Introduction: Infections associated with prosthetic joints cause significant morbidity and account for substantial costs for health care systems. The management of prosthetic joint infections is less standardized, because of the variable clinical presentations and the lack of data from randomized, controlled trials.

We evaluated the results of surgical one stage versus two stage exchange of patients diagnosed positive for prosthetic infection following total hip replacement in correlation with a classification described by Mc Pherson.

Material and Methods: 94 patients were diagnosed positive for prosthetic joint infection following total hip replacement in the years 1995 to 2004: gender distribution was 45 male and 49 female patients. 37 patients were treated with a one stage exchange, 57 patients underwent a two step procedure. Patients were further divided into two groups following the mentioned classification described by Mc Pherson as infection type I+II and III. Further characterisation was performed following systemic host grade (A versus B+C) and local extremity grade 1 versus 2+3.

Results: Eradication of prosthetic infection was achieved in 94, 5% (n=52) within the group of two stage exchange and 56, 8% (n=21) of patients treated with a one stage procedure. Outcome of patients following a one stage or a two step exchange was overall significantly different with p< .001. Further deviations between the described two procedures were noted in the subgroups following the classification described by Mc Pherson. A benefit of patients who underwent a two step procedure was seen according the severity of the classification following Mc Pherson.

Conclusion: Eradication rate of prosthetic joint infections differs statistically significant overall and in the subgroups following Mc Pherson in dependence of the surgical procedure. For this reason the individual surgical procedure should be geared to an algorithm, following the classification described by Mc Pherson.

Introduction: Prosthetic joint infections occur in 1–2 % following total knee replacement. Different options of treatment are described in literature with a lack of data from randomized, controlled trials.

We classified septic revision surgeries following total knee according to a classification published by Mc Pherson. Eradication rate of one stage versus two stage exchange was compared.

Materials and Methods: We included 74 patients who underwent septic revision surgeries following total knee replacement in the years 1998 to 2005. Gender distribution was 42 female and 32 male patients. The mean age at revision surgery was 71 years, at primary implantation mean 68,8 years.

Results: The eradication rate overall was 77 %, in one stage exchange 41.7% and in two stage procedures 86%. Multiple stage revision showed an eradication rate of 75%, necrectomy/debridement 50%, arthrodesis and amputation 100%.

Regarding Mc Pherson’s systemic grades classification the eradication rate for two stage exchanges was 85,7% in group A+B and 60%% in group C. One stage procedures achieved 0% eradication rate in group B and 60% in group C. Regarding Mc Pherson’s local extremity grade classification eradication rates within two stage revisions were 84% in group 2 and 75% in group 3. One stage revision achieved 40% and 0%.

Conclusion: Although two stage revision surgeries achieved better results regarding eradication rates then one stage revision surgery, results were statistically not significant. Reason could be a too small number of included patients for a significant statistical impact. The individual surgical procedure should orientate on the classification published by Mc Pherson.

Introduction: Despite advances in radiotherapy and chemotherapy, metastatic disease of the spine remains a challenging situation for spinal surgeons. An individual therapy should be chosen to provide the maximum palliative effect (reduction of pain, restoration of stability and function) with a minimum of operative morbidity and mortality. Predicting prognosis is the key factor in selecting the proper treatment. Therefore, various assessment systems have been designed in order to provide a basis for deciding the course of treatment. Such systems have been proposed by Tokuhashi, Sioutos, Tomita, Van der Linden, and Bauer. The scores differ greatly in the kind of parameters assessed. The aim of this study was to evaluate the prognostic value of each score.

Patients and Methods: Eight parameters were assessed for 69 patients (37 male, 32 female): location, general condition, number of extraspinal bone metastases, number of spinal metastases, visceral metastases, primary tumour, severity of spinal cord palsy, and pathological fracture. Scores according to Tokuhashi (original and revised), Sioutos, Tomita, Van der Linden, and Bauer were assessed as well as a modified Bauer score without scoring for pathologic fracture.

Results: Nineteen patients were still alive as of September 2006 with a minimum follow-up of 12 months. All other patients died after a mean period of 17 months after operation. The mean overall survival period was only 3 months for lung cancer, followed by prostate (7 months), kidney (23 months), breast (35 months), and multiple myeloma (51 months). At univariate survival analysis, primary tumour and visceral metastases were significant parameters, while Karnofsky score was only significant in the group including myeloma patients. In multivariate analysis of all seven parameters assessed, primary tumour and visceral metastases were the only significant parameters. Of all seven scoring systems, the original Bauer score and a Bauer score without scoring for pathologic fracture had the best association with survival (P < 0.001).

Conclusion: The data of the present study emphasize that the original Bauer score and a modified Bauer score without scoring for pathologic fracture seem to be practicable and highly predictive preoperative scoring systems for patients with spinal metastases. However, decision for or against surgery should never be based alone on a prognostic score but should take symptoms like pain or neurological compromise into account.

Problem: There are known numberous surgical treatments for problems of arthrotic ankle-joints. Recently there is comeing up more and different kind of arthroplasty. The overall aim is to create good axis, stable situation and full weight-bearing situation without pain for a long time.

Our technique is a single anterior surgical aproach and internal fixation with 2 cannulated percutaneous titanium screws.

This procedure allowes both in young active persons and in cases after failed surgery a good and recomendable solution with early weight-bearing and durable results without following surgery.

Method and Results: We present our follow up results of 40 Patients in paired samples tests and VAS at minimum 24 month.

Difficult revisionsurgery and degenerative cases are shown in pictures. Cases of Revision after Arthroplasty are done.

Facit: In our hands this procedure is the standard procedure. We can reach the aim of good, safe and longterm standing results. The biomechanical positioning is mandatory. The overuse of following joints is not clinicly relevant and reduceable by wearing adapted shoes.

Even in cases of revisionsurgery after arthroplasty the modification with “malleolus lateralis-Interposition” is a good possbility to reach functionally good results without loosing height at safe softtissue.