Introduction Austin Moore cervicocephalic prostheses have been a therapeutical option for femoral neck fractures in patients with a reduced general condition for many years. Since treatments other than total hip arthroplasties have also been included in National arthroplasty registers during the last decade, adequate reference data for comparative analyses have recently become available. Materials and Methods Based on a standardised methodology, a comprehensive literature analysis of clinical literature and register reports was conducted. On the one hand, the datasets were examined with regard to validity and the occurrence of possible bias factors, on the other hand, the objective was to compile a summary of the data available. The main criterion is the indicator of Revision Rate. The definitions used with respect to revisions and the methodology of calculations are in line with the usual standards of international arthroplasty registers. Results Publications of clinical studies since the year 2000 have been found to significantly underestimate revision rates, on average by a factor of 2.15 as compared to register data. With 2 revisions per 100 observed component years, the revision rate in registers clearly exceeds the comparative values for total hip arthroplasty. The medium-term outcome of treatment with Austin Moore implants shows statistically significantly worse values than the use of total hip endoprostheses, bipolar implants or modular cervicocephalic prostheses. This may be rated as a hint that, in particular cases, there is potential for improvement as regards the indication for cervicocephalic implants. In the datasets of a single National register of a country such as Australia, with a population of just over 21.7 million, approximately 3 times as many cases have been documented within a period of 9 years than in all clinical studies that have been published in Medline-listed journals since the year 1960. Since these data are much more homogeneous, they allow for markedly more accurate evaluations and statements of higher validity. The period of time by which sufficient data are available for a well-founded recommendation is considerably shorter in a register. Conclusion The results of a meta-analysis of clinical literature deviate conspicuously from data from a National arthroplasty register. The medium- and long-term revision rates after treatment with Austin Moore implants are significantly higher than for treatment with total hip prostheses or modular implants. There is evidence that more stringent indications for monobloc implants could improve the outcome of surgery.

In Scandinavia national arthroplasty registers are accepted instruments in the assessment of joint implants. They have contributed essentially to the rapid detection of inferior products and, by encouraging a continuous process of quality improvement through feedback, have helped to avoid revision operations. However, national registers have a limited significance with regard to other countries and rarely used implants. In recent years, a great number of registers have been founded. The European Arthroplasty Register (EAR), an EFORT project, aims at supporting these projects, enhancing cooperation within a network, realising further benefit through registers, and fostering scientific activities. The registers have been conceived according to the successful Scandinavian model. It is, however, necessary to adapt the concept to the individual national circumstances. In order to increase the value of register publications for other countries, it makes sense to achieve a minimum of stardardisation in datasets, definitions, product designations, as well as in evaluation and publication methods. Since the datasets of national registers implicitly reflect the prevailing national circumstances, they are always more valuable for use in the respective country than evaluations from aggregated, supranational and therefore larger datasets. Supranational evaluations may yield additional findings, but they cannot replace a national register. Therefore, EAR has been conceived as a network of independent national registers considering itself as a supplement and by no means as a competitor of the established national registers.

Problem: There is a difference in the use of redon drainage following hip arthroplasty worldwide. The aim of the study was to find the best version. Method: In a prospective randomized study including 158 patients with coxarthrosis we implanted cementless Alloclassic hip-endoprostheses and registered consumption of blood, blood loss, hemoglobin level, subcutaneuos hematoma, swelling of the proximal thigh, bleeding and exsudation of the wound in four groups supplied with three, two (subcutaneously and subfascial) and one (subcutaneously or subfascial) drainage with compression bandage and one group with two redons(subcutaneously and subfascial) without compression bandage. For prophylaxis of deep vein thrombosis we used low dose heparin. Result: We could demonstrate, that the application of two redons one subcutaneously and one subfascial gave the best result. Compared to the conventional procedure with three redons we achieved a reduction of 47% of blood units, a significant reduction of exsudation and bleeding out of the wound, subcutaneous hematomas and a reduced swelling of the proximal leg in addition to better clinical conditions of the patients. The reason is a more accelerated stop of the bleeding out of the spongy bone. The application of one drain subcutaneously or subfascial showed no further reduction of blood loss, but an increase of wound exsudation and bleeding out the wound and an increase of subcutaneous hematomas. Sufficient external compression of the area of operation by a compression bandage is very important. Disadvantages as a result of changing the way of drainage have not been detected. Conclusion: The use of two Redons one subcutaneousley and one subfascial showed an obvious benefit without any clinical disatvantage compared to 3 redons or no drainage.

Ninety Burch-Schneider antiprotrusio cages in 87 patients implanted in primary and revision total hip arthroplasty were analyzed. Sixty-seven hips (64 patients) could be examined clinically and radiologically after an average of 50.3 months (minimum 23.6, maximum 131.0 months). Twenty patients (20 hips) died in interim and 3 patients (3 hips) were not available for follow-up. Of the 90 Burch-Schneider antiprotrusio cages, 4 had to be removed and 8 further cages were considered definitely loose. The survival rate is 93.4% (95% confidence interval, 74.3%-96.7%) after 131 months if the endpoint "cage explantation" is used. The average Harris Hip Score was improved from 28.2 preoperatively to 73.5 points at the time of follow-up. Radiolucent lines were often found in the Charnley/DeLee's zones II and III. In contrast, osteolyses were seldom seen.

BACKGROUND The efficacy of low energy extracorporeal shock wave treatment (ESWT) for chronic plantar fasciitis is discussed controversially. It is unclear whether the simultaneous application of local anesthesia (LA) interferes with clinical outcome. METHODS 60 patients with a chronic plantar fasciitis were enrolled in a triple-arm (20 patients per group), prospective randomized and observer-blinded pilot trial. The patients were randomly assigned to receive either active ESWT without LA (;3 x 1 500 shocks, total energy flux density [EFD] per shock 0.09 mJ/mm(2) [Group A]), ESWT with LA (3 x 1 500 shocks, EFD 0.18 mJ/mm(2) per shock [Group B]) or ESWT with LA (3 x 1 500 shocks, EFD 0.09 mJ/mm(2) [Group C]). Main outcome measures were: pain during first stepps in the morning (measured on a 0-10 point visual analogue scale) and number of patients with > 50 % reduction of pain and no further therapy needed, measured at 6 weeks after the last ESWT. RESULTS Group A improved in the VAS from 6.4 (SD: 1.7) to 2.2 (SD: 2.6) points, group B from 6.7 (SD: 1.5) to 4.1 (SD: 2.4) points, group C from 6.2 (SD: 1.6) to 3.8 (SD: 2.5) points. A reduction of pain of at least 50 % was achieved in 60 % of group A, in 36 % of group B and in 30 % of group C. Group A without LA showed a significantly higher improvement in the VAS and subjective evaluation than groups B (p = 0.007) and C (p = 0.016). CONCLUSION At 6 weeks success rates after low-energy ESWT with local anesthesia were significantly lower than after identical low-energy ESWT without local anesthesia. Higher energy levels could not balance the disadvantage of this effect. LA significantly influenced the clinical results after low energy ESWT in a negative way. Blinding patients by LA in ESWT studies must therefore be considered a systematic error in study design.

AIMThe radiological appearance of the cementless ALLOCLASSIC SL-stem, implanted in patients with primary osteoarthritis of the hip and aged at least 80 years at time of surgery, was investigated.METHOD66 hips in 58 patients were analysed. 17 patients (19 hips) died in the interim, 5 patients (5 hips) were not available for follow-up because of health reasons (4) or lack of co-operation (1). 1 stem had to be explanted after a periprosthetic fracture of the femur. Finally, 41 total hip arthroplasties in 35 patients could be analysed after an average of 67.9 months (39.2-93.4).RESULTSBone atrophy - especially in the proximal Gruen zones - was frequently found. In contrast, radiolucent lines and osteolyses were rare occurrences. The Harris Hip score was preoperatively on average 33.0 points, at time of follow-up 81.7 points. The survival rate (endpoint aseptic loosening) was 100 % after a mean follow-up of 5.7 years.CONCLUSIONAlso in very old patients the implantation of a cementless stem is possible and provides very good results.

Medial unicompartmental knee replacements have been used for more than 40 years. Due to increased experience in determining the indication for use and improvements in design of the prosthesis and tribology, the long-term results have now reached a high level. The advantages of these systems are less bone loss and better proprioception. The disadvantage is the risk of panarthrosis, which might be reduced by accurate indications for operations. Good indications are patients older than 60 years with normal weight and normal sports activity. Well-functioning collateral and cruciate ligaments are mandatory. Due to the fact that during implantation eversion of the patella is not necessary, a minimally invasive approach might be used. Overcorrection of the mechanical axis of the leg should be avoided. By observing these principles, very good long-term results can be achieved with medial unicompartmental arthroplasty. Better proprioception and better mobility of the knee are advantages of these implants compared to total knee arthroplasty. In the case of revision with a bicondylar implant, the situation is less complex compared to revisions after osteotomies or bicondylar replacements. Remobilization in this situation is shorter with better results compared to a revision with a bicondylar prosthesis.

Fragestellung: Ausgedehnte knöcherne Defekte im Bereich des Azetabulums werden sowohl in der primären Hüftendoprothetik wie auch in Revisionsfällen an unserer Abteilung mit der Burch-Schneider-Pfannendachschale versorgt.

Anhand der biomechanischen Grunddaten und anhand von klinischen Langzeitergebnisse mit der konischen Schraubpfanne – Typ Alloclassic CSF – und der sphärischen Pressfitpfanne Allofit sollen die prinzipiellen Vor- und Nachteile dieser Implantate verglichen werden. Die klinische Auswertung der konischen Schraubpfanne basiert auf Ergebnissen bis zu 15 Jahren Beobachtungszeit, die Auswertung der sphärischen Pressfitpfanne auf Ergebnissen mit bis zu 10 Jahren Beobachtungszeit nach folgenden Kriterien:

We reviewed 80 patients (87 hips) who were older than 80 years of age at the time of cementless total hip arthroplasty. An Alloclassic SL stem had been implanted in all patients. A variety of cementless acetabular components was used. After a mean follow-up of 69.3 months (39.2 to 94.1) 48 hips in 43 patients were analysed clinically and radiologically. One patient had sustained a traumatic periprosthetic fracture of the femur with subsequent exchange of the stem 73 months after operation. Thirty-two patients (34 hips) had died and five patients (five hips) were unavailable for follow-up because of health reasons (four patients) or lack of co-operation (one patient). If the endpoint is defined as removal of the prosthesis because of aseptic loosening, the survival rate was 100% for the cup and stem after 78 months. The mean Harris hip score was 81.9 points. Radiolucent lines and osteolysis were seldom found.

The first 100 Alloclassic (Centerpulse, Winterthur, Switzerland) hip prostheses implanted at Allgemeines Krankenhaus Linz were examined in this study. All cases involved primary total hip arthroplasty. Of these 100, 75 could be followed up clinically and radiologically. All living patients were contacted by telephone. The follow-up period was at least 10 years. If the endpoint is defined as removal of the prosthesis due to aseptic loosening, the survival rate was 96.9% for the cup and 100% for the stem after 132 months. The average Harris Hip Score was 85.4 points. Radiolucent lines and osteolyses were found primarily in the proximal zones of the stem.

PROBLEM:There is a difference in the use of redon drainage following hip arthroplasty worldwide. The aim of the study was to find the best version.METHOD:In a prospective randomized study including 158 patients with coxarthrosis we implanted cementless Alloclassic hip-endoprostheses and registered consumption of blood, blood loss, hemoglobin level, subcutaneuos hematoma, swelling of the proximal thigh, bleeding and exsudation of the wound in four groups supplied with three, two (subcutaneously and subfascial) and one (subcutaneously or subfascial) drainage with compression bandage and one group with two redons (subcutaneously and subfascial) without compression bandage. For prophylaxis of deep vein thrombosis we used low dose heparin.RESULT:We could demonstrate, that the application of two redons one subcutaneously and one subfascial gave the best result. Compared to the conventional procedure with three redons we achieved a reduction of 47% of blood units, a significant reduction of exsudation and bleeding out of the wound, subcutaneous hematomas and a reduced swelling of the proximal leg in addition to better clinical conditions of the patients. The reason is a more accelerated stop of the bleeding out of the spongy bone. The application of one drain subcutaneously or subfascial showed no further reduction of blood loss, but an increase of wound exsudation and bleeding out the wound and an increase of subcutaneous hematomas. Sufficient external compression of the area of operation by a compression bandage is very important. Disadvantages as a result of changing the way of drainage have not been detected.CONCLUSION:The use of two Redons one subcutaneously and one subfascial showed an obvious benefit without any clinical disadvantage compared to 3 redons or no drainage.

Polyethylene wear can be shown as a problem in long-term joint replacement. Metal-on-metal bearing is solving this problem, as long-term clinical and experimental investigations demonstrate. To avoid the problem of high friction found in old series, a new Metasul called technique with a smaller diameter was invented. Intermediate results of Weber and our own data show promising outlook for a solution to the wear-induced problem in hip replacement.

Seit 1981 wird für Kinder mit ju venil er rheumatischer Ar thritis jährlich ein Feriena ufenthalt in 4wöch iger Dau er durchgefüh rt. Die Kind er wurde n da bei von einem Team bestehend aus Pädiater , Orthopä den , Ergot he rapeuten, Physikoth era peut en und psychologisch gesc hulten Helfern betreut. Es konnte durch gezielte Schiene nbehand lung , Physikotltera pie un d Steigeru ng des Med ikamenten bewußtseins im Rahmen der The rapieferien eine signifikante Besserung der Gelenksbeweglichkeit und des Blutbildes sowie eine Steigerung des subje ktiven Woh lbefinden s erzielt werde n . Durch die Mehrfachau fenthal te der meisten der 103 Kind er bei 209 Thera piep lät zen war auch eine über Jahre anhalt end e Besserung der Gelenksbeweglichkeit zu beobachten . Du rch die gezielte Schulung, Gewöhnung an Schienen und Heilgymn astik konnte ein e Ak zeptanzerhöh ung erzielt werden , die auch im üb rigen Jahr einen praevent iven Effekt erbrachte . Der Er folg dieser Maßna hmen bestä rkt un s in der kon sequ ent en Weiterführung dieses P rojekt s.

Since 1981, annual four-week holidays have been arranged for children with juvenile rheumatic arthritis, during which the children are cared for by a team of pediatricians, orthopedists, ergotherapists, physiotherapists and assistants trained in psychology. With systematic splint therapy, physiotherapy, and by enhancing drug awareness during these therapeutic holidays significant improvements in joint mobility and subjective wellbeing were achieved. Of the 103 children treated (209 places were available), the majority spent several holidays, with a resulting improvement in joint mobility lasting several years. Through systematic training, adaptation to splints, and physiotherapy acceptance was also enhanced, with a preventive effect for the rest of the year. The success of these measures has encouraged the authors to continue the project.