Few studies dealing with chondrosarcoma of the pelvis are currently
available. Different data about the overall survival and prognostic
factors have been published but without a detailed analysis of surgery-related complications.
We aimed to analyse the outcome of a series of pelvic chondrosarcomas
treated at a single institution, with particular attention to the
prognostic factors. Based on a competing risk model, our objective
was to identify risk factors for the development of complications. In a retrospective single-centre study, 58 chondrosarcomas (26
patients alive, 32 patients dead) of the pelvis were reviewed. The
mean follow-up was 13 years (one week to 23.1 years).Aims
Patients and Methods
Instability of the hip is the most common mode of failure after
reconstruction with a proximal femoral arthroplasty (PFA) using
an endoprosthesis after excision of a tumour. Small studies report
improved stability with capsular repair of the hip and other techniques,
but these have not been investigated in a large series of patients.
The aim of this study was to evaluate variables associated with
the patient and the operation that affect post-operative stability.
We hypothesised an association between capsular repair and stability. In a retrospective cohort study, we identified 527 adult patients
who were treated with a PFA for tumours. Our data included demographics,
the pathological diagnosis, the amount of resection of the abductor
muscles, the techniques of reconstruction and the characteristics
of the implant. We used regression analysis to compare patients
with and without post-operative instability.Aims
Patients and Methods
The diagnosis of periprosthetic joint infection (PJI) remains
demanding due to limitations of all the available diagnostic tests.
The synovial fluid marker, α-defensin, is a promising adjunct for
the assessment of potential PJI. The purpose of this study was to
investigate the qualitative assessment of α-defensin, using Synovasure
to detect or exclude periprosthetic infection in total joint arthroplasty. We studied 50 patients (28 women, 22 men, mean age 65 years;
20 to 89) with a clinical indication for revision arthroplasty who
met the inclusion criteria of this prospective diagnostic study.
The presence of α-defensin was determined using the qualitative
Synovasure test and compared with standard diagnostic methods for
PJI. Based on modified Musculoskeletal Infection Society (MSIS)
criteria, 13 cases were categorised as septic and 36 as aseptic revisions.
One test was inconclusive.Aims
Patients and Methods
Aim of the study was to find out whether patients with positive minor criteria but without meeting the MSIS definition have a difference in the outcome after revision-surgery compared to patients without any MSIS-criteria? And does the reason for revision-surgery (eg. loosening) have an additional influence on the outcome parameters in patients with positive minor criteria? A retrospective matched-pair analysis with 98 patients who had undergone revision-surgery after TJA was performed. Forty-nine patients who showed 1 to 3 positive minor criteria (PMC) whereas 49 patients without any positive minor criteria (aseptic complications control group) were compared regarding re-revision-rate and revision-free survival. Patients were matched regarding sex, age, joint and comorbidities using the classification system by McPherson et al. Reasons for revisions were categorized in loosening, body wear, periprosthetic fracture/mechanical failure and soft-tissue complication. Endpoints were defined as re-revision for any cases.Aim
Method
Quantitative assessment of alpha-Defensin offers a promising approach for diagnosing a periprosthetic joint infection (PJI) with sensitivities and specificities ranging from 97% to 100% and 95% to 100%, respectively. However, to the best of our knowledge and after due inquiry little information exists concerning qualitative measurements of alpha-Defensin. The aim of this study was to assess the diagnostic accuracy of the alpha-Defensin test, a lateral flow test for the qualitative detection of alpha-Defensin. In this study, 50 patient with indicated revision surgery met the inclusion criteria due to septic or aseptic loosening. In addition to clinical standard diagnostics of PJI, the alpha-Defensin testAim
Method
Until now, there has been no consensus as to whether stemmed
acetabular components are appropriate for use in patients undergoing
revision total hip arthroplasty (THA) who have major acetabular
defects or pelvic discontinuity. We wished to address this deficiency
in the literature. We carried out a retrospective study of 35 patients (six men
and 29 women) with a mean age of 68 years (37 to 87), with major
acetabular defects who underwent revision THA between 2000 and 2012.Aim
Patients and Methods
The total hip arthroplasty (THA) is an effective operation for the restoration of the hip function. The number of operations is steadily climbing and is going to reach new heights in the future. The most devastating complication is the deep infection of the joint and has to be treated with a total revision of the prostheses. The risk factors for an infection play a very important role in the preoperative assessment of the patient and for the antibiotic treatment. There are many different opinions on which risk factors are associated with the development of a deep infection in the literature. Our goal was to analyze and find the risk factors, which matter most in the clinical treatment of patients. We searched the database “PubMed” and “Embase” with the keywords: „ Risk factors associated with a deep infection included the BMI (Body mass index), male gender, prolonged duration of surgery, diabetes mellitus type 2, the ASA (American society of anesthesiologists) score, the Charlson score and the NNIS (National Nosocomial Infections Surveillance System) risk index score. Female gender, age and the diagnosis of rheumatoid arthritis were not associated with deep infections. Patients with risk factors should be assessed preoperatively and receive an appropriate prophylactic antibiotic treatment, to reduce the risk of a deep infection. With the reduction of their weight and adjustment of the diabetes, patients can reduce the risk for infection by their own. Total hip replacement is still a safe and effective operation and thus should not be withheld from patients.
In a prospective randomized study of two groups of 65 patients each, we compared the acetabular component position when usingthe imageless navigation system compared to the freehand conventional technique for cementless total hip arthroplasty. The position of the component was determined postoperatively on computed tomographic scans of the pelvis. There was no significant difference for postoperative mean inclination (p=0.29), but a significant difference for mean postoperativ acetabular component anteversion (p=0.007), for mean deviation of the postoperative anteversion from the target position of 15°(p=0.02) and for the outliers regarding inclination (p=0.02) and anteversion (p<0.05) between the computer-assisted and the freehand-placement group.Material and Methods
Results
This scientific work is a non-interventional, experimental and prospective comparative study of two very high-viscosity PMMA bone cements: Fast-setting PMMA bone cements are used in the endoprothetics of the patella and knee (in Australia) and are also used to cement an artificial acetabulum (in the UK). Are there any differences regarding the characteristics of the two fast-setting PMMA bone cements? All cements were mixed as specified by the manufacturer and analysed on the following parameters: handling properties (mixing, waiting, working and hardening phase), powder/liquid-ratio, mechanical properties (ISO 5833:2002 and DIN 53435), fatigue strength (ISO 16402) and elution profile. All tests were done in an acclimatised laboratory with temperatures set at 23.5°C ± 0.5°C and a humidity of >40%. Of two batch numbers, 11 units of each bone cement were tested.BACKGROUND
MATERIALS AND METHODS
In a recent study we evaluated the clinical and radiographic long-term results as well as the serum metal concentrations of 105 cementless primary total hip prosthesis, performed between November 1992 and May 1994 with a 28-mm high-carbide-concentration metal-on-metal articulating surfaces. Forty-one patients who had had a total of forty-four arthroplasties were available for follow-up evaluation at a minimum of seventeen years postoperatively. The median serum cobalt concentration of the patients with their hip replacement as the only source of cobalt was 0.7 µg/L (range 0.4–5.1µg/L), showing no significant difference to the previous study after a minimum of 10 years follow-up. We were investigating the systemic dissemination, which in turn, did not show more severe effects, such as carcinogenicity or renal failure. There are many complex issues associated with the analysis of metal ions, including collecting technique, analysis and reporting of the results. At the AAOS in March 2013, the Hip Society mentioned, that systemic ion levels are just one factor in the evaluation and should not be relied upon solely to determine the need for revision surgery. Furthermore, the correlation between cobalt or chromium serum, urin or synovial fluid levels and adverse local tissue reactions is incompletely understood. In our present study we evaluated the serum, urin as well as the joint aspirate metal concentrations, of cementless total hip arthroplasties with a high-carbon, metal-on-metal bearing (Metasul®) at a mean of eighteen-years follow-up. We performed a correlation analysis to evaluate the relationship between these values and to determine whether elevated serum metal concentrations are associated with elevated and local metal concentrations and with early failure of metal-on-metal articulations.Introduction
Patients and Methods
Online video is increasingly becoming a key source for people to satisfy their information needs. YouTube is one of the post popular websites used for information exchange, with more than one billion unique visitors every month. In an attempt to participate in personal health decisions related to hip arthritis, patients may access YouTube for further information. As YouTube is a non peer-reviewed platform and little is known about the quality of available videos. We therefore asked the following research questions: (1) What is the information quality of YouTube videos related to the diagnosis of hip arthritis and (2) what information for the treatment of hip arthritis can be found on YouTube?Background
Questions/purposes
Computer Tomography (CT) imaging has been limited to beam hardening artefacts until now. Literature has failed to describe sensitivity and specifity for loosening of endoprothesis in CTs, as metal artefacts have always influenced the diagnostic value of CTs. In recent years a new technology has been developed, the Dual Energy CT. Dual Energy CT scanners simultaneously scan with two tubes at different energy levels, most commonly 100kVp and 140kVp. Furthermore pictures gained from Dual Energy CTs are post-processed with monoenergetic reconstruction, which increases picture quality while further reducing metal artefacts. This promising technology has increased the diagnostic value preventing more radiation for the patients, for example in detection of kidney stones or to map lung perfusion. In the musculoskeletal imaging it has not been established yet and further clinical investigations are necessary. Thus the aim of this study is to describe sensitivity and sensibility for endoprothesis loosening of this novel technology. 53 prospective patients (31 total hip- and 22 total knee-arthoplasties) who were planned for revision surgery underwent preoperative Dual Energy CT examination. All scans were performed with a second-generation, dual-energy multi-detector CT scanner. And all pictures were post-processed with monoenergetic reconstruction. Radiologists were blinded for patient´s history. Senior consultants, who are specialized in arthroplasty of the hip and the knee, performed surgery. Intraoperative information was used as gold standard.Introduction
Material and Methods
Septic arthritis is a therapeutic emergency with a high mortality rate (about 11%)(1). Inadequate treatment can cause permanent joint damage. Management of the septic arthritis includes prompt antibiotic treatment as well as joint-decompression and removal of purulent material(2). It is still discussed controversially and there is little evidence which surgical concept is preferable: arthroscopy with lavage and debridement or open arthrotomy with synovectomy(3,4). The aim of the study was to compare efficacy of arthroscopy and arthrotomy in patients with septic gonarthritis. We evaluated 70 consecutive patients who underwent arthroscopy or arthrotomy at our clinic, because of a bacterial monarthritis of the knee between 2002 and 2010. Our primary outcome was the early recurrence of infection (> 3 months after surgery), which made a second surgery necessary. We compared patients who suffered reinfection and those who did not, in regard to the surgery type as well as potential confounders like comorbidity (measured by Charlson comorbidity index), age, body mass index (BMI), Gächter's -, Kellgren and Lawrence - and Outerbridge classification, duration of symptoms and inflammatory parameters. Furthermore we evaluated differences of the confounders between the surgery groups. From the 70 patients 41 were treated arthroscopic and 29 with arthrotomy. In total eight patients (11.4%) had to undergo a second surgery because of early reinfection. The rate was significantly higher in patients treated with arthrotomy (n=6; 20.7%) compared to those treated with arthroscopy (n=2; 4.9%) (p=0.041). Whereas we found no significant influence of potential confounders between the reinfection group and the group where primary eradication was achieved. Patients who underwent arthrotomy were significantly older, had more comorbidities (both p<0.001) and higher grades of osteoarthritis according to Kellgren and Lawrence classification (p=0.023). In order to adjust the study population towards confounders we performed a subgroup analysis on patients of the second and third age percentile. When we repeated our analysis we still found a significant higher reinfection rate in the arthrotomy group (p=0.036). At the same time there were no differences in prevalence of confounders, neither between the two surgery groups, nor between the reinfection and the primary eradication group. Patients with bacterial monarthritis of the knee who were treated with arthroscopy had a significantly lower reinfection rate than those treated with arthrotomy. As arthroscopy is the less invasive and more sufficient method it should be considered the routine treatment according to our data.
Previous classification systems of failure of
limb salvage focused primarily on endoprosthetic failures and lacked sufficient
depth for the effective study of the causes of failure. In order
to address these inadequacies, the International Society of Limb
Salvage (ISOLS) formed a committee to recommend revisions of the
previous systems. The purpose of this study was to report on their
recommendations. The modifications were prepared using an earlier,
evidence-based model with subclassification based on the existing
medical literature. Subclassification for all five primary types
of failure of limb salvage following endoprosthetic reconstruction
were formulated and a complementary system was derived for the failure
of biological reconstruction. An additional classification of failure
in paediatric patients was also described. Limb salvage surgery presents a complex array of potential mechanisms
of failure, and a complete and precise classification of types of
failure is required. Earlier classification systems lacked specificity,
and the evidence-based system outlined here is designed to correct
these weaknesses and to provide a means of reporting failures of
limb salvage in order to allow the interpretation of outcome following
reconstructive surgery. Cite this article:
Resection of a primary sarcoma of the diaphysis
of a long bone creates a large defect. The biological options for reconstruction
include the use of a vascularised and non-vascularised fibular autograft. The purpose of the present study was to compare these methods
of reconstruction. Between 1985 and 2007, 53 patients (26 male and 27 female) underwent
biological reconstruction of a diaphyseal defect after resection
of a primary sarcoma. Their mean age was 20.7 years (3.6 to 62.4).
Of these, 26 (49 %) had a vascularised and 27 (51 %) a non-vascularised
fibular autograft. Either method could have been used for any patient in
the study. The mean follow-up was 52 months (12 to 259). Oncological,
surgical and functional outcome were evaluated. Kaplan–Meier analysis
was performed for graft survival with major complication as the
end point. At final follow-up, eight patients had died of disease. Primary
union was achieved in 40 patients (75%); 22 (42%) with a vascularised
fibular autograft and 18 (34%) a non-vascularised (p = 0.167). A
total of 32 patients (60%) required revision surgery. Kaplan–Meier
analysis revealed a mean survival without complication of 36 months
(0.06 to 107.3, Both groups seem to be reliable biological methods of reconstructing
a diaphyseal bone defect. Vascularised autografts require more revisions
mainly due to problems with wound healing in distal sites of tumour,
such as the foot. Cite this article:
The aims of this study were to evaluate the incidence
of local argyria in patients with silver-coated megaprostheses and
to identify a possible association between argyria and elevated
levels of silver both locally and in the blood. Between 2004 and
2011, 32 megaprostheses with silver coatings were implanted in 20
female and 12 male patients following revision arthroplasty for
infection or resection of a malignant tumour, and the levels of
silver locally in drains and seromas and in the blood were determined.
The mean age of the patients was 46 years (10 to 81); one patient
died in the immediate post-operative period and was excluded. Seven patients (23%) developed local argyria after a median of
25.7 months (interquartile range 2 to 44.5). Patients with and without
local argyria had comparable levels of silver in the blood and aspiration
fluids. The length of the implant did not influence the development
of local argyria. Patients with clinical evidence of local argyria
had no neurological symptoms and no evidence of renal or hepatic
failure. Thus, we conclude that the short-term surveillance of blood
silver levels in these patients is not required. Cite this article:
The aim of this study was to evaluate whether
coating titanium discs with selenium in the form of sodium selenite decreased
bacterial adhesion of In order to evaluate bacterial adhesion, sterile titanium discs
were coated with increasing concentrations of selenium and incubated
with bacterial solutions of The tested Selenium coating is a promising method to reduce bacterial attachment
on prosthetic material. Cite this article:
The current investigation includes a retrospective review of the experience of five Institutions with distal femur megaprostheses for tumor over a twenty year period, to analyze the incidence and etiology of failure, using a new classification system based upon the failure modes. Between 1974 and 2008, 2174 patients underwent primary limb preservation for a benign or malignant extremity tumor using a metallic megaprosthesis at five Institutions, 951 (43.7%) were distal femur replacements. Retrospective analysis of complications according to the Letson and Ruggieri Classification was performed and Kaplan-Meier curves of implant survival were defined. Segmental megaprosthetic reconstruction failures were categorized as mechanical and non-mechanical failures.Introduction
Methods
Modular endoprostheses today represent a standard treatment option in the management of musculoskeletal tumors of the lower extremities. Long-term results of these reconstructions, however, are often limited by the course of the underlying disease. We therefore report our experiences in cancer patients with megaprostheses of the lower limb after a minimum of 15 years. 62 patients, 34 men and 28 women, with a mean age of 26 years (median, 20; range, 6–83) were included in this investigation with a mean follow-up of 230 months (median, 228; range, 180–342). Endoprosthetic reconstructions of the proximal femur (11), the distal femur (28), the total femur (2) or the proximal tibia (21) were indicated for osteosarcoma (43), chondrosarcoma (5), malignant fibrous histiocytoma (3) or other tumors (11). All patients have received either a KMFTR (22) or a HMRS (40) modular prosthesis; 23 patients had a muscle flap, 14 had a fibular transposition osteotomy and 4 have received an artificial LARS ligament for soft-tissue reconstruction.Background
Materials and Methods
The rising incidence of atraumatic fractures in patients either with Ewing's sarcoma or osteosarcoma years after chemotherapy revealed a growing population of childhood cancer survivors with a decreased bone mineral density (BMD) possibly due to a long-term effect of the chemotherapy. Therefore we started to screen our patients below 50y of age who were treated for bone malignancies between 1994 and 2009. The first series of measurements included 15 patients – eight Ewing's sarcoma, three female and five male, with a mean age of 18y (±13SD), and seven osteosarcoma, two female and five male, with a mean age of 19y(±9SD). We screened the patients for deficits in their bone status using DEXA (dual-energy-x-ray-absorptiometry) to gain the T-and Z-Scores of the proximal femur and the lumbal spine. Additionally we took blood samples for endocrinological analysis and utilised a questionnaire to scan the patient's liefestyle. The mean time between diagnosis and investigation was 95months (±79SD) in Ewing's sarcoma and 105months (±54 SD) in osteosarcoma. The results of the age and gender matched lumbal measurement (Z-Score) of the Ewing's sarcoma patients showed a reduction of the BMD in six cases (6/8), including three times osteopenia (3/8) and two times osteoporosis (2/8). The osteosarcoma patients presented a BMD-decline in four cases (4/7) with two times osteopenia (2/7) and one osteoporosis (1/7). In the proximal femur six Ewing's sarcoma (6/8) and six osteosarcoma patients (6/7) showed a BMD-decrease including three osteopenic (3/8) and one osteoporotic (1/8) Ewing's sarcoma and four osteopenic osteosarcoma (4/7). We found two cases of pathologic fractures (2/15), one Ewing's sarcoma 29 months after diagnosis with a fracture of the distal femur and the proximal Tibia (1/8) and one osteosarcoma with a fractured distal femur after 72 months (1/7). As presented in our case series osteoporosis after chemotherapy is an underestimated long-term effect of the chemotherapeutic treatment. In our series BMD-reduction seems to be independent of tumour-type and chemotherapeutic agent like MTX.