Diagnostic parameters in periprosthetic infections: the current state of the literature.

Despite progress in recent years, a definitive diagnosis of PPI is not yet possible. Due to new diagnostic possibilities and the further development of already existing diagnostic tools, a more accurate diagnostic clarification of uncertain cases should be possible. The following article includes an overview of common existing diagnostic tools and instruments, which will likely gain importance in the future.

Reverse shoulder arthroplasty combined with latissimus dorsi transfer: A systemic review.

Reverse shoulder arthroplasty (RSA) combined with latissimus dorsi transfer (LDT) is described for patients with cuff arthropathy and a combined loss of abduction and external rotation. The purpose of this systemic review was to present clinical and radiological outcomes following RSA combined with LDT. A comprehensive literature review was performed to identify studies reporting clinical and radiological results of RSA combined with LDT. Seven articles that describe the treatment of 116 patients were selected. Functional scores, range of motion, radiological outcome, complications, rehabilitation regime, surgical technique, patient demographics and indication were analyzed and discussed. All studies reported significant improvement in functional scores and abduction and external rotation. Complications occurred in 26% of patients. Although high-level studies are lacking, this systemic review shows that RSA combined with LDT is a reliable surgical method with which to treat patients with loss of active abduction and loss of external rotation. The available data are insufficient to draw conclusions regarding the long-term outcomes of this procedure. LEVEL OF EVIDENCE: IV.

Relationship Between Medial Meniscal Extrusion and Cartilage Loss in Specific Femorotibial Subregions: Data From the Osteoarthritis Initiative.

OBJECTIVE: Medial meniscal extrusion is known to be related to structural progression of knee osteoarthritis. However, it is unclear whether medial meniscal extrusion is more strongly associated with cartilage loss in certain medial femorotibial subregions than in others. METHODS: Segmentation of the medial tibial and femoral cartilage (baseline; 1-year followup) and the medial meniscus (baseline) was performed in 60 participants with frequent knee pain (mean ± SD ages 61.3 ± 9.2 years, body mass index 31.3 ± 3.9 kg/m(2) ) and with unilateral medial radiographic joint space narrowing (JSN) grades 1-3, using double-echo steady-state magnetic resonance images. Medial meniscal extrusion distance and extrusion area (percentage) between the external meniscal and tibial margin at baseline, and longitudinal medial cartilage loss in 8 anatomic subregions were determined. RESULTS: A significant association (Pearson's correlation coefficient) was seen between medial meniscal extrusion area in JSN knees and cartilage loss over 1 year throughout the entire medial femorotibial compartment. The strongest correlation was with cartilage loss in the external medial tibia (r =-0.34, P < 0.01 in JSN; r =-0.30, P = 0.02 in knees without JSN). CONCLUSION: Medial meniscal extrusion was associated with subsequent medial cartilage loss. The external medial tibial cartilage may be particularly vulnerable to thinning once the meniscus extrudes and its surface is exposed to direct, nonphysiological, cartilage-to-cartilage contact.

[Operative therapy of isolated patellofemoral arthritis. Biomechanics as a guide]. / Operative Therapie der isolierten patellofemoralen Arthrose. Biomechanik als Wegweiser.

BACKGROUND: The treatment of patellofemoral arthritis places high demands on orthopedists. The exact analysis of the underlying pathobiomechanical relationships is the basis for every therapy decision. METHODS: Soft tissue procedures, such as medial patellofemoral ligament (MPFL) reconstruction for stabilization and bone interventions for alignment optimization (e.g. tuberosity transfer and corrective osteotomy) can play a role in treatment. In cases of advanced patellofemoral arthrosis these interventions can be used as well as in combination with partial joint replacement. For the choice of implant the use of anatomical prosthesis types is recommended because with these components the number of additional procedures can be reduced. CONCLUSION: The success of patellofemoral prosthetics depends mainly on the recognition of biomechanical deviations. If these can be corrected the risk of implant failure can be reduced.

Localization of preproenkephalin mRNA-expressing cells in rat auditory brainstem with in situ hybridization.

Hair cells and auditory nerve dendrites in the inner ear are innervated by pontine neurons that have been demonstrated by immunochemical techniques to contain several neurotransmitters, including acetylcholine and the opioid peptide enkephalins and dynorphins. The functions of these nerve fibers are not known, but may involve modifying auditory sensitivity to low intensity stimuli. In the guinea pig the opioid pathways originate in the lateral superior olivary region. A recent study in the gerbil has reported cells expressing preproenkephalin mRNA present only in the ventral nucleus of the trapezoid body, and not in the superior olivary region. In the present study, a non-radioisotopically labeled in situ hybridization method was used to identify cells expressing mRNA coding for preproenkephalin in rat pontine neurons, specifically in the ventral nucleus of the trapezoid body. These cells may represent an enkephalin-containing medial olivocochlear system in the rat, the origin of the lateral system in the rat that differs markedly from the better-studied guinea pig and cat, or a non-olivocochlear enkephalin-containing system.

[Preoperative autologous blood collection under erythropoietin stimulation. Preliminary results in patient selection, erythropoietin dosage and administration]. / Präoperative autologe Blutkollektion unter Erythropoietinstimulation. Vorläufige Ergebnisse in Patientenauswahl, Erythropoietin-Dosis und Administration.

In a randomised study we have evaluated the influence of erythropoietin (EPO) on the yield of autologous blood in elective surgery (total hip replacement). The study was performed placebo controlled in 82 patients: 25 patients received 200 IE EPO/kg 2 x/week i.v. over 3 weeks (group C), 30 patients 100 IE EPO in the same schedule (group B), and 27 patients received placebo (group A). All patients were treated with 3 x 250 mg Fe-sulfate p.o. during the study time. The number of collected blood conserves was not significantly different in these groups (5.4 in group C, 5.06 in group B, 4.8 in group A), but there was a significant difference in patients with a diminished hemoglobin (Hb < 14 g/dl): 5.2 in group C, 4.9 in group B, and 3.6 in group A. Patients with a normal hemoglobin level showed a significantly higher preoperative hemoglobin in group C against group A. We conclude that the application of EPO is suggestive in patients with a diminished hemoglobin, but also in patients with normal hemoglobin the blood picture at the time of surgery is higher in EPO treated patients.

Thromboembolic prophylaxis in total hip replacement: a comparison between the low molecular weight heparinoid Lomoparan and heparin-dihydroergotamine.

In a prospective, randomized, assessor-blind multicentre study two antithrombotic subcutaneous regimens were compared in patients undergoing total hip replacement. Group 1 (154 patients) received 750 anti-Xa units of a new low molecular weight heparinoid (Lomoparan) subcutaneously twice a day and group 2 (155 patients) received 5000 units heparin and 0.5 mg dihydroergotamine (heparin-DHE 5000) twice a day. The incidence of deep vein thrombosis, assessed by routine bilateral venography on day 10 (+/- 1), was 17 and 32 per cent in groups 1 and 2 respectively (risk reduction 47 per cent; P = 0.007). One patient in each group developed a symptomatic pulmonary embolism confirmed by lung scanning. Major bleeding complications occurred in one patient in each group and no significant difference was observed between the two groups with respect to minor bleeding complications. Subcutaneous Lomoparan appears to be as safe as heparin-DHE 5000 at the above doses with regard to bleeding complications, and is more efficacious with respect to venous thrombosis.