Background: Comparison of intra-articular corticoid injections and oral corticosteroids in the treatment of adhesive capsulitis of the shoulder

Methods: In a prospective randomized evaluation two different treatment regimen were compared. 40 patients with idiopathic adhesive capsulitis of the shoulder were treated either with an oral (20) corticoid treatment regimen for 4 weeks or intra-articular (20) injection series of corticosteroids (3 injections- 4, 8, 12 weeks).Patient groups were comparable in sex, age and affected side. Follow-up periods were after 4,8,12 weeks, 6 and 12 months. For the clinical evaluation the Constant and Murley Score, the Simple Shoulder Test and visual analog scales for pain, function and satisfaction were used.

Results: In the patients group treated with oral glucocorticoids significant improvements were found for the Constant and Murley Score (p< .0001), the Simple Shoulder Test (p=.035) and range of motion for flexion (p< .0001), abduction (p< .0001), external (p=.001) and internal rotation (p=.028) already at 4 weeks follow-up. The visual analog scales for pain, function and patient satisfaction also improved significantly after 4 weeks of treatment (p< .0001).)

The patient group treated with an intra-articular glucocorticoid injection series also showed significant improvements for the Constant and Murley Score (p< .0001), the Simple Shoulder Test (p< .0001) and the visual analog scales for pain, function and patient satisfaction (p< .0001) after 4 weeks and also at any other follow up. Significant improvements were also seen in abduction (p< .0001), flexion (p< .0001) and external rotation (p=.001) and internal rotation (p=.035) after 4 weeks of treatment. These results were confirmed at any other follow up.

Comparison of the two treatment regimen showed superior short term results for the intra-articular treatment regimen in range of motion, Constant Score and Simple Shoulder Test and patient satisfaction (p< .05). No significant differences were found in the visual analog scales for pain and function (p> .05).

Conclusion: The use of cortisone in the treatment of idiopathic adhesive capsulitis of the shoulder leads to fast pain relief and improves range of motion. Intra-articular injections of glucocorticoids showed superior short term results in objective shoulder scores, range of motion and patient satisfaction compared with a short course of oral corticosteroids.

Implantation of antibiotic-loaded beads is accepted as an efficient option for local antibiotic therapy in orthopedic-related infections. However, recent reports have emphasized the bacteria growth persistence on antibiotic-impregnated bone cement. Hence, the aim of this study was to elaborate if bacterial adherence and growth could be determined on explanted gentamicin- and gentamicin-vancomycin-loaded beads after infection eradication. 18 chains of antibiotic-loaded beads (11 gentamicin-, 7 gentamicin-vancomycin-loaded) were examined. Indications for primary beads implantation included postoperative infections after total hip or knee arthroplasty, rotator cuff reconstruction, chronic foot osteomyelitis, anterior cruciate ligament reconstruction and dorsal spondylodesis. Among the isolated organisms, Staphylococcus epidermidis, Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) were the most frequent ones. In 4 cases (3 × S. epidermidis, 1 × MRSA) bacteria growth persistence could be determined on the beads. S. epidermidis-strains persisted only on gentamicin-loaded beads, MRSA could grow on gentamicin-vancomycin-impregnated cement. In one case, the emergence of a gentamicin-resistant S. epidermidis-strain could be observed despite preoperative susceptibility. Bacteria growth persistence on bone cement is a hazardous problem in the orthopedic surgery and should therefore be born in mind. Adherence to cement can lead to emergence of bacteria resistance despite preoperative antibiotic susceptibility and might result in clinical recurrence of infection.

Introduction: The purpose of our investigation was to determine if tibial lateral meniscus insertions (anterior and posterior horn) can precisely and reproducibly be determined on preoperative radiographs. Bony landmarks and their topographic relations to the meniscus insertions were described, measured and statistically evaluated. We concentrated on the lateral meniscus because there are many reasons to restrict the indications for meniscus replacement on the lateral compartment.

Methods: We prepared the lateral meniscus insertions in 22 tibial plateaus from 11 body donors. Insertion site outline was performed on anterior and posterior horns with radio opaque 1.6 mm steal balls. Anteroposterior and lateral radiographs were performed. On these radiographs, different landmarks of the tibial head were defined and their distances measured (width, depth, distance from lateral tibia border to meniscus midpoint, distance from lateral tibia border to lateral tibial spine). These measures were statistically evaluated and percent values for meniscus insertion midpoint position were determined.

Results: On anteroposterior radiographs, from lateral to medial, the anterior meniscus midpoint was located on 45.1 % ± 1.3 % of the tibial width, the posterior meniscus midpoint on 49.8 % ± 1.9 % of the tibial width. On lateral radiographs, from anterior to posterior, the anterior meniscus midpoint was located on 41.9 % ± 3.2 % of the tibial depth, the posterior meniscus midpoint on 72.1 % ± 2.3 % of the tibial depth. With linear regression analysis, we could show that the lateral meniscus insertions have constant relations, as well to the dimensions of the tibia plateau as to the lateral tibial spine.

Conclusions: We think that it is possible to determine precisely and reproducibly on preoperative anteroposterior and lateral radiographs the insertions of the lateral meniscus. Our results and the method to determine preoperatively meniscus insertions might bring decisive advantages considering the optimal fixation of meniscus transplants, enhancing biomechanical conditions and possibly improving postoperative results.

Purpose: Medial Opening Wedge High Tibial Osteotomy (MOWHTO) is a joint preserving procedure of the knee. Currently we understand the anatomical changes occurring in the varus/valgus plane, but our understanding of other anatomical changes are limited. The objective of this study is to determine immediate anatomical changes occurring about the knee following MOWHTO. Our hypothesis is that anatomical changes occur in all planes of motion. More specifically, we hypothesize that posterior tibial slope is increased and patellar height is decreased immediately following the osteotomy.

Methods: This study was prospective in design. Patients with knee OA were evaluated according to strict inclusion and exclusion criteria. Pre-operative clinical assessment, radiographic evaluation, and patient assessment scores were performed. Intraoperatively, patients had radiostereometric analysis (RSA) beads placed in a predetermined pattern. Intraoperative radiographs were taken. The MOWHTO was then performed. A second radiograph was then taken following the osteotomy. The radiographs were analysed using dedicated RSA computer software to determine anatomical changes.

Results: Eleven patients were included in this study. Average age was 50 years. Mean error and condition number were 0.70 and 74 respectively, indicating highly accurate and reliable results. Analysis of the proximal tibia showed an average valgus correction angle of 8.69 degrees. The average osteotomy size was 12.5mm (9–17.5). Posterior tibial slope increased on average by 2.07 degrees (+5.91–−1.56). Analysis of the patella revealed anatomical changes occurred in all planes. However, the only consistent alteration was a decrease in patellar height by an average of 8.16mm (1.79–13.17). Additionally, there was a consistent increase in patellar tendon length by 5.30mm (2.38–7.34).

Conclusions: Using RSA in MOWHTO for the first time, we were able to demonstrate a useful and accurate measurement tool for this procedure. We found there were many immediate anatomical changes following MOWHTO that are inconsistent and not well understood. There were, however, several anatomical changes that remained consistent among all subjects. Patellar height decreased, patellar tendon length increased, and posterior tibial slope demonstrated an average increase.

Aims: The purpose of this study was to evaluate primary stability and the time of bony þxation of two different designed cementless titanium hip stems. Therefore we designed a prospective clinical study with high precision RSA and close follow up periods (3, 6,12, 24, 52, 104 weeks). Methods: One stem was a Ç straight stem È (BICONTACT, Aesculap AG, Germany) with a rough pure Titanium surface in the upper part for proximal þxation. The second stem (Image, Smith& Nephew, Germany) was anatomically shaped with additional HA coating. 34 IMAGE stems and 20 BICONTACT stems with RSA markers were implanted. Mean age in both groups was 64 years. In September 2002, 28 patients (14 X BICONTACT and 16 X IMAGE) were followed for more than 1 year and 12 patients (6 X BICONTACT and 6 X IMAGE) for more than 2 years. Results: Subsidence was predominantly observed between the postoperative control and the 6 weeks follow up. (IMAGE 0.83mm, BICONTACT 0,60mm) and decreased up to 12 weeks (IMAGE 0.05mm, BICONTACT 0,29mm). After 12 weeks both stems were stabilized (12–24 weeks: IMAGE 0.05mm, BICONTACT 0.06mm; 6 months -1 year: IMAGE 0.05mm, BICONTACT 0.04mm. Between 1 and 2 years subsidence for the IMAGE stem was 0.05mm compared to 0.16mm in the Bicontact group. Overall subsidence of the IMAGE stem during the þrst year was 0.96mm compared to 0.97mm for the BICONTACT stem. Conclusions: Titanium cementless hip stems with a rough proximal titanium surface or HA coating showed a sufþcient primary and mid-term stability. Bony þxation is achieved between 6 and 12 weeks. No statistical differences were found between both stems.

Aims: The purpose was to evaluate the biomechanical properties of Hamstring graft fixation methods with ability for circumferential graft ingrowth in a standardized experiment with high precision Radiostereometric Analysis (RSA). Methods: We used 30 porcine specimens for the study. A fourstranded graft was sutured with a baseball stitch. Ten trials were performed in each group. The sutured end of the graft was fixed with a Washer-Lock (WL) or two resorbable Cross-Pins (CP). In the Suture-Disc (SD) group 8 polyester sutures (Ethibond 5USP) were knotted over a titanium button. The tibial bone and the tendon-graft were marked with tantalum beads. The grafts were loaded axially under RSA control increasing the force in steps of 50N to load of failure. Micromotion between tendon graft and tibial bone was measured with RSA. Results: Load at failure was significantly higher for the WL and CP fixation (722±173N; 647±129N) compared to SD fixation (445±37N). Stiffness of fixation was significantly higher for WL and CP fixation 492N/mm; 416N/mm) compared to SD fixation 111N/mm). Graft displacement started at low loads for SD fixation (47N) compared to WL and CP (344N; 250N). Graft motion at 200N load was significantly higher in the SD group (1.85mm) than for the WL (0.33mm) and CP (0.3mm) fixation. Bungee cord effect at 200N for the SD was measured 1.32mm, for the CP 0.50mm and for the WL 0.22mm in average. Conclusions: Direct fixation of a quadrupled tendon graft with WL or CP is preferable to SD fixation. Low linear stiffness of SD fixation with linkage suture material allows for a high amount of elastic deformation.