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J Grifka

Publications and source records attributed to J Grifka.

At least 55 records · Page 3Linked to original sources
PubMed2004

[Unusual complication of silicon synovitis in the rheumatoid wrist].

Silicone synovitis is an important clinical entity recognized in rheumatoid patients after arthroplasties with silicone implants. It is a foreign body reaction to particulate material (silicone elastomer) characterized clinically by the re-occurrence of pain, stiffness and swelling at the site of arthroplasty after initial relief of symptoms. Whereas silicone synovitis is a rare complication in metacarpophalangeal implants, it is an important one in the wrist implant. Long-term follow-up studies have revealed that the rates of fracture and subsidence are high and that the implants deteriorate with time necessitating operative revisions in up to 50% of cases. Indications should therefore be restricted to a painful wrist in the elderly, very low demand patient with insufficient bone stock to permit total wrist arthroplasty with a metal-on-plastic design. Severe preoperative deformity and the need for use of ambulatory aids may further limit the indication. The unusual case of direct perforation of silicone particles from the wrist into the tendon sheath of the M. flexor pollicis longus inducing a tumor-like synovitis and a secondary carpal tunnel syndrome is presented. The importance of silicone synovitis and the indication at present for implantation of a silicone wrist spacer in the rheumatoid patient are discussed.

Arthritis, Rheumatoid↗
PubMed2004

[Navigated implantation of total knee endoprostheses in secondary knee osteoarthritis of rheumatoid arthritis patients as compared to conventional technique].

INTRODUCTION: The operative treatment of a secondary gonarthrosis due to RA claims high quality in soft tissue balancing and accurate alignment in total knee arthroplasty (TKA) which are essential for good long-term results. The efficiency of an imageless computer-assisted implantation in TKA was evaluated and compared with conventional technique. METHOD: The authors implanted each 40 TKA either using the imageless computer-assisted or classical surgeon-controlled technique. The quality of implantation was studied on postoperative long leg coronal and lateral x-rays. RESULTS: A postoperative leg axis between 3 degrees varus and 3 degrees valgus was obtained in 37 patients (92.5%) in the study group and 30 patients (75%) in the control group. Complications influencing the clinical outcome did not occur. CONCLUSION: The use of the imageless Vector-Vision navigation system provides the patient a good chance for longterm survival. Especially the ligament balancing tool appears to be useful. Cutting errors can be detected and intraoperatively corrected.

Arthritis, Rheumatoid↗
PubMed2004

[Adaptive patterns of the rheumatoid wrist after radiolunate arthrodesis].

OBJECTIVE: The aim of this study was the analysis of long-term carpal changes after radiolunate arthrodesis. METHODS: Pre- and postoperative X-rays of 91 wrists in 78 patients with rheumatoid arthritis, who were treated for carpal instability with a radiolunate arthrodesis, were examined concerning the midcarpal joint and the Larsen grade. The mean follow-up was 60 months. RESULTS: After radiolunate arthrodesis the midcarpal joint space remained unchanged in 28%. In 35% secondary arthritis and in 37% further arthritic destruction occurred. The mean Larsen grade increased from 3.2 to 3.8. Six wrists needed complete arthrodesis 25 to 87 months after the primary procedure and one was treated by total wrist replacement. Adaptive changes of the carpus during progressive disease and in secondary arthritis were recognized. Three types of joint lines could be identified: in 35% of the wrists a "perilunar", in 22% a "radio-midcarpal" and in 3% a purely "midcarpal" joint line. In 40% no specific joint line could be identified. CONCLUSION: After radiolunate arthrodesis the carpus remains unchanged in the long run in nearly a third of cases. But even if secondary arthritis or further arthritic destruction occurs as in the remaining cases, the carpus shows an amazing capacity for adaptation. A new intracarpal joint line may develop or the midcarpal joint re-establishes itself.

Arthritis, Rheumatoid↗
PubMed2004

A comparison of two indices for ulnar translation and carpal height in the rheumatoid wrist.

The indices for ulnar translation described by Chamay et al. (1983, Annales de Chirurgie de la Main, Vol. 2, pp. 5-17), and Bouman et al. (1994, Journal of Hand Surgery Vol. 19B, pp. 325-329), and for carpal height described by Youm et al. (1978, Journal of Bone and Joint Surgery, Vol. 40A, pp. 423-431) and Bouman et al. (1994) were compared in pre- and postoperative wrist X-rays of 91 patients with rheumatoid arthritis undergoing radiolunate arthrodesis. Both indices described by Bouman had a higher applicability and sensitivity than the Chamay and Youm indices and are recommended for use with the rheumatoid wrist. However false-negative values may result when the Bouman index for ulnar translation is used to follow up radiolunate arthrodesis.

Arthritis, Rheumatoid↗
PubMed2004

[Reconstruction of insufficient anterior cruciate ligament].

AIM: Reconstruction of insufficient anterior cruciate ligament (ACL) has become a standard operative procedure. Still, graft choice and fixation technique are discussed controversially. The objective of this study was to ascertain the current treatment of ACL reconstruction in german orthopedic surgery and trauma centers. METHODS: A total of 250 trauma and 220 orthopedic surgery centers were asked for their treatment strategy and postoperative procedure of ACL reconstruction in an anonymous German-wide survey. RESULTS: 230 questionnaires (48.9 %) were returned for evaluation. 90.4 % of the surgeons reconstruct the anterior cruciate ligament. Patellar tendon is used by 73 % of orthopedists and 80.7 % of trauma surgeons. Reconstruction with semitendinosus tendon transplant is performed by 71.6 % of the orthopedists and 41.6 % of trauma surgeons. For tibial fixation the interference screw is as well of the semitendinosus tendon as of the patellar tendon the most common technique. In about 30 % each the femoral fixation results from interference screw and endo-button. CONCLUSION: There is still no generally accepted intra- and postoperative strategy for reconstruction of ACL. Reconstruction with semitendinosus tendon becomes more common.

Analgesics↗
PubMed2004

[Influence of sequence type on the extent of the susceptibility artifact in MRI--a shoulder specimen study after suture anchor repair].

PURPOSE: To compare the extent of susceptibility artifacts after metallic suture anchor implantation by analyzing 14 different MRI sequences. MATERIALS AND METHODS: A metallic suture anchor was implanted in the central area of three glenoid porcine specimens. The specimens were imaged with a 1.5 T scanner using a protocol of 14 standard sequences including gradient echo, spin echo and turbo spin echo sequences with and without fat-saturation. Artifact size was measured for each specimen and sequence. The resulting mean artifact areas were determined for each type of sequence and the mean values of the three specimens compared. RESULTS: Gradient echo-sequences produced significantly larger artifact areas than the spin echo and turbo spin echo sequences, whereby the artifacts of the 3D-gradient echo sequences were smaller than the artifacts of the 2D-gradient echo sequences. A turbo spin echo sequence with a high readout band width and a short effective echo time showed the best results. For the conventional spin echo sequence, a reduction in the echo time did not significantly decrease the artifact size. Spectral fat-saturation did not affect the area of the susceptibility artifact compared to the non-saturated sequence. CONCLUSION: Gradient echo sequences should not be used after metallic suture anchor repair. Turbo spin echo sequences showed a decrease in the artifact size compared to conventional spin echo sequences and should be performed with a short effective echo time and a high band width. Spectral fat- saturation did not increase the artifact size significantly.

Animals↗
PubMed2004

[Plantar fibromatosis: therapy by total plantarfasciectomy].

Morbus Ledderhose is a rare fibromatous disease of the plantar fascia. Clinical features include palpable solitary or multiple nodules and cords, mainly affecting the medial part of the plantar fascia. When clinical symptoms occur, conservative options include stretching, orthotics, nonsteroidal antirheumatic drugs, local cortisone-injections and physiotherapy. Operative treatment is indicated in case of persistent pain or if conservative measures fail. The standard procedure includes a partial fasciectomy of the plantar aponeurosis. There is a high recurrence rate with an increased risk of complications and more aggressive ingrowth into anatomical structures after partial resection. Therefore we recommend a complete fasciectomy not only in recurrent disease, but also as the primary procedure of choice.

Adult↗
PubMed2004

Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique.

Restoration of neutral alignment of the leg is an important factor affecting the long-term results of total knee arthroplasty (TKA). Recent developments in computer-assisted surgery have focused on systems for improving TKA. In a prospective study two groups of 80 patients undergoing TKA had operations using either a computer-assisted navigation system or a conventional technique. Alignment of the leg and the orientation of components were determined on post-operative long-leg coronal and lateral films. The mechanical axis of the leg was significantly better in the computer-assisted group (96%, within +/- 3 degrees varus/valgus) compared with the conventional group (78%, within +/- 3 degrees varus/valgus). The coronal alignment of the femoral component was also more accurate in the computer-assisted group. Computer-assisted TKA gives a better correction of alignment of the leg and orientation of the components compared with the conventional technique. Potential benefits in the long-term outcome and functional improvement require further investigation.

Adult↗
PubMed2004

[Accuracy of an image-free cup navigation system--an anatomical study].

The position of the acetabular cup is of decisive importance for the function of a total hip replacement (THR). Using the conventional surgical technique, correct placement of the cup often fails due to a lack of information about pelvic tilt. With CT-based and fluoroscopically-assisted navigation procedures the accuracy of implantation has been significantly improved. However, additional radiation exposure, high cost and the increased time requirement have hampered the acceptance of these techniques. The present anatomical study evaluates the accuracy of an alternative procedure--image-free navigation. This method requires little extra effort, does not substantially delay surgery, and needs no additional imaging. Press-fit cups were implanted in 10 human cadaveric hips with the help of the image-free navigation system, and the position of the cups was checked intraoperatively with a CT-based navigation system and postoperatively by computed tomography. All cups were implanted within the targeted safe zone with an average inclination of 44 degrees (range 40 degrees-48 degrees, SABW 2.7 degrees) and an average anteversion of 18 degrees (range 12-24 degrees, SABW 4.1 degrees). Analysis of accuracy of the image-free navigation software revealed only a small, clinically tolerable deviation in cup anteversion and cup inclination in comparison with the CT-based navigation system and the post operative CT scans. The evaluated image-free navigation system appears to be a practicable and reliable alternative to the computer-assisted implantation of acetabular cups in total hip arthroplasty.

Acetabulum↗
PubMed2003

Laser-mediated microdissection facilitates analysis of area-specific gene expression in rheumatoid synovium.

OBJECTIVE: Current approaches to analyzing gene expression in rheumatoid arthritis (RA) synovium are based on RNA isolated either from cultured synovial cells or from synovial biopsy specimens. This strategy does not, in general, allow distinction of specific gene expression between cells originating from different synovial areas, due to potential mixture of expression profiles. Therefore, we established the combination of laser-mediated microdissection (LMM) and differential display to analyze profiles of gene expression in histologically defined areas of rheumatoid synovium. The present study was undertaken to establish parameters for this technique and assess its usefulness for gene expression analysis. METHODS: Cryosections derived from RA synovial tissues were used to obtain cell samples from synovial lining versus sublining, using a microbeam laser microscope. RNA was isolated and analyzed by nested RNA arbitrarily primed-polymerase chain reaction (RAP-PCR) for differential display fingerprinting. Differentially expressed bands were cut out, and PCR products were eluted, cloned, and sequenced. Differential expression of identified sequences was confirmed by in situ hybridization and immunohistochemistry analysis. RESULTS: Microdissected sections of RA synovial tissue containing approximately 600 cells yielded enough RNA to produce a reproducible RNA fingerprint pattern. Several genes could be identified as being expressed differentially between the synovial lining and the sublining, and their expression could be confirmed at the messenger RNA and protein levels. CONCLUSION: The combination of LMM and RAP-PCR presents a valuable tool to obtain novel insights into the area-dependent differential regulation of gene expression in RA synovium. Both known and previously unknown genes were revealed with this technique. This study is the first to demonstrate the potential of this analytic strategy in the investigation of a nonmalignant, multifactorial, inflammatory disease.

Arthritis, Rheumatoid↗
PubMed2003

[CT-based and CT-free navigation in knee prosthesis implantation. Results of a prospective study].

INTRODUCTION: Accurate leg alignment is one important factor for long-term survival in total knee arthroplasty (TKA). The classical surgeon-controlled technique is associated with a deviation of the leg axis of more than 3 degrees in up to 30% of cases, regardless of the surgeon's experience. The aim of this study was to test the efficiency of a CT-based and CT-free navigation system in restoration of the leg axis. METHOD: 100 TKA (PFC-Sigma, DePuy) were implanted either using the CT-based or CT-free module of the Vector-Vision navigation System (BrainLAB). There were no significant differences between the groups in preoperative leg deformity. Accuracy of implantation was determined on postoperative long-leg coronal and lateral X-rays. RESULTS: A postoperative leg axis between 3 degrees varus and 3 degrees valgus was obtained in 46 patients (92%) in the CT-based group (A) and in 48 patients (96%) in the CT-free group (B). No significant differences were found for varus / valgus orientation (+/-3 degrees ) of the femoral (A=96%; B=94%) and tibial (A and B each 98%) components. CONCLUSION: The use of the CT-based and CT-free Vector-Vision system allows a significant improvement in the accuracy of implantation in TKA. The CT-based module has the advantage of precise preoperative planning. On the other hand there are additional costs and time-consuming logistics. The advantages of the CT-free module are the intraoperative visualisation of the leg axis, the ligament balancing and joint kinematics. Cutting errors can be detected and corrected with both modules.

Adult↗
PubMed2003

[Complex regional pain syndrome type I (CRPS I). Pathophysiology, diagnostics, and therapy].

Complex regional pain syndrome type I (CRPS type I)--formerly termed Sudeck's atrophy or reflex sympathetic dystrophy (RSD)--causes chronic, poorly controllable pain, autonomic, sensorimotor disorders,and serious trophic alterations in the later stages. It develops in the distal extremities mostly after minimal trauma or surgical intervention and rarely spontaneously. The severity of symptoms is disproportionate to the causative event. The latest scientific findings show that the previously called reflex sympathetic dystrophy (RSD), which was supposed to be a result of a hyperreactive autonomic nervous system,is a very complex syndrome that occurs on different integration levels of the nervous system. Sympathetically maintained pain (SMP) may be facultatively characteristic, but is not to be misunderstood as an underlying mechanism. A neurogenic inflammation reaction has recently been discussed, just as had been postulated by Paul Sudeck long before. That was the reason why the International Association for the Study of Pain (ISAP) introduced the more descriptive term "complex regional pain syndrome" (CRPS) type I in 1994. Due to the complexity of the process necessitating qualified knowledge, it is important to immediately refer patients to a specialized pain OPD or clinic. The diagnosis of CRPS type I is based upon a carefully taken case history and a clinical examination by an experienced practitioner. Imaging diagnostic tools and laboratory findings are of no or only low predicative value. The question of whether SMP exists after diagnosing CRPS type I is eminent for therapy planning. Therefore, diagnostic regional anesthetics are still important in spite of their uncertain prognostic relevance. Physical therapy, occupational therapy, medical treatment, and psychotherapy play an important role in the primary treatment of CRPS type I as noninvasive procedures. Despite heavy criticism, invasive sympathetic block, subsequent to adequate diagnostics, is an important part of the therapeutic concept. A multimodal therapeutic concept, which includes all available possibilities, is absolutely necessary to avoid grave permanent disabilities caused by insufficient or failed therapy. Nevertheless, already established as well as new treatment modalities have to be critically observed by further randomized, prospective control trials.

Autonomic Nervous System↗
PubMed2003

[Unrecognized and untreated rupture of the Achilles tendon-operative treatment in cases of unstable scar tissue].

Although the clinical picture of an acute rupture of the Achilles tendon is clear, it remains unrecognized or falsely evaluated in up to 10% of all cases. Wrong management without surgical intervention or adequate immobilization frequently leads to unstable scar tissue, requiring completely different therapy and rehabilitation than in the case of an acute injury. Between 6/2000 and 3/2002 11 patients (average age 53 years, M:F=9:2) with a neglected rupture of the Achilles tendon undergoing reconstruction of unstable scar tissue were evaluated in a prospective study. The preoperative cardinal symptoms were loss of strength and stress pain. The length of the unstable scar tissue measured 3.5 cm on average (2.0-6.0 cm). After resection of the scar lesion, a broad central gastrocnemius aponeurotic flap was performed in nine cases,whereas two cases underwent a central tendon shift. As a result of the surgical tendon reconstruction,we noted a 40% mean increase of strength in the final examination. This improvement was associated with less pain and a comparable range of motion. Protracted wound secretion and superficial wound necrosis were recorded on one and two occasions, respectively. Ultrasound and X-ray as preoperative imaging diagnostic tools in addition to the clinical picture appear to be sufficient for proper indication and planning of surgical intervention. The broad central aponeurotic flap has proven to be the most successful method in our patients. In cases of a short distal end, the "grip-box plasty" with a central tendon shift is indicated. Even lesions up to 6 cm can thus be repaired with autologous tissue.

Achilles Tendon↗
PubMed2003

[Imaging in rheumatoid arthritis of the elbow].

Early specific radiologic changes of rheumatoid arthritis can usually be detected in the hands and feet. Later stages of the disease process show a typical centripetal spread of the affected joints, i.e., shoulder, elbow, and knee. For prognostic assessment of cubital rheumatoid arthritis, conventional radiography still remains the gold standard. X-rays allow objective scoring and thus classification into standardized stages. A concentric destruction of the rheumatic joint as compared to deformity in the degenerative joint is the typical radiologic symptom to look for. For soft tissue assessment, ultrasound (US) should be the diagnostic tool of choice. Due to the thin surrounding soft tissue layer, as well as the advanced high-resolution technology, bony structures can also be well demonstrated in any plane. In the early arthritic stages, particularly the small changes, e.g., minimal erosions of the cortical area, are very well detectable by US. The use of "color" allows good evaluation of the synovial inflammatory status. Modern imaging methods such as computer- assisted tomography (CAT) scan and magnetic resonance imaging (MRI) are restricted to a few set indications and should not be chosen for routine examination. More invasive methods such as arthrography are no longer indicated for assessment of cubital rheumatoid arthritis.

Arthritis, Rheumatoid↗
PubMed2003

[Joint-preserving procedures for the rheumatoid elbow joint. Medium-term results].

The follow-up of 42 patients with 50 symptomatic elbow joints [average age at operation: 66.1 years (46-79 years)] with rheumatoid arthritis at an average of 6.8 years (SD: 3.5 years) after joint-preserving open operation is presented in this study. Synovectomy was mandatory. Open synovectomy with facultative additional soft tissue techniques (AS) was performed on 17 elbows, while in 33 elbows joint surface remodeling (SR)-radial head excision included-was performed. There was only a slight progression in the overall Larsen staging from 3.70 to 4.02 in the operated joints, while the non-operated joints were nearly unchanged (3.43 vs 3.56). Especially in the SR group a nearly significant ( p=0.06) increase of 31.0 degrees for the total elbow ROM as a sum of extension/ flexion and pronation/supination could be detected, while the AS group slightly decreased with -1.1 degrees. Both groups gained a comparable average Morrey score result (AS 77.6 points vs SR 75.6 points). Poor results were not noticed at all. A mild collateral instability was seen in 40% of the AS and in 20% of the SR cases, respectively. Moderate instability was found in 10% in the AS vs 5% in the SR group. Both groups showed an excellent benefit in terms of pain relief, function, and satisfaction according to the patients' self-assessment on a visual analog scale.Joint-preserving operations on the rheumatoid elbow proved to be safe and efficient methods on a medium term even at late stages. Especially joint surface remodeling guarantees a noticeable increase for the elbow ROM without provoking marked collateral instability. The patients' expectations for pain relief and functionality can be fulfilled completely with these methods.

Aged↗
PubMed2003

[Total elbow arthroplasty. Indications, operative technique and results after implantation of an Acclaim elbow prosthesis].

Total elbow arthroplasty has become a reliable treatment option for patients with rheumatoid arthritis as well as primary or posttraumatic arthrosis. The aim of this study is to present the indications, operative technique and results for the implantation of an Acclaim elbow prosthesis. Case reports are given to demonstrate the indications for prosthesis implantation. Furthermore, the follow-up results are reported for 65 patients after implantation of an Acclaim prosthesis. Pre- and postoperative pain were evaluated using the visual analogue scale. The pain level decreased from 8.0 to 2.3 postoperatively. After implantation of an elbow prosthesis, there was a significant improvement in the range of motion. The mean flexion increased from 103 degrees preoperatively to 140 degrees postoperatively. An increase of 10 degrees was found for both supination and pronation. Complications included temporary ulnary nerve irritation in seven patients, intraoperative fractures in four cases and postoperative elbow dislocation in one case. In conclusion, total elbow arthroplasty results in a reduction of pain and an improvement in elbow movement. However, selection of the right patient is important. Patients are advised not to lift heavy objects or to perform hard physical work. If patients' compliance can not be ensured preoperatively, no total elbow arthroplasty should be performed.

Aged↗
PubMed2003

[Innovations in total knee arthroplasty].

The development of total knee arthroplasty started in the fifth decade last century. Modern total knee joint systems represent a high grade of modularity for a usage within the whole range of joint destruction situations, such as for rheumatoid arthritis. Innovations for improved long term survival can be seen in methods reducing aseptic loosening, such as new implant materials or mobile platforms. Moreover improved surgical techniques for precise component orientation and reconstruction of a neutral leg axis have been introduced using computer assisted surgery. So far the results using this technique are very promising. Long term results are not yet available.

Arthroplasty, Replacement, Knee↗