A correction to this paper has been published: https://doi.org/10.1007/s12306-021-00717-8

Background: There is a trend for using jumbo cups/oblong devices for acetabular reconstruction as alternative to biological solutions. We report about a spectrum of reconstruction methods and their mid-term results. Methods: Inclusion of 214 consecutive patients undergoing total hip arthroplasty revision surgery. Patients were examined using the Harris Hip Score (HHS). Based on the intraoperative acetabular defect situation, cases were classified into 1 of 5 possible categories of a stability classification for acetabular replacement (SCAR). Results: Mean HHS improved from 42 preoperatively (range 12-62) to 77 (range 54-90;p< 0.05) 6 months after operation. There were significant differences of the pre-and postoperative HHS between SCAR subgroups (p< 0.05). Inter-observer reliability of the SCAR was high (kappa 0.94 (95% CI, 0.90-0.98)). Re-revision was performed in 15 cases (7%). Conclusion: The SCAR classification is a practicable tool for intraoperative decision-making as it provides standardised treatment recommendations.

To introduce a (semi-)quantitative surgical score for the classification of rotator cuff tears.

In primary total hip arthroplasty in patients affected by congenital dysplasia of the hip, stabilisation of the cup because of the altered shape of the acetabulum presents a problem. We have obviat...

Aims and Objectives: This study intended to develop a new surgical approach combining easy operative handling as well as high functional outcomes for the reconstruction of the ACL. Materials and Methods: For the substitution of the ACL we use a Bone-tendon-bone auto-graft. After resecting the transplant from its original position and the mobilization of the Hoffa body the surgeon has an optimal sight onto the site of damage. During the whole intervention, the joint capsule is not resected. Results: In the time between September 2009 and January 2012 we treated 24 consecutive patients using this approach. Patients were evaluated using the Lysholm and the IKDC Score. Before the intervention patients scored 48, 6 ± 7, 4 resp. 43, 0 ± 4,8. After 36 months patients’score improved to 97, 1 ± 2, 6 resp. 96, 8 ± 2, 4; p = 0,037). Conclusion: Easy handling and precise placement of the graft demand the consideration of this technique as a standard treatment option.

Arthroscopic procedures for ruptured anterior cruciate ligament (ACL) tears are a common standard. However, there are strong alternatives to this standard. The purpose of this study is to present a precise, fast, and minimally invasive but open procedure for reconstruction of the ruptured ACL. The torn ACL is substituted by a widely used bone–patellar tendon–bone (BPTB) autograft. After the BPTB graft has been harvested, the Hoffa body is exposed and mobilized ventrally. The surgeon then has a free view of the remnants of the torn ACL, which are to be removed completely. Through the tibial and femoral footprints of the ACL, a tunnel is drilled under a direct view, thus ensuring optimal anatomic positioning of the BPTB graft. The described approach is simple in handling and advantageous because all steps are performed under a direct view, which improves overall precision and intraoperative functional control.

Background Since the first publication concerning osteoinductive proteins by Urist in 1965, much progress in the identification, characterization and clinical use of these growth factors has been made in orthopaedics. Methods From June 2004 to July 2006, we led a randomized prospective study with 120 cementless hip joint arthroplasties. Sixty hip replacements were performed by the same senior surgeon using an osteoinductive gel placed on the fixation surface of the implants. We compared these patients with 60 patients who had hip replacements without osteoinductive material (control group). The gel contains three elements: cancellous bone chips, platelet-rich plasma and bone marrow. Blood loss, operation time, hemoglobin drop values and clinical results were collected, and statistical analyses were done. Dual energy x-ray absorptiometry (DEXA) analysis also was performed. Results There was a statistically significant difference in the operation time, while the blood loss was statistically significantly less in the group treated with gel. The Harris Hip Score moved from an average of 43.5 points preoperatively to 82.9 points at 40 days, 89.8 points at 3 months, 92 points at 6 months and 93.7 points at 12 months in the study group. For the control group the preoperative values were 41.2 points and moved to 74.1 points at 40 days, 80.7 points at 3 months, 85.4 points at 6 months and 93.9 points at 12 months. At 40 days, 3 months and 6 months follow-up, statistically significant differences were measured (P<0.0001). At 1 year no more significant differences were noted. DEXA data showed a faster osteointegration within 40 days in the study group. No complications such as dislocations, deep vein thrombosis, infection, stem subsidence, or mobilization were observed. Conclusions Our procedure shows a faster clinical and functional recovery using osteoinductive gel without major complications. The procedure is safe because it includes only autologous factors without risk of disease transmission or immune response.

In order to avoid the disadvantages of a fixed axis the newly-designed knee-joint prosthesis was equipped with a sliding one. This is not a load-bearing component; its main purpose is to guide the movement of the endoprosthesis. The design permits almost physiological movement, thus diminishing the detrimental forces at the anchor points. To further improve anchoring the shafts of the prosthesis were designed with an anatomical cross-section. The design of the anatomical sliding-axis prosthesis is described and the results of the first 36 implantations are presented.

The pathologies of the hip (epiphisiolysis, Perthes, congenital dysplasia) cause invalidating outcomes in young patients. In the years many authors searched for the golden standard if total hip arthroplasty is necessary. From Smith-Petersen to McKee, to Amstutz the saving of the femoral neck has been the main objective, with the longevity of the system. Therefore the combination metal-metal has been used for articular components, because the friction of metallic components creates sub-micron metallic particles causing only minimal foreign body reactions andvery low wear rates. Our study group (Arthro Surgery Group) has implanted, from April 2003, 28 cementless resurfacing hip prosthesis with metal-metal articular components. The average follow-up has been of 6 months (from 3 months to 1 year). In all cases, the Harris Hip Score has been good or excellent (from 77 to 100), and radiographic exams didn’t show signs of radiolucence or resorption. This type of prosthesis allows moreover an minimum-invasive approach to the hip and a second line of defense in case of revision.

The improvement of the anchorage surfaces of the total hip arthroplasty (THA) has allowed a better bone integration of the stem and of the cup more durable in the time and often more advanced to the duration of those articular components subject to wear. In case of lesion of one of these components, our study group (Arthro Surgery Group) has created a standard protocol for the revisions of total hip arthroplasty with well fixed stems and shells (PIT-STOP). We operated 22 patients with THA more than 10 years ago after the first implantation. The average HARRIS HIP SCORE post-op is 92 in 1 year follow-up. The X-rays exams are excellent. In case of wear of the polyethylene liner or of the head, we proceed to the substitution of the components if available and if the fixation mechanism is not damaged. In case of old designed THA, with articular components not available (polyethylene liner for the cup and ceramic or metal head), we use the liner fixation by cementation into the well fixed original metal back and a new head. If an alteration or an anomalous size of the neck is evidenced, we put on a metallic special device of measure adapted (taper case) on which we put a new ceramic head. In case of fracture of a ceramic head, we remove all the fragments and put on the prosthetic neck a new ceramic head with the metallic special device (taper case), after many washing and radical sinoviectomy.

Endoprothetischer Gelenkersatz der Hüfte unter größtmöglicher Erhaltung der Schenkelhalslänge. Wiederherstellung einer schmerzfreien Gelenkfunktion.

BACKGROUND:In an anatomical study we investigated the medial approach to the hip joint and developed the surgical technique for patients with hip joint replacement.MATERIAL AND METHODS:The temporary detachment of the adductor longus tendon allows a perfect exposure of the surgical site without risk of damaging important structures.RESULTS:The operation is possible with normal instruments. The blood loss is little.CONCLUSION:The abductor apparatus (gluteal muscles and fascia lata) and the superior gluteal nerve remain intact. Immediate lateral positioning is allowed after surgery. The scar is unremarkable.

Bionic systems are aiming to integrate natural observing into mechanical solutions. This has been realized in the design of metal on metal bearing in total hip resurface arthroplasty. The articular side of the femoral cup is covered with a dimple like surface. Under laboratory condition this so called "surf-metal-cup" achieved a reduction of the mechanical wear to almost a third part in comparison to a metal-cup with plane surface. This advantage, caused by the reduced friction-coefficient due to improved hydrodynamic lubrication could also be proved under laboratory conditions. The clinical introduction is expected to offer a significant extension of durability in this prosthetic system and needs to be proved in a long-term study.

An uncemented implanted acetabular cup must ensure primary stability and postoperative osteointegration. For both conditions the immediate postoperative contact between bone and the structured surface of the cup is of decisive importance. Two different types of acetabular cups manufactured by ESKA (standard model and Kapuziner model) were implanted in the innominate bones of elderly deceased persons. After plastination, thin serial sections were obtained. On the basis of X-rays of these sections, contact between bone and the reticulate surface of the cups was quantified. The quality of the contact was analysed densitometrically.

Direkter Zugang zum Hüftgelenk mit guter Sicht über den Situs ohne Gefahr der Schädigung wichtiger Strukturen (Gefäße, Nerven, Muskeln).

The ESKA femoral neck endoprosthesis (CUT) is a mini endoprosthesis anchored in the metaphysis for surgical management of young arthrosis patients with good bone quality. The necessary surgical intervention can be considered minimally invasive and adequate because only the affected femoral head is removed. The preserved femoral neck is used for fixation of the endoprosthesis to obtain proximal physiological force transmission and avoid stress shielding. Since the diaphyseal marrow cavity is not opened, the procedures entail decidedly less blood loss. Should the need arise to change the endoprosthesis, an endoprosthetic stem anchored in the diaphysis can easily be implanted after resection of the femoral neck near the base.