[An unusual observation of total hip replacement with meta on metal gliding bearings]. / Ungewöhnliche Beobachtung nach Hüft-TEP mit Metall/Metall-Gleitpaarung.

QUESTION: The conically clamping inlay of solid metal for the Hofer-Imhof threaded socket makes possible the use of a metal-metal-bearing by completely dispensing with polyethylen but keeping the four-elements-construction of THR. In order to perceive long-term problems and complications patients of our hospital who took part in a closed multi-center-study which was established prospectively were checked again. METHOD: Clinical and X-ray examination of 27 patients after 19 months on an average (12-23 months). RESULTS: Harris-score increased from 38 points before the operation to 89 points three months after the operation and 91 points in the present check-up. Three months after the operation 22 patients were free of pain, at present only 12. X-Rays did not show any signs of loosening within the prostheses. But increasing ectopic ossifications of Brooker were found: ten times Class I, once Class II and six times Class III. CONCLUSION: Using equal form of after treatment the increasing break out of pain as well as the growing symptom of ectopic ossifications in the hip area after the implantation of the Hofer-Imhof threaded socket with solid metal inlay is presumably caused by the use of the metal-metal-bearing as well as by the direct lining of the Co-Cr-inlay in the titan-socket and by possible changes in corrosion.

[Imaging of the Achilles tendon on the computed tomogram. Normal findings and pathological changes]. / Die Darstellung der Achillessehne im Computertomogramm. Normalbefunde und pathologische Veränderungen.

Ligaments and tendons, including the Achilles tendon, show the highest density among normal soft tissue structures in the body. Traumatic and degenerative changes of the Achilles tendon are often associated with marked thickening and reduction in density associated with increased opacity of the space in front of the Achilles tendon. These changes are easily demonstrated by CT, whereas conventional radiological techniques only show non-specific changes. Twenty-five patients were examined, including nine with pain, seven following rupture of the Achilles tendon and nine post-operative controls; it was found that CT can add information important for the diagnosis and treatment planning of abnormalities of the Achilles tendon.

Diagnosis of chondromalacia patellae using CT arthrography.

Using anatomical specimens for experimental investigations, the physical-technical prerequisites for proper demonstration of the femoro-patellar articulation were determined and the following results obtained: hyaline cartilage possesses an attenuation value of 25-35 HU; artificial lesions from 1 mm. deep and 2 mm. wide minimum can be visualized; the use of positive contrast medium is best suited for demonstration of chondral lesions. In clinical practice we found that the various stages of cartilaginous degeneration peculiar to chondromalacia (Fründ I to III) are clearly demonstrated by CT arthrography. In CT the predisposing changes in the morphology of the patella and the femoro-patellar articulation are more precisely defined than in conventional tangential roentgenograms. In 69 cases the CT arthrographic findings could be verified at operation. However, the extent and severity of the lesions was, at times, underestimated.

[Arthroscopic knee surgery]. / Arthroskopische Operationen am Knie.

Endoscopic knee operations have become increasingly accepted during the last years. Meniscectomy is the most important of the endoscopic operations. The technique, developed in Linköping/Sweden, makes it possible to perform partial, subtotal or total meniscectomy according to what is needed to treat the patient appropriately. The technique involves the use of a pump system to distend the joint with saline, a mechanical assistant, a special knife with retractable blades, a grasping and a basket forceps. This very simple and inexpensive equipment makes all kinds of endoscopic meniscus surgery possible. The results of endoscopic meniscectomy have been rewarding. The time for sick leave is very short and the operation can be done on out-patients. Athletes ae back to sport usually within 4 weeks. There have been no complications.

[Cartilage injuries of the femoro-patellar joint in the computerized tomogram]. / Knorpelschäden des Femoro-Patellar-Gelenks im Computer-Tomogramm.

The conventional arthrographic methods for demonstration of the femoro-patellar joint are not sufficiently reliable. Through the use of CT-arthrography a cross-sectional image free of superimposition and possessing a high density resolution is available thus facilitating a direct demonstration of the joint cartilage. Traumatic and degenerative lesions of the cartilage can be clearly shown by CT-arthrography. Damage of cartilage in patients with chondromalacia patellae can be differentiated in its different stages. The shape of the patella and its relation to femoral condyles can be evaluated more accurate than by conventional axial x-rays.

[Meniscus ganglia. Diagnosis and differential diagnosis]. / Meniskusganglien Diagnose und Differentialdiagnose.

3% of isolated meniscectomies were performed on patients with cysts of the meniscus. The etiology is not yet fully elucidated. The problems in clinical and radiological diagnosis are discussed using the examples of two operatively verified cases. In computerized tomography the density values of these lesions range from 20 to 35 Hounsfield units thus allowing specific diagnosis. Localization and extent of the cyst can be shown exactly by computerized tomography.

Evaluation of the cruciate ligaments by CT.

Delineation of the cruciate ligaments in 112 patients using the computed tomography under arthrographic conditions was reported. Special position were used allowing for the demonstration of both cruciate ligaments in their complete lengths. In 6.2% of the examinations a reliable demonstration of the cruciates was not possible for technical reasons. Demonstration of normal cruciate ligaments in CT arthrography was described and normal values were tabulated. Recent cruciate ligament injuries were seldom examined by CT arthrography since the clinical symptoms were mostly unequivocal. The old ruptures of the ACL were divided into 4 different types: Type I: Rupture of the femoral origin that adjoins the PCL. Type II: Attenuation of the intraligamentary ruptured ligament with a preservation of origin and insertion. Type III: Complete rupture with shrinking and retraction of the fragments. Type IV: Osseous involvement of the femoral origin or tibial insertion. In 36 old cruciate ligament ruptures, the sensitivity of this method of investigation was 97%, the specificity 100%. After reconstructive surgery, CT arthrography allows for an objective analysis of the operative results and permits the comparison of different techniques of surgical repair.

[The clinical importance of arthrography after lesions of the meniscus and capsular ligament (author's transl)]. / Die klinische Bedeutung der Arthrographie nach Meniskus- und Kreuzbandläsionen.

Clinical, arthrographic and operative findings of 100 patients were compared and analyzed by a study group with the result, that in questionable lesions of the meniscus, the indication for a double contrast arthrography was markedly reduced when plain films of the knee, an exact case history and a physical examination of the knee joint were performed. Above all, the improved examination technique, with the knowledge of the functional anatomy of the capsular ligament apparatus and the correlation of all stabilizing forces of the knee joint had reduced clinical errors in diagnosis. Clinically clearly analyzed meniscus lesions are therefore no indication for arthrography. In our clinic the indicatin will be reduced to those cases where there are still complaints after meniscectomy. There is a great advantage, if the examinating physician, the radiologist and the orthopedic surgeon cooperate closely together.