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Restoration of the hip geometry after two-stage exchange with intermediate resection arthroplasty for periprosthetic joint infection
No full textAbstract Two-stage exchange with intermediate resection arthroplasty (RA) is a well-established surgical procedure in the treatment of chronic periprosthetic joint infection (PJI), whereby a higher failure rate of final hip geometry restoration due to tissue contraction is controversially discussed. The aim was to evaluate radiographic changes of hip geometry parameters during PJI treatment and to determine the impact of the intermediate RA on the final joint restoration after reimplantation of a total hip arthroplasty (reTHA). Radiographic parameters (leg length (LL), femoral offset (FO), horizontal/vertical acetabular center of rotation distance (h/vCORD)) of 47 patients (mean age: 64.1 years) were measured on standard radiographs of the pelvis and compared between four different stages during PJI treatment (pre-replacement status (preTHA), primary total hip arthroplasty (pTHA), RA and reTHA). The RA duration (mean: 10.9 months) and the number of reoperations during this period (mean: n = 2.0) as well as their impact on hip geometry restoration were evaluated. Between preTHA and pTHA/reTHA an equivalent restoration was measured regarding the FO ( p < 0.001/ p < 0.001) and hCORD ( p = 0.016/ p < 0.001), but not regarding the LL and vCORD. In contrast, analysis revealed no influence of RA and an equivalent reconstruction of LL ( p = 0.003), FO ( p < 0.001), v/hCORD ( p = 0.039/ p = 0.035) at reTHA compared to pTHA. Furthermore, RA duration ( p = 0.053) and the number of reoperations after RA ( p = 0.134) had no impact on radiographic hip geometry restoration. The two-stage exchange with intermediate RA does not alter the preexisting hip joint parameters, whereby a good restoration of the final hip geometry, independent of the duration or the number of reoperations, can be achieved
Analyse von Kalzifizierungen im hyalinen Knorpel - Chondrokalzinose als systemische Erkrankung des Gelenkknorpels
No full textFahrtauglichkeit nach Knie-und Hüftgelenkstotalendoprothese : Eine Beobachtungsstudie aus der Perspektive der rehabilitativen orthopädischen Therapie
Full text linkZiel der vorgelegten Dissertation ist es, herauszufinden, wann Patienten mit Ersatz des Knie- oder Hüftgelenks postoperativ das Autofahren wieder aufnehmen, und ob Faktoren wie operiertes Gelenk, die operierte Seite, das Geschlecht des Patienten, der Wohnort und die ärztlichen Empfehlungen einen Einfluss auf die postoperative Wiederaufnahme des Fahrens haben.
Dazu wurde eine einarmige monozentrische, experimentelle, prospektive
Beobachtungsstudie aus der Perspektive der rehabilitativen orthopädischen Therapie
konzipiert und durchgeführt.
Wesentliche Ergebnisse dieser Studie sind die Darstellung signifikanter Unterschiede bei der Wiederaufnahme des postoperativen Autofahrens hinsichtlich Geschlecht, Wohnsitz, Seite des Eingriffs bei Knie-TEP und die Identifikation von Risikogruppen
Is centrally induced alveolar bone loss in a large animal model preventable by peripheral hormone substitution?
No full textCostal Cartilage Calcification: Prevalence, Amount, and Structural Pattern in the General Population and Its Association with Age: A Cadaveric Study
No full textChronic hyponatremia in patients with proximal femoral fractures after low energy trauma: A retrospective study in a level-1 trauma center
No full textIntroduction We evaluated the prevalence and influence of chronic hyponatremia in patients with low energy trauma. We also investigated the influence of medication and diseases on hyponatremia. Material and methods This retrospective study included 314 cases of proximal femoral fracture due to low energy trauma. Patients were treated in the University Medical Center Goettingen within 3 years. Hyponatremia was defined as serum sodium <135 mmol/L at admission. Results Overall, 15.6% of patients in the low energy trauma group had hyponatremia. Among patients older than 80 years, women showed distinctly higher rates of hyponatremia (female: 16.4%; male: 5.9%). In contrast only 4.7% of patients who underwent elective hip arthroplasty showed hyponatremia. Patients on sartanes and aldosterone antagonists showed significantly higher rates of hyponatremia. Alcoholism was significantly associated with hyponatremia. Conclusions We confirmed a high prevalence of chronic hyponatremia in patients with fractures due to low energy trauma. Our data underscore chronic hyponatremia as a contributing factor to hip fractures. Women older than 80 have a higher risk of developing hyponatremia. Sartanes, aldosterone antagonists, and alcohol disease are associated with hyponatremia. Treating hyponatremia may decrease the risk of fracture after low energy trauma. Therefore, physicians of different specialties should focus on treatment of chronic hyponatremia to reduce the fracture rate associated with low energy trauma
Robot guidance for percutaneous minimally invasive placement of pedicle screws for pyogenic spondylodiscitis is associated with lower rates of wound breakdown compared to conventional fluoroscopy-guided instrumentation
Full text linkPostoperative wound healing can pose a problem
in patients undergoing instrumented surgery for pyogenic
spondylodiscitis. Robotic guidance allows the minimally
invasive placement of pedicle screws in the
thoracolumbar spine. We assessed whether using this
technique to perform minimally invasive surgery had an
impact on wound healing in patients with pyogenic
spondylodiscitis when compared to conventional open
fluoroscopy-guided surgery. We reviewed charts of 206
consecutive patients who underwent instrumentation for
pyogenic spondylodiscitis. The need for wound revision
was the primary outcome measure. Patient variables and
comorbidities as well as surgical technique (robotic versus
fluoroscopy-guided) were analyzed. We also compared
fluoroscopy times between the two groups. Multivariate
regression analysis was performed to identify predictors
of wound breakdown. A total of 206 patients underwent
surgery for spondylodiscitis. Robotic surgical assistance
was used for percutaneous instrumentation in 47.6% of
cases (n = 98). Wound healing problems requiring
revision occurred in 30 out of 206 patients (14.6%).
Univariate analysis revealed a potential association of
wound breakdown with (1) robotic technique, (2)
age > 70 years, and (3) the presence of methicillinresistant
Staphylococcus aureus. After multivariate correction
however, only robotic technique retained significance
with an odds ratio of 0.39 (CI 95% 0.16–0.94;
p = 0.035). Wound revision was required in eight out of
98 patients (8.1%) in the robot group and 22/108 (20%) in
the conventional surgery group. Fluoroscopy times were
significantly lower in the robot group with a mean of
123 ± 86 s in comparison with a mean of 157 ± 99 s in
the conventional group (p = 0.014). While initially designed
to improve the accuracy of pedicle screw placement,
robot-assisted minimally invasive technique had a
tangible effect on both radiation exposure and the rate of
wound breakdown i n p a t i e n t s wi t h pyogenic
spondylodiscitis in our large single-center study
Rapid direct detection of pathogens for diagnosis of joint infections by MALDI-TOF MS after liquid enrichment in the BacT/Alert blood culture system.
No full textPathogen identification is a critical step during diagnosis of infectious diseases. Matrix-Assisted Laser Desorption/Ionization Time-Of-Flight mass spectrometry (MALDI-TOF-MS) has become the gold standard for identification of microorganisms cultured on solid media in microbiology laboratories. Direct identification of microbes from liquid specimen, circumventing the need for the additional overnight cultivation step, has been successfully established for blood culture, urine and liquor. Here, we evaluate the ability of MALDI-TOF MS for direct identification of pathogens in synovial fluid after liquid enrichment in BacT/Alert blood culture bottles. Influence of synovial specimen quality on direct species identification with the MALDI BioTyper/Sepsityper was tested with samples inoculated from pretested native synovia with concomitant inoculation of blood or pus, or highly viscous fluid. Here, we achieved >90% concordance with culture on solid medium, and only mixed-species samples posed significant problems. Performance in routine diagnostics was tested prospectively on bottles inoculated by treating physicians on ward. There, we achieved >70% concordance with culture on solid media. The major contributors to test failure were the absence of a measurable mass signal and mixed-specimen samples. The Sepsityper workflow worked well on samples derived from BacT/Alert blood culture bottles inoculated with synovial fluid, giving concordant results to identification from solid media. Host remnant material in the inoculum, such as blood or pus, had no detrimental effect on identification score values of the BioTyper system after processing with the Sepsityper workflow, and neither had the initial viscosity of the synovial sample
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