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The Bone & Joint Journal
Vol. 99-B, Issue 10 | Pages 1373 - 1380
1 Oct 2017
Rienmüller A Buchmann N Kirschke JS Meyer EL Gempt J Lehmberg J Meyer B Ryang YM

Aims

We aimed to retrospectively assess the accuracy and safety of CT navigated pedicle screws and to compare accuracy in the cervical and thoracic spine (C2-T8) with (COMB) and without (POST) prior anterior surgery (anterior cervical discectomy or corpectomy and fusion with ventral plating: ACDF/ACCF).

Patients and Methods

A total of 592 pedicle screws, which were used in 107 consecutively operated patients (210 COMB, 382 POST), were analysed. The accuracy of positioning was determined according to the classification of Gertzbein and Robbins on post-operative CT scans.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_4 | Pages 1 - 1
1 Feb 2017
Guggi T Leunig M Rienmüller A
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Dedication to quality has a longstanding tradition within the Schulthess Clinic. Pioneering documentation Maurice E. Müller initiated an International Documentation & Evaluation System (IDES) in the era of hip replacement becoming an increasingly wide spread and standardized procedure. Starting in 1984, IDES was used to document each and every hip replacement and as of 1995 also for every knee arthroplasty performed. Norbert Gschwend became the driving authority in the clinic for standardizing documentation and regular long term follow-up intervals for all patients.

With increasing interest in patient reported outcomes (PROMs) a shift took place in the basic conception and electronic means (iPads) were introduced in 2012 to let patients complete their part of questionnaires, i.e. EQ-5D, OHS, OKS, UCLA & WOMAC while the clinical part was addressed in the same manner using HHS & KSS.

Optimizing user experience while answering routine questions and allowing for the physician to quickly enter required data without the numbing experience of ever same paper forms largely increased the return on information. This approach also guarantees for complete data sets, often a problem when using pen and paper.

Using these modern tools in combination with a refined recall procedure, we today show follow-up rates of well over 90% in the first post-operative years vs rates of 80% or less prior to introduction.

As of late 2012 the Swiss implant registry for knees & hips was introduced and here again we today use iPads with an app specifically designed to quickly document and register all operations on a daily base, reducing the chore of using paper or web based on line options from 3 to 10 minutes per operation to a mere 20 seconds, fully plausibilized and in this way never returned for corrections.

Pooling this data allows not only for generalized and stringent quality control but also facilitates spotting aberrant trends in the sense of an early warning system within our clinic with regard to procedures and implants.

Pioneering this approach to facilitate & perfect all documentation related procedures we aspire towards an elevated quality level in reporting to help sustain & guarantee patient satisfaction despite the high day-by-day volume.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 511 - 511
1 Sep 2012
Rienmüller A Guggi T Von Knoch F Drobny T Preiss S
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Introduction

Patellofemoral complications remain a very common post-operative problem in association with total knee arthoplasty (TKA). As malrotation of the femoral component is often considered crucial for the outcome, we analyzed absolute rotational femoral alignment in relation to patellar tracking pre- and postoperatively and matched the results with the two year functional outcome.

Methods

Femoral rotation and component rotation was assessed by axial radiography using condylar twist angle (CTA). The lateral patellar displacement, patellar tilt and Insall-Salvati index were measured on conventional radiographs. All assessments were done pre-operatively and at 2-year follow up. The series included 48 consecutive TKA (21 men, 27 women) performed at a single high-volume joint-replacement-center in 2008. All operations were performed using a tibia first-ligament balancing technique without patella resurfacing. The implant used was a condylar unconstrained ultracongruent rotating platform design. Outcome was assessed using the international knee society score (KSS) and the Kujala Score for anterior knee pain.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_II | Pages 327 - 327
1 May 2010
Rienmüller A Guggi T Naal F Von Knoch M Drobny T Munzinger U Preiss S Von Knoch F
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Introduction: Rotational alignment of the femoral component is widely believed to be crucial for the ultimate success of total knee arthroplasty (TKA). However there is a paucity of normative data on femoral component rotation in ‘perfect’ TKA.

Methods: Femoral component rotation in well-functioning TKA was assessed by means of axial radiography as described by Kanekasu et al. Well-functioning TKA were defined by three criteria at 5-year follow-up:

Knee Society objective and functional score of 190 or above

full knee extension and a maximum flexion of 125° or above

excellent subjective patient rating.

Thirty TKA of 29 patients (9 male, 20 female) with a median age of 70 years (range, 31–87) at time of surgery fulfilled the study criteria. All TKA were implanted at a single high-volume joint replacement center in 2002. In all cases both the condylar twist angle (CTA) using the clinical epicondylar axis (CEA) and the posterior condylar angle (PCA) using the surgical epicondylar axis (SEA) were used to assess rotational alignment of the femoral component.

Results: Overall, the mean CTA was 3.6+−3.5° of internal rotation (IR) (range, 4.1° of external rotation (ER) to 8.6° of IR) for the femoral component. For females, the CTA had a mean value of 4 +/−3.7° of IR (range, 7.6° of IR to 4.1° of ER) compared to 2.3 +/−3° of IR (range, 5.3° of IR to 2.5° of ER) in males. Overall, the mean PCA was 1.5 +/−3.5° of ER (range, 8.4° of ER to 5.1° of IR). In females, the mean PCA was 1 +/−3.9° ER (range, 2.3° of IR to 5.8° of ER) compared to 2.8 +/−2° ER (range, 0.4° of ER to 5.7° of ER) in males. The mean angle between CEA and SEA was overall 5.1 +/−1.8° (range, 3.3° to 9.1°), in females 5.1 +/−1.6° (range, 3.5° to 9.0°) compared to 5.0 +/−2.4° (range, 3.2° to 9.1°) in males.

Conclusion: Well-functioning TKA demonstrated a highly variable rotational alignment of the femoral component ranging from excessive external rotation to excessive internal rotation. These findings challenge current reference values for optimal femoral component rotation.