There is a high risk of venous thromboembolism when patients are immobilised following trauma. The combination of low-molecular-weight heparin (LMWH) with graduated compression stockings is frequently used in orthopaedic surgery to try and prevent this, but a relatively high incidence of thromboembolic events remains. Mechanical devices which perform continuous passive motion imitate contractions and increase the volume and velocity of venous flow.

In this study 227 trauma patients were randomised to receive either treatment with the Arthroflow device and LMWH or only with the latter. The Arthroflow device passively extends and plantarflexes the feet. Patients were assessed initially by venous-occlusion plethysmography, compression ultrasonography and continuous wave Doppler, which were repeated weekly without knowledge of the category of randomisation. Those who showed evidence of deep-vein thrombosis underwent venography for confirmation. The incidence of deep-vein thrombosis was 25% in the LMWH group compared with 3.6% in those who had additional treatment with the Arthroflow device (p < 0.001). There were no substantial complications or problems of non-compliance with the Arthroflow device. Logistic regression analysis of the risk factors of deep-vein thrombosis showed high odds ratios for operation (4.1), immobilisation (4.3), older than 40 years of age (2.8) and obesity (2.2).

Aim of the study: Results of total hip replacement in consideration of quality of life and their correlation to clinical radiologic findings were examined.

Material and methods: 46 of 61 patients with aseptic loosing and total hip replacement were examined in average 4,3 years after surgery with the Harris Hip Score, Merle d’Aubigne Score, Postel Score, WOMAC-Score and SF-36 Health Survey Score. The study of radiographs was completed by the Scores of Brooker, Lee and Gruen. Allograft were used in 38 (83,6%) cases.

Results: The result of the Merle d’Aubigne Score and Postel Score in average account for 11,5 points. Harris Hip Score obtains 62,7 points. The comparison form patient and control group with the SF-36-Score shows unpropitious results particularly for physical functioning, roll limitation because of physical health problems and roll limitation because of physical emotional problems. The outcome for general mental health and vitality show better results for the patients as for the control. Evaluation of the physical and psychical scale applies to impairments of daily life depending on the disease. Patients with hip arthroplasty shows in comparison to patients with cancer or cardiac infarction worst results for the physical category, whereas the best results for the psychical category. Radiographs of 33 patients were completely evaluated. In eight cases (24,2%) there were loosening lines in femur shaft area. In 18 cases (54,55%) there were loosening lines in the area of the acetabular cup, in three cases (9%) a migration

Conclusion: After a total hip replacement the physical functions are limited. Primary hip arthroplasty for young patients should be indicated reserved in consideration of above mentioned results, even if psychological results surprised.

Aim of the study: The question wether there is a clinical relevance between the clinical outcome and life quality and radiological parameters.

Material and methods: 17 patients (average age 68.2 years) with total knee arthroplasty (Genesis I) were examined after a follow-up period of in average 24,6 months. The examination included the HSS-score for clinical parameters and the SF-36 for life quality. The evaluation of the radiological examinations were performed according to Ewald and Lotke and a special designed score of our unit.

Results: The HSS-Score resulted in average in 81 points and the SF-36 Fragebogens demonstrated significant worse results than in the age matched healthy population. The evaluation of the radiologic examinations according to Lotke showed an average value of 76,3. Correlations between the radilogical results and the HSS-score were not found. The correlation analysis between the SF-36 and HSS-score showed only positive values for the social functions. Correlations between the radiological evaluations according to Ewald and Lotke with the SF-36 score were found only for body pain and vitality.

Clinical relevance: This is the first study to find out the correlation between clinical and radiological parameters and also the outcome of life quality. The results of the positioning of the implants showed satisfying values in most of the cases, but some differences could be found. Because of deficits in the clinical and life quality outcome it can be supposed that the radiological parameters have significant influence. In our study we could not demonstrate correlations between the clinical and radiological examinations. Surprisingly also between the HSS and SF- 36 score no correlations were found. This findings showed us that the importance of the positioning of our implants has lower influence to the clinical results and life quality than we supposed.

Aims: Tibiotalar fusion is considered as gold standard for end-stage posttraumatic arthritis of the ankle. This study analyses the long-term results after talar joint fusions, especially the health related quality of life, correlated to the clinical and radiological results. Methods: We examined 16 males and 1 female patient, with 18 ankle fusions, clinically, radiographically and in regard of quality of life with the SF-36 Health Survey after a minimum follow-up period of 20 years (mean 23, range 20–33). Mean age at operation was 37 years (SD=8y), at follow up 61 years. Between injury and arthrodesis was an interval of six years in average. In eleven cases an external þxation was used. Results:. Subjectively 50% were not handicapped performing daily life activities and 44% were in the same job as at the time of injury. Out of 11 complications, the most frequent one was wound infection in seven cases (68%). On clinical examination þve feet were stiff at the forefoot. Eight patients had 25%, three had 50%, one had 75% and one the full range of motion. We found one valgus and seven varus deformities of the ankle. Following roentgenographic measurements with the MORREY as well as the TAKAKURA score, degenerative arthritis in the subtalar and Chopart joints was 2.7 (SD=0.77). The mean OMA score was 59.4 points, the visual analogue scale was 1.99, the radiologic score was 2.7 and the SF-36 revealed for physical functioning, emotional role functioning and bodily pain signiþcant deþcits. A signiþcant correlation was found between the OMA and the radiological score at 0.05, and between the clinical and the SF-36 score at 0.01. No correlation was found between the radiologic score and the SF-36 questionnaire. Conclusion: Ankle arthrodesis leads to deþcits in the functional outcome, to limitations in the activities of daily living and to roentgenographic changes in the adjoining joints. The clinical outcome and the SF-36 score correlate tightly.

Tibiotalar fusion is considered to be the standard treatment for end-stage post-traumatic arthritis of the ankle. We report a retrospective, objective long-term study of the quality of life of 17 patients with 18 arthrodeses of the ankle, over a period of more than 20 years. We looked particularly for correlation between clinical and radiological signs of osteoarthritis in adjoining joints. At serial physical examinations, clinical grades were awarded according to the Olerud Molander Ankle (OMA) score. Any degree of degenerative change in the adjoining joints was recorded on standing radiographs. Patients filled out a SF-36 Health Survey form.

Subjectively, 50% of patients were not handicapped in the performance of daily activities and 44% were in the same job as at the time of injury. At follow-up the mean OMA score was 59.4 points, the visual analogue scale was 1.99 and the radiological score was 2.7. The SF-36 for physical function, emotional disturbance and bodily pain revealed significant deficits. There was a significant correlation between the OMA and the radiological score (p = 0.05), and between the clinical and the SF-36 score (p = 0.01), but no significant correlation between the radiological score and the SF-36 score.

Arthrodesis of the ankle leads to deficits in the functional outcome, to limitations in the activities of daily living and to radiological changes in the adjoining joints. The clinical outcome score correlates closely with the SF-36 score.