[Medium-term results following implantation of cemented Weller type endoprostheses]. / Mittelfristige Ergebnisse nach zementierten Endoprothesen Typ Weller.

102 cement-fixed endoprothesis of Type Weller I, which were followed up for six years on average, showed good results. We saw three aseptic loosenings and one septic loosening (1.5 years after implantation). Circumscribed progressive resorption of the cortical layer is a typical radiological sign of loosening of an endoprothesis. However, radiolucent lines do not prove aseptic loosening. Even stems with a collar may sinter without loosening. No correlation was found between the type of the hip affection (osteoarthritis, aseptic necrosis of the hip, rheumatoid arthritis etc.) and the result of the operation. Regarding our results we consider cement-fixation in total hip replacement as a good procedure in elder patients.

[Initial experiences with the cementless PM endoprosthesis]. / Erste Erfahrungen mit der zementlosen PM-Endoprothese.

A follow up of 40 cementless fixed endoprostheses type PM showed good results, similar to cement fixed prostheses. In cementless fixation seem to be more early complications and less late complications, so these results are encouraging what concerns cementless fixation.

[Results with ceramic-on-ceramic sliding endoprosthesis completely or partially fixed without cement]. / Erfahrungen mit Endoprothesen mit Keramik/Keramik-Gleitpaarung ganz oder teilweise zementlos fixiert.

41 patients with ceramic total hip arthroplasty were followed up (on an average 2.8 years p. op., mean age 49.7 years). 9 prostheses were of type Lindenhof, 32 were of type Mittelmeier. In 27 cases cementless implantation was performed, 7 cases were reimplants. Hip scores according to Merle d'Aubigne reached 41 to 18 in 11 cases, 12 to 14 in 12 cases, and less than 12 in 17 cases. In cementless total hip arthroplasty a major problem appears to be associated with the anchorage of the femoral stem. Using a screw type fixation of the acetabular component seems to guarantee good anchorage, this was found also for reimplants. Doubts are raised about the use of ceramic on ceramic combination in arthroplasty.

[Experiences with Wagner's cup prosthesis]. / Erfahrungen mit der Schalenprothese nach Wagner.

Surface replacement is an alternative procedure especially in younger patients who absolutely need hip replacement. Accurate diagnosis is imperative and the range of indications is naturally small. A follow up study of 44 patients (range, 10 months to 4 years) showed 2 loosenings (5%); other severe complications were not seen. In 39 (89%) hips was no more pain after operation and there was a distinct improvement of motility in 39 (89%) cases. Avascular necrosis should not be treated by surface replacement. Primary inflammatory diseases (rheumatoid arthritis) seem to have a higher incidence of complications, especially when long time treated with large doses of steroids. Cortisone medication promotes avascular necrosis of the hip and lytic enzymes coming from the pannus might be another reason for loosening. According to our experience the position of the cup according to varus or valgus has no influence on the result of the operation. The Watson-Jones approach seems to be better than the approach recommended by Wagner, because paraarticular calcifications are seldom seen.

[Osteochondrosis dissecans of the elbow joint and the therapy depending on stage of development (author's transl)]. / Die Osteochondrosis dissecans des Ellenbogengelenkes und die Therapie in Abhängigkeit vom Entwicklungsstadium.

Of 46 cases of Osteochondrosis dissecans (OD) of the elbow joint between 1949 and 1976 in 35 patients we could control 31 patients with totally 42 diseases. According to clinical symptoms and roentgenological signs we classified the OD in an early, medium and late stage of development. The success of the therapy was discussed depending on the method of therapy, on the stage of the disease and on the age of the patients.

The operative treatment of elbow dislocation in the adult.

Operative treatment of traumatic dislocation of the elbow joint is indicated when there is proved gross instability or osteochondral fractures and loose bodies, or both. We performed a capsule-ligament repair in twenty-eight patients, and no cast was applied postoperatively. Satisfactory results were achieved with an average follow-up of two and one-half months. In all patients postoperative assisted range-of-motion exercise was begun after the operative wound and healed. The functional outcome depended on the osseous lesions involving the articular surface and on the time interval between the accident and the operation.

Spontaneous rupture of the gastrocnemius muscle.

Nineteen ruptures of the medial head of the gastrocnemius muslce are described. These were caused by sudden overstretching of the muscle though concomitant ankle dorsiflexion and knee extension. Surgical exploration in 12 patients verified rupture of the musculotendinous junction. A 2-year follow-up showed that the surgical approach with suture of the muscle gave better results than conservative treatment, especially in the younger and athletic patients.

[Capsular arthroplasty of the elbow joint for the treatment of recurrent dislocation. Personal results in comparison with case reports in literature. Indication--methods--after care]. / Die Kapselplastik des Ellenbogengelenkes zur Behandlung der rezidivierenden Luxation. Eigene Ergebnisse im Vergleich mit der Literaturkasuistik. Indikation--Technik--Nachbehandlung.

Four cases of recurrent dislocation of the elbow joint are reported. Instability of the postero-lateral ligaments were found in all patients, both clinically and during operation. In one case there was also instability of the medial ligament. Lateral instability is regarded as the primary lesion responsible for recurrent dislocation. Intraarticular pathological lesions such as osteochondral fractures were also diagnosed in our patients. All were treated by a capsuloligamentous repair as proposed by Osborne and Cotterill [8]. Based on follow-ups of 2 to nearly 5 years no recurrences were seen. The patients were free of pain with a nearly full range of motion. Considering the results reported in the literature of cases treated by the same method, the authors are convinced that the operation repairs the essential lesion.

[The operative treatment of recurrent and simple traumatic dislocations of the elbow by the method of Osborne and Cotterill (author's transl)]. / Die operative Behandlung der rezidivierenden und traumatischen Luxation des Ellenbogengelenkes nach Osborne und Cotterill

The essential pathological defect causing dislocation of the elbow is failure of the postero-lateral ligamentous and capsular structures. A pocket of the capsule is created into which the head of the radius is received as it slides off its articulation with the humerus. Damage to the osteochondral surface of the radius and capitulum humeri is often significant in recurrent and also simple traumatic dislocations of the elbow joint. An osteochondral fracture may occur in simple dislocation happening but once and predispose for recurrent dislocation. For treatment of recurrent dislocation we prefer the simple method of Osborne and Cotterill because in our opinion it attacks the essential lesion. More complicated techniques such as bone blocks or tendon transfers, are believed to be less effective and unnecessary. Four patients with recurrent dislocation of the elbow joint were treated successfully by this method, based on an follow-ups of from 2 to 4 years. Encouraged by the results we transferred the method to the treatment of simple traumatic dislocations in 10 patients. A follow-up of these patients has shown that an early operation will give satisfactory functional results. In the meanwhile the method of Osborne and Cotterill has become a standard technique for the treatment of osteochondrosis dissecans too by the authors.

[Proximal rupture in the triceps surae a typical, but often unrecognized injury]. / Die proximale Ruptur im Triceps surae--eine typische, aber oft verkannte Verletzung

An account is given of 12 high ruptures of the triceps surae, a traumatic lesion of the medial belly of the gastrocnemius, caused by sudden overstreching of the muscle by concomitant ankle dorsiflexion and full knee extension. In all cases the authors found characteristic clinical features. Surgical exploration in 5 of 12 cases verified the ruptures of the musculotendinous junction of the medial gastrocnemius belly. A follow-up study of 2 years showed that the surgical treatment seems to be better, especially in younger and athletic patients.

[Phleborgaphic studies of subclavian vein compression at the shoulder girdle]. / Phleborgraphische Untersuchungen über Kompressionserscheinungen beim Schultergürtelsyndrom

60 healthy persons without clinical signs of neurovascular compression at the shoulder girdle were investigated with phlebograms of the arm under various arm-positions. Venous obstruction could be demonstrated under hyperabduction and shoulder-retraction in 70 per cent of the phlebograms. A compression of the subclavian vein in extreme positions of the arm can therefore be demonstrated in a significant number of healthy individuals. A narrowing of the costoclavicular space and an impression by the head of the humerus seem tobe the most frequent mechanisms of compression. Repeated compression between clavicula and first rib leads to thickening of the vein wall, forced expiration (Valsalva) to temporary stasis. These mechanisms could be the reason for primary subclavian vein thrombosis in otherwise healthy individuals.