Guidelines for Chiari's osteotomy in the immature skeleton developed from a canine model.

Three variations of Chiari's pelvic osteotomy were performed on 18 dysplastic hip joints in young, growing German shepherd dogs and rottweilers. The results of the operations and the reactions of the skeletal tissue were investigated radiologically and histologically after six and 12 months. By use of polyfluorochrome sequential labeling and microangiography, it was demonstrated that neither the formation of new bone nor the blood supply in the vicinity of the rim of the acetabulum (apophysis of the acetabular roof) was seriously impaired by the operation. Conversely, the operative technique was of decisive importance to the result of the operation. Only if the osteotomy was performed through the original acetabular rim, completely covering the femoral head, was the newly formed acetabular roof adequately biomechanically loaded, providing the conditions required for functionally adapted differentiation of skeletal tissue. Chiari's pelvic osteotomy can be performed on canine hips with good chances of success, provided one uses the proper operative technique. Apophyseal bone growth and the blood supply of the newly formed acetabular roof were apparently not disturbed by Chiari's operation.

[Controlled ultra-high dosage methotrexate therapy in three patients with metastatic osteosarcoma (author's transl)]. / Ultrahochdosierte Methotrexattherapie mit plasmaspiegelgesteuerter Verabreichung bei 3 Pateiten mit metastasierendem Osteosarkom.

9 HDMTX infusions with 30 to 55 g MTX and leucovorin rescue were given to 3 patients with multifocal osteosarcoma. Resistance to standard MTX infusions with up to 12 g/m2 body surface in 4 hours indicated the administration of these higher doses (27 g/m2 body surface on average) over a shorter period of time (160 min on average). MTX input was controlled by the increase in plasma MTX levels which were determined by EMIT enzyme assay within a few minutes of sampling. The plasma MTX levels were found to be up to 10 times (average 4 times) higher than those achieved by the standard infusion. All infusions proved to be relatively well tolerated in all 3 cases, although, thrice after 36 hours an increased leucovorin rescue had to be made for 12 hours, because of delayed renal methotrexate excretion; the usual leucovorin rescue (15 mg every 6 hours) was given for an average of five days. No therapeutic effects were seen either clinically, radiologically, or histologically. The resistance to HDMTX in these three patients could not be broken by HDMTX PLRD infusions.

[The vertebrotomy as additional therapy at spondylitis tuberculosa (author's transl)]. / Die Herdausräumung als zusätzliche Therapie bei der Spondylitis tuberculosa.

One hundred and three patients with spondylitis tuberculosa were treated with 104 vertebrotomies, without deaths. The results of 71 cases, one until 24 years after the operation, were evaluated. Most of them showed bony healing, only one had a soft tissue rezidivism. Through the modern antituberculous therapy the time of immobilization (plaster-bed and cast) could have been shortened in the last 13 years from 38,4 to 20,3 months.

[A ceramic total hip endoprosthesis for implantation without bone cement. Preliminary report (author's transl)]. / Eine keramische Hüfttotalendoprothese zur zementfreien Implantation. Vorläufige Mitteilung.

A new total hip endoprosthesis for implantation without bone cement is reported. This prosthesis consists of a ceramic socket and a titanium femoral component which is covered with a ceramic layer (Al2O3). The proximal end of the femoral component is shaped to a conus on which a ceramic ball for articulation with the socket is placed. Beside the construction principles the implantation technique and first clinical experiences are described.

[History and present indications for corrective surgery of the acetabulum in hip dysplasia (author's transl)]. / Geschichte und aktuelle Indikation der pfannenbildenden Eingriffe am Hüftgelenk

F. König published the first shelf-operation above the dislocated femoral head, which could improve the function in 1891. In Europe only after 1920 the techniques of Spitzy and Lance grew popular and are still frequently performed with their different variations. Pelvic osteotomy with medialisation was published 25 years ago for special indications, some years later Salter's Innominate Osteotomy got very well known. Describing the history of these operations the actual indication for the different methods is analised.