[Fixed bearing unicondylar arthroplasty in medial osteoarthritis of the knee]. / Schlittenprothese mit fixiertem Tibiainlay bei medialer Gonarthrose.

OBJECTIVE: The unicondylar prosthesis replaces the medial femerotibial compartment only, the part presenting with osteoarthritic changes. The remaining compartments of the knee present less osteoarthritic changes and thus can be preserved. INDICATIONS: Osteoarthritis of the medial femorotibial compartment is the ideal indication for unicondylar arthroplasty. The knee should show an intraarticular deformity, which means the malalignment is caused by the osteoarthritic changes of the medial compartment. CONTRAINDICATIONS: Malalignment of >5°, flexion contracture of >10°, mediolateral instability and symptomatic osteoarthritis of a second compartment should be considered as contraindications for unicondylar arthroplasty. SURGICAL TECHNIQUE: In the current article, implantation of the BalanSys® system is presented. Femoral bony resection is solely ligament balanced. The technique allows creation of an optimal extension and flexion gap. Bone cuts were performed using a soft tissue tension device for measuring the extension and flexion gap. POSTOPERATIVE MANAGEMENT: Full weight bearing on crutches is allowed immediately after surgery without restriction in flexion. Crutches are recommended for 4 weeks in order to compensate for neuromuscular deficits. Anticoagulation is recommended for 11-14 days according to the AWMF guidelines (S3 guidelines, Release:15 October 2015). RESULTS: The clinical follow-up after 2 years showed 87 ± 13 points in the knee score and 80 ± 10 points in the function score. The mean range of motion increased from 113°±24° prior to surgery to 122°±23° after surgery. A preoperative extension deficit of 10° was observed in 9 patients and reduced postoperatively in 3 patients.

[Prevention and health promotion as a responsibility of legal health insurance--exemplified by a local insurance bureau]. / Prävention und Gesundheitsförderung als Aufgabe der gesetzlichen Krankenkassen--dargestellt am Beispiel einer Ortskrankenkasse.

The German statutory health insurance bodies are legally obliged to support health promotion of the assured, as stipulated by German social legislation since 1988. An analysis was performed covering a period of 5 years (1986-1990) in respect of all health-promoting and preventive measures carried out by a local so-called "Allgemeine Ortskrankenkasse (= AOK)" looking after 170,000 insured persons, to find out the impact of the new legislation on the practice of that particular local insurance body. During the period under report no changes in activities were recorded that would be worth mentioning. Although expenditure for prevention rose by 50%, it was nevertheless impossible to administer preventive measures to all the insured persons throughout the area since the total amount reserved for this purpose was only 0.42% of the overall expenditure. A major portion of the documented measures such as consultation on foods, health-promoting sports, getting rid of the smoking habit, social counselling, anti-stress training courses and the like were not performed for primary prevention but on subjects who were already sick (diabetics, cardiovascular patients, patients suffering from diseases of the locomotor apparatus). Definite statements on the quality or success of the measures were possible in selected cases only. The results of the study prompted organisational improvements in that particular insurance body. Since their financial resources are limited, these bodies should shift the emphasis of their expert possibilities in prevention to on-target care of high-risk groups and to the training of multiplicators.