Status and future of modern technologies in arthroplasty : Results of a survey of the German Society for Orthopedics and Trauma Surgery (DGOU).

BACKGROUND: The orthopedic community is divided on the question of whether modern technologies in arthroplasty improve outcomes. Therefore, the aim of this initiative of the working group on intraoperative imaging and technology integration (Arbeitsgemeinschaft intraoperative Bildgebung und Technologieintegration, AGiTEC) is to initiate the collection of additional data for the scientific evaluation of modern technologies. QUESTION: To what extent are modern technologies currently used and which implementations are planned? Do the members of the German Society for Orthopedics and Trauma Surgery (DGOU) consider the acquisition of additional data for scientific assessment necessary? METHODS: Members of the DGOU were asked via an e­mail survey about the distribution and projected introduction of modern technologies in arthroplasty. They were also asked whether sufficient data were collected for scientific evaluation and whether acquisition of additional data in studies or arthroplasty registries were considered necessary. RESULTS: Of the 7923 probands surveyed, 428 completed the questionnaire in full (5.4%). It was found that individual implants and navigation are currently the most frequently used (31% and 29%, respectively). The largest increases in the next 2 years are projected for virtual reality and robotics (+30% and +23%, respectively), 85% of respondents indicated that insufficient data were collected for scientific evaluation, and 89% each requested initiation of multicenter studies and inclusion of technologies in the arthroplasty registry. CONCLUSION: The results of this study should motivate the scientific community, industry, and those responsible for the arthroplasty registries to collect and analyze data for the scientific assessment of modern technologies.

Skull base trauma: Masking, stimulating or neutral factor for the insidious development of angiosarcoma in a 19-year-old.

Angiosarcoma is a malignancy of endothelial tumor and represents 1-2% of all soft tissue sarcomas, uncommonly found in the head and neck region. The etiology is not clear but there are definite risk factors including chronic lymphoedema, history of radiation, environmental carcinogens and certain familial syndromes. Presented here is a case of a patient treated due to the skull base trauma and diagnosed with this type of tumor.

Influence of hip replacement on sagittal alignment of the lumbar spine: An EOS study.

INTRODUCTION: Changes in pelvic position can influence the sagittal alignment of the lumbar spine. The restoration of hip kinematics by hip replacement thus appears to offer the possibility of correcting sagittal alignment. This preliminary retrospective study used EOS imaging to investigate the influence of total hip arthroplasty on pelvic parameters in patients with normal preoperative pelvic parameters. METHODS: Twenty patients with hip osteoarthritis undergoing total hip arthroplasty (THA) between 2011 and 2012 received unilateral THA. To evaluate the preoperative and postoperative changes of the pelvic parameters, we analyzed EOS imaging of the patients to determine pelvic incidence, sacral slope, sacral tilt, pelvic tilt, anterior pelvic plane inclination and pelvic axial rotation. Additionally, anteversion and inclination of the acetabular cup position were determined. RESULTS: No statistically significant difference was found between the preoperative and postoperative measurements of pelvic parameters, although the change in pelvic tilt approached significance. Postoperatively, respective average values of 42.6° and 22.7° were measured for inclination and anteversion of the acetabular cup position. CONCLUSION: THA did not influence pelvic position and sagittal alignment in patients with normal preoperative pelvic parameters. A subsequent study will investigate whether corrections of pelvic parameters outside the norm in patients with OA are possible with THA.

Tigecycline in treatment of multidrug-resistant Gram-negative bacillus urinary tract infections: a systematic review.

OBJECTIVES: To review cases of multidrug-resistant (MDR) Gram-negative bacillus urinary tract infections (UTIs) treated with tigecycline and the literature related to this subject. METHODS: We performed a systematic review of the literature identifying patients with MDR Gram-negative bacillus UTIs treated with tigecycline. RESULTS: Fourteen cases describing treatment of UTIs caused by MDR Gram-negative bacilli with tigecycline are reviewed. Favourable clinical outcomes were noted in 11 of 14 cases. An initial favourable microbiological outcome was noted in 12 cases. Post-treatment cultures in two cases were positive for tigecycline-resistant organisms. CONCLUSIONS: The clinical efficacy of tigecycline for treatment of UTIs has not been extensively evaluated. Based on the available literature, tigecycline appears to have efficacy in some patients with MDR Gram-negative bacillus UTIs. Further research in this area is needed to fully elucidate the role of tigecycline in treating such patients.

Acute injuries in Taekwondo.

Although Taekwondo is becoming an increasingly popular sport, there is a lack of reliable epidemiologic data on Taekwondo injuries. To perform an epidemiologic study on the variety of types of injury in professional and amateur Taekwondo athletes and to find a relation between Taekwondo style, skill level, weight-class and warm-up routine and the occurrence of injuries, we analysed the injury data using a 7-page questionnaire from a total of 356 Taekwondo athletes who were randomly selected. Overall, we registered a total of 2,164 injuries in 356 athletes. Most traumas were contusions and sprains in the lower extremities. Professional Taekwondo athletes have an increased risk of injury in comparison to recreational athletes. Taekwondo style, weight class and tournament frequency have an influence on the athlete's injury profile. Warm-up routines were found to have a positive effect on injury rates. Overall, Taekwondo may be considered a rather benign activity, if injuries during Taekwondo tournaments can be avoided. If not, Taekwondo can result in serious musculoskeletal problems.

[Gorham-Stout syndrome (GSS) with fulminant aseptic osteonecrosis of the shoulder]. / Gorham-Stout-Syndroms (GSS) mit fulminanter aseptischer Osteonekrose an der Schulter.

We report here a case of the rare Gorham-Stout syndrome (GSS) of the humerus. GSS is a disease in the course of which spontaneous idiopathic osteolysis occurs. We describe a case of a 46-year-old business economist who suffered an inadequate trauma and within 3 weeks developed self-limited idiopathic osteolysis of the left humerus head, also affecting the rotator cuff. This could be diagnosed especially on the basis of histopathological findings. Hereupon we indicated operative repair by means of inverted shoulder joint endoprosthesis.

The future of surgical orthopaedics of the knee.

Over the past two decades, orthopaedics has gone through major changes, principally in the surgical treatment options for articular defects of the knee. This paper explores the advantages and shortcomings of the current surgical treatment modalities for cartilaginous defects in the knee. Emphasis is placed on current techniques in knee arthroplasty, including a view on the future of orthopaedic knee surgery.

Effects of terbutryn on aufwuchs and Lumbriculus variegatus in artificial indoor streams.

The effects of the herbicide terbutryn on a simple lotic food web were investigated during a 72-d exposure period in five artificial indoor streams in a greenhouse. The model compound terbutryn, an s-triazine and an inhibitor of photosynthesis, was applied once in each stream at nominal concentrations of 0.6, 6, 60, or 600 microg/L. Terbutryn concentrations in the water were analyzed by gas chromatography/mass spectrometry, and an overall time to 50% dissipation (DT50) of 28 d was calculated. The development of aufwuchs and the population growth and development of the oligochaete Lumbriculus variegatus were investigated. We determined that terbutryn was toxic to L. variegatus at 23.7 mg/L (96-h median lethal concentration [LC50]) and 16.5 mg/L (96-h median effective concentration [EC50]) in static acute toxicity tests. Terbutryn decreased aufwuchs production at 0.6 microg/L in the experimental streams. Population growth of L. variegatus was decreased by 50% at 6 microg/L. The effect of terbutryn on the aufwuchs was a direct effect of decreases in the periphyton. However, the effects on L. variegatus were an indirect effect of terbutryn as a consequence of decrease in the aufwuchs food source and occurred at three-orders-of-magnitude-lower concentrations of terbutryn than the acute toxicity effects. Our study demonstrates the utility of indoor lotic microcosm studies for evaluating both direct and indirect effects of contaminants on aquatic ecosystems.

Artificial indoor streams as a method to investigate the impact of chemicals on lotic communities.

The potential hazard of chemicals on aquatic communities are generally evaluated by standardised single-species bioassays. Safety assessment is based on results gained from organisms adapted to lentic systems and biological interactions in ecosystems are neglected. While lotic communities are often at first in contact with chemicals, it is astonishing that microcosms with lentic communities are mainly used as a bridge between laboratory bioassays and outdoor aquatic systems. Hence, we established five artificial indoor streams to simulate abiotic factors of small rivers. The closed-circuit system was filled with nutrients added to tap water. Washed pebbles were used as sediment. The dynamics of a simple biocoenoses consisting of aufwuchs, Lumbriculus variegatus Asellus aquaticus and Gammarus fossarum was investigated. The dynamic of aufwuchs and periphyton was determined as dry weight and chlorophyll-a, respectively and qualitatively by pigment pattern. The abundance of different developmental stages of L. variegatus was determined at the end of the experiment as well as the population dynamics of G. fossarum and A. aquaticus. Survival rates of gammarids and juveniles per female were investigated and data were used for modelling the population dynamics. The experiment was carried out to investigate the performance of the established artificial streams and the developed approaches to investigate effects of chemicals on a basic lotic community. The prime reason to establish this approach was to close a gap between complex artificial stream systems and laboratory single species tests to assess the impact of chemicals on the aquatic environment.

Measurement of left ventricular volume using single-photon emission computed tomography.

A count-based method for measuring left ventricular (LV) volume using technetium-99m-labeled red cells and ungated single-photon emission computed tomography is described. The tomographic slices were used to determine the counts per milliliter in the center of the left ventricle and total LV counts, which were used to derive mean LV volume. End-diastolic and end-systolic volumes were calculated from the mean volume using the LV time-activity curve from planar gated blood pool images. Phantom evaluation with simulated LV volumes (50 to 400 ml) in air, in a phantom filled with water, with 10% background, and with a simulated right ventricle, showed excellent accuracy. For clinical validation, 30 patients underwent electrocardiographically gated planar and nongated tomographic acquisition of the cardiac blood pool followed by single-plane cineangiography. For end-diastolic and end-systolic volumes combined, the correlation with cineangiography showed a standard error of the estimate (SEE) of 24 ml and 14 ml, respectively. Mean intra- and interobserver deviation was 12 ml and 14 ml (SEE 13 ml and 16 ml), respectively. It is concluded that this noninvasive count-based technique, requiring no assumptions regarding LV geometry, is an accurate and reproducible way to measure LV volume.