Purpose

The aim of the current study was to evaluate the clinical and radiographic results of primary total hip arthroplasty (THA) performed with the Alloclassic Variall system (a modified version of the Alloclassic Zweymüller system) and to compare them with those in the literature for the original system.

Purpose

It is well known that meniscus extrusion is associated with structural progression of knee OA. However, it is unknown whether medial meniscus extrusion promotes cartilage loss in specific femorotibial subregions, or whether it is associated with a increase in cartilage thickness loss throughout the entire femorotibial compartment. We applied quantitative MRI-based measurements of subregional cartilage thickness (change) and meniscus position, to address the above question in knees with and without radiographic joint space narrowing (JSN).

Introduction

Insufficient arthroscopic cuff tear reconstruction leading to massive osteoarthritis and irreparable rotator cuff tears might be salvaged by implantation of an inverted total shoulder prosthesis Delta in the elderly. However, despite the generally high success rate and satisfying clinical results of inverted total shoulder arthroplasty, this treatment option has potential complications. Therefore, the objective of this study was a prospective evaluation of the clinical and radiological outcome after a minimum of 2 years follow-up of patients undergoing inverted shoulder replacement with or without prior rotator cuff repair.

We want to show our results of infected THR in the years from 2006 to 2008. We use an algorithm similar to Mc Phersons’s:

In early cases with not affected surrounding tissue we prefer the one stage procedure:

When there are no radiolucent lines in X-ray und the Scan does not show any tracer enhancement we perform synovectomy and replacement of the poly liner.

If soft tissue does not have an inflammation and only the bony bed is affected, we perform a one stage procedure with use of antibiotic augmented morcelliced bone graft. We use freeze-dried cancellous bone granula from a commercial tissue bank which are bathed for 30 minutes in a combination of Tobramycin and Vancomycin which is placed into the interface of implant and bony bed.

In chronic cases with affected soft tissue we treat the patient with a two stage exchange by use of a so called intermediate spacer and the definite revision after 3 months. The intermediate spacer contains a stainless steel rod coated by Gentamicin bone cement (Tecres company) in the shape of a prosthesis. This provides the release of antibiotics into the surrounding tissue.

We treated 36 patients:

18 patients were treated by use of a single procedure and 15 could be healed in 5 cases we could heal the patients by synovectomy and change of the poly liner.

Using Mc Pherson’s algorithm we could be successful with a single stage procedure in 15 from 18 cases. The remnant three patient could be healed by a two stage procedure. Only 4 patient could not be healed by a two stage procedure which was performed for 20 times. As we were successful too in three cases by treating chronic periprosthetic hip infection with a single procedure by using antibiotic augmented bone granula, investigation are requested to prove if this procedure could be postulated for all chronic periprothetic infections too.

Objectives: The aim of this study was a clinical and radiological evaluation of 68 shoulders operated with the Delta reverse-ball-and-socket total shoulder prosthesis by the senior author with a mean follow-up of 42 months.

Methods: This is a retrospective study in one consecutive series of 68 shoulders, operated by the senior author, which were clinically assessed using the Constant score for pain, Constant Shoulder Score, Oxford Shoulder Score, UCLA Shoulder rating scale, DASH Score, Rowe Score for Instability and Oxford Instability Score. Radiological evaluation was graded by the classification according to Nerot et al. and complications were analysed according to Goslings and Gouma. Patients were evaluated before surgery and at a mean clinical follow-up of 42 months.

Results: There was a significant improvement in all clinical and stability scores. On the average, the Constant score for pain increased from 4.62 to 11.08 points (p< 0.05); the Constant Shoulder Score from 32.65 to 60.31 (p> 0.05); the Oxford Shoulder Score increased from 32.65 to 60.31 (p< 0.05) and the UCLA Shoulder rating scale increased from 15.08 to 27.42 (p< 0.05). The evaluation of stability showed an increase from 49.42 to 80.19 points in the Rowe Score for Instability and from 22.04 to 37.62 in the Oxford Instability score (p< 0.05). According to the Nerot classification, 65 percent of patients were graded as “0”, 20 percent as “1”, 3 percent as “2”, 6 percent as “3” and 6 percent as “4”. Eight complications occurred in terms of a nerve lesion which was graded according to Goslings and Gouma as “1” once, loosening of the humeral stem which was graded as “2” three times and loosening or fracture of the glenoid component which was graded as “2” in five times. At mean follow-up of 42 months, one patient of this series had died of decrepitude which was graded as “4” and one patient was lost of follow-up.

Conclusions: We summarize, that there were significant advantages identified in terms of the Constant score for pain, all clinical scores and the instability scores. Radiological analyses showed 85 percent of patients without or with a small notch only. On the other hand, the rate of complications should be taken into account. We conclude that shoulder arthroplasty with the Delta prosthesis shows significant benefits in terms of less shoulder pain, a higher stability and a gain of range of motion but on the other hand, we emphasize that this treatment remains a salvage procedure in the elderly only.

Introduction: Bone marrow edema (BME) is a common cause of pain in the knee with restricted treatment options. The authors performed a double-blind, randomized, active-controlled study in order to explore the clinical effects of the prostacyclin analog iloprost (Schering AG, Germany)

Materials and Methods: Forty-one patients with painful bone marrow edema associated with osteonecrosis, osteoarthritis, bone bruise or axis deformities were evaluated. Patients were randomized either to iloprost (n=21, 15 male, 6 female; mean age 53 years) or to Tramadol (n=20, 12 male, 8 female; mean age 51 years). An individual dose adjustment was allowed within the range of 100–300 μg of iloprost, and 100–300 mg of Tramadol. The treatment duration was 4 weeks. The treatment period was followed by an 8-week treatment-free follow-up. During and after treatment, full weight bearing was allowed as tolerated. Efficacy of treatment was assessed by 10 cm visual analog scales for pain at rest and on exertion, Larson’s knee score, and magnetic resonance imaging.

Results: The results are presented below.

These clinical effects were sustained over the entire follow-up. At the end of study, 53% of iloprost patients showed healing of at least one BME affected bone as compared to only 19% of Tramadol patients. Regression of subchondral lesions occurred in 4 iloprost patients. No serious adverse events occurred; however, three Tramadol patients discontinued the treatment prematurely due to adverse events.

Discussion: The authors conclude that the oral application of the vasoactive drug iloprost results in substantial treatment effects on pain relief and joint function improvement. These effects were similar for iloprost and Tramadol. Iloprost treatment was associated more often with BME regression than Tramadol. Oral iloprost may offer a new and safe treatment option for patients with painful BME.