[Status of cementation technique in total hip endoprostheses in Germany]. / Der Stand der Zementiertechnik bei Hüfttotalendoprothesen in Deutschland.

AIM: The correlation between improved cementing techniques and improved long-term results after total hip arthroplasty (THA) is well documented. The purpose of this study was to assess the use of modern cementing techniques in Germany. METHODS: A detailed questionaire regarding cement and bone preparation, cementing techniques on actabulum and femur, and implants used was sent to 584 German orthopaedic and trauma hospitals, as well as to visiting surgeons with an interest in THA. In total, 333 questionaires were available for evaluation and statistical analysis. RESULTS: In this survey, Palacos bone cement is used in 84%, low viscosity cement in 9%. Cement chilling is performed in 58%. Mixing is done by hand without vacuum mixing systems in 53%, the mixing time is standardised in 66%. For the femur 83% and for the acetabulum 74% preserve cancellous bone, 13% use pulsed lavage. Cement application is done via cement gun in 97%, in 41% in a retrograde manner and in 18% without drainage of the intramedullary canal. A cement pressurising technique is used in 63% for the femur and in 57% for the acetabulum. A cement mantle of less than 2 mm is attempted in 41%. More than 50 different stem design are implanted with the Müller straight stem being used most often, followed by anatomic designs. Almost 50% of hips are used with a 28 mm head, and almost 50% are implanted with a 32 mm head. Half the heads are ceramic, half are metal. CONCLUSIONS: The results from this survey document, that overall only slightly more than 10% of hips are implanted using second/third generation (modern) cementing techniques with application of pulsed lavage. This has implications on the number of arthroplasties that may require revision. From the data available the current status of cementing technique in Germany cannot be judged satisfactory.

[Orthotic treatment and walking ability of patients with myelomeningocele--analysis of influencing factors]. / Orthetische Versorgung und Gehfähigkeit von Patienten mit Myelomeningozele--eine Analyse der Einflussfaktoren.

In 106 patients with myelomeningocele, which were fitted with orthotic devices, we analyzed the influence of level of neurologic deficit, scoliosis and contractures of the lower extremities on different walking parameters, e.g. orthotic wearing time, duration of walking and velocity, step length and mobility status. The most important factor is the level of neurologic deficit. From a functional point of view a bilateral hip dislocation can be neglected. Whereas impairment of walking ability is strongly correlated with scoliosis of more than 50 degrees and unilateral hip dislocation; therefore both conditions should be treated operatively.

[Normal synoviocytes and synoviocytes from osteoarthritis and rheumatoid arthritis bind extracellular matrix proteins differently]. / Normale Synoviozyten und Synoviozyten aus Osteoarthritis und rheumatoider Arthritis binden unterschiedlich an extrazelluläre Matrixproteine.

Extracellular matrix proteins are increased in inflammatory synovitis. We showed previously that the in situ expression of the corresponding extracellular matrix receptors (beta 1-integrins) is enhanced in synoviocytes (SC) of synovitis of different etiology (16). To investigate the adhesion of SC to extracellular matrix proteins, we examined the attachment of SC from normal and inflamed synovia to fibronectin, tenascin, laminin and collagen type IV. Compared to normal SC and SC of osteoarthritis, SC of rheumatoid arthritis showed an increased binding to tenascin, laminin, fibronectin and collagen type IV, suggesting a distinctive interaction of SC and extracellular matrix proteins in rheumatoid arthritis. Furthermore, the increased binding of SC of rheumatoid arthritis to extracellular matrix proteins may play a role in tissue remodelling associated with rheumatoid arthritis.

[Hip joint problems in patients with Down's syndrome]. / Hüftgelenksprobleme bei Patienten mit Morbus Down.

10 patients with Down's syndrome and hip disorders have been examined. Hip instability was present in 5 patients: habitual dislocations occurred in 2 patients, persistent subluxation was found in 2 patients and 1 patient had bilateral fixed hip dislocation. Hip instability usually occurs after the begin of walking and we suggest to perform regularly radiographic examinations on hip instability. Other hip disorders as slipped femoral capital epiphysis may be complicated by hip instability. Legg-Calvé-Perthes disease was found in 2 patients and slipped femoral capital epiphysis in 3 patients. 7 of the 10 patients underwent operative treatment. Subsequently a second or third operation was necessary in 2 patients because of an unexpected instability of the hip following the primary surgery. This was caused by the ligamentous laxity which is often found in Down's syndrome. An increased rate of infections is known in trisomy 21 and wound infections occurred in 2 of the 7 operated patients. Therefore we recommend to consider ligamentous laxity and susceptibility to infection in the treatment of hip disorders in Down's syndrome.