Introduction

Austin Moore cervicocephalic prostheses have been a therapeutical option for femoral neck fractures in patients with a reduced general condition for many years. Since treatments other than total hip arthroplasties have also been included in National arthroplasty registers during the last decade, adequate reference data for comparative analyses have recently become available.

Purpose: To present 8 year results of a prospective clinical study of 246 patients with the Innex total knee system performed between 2000 and 2002.

Methods: 88 men and 158 women aged between 39.3 to 92.8 (mean, 71.2) years who underwent primary TKAs using the Innex prosthesis were followed up for up to 8 years. TKA was performed using ultracongruent mobile or fixed bearings, both groups with or without patella replacement. All TKAs were cemented. Patients were assessed using the Knee Society Clinical Rating System.

Results: The mean ROM improved from preoperative 105.54° up to 110.05° at the last FUP. The mean total Knee Society Score before surgery was 112.04 (range, 52–160) and improved post op up to 179.49 (55–200). There were 2 postraumatic patella fractures (14 and 49 months after surgery), 2 patients without patella replacement showed peripatellar pain syndrome and femoropatellar overload. One became fine after conservative treatment, the other patient hat patella replacement 55 months after initial surgery. 3 patients had early mobilisation under anaesthesia for postoperative stiffness. There were no deep vein thromboses or pulmonary embolism. Revisions were done in 6 patients. 4 revisions were done due to aseptic loosening and 2 due to deep infections. After 8 years we saw a survival rate of 96.09% with revision or indication for revision for any reason as the endpoint. With aseptic loosening as the endpoint survival rate was at 96.52%. Post operative results in TKA with fixed bearings and patella replacement (ROM=126.67°,KSS=190.5) where superior compared to fixed without patella replacement (ROM=118°,KSS=186). In TKA with mobile bearings again those who had patellar replacement showed somewhat clinically better results (ROM=114.44°, KSS=185.89).

Conclusion: The Innex TKA showed generally good longterm results. Selection to fixed or mobile was in our series depending on praeoperative stability and fixed preferable used tor rheumatoid patients. Patella replacement gave better results in both groups.

Introduction: Clinical follow-up studies are sample based, in contrast to arthroplasty register data, which refer to the entire population treated. Aim of this study is to assess the differences in revision rate to quantify bias-factors in published literature.

Materials and Methods: A structured literature review of Medline-listed peer reviewed journals concerning the STAR Total Ankle Replacement have been conducted.

The published results from clinical follow up studies have been compared to Arthroplasty register Results: Results: 24% of all papers were published by the inventor of the implant.

These publications show a 3,4 times lower revision rate compared to independent studies and a 4,6 times lower revision rate compared to Register based publications.

The cumulative revision rate per 100 observed component years of register based publications is 1,36 times higher compared to independent clinical studies. The difference is statistically not significant.

Pooling the published data from all follow up studies the impact of the studies published by the inventor leads to a statistically significant bias.

Discussion and Conclusion: Publications by the inventor of the implant are overrepresented in peer reviewed scientific journals. This bias has a statistically significant impact on the final result of a Metaanalyses.

Arthroplasty Register data are able to detect bias factors and lead to a better quality of assessments concerning the outcome of arthroplasty.

Introduction: 1986 we started with ultrasound screening for congenital dislocation of the hip (CDH) in all newborn children from our hospital. In 1995 an regime was investigated we developed out of our expieriences of the previous years and started a prospective study.

Material and methods: In the period 1995 to 2006 we did ultrasound screening in newborn babies within the first week of life. There were 14744 ultrasound checkups in 7372 children. Following the classification of Graf we had 7213 children with stage Ia,Ib or IIa. In 159 children (2,15%) we saw a ultrasound measurement stage IIc or worse (D,IIIa/b; IV a/b) which was an indication for treatment with the Pavlik bandage. Over all we treated 203 dysplastic hips with our regime. By dedecting a congenital dislocated hip we applyed the Pavlik harness immediately after diagnosis in 110 degrees of flection an 45 degrees of abduction. The fist controll reviewing the compliance of the parents and the setting of the bandage was 10 to 14 days after starting treatment. Every 10 to 14 days we did bandage checks combined with ultrasound controlls. We stopped treatment with the pavlik harness when the ultrasound showed a mature, well developed picture of both hips compared to Graf stage Ia/b.

Results: We treated 159 newborn with 203 dislocated hips. There were 131 (82.4%) female an 28 (17.6)% male patients. 100 right (49.5%) and in 103 left (50.5%) hips. The distribution following Graf classification were 150 for typ IIc (73.9%), 18 for type D (8.9%), 31 for type IIIa/b (15.3%) and 4 type IVa/b (1.9%). Summerizing there were 150 hips, stage IIc (73,9%), to be at risk to develope an luxation, but 53 (26,1%) hips were already luxated at the moment of birth. The average treatment time over all was 53 days (7,6 (3–26) weeks). Subdividing the groups the treatment period for stage IIc was in mean 7.6 weeks, for stage D 7.1 weeks, for stage III a/b 9.5 weeks and for stage IV a/b 9 week. We had a lost to follow up in 4 (1,81%) patients (3 times compliance problems with the parents at stage II a in both sides). Once we had to treat with a so called Fettweiss-cast after one week of therapy because the baby was to small for the bandage but in the other cases there was no need für additional methodes of treatment. At no time we ever had a degradation of the disease. Furthermore we had no necrosis of the femoral head in our study population.

Conclusion: The treatment with the Pavlik bandage of the CDH in every stage in newborn was possible and showed good result in 203 hips. To establish a standardised therapy you have to do an area-wide ultrasound screening as well as an consistently follow up of your therapy.

Aim of the study: Due to the fact, that there is no publication in Medline available concerning the influence of external compression of the wound area after total hip arthroplasty we started a prospective, randomised study to evaluate this effect.

Materials and Methods: In a prospective randomised study including primary total hip replacements we compared 2 different prefabricated compression bandages, maintaining different levels of pressure on the wound area(Group A, B), a group with circular semi elastic bandages (group C) and a group without any bandage (group D). The sample calculated for each group was 130 Patients (level of significance 0.05, power 90%). Parameters concerning postoperative blood loss (haematocrit, need of blood units, blood in drainage) and wound heeling (bleeding of wound area, secretion, haematoma, additional need of antibiotics) were measured. For statistical evaluations Chi²-Test and T-Test were used.

Results: The group using semi elastic, circular bandages (C ) had to be stopped after 13 patients due to non-compliance of more than 50% of the patients because of discomfort and skin lesions. Without compression bandage the frequency of re-operations due to early septic complications was statistically significant higher than in groups using external compression. In the groups B and D the rates of wound secretion have been significantly higher than in group A using high pressure bandages. Duration and quantity of secretion, need of additional antibiotics as well as subcutaneous haematoma were increasing by decreasing external compression. The amounts of blood in Redon drainage were significantly reduced by external compression. In regard to the need of blood units no statistical differences could be detected.

Conclusion: Sufficient compression bandages are able to significantly reduce the frequency of re-operations due to septic complications and support wound healing after total hip arthroplasty. A remarkable number of insufficient products are sold on the market.