Introduction: Knee arthroplasty is exposed to demographic changes as patients age. An analysis of risk factors for surgical treatment decisions in patients over 80 years old is crucial. This study compared perioperative complications between groups of patients undergoing primary knee arthroplasty, under 60 years old and over 80 years old.Materials and Methods: For this retrospective study, data from 400 patients with primary cemented bi- and unicondylar total knee endoprosthesis during inpatient stay from 2017 to 2018 were analyzed. Patients aged 61-79 years (257) were excluded. An analysis of the remaining 143 patients was performed. The incidence of surgery-related and systemic complications (eg, urinary tract infections, electrolyte imbalances, and cases of pneumonia), the blood supply and C-reactive protein (CRP) as well as hemoglobin progression were compared across both age groups. Furthermore, a correlation between prevalent diseases and systemic complications were investigated. Statistical analysis was performed using IBM SPSS (Armonk, US).Results: Data analyses showed a significant difference in the occurrence of systemic complications and blood transfusion between the age groups (P = 0.001, phi = 0.44; phi= 0.55, P = 0.001). Surgical complications did not differ significantly between the age groups. Age-typical pre-existing conditions, especially arterial hypertension (P = 0.003), showed a significant association with the occurrence of systemic complications. In addition, high postoperative CRP values in elderly patients revealed an association to systemic complications (P = 0.008).Discussion and Conclusion: The study shows that primary cemented knee arthroplasty is a safe procedure without an increased incidence of surgical complications, even in elderly patients. The increased incidence of internal complications in octogenarians, in turn, should receive more attention in the perioperative course. The interdisciplinary preoperative optimization of pre-existing conditions and drug therapy, as well as close interdisciplinary assessments of elderly patients, should be ensured.

Total hip (THA) and knee arthroplasty (TKA) are surgical interventions for patients with primary and posttraumatic osteoarthritis. The present clinical investigation compared gender differences in THA and TKA. Data from 419 patients following primary THA and TKA were collected. The occurrence of systemic and surgery-related complications, the units of blood transfused, and the change in Hb were investigated. Hb was collected preoperatively and at 1, 2, 4 and 7 days postoperatively. Statistical analysis was performed using the software IBM SPSS 28. There was no significant difference in surgery-related and general complications in men between THA and TKA. A significant difference between THA and TKA in systemic complications in women was observed. No significant difference between THA and TKA in related to surgery-related complications was evidenced. In men, no difference in Hb progression was observed. In women, a significant Hb drop was evidenced (p = 0.03). The rate of blood transfusion units in women was significantly greater in TKA than in THA (p = 0.001). No statistically significant difference was observed in men in the rate of transfusion between THA and TKA. Perioperative care should be organized differently for women and men. Furthermore, a differentiation between the procedures for each sex could prevent the occurrence of perioperative complicated courses.

Introduction Total knee arthroplasty (TKA) is a good treatment for end-stage knee osteoarthritis (KOA). Approximately 60% of the patients are females, and 40% are males. This study analyzed pre- and postoperative angle differences in the range of motion (ROM), and the occurrence of complications with traditional posterior stabilization versus kinematic TKA in relation to gender. Methods Data from 434 patients with primary cemented total knee arthroplasty from 2018 to 2021 were collected. Alpha and beta angles were determined pre- and postsurgery. The ROM was collected pre- and postoperatively and during follow-up. Additionally, perioperative complications, revision rate, and blood transfusion management were investigated. Results The pre- and postoperative alpha-angle between men and women was significantly different, as was the level of alpha-angle correction between men and women (p = 0.001; p = 0.003). Same-gender differences in pre- to postoperative alpha-angles between traditional and kinematic TKA were shown (women (w): p = 0.001; men (m); p = 0.042). High postoperative alpha angles led to less ROM in traditional TKA for women (p = 0.008). No significant gender differences in ROM, perioperative complications, or revision surgery and transfusion rates were found. Conclusion Despite high gender differences in pre- and postoperative angles, only female patients with traditional arthroplasty and high postoperative alpha angles showed less ROM in the follow-up. This leads to the assumption that gender-related pre- and postoperative angle differences, and the degree of angle correction, do not influence the ROM or perioperative occurrence of complications. Both designs present safe procedures for both genders with a wide spectrum of axis deformities.

Der Einsatz von Schuheinlagen und deren therapeutischen Nutzen beim kindlichen Knick-Senk-Fuß wird in der internationalen Literatur kontrovers diskutiert. Auch vor dem Hintergrund zunehmenden Kostendrucks im Gesundheitswesen und den Anforderungen der evidenzbasierten Medizin ist eine kritische Analyse des klinisch-funktionellen Effekts von orthopädischen Einlagen beim kindlichen Knick-Senk-Fuß erforderlich. Es erfolgte eine strukturierte Literaturrecherche in Pubmed unter Verwendung der Schlagwörter bzw. Verknüpfungen "paediatric pes planus", "fexible flat foot" AND/OR "insoles" AND/OR "orthosis". Die biomechanischen und materialtechnischen Anforderungen an eine Schuheinlagenversorgung beim Knick-Senk-Fuß, deren idealer Behandlungszeitraum und die klinischen Ergebnisse sollen herausgestellt werden. Die Aussagekraft der verfügbaren Studien zur Einlagenversorgung beim kindlichen Knick-Senk-Fuß ist gering. Wissenschaftliche Evidenz lässt sich in Anbetracht dieser Studien auch aufgrund geringer Patientenfallzahl, oft ungenau definierter Zielparameter sowie nicht selten Fehlen validierter Scores oder PROMS kaum generieren. Prospektive Studien zum therapeutischen Nutzen von Schuheinlagen beim kindlichen Knick-Senk-Fuß über einen langen Beobachtungszeitraum mit klar definierten Zielparametern sind zwingend erforderlich. Auch hinsichtlich optimaler Materialien und Bauweise der Schuheinlagen bedarf es weiterer Analysen. The use of shoe insoles and their therapeutic benefit in children with flexible flat foot is subject of controversial discussion in the international literature. Because of increasing cost pressure in health care systems and requirements of evidence-based medicine, a critical analysis of the clinicalfunctional effect of orthopaedic insoles in children with pes planovalgus is necessary. A structured literature search was carried out in Pubmed using the keywords or links "pediatric pes planus", "flexible flat foot" AND/OR "insoles" AND/OR "orthosis". Biomechanical and material-technical requirements for insoles for flat feet, their ideal treatment period and the clinical results are to be highlighted. Overall, the informative value of the available studies on insoles for children with flexible flat foot is low. In view of these studies, scientific evidence can hardly be generated due to the small number of patients, imprecisely defined target parameters and frequent lack of validated scores or PROMS. Prospective studies on the therapeutic benefit of shoe insoles in children with flexible flat foot over a long period of observation with clearly defined target parameters are imperative. Further analyzes are also required with regard to the optimal materials and construction of such shoe insoles.

The most common spinal disorder in elderly is lumbar spinal stenosis (LSS), resulting partly from ligamentum flavum (LF) hypertrophy. Its pathophysiology is not completely understood. The present study wants to elucidate the role of estrogen receptor α (ER α) in fibroblasts of hypertrophied LF. LF samples of 38 patients with LSS were obtained during spinal decompression. Twelve LF samples from patients with disk herniation served as controls. Hematoxylin & Eosin (H&E) and Elastica stains and immunohistochemistry for ER α were performed. The proportions of fibrosis, loss and/or degeneration of elastic fibers and proliferation of collagen fibers were assessed according to the scores of Sairyo and Okuda. Group differences in the ER α and Sairyo and Okuda scores between patients and controls, male and female sex and absence and presence of additional orthopedic diagnoses were assessed with the Mann–Whitney U test. There was a tendency towards higher expression of ER α in LF fibroblasts in the hypertrophy group (p = 0.065). The Sairyo and Okuda scores were more severe for the hypertrophy group but, in general, not statistically relevant. There was no statistically relevant correlation between the expression of ER α and sex (p = 0.326). ER α expression was higher in patients with osteochondrosis but not statistically significant (p = 0.113). In patients with scoliosis, ER α expression was significantly lower (p = 0.044). LF hypertrophy may be accompanied by a higher expression of ER α in fibroblasts. No difference in ER α expression was observed regarding sex. Further studies are needed to clarify the biological and clinical significance of these findings.

Purpose In Germany, neonates undergo hip sonography examination using the Graf method during the routine U3 screening examination, performed by consultant physicians four to five weeks after birth, and are referred to specialized orthopaedic departments if there are any uncertainties. This study evaluated the quality of sonographic screening in the outpatient sector and the treatment requirements of referred children. Methods We performed a retrospective analysis of the patient data of 384 neonates collected in consultations performed between April 2016 and April 2019. Results In total, 74% (n = 284) of neonates presented a hip type Ia/b. Treatment (abduction brace or Fettweis cast) was required in 32% (n = 122) of cases. The treatment duration was significantly correlated with age at first presentation (Pearson's r = 0.678; p = 0.001). The treatment duration for patients aged > 200 days old at first presentation was twice as long as those aged 100 days at first presentation. Patients with public health insurance require referral by a consultant. Developmental dysplasia of the hip as referral diagnosis could not be confirmed in control examination in 64% (n = 132) of cases. Of the public health insured children, 97% (n = 200) were referred through a consultant paediatrician. Conclusion We identified deficits in performing and interpreting the Graf method of ultrasound examination. A total of 64% of referred pathological hips turned out to be physiological configurations in our control examination. The future goal should be to increase anatomical knowledge of the newborn hip and ensure the correct use of Graf ultrasound method. Advanced training courses are recommended and necessary. Level of evidence IV

Fragestellung Minimalinvasive Verfahren werden immer beliebter, um die Rehabilitation und die Fast-track-Chirurgie der gesamten Hüftendoprothese (THA) zu erleichtern. Die NANOS (Smith + Nephew)-Schenkelhalsprothese wurde entwickelt, um ein System mit metaphysären Verankerung und Lastverteilung zu schaffen. Das Implantat erfordert nur eine minimale Knochenresektion. Diese prospektive, multizentrische Beobachtungsstudie wurde durchgeführt, um die langfristige Sicherheit und Wirksamkeit des NANOS-Hüftschafts zu bestimmen. Es werden Fünfjahresergebnisse einer geplanten 10-Jahres-Analyse vorgestellt.

Background Juvenile flexible flatfoot deformity is a common problem in childhood. In severe cases, the subtalar extra-articular screw arthroereisis (SESA) according to De Pellegrin is a viable and effective option. There are just a few retrospective studies showing long-term outcomes, but the interval right after the surgery has not been described so far, even though the short time of healing is one of the great benefits of this technique. In this study, we examined if the pedobarographic measurements are able to demonstrate functional changes in the month after surgery. Methods Data were analyzed for seven patients (13 feet). Measurements were performed before surgery, as well as 3, 14 and 28 days after. For analysis, the foot was comparted in six areas—fore-, mid- and hindfoot, each split in their lateral and medial parts. Plantar forces and contact area were measured under static and dynamic conditions. Time-dependent changes of plantar acting forces and the contact area were compared. Results During bipedal stance, the ground force increased significantly in lateral foot areas ( p < 0.001) and decreased in medial areas ( p < 0.001). While the force in the medial midfoot remained reduced, in the medial forefoot, the force increased 14 days after surgery ( p < 0.05) Conclusion The functional changes after SESA can be accurately assessed using pedobarography. The results indicate morphologic changes of the foot, in particular the development of a longitudinal arch. Post-surgical progression can be monitored and success of the surgery can be verified.

BACKGROUND:The Polarstem (Smith & Nephew, Baar, Switzerland) is a tapered straight stem, an implant with an excellent survival rate. Although the most recent annual report of the National Joint Registry in the United Kingdom also reports excellent survivorship for the cementless Polarstem, no prospective studies have been published focusing on both its efficacy and clinical performance. Therefore, the present study was designed to prospectively evaluate its functional and radiographic outcomes at midterm.METHODS:This prospective observational study conducted at 3 independent orthopaedic hospitals was designed to collect data in patients undergoing cementless primary total hip arthroplasty (THA). A total of 225 total hip arthroplasties (75 at each site) were performed. The predominant diagnosis was primary osteoarthritis. Anteroposterior and lateral radiographs were obtained at each follow-up (3 months, and 1, 3, and 5 years). Survivorship and the Harris Hip Score (HHS) and Western Ontario and McMaster Universities Index (WOMAC) were calculated.RESULTS:Subjects experienced statistically significant improvements from baseline in mean HHS (48.5 to 88.0, P < .01) and WOMAC scores (58.6 to 9.3, P < .01) at all intervals through 5 years. The stem survivorship was 99.6% at 5 years with stem revision due to any reason. There were no observed cases of mechanical failure of the stem or signs of radiographic loosening.CONCLUSIONS:A revision rate of the femoral stem for any reason of 0.4%, as well as good clinical results based on HHS and WOMAC scores, was noted at 5-year follow-up. Therefore, safety and efficacy of the cementless Polarstem at midterm follow-up is confirmed.

Background: A juvenile flexible flatfoot is a common abnormality during growth. For children with a pathological manifestation, subtalar extra-articular screw arthroereisis is a popular operative technique. Although this minimally invasive operation technique has been performed for > 45 years, complications still occasionally occur. For this reason, we created this pilot study to investigate whether a two-dimensional (2D) gait analysis is able to identify functional movement deficits after surgery. Methods: Fourteen children (27 ft) with a mean age of 12.38 years (SD, 1.40 years) were analyzed. Biomechanics were examined before and 4 weeks after surgery using a 2D gait analysis. For this purpose, the patients were filmed on a treadmill. In focus were static and dynamic recordings of the heel angle, rearfoot angle, and the leg axis angle. In addition, the step length and self-selected speed were measured. Findings: After surgery rearfoot angle showed significant reduction (p < 0.001) from 12.49 degrees to 3.63 degrees under static conditions and from 12.65 degrees to 4.58 degrees under dynamic conditions. Heel angle responded similar (p < 0.001). There were no significant differences in self-selected speed or step length. Undoubtedly, gait analysis was able to identify intraindividual deficits, leading to a closer monitoring of five patients and an adjustment of the screw in one foot. Interpretation: By means of the 2D gait analysis, we were able to show functional improvement after subtalar extra-articular screw arthroereisis. Nonetheless, we identified a few children who still had functional abnormalities. Certainly, it is unclear whether this additional examination is able to reveal all complications that would have occurred later.

Since its introduction by Metaizeau and Prevot, elastic-stable intramedullary nailing (ESIN) has been used for almost all diaphyseal fractures in children. Here, we present a retrospective study analyzing the long-term results of ESIN of forearm fractures in children.A total of 122 patients with diaphyseal forearm fractures and single subtypes in childhood were treated from 2000 to 2007 at our University Hospital by ESIN. At follow-up, the current conditions of the patients were evaluated using the Disabilities of Arm, Shoulder, and Hand (DASH) Score, and the Mayo Wrist score. Moreover, an individual questionnaire with 16 items was used to collect further information about the patient's condition and limitations as adults.The evaluation was performed at 12.4 years (average) after surgery. In our study population (n = 90), the average DASH scores for sports, performing arts, and work were 0.4 (standard deviation: 1.45), 0.9 (standard deviation: 5.68), and 0.3 (standard deviation: 7.39), respectively. Furthermore, 77% of our patients achieved a DASH Score of 0 (optimum outcome). The average Mayo Wrist Score was 97.64 (standard deviation: 7.39), and 82% of the study population achieved a score of 100 (optimum outcome). A correlation between the DASH and Mayo Wrist Scores was found in few patients. Overall, the DASH Score, Mayo Wrist Score, and results of our individual questionnaire demonstrated convincing point values.This study demonstrated favorable long-term results achieved by ESIN of forearm fractures in children. It seems that good outcomes, reported by various studies with short- to mid-term follow-up beforehand, do not deteriorate over time.Level of Evidence: Level III; retrospective study; therapeutic study.

Parents whose children are affected by systemic diseases, anomalies, deformities, or further orthopedic defective positions use the Internet to increase their knowledge. However, there have been few studies that focus, as this one does, on Internet enquiries done before the parents contact the pediatric orthopedic surgeon. This study analyzed data gathered through a standardized questionnaire on general habits of Internet use, parents’ hardware, age, and educational background of the parents. A total of 521 questionnaires were completed for a response rate of 96%. One-quarter of parents (n = 127) attended the consultation because of a gait anomaly or foot deformity, followed by children with DDH (20%, n = 99), clubfoot (9%, n = 47), and scoliosis (6%, n = 29). Parents of children with clubfoot were especially likely to look for health information online (84%, n = 38), followed by parents of children with scoliosis (69%, n = 20), with DDH (67%, n = 66), and with foot deformity/gait anomaly (49%, n = 62). Most people (97%, n = 295) using the Internet for health research purposes made use of a search engine. Concerning use of social media, respondents with clubfoot children were the most numerous (38%, n = 18). There were 35 parents who intended to discuss the results of their Internet research with the pediatric orthopedic surgeon. Most (84%, n = 254) of the respondents who used the Internet for health research planned to do so again.

Background Several studies have investigated motor and cognitive skills in infants as well as gross motor abilities in schoolchildren treated for congenital idiopathic clubfoot, mostly indicating specific impairments in those children. However, until now, little is known about the motor and cognitive abilities of preschool children treated for idiopathic clubfoot. Thus, it was the aim of this study to examine gross motor, fine motor and cognitive skills of 3-year-old-children treated for idiopathic clubfoot. Method We tested gross motor, fine motor and cognitive functioning of 10 children treated for idiopathic clubfoot and 10 typically developing children at the age of 40 months (SD = 1) with the Bayley Scales of Infant and Toddler Development. Results The children treated for idiopathic clubfoot showed a slight delay in gross motor development. In particular, they demonstrated difficulties in tiptoeing, walking upstairs and walking downstairs. Moreover, we found some slight deficits in cognitive development, particularly in visual-spatial memory. Discussion Children treated for idiopathic clubfoot appear to have an increased risk of gross motor and spatial cognitive deficits. Orthopedic pediatrics should incorporate measures of gross motor functioning, for example tiptoeing, in their orthopedic setting. Moreover, future studies are needed to clarify whether the observed deficits persist through childhood. If so, some kind of a motor training for children with idiopathic clubfoot might be required.

The aim of this investigation was to analyse “total blood loss” (TBL), “blood transfusion rate” (BT) and the “amount of transfused blood units” (BU) between the different primary shoulder arthroplasty (SA) types: reverse, anatomical and stemless. Only primary SA was included. Further goal was to identify risk factors for TBL, amount of BU and BT rate.

BACKGROUND:There have been few publications on the organisational structures of self-help groups that handle orthopaedic disorders in children. MATERIAL AND METHODS:A standardised questionnaire was sent by post to the corresponding support groups. The aim was to evaluate the self-help group's structure, use of social media and financial background. RESULTS:Support groups for dwarfism, infantile cerebral palsy and Down syndrome responded and sent the questionnaire back to our department. Most self-help groups were incorporated societies and belonged to an umbrella organisation. The founding year was predominantly in the decade 1990 - 2000 (n = 15). The founders were predominantly parents (n = 28; 77.8%), concerned individuals (n = 11; 30.6%) and - in two cases - physicians (5.6%). 29 support groups (80.6%) received donations for financial support. The aims, activities, and manner of contact were presented in the home page (n = 35; 97.2%). Most self-help group focussing on paediatric orthopaedic disorders cooperate with physicians in different specialisations to obtain information and recommendations. CONCLUSIONS:The study presents the first information on self-help groups and documents the multidisciplinarity of paediatric orthopaedics. Close collaboration between paediatric orthopaedic surgeons and regional support groups might contribute to the reduction of uncertainty and fears and improve of medical provision.

It was the aim of this study to examine the motor and cognitive development of infants with congenital idiopathic clubfoot, compared with typically developing infants. We repeatedly tested the gross motor, fine motor, and cognitive abilities of 12 infants with clubfoot and 12 typically developing infants at the ages of 4, 6, 9, and 12 months with the Bayley-III Scales. All infants with clubfoot were treated with the Ponseti method, which led to a restriction of normal movements of the lower extremities in the first months of life. They showed a great delay in gross motor development but not in fine motor or cognitive development. However, in the clubfoot group, we found some slight deficits in specific cognitive tasks, including problem solving and spatial memory. In addition, our results revealed significant correlations between gross and fine motor performance and cognitive performance in the control group but only between fine motor and cognitive performance in infants with clubfoot, indicating that both, fine and gross motor skills, are related to cognitive processes and can mutually replace each other to a certain degree. Further research is needed to gain a deeper understanding of clubfoot infants’ development and to clarify the need for mobility training.

The internet has become one of the most important sources to obtain medical and health information. Parents, whose children are affected by systemic diseases, anomalies, deformities or further orthopaedic defective positions, use the internet to increase their knowledge. There is a lack of studies with focus of parental enquiries in the internet before contacting the pediatric orthopaedic surgeon. This study shows current trends and also allows a follow up. Parental internet search was evaluated using a standardized questionnaire. General habits of internet use, local hardware equipment, age and educational background of the parents were analyzed. In particular, parental use of general medical websites, use of search machines like Google or Yahoo or the use of homepages from support groups was asked. A total of 521 questionnaires were completed, this corresponds to a response rate of 96%. One quarter of parents attended the consultation because of a gait anomaly or foot deformity, followed by children with DDH (20%), club foot (9%) and scoliosis (6%). 87% of parents use a Smartphone to get internet access, 68% a Laptop, 55% a Tablet and 45% a Laptop. Especially parents with children with clubfoot looked for health information online (80%), followed by scoliosis 69% (n=20), DDH 67% (n=66), foot deformity / gait anomaly 49% (n= 62). 98% of those using the internet for health medical purpose made use of a search engine, 99% (n=291) of internet users searched through Google, with 44% (n=129) of them describing their research helpful. Concerning use of social media responders of clubfoot children were again the most numerous in number (38%, n=18). 10 of them stated to have exchanged with other social media users and 60% of them evaluated social media as helpful. There were 35 parents who intended to discuss the results with their pediatric orthopedic surgeon. 84% of the responders who used the internet for health research would return to the internet. This study documents that the internet is an important source of information for parents or caregivers in the field of pediatric orthopedics and that the meaning goes even further. Treating physicians will increasingly be confronted with the results of internet research. In particular, parents whose children suffer from club feet frequently research the Internet. The study was conducted in accordance with the principles laid down in the Declaration of Helsinki. Prior to the investigations, an approval was secured by the local board of ethics on 8 of September 2017 (AZ 107/17).

BACKGROUND:Knee and hip replacement surgery are still the mainstay therapy for osteoarthritis. In spite of the improvement of techniques and implants, anemia is a relatively common complication, with transfusion rates of up to 23% in some centers.OBJECTIVE:The purpose of the study was to determine a correlation of transfusions to complications including infection since this topic is still being debated or even disputed in the literature.METHODS:This is a level III, single center retrospective observational cohort study of 2760 unilateral primary knee and hip replacements. Preoperative assessment, the number of transfusions and the occurrence of complications were collected and the correlations were analyzed using analysis of variance and logistic regression.RESULTS:Fifteen percent of all patients developed at least one complication. Transfusion rate was 9%. Risk factors for receiving a transfusion were female gender, hip replacement, American Society of Anesthesiologists' Score (ASA) > III, history of myocardial infarction, chronic cardiac disease, diabetes mellitus, chronic kidney disease, and length of surgery. The risk factors for developing a complication were: ASA score, presence of chronic renal insufficiency, and transfusion during hospital stay. Transfusion increases the risk of complications and infection rate. Complication rate with transfusion was 34.7% and without transfusion 13.2%. Infection rate without transfusion was 0.4% and with transfusion 2.82%.CONCLUSIONS:The complication rate is higher in transfused patients. The number of complications rises linearly with the number of transfusions. Infection rate is also higher after a transfusion. Efforts should be made to reduce the transfusion rate.

The aim of this study was to examine the link between joint attention skills and locomotor experiences in infants with locomotor delay due to congenital idiopathic clubfoot compared to typically developing infants. Using a following of point and gaze gesture task, we repeatedly tested joint attention skills of 11 infants with congenital idiopathic clubfoot and 14 typically developing infants at the ages of 6, 9, and 12 months. Additionally, we tested all typically developing infants and eight infants treated for idiopathic clubfoot at onset of crawling on hand and knees and after they had been crawling for about 5 to 6 weeks. Our results confirmed a delayed onset of locomotion in infants treated for idiopathic clubfoot; however, our results did not indicate lower joint attention performances in those infants in general. Moreover, we found a positive effect of crawling on the development of joint attention skills in typically developing infants; however, not in infants treated for idiopathic clubfoot. Our results complement previous work by indicating that locomotor experience, especially crawling is an important, however not necessary agent for developing joint attention skills.

Background:In foot and ankle surgery, the calcaneus serves as an established harvest site for autogenous grafts.As described in current literature, the procedure is associated with a low complication rate of 0 to 13.8%.But, only small amounts of bony material are harvestable by a lateral approach that has not been standardized until now.Moreover, the current technique neither considers the material quantity nor the material quality within the calcaneus.Our study was designed to determine the calcaneal area providing the highest density values in Hounsfield units (HU) in order to harvest more material while causing less damage to the bone. Methods:In 402 eligible sagittal foot and ankle CT scans, the calcaneus was divided into areas I, II, III and IV on the basis of anatomical landmarks.HU values were obtained per area and per measuring slice.Additional peculiarities, such as the location of the neutral triangle, were also recorded. Results:The average density value was 284 HU for area I, 185 HU for area II, 183 HU for area III and 173 HU for area IV.Age-dependent as well as ageindependent density values were significantly higher in area I than in areas II to IV (all p < 0.0001).When comparing HU values of all males (215; 53.5 %) to HU values of all females (187; 46.5 %), no significant difference was found for areas I and II (both p = 0.9995). Conclusion:Our study revealed that area I is the best harvest site for the retrieval of cancellous autografts of the calcaneus, regarding the available material.Thus, the current lateral approach needs to be modified: a lateral-superior approach or a dorsal approach might be conceivable.Further research on consequential complications and biomechanical impacts is required.