[Influence of surgeon experience in total hip arthroplasty. Dependence on operating time and complication risk]. / Einfluss der Erfahrung des Operateurs in der Hüftendoprothetik. Abhängigkeit von Operationsdauer und Komplikationsrisiko.

BACKGROUND: As a consequence of limited personnel and financial resources, the increase in total hip arthroplasties places higher demands on orthopedic surgeons. OBJECTIVES: In order to maintain high quality treatment, the correlation between surgical experience, duration of surgery and risk of complications was examined. MATERIAL AND METHODS: The surgery time and, if applicable, complications (until discharge from hospital) of 1129 total hip arthroplasties over a period of 4 years were evaluated retrospectively. RESULTS: The group of most experienced surgeons needed an average time of 53.2 ± 17.6 min for each implantation, followed by moderately experienced surgeons (74.5 ± 25.5 min) and less experienced surgeons (80.8 ± 21.9 min). Of all included cases, a total of 41 complications until discharge from hospital occurred. The number of complications increased with duration of surgery, whereby the risk of complications was significantly lower for shorter surgery times conducted by the most experienced surgeons as well as moderately experienced surgeons. The complication risk of less experienced surgeons remained constant independent of surgery duration. CONCLUSION: These results underline the recommendations of the German Endocert system, which determine a minimum number of total joint arthroplasties as a quality indicator not only for hospitals but also for individual surgeons.

[Total knee replacement with ceramic femoral components: a national prospective multicenter study of clinical and radiological outcomes]. / Knieendoprothetik mit keramischen Femurkomponenten: Nationale prospektive Multicenterstudie zum klinischen und radiologischen Outcome.

BACKGROUND: The purpose of this prospective multicenter study was to evaluate the clinical and radiological outcomes of an unconstrained bicondylar total knee prosthesis with a new ceramic femoral component made of BIOLOX® delta. MATERIAL AND METHODS: Fifty patients underwent cemented total knee arthroplasty in three hospitals/centers. Clinical and radiological evaluations were undertaken preoperatively and at 3 as well as 12 months postoperatively using the HSS, WOMAC, and SF-36 scores. RESULTS: During 12 months follow-up three patients had to undergo revision surgery due to non-implant-related reasons (infection, periprosthetic fracture, and retropatellar replacement). The mean preoperative HSS score amounted to 56.2±11.0 points. At 3 and 12 months follow-up the mean HSS score was 75.5±11.5 and 83.6±10.9 points, respectively. Therefore, HSS and WOMAC scores improved significantly from preoperative values at both postoperative evaluations. The first significant improvement of SF-36 score was seen after 12 months. Radiolucent lines around the femoral ceramic components were found in one case. CONCLUSION: Subsequent long-term studies must be carried out in order to clarify the potential benefits of ceramic femoral components and confirm the good early clinical result. Moreover, the specific material properties of ceramic implants must be considered during implantation.

[Bicondylar knee arthroplasty - influence of preoperative functional restriction on early functional postoperative outcome]. / Bikondylärer Oberflächenersatz - Einfluss präoperativer Funktionseinschränkungen auf das frühfunktionelle postoperative Outcome.

AIM: The point of time for total knee arthroplasty has a significant importance due to limited implant survival rate. To what extent the preoperative stage of physical and psychological function limitation, which is increasing with the progression of the osteoarthritis, has an influence on the early functional outcome after total knee arthroplasty should be clarified in a clinical evaluation. PATIENTS AND METHOD: 47 Patients were treated with the same bicondylar knee endoprosthesis system (Type Genia, ESKA Implants, Lübeck). A clinical evaluation was undertaken preoperatively and at 3 and 6 months postoperatively using HSS score, WOMAC index and SF-36 score. In relation to the preoperative HSS score the patients were allocated into three groups depending upon whether their level of function was "good", "average" or "poor". Additionally, all patients were assigned to three body mass index (BMI) groups (< 30, 30 - 35, > 35) which were descriptively analysed. RESULTS: The preoperative differences in HSS score and SF-36 score in all three groups show a high reduction after 3 and 6 months. Postoperatively there were no significant differences in all three groups at both timepoints. Patients with "poor" preoperative function achieved on average a lower score niveau than patients with preoperative "good" function, but have the benefit of the best function improvement. The early postoperative period (3 months) showed the highest decrease in physical and psychological function derogation. The BMI had no significant influence on the early functional outcome. CONCLUSION: Therefore, older people should receive early total knee arthroplasty to gain a high postoperative score niveau. In younger patients the indication for implant should be considered essentially because of the limited survival rate. Even in progressive osteoarthritis and extreme functional limitation the bicondylar surface replacement gives the possibility of a good early functional postoperative outcome. Total knee arthroplasty of obese patients is under attention of the perioperative internistic risks, a safe procedure with good functional results and can increase patient's mobility.