Painful Arthrosis Research Articles

Update: Endoprothetik am oberen Sprunggelenk

The ankle joint has to bear the entire body weight on arelatively small joint surface. Incongruities, instabilities and deformities lead to painful arthrosis and considerable restrictions in everyday life. For many years, arthrodesis has proven to be the gold standard for end stage arthrosis; however, considering modern endoprostheses for the ankle joint it is no longer appropriate to offer only arthrodesis. The very good results of the 3rd generation 3‑component prostheses and the 4th generation 2‑component prostheses show how much the surgical treatment options for the ankle joint are currently changing. The simplified implantation techniques enable access to arthroplasty of the ankle joint for abroader spectrum of surgeons and explain the increasing implantation rates in recent years. Decisive for postoperative success are correct planning with knowledge of the leg axes and foot position, correct patient selection and exact surgical placement of the components.

Prospective Evaluation of Low-Dose External Beam Radiotherapy (LD-EBRT) for Painful Trapeziometacarpal Osteoarthritis (Rhizarthrosis) on Pain, Function, and Quality of Life to Calculate the Required Number of Patients for a Prospective Randomized Study.

Background: Retrospective studies have described the effectiveness of low-dose radiotherapy (LD-EBRT) in painful arthrosis of small finger joints, but two recent prospective studies have yielded ambiguous results. To generate accurate data for the planning of a trial, we conducted a prospective, monocentric, observational study to describe the effects of LD-EBRT as precisely as possible. Methods: Twenty-five consecutive patients with symptomatic trapeziometacarpal (TMC) arthrosis were irradiated with 6 × 0.5 Gy. Before, 3, and 12 months after LD-EBRT, we assessed subjective endpoints (modified “von-Pannewitz score”, 10-point visual analogue scale (VAS), “patient-rated wrist evaluation” (PRWE)), and objective measurements (“active range of motion” (AROM), Kapandji index, grip strength, pinch grip). Results: At 3/12 months, 80%/57% reported partial and 4%/18% complete remission according to the “von-Pannewitz” score. VAS “overall pain” significantly decreased from a median of seven (IQR 4) at baseline to three (IQR 6; p = 0.046) and to two (IQR 2; p = 0.013). Similar results were obtained for VAS “pain during exercise”, VAS “pain during daytime”, and VAS “function”. “PRWE overall score” was reduced from 0.5 at baseline (SD 0.19) to 0.36 (SD 0.24, p = 0.05) and to 0.27 (SD 0.18, p = 0.0009). We found no improvements of the objective endpoints (AROM, Kapandji, grip strength) except for flexion, which increased from 64° (SD 12°) at baseline to 73° (SD 9.7°, p = 0.046) at 12 months. Conclusions: We recommend the PRWE score as a useful endpoint for further studies for this indication. To prove a 15% superiority over sham irradiation, we calculated that 750 patients need to be prospectively randomized.

Shaped titanium wedges for subtalar distraction arthrodesis: Early clinical and radiological results

BackgroundDisplaced intraarticular calcaneum fractures are associated with late symptomatic hind foot malalignment and painful arthrosis for which distraction subtalar fusion might be considered. During subtalar distraction arthrodesis, a structural graft is often used to fill gaps. Autograft, the current gold standard, is limited in availabilityand is associated with donor-site morbidity and collapse. Allografts have the risk of infectious disease transmission, rejection and failure to integrate. The clinical outcomes and midterm results of subtalar distraction arthrodesis with biofoamtitanium wedges are presented. MethodsA review of 4 patients (3 male and 1 female) undergoing subtalar bone block distraction arthrodesis using biofoam titanium wedges is reported. Results were evaluated clinically and radiologically Mean time from trauma to surgery was 27.5 months and mean follow up was 12 months. ResultsThe mean FAAM ADL score improved from 31.4% preoperatively to 74.2% postoperatively and mean AOFAS score improved from 23.4 preoperatively to 69.6 postoperatively.There was improvement in all radiographic parameters, with 44% improvement in calcaneal pitch, 23% improvement in talocalcaneal angle, 21% increase in talus-first metatarsal angle, and 13.5% correction of talocalcaneal height. VAS Pain scores wasimproved from a pre-operative mean of 8 to a post-operative mean of 2. Mean time to fusion was 13 weeks. Union was achieved in all cases. ConclusionOur data suggest titanium wedges may be used as a structural graft option for subtalar bone block distraction arthrodesis. Fusion rates and time to incorporation are comparable to autogenous bone graft without the associated morbidity.Level IV Case Series.

Reverse shoulder arthroplasty

Reverse polarity total shoulder arthroplasty is an innovation primarily designed to treat the rotator cuff-deficient shoulder by increasing constraint and thereby addressing the challenges of pseudoparalysis. Forward elevation can be regained, pain and quality of life can be improved. Recently, there has been an expansion in both the breadth of indications and the volume of surgeries performed. We aim to review current practice and direction of travel. The impact of rotator cuff tear arthropathy (CTA) is often significant and disabling. This condition is associated with painful arthrosis of the shoulder in conjunction with instability, which allows the humeral head to escape antero-superiorly. The resulting loss of function in the shoulder is aptly described as ‘pseudoparalysis’. Figure 1 shows the normal deltoid function around a shoulder with an intact soft-tissue envelope, and the superior migration that results when the superiorly directed force vector is not neutralised. Conventional anatomical arthroplasty of the shoulder fails to restore function in these patients due to the inadequate stability of the joint around a central point of pivot, combined with an inability of the surrounding muscles to compensate for a weak or torn rotator cuff. Fig. 1 Proximal migration in cuff tear arthropathy with resulting deltoid dysfunction- schematic This combination results in a complex and disabling condition that has vexed shoulder surgeons since the early days of development in shoulder arthroplasty systems. A better understanding of shoulder biomechanics and the mechanisms of failure in total shoulder arthroplasty led to the development of reverse shoulder arthroplasty (RSA) designs. While the original indication was CTA, there has been a rapid expansion of indications to include a spectrum of pathologies: proximal humeral fractures and trauma sequelae; massive cuff tears; tumours; primary glenohumeral osteoarthritis (OA); and the revision of failed shoulder arthroplasties. Themistocles Gluck most likely developed a shoulder arthroplasty in the …

DEGRO guidelines for the radiotherapy of non-malignant disorders. Part II: Painful degenerative skeletal disorders.

The purpose of this article is to summarize the updated DEGRO consensus S2e guideline recommendations for the treatment of benign painful degenerative skeletal disorders with low-dose radiotherapy. This overview reports on the role of low-dose radiotherapy in the treatment of enthesiopathies (shoulder syndrome, trochanteric bursitis, plantar fasciitis, and elbow syndrome) and painful arthrosis (knee, hip, hand, and finger joints). The most relevant aspects of the DEGRO S2e Consensus Guideline Radiation Therapy of Benign Diseases 2014 regarding diagnostics, treatment decision, dose prescription as well as performance of radiotherapy and results are summarized. For all indications mentioned above, retrospective and some prospective analyses have shown remarkable effects in terms of pain relief. Nevertheless, the Level of Evidence (LoE) and the Grade of Recommendation (GR) vary: LoE 1b-4 and GR A-C. Low-dose radiotherapy for painful degenerative skeletal disorders is effective in the majority of the patients and therefore it may be a reasonable therapeutic alternative when simple and non-invasive methods have been used without persistent success. For all discussed entities, single fraction doses of 0.5-1.0 Gy and total doses of 3.0-6.0 Gy/series applied with 2-3 fractions per week are recommended.

Die belastungsstabile Lapidus-Arthrodese bei Hallux-valgus-Deformität mittels IVP-Plattenfixateur (V-TEK®-System)

Correction of hallux valgus deformities without loss of toe length. Achievement of full weight-bearing. Hallux valgus with intermetatarsal angle of more than 20°. Hypermobility of the first metatarsal bone combined with instability. Recurrence of hallux valgus deformity. Hallux limitus combined with metatarsus primus elevatus. Painful arthrosis of the metatarsal-cuneiform-medial joint (TMT1). Arterial occlusive disease. Infection of the foot. Nicotine abuse. Strict verification of indication in patients with diabetes mellitus. Lateral release of the proximal phalanx joint of the hallux with tenotomy of the adductor hallucis tendon. Resection of the medial pseudoexostosis. Cartilage removal at the joint basis of the metatarsus 1 and the joint basis of the medial cuneiform bone to prepare for the corrective arthrodesis. Proximal osteotomy of the metatarsus 1. Lateralization and, if required, derotation of the distal metatarsus 1 segments using a special L-type chisel to prepare the intramedullary bed for the plate, going right into the medial cuneiform. Insertion of the IVP plate and fixation using stable screws in the correct angle. Medial capsuloraphy. Early functional rehabilitation with increasing weight-bearing using a special shoe for 6-8weeks. Full weight-bearing usually after 2weeks. Physical therapy, lymphatic drainage, cryotherapy. Leg elevation. In all, 21consecutive patients, 19women, 2men, between 41 and 75years of age (mean age 62.3years) were included. Mean follow-up was 21months (12-27months). Preoperative hallux valgus angle (48°; range 40-63°) improved to 15° (range 6-28°). The intermetatarsal angle averaged 18° (range 12-27°) preoperatively and 8° (range 7-10°) postoperatively. The Kitaoka score improved from 47points (37-49points) preoperatively to 81points (77-86points) postoperatively. Complications included loosening of screws in 4cases. All were treated by partial hardware removal under local anesthesia without further sequelae. In 5cases, prolonged wound secretion (up to 5weeks) healed without infection.

Management of Thumb Metacarpophalangeal Ulnar Collateral Ligament Injuries

Untreated ulnar collateral ligament (UCL) injury of the thumb metacarpophalangeal joint (MCPJ) can lead to long-term pain and functional limitations.Detection of a UCL injury involves sequential examination of true and accessory ligaments and comparison with the uninjured side.Acute partial UCL injuries can be successfully treated nonoperatively.Acute complete or displaced UCL injuries can be successfully treated with operative repair.In cases of chronic UCL injury, treatment options include static and dynamic reconstructions.If painful arthrosis is present with chronic UCL instability, salvage may be performed with MCPJ fusion.

Anterior Approach for Operative Fixation of Coronoid Fractures in Complex Elbow Instability

The coronoid process has been shown to play a critical role in ulnohumeral stability. Coronoid process fractures can occur in isolation or as part of a complex injury pattern. The most common complex pattern, known as the "terrible triad," includes a radial head fracture and elbow dislocation along with the coronoid fracture. Failure to address these fractures and ligamentous injuries can result in recurrent instability and progression to painful arthrosis. Both medial and lateral approaches to the coronoid have been popularized in recent literature, but there is no universally accepted approach. Common fixation techniques include suture lasso, suture anchors, lag screws, and plating all of which have various drawbacks. We describe a direct anterior approach to address coronoid process fractures made in addition to a lateral approach to address radial head and lateral collateral ligament injuries. Coronoid fractures addressed through the anterior approach were stabilized with anterior to posterior screw fixation combined with buttress plating, which allowed anatomic reduction and stable internal fixation at short-term follow-up.

Study of A.D. Bio-Phyto-Modulators in Pain Management - Arthrosis

We realized a study on a number of 60 patients who have painful arthrosis at various sites to which we have established biocompatibility using DIEE and DEA on Oberon bioresonance device. I’ve got favorable effects in joint pain therapy and so we reduced the doses of antialgic and anti-inflammatory drugs controlling patients’ pain. Physical activity, massage and relaxation techniques have an important role in joint pain management.

Arthrodese vs. Gelenkersatz

Despite encouraging results with the third generation of ankle joint prostheses, the high complication, revision and loosening rates as well as many contraindications mean that arthrodesis of the ankle joint is still the gold standard with a well-defined risk factor. Our own modification of the standardized 4-screw arthrodesis procedure has proven to be an optimized conception over the last 20 years. In cases of painful arthrosis, if the indications for arthrodesis of the upper ankle joint are recognized early enough, the bony convergence of the ankle joint can be operatively retained and the neutral position of the foot achieved by a central positioning of the talus relative to the anatomical axis of the lower leg axis in both planes. Using a minimally invasive technique by maximum stability of the 4-screw arthrodesis technique an early functional follow-up treatment can be carried out with the Vario-Stabil orthopedic boot. Using this method an average AOFAS score of 24 can be achieved for the transverse tarsal joint for compensation of stretching and bending and in the long-term over 90% very good and good results can also be achieved.

Ulnar Head Implant Arthroplasty

Ulnar head arthroplasty has been an emerging alternative for salvage of resection arthroplasty at the distal radioulnar joint (DRUJ) since the early 1990s. Recently, it has been offered for initially treating painful arthrosis or instability of the DRUJ. This follow-up study reports a surgeon's experience treating DRUJ disorders with ulnar head arthroplasty. Twenty-two wrists in 20 patients (11 females, 9 males), 6 with no prior wrist procedures were treated between 1995 and 2006 for painful DRUJ disorders with either Herbert-Martin (Martin Medizin-Technik, Tuttingen, Germany) or Avanta (Small Bone Innovations, New York, NY) head prosthesis. Follow-up averaged 54.3 months. A standardized telephone survey determined preoperative /postoperative verbal analog pain scores and a modified Mayo Wrist Score (delineating poor, fair, good, or excellent outcomes). Data suggest that ulnar head implant arthroplasty is a reasonable treatment option for DRUJ-related pain, loss of function, or salvage of failed distal ulna resection procedures. The analog pain score statistically significant decreased by 1.68 points when comparing preoperative to postoperative scores. Average Modified Mayo Wrist Scores were good, independent of whether the procedure was primary or salvaged. No significant difference was seen between the primary or salvage group modified Mayo Wrist Scores. Whereas averaged modified Mayo scores for both the primary and salvage groups were in the good category, prostheses used as primary procedures may be associated with fewer poor or fair outcomes. Two good and 1 excellent outcome of 3 wrists requiring revision procedures suggest that even with revision of the implant arthroplasty, satisfactory results may be expected.

Ankle arthrodesis- a 5 year review

Painful arthrosis is the commonest indication for ankle arthrodesis. This procedure is infrequently undertaken in our centre - National Orthopaedic Hospital, Igbobi, Lagos (NOHIL), which is the biggest orthopaedic hospital in Nigeria. In order to determine its relevance to orthopaedic practice in Nigeria, we carried out a retrospective study on the indications, complications and functional outcome of ankle arthrodesis at the NOHIL, Nigeria. The study was a 15-year retrospective analysis of all cases of ankle arthrodesis undertaken at NOHIL. There were 58 patients that underwent ankle arthrodesis during the period 1989 to 2003. Thirty five of these with complete records and radiographic films were included in the study. Demographic data, indications, surgical techniques, complications and outcome of treatment were analysed using SPSS version 11. There were 37 arthrodeses, involving 18 male and 17 female patients. The mean age was 41.4years with a mean follow-up period of 17months. The main indication for arthrodesis was posttraumatic arthrosis followed by severe acute ankle injuries. AO and Charnley compression techniques were the commonest surgical procedures employed. Eighteen (48.6%) patients had a good outcome, 10 (27.0%) patients had a fair outcome and 5 (13.5%) had a poor outcome. The outcome of the remaining 4 cases could not be ascertained as they were lost to follow up at an average of 4.6 months post surgery. The commonest indication for ankle arthrodesis was post-traumatic ankle arthrosis in this study. The use of external fixation technique was the most prevalent method of achieving arthrodesis with a fusion rate of 85%. Post surgical infection was however high but a good outcome was achieved in majority of cases.

Validated HPTLC methods for the determination of salicin in Salix sp. and of harpagoside in Harpogophytum procumbens

Preparations of Harpagophytum procumbens and of Salix species are successfully used for the treatment of degenerative rheumatism and painful arthrosis. For the quality control of both drugs, rapid methods of quantification are desirable. Here we report the development of two HPTLC methods enabling the determination of harpagoside in Harpagophyti radix and of salicin in Salicis cortex. We focused on a standardized methodology and thorough validation including two laboratories. The methods allow the analyses of up to 16 samples in parallel demonstrating the proposed methods as very rapid and cost efficient.

Clinical experiences with Wilhelm's method of wrist joint denervation

Wrist joint denervation for treatment of painful arthrosis was carried out in 36 patients in the last five years. 33 Patients could be followed up. Besides subjective reports on pain and maximum stress, strength, mobility and the X-ray of the wrist-joint were also considered in the evaluation of the results. As a whole, a success rate of 84% could be attained. We have not observed disorders of sensitivity or trophic alterations. An increase of symptoms after the second postoperative year was noteworthy.

Results of resection of the head of the ulna

A follow up of 57 wrists with resection of caput ulnae shows different value to different groups of patients. The painful arthrosis of distal radioulnar joint gives indication in posttraumatic cases. Release of pain and improvement of range of motion will be achieved; loss of strength is the most impairing problem for younger patients. 13 patients out of 21 with posttraumatic deformities were satisfied with the post-operative outcome; 13 patients showed significant loss of strength, too. In case of rheumatoid arthritis with caput-ulnae-syndrome the resection is without alternative, needs to be combined with the arthrodesis of radiolunar-joint, if necessary. 20 of 34 rheumatics were satisfied with the outcome after resection of caput ulnae; in 6 cases an ulnar drift was evident, which implied simultaneous or later partial arthrodesis of the wrist. For all patients release of pain decided on their satisfaction with surgery.

High tibial closing wedge osteotomy for medial compartment osteoarthrosis of knee

Background:Most patients of symptomatic osteoarthrosis of knee are associated with varus malalignment that is causative or contributory to painful arthrosis. It is rational to correct the malalignment to transfer the functional load to the unaffected or less affected compartment of the knee to relieve symptoms. We report the outcome of a simple technique of high tibial osteotomy in the medial compartment osteoarthrosis of the knee.Materials and Methods:Between 1996 and 2004 we performed closing wedge osteotomy in 78 knees in 65 patients. The patients selected for osteotomy were symptomatic essentially due to medial compartment osteoarthrosis associated with moderate genu varum. Of the 19 patients who had bilateral symptomatic disease 11 opted for high tibial osteotomy of their second knee 1-3 years after the first operation. Preoperative grading of osteoarthrosis and postoperative function was assessed using Japanese Orthopaedic Association (JOA) rating scale.Results:At a minimum follow-up of 2 years (range 2-9 years) 6-10° of valgus correction at the site of osteotomy was maintained, there was significant relief of pain while walking, negotiating stairs, squatting and sitting cross-legged. Walking distance in all patients improved by two to four times their preoperative distance of 200-400 m. No patient lost any preoperative knee function. The mean JOA scoring improved from preoperative 54 (40-65) to 77 (55-85) at final follow-up.Conclusion:Closing wedge high tibial osteotomy performed by our technique can be undertaken in any setup with moderate facilities. Operation related complications are minimal and avoidable. Kirschner wire fixation is least likely to interfere with replacement surgery if it becomes necessary.

Funktionelle Ergebnisse der Kapandji-Sauvé-Operation als Rettungseingriff am distalen Radioulnargelenk

The Kapandji-Sauvé procedure is a salvage operation for the treatment of painful arthrosis of the distal radioulnar joint (DRUJ). It should be performed if an anatomical reconstruction of the DRUJ is not longer possible. The present study was designed to evaluate mid-term results by means of objective parameters (strength, range of motion, Krimmer and Mayo wrist scores) and subjective self-assessment of patient disabilities (DASH, pain) after the Kapandji-Sauvé procedure. Fifteen patients (8 female, 7 male, average age 49 years) underwent Kapandji-Sauvé procedure and were retrospectively reviewed 55 months after the operation (range, 6 months to 8 years). As a reason for DRUJ arthrosis we found fractures of the distal radius in 7 patients, severe contusion and distorsion trauma (5), luxation of the DRUJ (2) and a Madelung deformity (1). For evaluation of grip strength the Jamar dynamometer was used. Pain assessment was performed with a visual analogue scale (VAS 0 - 100) pre- and postoperatively, before and after physical load was used. The DASH questionnaire was used in all patients for subjective outcome assessment. Forearm rotation improved by 59,7 % (89,3 to 142,7 degrees) as well as grip strength by 63,6 % (13 to 20,7 kg) compared preoperative to postoperative. Pain reduction was significant (p = 0,003) before physical load by 48,6 % and after physical load by 63,1 % compared with the preoperative values. The mean DASH score was 41,6 points, Krimmer and Mayo-Wrist scores were 61 and 63 respectively. Radioulnar impingement occurred in 14 patients after an X-ray under load. Because of the improvement of forearm rotation and grip strength 12 patients would undergo the procedure again, three patients were not satisfied with their results. Our clinical findings show good improvement of forearm rotation, grip strength and reduction of pain after Kapandji-Sauvé procedure. However midrange DASH, Mayo and Krimmer-Wrist scores suggest that the Kapandji-Sauvé procedure is not able to provide a solution for every complex, non-reconstructable DRUJ disorder.

Retro-Odontoid Mass in High Elderly Patients-Genesis, Therapeutic Strategies and Post-Operative Care-

It has been controversial whether surgical treatment for retro-odontoid mass including disc hernia is indicated. We surgically treated 8 patients with retro-odontoid mass. We discuss clinical characteristics, therapeutic strategies, the genesis based on histological findings, and problems of post-operative care in this lesion.Age distribution of the patients was from 77 to 86 years old (mean: 81.0 years). Male/female ratio was 6/2. All patients showed neurological deficits due to myelopathy. Pre-operative magnetic resonance (MR) imaging showed an isointensity mass at the retro-odontoid space. Only marginal enhancement was seen in 2, and heterogenous enhancement in 6 patients.All patients underwent surgery via postero-lateral transdural approach for removal of the extradural retro-odontoid mass. All patients showed neurological improvement, however, severe neurological deficits still remained in 2 patients who had been in bed-ridden pre-operatively. The surgical specimens consisted of degenerative cartilaginous tissue and reactive fiborvascular tissue.As the retro-odontoid mass contains various pathological lesions, histological confirmation is necessary. Among reported surgical approaches, the postero-lateral transdural approach is less invasive, especially for high elderly patients. A source of cartilaginous tissue is probably derived from the herniated disc penetrated posterior longitudinal ligament at C2/3, which has migrated upward to the retro-odontoid space. Not only such migration, but also some proliferative change might come to form the retro-odontoid mass.Retro-odontoid mass is characteristic in very elderly patients. Elderly patient-specific problems such as disuse atrophy due to less movement and painful arthrosis deformans in the lower extremities prevent successful rehabilitation. Earlier planning to advance rehabilitation in cooperation with neurosurgeons, orthopedists, and rehabilitation physicians is necessary for very elderly patients' quality of life.

OSG-Totalendoprothese Agility: Indikationen, Operationstechnik und Ergebnisse

The surgical treatment of painful arthrosis of the ankle joint is still controversial and remains a real challenge for the surgeon and for the patient. The longterm results of ankle joint arthrodesis are still disappointing. The new generation of total ankle arthroplasty shows good short and middle-term results. Agility total ankle is one of these. It is a semi-constrained prosthesis with three components, a tibial component in titanium, a polyethylene inlay and a talar component in chrom-cobalt. The prosthesis is implanted without cement and allows a range of motion of 60° in dorsal- and plantar flexion. Unlike other prostheses of this generation the agility total ankle allows the complete replacement of all facets of the ankle joint which helps to prevent medial or lateral impingement. The support of the prosthesis both on the tibial and fibular cortex gives a very good primary stability and helps to prevent a proximal migration of the tibial component, particularly in osteoporotic bone. Between October 1999 and April 2003, 66 agility total ankle replacements were performed in our clinic. A consecutive series of 36 patients was prospectively reviewed with a minimum followup of 18 months (average 29 months). In this group, the KOFOED score improved from an average of 40 points preoperatively up to 86 points and the AOFAS-ankle/hindfoot score from 45 points preoperatively to 88 points at longest followup. The average range of motion at the ankle joint reached 11° of dorsal extension and 29° of plantar flexion. Adequate patient selection and sufficient experience in foot and ankle surgery are important factors to obtain good results with total ankle replacement and to use it as a possible alternative to arthrodesis in the treatment of painful ankle arthrosis. The short and middle-term results are encouraging; further investigations and longer followup periods are still necessary to confirm this tendency. Die chirurgische Behandlung der schmerzhaften Arthrose des oberen Sprunggelenkes (OSG) wird immer noch kontrovers diskutiert, und bleibt eine echte Herausforderung, sowohl für den Chirurgen, als auch den Patienten. Die Langzeitergebnisse der OSG-Versteifung sind unbefriedigend. Die neue Generation von OSG-Totalendoprothesen mit drei Komponenten zeigt erfolgversprechende kurz- und mittelfristige Resultate. Die OSG-Totalendopro-these Agility gehört zu dieser dritten Generation. Sie ist eine „semi-constrained” Prothese aus drei Komponenten, einer Tibia-Komponente aus Titan, einem Inlay aus Polyethylen und einer Taluskomponente aus Chrom-Cobalt. Die Prothese wird unzementiert eingebaut und erlaubt eine Bewegungsamplitude von insgesamt (oder idealerweise) ca. 60° in der Sagitalebene (Dorsal-/Plan-tarflexion). Im Gegensatz zu den anderen Prothesen dieser Generation, ermöglicht die Agility-Prothese einen vollständigen Ersatz aller Gelenkflächen im OSG. Die Abstützung der Prothese sowohl auf der Tibia, als auch auf der Fibula, gibt eine sehr gute Primärstabilität und beugt einem Einsinken beziehungsweise Wandern der tibialen Komponente nach proximal vor, insbesondere im osteo-porotischen Knochen. Von Oktober 1999 bis April 2003 wurden 66 OSG-Totalendoprothesen des Typs Agility implantiert. Eine konsekutive Serie von 36 Patienten, mit einem Followup von mindestens 18 Monaten (Durchschnitt: 29 Monate), wurde prospektive nach kontrolliert. In dieser Gruppe konnte der KOFOED-Score im Mittel von 40 Punkten präoperativ auf 86 Punkte postoperativ, und der AOFAS-Score von 45 Punkten auf 88 Punkte verbessert werden. Die OSG-Beweglichkeit erreichte eine durchschnittliche Bewegungsamplitude von 40° (11° Dorsalflexion und 29° Plantarflexion). Bei einer sorgfältigen Indikationsstellung und in erfahrenen Händen ist die OSG-Totalprothese Agility eine gute Alternative zur OSG-Arthrodese in der Behandlung der OSG-Arthrose. Die kurz -und mittelfristigen Resultate sind erfolgversprechend, längere Verläufe sind aber noch nötig, um diese positive Tendenz zu bestätigen.

Nonunion of the Distal Radius

Nonunion of the Distal Radius