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Andronic O, Chaharbakhshi EO, Zingg PO, Germann C, Rahm S, Lall AC, Domb BG. No Difference in Patient-Reported Outcomes for Periacetabular Osteotomy and Hip Arthroscopy With Capsular Plication in the Setting of Borderline Hip Dysplasia: A Propensity-Matched Multicenter Study With Minimum 5-Year Follow-Up. Arthroscopy 2024; 40:754-762. [PMID: 37422025 DOI: 10.1016/j.arthro.2023.06.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE To compare minimum 5-year patient-reported outcome measures after hip arthroscopy (HA) and periacetabular osteotomy (PAO) for borderline hip dysplasia. METHODS Hips with a lateral center-edge angle (LCEA) between 18° and less than 25° that underwent either PAO or HA were selected from 2 institutions. The exclusion criteria were as follows: LCEA less than 18°, Tönnis osteoarthritis grade greater than 1, prior hip surgical procedures, active inflammatory disease, Workers' Compensation, and concomitant surgery. Patients underwent propensity matching based on age, sex, body mass index, and Tönnis osteoarthritis grade. Patient-reported outcome measures included the modified Harris Hip Score, as well as calculation of the minimal clinically important difference, patient acceptable symptom state, and maximum outcome improvement satisfaction threshold. Preoperative radiographic predictors included comparison of the Femoro-epiphyseal Acetabular Roof index and ligamentum teres lesions. RESULTS A total of 28 PAO patients underwent propensity matching to 49 HA patients. The 2 groups were similar in terms of mean age, sex, preoperative body mass index, and LCEA. The PAO group had a longer mean follow-up period (95.8 months vs 81.3 months, P = .001). The mean Femoro-epiphyseal Acetabular Roof index was significantly lower preoperatively in the HA group (P < .001). The 2 groups showed similar and significant improvements in the mean modified Harris Hip Score from preoperatively to latest follow-up (P < .001). The relative risk of subsequent surgery in the PAO group was 3.49 (P = .024), mostly attributed to hardware removal (25%). The revision rate was 3.6% in the PAO group and 8.2% in the HA group (P = .65). One patient in the PAO group required revision HA for intra-articular adhesions. Three of the patients requiring revision in the HA group underwent PAO because of persistent pain, and one underwent revision HA alone. Conversion to total hip arthroplasty was required in 1 patient in the HA group and no patients in the PAO group. CONCLUSIONS Both PAO and HA with capsular plication provide borderline hip dysplasia patients with clinically significant improvements and low revision rates at a minimum of 5 years postoperatively. LEVEL OF EVIDENCE Level III, retrospective, comparative therapeutic trial.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | | | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christoph Germann
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ajay C Lall
- LALL Orthopedics Research Academy, Paramus, New Jersey, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
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Hoch A, Liebmann F, Farshad M, Fürnstahl P, Rahm S, Zingg PO. Augmented reality-guided pelvic osteotomy of Ganz: feasibility in cadavers. Arch Orthop Trauma Surg 2024; 144:1077-1089. [PMID: 38133802 PMCID: PMC10896923 DOI: 10.1007/s00402-023-05167-4] [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: 01/21/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The periacetabular osteotomy is a technically demanding procedure with the goal to improve the osseous containment of the femoral head. The options for controlled execution of the osteotomies and verification of the acetabular reorientation are limited. With the assistance of augmented reality, new possibilities are emerging to guide this intervention. However, the scientific knowledge regarding AR navigation for PAO is sparse. METHODS In this cadaveric study, we wanted to find out, if the execution of this complex procedure is feasible with AR guidance, quantify the accuracy of the execution of the three-dimensional plan, and find out what has to be done to proceed to real surgery. Therefore, an AR guidance for the PAO was developed and applied on 14 human hip cadavers. The guidance included performance of the four osteotomies and reorientation of the acetabular fragment. The osteotomy starting points, the orientation of the osteotomy planes, as well as the reorientation of the acetabular fragment were compared to the 3D planning. RESULTS The mean 3D distance between planned and performed starting points was between 9 and 17 mm. The mean angle between planned and performed osteotomies was between 6° and 7°. The mean reorientation error between the planned and performed rotation of the acetabular fragment was between 2° and 11°. CONCLUSION The planned correction can be achieved with promising accuracy and without serious errors. Further steps for a translation from the cadaver to the patient have been identified and must be addressed in future work.
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Affiliation(s)
- Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Florentin Liebmann
- Research in Orthopaedic Computer Science, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopaedic Computer Science, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Hasler J, Flury A, Hoch A, Cornaz F, Zingg PO, Rahm S. Total hip arthroplasty through the direct anterior approach for sequelae of Legg-Calvé-Perthes disease. Arch Orthop Trauma Surg 2023; 143:5935-5944. [PMID: 36806985 PMCID: PMC10449662 DOI: 10.1007/s00402-023-04791-4] [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: 07/13/2022] [Accepted: 01/22/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Due to multiplanar deformities of the hip, total hip arthroplasty (THA) for sequelae of Legg-Calvé-Perthes disease (LCPD) is often technically demanding. This study aimed to compare the clinical and radiographic outcomes of patients with sequelae of LCPD undergoing THA through the direct anterior approach (DAA) and non-anterior approaches to the hip. METHODS All patients with sequelae of LCPD who underwent primary THA between 2004 and 2018 (minimum follow-up: 2 years) were evaluated and separated into two groups: THA through the DAA (Group AA), or THA through non-anterior approaches to the hip (Group non-AA). Furthermore, a consecutive control group of patients undergoing unilateral THA through the DAA for primary hip osteoarthritis (Group CC) was retrospectively reviewed for comparison. RESULTS Group AA comprises 14 hips, group non-AA 17 hips and group CC 30 hips. Mean follow-up was 8.6 (± 5.2; 2-15), 9.0 (± 4.6; 3-17) and 8.1 (± 2.2; 5-12) years, respectively. At latest follow-up, Harris Hip Score was 90 (± 20; 26-100), 84 (± 15; 57-100), and 95 (± 9; 63-100) points, respectively. Overall, 6 patients treated for LCPD (each 3 patient in the AA and non-AA group) developed postoperative sciatic nerve palsy, of which only one was permanent. Complication-related revision rate at the latest follow-up was 15% in the AA-group and 25% in the non-AA group, respectively. CONCLUSION THA through the DAA might be a credible option for the treatment of sequelae of LCPD with comparable complication rates and functional outcomes to non-anterior approaches.
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Affiliation(s)
- Julian Hasler
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Andreas Flury
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Frédéric Cornaz
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Kaiser D, Hoch A, Rahm S, Stern C, Sutter R, Zingg PO. Combining the advantages of 3-D and 2-D templating of total hip arthroplasty using a new tin-filtered ultra-low-dose CT of the hip with comparable radiation dose to conventional radiographs. Arch Orthop Trauma Surg 2023; 143:5345-5352. [PMID: 36460762 PMCID: PMC10374735 DOI: 10.1007/s00402-022-04697-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/13/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Inaccurately scaled radiographs for total hip arthroplasty (THA) templating are a source of error not recognizable to the surgeon and may lead to inaccurate reconstruction and thus revision surgery or litigation. Planning based on computed tomography (CT) scans is more accurate but associated with higher radiation exposure. The aim of this study was (1) to retrospectively assess the scaling deviation of pelvic radiographs; (2) to prospectively assess the feasibility and the radiation dose of THA templating on radiograph-like images reconstructed from a tin-filtered ultra-low-dose CT dataset. METHODS 120 consecutive patients were retrospectively analyzed to assess the magnification error of our current THA templates. 27 consecutive patients were prospectively enrolled and a radiographic work-up in the supine position including a new tin-filtered ultra-low-dose CT scan protocol was obtained. THA was templated on both images. Radiation dose was calculated. RESULTS Scaling deviations between preoperative radiographs and CT of ≥ 5% were seen in 25% of the 120 retrospectively analyzed patients. Between the two templates trochanter tip distance differed significantly (Δ2.4 mm, 0-7 mm, p = 0.035)), predicted femoral shaft size/cup size was the same in 45%/41%. The radiation dose of the CT (0.58 mSv, range 0.53-0.64) was remarkably low. CONCLUSION Scaling deviations of pelvic radiographs for templating THA may lead to planning errors of ≥ 3 mm in 25% and ≥ 6 mm in 2% of the patients. 2-D templating on radiograph-like images based on tin-filtered ultra-low-dose CT eliminates this source of error without increased radiation dose. LEVEL OF EVIDENCE Retrospective and prospective comparative study, Level III.
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Affiliation(s)
- Dominik Kaiser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Christoph Stern
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Schenk P, Schöni M, Urbanschitz L, Filli L, Rahm S, Zing P. Tenosynovial Giant Cell Tumor (TSGCT) of the hip: MRI accuracy and results of surgical treatment. Acta Orthop Belg 2023; 89:65-69. [PMID: 37294987 DOI: 10.52628/89.1.10424] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Tenosynovial Giant Cell Tumor (TSGCT) or formerly pigmented villonodular synovitis (PVNS) is a rare nonmalignant tumor of the synovia seldom affecting the hip. MRI and surgical resection are the gold standards in its diagnosis and treatment. However, the accuracy of MRI is unknown, and only few reports on its surgical treatment results exist. The goal of the study was to investigate the MRI accuracy, results after surgical treatment, and natural history of untreated MRI-diagnosed hip TSGCT. Twenty-four consecutive patients with suspected TSGCT on hip MRI, between December 2006 and January 2018, were identified from our medical database. Six refused to participate. About 18 patients with a minimal follow-up of 18 months were enrolled. Charts were reviewed for histopathology results, specific treatment and recurrence. At the last follow-up, all patients had a clinical (Harris Hip Score [HHS]) and radiological examination (x-ray and MRI). Out of 18 patients with suspected TSGCT on MRI, with a mean age of 35y (range 17-52), 14 had surgi- cal resection and 4 refused surgery 1 of whom had a CT-guided biopsy. Out of 15 cases with biopsies, in 10 TSGCT was confirmed. Three surgically-treated patients showed recurrence on MRI after 24, 31 and 43 months. Two non-treated patients showed progression after 18 and 116 months. At the last follow-up (65 m; range 18-159), the mean HHS with or without recurrence was 90 and 80pts (ns). Operative vs. non-operative treatment showed HHS of 86 and 90pts (ns). In the conservatively-treated group, HHS with and without progression was 98 and 82pts (ns), respectively. MRI-suspected TSGCT of the hip was confirmed with biopsy in two-thirds of the cases. Surgical treatment showed recurrence in more than one-third of the patients. Two out of four untreated patients showed progression of the TSGCT-suspected lesion.
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Schenk P, Dimitriou D, Rahm S, Zimmermann SM, Finsterwald M, Higashigaito K, Sutter R, Zingg PO. Natural History of Degenerative Hip Abductor Tendon Lesions. Am J Sports Med 2023; 51:160-168. [PMID: 36412545 PMCID: PMC9810830 DOI: 10.1177/03635465221135759] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The best treatment of degenerative hip abductor tendon lesions remains largely unknown, as the natural course of the disease has not yet been reported. The aim of the present study was to investigate the natural history of symptomatic degenerative hip abductor lesions. HYPOTHESIS Nonoperatively treated hip abductor lesions progress over time, resulting in refractory hip pain and low functional outcomes. STUDY DESIGN Case series (prognosis); Level of evidence, 4. METHODS Consecutive patients with greater trochanteric pain syndrome and degenerative changes on magnetic resonance imaging (MRI) of the symptomatic hip were included. Bilateral hip MRI scans and a clinical examination were performed at a minimum follow-up of 36 months to study the type and location of hip abductor lesion. Progression of a lesion was defined as a more severe lesion as compared with the initial MRI results or if the lesion extended to another, initially not involved, trochanteric facet. The muscle's fatty infiltration (FI) was also described. RESULTS From 106 patients identified, 58 patients (64 hips) aged 66 ± 14 years (mean ± SD) agreed to return to the clinic for follow-up MRI and met the inclusion criteria. At a mean 71-month follow-up, an overall 34% (22/64) of lesions had progressed over time: from trochanteric bursitis to tendinopathy (9/64, 14%) or partial tear (5/64, 8%), from tendinopathy to partial tear (4/64, 6%), from a partial to complete tear (3/64, 4.5%), and with 1 complete tear (1/64, 1.5%) extending to another trochanteric facet. Interestingly, 90% of partial tears remained stable or transformed into a scar. Although patients with a progressive lesion experienced more trochanteric pain (visual analog scale, 4.6 vs 2.8; P = .001), the functional outcomes were comparable with patients with a stable lesion. The majority of hips with a partial tear (64%) demonstrated a progression of gluteus minimus FI from a median grade of 1 to 2, whereas only 1 hip (3%) progressed from grade 2 to 3. Only 3 hips (9%) with a partial tear had a progression of gluteus medius FI, which did not differ significantly from the contralateral unaffected side. CONCLUSION Nonoperative treatment might be a valid long-term option for degenerative hip abductor lesions, especially for partial tears, which demonstrated a low risk of clinically relevant progression or muscle FI and similar clinical outcomes to those reported in the literature for operatively treated hip abductor tendon lesions.
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Affiliation(s)
- Pascal Schenk
- Department of Orthopedics, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Dimitris Dimitriou
- Department of Orthopedics, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland,Dimitris Dimitriou, MD, Department of Orthopedics, University
Hospital Balgrist, University of Zürich, Forchstrasse 340, 8008, Zürich,
Switzerland ()
| | - Stefan Rahm
- Department of Orthopedics, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Stefan M. Zimmermann
- Department of Orthopedics, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Michael Finsterwald
- Department of Orthopedics, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Kai Higashigaito
- Department of Radiology, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Reto Sutter
- Department of Radiology, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Patrick O. Zingg
- Department of Orthopedics, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland
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Kaiser D, Ried E, Zingg PO, Rahm S. Acetabular reconstruction with femoral head autograft in primary total hip arthroplasty through a direct anterior approach is a reliable option for patients with secondary osteoarthritis due to developmental dysplasia of the hip. Arch Orthop Trauma Surg 2022; 142:2957-2964. [PMID: 34581861 PMCID: PMC9474438 DOI: 10.1007/s00402-021-04187-2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 09/19/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Developmental dysplasia is challenging to treat with total hip arthroplasty via the direct anterior approach (DAA). Reconstructing the former anatomy while restoring the acetabular bone stock for future revisions in this young patient collective combined with the known advantages of the DAA would be desirable. The purpose of this study was to analyze the feasibility, radiographic outcome and clinical outcome of primary uncemented total hip arthroplasty with bulk femoral head autograft for acetabular augmentation through a DAA with a minimal follow-up of 12 months. METHODS A retrospective, consecutive series from March 2006 to March 2018 of 29 primary total hip arthroplasty with acetabular augmentation with bulk femoral head autograft through a direct anterior approach was identified. All complications, reoperations and failures were analyzed. Radiographic and clinical outcome was measured. RESULTS 24 patients (29 hips) with a mean age of 43 (18-75) years and a mean follow-up of 35 months (12-137) were included. Surgical indication was secondary osteoarthritis for developmental dysplasia of the hip (Hartofilakidis Grade A (n = 19), B (n = 10)) in all cases. We noted no conversion of the approach, no dislocation and no acetabular loosening. The center of rotation was significantly distalized by a mean of 9 mm (0-23) and significantly medialized by a mean of 18 mm (6-29). The bone graft was fully integrated after 12 months in all cases. CONCLUSION Acetabular reconstruction with femoral head autograft in primary THA through a direct anterior approach seems to be a reliable option for the treatment of secondary osteoarthritis in patients with DDH Hartofilakidis grade A and B. Prospective cohort studies with a large sample population and a long-term follow-up are necessary to confirm our findings.
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Affiliation(s)
- Dominik Kaiser
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland.
| | - Emanuel Ried
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
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Walser F, Prinz J, Rahm S, Zingg PO, Mancini S, Imkamp F, Zbinden R, Achermann Y. Antimicrobial susceptibility testing is crucial when treating Finegoldia magna infections. Eur J Clin Microbiol Infect Dis 2022:10.1007/s10096-022-04439-y. [PMID: 35391578 DOI: 10.1007/s10096-022-04439-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/24/2022] [Indexed: 11/03/2022]
Abstract
Finegoldia magna is an anaerobic gram-positive bacterium that can cause invasive human infections. Recently, a 52-year-old patient suffering from a periprosthetic joint infection (PJI) due to F. magna was treated with cefepime on hemodialysis; however, treatment failed due to relapse caused by antibiotic-resistant strains. Reports on the antimicrobial susceptibility of F. magna clinical isolates are rare. We collected 57 clinical F. magna isolates from Zurich, Switzerland, between September 2019 and July 2020 and tested their antimicrobial susceptibility to investigate the local resistance pattern. Antimicrobial susceptibility testing (AST) was evaluated for nine antibiotics (benzylpenicillin, amoxicillin/clavulanic acid, cefuroxime, cefepime, levofloxacin, rifampicin, metronidazole, doxycycline, and clindamycin) by E-test according to CLSI guidelines. All F. magna strains were susceptible to benzylpenicillin, amoxicillin/clavulanic acid, and metronidazole, while 75% to clindamycin. F. magna isolates showed MIC values lower than species-unrelated breakpoints for cefuroxime, levofloxacin, and cefepime in 93%, 56%, and 32% of the cases, respectively. MIC values for rifampicin and doxycycline were lower than locally determined ECOFFs in 98% and 72% of the cases, respectively. In summary, we recommend the use of benzylpenicillin, amoxicillin/clavulanic acid, or metronidazole without prior AST as first-line treatment option against F. magna PJI infections. If cefuroxime, cefepime, levofloxacin, rifampicin, doxycycline, or clindamycin are used, AST is mandatory.
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Affiliation(s)
- Fabienne Walser
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Julia Prinz
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefano Mancini
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Frank Imkamp
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Reinhard Zbinden
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Yvonne Achermann
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
- Dermatology, University Hospital Zurich, University of Zurich And Department of Internfal Medicine, Hospital Zollikerberg, Zollikerberg, Switzerland.
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Flury A, Aregger F, Rahm S, Hoch A, Zingg PO. Subtrochanteric osteotomy in the management of femoral maltorsion results in anteroposterior malcorrection of the greater trochanter: computed simulations of 3D surface models of 100 cadavers. Hip Int 2022; 33:525-532. [PMID: 35067083 PMCID: PMC10170563 DOI: 10.1177/11207000211071046] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM The purpose of this study was to investigate the greater trochanter's (GT) behaviour in simulated subtrochanteric osteotomy. MATERIALS AND METHODS Measurement of functional and anatomical femoral torsion, and position of the GT and lesser trochanter was performed using 3-dimensional (3D) surface models of 100 cadaveric femora. Femoral torsion between 2° and 22° was defined as normal, femora with <2° and >22° of femoral torsion were assigned to the low- and high-torsion group. Subtrochanteric osteotomy was simulated to normalise torsional deformities to 12°. RESULTS With subtrochanteric osteotomy, functional torsion was simultaneously corrected while adjusting anatomical torsion (R2 = 0.866, p < 0.001). Compared to the normal-torsion group, an anteroposterior (AP) overcorrection of ±0.5 centimetres (range 0.02-1.1 cm) of the GT resulted in the high- and low-torsion group, respectively (p < 0.001): Mean AP GT distance to a standardised coronal plane was 2.1 ± 0.3 cm (range 12-30 cm) in the normal-torsion group compared to 1.61 ± 0.1 cm (range 1.4-1.71 cm) and 2.6 ± 0.6 cm (range 1.8-3.6 cm) for the corrected high and low-torsion groups, respectively. The extent of the GT shift in AP direction correlated strongly with the extent to which anatomical femoral torsion was corrected (R2 = 0.946; p < 0.001). CONCLUSIONS Subtrochanteric osteotomy for femoral maltorsion reliably adjusts anatomical and functional torsion, but also results in a ±1 cm AP shift of the GT per 10° of torsional correction. However, this effect of the procedure is most likely not clinically relevant in relation to hip abductor performance.
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Affiliation(s)
- Andreas Flury
- Andreas Flury, Armando Hoch, Patrick O Zingg and Fabian Aregger contributed equally to this work
| | - Fabian Aregger
- Andreas Flury, Armando Hoch, Patrick O Zingg and Fabian Aregger contributed equally to this work
| | | | - Armando Hoch
- Andreas Flury, Armando Hoch, Patrick O Zingg and Fabian Aregger contributed equally to this work
| | - Patrick O Zingg
- Andreas Flury, Armando Hoch, Patrick O Zingg and Fabian Aregger contributed equally to this work
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Andronic O, Hincapié CA, Burkhard MD, Loucas R, Loucas M, Ried E, Rahm S, Zingg PO. Lack of Conclusive Evidence of the Benefit of Biologic Augmentation in Core Decompression for Nontraumatic Osteonecrosis of the Femoral Head: A Systematic Review. Arthroscopy 2021; 37:3537-3551.e3. [PMID: 33964392 DOI: 10.1016/j.arthro.2021.04.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess whether biologic augmentation in addition to core decompression (CD), compared with CD alone, improves clinical and radiographic outcomes in the treatment of nontraumatic osteonecrosis of the femoral head (ONFH). Our hypothesis was that biologic augmentation would reduce the progression of osteonecrosis and therefore also the rate of conversion to total hip arthroplasty (THA). METHODS A systematic review was performed in accordance with the Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA) statement. Six databases were searched: Central, MEDLINE, Embase, Scopus, AMED, and Web of Science. Studies comparing outcomes of CD versus CD plus biologic augmentation (with or without structural augmentation), with a reported minimum level of evidence of III and ≥24 months of follow-up, were eligible. Procedural success was conceptualized as (1) avoidance of conversion to THA and (2) absence of radiographic disease progression. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal checklists. A quantitative analysis of heterogeneity was undertaken. RESULTS We included studies reporting on 560 hips in 484 patients. Biologic augmentation consisted of bone marrow stem cells in 10 studies, bone morphogenic protein in 2, and platelet-rich plasma in 1. Three studies used additional structural augmentation. The median maximum follow-up time was 45 months. Only 4 studies reported improvement in all clinical scores in the augmentation group. Seven studies observed a reduction in the rate of radiographic progression, and only 5 found reduced rates of conversion to THA when using augmentation. A high risk of bias and marked heterogeneity was found, with uncertainty about the study designs implemented, analytical approaches, and quality of reporting. CONCLUSION Current evidence is inconclusive regarding the benefit of biologic augmentation in CD for nontraumatic ONFH, because of inconsistent results with substantial heterogeneity and high risk of bias. LEVEL OF EVIDENCE III, systematic review of level I, II, and III studies.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland.
| | - Cesar A Hincapié
- Department of Chiropractic Medicine, Faculty of Medicine, Balgrist University Hospital and University of Zurich, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Marco D Burkhard
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Rafael Loucas
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Marios Loucas
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Emanuel Ried
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
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Andronic O, Rahm S, Fritz B, Singh S, Sutter R, Zingg PO. External snapping hip syndrome is associated with an increased femoral offset. Eur J Orthop Surg Traumatol 2021; 32:1481-1489. [PMID: 34550475 PMCID: PMC9587962 DOI: 10.1007/s00590-021-03123-9] [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] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/13/2021] [Indexed: 11/15/2022]
Abstract
Background External snapping hip syndrome (ESH) is postulated to be one of the causes of greater trochanteric pain syndrome, which also includes greater trochanteric bursitis and tendinopathy or tears of the hip abductor mechanism. However, it was not yet described what kind of bony morphology can cause the snapping and whether symptomatic and asymptomatic individuals have different imaging features. Purpose It was the purpose of this study to look for predisposing morphological factors for ESH and to differentiate between painful and asymptomatic snapping. Methods A consecutive cohort with ESH and available magnetic resonance imaging (MRI) between 2014 and 2019 was identified. The control group consisted of patients that underwent corrective osteotomies around the knee for mechanical axis correction and never complained of hip symptoms nor had undergone previous hip procedures. The following parameters were blindly assessed for determination of risk factors for ESH: CCD (corpus collum diaphysis) angle; femoral and global offset; femoral antetorsion; functional femoral antetorsion; translation of the greater trochanter (GT); posterior tilt of the GT; pelvic width/anterior pelvic length; intertrochanteric width. Hip and pelvic offset indexes were calculated as ratios of femoral/global offset and intertrochanteric/pelvic width, respectively. For the comparison of symptomatic and asymptomatic snapping, the following soft-tissue signs were investigated: presence of trochanteric bursitis or gluteal tendinopathy; presence of surface bony irregularities on trochanter major and ITB (Iliotibial band) thickness. Results A total of 31 hips with ESH were identified. The control group (n = 29) consisted of patients matched on both age (± 1) and gender. Multiple regression analysis determined an increased hip offset index to be independent predictor of ESH (r = + 0.283, p = 0.025), most likely due to the higher femoral offset in the ESH group (p = 0.031). Pearson correlation analysis could not identify any significant secondary factors. No differences were found between painful and asymptomatic snapping on MRI. Conclusions A high hip offset index was found as an independent predictor for external snapping hip in our cohort, mainly due to increased femoral offset. No imaging soft-tissue related differences could be outlined between symptomatic and asymptomatic external snapping. Level of evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00590.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Benjamin Fritz
- Department of Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sarvpreet Singh
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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12
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Hoch A, Schenk P, Jentzsch T, Rahm S, Zingg PO. FAI morphology increases the risk for osteoarthritis in young people with a minimum follow-up of 25 years. Arch Orthop Trauma Surg 2021; 141:1175-1181. [PMID: 32601879 DOI: 10.1007/s00402-020-03522-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 04/13/2020] [Accepted: 06/21/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The mechanical conflict in symptomatic femoroacetabular impingement can lead to early osteoarthritis. However, radiographic impingement morphology is often seen in asymptomatic individuals. Long-term observation regarding the risk of developing osteoarthritis in these individuals is lacking. Our study addressed the following questions: Does femoroacetabular impingement morphology increase the risk for development of osteoarthritis after at least 25 years? If yes, which radiographic parameter is the most predictive? Does the level of activity influence the risk for development of osteoarthritis? Are PROM influenced by the grade of osteoarthritis in this population? METHODS We investigated 51 (32 male, 19 female) patients for whom AP pelvis and Dunn view radiographs were available with a minimum follow-up of 25 years. Alpha angle in AP pelvis and Dunn view radiographs, femoral torsion in Dunn view, lateral center edge angle, cross-over sign, posterior wall sign and prominence of ischial spine sign in AP pelvis radiographs were determined. On the follow-up radiographs, osteoarthritis was graded. Tegner Score for the time of the index radiograph was evaluated. Harris Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index were assessed at latest follow-up. RESULTS The mean follow-up was 43 years (range 25-58). Cam impingement morphology showed to increase the risk for development of osteoarthritis: Alpha angles of ≥ 55° on AP pelvis and Dunn view radiographs were associated risk factors and showed an OR of 1.05 (p = 0.002) and 1.10 (p = 0.001), respectively. Abnormal femoral torsion and acetabular retroversion were not risk factors for osteoarthritis. Tegner Score at index presentation, HHS and WOMAC Score did not correlate with the grade of osteoarthritis. CONCLUSION This study showed that cam impingement morphology in young patients raises the risk for development of hip osteoarthritis by 5-10% in a long-term follow-up with a minimum of 25 years, thus its contribution was small.
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Affiliation(s)
- Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Pascal Schenk
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Thorsten Jentzsch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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13
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Roth T, Rahm S, Jungwirth-Weinberger A, Süess J, Sutter R, Schellenberg F, Taylor WR, Snedeker JG, Widmer J, Zingg P. Restoring range of motion in reduced acetabular version by increasing femoral antetorsion - What about joint load? Clin Biomech (Bristol, Avon) 2021; 87:105409. [PMID: 34144389 DOI: 10.1016/j.clinbiomech.2021.105409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/22/2020] [Revised: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acetabular retroversion results in reduced range of motion, and is thought to contribute to femoroacetabular impingement. Severe retroversion can be corrected with a periacetabular osteotomy, which is a technically demanding intervention. In this study, we investigated whether increasing femoral antetorsion is a potential alternative to restore the range of motion and how this approach would affect hip joint loading. METHODS Six different finite element models of the same subject were built from MRI and used to simulate different load scenarios during stance phase, including healthy and pathological configurations with different acetabular version and femoral torsion angles. The subject's gait was analysed in our gait lab and motion data as well as joint reaction forces were integrated into the model. Hip range of motion, hip abductor muscle forces as well as localization and magnitude of hip joint loads were determined. FINDINGS The negative effects of acetabular retroversion on hip range of motion including flexion and internal rotation can be reversed by increasing femoral anteversion. The rotation of the femur furthermore affected muscular functionality by shortening the moment arms of the hip abductor muscles, resulting in increased abductor muscle forces, joint reaction forces and hip joint loading. INTERPRETATION Even though increased femoral antetorsion can compensate for the loss of hip range of motion due to reduced acetabular version, rotational ostotomy of the proximal femur is likely to alter muscular moment arms and therefore increase hip joint load, conflicting the goal of a long-term healthy joint.
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Affiliation(s)
- Tabitha Roth
- Institute for Biomechanics, ETH Zurich, Rämistrasse 101, 8092 Zurich, Switzerland; Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Stefan Rahm
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Anna Jungwirth-Weinberger
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Janine Süess
- Institute for Biomechanics, ETH Zurich, Rämistrasse 101, 8092 Zurich, Switzerland; Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Reto Sutter
- Radiology, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Florian Schellenberg
- Institute for Biomechanics, ETH Zurich, Rämistrasse 101, 8092 Zurich, Switzerland.
| | - William R Taylor
- Institute for Biomechanics, ETH Zurich, Rämistrasse 101, 8092 Zurich, Switzerland.
| | - Jess G Snedeker
- Institute for Biomechanics, ETH Zurich, Rämistrasse 101, 8092 Zurich, Switzerland; Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Jonas Widmer
- Institute for Biomechanics, ETH Zurich, Rämistrasse 101, 8092 Zurich, Switzerland; Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Patrick Zingg
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
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14
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Waibel FWA, Berndt K, Jentzsch T, Farei-Campagna J, Rahm S, Dora C, Zingg PO. Symptomatic leg length discrepancy after total hip arthroplasty is associated with new onset of lower back pain. Orthop Traumatol Surg Res 2021; 107:102761. [PMID: 33316448 DOI: 10.1016/j.otsr.2020.102761] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 02/22/2020] [Revised: 08/31/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Leg length discrepancy (LLD) is common after total hip arthroplasty (THA) with a plethora of clinical consequences. The associations between symptomatic (sLLD; disturbing perception of anatomical leg length discrepancy), anatomical (aLLD; side difference in leg length between the center of rotation of the hip and the center of the ankle joint) and intraarticular (iLLD; side difference between the tear drop figure and the most prominent point of the trochanter minor) LLD and lower back have not yet been reported in the literature. We performed a retrospective study to answer if postoperative (1) symptomatic LLD, (2) anatomic LLD, and (3) a change in intraarticular leg length are associated with lower back pain in patients undergoing THA. Further, we aimed to answer (4) whether symptomatic LLD is associated with the magnitude of anatomical LLD and the change in intraarticular leg length. HYPOTHESIS LLD after THA is associated with lower back pain. MATERIALS AND METHODS Seventy-nine consecutive patients were retrospectively analyzed for the presence of aLLD and iLLD using EOS™ and X-rays, and were interviewed for the presence of sLLD and lower back pain using a questionnaire 5 years after primary THA. RESULTS Postoperative new onset of lower back pain was reported by 9 (11%) patients. Twenty (25%) patients reported sLLD. Anatomical LLD>5mm was present in 44 (56%) (median 8.0 (IQR -3.0 to 12.0; range -22 to 22) mm) and>10mm in 17 (22%) (median 12.0 (IQR 11.0 to 16.5; range -22 to 22) mm) patients. iLLD changed>5mm in 44 (56%) (median 8.5 (IQR 7.0 to 10.0; range -8 to 18) mm) and>10mm in 10 (13%) (median 14.0 (IQR 12.5 to 14.5; range 11 to 18) mm). New onset lower back pain was associated with sLLD (p=0.002) but not with aLLD or iLLD. Patients without preoperative lower back pain had a statistically significant association between presence of sLLD and an aLLD of >10mm (p=0.01). CONCLUSIONS Symptomatic LLD after primary THA is associated with postoperative new onset of lower back pain irrespective of the magnitude of LLD. In patients without lower back pain prior to THA, symptomatic LLD is associated with anatomical LLD of more than 10mm. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Felix W A Waibel
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Kersten Berndt
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Thorsten Jentzsch
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Jan Farei-Campagna
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Claudio Dora
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
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15
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Maurer SM, Kursawe L, Rahm S, Prinz J, Zinkernagel AS, Moter A, Kuster SP, Zbinden R, Zingg PO, Achermann Y. Cutibacterium avidum resists surgical skin antisepsis in the groin-a potential risk factor for periprosthetic joint infection: a quality control study. Antimicrob Resist Infect Control 2021; 10:27. [PMID: 33522957 PMCID: PMC7852298 DOI: 10.1186/s13756-021-00883-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 01/05/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The skin commensal Cutibacterium avidum has been recognized as an emerging pathogen for periprosthetic joint infections (PJI). One currently assumes that the early occurring PJIs are a consequence of skin commensals contaminating the peri-implant tissue during surgery. We addressed whether standard skin antisepsis with povidone-iodine/alcohol before total hip arthroplasty (THA) is effective to eliminate colonizing bacteria with focus on C. avidum. METHODS In a single-center, prospective study, we screened all patients for skin colonizing C. avidum in the groin before THA. Only in the patients positive for C. avidum, we preoperatively repeated skin swabs after the first and third skin antisepsis and antibiotic prophylaxis. We also obtained dermis biopsies for microbiology and fluorescence in situ hybridization (FISH). RESULTS Fifty-one out of 60 patients (85%) were colonized on the skin with various bacteria, in particular with C. avidum in 12 out of 60. Skin antisepsis eliminated C. avidum in eight of ten (20%) colonized patients undergoing THA. Deeper skin (dermis) biopsies were all culture negative, but FISH detected single positive ribosome-rich C. avidum in one case near sweat glands. CONCLUSION Standard skin antisepsis was not effective to completely eliminate colonizing C. avidum on the skin in the groin of patients undergoing THA. Colonizing with C. avidum might pose an increased risk for PJI when considering a THA. Novel more effective antisepsis strategies are needed. Trial registration No clinical trial.
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Affiliation(s)
- Steven M Maurer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Laura Kursawe
- Institute of Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Rahm
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Julia Prinz
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annelies S Zinkernagel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annette Moter
- Institute of Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Reinhard Zbinden
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Yvonne Achermann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Rahm S, Hoch A, Tondelli T, Fuchs J, Zingg PO. Revision rate of THA in patients younger than 40 years depends on primary diagnosis - a retrospective analysis with a minimum follow-up of 10 years. Eur J Orthop Surg Traumatol 2021; 31:1335-1344. [PMID: 33495905 PMCID: PMC8448705 DOI: 10.1007/s00590-021-02881-w] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/15/2021] [Indexed: 01/12/2023]
Abstract
Background Treating osteoarthritis in elderly patients with THA is very successful. However, surgeons hesitate to recommend THA in younger patients. The spectrum of etiologies for end stage hip disease in the younger population is diverse and therefore different courses may be assumed. Our objective was to evaluate THA revision rate within a minimum follow-up period of 10 years in young patients and to analyze the difference between different primary diagnoses. Methods We included 144 consecutive hips in 127 patients younger than 40 years, who received a primary THA from 01/1996 to 12/2007. Operative reports, clinical and radiographic documentation were reviewed to determine primary diagnosis, prior hip surgery, component specifications and revision surgery. 111 hips in 97 patients were available for outcome analysis with a minimum follow-up of 10 years. Results The mean age was 33 years (range 15–40 years) at the time of the index THA, 68 patients were female and 59 were male. Ten years revision rate on the prosthetic components was 13%. The most common primary diagnosis was DDH. DDH was associated with a risk of 17% for requiring a reoperation on the prosthetic components because of mechanical fatigue and therefore, significantly higher than for any other primary diagnosis (p = 0.005). Conclusion THA in young patients is associated with a high revision rate of 13% in 10 years. 17% of patients with DDH required revision surgery for mechanical fatigue within 10 years, which was significantly higher than for any other primary diagnosis (1.2%, OR 16.8).
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Affiliation(s)
- Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Timo Tondelli
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Johannes Fuchs
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
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17
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Rahm S, Jud L, Jungwirth-Weinberger A, Tondelli T, Falkowski AL, Sutter R, Zingg PO. Mid-term results after in situ pinning and hip arthroscopy for mild slipped capital femoral epiphysis: a minimum five-year follow-up. J Child Orthop 2020; 14:521-528. [PMID: 33343747 PMCID: PMC7740677 DOI: 10.1302/1863-2548.14.200068] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE In situ pinning of mild slipped capital femoral epiphysis (SCFE) results in an aspherical head-neck junction and arthroscopic osteochondroplasty can successfully correct the head-neck junction. However, whether the correction stays stable over at least five years remains unknown. METHODS In a retrospective and consecutive series, 11 patients with a mean age of 12 years (range, 10 years to 15 years) were included. All patients were treated for mild SCFE with in situ pinning and staged hip arthroscopy correcting the head-neck junction. All patients were assessed clinically and radiographically (radiograph and magnetic resonance imaging (MRI)) pre-operatively, 12 weeks and at least five years' post-operatively. RESULTS The mean range of motion (ROM) for flexion and internal rotation was stable over time with 100° (sd 4) and 21° (sd 6), respectively at the last follow-up. The mean alpha angle decreased from pre-operative 64° (range 61° to 68°) to 12 weeks post-operative 49° (range 46° to 52°; p = 0.001) and stayed stable over time. New superficial cartilage damage on either the acetabular or femoral side was seen in each three patients. Progressive labral degeneration was present in two patients. CONCLUSION In situ pinning and staged hip arthroscopy for the correction of mild SCFE is safe, restores normal alpha angles and reveals stable morphological correction at mid-term follow-up. Furthermore, the clinical results were excellent with almost normalized internal hip rotation at mid-term follow-up in patients who had reached adulthood. However, there was some joint deterioration, but without negative impact on subjective and clinical outcome after at least five years. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland,Correspondence should be sent to Stefan Rahm, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich 8008, Switzerland. E-mail:
| | - Lukas Jud
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Timo Tondelli
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Anna L. Falkowski
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick O. Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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18
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Kiarostami P, Dennler C, Roner S, Sutter R, Fürnstahl P, Farshad M, Rahm S, Zingg PO. Augmented reality-guided periacetabular osteotomy-proof of concept. J Orthop Surg Res 2020; 15:540. [PMID: 33203429 PMCID: PMC7672946 DOI: 10.1186/s13018-020-02066-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/04/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The Ganz' periacetabular osteotomy (PAO) consists of four technically challenging osteotomies (OT), namely, supraacetabular (saOT), pubic (pOT), ischial (iOT), and retroacetabular OT (raOT). PURPOSE We performed a proof of concept study to test (1) the feasibility of augmented reality (AR) guidance for PAO, (2) precision of the OTs guided by AR compared to the freehand technique performed by an experienced PAO surgeon, and (3) the effect of AR on performance depending on experience. METHODS A 3D preoperative plan of a PAO was created from segmented computed tomography (CT) data of an anatomic plastic pelvis model (PPM). The plan was then embedded in a software application for an AR head-mounted device. Soft tissue coverage was imitated using foam rubber. The 3D plan was then registered onto the PPM using an anatomical landmark registration. Two surgeons (one experienced and one novice PAO surgeon) each performed 15 freehand (FH) and 15 AR-guided PAOs. The starting point distances and angulation between the planned and executed OT planes for the FH and the AR-guided PAOs were compared in post-intervention CTs. RESULTS AR guidance did not affect the performance of the expert surgeon in terms of the mean differences between the planned and executed starting points, but the raOT angle was more accurate as compared to FH PAO (p = 0.0027). AR guidance increased the accuracy of the performance of the novice surgeon for iOT (p = 0.03). An intraarticular osteotomy performed by the novice surgeon with the FH technique could be observed only once. CONCLUSION AR guidance of osteotomies for PAOs is feasible and seems to increase accuracy. The effect is more accentuated for less-experienced surgeons. CLINICAL RELEVANCE This is the first proof of concept study documenting the feasibility of AR guidance for PAO. Based on these findings, further studies are essential for elaborating on the potential merits of AR guidance to increase the accuracy of complex surgical procedures.
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Affiliation(s)
- Pascal Kiarostami
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Cyrill Dennler
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Simon Roner
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Philipp Fürnstahl
- Computer Assisted Research & Development Group, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Mazda Farshad
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Patrick O. Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
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Andronic O, Achermann Y, Jentzsch T, Bearth F, Schweizer A, Wieser K, Fucentese SF, Rahm S, Zinkernagel AS, Zingg PO. Factors affecting outcome in the treatment of streptococcal periprosthetic joint infections: results from a single-centre retrospective cohort study. Int Orthop 2020; 45:57-63. [PMID: 32856092 PMCID: PMC7801309 DOI: 10.1007/s00264-020-04722-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/07/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To report and analyse factors affecting the outcome of streptococcal periprosthetic joint infections (PJIs). METHODS A retrospective analysis of consecutive streptococcal PJIs was performed. Musculoskeletal Infection Society 2013 criteria were used. Outcome was compared with a prospective PJI cohort from the same institution. RESULTS The most common isolated streptococcal species was Streptococcus dysgalactiae (9/22, 41%) among 22 patients included. Surgical treatment consisted of DAIR (debridement, antibiotics, irrigation and retention) in 12 (55%), one-stage revision arthroplasty in one (4%), two-stage revision arthroplasty in eight (37%) and implant removal in one (4%) patient. An infection free-outcome was achieved in 15 cases (68%), whilst seven (32%) patients failed initial revision and relapsed with the same pathogen, from which six were treated with DAIR and one with one-stage revision arthroplasty. No failures were observed in patients who received a two-stage revision. Failure rates did not differ in the cases treated with rifampin (1/5) from those without 6/17 (p = 0.55). There was no correlation between the length of antibiotic treatment and relapse (p = 0.723). In all failures, a persistent distant infection focus was identified at the time of relapse. Compared with our prospective PJI cohort, relapse rates were significantly higher 32% vs 12% (p < 0.05). CONCLUSION No correlation with the use of rifampin or length of antibiotic treatment was found. No failures were observed in patients who received a two-stage revision, which may be the surgical treatment of choice. A distant persisting infection focus could be the reason for PJI relapse with recurrent hematogenous seeding in the joint.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Yvonne Achermann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thorsten Jentzsch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Flurin Bearth
- University of Zurich, Rämistrasse 71, 8006, Zürich, Switzerland
| | - Andreas Schweizer
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Annelies S Zinkernagel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Galley J, Sutter R, Stern C, Filli L, Rahm S, Pfirrmann CWA. Diagnosis of Periprosthetic Hip Joint Infection Using MRI with Metal Artifact Reduction at 1.5 T. Radiology 2020; 296:98-108. [PMID: 32396046 DOI: 10.1148/radiol.2020191901] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background MRI with metal artifact reduction has gained importance in assessment of pain with total hip arthroplasty (THA). However, its role in diagnosis of periprosthetic joint infection (PJI) has not been well defined. Purpose To evaluate findings of PJI after THA and to determine the diagnostic performance of 1.5-T MRI with metal artifact reduction. Materials and Methods Dedicated compressed sensing-based slice encoding for metal artifact correction 1.5-T MRI examinations (from January 2015 to April 2018) in patients with THA PJI (infection group) and noninfected THA (control group) were retrospectively evaluated by two musculoskeletal radiologists. Fisher exact test was used to compare the groups. Sensitivity, specificity, and accuracy were evaluated for each finding. Interobserver reliability was assessed with κ statistics. Results Forty patients (mean age, 69 years ± 11 [standard deviation]; 26 men) in the infection group and 100 patients (mean age, 67 years ± 11; 42 men) in the control group were evaluated. Periosteal reaction, capsule edema, and intramuscular edema differed between the two groups (P < .001 for each finding). Periosteal reaction was found in 31 of 40 patients with infection and 10 of 100 participants in the control group (sensitivity, 78%; specificity, 90%; accuracy, 86%); capsule edema was found in 33 of 40 (infection group) and five of 100 (control group) (sensitivity, 83%; specificity, 95%; accuracy, 91%); and intramuscular edema was found in 38 of 40 (infection group) and 14 of 100 (control group) (sensitivity, 95%; specificity, 86%; accuracy, 89%). Interobserver agreement was almost perfect, with κ values between 0.88 and 0.92. No difference between the two groups was found regarding the presence of osteolysis (infection group, 23 of 40; control group, 60 of 100), bone marrow edema (39 of 40 vs 87 of 100), effusion (20 of 40 vs 26 of 100), abductor tendon lesion (22 of 40 vs 62 of 100), or bursitis (14 of 40 vs 34 of 100) (P > .05 for each finding). Conclusion The presence of periosteal reaction, capsule edema, and intramuscular edema after total hip arthroplasty at 1.5-T MRI with metal artifact reduction had a high accuracy in evaluation of periprosthetic joint infection. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Zanetti in this issue.
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Affiliation(s)
- Julien Galley
- From the Departments of Radiology (J.G., R.S., C.S., L.F., C.W.A.P.) and Orthopedic Surgery (S.R.), Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland; and Department of Radiology, HFR, University of Fribourg, Fribourg, Switzerland (J.G.)
| | - Reto Sutter
- From the Departments of Radiology (J.G., R.S., C.S., L.F., C.W.A.P.) and Orthopedic Surgery (S.R.), Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland; and Department of Radiology, HFR, University of Fribourg, Fribourg, Switzerland (J.G.)
| | - Christoph Stern
- From the Departments of Radiology (J.G., R.S., C.S., L.F., C.W.A.P.) and Orthopedic Surgery (S.R.), Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland; and Department of Radiology, HFR, University of Fribourg, Fribourg, Switzerland (J.G.)
| | - Lukas Filli
- From the Departments of Radiology (J.G., R.S., C.S., L.F., C.W.A.P.) and Orthopedic Surgery (S.R.), Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland; and Department of Radiology, HFR, University of Fribourg, Fribourg, Switzerland (J.G.)
| | - Stefan Rahm
- From the Departments of Radiology (J.G., R.S., C.S., L.F., C.W.A.P.) and Orthopedic Surgery (S.R.), Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland; and Department of Radiology, HFR, University of Fribourg, Fribourg, Switzerland (J.G.)
| | - Christian W A Pfirrmann
- From the Departments of Radiology (J.G., R.S., C.S., L.F., C.W.A.P.) and Orthopedic Surgery (S.R.), Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland; and Department of Radiology, HFR, University of Fribourg, Fribourg, Switzerland (J.G.)
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Ernstbrunner L, Rahm S, Suter A, Imam MA, Catanzaro S, Grubhofer F, Gerber C. Salvage reverse total shoulder arthroplasty for failed operative treatment of proximal humeral fractures in patients younger than 60 years: long-term results. J Shoulder Elbow Surg 2020; 29:561-570. [PMID: 31594724 DOI: 10.1016/j.jse.2019.07.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 04/29/2019] [Revised: 07/18/2019] [Accepted: 07/28/2019] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Is salvage reverse total shoulder arthroplasty (RTSA) a justifiable treatment for failed operative treatment (open reduction-internal fixation [ORIF] or primary and secondary hemiarthroplasty) of proximal humeral fractures in patients younger than 60 years? METHODS Thirty patients (mean age, 52 years; age range, 30-59 years) were reviewed after a mean follow-up period of 11 years (range, 8-18 years). Of the patients, 7 (23%) underwent RTSA for failed ORIF and 23 (77%) for failed hemiarthroplasty. Clinical and radiographic outcomes were assessed longitudinally. RESULTS At final follow-up, the mean relative Constant score had improved from 25% (±12%) to 58% (±21%, P < .001). Significant improvements were seen in the mean Subjective Shoulder Value (20% to 56%), active elevation (45° to 106°), abduction (42° to 99°), pain scores, and strength (P < .001). Clinical outcomes did not significantly deteriorate over a period of 10 years. Patients with salvage RTSA for failed secondary hemiarthroplasty (n = 8) vs. those for failed ORIF (n = 6) showed significantly inferior active abduction (77° vs. 116°, P = .023). Patients with a healed greater tuberosity (n = 9) showed significantly better external rotation than patients with a resorbed/resected greater tuberosity (n = 13, 21° vs. 3°, P = .025). One or more complications occurred in 18 shoulders (60%), and 6 (20%) resulted in explantation of the RTSA. CONCLUSIONS Salvage RTSA in patients younger than 60 years is associated with a high complication rate. It leads nonetheless to substantial and durable improvement beyond 10 years, provided the complications can be handled with implant retention. Inferior shoulder function is associated with greater tuberosity resorption or resection and inferior overhead elevation with the diagnosis of failed hemiarthroplasty.
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Affiliation(s)
- Lukas Ernstbrunner
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
| | - Stefan Rahm
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Aline Suter
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Mohamed A Imam
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Sabrina Catanzaro
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Florian Grubhofer
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Christian Gerber
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Bouaicha S, Epprecht S, Jentzsch T, Ernstbrunner L, El Nashar R, Rahm S. Three days of training with a low-fidelity arthroscopy triangulation simulator box improves task performance in a virtual reality high-fidelity virtual knee arthroscopy simulator. Knee Surg Sports Traumatol Arthrosc 2020; 28:862-868. [PMID: 31079163 DOI: 10.1007/s00167-019-05526-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 01/07/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this work is to evaluate the effectiveness of training with the low-fidelity ArthroBox® regarding performance of different basic arthroscopy tasks using a validated high-fidelity virtual reality simulator of the knee. METHODS Nineteen volunteers (14 females and 5 males) without any previous experience in arthroscopy were randomly assigned either to the ArthroBox® training group (n =10) or the non-training group (n =9). The training group underwent a supervised ArthroBox ® training consisting of a daily 60-min session for three consecutive days. Both groups completed the basic and the final assessment using a validated virtual reality-based passive haptic knee arthroscopy simulator (ArthroS, VirtaMed™). The following three factors were measured in different exercises (explained in "Materials and methods"): amount of time to finish the task, length of camera and scope path within the joint. Furthermore, the volunteers' demographics (age, sex, dexterity, video game experience, sport activities and profession) was assessed but showed no differences between the groups. RESULTS There were no significant differences between the training and non-training group regarding the above-mentioned demographic factors. However, the training group showed significant improvement from baseline to follow-up in most activities (e.g. task performance time in seconds, intra-articular camera and grasp distance in centimetres; see Table 1) in comparison to the non-training group. CONCLUSIONS The results from this study demonstrate that training for three consecutive days using a portable and versatile low-fidelity simulator significantly improves arthroscopy performance when using a validated high-fidelity virtual knee simulator. Arthroscopic triangulation training outside the operating theatre with a portable, low-cost simulator has proven to be a valuable educational tool to improve the arthroscopic skills of trainee surgeons. LEVEL OF EVIDENCE Diagnostic study, Level II.
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Affiliation(s)
- Samy Bouaicha
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Susanne Epprecht
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Thorsten Jentzsch
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Lukas Ernstbrunner
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Rany El Nashar
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Jud L, Vlachopoulos L, Häller TV, Fucentese SF, Rahm S, Zingg PO. The impact of mal-angulated femoral rotational osteotomies on mechanical leg axis: a computer simulation model. BMC Musculoskelet Disord 2020; 21:50. [PMID: 31973718 PMCID: PMC6979061 DOI: 10.1186/s12891-020-3075-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 08/15/2019] [Accepted: 01/17/2020] [Indexed: 12/01/2022] Open
Abstract
Background Subtrochanteric or supracondylar femoral rotational osteotomies are established surgical treatments for femoral rotational deformities. Unintended change of the mechanical leg axis is an identified problem. Different attempts exist to plan a correct osteotomy plane, but implementation of the preoperative planning into the surgical situation can be challenging. Goal of this study was to identify the critical threshold of mal-angulation of the osteotomy plane and of femoral rotation that leads to a relevant deviation of the postoperative mechanical leg axis using a computer simulation approach. Methods Three-dimensional (3D) surface models of the lower extremity of two patients (Model 1: 42° femoral antetorsion; Model 2: 6° femoral retrotorsion) were generated from computed tomography data. First, baseline subtrochanteric and supracondylar rotational osteotomies, perpendicular to the femoral mechanical axis were simulated. Afterwards, mal-angulated osteotomies in sagittal and frontal plane followed by different degrees of rotation were simulated and frontal mechanical axis was analyzed. Results 400 mal-angulated osteotomies have been simulated. Mal-angulation of ±30° with 30° rotation showed maximum deviation from preoperative mechanical axis in subtrochanteric osteotomies (4.0° ± 0.4°) and in supracondylar osteotomies (12.4° ± 0.8°). Minimal mal-angulation of 15° in sagittal plane in subtrochanteric osteotomies and mal-angulation of 10° in sagittal plane in supracondylar osteotomies altered the mechanical axis by > 2°. Mal-angulation in sagittal plane showed higher deviations of the mechanical axis (up to 12.4° ± 0.8°), than in frontal plane mal-angulation (up to 4.0° ± 1.9°). Conclusion A femoral rotational osteotomy, perpendicular to the femoral mechanical axis, has no considerable influence on the mechanical leg axis. However, mal-angulation of femoral rotational osteotomies showed relevant changes of the mechanical leg axis. In supracondylar respectively subtrochanteric procedures, mal-angulation of only 10° in combination with already 15° of femoral rotation respectively mal-angulation of 15° in combination with 30° of femoral rotation, can lead to a relevant postoperative mechanical leg axis deviation of more than 2°, wherefore these patients probably would benefit from the use of navigation aids.
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Affiliation(s)
- Lukas Jud
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland.
| | - Lazaros Vlachopoulos
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Thomas V Häller
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Stefan Rahm
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
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Wirth SH, Rahm S, Kamath AF, Dora C, Zingg PO. Periacetabular osteotomy using three-dimensional cutting and reposition guides: a cadaveric study. J Hip Preserv Surg 2019; 6:411-420. [PMID: 33585036 PMCID: PMC7869095 DOI: 10.1093/jhps/hnz051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 05/08/2019] [Revised: 08/29/2019] [Accepted: 10/03/2019] [Indexed: 11/13/2022] Open
Abstract
The goal of periacetabular osteotomy (PAO) is to reorient the acetabulum in a more physiological position. Its realization remains challenging regarding the final position of the acetabulum. Assistance with custom cutting- and reorientation-guides would thus be very helpful. Our purpose is to present a pilot study on such guides. Eight cadaveric hemipelvis were scanned using CT. After segmentation, 3D models of each specimen were created, a PAO was virtually performed and reorientation of the acetabula were defined. A specific guide was designed aiming to assist in iliac, posterior column and superior pubic ramus cuts as well as in acetabulum reorientation. Furthermore, the acetabular position was planned. Three-dimensional printed guides were used to perform PAO using the modified Smith-Peterson approach. The post-operative CT images and virtually planned acetabulum reorientation were compared in terms of acetabular index (AC), lateral centre edge angle (LCE), acetabular anteversion angle (AcetAV). There was no intra-articular or posterior column fracture seen. Two cadavers showed very low bone quality with insufficient stability of fixation and were excluded from further analysis. Correlation between the post-operative result and planning of the six included cadavers revealed the following mean deviations: 5° (SD ±3°) for AC angle, 6° (SD ±4°) for LCE angle and 15° (SD ±11°) for AcetAV angle. The use of 3D cutting and reorientation blocks for PAO was possible through a modified Smith-Peterson approach and revealed accurate fit to bone, accurate positioning of the osteotomies and acceptable planned corrections in cadavers with good bone quality.
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Affiliation(s)
- Stephan H Wirth
- Department of Orthopaedics, University of Zürich, Balgrist Hospital, Zürich 8032, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, University of Zürich, Balgrist Hospital, Zürich 8032, Switzerland
- Correspondence to: S. H. Rahm, Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Balgrist Hospital, Forchstrasse 340, 8008 Zürich, Switzerland. E-mail:
| | - Atul F Kamath
- Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH 44139, USA
| | - Claudio Dora
- Department of Orthopaedics, University of Zürich, Balgrist Hospital, Zürich 8032, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, University of Zürich, Balgrist Hospital, Zürich 8032, Switzerland
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Newberry R, Brown D, Mitchell T, Achay J, Rahm S, Long B, Becker T, Maddry J, Grier G, Davies G. 275 Comparison of Standard Left Anterolateral Thoracotomy vs. Modified Bilateral “Clamshell” Thoracotomy Performed by Emergency Physicians. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Berndt K, Rahm S, Dora C, Zingg PO. Total hip arthroplasty with accolade/trident through the direct minimally invasive anterior approach without traction table: Learning curve and results after a minimum of 5 years. Orthop Traumatol Surg Res 2019; 105:931-936. [PMID: 31255503 DOI: 10.1016/j.otsr.2019.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 09/04/2018] [Revised: 02/24/2019] [Accepted: 05/02/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The direct minimally invasive anterior approach (DMIAA) in total hip arthroplasty (THA) is widely accepted. In our department the DMIAA according to Rachbauer together with the Trident cup and Accolade stem was introduced in 2004. The purpose of the study was to demonstrate the five-year results and to analyze the learning curve of a new introduced approach. PATIENTS AND METHODS Between July 2004 and May 2006, a consecutive series of 151 THA in 147 patients was retrospectively analyzed. All patients were planned to received a THA with the Accolade/Trident implant system using the DMIAA without traction table. Clinical and radiographic data, complications and survivorship were documented with a follow-up of at least 5 years. RESULTS Regarding cup implantation, there were 11 (7.3%) failed intentions to treat due to missing pressfit (8 cases) and acetabular floor perforation (3 cases). No failed intentions to treat occurred during stem implantation. Total implant survival after 5 years follow-up after exclusion of 11 cases with failed intention to treat (N=140) was 96.9% (SD 1.4; CI 94.3-99.6). After exclusion of the failed intentions to treat (N=140, N=4 in the first 20 cases), there was significant (p<0.001) difference between the first 16 implants with a 5 year-survival of 83.2% (SD 8.6; CI 66.4-100) and 95.7% (SD 0.9; CI 93.9-97.5) for the following 124 implants. Radiolucent lines were observed in Gruen zone 1 in 3.3% and in Gruen zone 1 and 2 in 1.1%. DISCUSSION THA with Accolade/Trident using the DMIAA without traction table according to Rachbauer temporary exposed patients to a higher risk of implant revisions, which was normalized after the first 20 cases. Results of the learning curve are comparable to other techniques using an orthopaedic traction table. After the typical learning curve, the rate of 5 years implant failure is in accordance with the registry data for non-cemented implants. The Accolade stem showed minimal radiographic signs of radiolucency. LEVEL OF EVIDENCE IV, retrospective, consecutive case series.
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Affiliation(s)
- Kersten Berndt
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland.
| | - Claudio Dora
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
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Rahm S, Tondelli T, Steinmetz S, Schenk P, Dora C, Zingg PO. Uncemented Total Hip Arthroplasty Through the Direct Anterior Approach: Analysis of a Consecutive Series of 275 Hips With a Minimum Follow-Up of 10 Years. J Arthroplasty 2019; 34:1132-1138. [PMID: 30795936 DOI: 10.1016/j.arth.2019.01.062] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 12/13/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to document complications, outcomes, and 10-year survivorship of primary total hip arthroplasty (THA) using a direct anterior approach with an uncemented, straight, hydroxyapatite-coated stem and an uncemented cup. METHODS A retrospective, consecutive series of 275 primary THAs through a direct anterior approach with traction table using Medacta Versafit cup and Quadra-H stem with a minimum of 10-year follow-up was identified. The cumulative 10-year survival of the implants was estimated using Kaplan-Meier estimator. All complications, reoperations, and failures were analyzed. Subjective and clinical outcomes (Subjective Hip Value, Western Ontario and McMaster Universities Osteoarthritis Index, and Harris Hip Score) were measured. RESULTS Of 256 patients (275 hips, 143 men and 113 women) with a mean age of 63 (range, 24-85) years, 48 (19%) patients (52 hips) deceased not related to the surgery after a mean time 49 months (range, 3-118) postoperatively. At >10-year follow-up, 9 THAs were revised. The overall implant survival rate was 96.8% (95% confidence interval, 94.4-98.7) at 10 years. One cup and 1 stem were revised because of aseptic loosening. At the last follow-up, the median Subjective Hip Value was 90% (range, 20-100), the Western Ontario and McMaster Universities Osteoarthritis Index score reached a median of 0.2 points (range, 0-6.3), and the median Harris Hip Score points was 99 (range, 29-100). CONCLUSION Primary THA through an anterior minimal invasive approach with the mentioned implants showed low revision rates and good to excellent clinical outcome after at least 10 years.
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Affiliation(s)
- Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Timo Tondelli
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Sylvain Steinmetz
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Pascal Schenk
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Claudio Dora
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Bauer DE, Wieser K, Aichmair A, Zingg PO, Dora C, Rahm S. Validation of a Virtual Reality-Based Hip Arthroscopy Simulator. Arthroscopy 2019; 35:789-795. [PMID: 30733023 DOI: 10.1016/j.arthro.2018.10.131] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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] [Received: 03/13/2018] [Revised: 10/26/2018] [Accepted: 10/27/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess construct and face validity of a novel virtual reality-based hip arthroscopy simulator using the previously validated Arthroscopic Surgery Skills Evaluation Tool (ASSET), metric parameters, and a questionnaire. METHODS Metric parameters including task completion time, camera path, and grasper path were recorded, and the ASSET score was used to assess construct validity. Face validity was evaluated using a questionnaire. RESULTS Nine hip arthroscopy experts, of whom the majority performed more than 200 procedures (age, 48 ± 7.3; range, 38-61 years; 8 men, 1 woman), and 33 nonexperts (age, 33 ± 7.9; range, 26-62 years; 25 men, 8 women) performed 3 individual tasks on a virtual reality-based arthroscopy simulator of a left hip. The ASSET global rating scale showed a statistically significant difference between the hip arthroscopy expert and the nonexpert group, indicating strong construct validity (25.0 in the expert group, range, 17-34, versus 15.30 in the nonexpert group, range, 8-30 [P < .001], respectively). This also applied to most metric parameters recorded by the simulator. The simulator also demonstrated high face validity. The overall impression in terms of realism was graded "completely realistic" by 17% and "close to realistic" by 62% of participants. CONCLUSIONS The tested simulator demonstrated high construct and face validity. CLINICAL RELEVANCE This study demonstrates the construct and face validity of a novel hip arthroscopy simulator. The device proved to be an adequate model for the simulation of some arthroscopic procedures of the hip.
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Affiliation(s)
- David E Bauer
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Karl Wieser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Alexander Aichmair
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Claudio Dora
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Rahm S, Wieser K, Bauer DE, Waibel FW, Meyer DC, Gerber C, Fucentese SF. Efficacy of standardized training on a virtual reality simulator to advance knee and shoulder arthroscopic motor skills. BMC Musculoskelet Disord 2018; 19:150. [PMID: 29769058 PMCID: PMC5956558 DOI: 10.1186/s12891-018-2072-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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: 04/17/2017] [Accepted: 05/04/2018] [Indexed: 01/07/2023] Open
Abstract
Background Most studies demonstrated, that training on a virtual reality based arthroscopy simulator leads to an improvement of technical skills in orthopaedic surgery. However, how long and what kind of training is optimal for young residents is unknown. In this study we tested the efficacy of a standardized, competency based training protocol on a validated virtual reality based knee- and shoulder arthroscopy simulator. Methods Twenty residents and five experts in arthroscopy were included. All participants performed a test including knee -and shoulder arthroscopy tasks on a virtual reality knee- and shoulder arthroscopy simulator. The residents had to complete a competency based training program. Thereafter, the previously completed test was retaken. We evaluated the metric data of the simulator using a z-score and the Arthroscopic Surgery Skill Evaluation Tool (ASSET) to assess training effects in residents and performance levels in experts. Results The residents significantly improved from pre- to post training in the overall z-score: − 9.82 (range, − 20.35 to − 1.64) to − 2.61 (range, − 6.25 to 1.5); p < 0.001. The overall ASSET score improved from 55 (27 to 84) percent to 75 (48 to 92) percent; p < 0.001. The experts, however, achieved a significantly higher z-score in the shoulder tasks (p < 0.001 and a statistically insignificantly higher z-score in the knee tasks with a p = 0.921. The experts mean overall ASSET score (knee and shoulder) was significantly higher in the therapeutic tasks (p < 0.001) compared to the residents post training result. Conclusions The use of a competency based simulator training with this specific device for 3-5 h is an effective tool to advance basic arthroscopic skills of resident in training from 0 to 5 years based on simulator measures and simulator based ASSET testing. Therefore, we conclude that this sort of training method appears useful to learn the handling of the camera, basic anatomy and the triangulation with instruments.
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Affiliation(s)
- Stefan Rahm
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.
| | - Karl Wieser
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - David E Bauer
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Felix Wa Waibel
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Dominik C Meyer
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Christian Gerber
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Sandro F Fucentese
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
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Abstract
Total hip arthroplasty (THA) is a very successful and effective orthopedic operation with very good immediate as well as long-term results to alleviate pain and improve health-related quality of life. A THA is indicated in end-stage hip osteoarthritis with a high degree of persistent suffering when conservative treatment has failed and in patients who wish a THA. This statement is generally valid for patients where the medical history, clinical examination and radiographic findings are conclusive, the pressure of suffering and the expectations are realistic. The timing of THA is based on the patient's discomfort. The treatment of these patients should include an interdisciplinary approach and the main goal is to improve the quality of life. Patients will learn to have reasonable expectations and should be well informed about the risks and benefits of THA. Realistic patient expectations seem to be a predictive factor for a good subjective outcome after THA.
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Affiliation(s)
- S Rahm
- Universitätsklinik Balgrist, Forchstr. 340, 8008, Zürich, Schweiz.
| | - P O Zingg
- Universitätsklinik Balgrist, Forchstr. 340, 8008, Zürich, Schweiz
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Ernstbrunner L, Suter A, Catanzaro S, Rahm S, Gerber C. Reverse Total Shoulder Arthroplasty for Massive, Irreparable Rotator Cuff Tears Before the Age of 60 Years: Long-Term Results. J Bone Joint Surg Am 2017; 99:1721-1729. [PMID: 29040126 DOI: 10.2106/jbjs.17.00095] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND There has been serious concern regarding the longevity and durability of outcomes of reverse total shoulder arthroplasty (RTSA) in younger patients. It was the purpose of this study to analyze long-term outcomes and complications of RTSA for irreparable rotator cuff tears in patients younger than 60 years. METHODS Twenty patients (23 shoulders) with a mean age of 57 years (range, 47 to 59 years) were evaluated at a mean of 11.7 years (range, 8 to 19 years) after RTSA. Fifteen shoulders (65%) had undergone previous non-arthroplasty surgery. Longitudinal clinical and radiographic outcomes were assessed. RESULTS At the time of final follow-up, the mean absolute and relative preoperative Constant score (CS) (and standard deviation) had improved from 24 ± 9 to 59 ± 19 points (p < 0.001) and from 29% ± 11% to 69% ± 21% (p < 0.001), respectively. The mean Subjective Shoulder Value (SSV) had increased from 20% ± 13% to 71% ± 27% (p < 0.001). There were also significant improvements in the mean active anterior elevation (from 64° to 117°), active abduction (from 58° to 111°), pain scores, and strength (all p ≤ 0.001). Clinical outcomes did not significantly deteriorate beyond 10 years and the functional results of patients with previous surgical procedures were not significantly inferior to the results of those with primary RTSA. The grade of, and number of patients with, radiographically apparent notching increased over time; the mean relative CS was lower in patients in whom the notching was grade 2 or higher (57%) than it was in those with no or grade-1 notching (81%; p = 0.006). Nine (39%) had ≥1 complication, with 2 failed RTSAs (9%). CONCLUSIONS RTSA in patients younger than 60 years leads to substantial subjective and functional improvement without clinical deterioration beyond 10 years. It is associated with a substantial complication rate, and complications compromise ultimate subjective and objective outcomes. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Lukas Ernstbrunner
- 1Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Meyer DC, Aguirre JA, Wieser K, Fucentese SF, Wirth S, Gerber C, Rahm S. Intra-osseous local anaesthetic patellar pain catheter suppresses osteoarthritic patello-femoral pain. Knee 2017; 24:882-889. [PMID: 28499486 DOI: 10.1016/j.knee.2017.04.010] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 04/10/2017] [Accepted: 04/13/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The source of pain in patellofemoral osteoarthritis is not fully understood. The purpose of this study was to identify the origin of pain using intraosseous pain catheters and to show early results with an osteotomy that is potentially denervating and hydrostatic pressure-relieving. METHODS Five patients with patellofemoral osteoarthritis and pain with straight downward patellofemoral compression were included. All underwent arthroscopic placement of two 0.8mm catheters into the medial and lateral patella prior to subsequent patellar facetectomy with an incomplete horizontal patellar osteotomy. The catheters were first flushed with 0.5ml saline, then with local anaesthetic to determine pain response. After a mean of 44months the latest clinical examination was performed. RESULTS Instillation of less than 0.5ml of saline provoked sharp pain, which could be localised by all patients as medial or lateral within the patella. Subsequent instillation of local anaesthetic suppressed the mean patellar tenderness during axial compression from VAS 6 to VAS 1. In one of the five patients, patellar osteotomy did not relieve symptoms and further surgical intervention was required. The remaining four patients experienced a clinical improvement with a mean subjective knee value of 55 (range 40 to 65) out of 100. CONCLUSION This is the first report on intraosseous catheters applying local anaesthetics into bone. There is a surprisingly precise intraosseous spatial resolution of pain perception in the patella and triggering of pain in osteoarthritis appears at least in part to occur through intraosseous increase of hydrostatic pressure. LEVEL OF EVIDENCE Level IV, Case Series.
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Affiliation(s)
- Dominik C Meyer
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland
| | - José A Aguirre
- Division of Anesthesiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland
| | - Karl Wieser
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland
| | - Sandro F Fucentese
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland
| | - Stephan Wirth
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland
| | - Christian Gerber
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland
| | - Stefan Rahm
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Zurich, Switzerland.
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Zimmermann SM, Scheyerer MJ, Farshad M, Catanzaro S, Rahm S, Gerber C. Long-Term Restoration of Anterior Shoulder Stability: A Retrospective Analysis of Arthroscopic Bankart Repair Versus Open Latarjet Procedure. J Bone Joint Surg Am 2016; 98:1954-1961. [PMID: 27926676 DOI: 10.2106/jbjs.15.01398] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Various operative techniques are used for treating recurrent anterior shoulder instability, and good mid-term results have been reported. The purpose of this study was to compare shoulder stability after treatment with the 2 commonly performed procedures, the arthroscopic Bankart soft-tissue repair and the open coracoid transfer according to Latarjet. METHODS A comparative, retrospective case-cohort analysis of 360 patients (364 shoulders) who had primary repair for recurrent anterior shoulder instability between 1998 and 2007 was performed. The minimum duration of follow-up was 6 years. Reoperations, overt recurrent instability (defined as recurrent dislocation or subluxation), apprehension, the subjective shoulder value (SSV), sports participation, and overall satisfaction were recorded. RESULTS An open Latarjet procedure was performed in 93 shoulders, and an arthroscopic Bankart repair was done in 271 shoulders. Instability or apprehension persisted or recurred after 11% (10) of the 93 Latarjet procedures and after 41.7% (113) of the 271 arthroscopic Bankart procedures. Overt instability recurred after 3% of the Latarjet procedures and after 28.4% (77) of the Bankart procedures. In the Latarjet group, 3.2% of the patients were not satisfied with their result compared with 13.2% in the Bankart group (p = 0.007). Kaplan-Meier analysis of survivorship, with apprehension (p < 0.001), redislocation (p = 0.01), and operative revision (p < 0.001) as the end points, documented the substantial superiority of the Latarjet procedure and the decreasing effectiveness of the arthroscopic Bankart repair over time. Twenty percent of the first recurrences after arthroscopic Bankart occurred no earlier than 91 months postoperatively, as opposed to the rare recurrences after osseous reconstruction, which occurred in the early postoperative period, with only rare late failures. CONCLUSIONS In this retrospective cohort study, the arthroscopic Bankart procedure was inferior to the open Latarjet procedure for repair of recurrent anterior shoulder dislocation. The difference between the 2 procedures with respect to the quality of outcomes significantly increased with follow-up time. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Rahm S, Ebneter L, Schultz B, Spross C, Kulling F, Erhardt JB. Comparison of interfragmentary compression in conventional and locked plating of proximal unicondylar tibia fractures : A biomechanical cadaver study. Acta Orthop Belg 2016; 82:586-592. [PMID: 29119901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The extent of interfragmentary compression in intra-articular fractures treated with various fixation methods have not yet been reported. Lateral split fractures were created in six pairs of cadaver tibiae treated -using buttress plating with lag screws (group C) or locked buttress plating after clamp compression (group L). Interfragmentary compression and fracture displacement were continuously measured using pressure sensors and a stereoscopic 3-D image correlation system. Significantly larger interfragmentary compression was found initially after clamping the fragment (p < 0.05) in group C (median ± SD ; 45.1 ± 5.0 N/mm2) compared with group L (33.6 ± 3.4 N/mm2), and a statistical trend towards larger compression was also found after cyclic loading (p = 0.05) in group C (45.3 ± 8.6 N/mm2) compared with group L (28.7 ± 5.8 N/mm2). These data indicate that conventional plating with lag screws achieves higher interfragmentary compression in this model compared with external clamp compression and locked plating.
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Jentzsch T, Rahm S, Seifert B, Farei-Campagna J, Werner CML, Bouaicha S. Correlation Between Arthroscopy Simulator and Video Game Performance: A Cross-Sectional Study of 30 Volunteers Comparing 2- and 3-Dimensional Video Games. Arthroscopy 2016; 32:1328-34. [PMID: 27006104 DOI: 10.1016/j.arthro.2015.12.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 03/23/2015] [Revised: 10/27/2015] [Accepted: 12/22/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the association between arthroscopy simulator performance and video game skills. METHODS This study compared the performances of 30 volunteers without experience performing arthroscopies in 3 different tasks of a validated virtual reality knee arthroscopy simulator with the video game experience using a questionnaire and actual performances in 5 different 2- and 3-dimensional (D) video games of varying genres on 2 different platforms. RESULTS Positive correlations between knee arthroscopy simulator and video game performances (ρ = 0.63, P < .001) as well as experiences (ρ = 0.50, P = .005) were found. The strongest correlations were found for the task of catching (hooking) 6 foreign bodies (virtual rings; "triangulation") and the dribbling performance in a sports game and a first-person shooter game, as well as the meniscus resection and a tile-matching puzzle game (all ρ ≥ 0.60, P < .001). No correlations were found for any of the knee arthroscopy simulator tasks and a strategy game. CONCLUSIONS Although knee arthroscopy performances do not correlate with 2-D strategy video game skills, they show a correlation with 2-D tile-matching puzzle games only for easier tasks with a rather limited focus, and highly correlate with 3-D sports and first-person shooter video games. These findings show that experienced and good 3-D gamers are better arthroscopists than nonexperienced and poor 3-D gamers. LEVEL OF EVIDENCE Level II, observational cross-sectional study.
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Affiliation(s)
- Thorsten Jentzsch
- Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, University of Zürich, Zürich, Switzerland; Orthopedic Department, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
| | - Stefan Rahm
- Orthopedic Department, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Burkhardt Seifert
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Jan Farei-Campagna
- Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, University of Zürich, Zürich, Switzerland; Orthopedic Department, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Clément M L Werner
- Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Samy Bouaicha
- Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, University of Zürich, Zürich, Switzerland; Orthopedic Department, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Rahm S, Germann M, Hingsammer A, Wieser K, Gerber C. Validation of a virtual reality-based simulator for shoulder arthroscopy. Knee Surg Sports Traumatol Arthrosc 2016; 24:1730-7. [PMID: 26860098 DOI: 10.1007/s00167-016-4022-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 04/30/2015] [Accepted: 01/21/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE This study was to determine face and construct validity of a new virtual reality-based shoulder arthroscopy simulator which uses passive haptic feedback. METHODS Fifty-one participants including 25 novices (<20 shoulder arthroscopies) and 26 experts (>100 shoulder arthroscopies) completed two tests: for assessment of face validity, a questionnaire was filled out concerning quality of simulated reality and training potential using a 7-point Likert scale (range 1-7). Construct validity was tested by comparing simulator metrics (operation time in seconds, camera and grasper pathway in centimetre and grasper openings) between novices and experts test results. RESULTS Overall simulated reality was rated high with a median value of 5.5 (range 2.8-7) points. Training capacity scored a median value of 5.8 (range 3-7) points. Experts were significantly faster in the diagnostic test with a median of 91 (range 37-208) s than novices with 1177 (range 81-383) s (p < 0.0001) and in the therapeutic test 102 (range 58-283) s versus 229 (range 114-399) s (p < 0.0001). Similar results were seen in the other metric values except in the camera pathway in the therapeutic test. CONCLUSION The tested simulator achieved high scores in terms of realism and training capability. It reliably discriminated between novices and experts. Further improvements of the simulator, especially in the field of therapeutic arthroscopy, might improve its value as training and assessment tool for shoulder arthroscopy skills. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Stefan Rahm
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Marco Germann
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Andreas Hingsammer
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Karl Wieser
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Christian Gerber
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Rahm S, Wieser K, Wicki I, Holenstein L, Fucentese SF, Gerber C. Performance of medical students on a virtual reality simulator for knee arthroscopy: an analysis of learning curves and predictors of performance. BMC Surg 2016; 16:14. [PMID: 27015842 PMCID: PMC4807575 DOI: 10.1186/s12893-016-0129-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 03/17/2016] [Indexed: 01/22/2023] Open
Abstract
Background Ethical concerns for surgical training on patients, limited working hours with fewer cases per trainee and the potential to better select talented persons for arthroscopic surgery raise the interest in simulator training for arthroscopic surgery. It was the purpose of this study to analyze learning curves of novices using a knee arthroscopy simulator and to correlate their performance with potentially predictive factors. Methods Twenty medical students completed visuospatial tests and were then subjected to a simulator training program of eight 30 min sessions. Their test results were quantitatively correlated with their simulator performance at initiation, during and at the end of the program. Results The mean arthroscopic performance score (z-score in points) at the eight test sessions were 1. -35 (range, -126 to -5) points, 2. -16 (range, -30 to -2), 3. -11 (range, -35 to 4), 4. -3 (range, -16 to 5), 5. -2 (range, -28 to 7), 6. 1 (range, -18 to 8), 7. 2 (range, -9 to 8), 8. 2 (range, -4 to 7). Scores improved significantly from sessions 1 to 2 (p = 0.001), 2 to 3 (p = 0.052) and 3 to 4 (p = 0.001) but not thereafter. None of the investigated parameters predicted performance or development of arthroscopic performance. Conclusion Novices improve significantly within four 30 min test virtual arthroscopy knee simulator training but not thereafter within the setting studied. No factors, predicting talent or speed and magnitude of improvement of skills could be identified.
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Affiliation(s)
- Stefan Rahm
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.
| | - Karl Wieser
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Ilhui Wicki
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Livia Holenstein
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Sandro F Fucentese
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Christian Gerber
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
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Chouza F, Reitebuch O, Groß S, Rahm S, Freudenthaler V, Toledano C, Weinzierl B. Aerosol Backscatter and Extinction Retrieval from Airborne Coherent Doppler Wind Lidar Measurements. EPJ Web of Conferences 2016. [DOI: 10.1051/epjconf/201611923001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Smalikho IN, Banakh VA, Holzäpfel F, Rahm S. Method of radial velocities for the estimation of aircraft wake vortex parameters from data measured by coherent Doppler lidar. Opt Express 2015; 23:A1194-A1207. [PMID: 26406749 DOI: 10.1364/oe.23.0a1194] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The method of radial velocities (RV) is applied to estimate aircraft wake vortex parameters from measurements conducted with pulsed coherent Doppler lidar (PCDL). Operations of the Stream Line lidar and the 2-µm PCDL are simulated numerically to analyze the accuracy of the estimated wake vortex parameters with the RV method. The RV method is also used to estimate wake vortex trajectories and circulation from lidar measurements at Tomsk and Munich airports. The method of velocity envelopes and the RV method are compared employing data gathered with the 2-µm PCDL. The domain of applicability of the RV method is determined.
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Rahm S, Klammer G, Benninger E, Gerber F, Farshad M, Espinosa N. Inferior results of salvage arthrodesis after failed ankle replacement compared to primary arthrodesis. Foot Ankle Int 2015; 36:349-59. [PMID: 25377389 DOI: 10.1177/1071100714559272] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Up to now, there has been no evidence that salvage arthrodesis would perform inferior when compared with primary ankle arthrodesis. The purpose of this study was to compare their clinical and radiographic results. METHODS A retrospective analysis was performed using 2 validated scores and assessment of radiographic union by comparing 23 patients who underwent salvage ankle arthrodesis (group SA = salvage arthrodesis) after failed total ankle replacement with 23 matched patients who received primary ankle arthrodesis (group PA = primary arthrodesis). The mean follow-up period was 38 (range 16-92) months in group SA and 56 (23-94) months in group PA. RESULTS Complete union was achieved in 17 patients (74%) after a mean time of 50 (13- 114) weeks in group SA and in 16 patients (70%) after a mean time of 23 (10-115) weeks in group PA. The SF-36 score averaged 48 points (7-80) in SA and 66 points (14-94; P = .006) in group PA. In group SA the mean FFI was 57% (22-82) for pain and 71% (44-98) for function. In group PA significantly better results for pain with 34% (0-88; P = .002) and function with 48% (1-92; P = .002) were found. CONCLUSION Salvage arthrodesis led to impaired life quality and reduced function combined with significantly higher pain when compared with primary ankle arthrodesis. These findings can be used to counsel our patients preoperatively. LEVEL OF EVIDENCE Level III, retrospective case series.
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Affiliation(s)
- Stefan Rahm
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Georg Klammer
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Emanuel Benninger
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Fabienne Gerber
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Norman Espinosa
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Fucentese SF, Rahm S, Wieser K, Spillmann J, Harders M, Koch PP. Evaluation of a virtual-reality-based simulator using passive haptic feedback for knee arthroscopy. Knee Surg Sports Traumatol Arthrosc 2015; 23:1077-85. [PMID: 24519617 DOI: 10.1007/s00167-014-2888-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [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] [Received: 07/11/2013] [Accepted: 01/30/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this work is to determine face validity and construct validity of a new virtual-reality-based simulator for diagnostic and therapeutic knee arthroscopy. METHODS The study tests a novel arthroscopic simulator based on passive haptics. Sixty-eight participants were grouped into novices, intermediates, and experts. All participants completed two exercises. In order to establish face validity, all participants filled out a questionnaire concerning different aspects of simulator realism, training capacity, and different statements using a seven-point Likert scale (range 1-7). Construct validity was tested by comparing various simulator metric values between novices and experts. RESULTS Face validity could be established: overall realism was rated with a mean value of 5.5 points. Global training capacity scored a mean value of 5.9. Participants considered the simulator as useful for procedural training of diagnostic and therapeutic arthroscopy. In the foreign body removal exercise, experts were overall significantly faster in the whole procedure (6 min 24 s vs. 8 min 24 s, p < 0.001), took less time to complete the diagnostic tour (2 min 49 s vs. 3 min 32 s, p = 0.027), and had a shorter camera path length (186 vs. 246 cm, p = 0.006). CONCLUSION The simulator achieved high scores in terms of realism. It was regarded as a useful training tool, which is also capable of differentiating between varying levels of arthroscopic experience. Nevertheless, further improvements of the simulator especially in the field of therapeutic arthroscopy are desirable. In general, the findings support that virtual-reality-based simulation using passive haptics has the potential to complement conventional training of knee arthroscopy skills. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Sandro F Fucentese
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Abstract
Background Accessory carpal ossicles may be the cause of atraumatic wrist pain or may be misinterpreted as a fracture after a trauma. Case Description We report the case of a patient suffering with chronic, bilateral wrist pain without history of trauma. Sonographic examination showed a bilateral symptomatic os epilunatum, both of which were surgically resected, resulting in pain relief. Literature Review Os epilunatum is a rare entity that has been reported only in few cadaveric specimen. Clinical Relevance Os epilunatum is a rare accessory ossicle of the carpus that can cause this aggravating pain. Sonography enabled accurate diagnosis of this anomaly. Because of possible associated tear of the scapholunate ligament, we recommend intraoperative testing of the stability of the scapholunate joint.
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Affiliation(s)
- Flavien Mauler
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Andreas Schweizer
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Ladislav Nagy
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
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Wieser K, Rahm S, Schubert M, Fischer MA, Farshad M, Gerber C, Meyer DC. Fluoroscopic, magnetic resonance imaging, and electrophysiologic assessment of shoulders with massive tears of the rotator cuff. J Shoulder Elbow Surg 2015; 24:288-94. [PMID: 25179370 DOI: 10.1016/j.jse.2014.05.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 02/06/2014] [Revised: 05/07/2014] [Accepted: 05/15/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND It was the purpose of this paper to analyze structural, functional, and electrophysiologic variables that may determine preserved overhead function for patients with massive rotator cuff tears. METHODS Nineteen patients (20 shoulders) were prospectively included in either the pseudoparalytic (n = 9) or the non-pseudoparalytic group (n = 11). Fatty infiltration was graded according to Goutallier, and anterior (subscapularis) and posterior (infraspinatus and teres minor) tear extension was graded 0 (no involvement) to 4 (full tear) on magnetic resonance imaging. Glenohumeral and scapulothoracic rhythm was assessed by fluoroscopic motion analysis, and electromyographic evaluation of the deltoid muscle was performed. RESULTS We found no significant difference of fatty infiltration of the supraspinatus (3.9 vs 3.6), infraspinatus (3.9 vs 3.8), and teres minor (1.7 vs 0.6) or of the posterior tear extension (2.6 vs 2.0) between pseudoparalytic and non-pseudoparalytic shoulders. Global tear extension in the parasagittal plane (205° vs 163°) and subscapularis involvement (2.6 vs 1.2), however, showed significant differences between the two groups, and no patient with a full-thickness supraspinatus and infraspinatus tear with extension into the inferior half of the subscapularis was able to lift the arm to 90°. Fluoroscopic assessment revealed almost total loss of active glenohumeral abduction in the pseudoparalytic group. CONCLUSION Despite global tear extension, the single most important predictor for preserved shoulder function is the integrity of the inferior subscapularis insertion. Furthermore, electromyographic evaluation identifies a well-differentiated deltoid innervation as beneficial for a well-preserved shoulder function, but it does not protect from pseudoparalysis.
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Affiliation(s)
- Karl Wieser
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Martin Schubert
- Department of Neurology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Michael A Fischer
- Department of Radiology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Mazda Farshad
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Christian Gerber
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Dominik C Meyer
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Banakh VA, Smalikho IN, Rahm S. Estimation of the refractive index structure characteristic of air from coherent Doppler wind lidar data. Opt Lett 2014; 39:4321-4324. [PMID: 25078167 DOI: 10.1364/ol.39.004321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A technique is proposed for estimating the refractive index structure characteristic of air from data of a coherent Doppler wind lidar. The proposed technique is tested in atmospheric experiments. Time profiles of the structure characteristic in the atmospheric surface layer are obtained and compared with the time profiles of the dissipation rate of the kinetic energy of turbulence obtained from the same lidar data. It is shown in this way that coherent lidars can be used for investigating not only wind turbulence, but also temperature turbulence.
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Langenhan J, Thier M, Bußmeier U, Rahm S, Kopp S. Fernröntgenseitenbild in der Therapie der obstruktiven Schlafapnoe. Somnologie 2013. [DOI: 10.1007/s11818-013-0630-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Becker K, Bußmeier U, Kopp S, Langenhan J, Rahm S, Sens M, Thier M, Wego J, Wilhelm G. Fernröntgenseitenbild in der Therapie der obstruktiven Schlafapnoe. Somnologie 2013. [DOI: 10.1007/s11818-013-0629-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Meyer DC, Rahm S, Farshad M, Lajtai G, Wieser K. Deltoid muscle shape analysis with magnetic resonance imaging in patients with chronic rotator cuff tears. BMC Musculoskelet Disord 2013; 14:247. [PMID: 23957805 PMCID: PMC3751864 DOI: 10.1186/1471-2474-14-247] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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: 02/21/2013] [Accepted: 08/15/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It seems appropriate to assume, that for a full and strong global shoulder function a normally innervated and active deltoid muscle is indispensable. We set out to analyse the size and shape of the deltoid muscle on MR-arthrographies, and analyse its influence on shoulder function and its adaption (i.e. atrophy) for reduced shoulder function. METHODS The fatty infiltration (Goutallier stages), atrophy (tangent sign) and selective myotendinous retraction of the rotator cuff, as well as the thickness and the area of seven anatomically defined segments of the deltoid muscle were measured on MR-arthrographies and correlated with shoulder function (i.e. active abduction). Included were 116 patients, suffering of a rotator cuff tear with shoulder mobility ranging from pseudoparalysis to free mobility. Kolmogorov-Smirnov test was used to determine the distribution of the data before either Spearman or Pearson correlation and a multiple regression was applied to reveal the correlations. RESULTS Our developed method for measuring deltoid area and thickness showed to be reproducible with excellent interobserver correlations (r = 0.814-0.982).The analysis of influencing factors on active abduction revealed a weak influence of the amount of SSP tendon (r = -0.25; p < 0.01) and muscle retraction (r = -0.27; p < 0.01) as well as the stage of fatty muscle infiltration (GFDI: r = -0.36; p < 0.01). Unexpectedly however, we were unable to detect a relation of the deltoid muscle shape with the degree of active glenohumeral abduction. Furthermore, long-standing rotator cuff tears did not appear to influence the deltoid shape, i.e. did not lead to muscle atrophy. CONCLUSIONS Our data support that in chronic rotator cuff tears, there seems to be no disadvantage to exhausting conservative treatment and to delay implantation of reverse total shoulder arthroplasty, as the shape of deltoid muscle seems only to be influenced by natural aging, but to be independent of reduced shoulder motion.
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Affiliation(s)
- Dominik C Meyer
- Orthopaedic Department, Balgrist University Hospital, University of Zurich, Rämistrasse 71, 8006, Zurich, Switzerland
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Rahm S, Spross C, Gerber F, Farshad M, Buck FM, Espinosa N. Operative treatment of chronic irreparable Achilles tendon ruptures with large flexor hallucis longus tendon transfers. Foot Ankle Int 2013; 34:1100-10. [PMID: 23624909 DOI: 10.1177/1071100713487725] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Transfer of the flexor hallucis longus (FHL) tendon aims to restore function and relieve pain in chronic Achilles tendon (AT) disease. The goal of the present study was to investigate the clinical and radiographic outcomes of FHL transfer to the AT and to compare the transtendinous technique to the transosseous technique. We hypothesized that the type of technique would have a notable impact on outcome. METHODS Forty patients (42 ankles) were retrospectively reviewed and divided into group 1 (transtendinous technique, 22 patients/24 ankles) and group 2 (transosseous technique, 18 patients/18 ankles). Outcome parameters included the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, Victorian Institute of Sports Assessment-Achilles (VISA-A) score, Foot Function Index (FFI), and Short Form-36 (SF-36) scores. Magnetic resonance imaging of the lower leg was performed preoperatively to assess muscle quality and fatty infiltration. Postoperatively, isokinetic plantar flexion strength was assessed using a Con-Trex dynamometer. RESULTS In group 1 (follow-up, 73 months; age, 52 years), the AOFAS score improved from 66 points to 89 points (P < .001) with average values for the VISA-A of 76 points, FFI-D pain 15%, and FFI-D function 22%. In group 2 (follow-up, 35 months; age, 56 years), the AOFAS score increased from 59 points to 85 points (P < .001) with mean values for the VISA-A 76 points, FFI-D pain 25%, and FFI-D function 24%. At follow-up, the average SF-36 score in group 1 was 66% and in group 2 was 77%. Isokinetic testing at 30 deg/s in group 1 revealed notable weakness in the operated ankle averaging 54.7 N·m (75% of normal), and in group 2 the average was 58.2 N·m (77% of normal). No statistically significant differences were found between the groups. CONCLUSION The hypothesis was disproved. Both techniques for FHL transfer to AT, intratendinous and transosseous, provided good to excellent clinical and functional outcome in the treatment of irreparable AT disease. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Wieser K, Rahm S, Farshad M, Ek ET, Gerber C, Meyer DC. Stitch positioning influences the suture hold in supraspinatus tendon repair. Knee Surg Sports Traumatol Arthrosc 2013; 21:1587-92. [PMID: 22706969 DOI: 10.1007/s00167-012-2103-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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: 03/06/2012] [Accepted: 06/05/2012] [Indexed: 12/20/2022]
Abstract
PURPOSE This study was designed to compare the pull-out strength of simple suture stitches in human supraspinatus tendons with respect to the position of the rotator cable. METHODS Fifty-four tests were performed on 6 intact, human supraspinatus tendons, to assess the cutout strength of a simple suture configuration in different positions; medial to, lateral to, or within the rotator cable. Tendon thickness was measured and correlated for each positioned suture. RESULTS Suture positioning lateral to or in the rotator cable showed significantly lower suture retention properties compared with positioning the suture medial to the cable (p = 0.002). In all tested specimens, the central stitch in the row medial to the rotator cable provided the optimum retention properties (mean: 191 N; SD: ± 44; p < 0.01), even after correcting for tendon thickness. CONCLUSION This study shows that it is desirable to identify the rotator cable and to pass sutures just medial to it, close to the middle of the tendon, which provided highest possible suture retention properties.
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Affiliation(s)
- Karl Wieser
- Orthopaedic Department, Balgrist Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland.
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Hovander L, Malmberg T, Athanasiadou M, Athanassiadis I, Rahm S, Bergman A, Wehler EK. Identification of hydroxylated PCB metabolites and other phenolic halogenated pollutants in human blood plasma. Arch Environ Contam Toxicol 2002; 42:105-17. [PMID: 11706375 DOI: 10.1007/s002440010298] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2001] [Accepted: 07/01/2001] [Indexed: 05/23/2023]
Abstract
A growing number of studies have reported phenolic halogenated compounds (PHCs) that are retained in the blood of humans and wildlife. These PHCs may be industrial chemicals; metabolites thereof, as in the case with polychlorobiphenylols (OH-PCBs); or of natural origin. The present study was aimed to identify hitherto unknown PHCs in human plasma with chemical structures that are consistent to PHCs known to possess endocrine-disrupting activity. For this purpose, samples of blood plasma from 10 randomly selected male blood donors from Sweden were pooled and analyzed by GC/ECD and GC/MS. Brominated, bromochlorinated, and chlorinated methyl derivatives of phenols and OH-PCBs were synthesized to be used as authentic reference standards. More than 100 PHCs were indicated in the plasma, and among those a total of 9 monocyclic brominated or chlorinated phenol-, guaiacol-, and/or catechol-type compounds were identified as their methylated derivatives. The two major compounds were 2,4,6-tribromophenol and pentachlorophenol. Thirty-eight OH-PCB congeners were structurally identified on two GC columns of different polarity. The origin of the OH-PCB metabolites in the context of their parent PCB congeners are suggested. Other PHCs identified in the male plasma were Triclosan (5-chloro-2-[2,4-dichlorophenoxy] phenol), a common bactericide; 4-hydroxy-heptachlorostyrene, a metabolite of octachlorostyrene; and 3,5-dibromo-2-(2,4-dibromophenoxy)phenol, a natural compound and a potential metabolite of polybrominated diphenyl ethers.
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Affiliation(s)
- L Hovander
- Department of Environmental Chemistry, Stockholm University, S-106 91 Stockholm, Sweden.
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