[Influence of local anesthesia and energy level on the clinical outcome of extracorporeal shock wave-treatment of chronic plantar fasciitis]. / Einfluss von Lokalanästhesie und Energieflussdichte bei niederenergetischer Extrakorporaler Stosswellentherapie der chronischen Plantaren Fasziitis -- Eine prospektiv-randomisierte klinische Studie.

BACKGROUND: The efficacy of low energy extracorporeal shock wave treatment (ESWT) for chronic plantar fasciitis is discussed controversially. It is unclear whether the simultaneous application of local anesthesia (LA) interferes with clinical outcome. METHODS: 60 patients with a chronic plantar fasciitis were enrolled in a triple-arm (20 patients per group), prospective randomized and observer-blinded pilot trial. The patients were randomly assigned to receive either active ESWT without LA (;3 x 1 500 shocks, total energy flux density [EFD] per shock 0.09 mJ/mm(2) [Group A]), ESWT with LA (3 x 1 500 shocks, EFD 0.18 mJ/mm(2) per shock [Group B]) or ESWT with LA (3 x 1 500 shocks, EFD 0.09 mJ/mm(2) [Group C]). Main outcome measures were: pain during first stepps in the morning (measured on a 0-10 point visual analogue scale) and number of patients with > 50 % reduction of pain and no further therapy needed, measured at 6 weeks after the last ESWT. RESULTS: Group A improved in the VAS from 6.4 (SD: 1.7) to 2.2 (SD: 2.6) points, group B from 6.7 (SD: 1.5) to 4.1 (SD: 2.4) points, group C from 6.2 (SD: 1.6) to 3.8 (SD: 2.5) points. A reduction of pain of at least 50 % was achieved in 60 % of group A, in 36 % of group B and in 30 % of group C. Group A without LA showed a significantly higher improvement in the VAS and subjective evaluation than groups B (p = 0.007) and C (p = 0.016). CONCLUSION: At 6 weeks success rates after low-energy ESWT with local anesthesia were significantly lower than after identical low-energy ESWT without local anesthesia. Higher energy levels could not balance the disadvantage of this effect. LA significantly influenced the clinical results after low energy ESWT in a negative way. Blinding patients by LA in ESWT studies must therefore be considered a systematic error in study design.

[Radiological appearance of the cementless ALLOCLASSIC SL-stem implanted in very old patients with primary hip osteoarthritis]. / Radiologisches Erscheinungsbild des zementfreien ALLOCLASSIC SL-Schaftes bei sehr alten Patienten mit primärer Coxarthrose.

AIM: The radiological appearance of the cementless ALLOCLASSIC SL-stem, implanted in patients with primary osteoarthritis of the hip and aged at least 80 years at time of surgery, was investigated. METHOD: 66 hips in 58 patients were analysed. 17 patients (19 hips) died in the interim, 5 patients (5 hips) were not available for follow-up because of health reasons (4) or lack of co-operation (1). 1 stem had to be explanted after a periprosthetic fracture of the femur. Finally, 41 total hip arthroplasties in 35 patients could be analysed after an average of 67.9 months (39.2-93.4). RESULTS: Bone atrophy - especially in the proximal Gruen zones - was frequently found. In contrast, radiolucent lines and osteolyses were rare occurrences. The Harris Hip score was preoperatively on average 33.0 points, at time of follow-up 81.7 points. The survival rate (endpoint aseptic loosening) was 100 % after a mean follow-up of 5.7 years. CONCLUSION: Also in very old patients the implantation of a cementless stem is possible and provides very good results.

Cementless total hip arthroplasty in patients older than 80 years of age.

We reviewed 80 patients (87 hips) who were older than 80 years of age at the time of cementless total hip arthroplasty. An Alloclassic SL stem had been implanted in all patients. A variety of cementless acetabular components was used. After a mean follow-up of 69.3 months (39.2 to 94.1) 48 hips in 43 patients were analysed clinically and radiologically. One patient had sustained a traumatic periprosthetic fracture of the femur with subsequent exchange of the stem 73 months after operation. Thirty-two patients (34 hips) had died and five patients (five hips) were unavailable for follow-up because of health reasons (four patients) or lack of co-operation (one patient). If the endpoint is defined as removal of the prosthesis because of aseptic loosening, the survival rate was 100% for the cup and stem after 78 months. The mean Harris hip score was 81.9 points. Radiolucent lines and osteolysis were seldom found.

Short term prophylaxis against heterotopic bone after cementless hip replacement.

The aim of the current study was to reveal whether 7 days of indomethacin treatment sufficiently prevents heterotopic ossification after cementless total hip arthroplasty. One group received indomethacin for 14 days (n = 102), and the second for 7 days (n = 99) after cementless total hip arthroplasty. At followup 1 year postoperatively, the average Harris Hip Score was 91 points in the 14-day treatment group and 89 points in the 7-day treatment group. The incidence of heterotopic ossification as outlined by Brooker was similar in both groups. Ninety-six patients in the 14-day treatment group had heterotopic ossification Grades 0 or 1, and 6 patients had Grade II heterotopic ossification; whereas in the 7-day treatment group, 95 patients had Grades 0 or 1 heterotopic ossification and 4 patients had Grade II ossification. None of the patients had Grades III or IV heterotopic ossification. In the 14-day treatment group, headache, dizziness, or gastritic disorders develop in 10 patients, and in the 7-day treatment group, 7 patients had these effects. This study shows that treatment with 100 mg indomethacin daily for 7 days is not significantly different than 14 days of treatment for the prevention of formation of severe heterotopic ossification after cementless hip arthroplasty.

Indomethacin for prevention of ectopic ossification in cementless hip arthroplasties. A prospective 1-year study of 100 cases.

In a prospective series of 100 patients we investigated the effect of indomethacin for 6 weeks in the prophylaxis of ectopic bone formation in hip replacements with cementless fixation. Indomethacin prophylaxis reduced (P < 0.0001) ectopic bone formation compared to a retrospective control group of equal size. Side-effects occurred in one-fifth of the patients, but most of these could continue the medication for at least 4 weeks.