[Salvage options following failed total ankle arthroplasty]. / Revisionsmöglichkeiten nach gescheiterter Sprunggelenkprothese.

The number of patients with osteoarthritis of the ankle, which are treated by arthroplasty, has continuously increased in recent years. The survival time of these implants is far below the results following hip and knee arthroplasty. In some cases a failure rate of approximately 1% per year or a survival rate of 70% after 10 years has been reported. The most frequent reasons for revision of an ankle prosthesis are aseptic loosening, technical implantation errors and persisting pain. For the revision of an ankle prosthesis there are basically two treatment options. For a long time, ankle arthrodesis was considered the gold standard after a failed prosthesis. In recent years, there has been an increasing trend towards re-implantation of an ankle prosthesis, as this preserves the functionality and mobility of the ankle joint as far as possible. Depending on the reason for failure and the size of the bony defect, a decision must be made regarding a one-stage and a two-stage procedure with bone augmentation. This article presents the advantages and disadvantages of arthrodesis and revision arthroplasty after failed primary ankle arthroplasty and highlights the special features of surgery.

[Midportion Achilles tendinopathy]. / Midportion-Tendinopathien der Achillessehne.

Although the incidence of midportion Achilles tendinopathy is under 1% in the general population, it is quite a common disease in runners that is characterized by the symptom triad of pain, swelling and impaired physical performance. Pain and swelling are located in the area 2 to 7 cm proximal the tendon insertion onto the calcaneus.Diagnosis is made by adequate clinical symptoms and corresponding findings in sonography and/or magnetic resonance imaging scans. Histopathologically, mostly degenerative changes in the tendon structure are found, sometimes accompanied by intra- and paratendinous inflammation.Treatment options are conservative or surgical, but conservative ones should be tried first. The best evidence is available for eccentric exercise protocols, which represent the gold standard in conservative treatment options, followed by extracorporal shockwave (ECSW) therapy and corticoid injections.In about 25% of all cases, because of unsatisfactory nonoperative treatment results, surgery is recommended. Open, minimally invasive as well as tenoscopic methods exist, which show patients' satisfactory rates of about 80%. The return to sport or full physical performance is variable and may take up to 18 months for both treatment regimens.

[Ankle impingement. Indications and arthroscopic therapy]. / Impingement des oberen Sprunggelenks. Indikationen und arthroskopische Therapie.

Ankle impingement syndromes are one of the most frequent chronic and posttraumatic pathologies of the ankle joint. Anterior and posterior impingement result from the abutting of anatomical structures leading to pain and limitation in the range of motion of the ankle joint. Ankle impingement can be classified based on the localization or the underlying cause. Besides chronic ankle pain, further symptoms are movement and load-dependent swelling of the ankle joint and limitations in dorsiflexion and plantar flexion. The clinical symptoms and physical examination play an essential role in diagnosing soft tissue impingement, whereas various imaging techniques are important for the diagnostics of bony impingement. From a therapeutic perspective, conservative treatment should be initially attempted. If non-operative treatment fails, arthroscopic resection and debridement of the underlying cause is nowadays the standard method of surgical treatment. With a current complication rate of approximately 3 % ankle arthroscopy is a safe operative method, which is associated with a high postoperative rate of patient satisfaction and significant relief of symptoms.

The endoscopic treatment of carpal tunnel syndrome as an outpatient procedure.

From September 1995 to July 1996 50 patients were treated for carpal tunnel syndrome as outpatients by endoscopic release in the rooms of an orthopaedic surgeon (two-portal-technique). The average age was 51.3 years (27-61 years). The average length of symptoms was 43 months, the postoperative time off work averaged 27 days. Six months postoperatively wasting of the thenar persisted in 2 out of 16 patients, a positive Tinel's sign in 1 out of 46 patients and delayed median nerve conduction in 2 out of 48 presenting these symptoms preoperatively. At 6 months the average handgrip strength had recovered to 109% of the preoperative value. One out of 49 patients still presented paresthesia and 1 out of 50 nocturnal dysesthesia. There were minor complications in 7 patients (14%), only one patient requires further treatment. We conclude that endoscopic carpal tunnel release done on outpatients in a private surgery can be reliable, safe and cost efficient.