Using the patient's perspective to develop function short forms specific to total hip and knee replacement based on WOMAC function items.

Although the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index was originally developed for the assessment of non-operative treatment, it is commonly used to evaluate patients undergoing either total hip (THR) or total knee replacement (TKR). We assessed the importance of the 17 WOMAC function items from the perspective of 1198 patients who underwent either THR (n = 704) or TKR (n = 494) in order to develop joint-specific short forms. After these patients were administered the WOMAC pre-operatively and at three, six, 12 and 24 months' follow-up, they were asked to nominate an item of the function scale that was most important to them. The items chosen were significantly different between patients undergoing THR and those undergoing TKR (p < 0.001), and there was a shift in the priorities after surgery in both groups. Setting a threshold for prioritised items of ≥ 5% across all follow-up, eight items were selected for THR and seven for TKR, of which six items were common to both. The items comprising specific WOMAC-THR and TKR function short forms were found to be equally responsive compared with the original WOMAC function form.

[Failure of unicompartmental tibiofemoral prosthesis in treatment of arthrosis: clinical study of 34 cases].

We studied retrospectively and prospectively 34 cases of failed knee arthroplasty. The failure was mostly due to contralateral progressive arthrosis in the tibiofemoral joint (15 cases, 44.1%). Instabilization of the knee joint and abnormal ranked prosthesis second (9 cases, 26.5%), and loosening third (7 cases, 20.6%). Infections were noted only in 3 cases (8.8%). This prosthesis demands meticulous surgical techniques and strict indications because of its geometric characteristics and stabilization. Contralateral progressive arthrosis and abnormal prosthesis accounted for 70.0% in all, and were resulted from poor surgical technique and improper indications.

[In "achillodynia" also consider a rare cause--a case report of schwannoma of the tibial nerve]. / Bei "Achillodynie" auch an seltene Ursachen denken--Ein Fallbericht über ein Schwannom des Nervus tibialis.

'Achillodynia' is a quite well-known pattern of complaints in sports medicine but is also known to occur among the general population. It is a complex of signs and symptoms with the principal sign of pain in the region of the Achilles tendon that can have a wide variety of causes; on-target therapy requires exact clarification of the underlying cause. Sonography has been successfully used in recent years as one of the diagnostic tools in this regard. This enables also the diagnosis of rare causes, such as tumours of peripheral nerves. The present article is a case report on a woman patient suspected to be suffering from achillodynia caused by a schwannoma of the tibial nerve.

[Vertebral joint ganglion]. / Wirbelgelenkganglion.

We describe a further case of ganglion of the vertebral joint at L4/L5. We give a review of literature about ganglions (synovial cysts) of the vertebral joint and discuss their etiology and their localisation.

[Hip endoprosthesis shaft fractures - a clinical and technological material study]. / Hüftendoprothesenschaft-frakturen - eine klinische und werkstofftechnische Untersuchung.

This paper begins with a discussion of purely clinical considerations concerning fractures of hip prosthesis shafts, based on findings in 19 cases treated in the University Orthopedic Clinics of Essen and Lübeck. A gradual increase in pain following stress is the principal symptom, although acute pain is not typical. In radiological diagnosis, which is indispensable, the fractures, which are initially often merely hairline cracks, must be looked for. In the patient collective analyzed, the high percentage of implantation defects was striking; this is a factor which increases the risk of fracture because it leads to loosening of the prosthesis. The authors also report on a materials investigation carried out on 18 broken prosthesis shafts. The investigation revealed that in the majority of cases loosening of the prosthesis was the decisive factor leading to the fracture; only in 3 cases was the fracture basically attributable to a fault in the material or in production.

[On Dwyer's scoliosis operation using memory alloy wire (author's transl)]. / Zur Dwyerschen Skoliosenoperation mittels Drähten aus Memory-Legierungen. Eine experimentelle Studie.

In Dwyer's spinal column correction a titanium cable is stretched from vertebra to vertebra by a special clamp and secured to each vertebra with screws and clips. It is suggested to replace the titanium wire with wire consisting of the memory alloy NiTi. This will permit the prestretched wire to be tensioned by heating it to 60 deg C after it has been fixed at its ends in the vertebrae. The functional principle of the NiTi memory wire was demonstrated in an experiment carried out on a plastic model. This consists of 8 plastic vertebrae with 30 mm sides which are connected by interposed wedge-shaped soft rubber discs, giving the model a curved shape. Memory wire prestretched by 7% is led through eylets on the convex side and fixed at the ends. On being heated (electrically in this experiment for the sake of simplicity), the wire shortens, righting the model so that it assumes a straight shape. The authors also describe in detail the manufacture of the alloy, i.e. the melting and shaping operations, as well as the properties of the material, that is, the stress-strain and strain-temperature relationships and the transformation temperatures, as well as mechanical problems.