treatment. The best results can be obtained by bony operations (exstirpation of the talus, lateral resection of the cuboid, subtalar arthrodesis). In knee joints the frequent flexion-gryposis is functionaly disturbing. It can be eliminated in most of the cases only by operation. The supracondylar extension-osteotomy has to be rejected in children in favour of a dorsal arthrolysis. Flexion-gryposis preponderate in hip joints. Conservative treatment is most often successful, when flexion is not supported by flexion-gryposis of the knee. Frog like contractures are very obstinate and need operative treatment. There exist different opinions whether open reduction of bilateral complete luxation of the hip is necessary or not. Our 3 patients with complete luxation of both hips had a satisfying function of hips after false external rotation was eliminated by osteotomy of the femur. Unilateral luxation of a hip needs open reduction even if a live in sitting position has to be expected. Our own experience is compared with reports of other authors and guiding principles for treatment are presented.

Arthrogryposis↗

PubMedDate not supplied

[The Freeman-Sheldon Syndrome].

Freeman-Sheldon syndrome (FSS) or craniocarpotarsal dysplasia is characterized by a triad of symptoms: 1. Masklike, whistling facial expression (whistling face syndrome), 2. Ulnar deviation of digits II to V and adduction contracture of the thumb and 3. Foot deformities. The pathogenesis of this malformation is unknown. Heredity is autosomal dominant and not sex-linked. Genetic counseling of affected individuals is imperative. The differential diagnosis should exclude the possibility of arthrogryposis multiplex congenita and particularly congenital windmill deformity of the fingers, which can also be accompanied by foot deformities. The foot and hand deformities associated with FSS are resistant to treatment and require consistent conservative and operative measures. Multiple, extensive operative interventions were unavoidable in both cases described.

Abnormalities, Multiple↗

PubMedDate not supplied

[Experiences with an ankle joint motion device in prevention of thrombosis in patients after total endoprosthesis knee replacement].

PURPOSE: Thromboprophylaxis with heparins after total joint replacement is well accepted. The aim of this prospective randomized study was to evaluate the thrombo-prophylactical efficiency of an ankle joint moving device (Artroflow) after total knee arthroplasty. METHOD: In this prospective study 160 patients were examined who had undergone total knee arthroplasty (TKA). All of the 160 patients received Enoxaparin 1 x 40 mg subcutaneously per day. In addition to this, 90 patients received Artroflow three times a day for 30 minutes. The passive movements of the ankle joint lead to an emptying of the foot and calf veins. Except for the daily routine, we performed physical examination and ultrasound in colour, compression and duplex technique one day before surgery and at the 7th and 14th day after surgery. If a thrombosis was suspected, an ascending phlebography was carried through. RESULTS: The overall thrombosis rate was 6.3% (n = 10). 11.4% (n = 70) deep vein thromboses (DVT) could be observed in the group without Artroflow. Thrombosis occurred in the group with Artroflow in 2 cases (2.2%, n = 90). A statistical difference was found between the two patient groups (p < 0.05, Chi-Square-test). One patient was excluded from the study because of pain in the ankle joint at the fourth day of treatment. CONCLUSION: In addition to heparins, this ankle joint moving device can be recommended as a physical way to prevent DVTs in the thromboprophylaxis of total knee arthroplasty.

Adult↗

PubMedDate not supplied

[Standardized testing of bone implant surfaces with an osteoblast cell culture system. II. Titanium surfaces of different degrees of roughness].

The effect of titanium surfaces with different degrees of roughness on osteoblast proliferation and differentiation was investigated using a standardised cell culture system. Human foetal osteoblasts (hFOB 1.19) were cultured on polished (Ti pol), sandblasted (Ti sb) and sandblasted/heat treated (Ti sb-ht) titanium surfaces for 17 days. Cell culture quality polystyrene (Ps) was used as a control. Cell number and viability were determined for assessment of proliferation. Alkaline phosphatase activity, collagen I and osteocalcin production were measured as parameters for osteoblast differentiation. In the early phase, higher proliferation values were measured on Ti pol. However, on Ti sb and Ti sb-ht higher proliferation was found in the late phase. The activity of the early differentiation marker alkaline phosphatase was higher on Ti pol. No differences were seen for the late differentiation parameters collagen I and osteocalcin. The test system permits the influence of the surface structure on the dynamics of the osteoblast development cycle to be determined. The larger surface area of rough materials leads to an initially delayed, but then prolonged cell proliferation. This model correlates with recent in vivo findings, and confirms the use of rough surfaces for implants in direct contact with bone, even at the cellular level.

Cell Differentiation↗

PubMedDate not supplied

[Standardized testing of skeletal implant surfaces with an osteoblast cell culture system. IV. Specific gene expression during differentiation].

Successful osseointegration of an implant depends on the properties of the material of which it is made. A standardized cell culture system for the assessment of the biological effect of material surfaces has already been described. In the present study, this system has been extended to include the quantitative analysis of the material-dependent osteoblast gene expression. Human foetal osteoblasts (hFOB 1.19) were cultured for 3 weeks on titanium surfaces of varying roughness, and on surfaces of chromium-cobalt-molybdenum alloy (CrCoMo). Using a real time RT-PCR technique, expressions of alkaline phosphatase, collagen 1 and osteocalcin were determined as parameters of osteoblast differentiation. In comparison with CrCoMo, differentiation was accelerated on titanium. While the smooth titanium surface leads to earlier cell growth, the rough surface induces more prolonged and stronger cell proliferation. Our results confirm at the molecular level the excellent clinical biocompatibility of titanium surfaces. The real-time RT-PCR provides a new method for the quantitative assessment of material-dependent osteoblastic differentiation.

Cell Differentiation↗