Introduction. Cosmetic lengthening is currently growing, raising Ethical concerns. In cosmetic lengthening, the psychological benefit vs process and risks is not quantified in publications. We designed a prospective longitudinal study for evaluating quantitatively the psychological PROMs of patients with cosmetic lengthening and value its interest. Materials and Methods. Forty five cosmetic patients were operated on with the G-Nail with full weight-bearing, and sports: M/F 34/11, age 29.3±11.5 year-old, Gain 79 mm (range 86–187). All undertook preoperative preparation, psychological tests, post-operating training (lengthening period, twice daily) and a specific psychological program. No patient presented sequels. Questionnaires were provided before and 40.0 month after surgery (scale 0–10) with: Psychological suffering, Happiness in Life (HiL), Quality of Live (QoL), Self-Esteem, Self-Image, Self-Confidence, Professional, Family, Friends and Sexual Relations, Sexual Attraction. Average, SD of changes and T-Test (unequal variances) were computed. Results. Improvements were greater for self-Image (+54%, p 1.21×10. −12. ) raising from an initial value of 5.44 (+/− 1.62) to 8.40 +/− 1.20), Self-esteem, Self-confidence and HiL or over (p between 1.7×10. —7. and 1.8×10. −10. ), QoL (+22%, p 8.1×10. −5. ), Professional relationships (+20%, p 4.2×10. −5. ), Family relationships (+12%, p 0.003), Friendship (+11%, p 0.002), Sexual Attraction (+24%, p 1.0×10. −5. ), Sexual relationships (+19%, p 0.001) and psychological suffering due to the statue decreased by 53% (p 0.0002). Conclusions. Within the protocols used, patients improved strongly their Psychological Health, with +44% of their self-image, self-esteem and self-confidence. With a reliable technique and strong programs for supporting recovery both physically and psychologically, cosmetic surgery can benefit strongly to patients

To investigate clinical outcome scores in surgically treated patients with either spontaneous or postoperative pyogenic spondylodiscitis after 3, 12 and 24 month. 70 consecutive patients (mean age 64y; male n=33 female n=27) underwent surgical treatment due to pyogenic spondylodiscitis with or without epidural abscess at our department from 2011 to 2013. We performed either microsurgical debridement or debridement in combination with ventral support employing dorsally instrumented spondylodesis followed by bracing and antibiotic therapy up to 12 weeks. European life quality score (EQ-5D), Oswestry disability index (ODI) and visual analogue scale for pain (VAS) were recorded 3, 12 and 24 month after surgery. Length of hospital stay (LOS) was 25,3 days. The Mean time to presentation at our spine center and diagnosis was 3,8 weeks. Distribution of inflammation was lumbar in 66 (94%) and thoracic in 4 (6%) patients. Thirtyfour patients (49%) had isolated spondylodiscitis (SD). Epidural abscess (ED) was found in 26 patients (37%). Ten patients (14%) showed a combination of SD and ED. SD or ED were predominantly found after previous surgery at the same or contiguous level 38 (54%). Nine patients (13%) suffered from ED or SD after previous lumbar epidural steroid injections (LESI). Spontaneous idiopathic inflammation was found only in 13 cases (19%). Standardized follow-up (FU) protocol was scheduled at 3, 12, and 24 month. FU rate was 60%. Healing of the inflammation was the rule. In our study cumulative EQ-5D increased from 0.47 to 0,80. ODI decreased from 41.1 to 24.3 and VAS concerning back pain decreased from 58.4 to 22.6 VAS according sciatica decreased from 46.8 to 20.5. Due to an increasing number of spine surgeries and spinal interventions as well as the increasing age and morbidity of patients, spinal surgeons have to deal more often with the diagnosis pyogenic spondylodiscitis. Standardized conservative or radical surgical treatment strategies in order to achieve good results according to patients life quality are gaining more importance

Introduction. Total ankle arthroplasty is increasingly used as an alternative to arthrodesis to treat advanced ankle arthritis. In an attempt to assess the survivorship and patient outcome as well as peri- and postoperative complications and possible risk factors, we retrospectively analyzed the demographics, clinical outcome and radiographic characteristics of 100 ankle prostheses (97 patients). Patients and methods. Between 3/2005 and 5/2010 114 S.T.A.R. Prostheses were implanted by one surgeon at our institution. Indication for TAA was primary and secondary osteoarthritis, 81 cases were posttraumatic. From the 53 female and 44 male patients the mean age was 63 and the mean BMI was 28,4. 11 patients had been smoking for longer than 12 years, 29 patients either had a history of diabetes, peripheral vascular or cardiovascular disease or varicosis. All operations were performed with a tourniquet, using a standard anterior midline incision. All patients received the same postoperative rehabilitation and follow up program. Postoperative evaluation included the AOFA Score and clinical radiographic follow ups 6 weeks after surgery and yearly thereafter. Additional procedures during surgery included lengthening of the Achilles tendon for 12 patients and fusion of the subtalar ankle for 5 patients. Results. The average follow up was 36 months. The preoperative AOFA Score of 36.87 (22–58) increased to 75.99 postoperative. 87 cases reported a better life quality and 82 cases would go for surgery again. 27 ankles incurred complications after primary surgery. 21 prostheses had to go for revision surgery. Most complications were due to aseptic loosening/ implant failure. Other complications include arthrofibrosis and impingement as well as delayed wound healing and deep infection. Four patients had to be revised to an athrodesis. Conclusion. Our study shows a high satisfaction rate after total ankle replacement and clear pain relief which is the primary indication for ankle arthroplasty. Patients with a body mass Index higher than 30 as well as patients with a history of diabetes or peripheral vascular disease and smokers showed a higher rate of complications. Although these are encouraging results, the rate of complications should be discussed with patients. Compared with ankle fusion, the rates of complications seem to be comparable