Zeitschrift für Orthopädie und Unfallchirurgie
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The outcome of orthopaedic surgery such as total hip replacement (THR) or total knee replacement (TKR) is commonly given by the change in mean scores on patient-reported outcome measures (Prom's). This may give the impression that all enrolled patients have experienced an improvement. But the Swedish hip registry and other studies report a reduction of complaints in 80-85 % of patients ("responders"), with the remainder (approximately one in six) remaining unchanged or reporting worse complaints ("non-responders"). According to Cohen, the degree of success in the "responders" group can be subdivided into excellent, good and moderate. For a given treatment, a total of 5 different outcome groups can therefore be defined: excellent, good, moderate, unchanged and worse. Allocation to the groups is based on the "relative effect per patient" (REPP). The REPP is calculated as the base-line score minus the post-treatment score divided by the baseline score. The maximum possible REPP is 1; a REPP of 0 means no effect and a negative REPP means deterioration. Allocation to the outcome groups is as follows: excellent 0.95 to 1 REPP, good 0.5 to 0.95 REPP, moderate over 0.2 to 0.5 REPP, unchanged -0.2 to 0.2 REPP and worse below -0.2 REPP. ⋯ Calculation of the REPP and the subsequent allocation to outcome groups is simple. The distribution of outcomes depends on the intervention (THR results better than TKR) and the patient questionnaire used (better results with a condition-specific than a generic questionnaire). The proportion of "unchanged" and "moderate" outcomes was greater with the generic questionnaire than with the condition-specific questionnaire, while the proportion of "worse" outcomes was similar for the two instruments. Partitioning of the degree of success into sub-groups, based on the REPP, provides more information for both the patient and the orthopaedic surgeon.
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The trend in arthroplasty of the hip joint to implement new models is partly based on theoretical considerations. In order to verify to which extent the philosophy of individual models is ultimately successful, the presentation of long-term results is required. In the years 1991 and 1992, 433 patients with primary implantation of an uncemented total hip replacement in primary coxarthrosis with a stem type AML (anatomic medullary locking) were treated surgically. 283 of them got a cementless cup type Duraloc. ⋯ A subsiding of the stem in 2 cases had no effect on the clinical symptoms and quality of life. The press-fit implanted AML stem and the Duraloc cup revealed very good results during the investigation period. Like other implants, the survival rate is limited at the presented implant mainly by the cup.
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Only limited data are available concerning the effect of ventral thoracoscopic spondylodesis (VTS) on elderly patients and the medium-term outcome. ⋯ Also in older patients VTS seems to be an adequate treatment of traumatic burst fractures of the thoracolumbar spine. Perioperative pulmonary complications were easy to handle and had no effect on the clinical outcome. Postoperative radiographs showed only little loss of correction, in four cases iatrogenic damage of the cover-plate led to a distinct loss of correction. Careful and accurate preparation of the cover plates is therefore decisive.
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Clinical Trial
[Impact of surgical strategy on quality of life and radiological outcome in traumatic fractures of the thoracolumbar spine].
There are a variety of surgical strategies for the treatment of traumatic thoracolumbar vertebral fractures. There is still no proof for the superiority of any strategy concerning clinical or radiological outcomes. The aim of this study was the evaluation of residual complaints and correlation with radiological findings. ⋯ Overall outcomes of the four surgical strategies were comparable in our study concerning loss of correction and quality of life, respectively. The use of bone grafts, however, results in a high rate of non-fusion with a remarkable number of patients complaining about bone graft morbidity. Therefore we prefer the use of expandable titanium cages for anterior stabilisation if additional anterior stabilisation is necessary due to type of fracture or damage of adjacent discs. In any other cases, a limited approach by posterior instrumentation alone should be considered.
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The Young Forum of the German Society of Orthopedics and Traumatology is an interest group of young orthopedics and trauma surgeons in Germany. Besides dealing with topics of political interest, the group tries to arouse enthusiasm and interest for musculoskeletal surgery by means of new lectures and teaching methods. An example is the newly invented optional subject for students at the Medical School in Göttingen (Germany). ⋯ The course is divided in two main parts: a theoretical (16 hours) and a practical (10 hours) one. A good ratio of lectures, skills stations and workshops was on choice. This article explains the course in detail and shows a first evaluation result.