1
|
Afghanyar Y, Möller JH, Wunderlich F, Dargel J, Rehbein P, Gercek E, Drees P, Kutzner KP. An isoelastic monoblock cup versus a modular metal-back cup: a matched-pair analysis of clinical and radiological results using Einzel-Bild-Röntgen-Analyse software. Arch Orthop Trauma Surg 2024; 144:493-500. [PMID: 37740060 PMCID: PMC10774207 DOI: 10.1007/s00402-023-05058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/01/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION Bone preservation and long-term survival are the main challenges in cementless total hip arthroplasty (THA). A good bone stock is especially important for adequate anchorage of the cup in revision cases. However, the optimal acetabular cup design for preserving good bone stock is still unclear. We aimed to compare clinical outcome, radiological alterations, migration, and wear at mid-term for two different cup types. MATERIALS AND METHODS This retrospective matched-pair study was performed using the data for 98 THA cases treated with a monoblock cup composed of vitamin E-blended highly cross-linked polyethylene (VEPE; monoblock group) or a modular cup composed of a highly cross-linked polyethylene (HXLPE) without an antioxidant (modular group). Clinical results were evaluated using the Harris Hip Score (HHS). The obtained radiographs were analyzed for radiological alterations, migration, and wear using Einzel-Bild-Röntgen-Analyse (EBRA) software. RESULTS The mean follow-up duration was 73.2 ± 19.2 months (range: 32-108 months) and 60.5 ± 12.2 months (range: 20-84 months) in the monoblock and modular groups, respectively. HHS improved to 95.7 points in the monoblock group and 97.6 points in the modular group, without significant differences (p = 0.425). EBRA measurements were obtained in all cases. Acetabular bone alterations were not detected on radiological assessments. Mean cup migration was 1.67 ± 0.92 mm (range: 0.46-3.94 mm) and 1.24 ± 0.87 mm (range: 0.22-3.62 mm) in the monoblock and modular groups. The mean wear rate was 0.21 ± 0.18 mm (range: 0.00-0.70 mm) and 0.20 ± 0.13 mm (range: 0.00-0.50 mm) in the monoblock and modular groups. Both migration and wear pattern showed no significant differences (p = 0.741 and 0.243). None of the cases required revision surgery, yielding an implant survival rate of 100% in both groups. CONCLUSION The isoelastic press-fit monoblock VEPE cup and modular metal-back HXLPE cup showed equivalent mid-term wear and cup migration. Long-term studies are required to determine the effects of modularity, isoelasticity, and polyethylene stabilization with vitamin E on cup loosening and survival rates.
Collapse
Affiliation(s)
- Yama Afghanyar
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Mainz, Germany.
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany.
| | - Jens Hendrik Möller
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | - Felix Wunderlich
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Jens Dargel
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | - Philipp Rehbein
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | - Erol Gercek
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Karl Philipp Kutzner
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Mainz, Germany
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
| |
Collapse
|
2
|
Sircar K, Hägermann C, Scaal M, Müller LP, Dargel J, Wegmann K. Thumb Metacarpophalangeal Joint Kinematics and Elongation of the Ulnar Collateral Ligament. J Hand Surg Am 2024; 49:8-14. [PMID: 37978963 DOI: 10.1016/j.jhsa.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/23/2023] [Accepted: 10/04/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE The purpose of the study was to determine if the sphericity of the thumb metacarpophalangeal (MCP) joint influences the joint's rotational axis (RA) and elongation patterns of the ulnar collateral ligament (UCL). METHODS Ulnar collateral ligament origins and attachments of 28 fresh-frozen cadaveric thumbs were marked with a radiopaque marker. Lateral radiographs were obtained in neutral and 20°, 40°, and 60° of flexion. The dorsal and palmar joint gap and the length of four different UCL portions were digitally measured in all flexion states. The RA was determined by the intersection of the midshaft axis of the proximal phalanx in neutral and flexion states. Sphericity of the MCP joint was assessed using morphometric parameters. Joints were grouped as round or flat. Differences in all measured parameters between groups were analyzed. RESULTS During flexion, the dorsal joint gap increased by 322% in flat joints and 163% in round joints. The palmar joint gap decreased to 45% in flat joints and to 87% in round joints. The RA was at 29% of metacarpal height and 96% of metacarpal length in flat joints and at 40% of height and 86% of length in round joints. Maximum UCL elongation (111%) was noted at 40° flexion in the dorsal proper UCL in flat joints and at 60° flexion in the accessory UCL (117%) in round joints. CONCLUSIONS In flat MCP joints, the RA is more dorsal and distal in the metacarpal head compared to round joints, resulting in a hinged flexion motion. Elongation of the UCL is highest at end flexion in round joints and highest at midflexion in flat joints. CLINICAL RELEVANCE The different kinematics of flat and round MCP joints may contribute to the understanding of the pathophysiology of UCL ruptures. The propensity of this injury and the position in which they occur may be affected by the MCP joint morphology.
Collapse
Affiliation(s)
- Krishnan Sircar
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | | | - Martin Scaal
- Faculty of Medicine, Institute of Anatomy II, University of Cologne, Cologne, Germany
| | - Lars-Peter Müller
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jens Dargel
- Department of Orthopedic Surgery, St.-Josefs-Hospital Wiesbaden, Wiesbaden, Germany
| | | |
Collapse
|
3
|
Trost M, Yarkin S, Knieps M, Frey S, Neiss WF, Eysel P, Gick S, Dargel J. Biomechanical comparison of different fixation methods in tibiotalocalcaneal arthrodesis: a cadaver study. J Orthop Surg Res 2023; 18:971. [PMID: 38105223 PMCID: PMC10726638 DOI: 10.1186/s13018-023-04444-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Various fixation methods are available for tibiotalocalcaneal arthrodesis: nail, plate, or screws. An intramedullary bone stabilization system within a balloon catheter has not previously been used in tibiotalocalcaneal arthrodesis. The aim of this study was to compare the stability of these techniques. METHODS Twenty-four lower legs from fresh-frozen human cadavers were used. Tibiotalocalcaneal arthrodesis was performed with a retrograde nail, a lateral locking plate, three cancellous screws, or an intramedullary bone stabilization system. The ankles were loaded cyclically in plantarflexion and dorsiflexion. RESULTS For cyclic loading at 125 N, the mean range of motion was 1.7 mm for nail, 2.2 mm for plate, 6.0 mm for screws, and 9.0 mm for the bone stabilization system (P < .01). For cyclic loading at 250 N, the mean range of motion was 4.4 mm for nail, 7.5 mm for plate, 12.1 mm for screws, and 14.6 mm for the bone stabilization system (P < .01). The mean cycle of failure was 4191 for nail, 3553 for plate, 3725 for screws, and 2132 for the bone stabilization system (P = .10). CONCLUSIONS The stability of the tibiotalocalcaneal arthrodesis differs depending on the fixation method, with nail or plate showing the greatest stability and the bone stabilization system the least. When three screws are used for tibiotalocalcaneal arthrodesis, the stability is intermediate. As the biomechanical stability of the bone stabilization system is low, it cannot be recommended for tibiotalocalcaneal arthrodesis.
Collapse
Affiliation(s)
- Matthias Trost
- Department of Orthopaedics and Traumatology, Saint Josef Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany.
| | - Suzan Yarkin
- Department of Orthopaedics and Traumatology, Protestant Hospital Cologne Weyertal, Cologne, Germany
| | - Matthias Knieps
- Department of Orthopaedics and Traumatology, Cologne University Hospital, Cologne, Germany
| | - Sönke Frey
- Department of Orthopaedics and Traumatology, Florence Nightingale Hospital, Düsseldorf, Germany
| | | | - Peer Eysel
- Department of Orthopaedics and Traumatology, Cologne University Hospital, Cologne, Germany
- Cologne Center for Musculoskeletal Biomechanics (CCMB), University of Cologne, Cologne, Germany
| | - Sascha Gick
- Department of Traumatology, Orthopaedics and Hand Surgery, Saint Vinzenz Hospital, Cologne, Germany
| | - Jens Dargel
- Department of Orthopaedics, Saint Josefs Hospital, Wiesbaden, Germany
| |
Collapse
|
4
|
Sircar K, Dargel J, Scaal M, Eysel P, Müller LP, Wegmann K. Thumb metacarpophalangeal joint morphology and reconstruction of the ruptured ulnar collateral ligament. J Hand Surg Eur Vol 2023; 48:768-772. [PMID: 37005740 DOI: 10.1177/17531934231164260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Studies on graft reconstruction techniques for ruptured thumb metacarpophalangeal (MCP) ulnar collateral ligaments (UCL) do not consider the variety of MCP joint morphology. Optimal reconstruction method for flat MCP joints is therefore unclear. Twenty-four fresh-frozen, human thumbs were tested for flexion, extension and valgus stability of the MCP joint. After resection of the UCL, four reconstruction methods, differing in the metacarpal origin and phalangeal attachment, were performed on each specimen, which were then tested again in the same way. Specimens were grouped as 'round' or 'flat' depending on morphometric parameters and group differences were analysed. In flat joints, only the non-anatomical Glickel reconstruction and a modified Fairhurst reconstruction maintained normal mobility and stability. In round joints, only the Glickel reconstruction maintained normal mobility and stability. The original Fairhurst method and a modification with the origin palmar in the metacarpus were disadvantageous in both flat and round joints.
Collapse
Affiliation(s)
- Krishnan Sircar
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Jens Dargel
- Department of Orthopedic Surgery; St.-Josefs-Hospital Wiesbaden, Wiesbaden, Germany
| | - Martin Scaal
- Faculty of Medicine, Institute of Anatomy II, University of Cologne, Cologne, Germany
| | - Peer Eysel
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Lars-Peter Müller
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Kilian Wegmann
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
- Orthopädische Chirurgie München, München, Germany
| |
Collapse
|
5
|
Riemer L, Dargel J, Schäferhoff P, Eysel P, Steimel T, Reineck S, Grevenstein D. Femoral condyle configuration and its impact on anterior cruciate ligament reconstruction. Technol Health Care 2023; 31:1607-1617. [PMID: 36970923 PMCID: PMC10578253 DOI: 10.3233/thc-220640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/12/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Rupture of the anterior cruciate ligament (ACL) is one of the most common knee injuries and has substantial impact on knee function. Beside primary ruptures, an increasing number of re-(re-)ruptures occur, representing a therapeutical challenge for the treating surgeon. Several risk factors for re-ruptures have been previously identified, including an increased tibial slope. OBJECTIVE In this study, we investigated the effect of femoral condyle configuration on ACL-ruptures and re-ruptures. METHODS In-vivo magnetic resonance imaging scans of three different groups of patients were compared. Group 1 included patients with an intact ACL on both sides, group 2 included patients with primary, unilateral ACL-rupture, while group 3 included patients with an ACL-re-rupture or re-(re-)rupture. Fourteen different variables were obtained and analyzed regarding their impact on ACL-re-(re-)rupture. RESULTS Overall, 334 knees were investigated. Our data allowed us to define parameters to identify anatomical configurations of bones associated with an increased risk of ACL-re-rupture. Our results show, that patients with ACL-re-rupture show increased radii of the extension facet of the lateral femoral condyle (p< 0.001) as well as of the extension facet of the medial femoral condyle (p< 0.001). CONCLUSION We conclude that a spherical femoral condyle form does influence the clinical outcome after ACL-reconstruction.
Collapse
Affiliation(s)
- Lena Riemer
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Jens Dargel
- Department for Orthopaedic Surgery, St. Josefs-Hospital Wiesbaden, Wiesbaden, Germany
| | - Peter Schäferhoff
- Department for Orthopaedic Surgery, ATOS MediaPark Klinik, Cologne, Germany
| | - Peer Eysel
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Cologne, Germany
| | | | | | - David Grevenstein
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine, University of Cologne, Cologne, Germany
| |
Collapse
|
6
|
Afghanyar Y, Kutzner KP, Pfeil J, Drees P, Rehbein P, Dargel J. Cementless Short Stems in Total Hip Arthroplasty: Chances and Limits. Z Orthop Unfall 2022. [PMID: 35104904 DOI: 10.1055/a-1678-7684] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In recent decades, a large number of cementless short stems have been introduced to the market. The concept aims at saving soft tissue using minimally invasive surgery and at the same time preserving as much bone as possible. In particular, the latest generation of short stems, which are implanted using a calcar-guided round-the-corner technique, are attracting increasing attention. An individualised resection level allows individual stem alignment and thus an ideal reconstruction of the hip anatomy. The early clinical results of short-stem total hip arthroplasty (THA) are promising and have led to an expansion of the indications and limitations for the use of short stems. In particular, the individual positioning in valgus or varus and the resulting individual metaphyseal or metadiaphyseal anchorage offers various possibilities to reconstruct even abnormal joint morphologies. Consequently, short stems are increasingly used in patients with complex anatomical variations or in cases of osteonecrosis of the femoral head. In some various cases, they can also be used in revision or conversion arthroplasty. In some patients, short stems can also be used after femoral neck fracture. Currently, scientific data on those areas of indication of short-stem THA is scarce.
Collapse
Affiliation(s)
- Yama Afghanyar
- Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
| | - Karl Philipp Kutzner
- Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland.,Zentrum für Orthopädie und Unfallchirurgie (ZOU), Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Joachim Pfeil
- Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
| | - Philipp Drees
- Zentrum für Orthopädie und Unfallchirurgie (ZOU), Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Philipp Rehbein
- Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
| | - Jens Dargel
- Klinik für Orthopädie und Unfallchirurgie, St Josefs Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
| |
Collapse
|
7
|
Afghanyar Y, Klug A, Rehbein P, Dargel J, Drees P, Kutzner KP. One-stage bilateral versus unilateral short-stem total hip arthroplasty: A matched-pair analysis of 216 hips. J Orthop 2021; 27:130-136. [PMID: 34616117 PMCID: PMC8476895 DOI: 10.1016/j.jor.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/19/2021] [Indexed: 12/01/2022] Open
Abstract
Background One-stage, bilateral, short-stem total hip arthroplasty (1B-ssTHA) represents an alternative to staged, unilateral, short-stem total hip arthroplasty (U-ssTHA); however, the safety and reliability of 1B-ssTHA remain unknown. The objective of the present study was to compare the functional outcomes, complications, and mortality rates between 1B-ssTHA and U-ssTHA at mid-term. Methods A retrospective, matched-pair study was performed, including 216 short stems implanted in 162 patients. Among the study population, 54 patients were treated with 1B-ssTHA. Patients were matched by gender, age, body mass index (BMI), and American Society of Anesthesiologists (ASA) classification. A total of 46 full matches could be accomplished. The mean follow-up time for the 1B-ssTHA group was 61.7 months (standard deviation [SD] 6.2 months), compared with was 63.4 months (SD 8.0 months) for the U-ssTHA group. Mortality, complication, and revision rates were documented. For clinical examinations, the visual analogue scale (VAS) was used to evaluate satisfaction, rest pain, and load pain, and the Harris Hip Score (HHS) was determined. Results No surgery-related deaths were observed. At mid-term, none of the 1B-ssTHA patients required stem revision. The rate of complications for both groups was low. The mean drop in haemoglobin measured in the 1B-ssTHA group was 4.42 mg/dl, compared with 3.18 mg/dl in the U-ssTHA group. The mean HHS in the 1B-ssTHA group was 98.3 points (SD 2.80), whereas, in the U-ssTHA group, the mean HHS was 97.9 points (SD 3.44) (p = 0.478). Satisfaction rates were significantly higher in the 1B-ssTHA group (p = 0.04) than in the U-ssTHA group, whereas no significant differences were found for pain at rest and pain at load (p = 0.56 and p = 0.26, respectively). Conclusion Our findings indicate that 1B-ssTHA is an effective and beneficial procedure for a select population. Mortality, complications, implant survival, and clinical outcomes were comparable to those for a matched group with unilateral osteoarthritis treated with U-ssTHA. However, an increase in blood loss must be acknowledged for the 1B-ssTHA procedure.
Collapse
Affiliation(s)
- Yama Afghanyar
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Alexander Klug
- Department of Orthopaedics and Traumatology, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Philipp Rehbein
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Jens Dargel
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Karl Philipp Kutzner
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany.,Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| |
Collapse
|
8
|
Lenz M, Neumann M, Spies CK, Stein G, Eysel P, Dargel J, Oppermann J. Effect of different forearm positions on fragment rotation in extra-articular distal radius fractures: A cadaveric study. Acta Orthop Traumatol Turc 2021; 55:349-354. [PMID: 34464312 DOI: 10.5152/j.aott.2021.21075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the effect of different arm positions (hand pronation/supination and elbow flexion/extension) on fragment rotation in extra-articular distal radius fractures in a cadaveric model. METHODS In this study, ten fresh-frozen cadaveric upper extremities from five donors with a mean age of 69 ± 12 years were used. Two cortical pins were inserted in the radius and the ulna. In a custom-made device, different forearm (30°, 60°, and 90° of pronation and supination) and elbow positions (full extension) were tested, using a fluoroscopic analysis. The degree of malrotation between the two pins was measured in these positions. At the last test sequence, the tendon of the brachioradialis muscle was released. RESULTS A significant difference was found in concerns of the rotational angle between the distal fragment and the radial shaft at different degrees of pronation and supination if the elbow joint was in an extended and flexed position. The release of the brachioradialis tendon did not show any effect. CONCLUSION The results of this study supported that rotational malpositions in distal radius fractures can be decreased if the forearm is in a neutral position. Accordingly, the forearm should be in a neutral position while initially immobilization in a plaster splint is performed.
Collapse
Affiliation(s)
- Maximilian Lenz
- Department of Orthopaedic and Trauma Surgery, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Maik Neumann
- Deparment of Internal Medicine, Hospital Wermelskirchen, Wermelskirchen, Germany
| | | | - Gregor Stein
- Department of Orthopaedic and Trauma Surgery, Helios Clinic, Siegburg, Germany
| | - Peer Eysel
- Department of Orthopaedic and Trauma Surgery, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Jens Dargel
- Department of Orthopaedic and Trauma Surgery, Helios Clinic, Siegburg, Germany
| | - Johannes Oppermann
- Department of Orthopaedic and Trauma Surgery, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| |
Collapse
|
9
|
Coutandin M, Afghanyar Y, Drees P, Dargel J, Rehbein P, Kutzner KP. Can hip resurfacing be safely revised with short-stem total hip arthroplasty? A case series of six patients. J Orthop 2021; 24:274-279. [PMID: 33897129 PMCID: PMC8050111 DOI: 10.1016/j.jor.2021.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/21/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The usage of short stems in primary total hip arthroplasty (THA) has constantly gained popularity over the last decade, however, to date, short stems are not eligible to be used as revision implants. The aim of this study was to retrospectively evaluate the outcome of revision surgery of failed hip resurfacing arthroplasty (HRA) using short-stem THA. METHODS In a single center, retrospective analysis, 6 consecutive patients who were treated with a calcar-guided short stem after failure of HRA were evaluated. The mean follow-up was 3.25 years (SD 0.45). Patient reported outcome measurements (PROMs) were recorded using the Harris hip score (HHS) and The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The health status was evaluated by the EQ-5D-5L score. Pain and satisfaction were obtained using the visual analogue scale (VAS). Radiographic analysis was performed by evaluating osteolysis, stress shielding, alignement and signs of aseptic loosening. Complications were documented. RESULTS At last follow-up, clinical outcome was excellent (HHS ≥ 90) in 5 patients and good (HHS = 87) in 1 patient. The mean WOMAC score was 5.73% (SD 3.66%). The mean EQ-5D-5L index was 0.914 (SD 0.07). Pain and satisfaction on VAS was 1.83 (SD 5.18) and 8.67 (SD 0.94), respectively. Radiologically, no signs of subsidence, aseptic loosening, stress shielding and fracture were obvious. No major complications occurred. To date, no further revision surgery was needed. CONCLUSIONS The outcomes of the present case series propose that HRA can be safely revised using short-stem THA in a selected patient group. Clinical and radiological results are encouraging. Based on the present data, short stems may be considered as a revision implant for failed HRA for experienced surgeons.
Collapse
Affiliation(s)
- Marcel Coutandin
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Yama Afghanyar
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Jens Dargel
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Rehbein
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Karl Philipp Kutzner
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| |
Collapse
|
10
|
Afghanyar Y, Joser S, Tecle J, Drees P, Dargel J, Rehbein P, Kutzner KP. The concept of a cementless isoelastic monoblock cup made of highly cross-linked polyethylene infused with vitamin E: radiological analyses of migration and wear using EBRA and clinical outcomes at mid-term follow-up. BMC Musculoskelet Disord 2021; 22:107. [PMID: 33485345 PMCID: PMC7827971 DOI: 10.1186/s12891-021-03981-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 01/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background The newest generation of cementless titanium-coated, isoelastic monoblock cup with vitamin E-blended highly cross-linked polyethylene (HXLPE) was introduced to the market in 2009. The aim of the present study was to obtain mid-term follow-up data including migration and wear analyses. Methods This prospective study investigated 101 primary total hip arthroplasty (THA) cases in 96 patients treated at a single institution. Patients were allowed full weight-bearing on the first day postoperatively. Harris hip score (HHS) and pain and satisfication on a visual analogue scale (VAS) were assessed at a mean follow-up of 79.0 months. Migration and wear were assessed using Einzel-Bild-Roentgen-Analyse (EBRA) software. Radiological acetabular bone alterations and complications were documented. Results At mid-term follow-up (mean 79.0 months, range: 51.8–101.7), 81 cases with complete clinical and radiological data were analyzed. Utilisable EBRA measurements were obtained for 42 hips. The mean HHS was 91.1 (range 38.0–100.0), VAS satisfaction was 9.6 (range 6.0–10.0), VAS rest pain was 0.2 (range 0.0–4.0), and VAS load pain was 0.6 (range 0.0–9.0). Mean migration was 0.86 mm (range: 0.0–2.56) at 24 months and 1.34 mm (range: 0.09–3.14) at 5 years, and the mean annual migration rate was 0.22 (range: − 0.24–1.34). The mean total wear was 0.4 mm (range: 0.03–1.0), corresponding to a mean annual wear rate of 0.06 mm per year (range: 0.0–0.17). Radiographic analysis did not reveal any cases of osteolysis, and no revision surgeries had to be performed. Conclusions After using vitamin-E blended HXLPE in cementless isoelastic monoblock cups, there were no obvious signs of osteolysis or aseptic loosening occurred. No patients required revision surgery after mid-term follow-up. Cup migration and wear values were well below the benchmarks considered predictive for potential future failure. Trial registration The trial registration number on ClinicalTrials.gov: NCT04322916 (retrospectively registered at 26.03.2020). Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-03981-8.
Collapse
Affiliation(s)
- Yama Afghanyar
- Department of Orthopaedic Surgery, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany.
| | - Sebastian Joser
- Department of Orthopaedic Surgery, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Jonas Tecle
- Department of Orthopaedic Surgery, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Jens Dargel
- Department of Orthopaedic Surgery, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Rehbein
- Department of Orthopaedic Surgery, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Karl Philipp Kutzner
- Department of Orthopaedic Surgery, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany.,Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| |
Collapse
|
11
|
Grevenstein D, Heilig J, Dargel J, Oppermann J, Eysel P, Brochhausen C, Niehoff A. COMP in the Infrapatellar Fat Pad-Results of a Prospective Histological, Immunohistological, and Biochemical Case-Control Study. J Orthop Res 2020; 38:747-758. [PMID: 31696983 DOI: 10.1002/jor.24514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 10/25/2019] [Indexed: 02/04/2023]
Abstract
Knee osteoarthritis (OA) involves several structures and molecules in the joint, which interact in a pathophysiological process. One of these molecules is the cartilage oligomeric matrix protein (COMP). Elevated COMP levels in the synovial fluid as well as in the serum have been described in OA patients. However, this has not been described in the infrapatellar fat pad (IPFP) tissue before. In this prospective trial, we collected 14 IPFPs from patients with high-grade OA (mean age 63.8 ± 17.6 years) who underwent total knee replacement (OA group) and from 11 healthy patients (mean age 33.7 ± 14.8 years) who underwent anterior cruciate ligament reconstruction (control group). The presence of macrophages (CD68 and CD206) and proinflammatory cytokines (interleukin 1β [IL-1β] and IL-6) was analyzed. Histological and immunohistological examinations as well as immunoblotting analysis for COMP, leptin, and matrix-metalloproteinase-3 were performed. The IPFPs of both the OA and control group consisted of adipose tissue and fibrous tissue, and the fibrous tissue showed higher score values than the adipose tissue for COMP staining (intensity as well as stained area) in both groups. Although COMP could be detected in most samples, leptin expression was found only in single specimens. COMP could be detected mostly in the fibrous tissue portion of the IPFP. We speculate that it is involved in a remodeling process taking place in the IPFP during OA. Presence of leptin was irregular in immunohistology, and the control group showed higher scores in case of presence. Interestingly, immunoblotting could detect leptin in all analyzed samples. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society J Orthop Res 38:747-758, 2020.
Collapse
Affiliation(s)
- David Grevenstein
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany.,Cologne Center for Musculoskeletal Biomechanics, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Juliane Heilig
- Cologne Center for Musculoskeletal Biomechanics, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Jens Dargel
- Cologne Center for Musculoskeletal Biomechanics, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany.,Departement for Orthopedic Surgery, St. Josefs-Hospital, Wiesbaden, Germany
| | - Johannes Oppermann
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany.,Cologne Center for Musculoskeletal Biomechanics, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Peer Eysel
- Department for Orthopaedic and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany.,Cologne Center for Musculoskeletal Biomechanics, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | | | - Anja Niehoff
- Cologne Center for Musculoskeletal Biomechanics, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany.,Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| |
Collapse
|
12
|
Kutzner KP, Donner S, Loweg L, Rehbein P, Dargel J, Drees P, Pfeil J. Mid-term results of a new-generation calcar-guided short stem in THA: clinical and radiological 5-year follow-up of 216 cases. J Orthop Traumatol 2019; 20:31. [PMID: 31673809 PMCID: PMC6823459 DOI: 10.1186/s10195-019-0537-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/23/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In recent years, a variety of short stems have been introduced. To date, mid- and long-term results of calcar-guided short-stem designs have been rarely available. MATERIALS AND METHODS Two hundred and sixteen calcar-guided short stems were included in combination with a cementless cup in a prospective study. Patients were allowed full weight-bearing on the first day postoperatively. Harris hip score (HHS) as well as pain and satisfaction on visual analogue scale (VAS) were assessed during a median follow-up of 61.7 months. Standardised radiographs were analysed at predefined time points regarding radiological alterations such as bone resorption and remodelling, radiolucency, osteolysis and cortical hypertrophy using modified Gruen zones. RESULTS At mid-term follow-up, no revision surgery of the stem had to be performed in the whole collective. At 5 years, HHS was 97.8 (SD 4.7), satisfaction on VAS was 9.7 (SD 0.7), rest pain on VAS was 0.1 (SD 0.5), and load pain on VAS was 0.6 (SD 1.2). Compared to the 2-year results, femoral bone resorption increased significantly at the 5-year follow-up (3.9% versus 42.3%). Rate of femoral cortical hypertrophy remained stable, occurring in a total of 9 hips (4.5%). At the 5-year follow-up, 2 stems (1.0%) showed non-progressive radiolucent lines with a maximum width of 2 mm. Signs of osteolysis were not observed. Compared to the 2-year follow-up, no further subsidence was observed. CONCLUSIONS The rate of stem revision (0%) at the mid-term follow-up was remarkable and indicates the principle of using a calcar-guided short stem as being a safe procedure. However, signs of bone-remodelling, indicating some amount of stress-shielding, must be acknowledged at 5 years depending on stem alignment and type of anchorage. LEVEL OF EVIDENCE IV, Prospective observational study Trial registration German Clinical Trials Register, DRKS00012634, 07/07/2017 (retrospectively registered).
Collapse
Affiliation(s)
- Karl Philipp Kutzner
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany. .,Department for Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Stefanie Donner
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Lennard Loweg
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Rehbein
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Jens Dargel
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| | - Philipp Drees
- Department for Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Joachim Pfeil
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
| |
Collapse
|
13
|
Oppermann J, Bredow J, Wissussek B, Spies CK, Boese CK, Chang SM, Eysel P, Dargel J. Correction to: Does increased femoral antetorsion predispose to cartilage lesions of the patellofemoral joint? Knee Surg Sports Traumatol Arthrosc 2019; 27:338. [PMID: 29605862 DOI: 10.1007/s00167-018-4905-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Unfortunately, the following reference was not included in the original publication of the article.
Collapse
Affiliation(s)
- Johannes Oppermann
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
| | - Jan Bredow
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Boris Wissussek
- Department for Orthopedic and Trauma Surgery, St. Vinzenz Hospital, Merheimer Straße 221-223, 50733, Cologne, Germany
| | - Christian Karl Spies
- Department of Hand Surgery, Vulpius Klinik, Vulpiusstraße 29, 74906, Bad Rappenau, Germany
| | - Christoph Kolja Boese
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Shi-Min Chang
- Department of Orthopedic Surgery, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue Road, 200090, Shanghai, People's Republic of China
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Jens Dargel
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| |
Collapse
|
14
|
Schnurr C, Giannakopoulos I, Arbab D, Dargel J, Beckmann J, Eysel P. No benefit of autologous transfusion drains in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:1557-1563. [PMID: 28577064 DOI: 10.1007/s00167-017-4585-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 05/23/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE AND HYPOTHESIS Autologous blood transfusion drains are commonly used to reduce allogeneic blood transfusion rate after total knee arthroplasty. There is conflicting evidence as to whether autologous transfusion drains (ABT drains) were effective when restrictive transfusion triggers were used. The aim of our study was to ascertain where, as a part of a blood management protocol, autologous blood transfusion drains reduce the allogeneic blood transfusion rate after total knee arthroplasty. METHODS Two-hundred total knee arthroplasty patients were included in the prospective randomized controlled study. After implantation, a Redon drain without vacuum assistance (control, n = 100) or an autologous blood transfusion drain (ABT group, n = 100) was used. Demographic and operative data were collected. The blood loss, total blood loss, blood values and transfusion rate were documented. RESULTS The blood loss in the drains was significantly increased for the ABT group (409 vs. 297 ml, p < 0.001). There was a non-significant trend towards a higher total blood loss for ABT patients (1844 vs. 1685 ml, n.s.). The allogeneic blood transfusion rate was similar for both groups (8 vs. 9%, n.s.). Similarly, the number of transfused blood units was comparable between both groups (0.2U/patient vs. 0.17U/patient n.s.). CONCLUSION In combination with restrictive blood transfusion triggers, ABT drains had no positive effect on the allogeneic blood transfusion rate. The blood loss in ABT drains was higher. As a consequence, the use of ABT drains was discontinued. LEVEL OF EVIDENCE I.
Collapse
Affiliation(s)
- Christoph Schnurr
- Clinic of Orthopedic Surgery, St. Vinzenz Hospital Düsseldorf, Schloßstr. 85, 40477, Düsseldorf, Germany.
| | - Ioannis Giannakopoulos
- Clinic of Orthopedic Surgery, St. Vinzenz Hospital Düsseldorf, Schloßstr. 85, 40477, Düsseldorf, Germany
| | - Dariusch Arbab
- Clinic of Orthopedic Surgery, Klinikum Dortmund, Beurhausstraße 40, 44137, Dortmund, Germany
| | - Jens Dargel
- Clinic for Orthopedic Surgery and Traumatology, University of Cologne, Joseph-Stelzmann-Str. 9, 50924, Cologne, Germany
| | - Johannes Beckmann
- Department for Endoprosthetics Lower Extremity, Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Germany
| | - Peer Eysel
- Clinic for Orthopedic Surgery and Traumatology, University of Cologne, Joseph-Stelzmann-Str. 9, 50924, Cologne, Germany
| |
Collapse
|
15
|
Dargel J, Pennig L, Schnurr C, Boese CK, Eysel P, Oppermann J. [Should we use hip-ankle radiographs to assess the coronal alignment after total knee arthroplasty?]. Orthopade 2017; 45:591-6. [PMID: 27246862 DOI: 10.1007/s00132-016-3264-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is no consensus on whether hip-ankle radiographs or rather standardized a‑p knee-radiographs should be used to assess implant position and coronal alignment after total knee arthroplasty (TKA). This study investigates whether implant position and alignment after TKA can reproducibly be assessed using a‑p knee-radiographs rather than hip-ankle radiographs. MATERIALS AND METHODS This study was performed on 100 weight-bearing hip-ankle radiographs after conventional primary TKA. The true mechanical and anatomical femorotibial angle as well as coronal implant position was assessed on hip-ankle radiographs. The radiographs were then cropped to 80, 60 and 40 % of the leg-length and tibial coronal implant position, and the anatomical axis and a surrogate mechanical axis were obtained. The difference in the alignment parameters between the hip-ankle radiographs were statistically compared with the cropped radiographs and the inter-observer correlation coefficient (ICC) was calculated. RESULTS The ICC for measurement of the mechanical femorotibial angle was higher in hip-ankle radiographs (0.95) when compared with a radiograph cropped to 40 % (0.61). There was a significant difference in the mechanical femorotibial angle between hip-ankle radiographs and any cropped radiograph. However, there were no significant differences in coronal implant position and the anatomical femorotibial angle between hip-ankle radiographs and any cropped radiograph. CONCLUSIONS We conclude that standard a‑p knee-radiographs are insufficient to assess the mechanical alignment following TKA. However, standard a‑p knee-radiographs are appropriate to assess the implant position when referenced against the anatomical axes. Weight-bearing hip-ankle radiographs should be questioned as a routine after TKA.
Collapse
Affiliation(s)
- J Dargel
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln, Joseph-Stelzmann-Straße 9, 50931, Köln, Deutschland.
- Cologne Center for Musculoskeletal Biomechanics, Medizinische Fakultät, Universität Köln, Köln, Deutschland.
| | - L Pennig
- Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Deutschland
| | - C Schnurr
- St. Vinzenz-Krankenhaus Düsseldorf, Schloßstraße 85, 40477, Düsseldorf, Deutschland
| | - C K Boese
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln, Joseph-Stelzmann-Straße 9, 50931, Köln, Deutschland
| | - P Eysel
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln, Joseph-Stelzmann-Straße 9, 50931, Köln, Deutschland
- Cologne Center for Musculoskeletal Biomechanics, Medizinische Fakultät, Universität Köln, Köln, Deutschland
| | - J Oppermann
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln, Joseph-Stelzmann-Straße 9, 50931, Köln, Deutschland
- Cologne Center for Musculoskeletal Biomechanics, Medizinische Fakultät, Universität Köln, Köln, Deutschland
| |
Collapse
|
16
|
Firner S, Zaucke F, Michael J, Dargel J, Schiwy-Bochat KH, Heilig J, Rothschild MA, Eysel P, Brüggemann GP, Niehoff A. Extracellular Distribution of Collagen II and Perifibrillar Adapter Proteins in Healthy and Osteoarthritic Human Knee Joint Cartilage. J Histochem Cytochem 2017; 65:593-606. [PMID: 28846474 DOI: 10.1369/0022155417729154] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Perifibrillar adapter proteins, interconnecting collagen fibrils, and linking the collagen network with the aggrecan matrix seem to play a crucial role in the pathogenesis of osteoarthritis (OA). Therefore, we examined immunohistochemically the extracellular distribution of collagen II and the main perifibrillar adapter proteins-collagen IX, decorin, cartilage oligomeric matrix protein (COMP), and matrilin-3-in human samples of healthy (n=4) and OA (n=42) knee joint cartilage. Histopathology assessment was performed using an OA score. Staining patterns were evaluated in relation to the disease stage. The perifibrillar adapter proteins were uniformly distributed in the upper zones of healthy cartilage. In moderate OA (n=8; score 14.3 ± 4.7), all proteins analyzed were locally absent in the fibrillated area or the superficial and upper mid zone. In advanced OA (n=20; score 18.9 ± 5.3), they were uniformly distributed in these zones and accumulated pericellularly. Perifibrillar adapter proteins are important for the stabilization of the collagen network in the upper zones of healthy cartilage. Their degradation might be a critical event in early OA. In advanced OA, there are indications for an increased synthesis in an attempt to regenerate the lost tissue and to protect the remaining cartilage from further destruction.
Collapse
Affiliation(s)
- Sara Firner
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Frank Zaucke
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Orthopaedic University Hospital Friedrichsheim gGmbH, Frankfurt, Germany.,Cologne Center for Musculoskeletal Biomechanics (CCMB), Medical Faculty, University of Cologne, Cologne, Germany
| | - Joern Michael
- Department of Orthopaedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Jens Dargel
- Department of Orthopaedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | | | - Juliane Heilig
- Cologne Center for Musculoskeletal Biomechanics (CCMB), Medical Faculty, University of Cologne, Cologne, Germany
| | | | - Peer Eysel
- Department of Orthopaedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany.,Cologne Center for Musculoskeletal Biomechanics (CCMB), Medical Faculty, University of Cologne, Cologne, Germany
| | - Gert-Peter Brüggemann
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany.,Cologne Center for Musculoskeletal Biomechanics (CCMB), Medical Faculty, University of Cologne, Cologne, Germany
| | - Anja Niehoff
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany.,Cologne Center for Musculoskeletal Biomechanics (CCMB), Medical Faculty, University of Cologne, Cologne, Germany
| |
Collapse
|
17
|
Bratke G, Oppermann J, Dargel J, Niehoff A, Maintz D, Müller D. Benefit of a Preoperative MRI Including T2 Mapping and Semiquantitative Analysis for Varus Gonarthritis. Semin Musculoskelet Radiol 2017. [DOI: 10.1055/s-0037-1600892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Grischa Bratke
- Department of Radiology, University Hospital Cologne, Cologne, Germany
| | - Johannes Oppermann
- Department of Orthopaedics and Traumatology, University Hospital Cologne, Cologne, Germany
| | - Jens Dargel
- Department of Orthopaedics and Traumatology, University Hospital Cologne, Cologne, Germany
| | - Anja Niehoff
- Cologne Center for Musculoskeletal Biomechanics, University Hospital Cologne, Cologne, Germany
| | - David Maintz
- Department of Radiology, University Hospital Cologne, Cologne, Germany
| | - Dirk Müller
- Department of Radiology, Hospital Graubünden, Chur
| |
Collapse
|
18
|
Schnurr C, Schellen B, Dargel J, Beckmann J, Eysel P, Steffen R. Low Short-Stem Revision Rates: 1-11 Year Results From 1888 Total Hip Arthroplasties. J Arthroplasty 2017; 32:487-493. [PMID: 27639304 DOI: 10.1016/j.arth.2016.08.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/11/2016] [Accepted: 08/08/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In total hip arthroplasty, short stems were developed as a bone-conserving alternative to traditional cementless stems. So far, there have been very few recorded medium to long-term results of these comparatively new implants. The aim of our retrospective study was to report on the survival of calcar-loading short stems. METHODS All Metha stem implantations from 2004 to 2014 were recorded from the operation protocols (n = 1888). Due to the chronological development of the stem, 3 different versions were implanted: modular titanium stems with neck adapters from titanium or cobalt-chrome and monoblock stems. Patients were questioned by post about revision, dislocation, and satisfaction. RESULTS Data were complete for 93% of the procedures (1090 monoblock stems, 314 modular stems with titanium neck, and 230 modular stems with cobalt chrome neck). Mean follow-up was 6 years (1-11 years). Fifteen modular titanium implants were affected by cone fractures (4%). Therefore, monoblock, modular cobalt chrome, and modular titanium implants were analyzed separately. The 7-year revision rate for monoblock stems was 1.5%; for modular cobalt-chrome stems it was 1.8%, and for modular titanium stems it was 5.3%. CONCLUSION Our data show the midterm survival of the monoblock and modular cobalt-chrome implants equivalent to the traditional cementless stems. These might, therefore, be considered as a bone-conserving alternative for young and active patients.
Collapse
Affiliation(s)
- Christoph Schnurr
- Clinic of Orthopedic Surgery, St. Vinzenz Hospital Düsseldorf, Düsseldorf, Germany
| | - Bernd Schellen
- Clinic of Orthopedic Surgery, St. Vinzenz Hospital Düsseldorf, Düsseldorf, Germany
| | - Jens Dargel
- Clinic for Orthopedic Surgery and Traumatology, University of Cologne, Cologne, Germany
| | - Johannes Beckmann
- Department for Endoprosthetics Lower extremity, Sportklinik Stuttgart, Stuttgart, Germany
| | - Peer Eysel
- Clinic for Orthopedic Surgery and Traumatology, University of Cologne, Cologne, Germany
| | - Reinhard Steffen
- Clinic of Orthopedic Surgery, Marienkrankenhaus Kaiserswerth, Düsseldorf, Germany
| |
Collapse
|
19
|
Endruweit M, Dargel J, Siewe J, Becker I, Sobottke R. [Injuries during Equestrian Vaulting]. Sportverletz Sportschaden 2016; 30:218-228. [PMID: 27984833 DOI: 10.1055/s-0042-117746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Vaulting is the least studied equestrian sports regarding the occurrence of injuries. As its sequences of motion do not compare to riding, vaulting must be assessed separately. Material and Methods: This retrospective, questionnaire-aided survey was aimed to gain insight into the overall frequency of injuries among equestrian vaulters. The second part of the study looked into the knee injuries that occurred. Survey forms were sent to 60 vaulting and equestrian clubs all over Germany, making for a response rate of 63 %. Results: 95 % of 624 responding athletes were female. The pool of participants consisted of both amateur and professional level vaulters with a mean age of 15 years. The survey showed a mean number of 4.1 injuries sustained during the observation period, i. e. the entire time an athlete had been active in the sport up to the data collection. The lower extremities were the most commonly injured area with a total proportion of 45 %, followed by injuries to the spine and the head with 30 %, and the upper extremities with 25 %. Contusions accounted for the highest number of reported injuries. Other frequently reported injuries included muscle strain to the head and spine, fractures to the upper extremity and ligament damage to the lower extremity. 14 % of the participants experienced at least one knee injury. The medial collateral ligament (27 %) was found to be most prone to lesions, followed by the anterior cruciate ligament (23 %) and the medial meniscus (22 %). Half of all knee injuries occurred during dismounts, especially when swing-offs or flanks led to faulty landings. Conclusions: The results show that the lower extremity is the most commonly affected area. The ligamentous injuries affecting the lower extremity mainly result from dismounts. A specific training aimed at improving landing techniques might therefore prove beneficial in preventing injuries. The frequency of contusions and fractures to the upper extremity suggests that these injuries are related to falls.
Collapse
|
20
|
Dargel J, Pennig L, Schnurr C, Boese CK, Eysel P, Oppermann J. [Erratum to: Should we use hip-ankle radiographs to assess the coronal alignment after total knee arthroplasty?]. Orthopade 2016; 45:700. [PMID: 27351428 DOI: 10.1007/s00132-016-3297-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- J Dargel
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln, Joseph-Stelzmann-Straße 9, 50931, Köln, Deutschland.
- Cologne Center for Musculoskeletal Biomechanics, Medizinische Fakultät, Universität Köln, Köln, Deutschland.
| | - L Pennig
- Medizinische Fakultät, Julius-Maximilians-Universität Würzburg, Würzburg, Deutschland
| | - C Schnurr
- St. Vinzenz-Krankenhaus Düsseldorf, Düsseldorf, Deutschland
| | - C K Boese
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln, Joseph-Stelzmann-Straße 9, 50931, Köln, Deutschland
| | - P Eysel
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln, Joseph-Stelzmann-Straße 9, 50931, Köln, Deutschland
- Cologne Center for Musculoskeletal Biomechanics, Medizinische Fakultät, Universität Köln, Köln, Deutschland
| | - J Oppermann
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln, Joseph-Stelzmann-Straße 9, 50931, Köln, Deutschland
- Cologne Center for Musculoskeletal Biomechanics, Medizinische Fakultät, Universität Köln, Köln, Deutschland
| |
Collapse
|
21
|
Boese CK, Dargel J, Jostmeier J, Eysel P, Frink M, Lechler P. Agreement Between Proximal Femoral Geometry and Component Design in Total Hip Arthroplasty: Implications for Implant Choice. J Arthroplasty 2016; 31:1842-8. [PMID: 26968692 DOI: 10.1016/j.arth.2016.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/03/2016] [Accepted: 02/09/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The present study aimed to analyze the agreement between proximal femoral geometry of adult hips and femoral component design in total hip arthroplasty. METHODS Anatomical femoral offset (FOAnat) and the anatomical neck-shaft angle (NSAAnat) of 800 adult hips were measured by computed tomography scans, and anatomical femoral neck height (FHAnat) was calculated. Corresponding best-fit implants of the most common hip system (standard, high offset and varus variant) were identified for each hip. Finally, the precision of the best possible anatomic reconstruction was assessed. RESULTS The mean FOAnat was 38.0 mm (range: 19.8-57.9 mm, standard deviation [SD]: 6.4 mm), the mean NSAAnat was 130.8° (range: 107.1°-151.9°; SD: 6.5°), and the mean FHAnat was 32.6 mm (range: 14.4-52.0 mm; SD: 5.5 mm). In 450 (56.3%) hips, the standard variant was identified to be the best-fit implant, followed by the varus (n = 282, 35.3%) and the high offset (n = 68, 8.5%) variants. The mean minimal distance from the best-fit implant was 4.5 mm (range: 0.1-20.2 mm, SD: 3.4 mm). Excellent agreement (distance: <2 mm) between hip anatomy and best-fit implant was found in 203 (25.4%) hips, combined excellent and acceptable agreement (distance: <6 mm) in 569 (71.1%) hips, whereas 213 (28.9%) hips were graded as poor (distance: ≥6 mm). CONCLUSION The present study revealed a mismatch between proximal femoral anatomy of a relevant proportion of adult hips and implant geometry of the most common femoral component in total hip arthroplasty.
Collapse
Affiliation(s)
- Christoph K Boese
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Jens Dargel
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Janine Jostmeier
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Peer Eysel
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Michael Frink
- Center of Orthopedic and Trauma Surgery, University of Giessen and Marburg, Marburg, Germany
| | - Philipp Lechler
- Center of Orthopedic and Trauma Surgery, University of Giessen and Marburg, Marburg, Germany
| |
Collapse
|
22
|
Oppermann J, Bredow J, Spies CK, Lemken J, Unglaub F, Boese CK, Dargel J, Eysel P, Zöllner J. Effect of prolonged-released oxycodone/naloxone in postoperative pain management after total knee replacement: a nonrandomized prospective trial. J Clin Anesth 2016; 33:491-7. [PMID: 27555214 DOI: 10.1016/j.jclinane.2016.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 03/01/2016] [Accepted: 04/02/2016] [Indexed: 01/16/2023]
Abstract
PURPOSE The purpose of this study was to examine the effect of postoperative prolonged release oxycodone/naloxone (OXN) in comparison to other opioids (control group) on the early postoperative rehabilitation outcome after total knee replacement. METHODS In a prospective, noninterventional, nonrandomized clinical trial, 80 patients were assigned to either the OXN group or a control group. Postoperative outcome and pain level at days 3, 6, 21, 35, and 6months were evaluated using the Bowel Function Index, Brief Pain Inventory Short Form questionnaire, the Hospital for Special Surgery score, modified Larson score, and the ability to attend physiotherapy. Medications were recorded and safety analysis was done. Both groups were compared using an analysis of covariance. RESULTS There were no significant differences between both groups regarding pain levels. OXN group patients reported better bowel function (median values of 0.0 for the OXN group and 20.0 for the control group). No effect of treatment group (P=.19) and no treatment-by-visit interaction on Hospital for Special Surgery final score (P=.67) could be detected, but Larson function score in the early postoperative phase was significantly better in the OXN group (P=.018). The proportion of OXN group patients who were able to attend without any restriction was 58.1%. The proportions of patients in the OXN group and control group who experienced mild or moderate adverse drug reactions were 23.3% and 37.8%, respectively. There were no serious adverse drug reactions. CONCLUSION In conclusion, OXN provides an effective analgesia and offers several benefits such as higher ability to participate in physiotherapy and better functional results. Incidence and severity of constipation can be reduced by using prolonged-released OXN as compared with other opioids.
Collapse
Affiliation(s)
- Johannes Oppermann
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne Germany, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Jan Bredow
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne Germany, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Christian K Spies
- Department of Hand Surgery, Vulpius Klinik, Vulpiusstrasse 28, 74906 Bad Rappenau, Germany.
| | - Julia Lemken
- Department of Orthopaedic Surgery, SRH Klinikum, Guttmannstrasse 1, 76307 Karlsbad Langensteinbach, Germany.
| | - Frank Unglaub
- Department of Hand Surgery, Vulpius Klinik, Vulpiusstrasse 28, 74906 Bad Rappenau, Germany.
| | - Christoph K Boese
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne Germany, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Jens Dargel
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne Germany, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Peer Eysel
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne Germany, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Jan Zöllner
- Department of Orthopaedic Surgery, Benedictus Clinic Tutzing, Section Endoprothesis, Bahnhofstraße 5, 82327 Tutzing, Germany.
| |
Collapse
|
23
|
Abstract
INTRODUCTION The aim of this study was to analyze the functional anatomy of the lateral collateral ligament complex (LCLC) and the surrounding forearm extensors. MATERIALS AND METHODS Using 81 human cadaveric upper extremities, the anatomy of the forearm extensors-especially the anconeus, supinator and extensor carpi ulnaris (ECU)-was analyzed. After removal of aforementioned extensors the functional anatomy of the LCLC was analyzed. The origin of the LCLC was evaluated for isometry. The insertion types of the lateral ulnar collateral ligament (LUCL) were analyzed and classified. RESULTS The ECU runs parallel to the RCL to dynamically preserve varus stability. The supinator and anconeus muscle fibers coalesce with the LCLC and lengthen during pronation. The anconeus fibers run parallel to the LUCL in full flexion. The LCLC consists of the annular ligament (AL) and the isometric radial collateral ligament (RCL). During elbow flexion, its posterior branches (LUCL) tighten while the anterior branches loosen. When performing a pivot shift test, the loosened LUCL fibers do not fully tighten in full extension. The LUCL inserts along with the AL at the supinator crest. Three different insertion types could be observed. CONCLUSIONS The LUCL represents the posterior branch of the RCL rather than a distinct ligament. It is non-isometric and lengthens during elbow flexion. The RCL was found to be of vital importance for neutralization of posterolateral rotatory forces. Pronation of the forearm actively stabilizes the elbow joint as the supinator, anconeus and biceps muscle work in unison to increase posterolateral rotatory stability.
Collapse
Affiliation(s)
- M Hackl
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Straße 62, 50937, Cologne, Germany. .,Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany.
| | - M Bercher
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - K Wegmann
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.,Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany
| | - L P Müller
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.,Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany
| | - J Dargel
- Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.,Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany
| |
Collapse
|
24
|
Boese CK, Jostmeier J, Oppermann J, Dargel J, Chang DH, Eysel P, Lechler P. The neck shaft angle: CT reference values of 800 adult hips. Skeletal Radiol 2016; 45:455-63. [PMID: 26695396 DOI: 10.1007/s00256-015-2314-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/06/2015] [Accepted: 12/14/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A precise understanding of the radiological anatomy and biomechanics as well as reliable reference values of the hip are essential. The primary goal of this study was to provide reference values of the neck-shaft angle (NSA) for adult patients based on the analysis of rotation corrected computed tomography (CT) scans of 800 hips. The secondary aim was to compare these measurements with simulated anteroposterior roentgenograms of the pelvis. MATERIALS AND METHODS Pelvic CT scans of 400 patients (54.3 years, range 18-100 years; 200 female) were reconstructed in the derotated coronal plane of the proximal femur and as CT-based simulated anteroposterior roentgenograms of the pelvis in the anterior pelvic plane. Femora were categorized as coxa vara (<120°), physiologic (≥120° to <135°), and coxa valga (≥135°). Intra- and inter-rater reliability were analyzed. RESULTS Primary research question: Mean NSA for male adults was 129.6° (range 113.2°-148.2°; SD 5.9°) and 131.9° (range 107.1°-151.9°; SD 6.8°) for females in derotated coronal reconstructions. Age (p < 0.001 in both views) and sex influenced the NSA significantly (p = 0.002 and p < 0.001); no significant differences were found between sides (p = 0.722 and p = 0.955). Overall, an excellent reliability of repeated measurements of one or two observers was found (ICC 0.891-0.995). Secondary research question: NSA values measured in the simulated anteroposterior roentgenogram and the rotation corrected coronal reconstruction differed significantly (p < 0.001). CONCLUSIONS While anteroposterior pelvis radiographs are susceptible to rotational errors, the coronal reconstruction of the proximal femur in the femoral neck plane allows the correct measurement of the NSA.
Collapse
Affiliation(s)
- Christoph Kolja Boese
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Str. 9, 50924, Cologne, Germany.
| | - Janine Jostmeier
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Str. 9, 50924, Cologne, Germany
| | - Johannes Oppermann
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Str. 9, 50924, Cologne, Germany
| | - Jens Dargel
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Str. 9, 50924, Cologne, Germany
| | - De-Hua Chang
- Department of Radiology and Neuroradiology, University Hospital of Cologne, Cologne, Germany
| | - Peer Eysel
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Str. 9, 50924, Cologne, Germany
| | - Philipp Lechler
- Center of Orthopedic and Trauma Surgery, University of Giessen and Marburg, Marburg, Germany
| |
Collapse
|
25
|
Abstract
Ischiofemoral impingement (IFI) is a rare cause of hip pain and was first described in 1977. While it can be related to trauma, it may also be idiopathic. We report a case of IFI in a 22-year old female, who was successfully treated by resection of the lesser trochanter. However, 8 months later, symptoms recurred on the contralateral side. Surgical intervention was required to alleviate the patient's symptoms. This case report discusses the clinical, diagnostic and therapeutic features of IFI.
Collapse
Affiliation(s)
- M Hackl
- Abteilung für Orthopädie und Unfallchirurgie, Universitätsklinik zu Köln (A. ö. R.)
| | - M Trost
- Abteilung für Orthopädie und Unfallchirurgie, Universitätsklinik zu Köln (A. ö. R.)
| | - C K Boese
- Abteilung für Orthopädie und Unfallchirurgie, Universitätsklinik zu Köln (A. ö. R.)
| | - D Müller
- Abteilung für Radiologie, Universitätsklinik zu Köln (A. ö. R.)
| | - P Eysel
- Abteilung für Orthopädie und Unfallchirurgie, Universitätsklinik zu Köln (A. ö. R.)
| | - J Dargel
- Abteilung für Orthopädie und Unfallchirurgie, Universitätsklinik zu Köln (A. ö. R.)
| |
Collapse
|
26
|
Bredow J, Katinakis F, Schlüter-Brust K, Krug B, Pfau D, Eysel P, Dargel J, Wegmann K. Influence of hip replacement on sagittal alignment of the lumbar spine: An EOS study. Technol Health Care 2015; 23:847-54. [DOI: 10.3233/thc-151029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J. Bredow
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - F. Katinakis
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - K. Schlüter-Brust
- Department of Orthopedics, St. Franziskus Hospital, Cologne, Germany
| | - B. Krug
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - D. Pfau
- Department of Neurophysiology, Center of Biomedicine and Medical Technology Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - P. Eysel
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - J. Dargel
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - K. Wegmann
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| |
Collapse
|
27
|
Kreuder A, Pennig D, Boese CK, Eysel P, Oppermann J, Dargel J. Mallet finger: a simulation and analysis of hyperflexion versus hyperextension injuries. Surg Radiol Anat 2015; 38:403-7. [DOI: 10.1007/s00276-015-1577-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
|
28
|
Dargel J, Oppermann J, Brüggemann GP, Eysel P. Dislocation following total hip replacement. Dtsch Arztebl Int 2015; 111:884-90. [PMID: 25597367 DOI: 10.3238/arztebl.2014.0884] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 09/01/2014] [Accepted: 09/01/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Hip replacement ranks among the more successful operations on the musculoskeletal system, but it can have serious complications. A common one is dislocation of the total hip endoprosthesis, an event that arises in about 2% of patients within 1 year of the operation. Physicians should be aware of how this problem can be prevented and, if necessary, treated, so that the degree of trauma due to hip dislocation after hip replacement surgery can be kept to a minimum. METHODS The authors searched Medline selectively for pertinent publications and analyzed the annual reports of international endoprosthesis registries. RESULTS The rate of dislocation of primary hip replacements ranges from 0.2% to 10% per year, while that of artificial hip joints that have already been surgically revised can be as high as 28%, depending on the patient population, the follow-up interval, and the type of prosthesis. Patient-specific risk factors for displacement of a hip endoprosthesis include advanced age, accompanying neurologic disease, and impaired compliance. Patients should scrupulously avoid hip movements such as bending far forward from a standing position, or internal rotation of the flexed hip. Operation-specific risk factors include suboptimal implant position, insufficient soft-tissue tension, and inadequate experience of the surgeon. Conservative treatment is justified the first time dislocation occurs without any identifiable cause. If a mechanical cause of instability is found, then operative revision should be performed as recommended in a standardized treatment algorithm, because, otherwise, dislocation is likely to recur. CONCLUSION The dislocation of a total hip endoprosthesis is an emotionally traumatizing event that should be prevented if possible. Preoperative risk assessment should be performed and the operation should be performed with optimal technique, including the best possible physical configuration of implant components, soft-tissue balance, and an adequately experienced orthopedic surgeon.
Collapse
Affiliation(s)
- Jens Dargel
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Institute of Biomechanics and Orthopedics, German Sport University Cologne
| | | | | | | |
Collapse
|
29
|
Boese CK, Lechler P, Rose L, Dargel J, Oppermann J, Eysel P, Geiges H, Bredow J. Calibration Markers for Digital Templating in Total Hip Arthroplasty. PLoS One 2015; 10:e0128529. [PMID: 26168410 PMCID: PMC4500467 DOI: 10.1371/journal.pone.0128529] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/28/2015] [Indexed: 11/19/2022] Open
Abstract
Digital templating with external calibration markers is the standard method for planning total hip arthroplasty. We determined the geometrical basis of the magnification effect, compared magnification with external and internal calibration markers, and examined the influence on magnification of the position of the calibration markers, patient weight, and body mass index (BMI). A formula was derived to calculate magnification with internal and external calibration markers, informed by 100 digital radiographs of the pelvis. Intraclass correlations between the measured and calculated values and the strength of relationships between magnification, position and distance of calibration markers and height, weight, and BMI were sought. There was a weak correlation between magnification of internal and external calibration markers (r = 0.297–0.361; p < 0.01). Intraclass correlations were 0.882–1.000 (p = 0.000) for all parameters. There were also weak correlations between magnification of internal and external calibration markers and weight and BMI (r = 0.420, p = 0.000; r = 0.428, p = 0.000, respectively). The correlation between external and internal calibration markers was poor, indicating the need for more accurate calibration methods. While weight and BMI weakly correlated with the magnification of markers, future studies should examine this phenomenon in more detail.
Collapse
Affiliation(s)
- Christoph Kolja Boese
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
- * E-mail:
| | - Philipp Lechler
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Marburg, Germany
| | - Leonard Rose
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Jens Dargel
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Johannes Oppermann
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Peer Eysel
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Hansjörg Geiges
- Mathematical Institute, University of Cologne, Cologne, Germany
| | - Jan Bredow
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| |
Collapse
|
30
|
Chang SM, Zhang YQ, Ma Z, Li Q, Dargel J, Eysel P. Fracture reduction with positive medial cortical support: a key element in stability reconstruction for the unstable pertrochanteric hip fractures. Arch Orthop Trauma Surg 2015; 135:811-8. [PMID: 25840887 PMCID: PMC4436685 DOI: 10.1007/s00402-015-2206-x] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE To introduce the concept of fracture reduction with positive medial cortical support and its clinical and radiological correlation in geriatric unstable pertrochanteric fractures. METHODS A retrospective analysis of 127 patients (32 men and 95 women, with mean age 78.7 years) with AO/OTA 31A2.2 and 2.3 hip fractures treated with cephalomedullary nail (PFNA-II or Gamma-3) between July 2010 and June 2013 was performed. They were classified into three groups according the grade of medial cortical support in postoperative fracture reduction (positive, neutral, and negative). The positive cortex support was defined that the medial cortex of the head-neck fragment displaced and located a little bit superomedially to the medial cortex of the shaft. If the neck cortex is located laterally to the shaft, it is negative with no cortical buttress, and if the two cortices contact smoothly, it is in neutral position. The demographic baseline, postoperative radiographic femoral neck-shaft angle and neck length, rehabilitation progress and functional recovery scores of each group were recorded and compared. RESULTS There were 89 cases (70 %) in positive, 26 in neutral, and 12 in negative support. No statistical differences were found between the three groups among patient age, sex ratio, prefracture score of activity of daily living, walking ability score, ASA physical risk score, number of medical comorbidities, osteoporosis Singh index, fracture reduction quality (Garden alignments), and the position of lag screw or helical blade in femoral head (TAD). In follow-up, patients in positive medial cortical support reduction group had the least loss in neck-shaft angle and neck length, and got ground-walking much earlier than negative reduction group, with good functional outcomes and less hip-thigh pain presence. CONCLUSION Fracture reduction with nonanatomic positive medial cortical support allows limited sliding of the head-neck fragment to contact with the femur shaft and achieve secondary stability, providing a good mechanical environment for fracture healing.
Collapse
Affiliation(s)
- Shi-Min Chang
- The Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090 People’s Republic of China
| | - Ying-Qi Zhang
- The Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090 People’s Republic of China
| | - Zhuo Ma
- The Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090 People’s Republic of China
| | - Qing Li
- The Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, 450 Tengyue Road, Shanghai, 200090 People’s Republic of China
| | - Jens Dargel
- Department of Orthopaedic and Trauma Surgery, Cologne University Hospital, Cologne, Germany
| | - Peer Eysel
- Department of Orthopaedic and Trauma Surgery, Cologne University Hospital, Cologne, Germany
| |
Collapse
|
31
|
Oppermann J, Wacker M, Stein G, Springorum HP, Neiss WF, Burkhart KJ, Eysel P, Dargel J. Anatomical fit of seven different palmar distal radius plates. Arch Orthop Trauma Surg 2014; 134:1483-9. [PMID: 25108754 DOI: 10.1007/s00402-014-2072-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The purpose of this study was to compare the anatomical fit of different, precontoured palmar distal radius plates. METHODS The anatomical fit of seven different types of palmar distal radius plates [Königsee variable fixed-angle radius plate 7/3-hole, Königsee variable fixed-angle radius plate 5/3-hole (Allendorf, Germany), Medartis 2.5 Adaptive TriLock, Medartis 2.5 TriLock, Medartis 2.5 TriLock extraarticular, (Basel, Switzerland), Synthes VA-LCP distal two-column-radius, Synthes LCP extraarticular (Bettlach, Switzerland)] were investigated in 25 embalmed human cadaveric radii. An imprint of the space between the well-positioned plate and the distal radius was attained using a silicone mass and the maximum height of the silicone imprint was digitally measured. The mean maximum imprint height was compared between the seven plates using an analysis of variance with repeated measures and Bonferroni correction for multiple comparisons. RESULTS The mean maximum distance between the plates and the radial cortex was <2 mm for all plates. The greatest difference was found with the Medartis Adaptive (1.99 ± 0.45 mm) and the least difference with the Synthes two-column (1.56 ± 0.76 mm), this difference being statistically significant (p = 0.005). CONCLUSION Although there was no complete congruency between the plates and the radial cortex, all distal palmar radius plates investigated in this study presented a reasonable anatomical shape. The Synthes VA-LCP distal two-column-radius plate palmar showed the best anatomical fit. A low profile and optimized anatomical precontouring minimizes irritation of the surrounding soft tissues and should be considered with plate design and implant choice.
Collapse
Affiliation(s)
- Johannes Oppermann
- Department of Orthopaedics and Trauma Surgery, Medical Faculty, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany,
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Yang PFF, Engel K, Sanno M, Dargel J, Wegmann K, Brüggemann GP, Rittweger J. Tibia segment deformation in response to simulated muscle forces: a cadaveric study with a novel optical segment tracking (OST) approach. J Musculoskelet Neuronal Interact 2014; 14:267-275. [PMID: 25198221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES A novel optical segment tracking (OST) approach reliant upon motion capturing was previously proposed to assess human tibia segment deformation. The purposes of the present study were to validate the OST approach and assess the contribution of muscular forces to the bone deformation in a well-defined ex vivo human model. METHODS A custom-made Lower Extremity Loading Device (LELD) was developed to simulate physiological muscle contractions in six human cadaveric lower extremities. Tibia segment deformation was measured by tracking the relative movement between two marker clusters which were affixed into the proximal and distal tibia, respectively. RESULTS Compared to the physiological norms, the simulated muscle forces remained at a low level. When quadriceps muscle was loaded with forces from 198 N to 505 N, posterior bending (0.12°-0.25°) and lateral bending (0.06°-0.21°) of the tibia segment were found. Large tibia bending angles were found when simulating the co-contraction of upper leg muscles and plantar flexors, and of all leg muscles, respectively. The standard deviations of the deformation angles between the repetitions remained at a low level. CONCLUSIONS We conclude that the OST approach has the potential to be applied in vivo and quantify muscle-induced bone deformations.
Collapse
Affiliation(s)
- P-F F Yang
- Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, China
| | | | | | | | | | | | | |
Collapse
|
33
|
Wegmann K, Burkhart KJ, Zimmermann J, Dargel J, Nijs S, Konerding MA, Müller LP. The interference of distal humeral plating with the medial and lateral collateral ligaments of the elbow. Arch Orthop Trauma Surg 2014; 134:501-7. [PMID: 24531976 DOI: 10.1007/s00402-014-1952-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The aim of the present study was to determine the anatomical relationship and evaluate the potential interference of today's common distal humerus plates with the medial and lateral collateral ligaments of the elbow. MATERIALS AND METHODS The elbow joints of 23 embalmed upper extremities were dissected. Three different brands of distal humerus double-plating systems were applied in a standardized fashion. We used a caliper to measure the amount of absolute overlap of the plates on the corresponding collateral ligaments. RESULTS The data show contact and overlap with the medial and lateral collateral ligaments in all tested medial and lateral plates. The posterolateral and posteromedial plates showed no contact with the ligaments, yet they did contact the posterior joint capsules. The medial plates showed less contact/overlap when compared with the lateral and extended medial plates. CONCLUSION Based on the present data, we conclude that distal humerus plating using the perpendicular technique with standard-sized medial plates shows the least amount of overlap over the medial and lateral collateral ligaments. The extent of the overlap of the ligaments by the humeral plates is clearly shown in the present study.
Collapse
Affiliation(s)
- Kilian Wegmann
- Center for Orthopaedic and Trauma Surgery, University Medical Center, Cologne, Germany,
| | | | | | | | | | | | | |
Collapse
|
34
|
Ninck J, Heck S, Gick S, Koebke J, Pennig D, Dargel J. [Treatment of proximal humerus fractures: relative position of different locking plates to the axillary nerve]. Unfallchirurg 2012; 116:1000-5. [PMID: 22814611 DOI: 10.1007/s00113-012-2242-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Placement of a proximal humerus locking plate through a percutaneous transdeltoid approach bears the advantages of a minimally invasive approach but may compromise the anterior branches of the axillary nerve. This anatomic study aimed to develop a risk profile for 6 types of modern proximal humerus locking plates as to their interference with the axillary nerve. MATERIALS AND METHODS In this study six different implants (Arthrex®, DePuy®, Königsee®, Smith & Nephew®, Stryker® and Synthes®) were placed on the intact proximal humerus of 33 embalmed cadaveric upper extremities and the relative positioning between the axillary nerve and the screw holes was determined. RESULTS All locking plates displayed an area of risk which concerned 3 out of 7 (Arthrex®), 4 out of 10 (DePuy®), 2 out of 9 (Königsee®), 3 out of 11 (Smith & Nephew®), 3 out of 11 (Stryker®) and 6 out of 12 (Synthes®) screw holes of the plate. CONCLUSIONS Using the anterolateral percutaneous deltoid splitting approach the relative position of the axillary nerve to the holes of a specific implant is of relevance for avoidance of iatrogenic lesions to the nerve.
Collapse
Affiliation(s)
- J Ninck
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Klinikum der Universität zu Köln, Joseph-Stelzmann-Straße 9, 50924, Köln, Deutschland
| | | | | | | | | | | |
Collapse
|
35
|
Springorum HP, Siewe J, Dargel J, Schiffer G, Michael JWP, Eysel P. [Classification and treatment of patella fractures]. Orthopade 2012; 40:877-80, 882. [PMID: 21938491 DOI: 10.1007/s00132-011-1780-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Patella fractures are rare and account for approximately 1% of all fractures. They are classified regarding their localization (proximal, distal) and appearance. The aim of any treatment is reconstruction of the extensor mechanism and joint surface. If dislocation and cartilage steps are less than 2 mm, conservative treatment may be indicated. Operative treatment is only necessary if a dislocation is more than 2 mm or when the extensor mechanism is unstable. Depending on the shape of the fracture, tension band wiring, interfragmentary screw fixation and combinations are the main techniques. Because patellectomy has functionally the worst result it should be avoided. Sleeve fractures (children) need exact reconstruction of the joint surface. In elderly patients conservative treatment or surgical patella-enclosing wiring techniques for stabilization are the best options due to low bone quality.
Collapse
Affiliation(s)
- H-P Springorum
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universität zu Köln, Köln, Deutschland.
| | | | | | | | | | | |
Collapse
|
36
|
Stein G, Pawel A, Koebke J, Müller LP, Eysel P, Thelen U, Dargel J, Michael JWP. Morphology of the first metatarsal head and hallux rigidus: a cadaveric study. Surg Radiol Anat 2012; 34:589-92. [PMID: 22418616 DOI: 10.1007/s00276-012-0957-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 03/03/2012] [Indexed: 01/24/2023]
Abstract
PURPOSE Treatment options for hallux rigidus include several conservative and surgical measures. The aetiology leading to the disease has not sufficiently been examined so far. MATERIALS AND METHODS We analysed the anatomical configuration of the first metatarsal head of 120 metatarsal bones of different collectives aiming to find a possible correlation between the geometry of the first metatarsophalangeal joint and manifestation of hallux rigidus. Wet human cadaveric specimens and macerated dry specimens served as material. The relevant parameters used for analysis were an axis running through the metatarsal head, the anatomical longitudinal axis, and the radius of curvature of the first metatarsal bone. RESULTS A significant difference was found in the radius of curvature of osteoarthritic and healthy subjects. Using the binary logistic regression, we were able to predict the probability of an occurrence of hallux rigidus in dependence of the radius of curvature. Furthermore, we were enabled to calculate a correct prediction for the appearance of osteoarthritis in 85 % of the healthy subjects, and 73 % of the osteoarthritic subjects. CONCLUSIONS A consolidated view of the factors indicates that persons with a high risk for the appearance of hallux rigidus should be identified by measuring the radius of curvature in conventional radiographs and preventive measures to postpone the occurrence of clinically relevant hallux rigidus considered.
Collapse
Affiliation(s)
- Gregor Stein
- Department of Orthopaedic and Trauma Surgery, Cologne University Hospital, Kerpener Str. 62, 50924, Cologne, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Koslowsky TC, Zilleken C, Dargel J, Thelen U, Burkhart KJ, Heck S, Skouras E. Reconstruction of a Bryan and Morrey type I capitellar fracture in a sawbone model with four different fixation devices: an experimental study. Injury 2012; 43:381-5. [PMID: 22209384 DOI: 10.1016/j.injury.2011.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/02/2011] [Accepted: 12/06/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND We evaluated 4 different fixation devices for the reconstruction of a standardised Bryan and Morrey capitellar shear fracture in a sawbone model. Outcome measurements were the quality of reduction, time for reconstruction and stability. METHODS 80 standardised Bryan and Morrey type I fractures were created for 5 different orthopaedic surgeons in 80 sawbones. Each surgeon reconstructed 16 fractures with 2mm K-wires, 3mm Herbert screws, 2.7 mm AO screws and 2.2mm fine-threaded wires (Fragment Fixation System: FFS). 4 fractures were allocated to each method with a standardised reconstruction procedure. Quality of reduction and time for reconstruction were measured after definitive fixation. Biomechanical testing was performed using a shear loading model with the application of monocyclic or polycyclic stress to the reconstructed capitulum. RESULTS There was no difference in the quality of reduction with the different fixation devices. Herbert and AO screw fixation was slower than the other implants (p<0.05). No difference in the time for reconstruction was observed with K-wires and FFS. Failure load was less for K-wires compared to FFS, Herbert screws and AO screws (p<0.05). With polycyclic loading, residual deformation was higher with K-wire reconstruction compared to FFS, Herbert screws and AO screws (p<0.05). CONCLUSION When using four different fixation devices, the fixation of standardised Bryan and Morrey type I fractures in the sawbone model differs when it comes to the time needed for reduction, but not in the quality of reduction. Stability was the same for the implants used, except for the K-wires. There is no argument in favour one of the screw implants over another in clinical use.
Collapse
Affiliation(s)
- Thomas C Koslowsky
- Department of Surgery, St. Elisabeth Hospital, Werthmannstrasse 1, D-50935 Cologne, Germany.
| | | | | | | | | | | | | |
Collapse
|
38
|
Dargel J, Schmidt-Wiethoff R, Feiser J, Koebke J, Schlüter-Brust K, Eysel P, Michael JWP. Relationship between human femorotibial joint configuration and the morphometry of the anterior cruciate ligament. Arch Orthop Trauma Surg 2011; 131:1095-105. [PMID: 21739115 DOI: 10.1007/s00402-011-1345-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Individual variations in the anatomy of the knee joint have been suggested to affect the ability to functionally compensate for ACL insufficiency or to put an individual at an increased risk of ACL injury. These variations include the posterior tibial slope, the concavity of the medial tibial plateau, the convexity of the lateral tibial plateau, and the configuration of the femoral condyles. METHOD This anatomical study investigates if there is a correlation between the individual surface geometry of the femorotibial joint and the morphometry of the ACL. These data were assumed to provide evidence whether or not the functional stability of an ACL-insufficient knee may be derived from its radiographic surface geometry. Standardised measurement techniques were used to analyse the surface geometry of 68 human cadaver knees. Data were correlated with the cross-sectional area, the area of insertion and position of the footprint of the ACL and its functional bundles. RESULTS Analysis revealed that there was a significant, but weak correlation between the femoral and tibial area of ACL insertion and the depth of the medial and lateral femoral condyle. No correlation was found between the surface geometry of the femorotibial joint and the cross-sectional area of the ACL. The results of this anatomical study suggest that the relationship between the joint surfaces and the morphometry of the ACL primarily is a function of size of the knee joint. CONCLUSIONS Based on our results, there is no evidence that the stability of the knee can be derived from its radiographic surface geometry.
Collapse
Affiliation(s)
- Jens Dargel
- Department of Orthopaedic and Trauma Surgery, University of Cologne, Kerpener Strasse 62, Cologne, Germany.
| | | | | | | | | | | | | |
Collapse
|
39
|
Dargel J, Gotter M, Mader K, Pennig D, Koebke J, Schmidt-Wiethoff R. Biomechanics of the anterior cruciate ligament and implications for surgical reconstruction. Strategies Trauma Limb Reconstr 2011; 2:1-12. [PMID: 18427909 PMCID: PMC2321720 DOI: 10.1007/s11751-007-0016-6] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 03/15/2007] [Indexed: 12/13/2022] Open
Abstract
Injury to the anterior cruciate ligament (ACL) is regarded as critical to the physiological kinematics of the femoral-tibial joint, its disruption eventually causing long-term functional impairment. Both the initial trauma and the pathologic motion pattern of the injured knee may result in primary degenerative lesions of the secondary stabilisers of the knee, each of which are associated with the early onset of osteoarthritis. Consequently, there is a wide consensus that young and active patients may profit from reconstructing the ACL. Several factors have been identified as significantly influencing the biomechanical characteristics and the functional outcome of an ACL reconstructed knee joint. These factors are: (1) individual choice of autologous graft material using either patellar tendon-bone grafts or quadrupled hamstring tendon grafts, (2) anatomical bone tunnel placement within the footprints of the native ACL, (3) adequate substitute tension after cyclic graft preconditioning, and (4) graft fixation close to the joint line using biodegradable graft fixation materials that provide an initial fixation strength exceeding those loads commonly expected during rehabilitation. Under observance of these factors, the literature encourages mid-to long-term clinical and functional outcomes after ACL reconstruction.
Collapse
Affiliation(s)
- J Dargel
- Department for Trauma and Orthopaedic Surgery, Hand and Reconstructive Surgery, St. Vinzenz Hospital, Merheimer Strasse 221-223, D-50733, Cologne, Germany,
| | | | | | | | | | | |
Collapse
|
40
|
|
41
|
Stein G, Koebke J, Faymonville C, Dargel J, Müller LP, Schiffer G. The relationship between the medial collateral ligament and the medial meniscus: a topographical and biomechanical study. Surg Radiol Anat 2011; 33:763-6. [DOI: 10.1007/s00276-011-0814-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 04/02/2011] [Indexed: 11/29/2022]
|
42
|
Dargel J, Michael JWP, Feiser J, Ivo R, Koebke J. Human knee joint anatomy revisited: morphometry in the light of sex-specific total knee arthroplasty. J Arthroplasty 2011; 26:346-53. [PMID: 20206467 DOI: 10.1016/j.arth.2009.12.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 11/08/2009] [Accepted: 12/22/2009] [Indexed: 02/01/2023] Open
Abstract
This study investigates differences in the anatomy of male and female knee joints to contribute to the current debate on sex-specific total knee implants. Morphometric data were obtained from 60 human cadaver knees, and sex differences were calculated. All data were corrected for height, and male and female specimens presenting with an identical length of the femur were analyzed as matched pairs. Male linear knee joint dimensions were significantly larger when compared with females. When corrected for differences in height, medial-lateral dimensions of male knees were significantly larger than female; however, matched paired analysis did not prove these differences to be consistent. Although implant design should focus interindividual variations in knee joint anatomy, our data do not support the concept of a female-specific implant design.
Collapse
Affiliation(s)
- Jens Dargel
- Department of Orthopedic Surgery, University of Cologne, Joseph-Stelzmann Strasse, Cologne, Germany
| | | | | | | | | |
Collapse
|
43
|
Dargel J, Pennig D, Springorum HP, Koebke J, Eysel P, Michael JWP. Morphometric and biomechanical comparison of tendons used for interposition arthroplasty in carpometacarpal arthritis of the thumb. ACTA ACUST UNITED AC 2011; 16:43-7. [PMID: 21348030 DOI: 10.1142/s0218810411005059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 09/13/2010] [Accepted: 09/21/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE To identify the wrist tendon most effectively maintaining the trapezial space in interpositional arthroplasty in osteoarthritis of the carpometacarpal joint of the thumb. METHODS The morphometrics of the os trapezium and the tendons of the flexor carpi radialis, extensor carpi radialis longus, and abductor pollicis longus were determined. The stiffness and compressive loading characteristics of the rolled-up tendons were compared to the os trapezium. RESULTS No significant morphometric differences between the three tendons were found. The mass and volume of the trapezium was significantly larger when compared to the tendon balls. No significant differences in the compressive loading resistance were found between the tendons, but the mean stiffness was 85% lower when compared to the os trapezium. CONCLUSIONS Neither tendon material approached the volume nor the stiffness provided by the os trapezium. Any tendon is considered to insufficiently maintain the trapezial space following trapeziectomy.
Collapse
Affiliation(s)
- Jens Dargel
- Department of Orthopaedic and Trauma Surgery, University of Cologne, D-50924 Cologne, Germany.
| | | | | | | | | | | |
Collapse
|
44
|
Affiliation(s)
- S Heck
- Klinik für Unfallchirurgie/Orthopädie, Hand- und Wiederherstellungschirurgie, St. Vinzenz-Hospital Köln, Akademisches Lehrkrankenhaus der Universität zu Köln, Merheimer Straße 221-223, 50733, Köln, Deutschland.
| | | | | | | |
Collapse
|
45
|
Battermann N, Appell HJ, Dargel J, Koebke J. An Anatomical Study of the Proximal Hamstring Muscle Complex to Elucidate Muscle Strains in this Region. Int J Sports Med 2010; 32:211-5. [DOI: 10.1055/s-0030-1268011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
46
|
Röllinghoff M, Zarghooni K, Dargel J, Schlegel UJ, Siewe J, Eysel P, Sobottke R. The present role of vertebroplasty and kyphoplasty in the treatment of fresh vertebral compression fractures. MINERVA CHIR 2010; 65:429-437. [PMID: 20802431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Vertebroplasty (VP) and kyphoplasty (KP) are minimally invasive vertebral augmentation procedures for the treatment of fresh vertebral compression fractures (VCFs) associated with osteoporosis, trauma, malignant conditions, hemangiomas, and osteonecrosis. During these procedures, bone cement (e.g., polymethylmethacrylate) is percutaneously injected into the vertebral body. Systematic reviews of both procedures have shown significantly improved back pain and quality of life compared to conservative therapy. Direct comparison between VP and KP is not possible because of the lack of prospective randomized data comparing the two procedures. Both appear to improve patient functional status in most studies, although it is difficult to pool the available data because of differing measurement scales. With increasing popularity of both techniques, particularly over the past ten years, a rising number of publications have detailed potential complications secondary to cement extravasation, from compression of neural elements to venous embolism. Overall complication rates for both procedures are low. Systematic reviews have found significantly higher rates of cement leakage after VP (40%) versus KP (8%), with 3% of VP leaks being symptomatic. The evidence for increased risk of adjacent level fracture after these procedures compared to conservative treatment is inconclusive. When performed by a well-trained practitioner in appropriately selected patients, vertebroplasty and kyphoplasty are both safe and effective treatments for fresh vertebral compression fractures. Results from ongoing randomized controlled trials will provide further detailed information about both procedures in the future.
Collapse
Affiliation(s)
- M Röllinghoff
- Department of Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany
| | | | | | | | | | | | | |
Collapse
|
47
|
Dargel J, Gick S, Mader K, Koebke J, Pennig D. Biomechanical comparison of tension band- and interfragmentary screw fixation with a new implant in transverse patella fractures. Injury 2010; 41:156-60. [PMID: 19665707 DOI: 10.1016/j.injury.2009.07.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 06/08/2009] [Accepted: 07/13/2009] [Indexed: 02/02/2023]
Abstract
AIM The aim of the present study was to compare the primary fixation stability and initial fixation stiffness of two established fixation techniques, the tension band wiring technique and interfragmentary screw fixation, with a mini-screw fragment fixation system in a model of transverse patella fracture. It was hypothesised that the biomechanical loading performance of the fragment fixation system would not significantly differ from the loading characteristics of the two established methods currently investigated. MATERIALS AND METHODS Ninety-six calf patellae were used in this biomechanical model. A standardized transverse patella fracture was induced and three different fixation methods, including the modified tension band wiring technique, interfragmentary screw fixation, and the mini-screw fragment fixation system, were used for fragment fixation. Specimens were mounted to a loading rig which was secured within a material testing machine. In each fixation group, eight specimens were loaded to failure at a simulated knee angle of either 0 degrees or 45 degrees . Another eight specimens were submitted to a polycyclic loading protocol consisting of 30 cycles between 20N and 300N at a simulated knee angle of 0 degrees or 45 degrees . The residual displacement between the first and the last cycle was recorded. Differences in the biomechanical performance between the three fixation groups were evaluated. RESULTS No significant differences between the three fixation groups were observed in the parameters maximum load to failure and linear fixation stiffness with monocyclic loading. Specimens being loaded at 45 degrees showed significantly lower maximum failure loads and linear stiffness when compared with 0 degrees . During polycyclic loading, no significant differences in the residual displacement were observed between the groups at 0 degrees loading angle, while at 45 degrees , residual displacement was significantly higher with tension band fixation when compared with interfragmentary screw fixation or the fragment fixation system. CONCLUSION The biomechanical performance of the fragment fixation system was comparable to interfragmentary screw fixation and superior to the tension band wiring technique. Given the advantages of a system which provides interfragmentary compression and which simplifies fracture fixation after open or closed reduction, we believe the fragment fixation system to be an adequate alternative in the osteosynthesis of transverse patella fractures.
Collapse
Affiliation(s)
- J Dargel
- St.-Vinzenz Hospital, Department of Trauma, Orthopaedics, Hand- and Reconstructive Surgery, Teaching Hospital, University of Cologne, Merheimer Strasse 221-223, D-50733 Cologne, Germany.
| | | | | | | | | |
Collapse
|
48
|
Dargel J, Feiser J, Gotter M, Pennig D, Koebke J. Side differences in the anatomy of human knee joints. Knee Surg Sports Traumatol Arthrosc 2009; 17:1368-76. [PMID: 19633830 DOI: 10.1007/s00167-009-0870-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 06/29/2009] [Indexed: 11/30/2022]
Abstract
Side-to-side comparison of anatomical or functional parameters in the evaluation of unilateral pathologies of the human knee joint is common practice, although the amount of symmetry is unknown. The aim of this study was to test the hypothesis that there are no significant differences in the morphometric knee joint dimensions between the right and the left knee of a human subject and that side differences within subjects are smaller than intersubject variability. In 20 pairs of human cadaver knees, the morphometry of the articulating osseous structures of the femorotibial joint, the cruciate ligaments, and the menisci were measured using established measurement methods. Data were analyzed for overall side differences and the ratio between within-subject side differences and intersubject variability was calculated. In three out of 71 morphometric dimensions there was a significant side difference, including the posterior tibial slope, the anatomical valgus alignment of the distal femur, and the position of the femoral insertion area of the ACL. In two additional parameters, including the cross-sectional area of the ACL and PCL, within-subject side differences were larger than intersubject variability. In general, there was a positive correlation in morphometric dimensions between right and left knees in one subject. It is concluded that a good correlation in the morphometric dimensions of a human knee joint exists between the right and the left side. This study supports the concepts of obtaining morphometric reference data from the contralateral uninjured side in the evaluation of unilateral pathologies of the knee joint.
Collapse
Affiliation(s)
- Jens Dargel
- Department of Orthopaedic Surgery, University of Cologne, Joseph-Stelzmann Strasse 9, Cologne 50733, Germany.
| | | | | | | | | |
Collapse
|
49
|
Abstract
Chronic dislocation of the elbow is an exceedingly disabling condition associated with severe instability, limitation of elbow function and significant pain. Due to the potentially conflicting goals of restoring elbow stability and regaining a satisfactory arc of motion, successful treatment is a challenge for the experienced trauma surgeon. We report our treatment strategy in three patients suffering from chronically unreduced fracture-dislocations of the elbow. The treatment protocol consists of in situ neurolysis of the ulnar nerve, distraction and reduction of the joint using unilateral hinged external fixation and repair of the osseous stabilizers. A stable elbow was achieved in all patients, without the need of reconstruction of the collateral ligaments. At final follow-up, the average extension/flexion arc of motion was 107 degrees (range, from 100 degrees to 110 degrees ). The average MEPI score at follow-up was 93, and the average DASH score was 19. This is a promising treatment protocol for the treatment of chronically unreduced complex elbow dislocations to restore elbow stability and regain an excellent functional outcome.
Collapse
Affiliation(s)
- Roland Ivo
- Department of Orthopaedic Surgery, University of Cologne, Joseph-Stelzmann-Str. 9, 50924, Cologne, Germany,
| | | | | | | |
Collapse
|
50
|
Koslowsky TC, Mader K, Dargel J, Schadt R, Koebke J, Pennig D. Olecranon fracture fixation with a new implant: biomechanical and clinical considerations. Injury 2009; 40:618-24. [PMID: 19394014 DOI: 10.1016/j.injury.2009.01.129] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 01/19/2009] [Accepted: 01/20/2009] [Indexed: 02/02/2023]
Abstract
UNLABELLED This study aims to describe the first clinical results in the treatment of dislocated olecranon fractures with 2.2-mm, fine-threaded wires with a washer. Furthermore, in the second part of the article, the stability of these new implants has been compared to standard tension band wiring in a sawbone model. PATIENTS The radiological and clinical outcomes in 24 patients (mean age: 53.6 years) with 24 isolated Mayo type I and II fractures of the olecranon were evaluated in a prospective study after open reduction and internal fixation (ORIF) with a new fixation device (FFS; Orthofix). The quality of reduction with the implementation of 24 FFS constructions was compared with 24 tension band-wiring procedures performed by six different surgeons in a standard sawbone Mayo type IIa fracture model. Stability was tested in all constructs using a single cycle load to failure protocol (group I), cyclic loading for 300 cycles between 10 and 500 N (group II) and incremental sinusoidal loading from 10 to 200 N with an incremental increase of 10 N per cycle (group III) in a laboratory study. RESULTS The Morrey elbow score was excellent in 23 patients and good in one patient, with mean DASH score of 1.6. No implant migration, secondary dislocation or nonunion was observed. In the sawbone model, the quality of reduction was the same with the FFS implants compared to the tension band wiring in the sawbone model. Here, bending moments in all three groups showed no significant difference, whereas displacement at failure was significantly greater in the tension band-wiring group at a single cycle load (p=0.017). CONCLUSION Clinical results were comparable to tension band wiring and stability of the implants in the sawbone model was the same; thus, we conclude that the FFS technique can serve as an alternative treatment option for isolated olecranon fractures.
Collapse
Affiliation(s)
- Thomas C Koslowsky
- Department of Surgery, St. Elisabeth Hospital, Werthmannstrasse 1, D-50935 Cologne, Germany.
| | | | | | | | | | | |
Collapse
|