Aim: Cementation of tibial implants in total knee arthroplasty is a gold-standard considering the high loosening rates of cementless implants. In contrast, only sparse data exist regarding unicondylar arthroplasty due to limited use. In this study, we compare cemented with cementless unicondylar knee arthroplasty and aim to define both clinical and radiological differences in treatment outcome.

Materials and Methods: In a retrospective study, 106 patients who had undergone a medial unicondylar replacement were examined after a mean postoperative period of 8 years. Of these, 42 patients (median age 81±7 years) had received a cemented and 64 (median age 73±7 years) a cementless knee arthroplasty by the same surgeon while 7 patients were deceased or could not be reached. Well-established clinical (VAS, HSS, KSS, UCLA, WOMAC) and quality of life (SF-36) scores were used to evaluate treatment outcome. X-rays were performed to evaluate periprosthetic loosening zones, according to Ewald’s criteria.

Results: The cementless patient group presented significantly better clinical scores (HSS, KSS, UCLA, WOMAC), except in the Visual Analogue Scale (VAS) for pain assessment. The quality of life was significantly better in the cementless group except in the subgroups concerning physical function, vitality and social role, which resembled normal population. Moreover, radiographic analysis using antero-posterior X-rays revealed significantly more and larger periprosthetic loosening areas in tibial zone 2 in the cementless group.

Conclusion: The inferior clinical results characterising the cemented group could be attributed to the higher mean age. Regarding the radiological loosening zones, we did not detect any differences in the techniques of fixation, although physical activity and mechanical stresses were higher in the cementless group.

Introduction: Mobile bearing total knee arthroplasty (TKA) has been developed to theoretically provide a better, more physiological function of the knee and produce less polyethylene (PE) wear. The theoretical superiority of mobile bearing TKA’s over fixed bearing devices has not yet been proven in clinical studies.

The objective of the present study was to analyze in vivo the knee joint kinematics in the sagittal plane in a patient population that had received either a fixed or a mobile TKA in a prospective, randomized, patient- and observer-blinded, clinical study.

Methods: 31 patients were evaluated by means of fluoroscopy during unloaded flexion and extension against gravity, as well as during step-up and step-down with full weight bearing. In these 31 patients, 22 fixed bearing TKAs, 16 mobile-bearing TKAs and 19 natural knee joints were included.

All patients had been operated in a prospective, randomized, patient- and observer-blinded, clinical study, and had received either fixed or a mobile bearing, cruciate retaining Genesis II TKA for primary osteoarthritis.

Fluoroscopic radiographs were evaluated by measuring the „patella tendon angle” as a measure of antero-posterior translation as well as the “kinematic index” as a measure of reproducibility.

Results: During unloaded movement, fluoroscopic analysis did not show a significant difference between both types of prosthesis designs and the natural knee. In the weight-bearing movement, both types of TKA designs did not show the typically arched but a more linear patellar tendon angle curve, with a greater angle in extension and in flexion than the natural knees. This means that the femur glides anteriorly under load near extension and does not show the natural roll-back in flexion. In the mobile-bearing group, inter-individual deviations from the mean during weight-bearing movements were significantly less than in the fixed-bearing group.

Conclusions: In the present study, no functional advantage of mobile bearing TKA over fixed bearing devices could be found. Both TKA designs showed the typical kinematics of an anterior instability. Long-term follow-ups are necessary to elucidate the possible influence of lower PE wear on the incidence of aseptic loosenings.

Purpose: In the treatment of acetabular dysplasia in adolescents and adults the triple osteotomy according to Tonnis is a common procedure. This retrospective study were undertaken to evaluate the clinical and radiological results and quality of life after triple osteotomy according to Tonnis.

Material and Methods: In our retrospective study 43 patients (f=32, m=11) with acetabular dysplasia after triple osteotomy procedure with an average age of 21.8 years (SD=7.6) were evaluated. The average follow-up was 9.3 years (range 0.6–19.1 ys). For clinical evaluation, the Harris Hip Score was used. The pre- and postoperative x-rays in ap and faux profile plane were evaluated for the CE-, VCA-, AC-, ACM-angle and the acetabular index. Quality of life was evaluated by the SF-36-health questionnaire.

Results: 48,8% of our patients achieved excellent or good results in the Harris Hip Score and 65,1% of the patients considered the subjective postoperative result as excellent or good. The CE angle improved significantly from preoperatively 8.8 to postoperatively 34.5 degrees. The VCA angle according to Lequesne and Seze improved significantly from 30.7 to 50.9 and the AC angle from 10.2 to 19.5 degrees. The ACM angle decreased significantly from 53.3 to 56 degrees and the acetabular index increased from 33.4 to 37.3 postoperatively. Range of motion of the operated extremity decreased significantly for hip flexion and internal roation. SF-36-health questionnaire results of the patient group showed significant differences for the parameters physical function, bodily pain and emotional role compared to those of a healthy reference group of the same age.

Four patients showed a pseudarthrosis of the ischial or pubic bone. Three patients had persisting pain of the pseudarthrosis and needed another operative procedure. Hypaesthesia in the area of N. cutaneus femoris lateralis occurred in seven cases.

Conclusion: The results of the operative treatment of an acetabular dysplasia with a triple osteotomy procedure according to Tonnis showed a satisfactory outcome, even though significant functional deficits and deficits of quality of life could be demonstrated in middle and long term follow-up.

Aim: Investigations on human hyaline cartilage of late stage degenerative arthritis showed that the vascular derived endothelian growth factor (VEGF) seems to play a role in the development of degenerative arthritis. The current study was designed to evaluate the expression of VEGF on chondrocytes of hyaline cartilage in the time course of degenerative arthritis.

Methods: In twelve white new-zealand-rabbits the anterior cruciate ligament was resected to create an anterior instability of the knee. In twelve control rabbits only a sham operation without resection of the ACL was done. Another four animals have not been operated at all (0 weeks). Four animals of each group were sacrificed at three, six and twelve weeks each. After opening of the knee joint, the degenerative arthritis was macroscopically graded and the hyaline cartilage of the load bearing area was evaluated histologically according to Mankin and by immunostaining for VEGF.

Results: The macroscopic and histological grade of degenerative arthritis according to Mankin showed a positive linear correlation to the time after surgery. The scores of the control group were constant in the time course. In the cartilage of the untreated animals (0 weeks) an average of 12 percent (SD 2.6) VEGF-positive chondrocytes were found. After 3 weeks the trial group (17.6%; SD 5.7) as well as the control group showed a significant increase (16.2%; SD 4.7). After 6 weeks the value in the control group dropped to normal (11.5%; SD 5.9) and remained constant after 12 weeks (11.6%; SD 3.3). In the trial group the percentage of VEGF positive chondrocytes rose steadily (19.4%; SD 4.6 after 6 weeks; 21.3%; SD 5.4 after 12 weeks). There was a positive linear correlation between the percentage of VEGF positive cells and the Mankin score (r=0.767; p< 0.01) and the macroscopic score (r=0.518; p=0.02).

Conclusion: The current study shows for the first time an in-vivo increase of VEGF expression on chondrocytes in the time course of osteoarthritis, which is dependent on macroscopic and histological grades. Further studies are needed to evaluate whether this pattern applies to human beings and whether new treatment approaches could evolve from this knowledge.

Introduction: Mobile bearing total knee arthroplasty (TKA) has been developed to theoretically provide better, more physiological function of the knee and produce less PE wear. The theoretical superiority of mobile bearing TKAs over fixed bearing devices has not yet been proven in clinical studies. The objective of the present study was to prospectively analyze clinical and functional outcomes of randomized fixed and mobile bearing total knee arthroplasty patients by means of gait analysis, electromyography and established clinical scores.

Methods: In a prospective, randomized, patient- and observer-blinded, clinical study, 33 patients (mean age 63 years) received a cruciate retaining Genesis II TKA for primary osteoarthritis. 16 patients received a mobile bearing and 17 patients a fixed bearing device. The day before surgery and 24 months postoperatively, established clinical (KSS, HSS, WOMAC, UCLA, VAS) and quality of life (SF-36) scores were used to compare both patient groups. Electromyography of standardized locations was measured with the MyoSystem 2000 and analyzed with Myoresearch software. Gait analysis was performed with a six camera motion analysis system and force platforms.

Results: Both groups showed significant improvements between pre- and postoperative evaluation in gait analysis and electromyography, but gait analysis results as well electromyography did not show any difference between both groups at follow-up. Clinical and quality of life results significantly improved from pre- to postoperative evaluation, but only the Knee Society Score showed a significant superiority of the mobile bearing group (mean 159.0; SD 27.7; range, 105–196) over the fixed bearing group (mean 134.4; SD 41; range, 56–198) (p=0.0022).

Conclusions: In the present study, no functional advantage of mobile bearing TKA over fixed bearing devices could be found, although the mobile bearing group had better clinical results. Thus, long-term clinical results and in-vivo wear analyses have to be followed, and more subtle functional analyses (e.g. fluoroscopy) have to be employed to finally judge over the theoretical advantage of mobile bearing TKAs.

Aims: Results of total hip replacement in consideration of quality of life and their correlation to clinical radiologic findings were examined. 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 were 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, role limitation because of physical health problems and role 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. Radiographs of 33 patients were completely evaluated. In 8 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 3 cases (9%) a migration and in 24 cases (72,7%) an ossification. 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.

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.