Due to the increasing life expectancy the incidence of gonarthrosis, the degeneration of articular cartilage and bone in the knee joint, is increasing worldwide. Although the success rate of knee arthroplasties is high, complications like the loosening of the implant necessitate subsequent treatments. Moreover, the morphology and microstructure of the knee joint varies considerably between patients, therefore the anatomical expertise of orthopedic surgeons is essential. In this analysis we therefore investigate the variation and micro-architectural alterations in subchondral bone in osteoarthritis (OA) patients undergoing a knee replacement surgery.

We investigate OA bone degenerations using clinical X-rays and micro-computed tomography (micro-CT). Tibial bone samples are collected from 100 patients undergoing a total knee arthroplasty at the Klinikum Wels-Grieskirchen. Images are obtained using an industrial micro-CT scanner RayScan 250E. Microstructural parameters include bone volume fraction and cortical thickness of the subcondral bone and are obtained from micro-CT images with isometric voxel sizes of 50 µm.

Using micro-CT, we show a high morphological variation in relation to cortical thickness, both within the respective condyle as well as between the medial and lateral condyle. Cortical thickness seems to correlate with cartilage thickness and knee joint alignment. The results are incorporated into a gonarthrosis database that integrates microstructural parameters via a combined analysis of X-ray and micro-CT data. This database aims to facilitate the assessment of osteoarthritis, i.e. in relation to cartilage degeneration, in future patients on the basis of the investigated patient collective.

Background

Innovative developments for total knee arthroplasty enhanced anatomical design and fixation in order to decrease particle-induced aseptic implant loosening. As hypersensitivity reactions to metallic implant materials have been recognized to possibly cause premature implant failure, ceramic materials might constitute a proper alternative solution. The aim of this prospective short-term study was the initial comparison of a completely metal-free ceramic with a geometrically identical metallic arthroplasty over a one-year follow-up period.

Introduction

Today TKR is considered one of the most successful operative procedures in orthopedic surgery. Nevertheless, failure rates of 2 – 10% depending on the length of the study and the design are still reported. This provides evidence for further development in knee arthroplasty. Particularly the oxide ceramics used now in THA show major advantages due to their excellent tribological properties, their significantly reduced third-body wear as well as their high corrosion resistance. A further advantage of ceramic materials is their potential use in patients with metal allergy. Metallic wear induces immunological reactions resulting in hypersensitivity, pain, osteolysis and implant loosening. The purpose of our study was to examine the safety of the tibial component of a novel all-ceramic TKR.

Neuropathic changes in the foot are common with a prevalence of approximately 1%. The diagnosis of neuropathic arthropathy is often delayed in diabetic patients with harmful consequences including amputation. The appropriate diagnosis and treatment can avoid an extensive programme of treatment with significant morbidity for the patient, high costs and delayed surgery. The pathogenesis of a Charcot foot involves repetitive micro-trauma in a foot with impaired sensation and neurovascular changes caused by pathological innervation of the blood vessels. In most cases, changes are due to a combination of both pathophysiological factors. The Charcot foot is triggered by a combination of mechanical, vascular and biological factors which can lead to late diagnosis and incorrect treatment and eventually to destruction of the foot.

This review aims to raise awareness of the diagnosis of the Charcot foot (diabetic neuropathic osteoarthropathy and the differential diagnosis, erysipelas, peripheral arterial occlusive disease) and describe the ways in which the diagnosis may be made. The clinical diagnostic pathways based on different classifications are presented.

Cite this article: Bone Joint J 2016;98-B:1155–9.

Introduction

Total knee arthroplasty (TKA) is the second most common and successful joint replacement in orthopedics. Due to long-term results the problem of aseptic loosening, implant failure and hypersensitivity to metal ions remain. Therefore the introduction of a new TKA with ceramic tibial and femoral components is introduced.

A large number of short stem prosthesis for hip arthroplasty has been introduced in the last years. The main aim of this device is to preserve the proximal bone stock in order to facilitate revisions in the future. Furthermore there is an increase in young and active patients in total hip arthroplasty that's why it's important to consider minimally invasive, muscle-considering procedures. Short stems allow to make minimal invasive approaches easier and improve the biomechanical reconstruction. However, there is a large increase of publication about short stems there is still little data about survival and revision rates. We report about the outcome of 81 patients, who have recieved NANOS short stem prosthesis between October 2012 and April 2014. The average age of the patient was 61,6. The oldest patient was 78 years old and our youngest patient was 41 years old. The main diagnoses were osteoarthritis in 67 patients, dysplastic osteoarthritis in 8 patients and avascular necrosis of the femoral head in 6 patients. We have included 37 female patients and 44 male patients. 3 patients had the surgery on both sides. The average operating time was 75,2 min ± 20,1 min and the average grading of patients for surgical procedures of the American Society of Anesthesiologists was 1,8±0,7. The patients were hospitalized 9,6 days ± 2,9 days. The average BMI was 28,2±5,2. Along with demographic data and co-morbidities, the Harris Hip Score was recorded pre-operatively and at follow-up. The Harris Hip Score increased from 36,6 ± 14,5 pre-operatively to 94,5 ± 8,8 at the final follow-up.

None of the 81 stems were revised this corresponds to a to a survival rate of 100%. Two of the patients suffered from a hip dislocation which was treated in both cases conservative. In further consequence unfortunately one of those patients thrombosed and suffered from a pulmonary embolism. The x-rays haven't shown any radiolucent lines in any patients.

All in all our patients reported about an high post-operative satisfaction. The clinical and radiographic results encouraged us to continue to use short stems with metaphyseal anchorage. However, there must be more long-term results to confirm our excellent mid term results.

Introduction

Presentation of our outcome in implant survival and clinical function using rotating-hinge knee prosthesis in revision total knee arthroplasty.

Summary Statement

Treatment of non-union is a highly demanding field with respect to bone healing. BMP 7 is a useful, wide-ranged tool in treating non-union of the foot and benign bone tumors. It represents a low-risk procedure with a high level of reliability.

Summary Statement

RANK is expressed in 18% of human osteosarcomas and is likely to provide additional prognostic information for clinical purposes in osteosarcoma patients at the time of diagnosis.

It is the aim of this study to investigate the influence of the age of vertebral fractures on the clinical and radiological outcome of balloon kyphoplasty. All data were recorded prospectively at each visit (admission, postoperatively, discharge) and no patient was lost. 92 Patients (27 male, 65 female, mean age 67,2 years, mean body mass index 26,4) with 102 vertebral fractures (84 patients had one fracture, six had two and two had three fractures) were included in this study. All fractures were type A of the AO-classification (29 were A1.1, 34 were A1.2, 36 were A1.3, 2 were A3.1 and one was A2.3). Radiologically verebral body height, kyphosis angle, kyphosis index, compression index and bone cement application were evaluated. Clinically pain intensity (VAS 0-10), pain medication consumption (WHO 1-3) and surgical specific data were documented. The age of the vertebral body fracture was less than one week in 23 patients, between 7 and 14 days in 22 patients and more than 14 days in 57 patients. The mean surgical time was 43 minutes with a mean cement volume of 3,3 ml. A significant reduction of the kyphosis angle and index and an increase of the verebral body height could be documented. Pain medication consumption was reduced from 1,8±0,9 preoperatively to 1,2±1,1 at discharge. A significat reduction of pain intensity was observed (8,2±1 preoperatively vs. 3,9±2,5 at discharge). The most intense pain reduction at discharge was seen in fresh fractures (ifracture age < 7 days 2,4±0,5, 7–14 days 4,0±0,6, > 14 days 4,4±0,3; p< 0,005). Balloon kyphoplasty is a reliable method to reduce vertebral body fractures. A pain reduction can be achieved in all cases, but pain is mot effectively reduced in fresh treated fractures.

We retrospectively compared wrist arthrodesis using the Mannerfelt technique in 19 or an AO-plate in 23 patients with long-standing rheumatoid arthritis. The mean follow-up was for 76 months.

Compared with the Mannerfelt fusion group, patients in the AO-plate group reported greater satisfaction with their wrist function (74% vs 37%, p = 0.015). Complications were reported in six wrists in the AO-plate group and two wrists in the Mannerfelt fusion group (p = 0.258). At final follow-up, 95% of patients (41) reported either no pain or only mild pain. There was improvement in flexion of the finger joints in both groups but no significant improvement in the extension lag in either group.

Both methods relieve pain and improve function. Overall, the activities of daily living scores and the patients’ subjective assessment of outcome tended to be higher in the AO-plate group than in the Mannerfelt fusion group, although the difference was not statistically significant. Similarly, although more postoperative complications occurred in the AO-plate group, the difference between the two groups was not statistically significant.

Aim: The purpose of this study was to describe the prevalence, recurrence rate and disease-free interval of aneurysmal and juvenile bone. Methods: A analysis of 141 cases of cystic bone lesions recorded in the Vienna Bone Tumor Registry between 1970 and 2000 was performed. 73 aneurysmal and 68 juvenile bone cysts were registered. 128 (92%) cases were managed by intralesional curettage and adjunctive chemical cautery with phenol followed by bone grafting. Seven cases (4%) were treated by single curettage, in four cases (2.8%) a marginal enbloc resection was performed and two (1.2%) cases were treated by intracystic injections of methylprednisolone acetate. All patients were followed up for a mean of 36 months (range, seven to 144 months) with frequent clinical and radiological examination. Results: The annual prevalence of aneurysmal bone cyst was between 0 and 1.238 per 105 individuals and for juvenile bone cyst between 0 and 0.963. The median age was 11.1 years (range 1– 19.7 years) with a male to female ratio of 1:1.81 for aneurysmal bone cyst and 10.4 years (range 0.5–19.9 years) and a rate of 1:1.96 for juvenile bone cyst. The cumulative probability of a survival without months after surgery was 0.83 (95% confidence interval, 0.77 to 0.90) for aneurysmal bone cyst and 0.79 (95% confidence interval, 0.69 to 0.90) for juvenile bone cyst. Conclusion: We think that the intralesional curettage with additional phenol induced cautery followed by bone grafting provides excellent results and is a successful and sufficient procedure in the therapy of these non-neoplastic bone lesions.