Der Orthopäde
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This article describes the history of pain therapy and anesthesiology with respect to the field of surgery. The history of this part of medicine is dependent upon the development of the appropriate medication groups, which were of great importance in the field of pain therapy and anesthesiology. ⋯ The above mentioned developments combined with the knowledge of physiology of pain and new results from psychological studies led to the modern pain therapy in recent perioperative treatment concepts. Modern pain therapy is a multimodal therapy concept with a variety of specialties working as a team to optimize an individualized therapy plan which respects the needs of every single patient under different circumstances (acute, perioperative and chronic pain).
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The German mandatory quality assurance programme collects data from all primary total hip and knee replacements. The quality of the indication is measured by clinical and radiological criteria. The results were analysed in terms of differences in establishing the indication subject to patient and hospital characteristics. ⋯ Further analyses are necessary to ascertain whether the differences in quality of care are deficits or only variances in medical care.
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Comparative Study
[Value of adjuvant physiotherapy in postoperative pain management].
In times of limited financial and human resources the application of adjuvant physiotherapy postoperatively in orthopaedic patients requires reevaluation. In the early postoperative course physiotherapy improves the patients' mobility. However, it is not able to reduce the need for pain medication. ⋯ In contrast, massages are of minor importance in the immediate postoperative course and are applied only in a few selected cases. Cryotherapy plays a major role especially after shoulder and knee surgery. On the other hand, transcutaneous electrical nerve stimulation (TENS) and acupuncture are applied only in selected patients after orthopaedic surgery, e.g., after limb amputation.
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Comparative Study
[New and evidence-based aspects of postoperative pain therapy].
Poorly managed postoperative pain has been recognised to delay patient recovery and hospital discharge. Recent metaanalyses support a multimodal approach with combinations of analgesics from different classes. ⋯ Local, intraarticular, epidural, and, more importantly, modern peripheral regional techniques can be used successfully to enhance perioperative analgesia. The use of continuous perineural techniques with local anaesthetic infusion has been extended beyond hospital discharge in many European countries.
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Skeletal geometry, soft tissues, and neuromuscular control influence the patellofemoral gliding mechanism. Abnormal skeletal geometry - such as increased femoral anteversion, trochlear dysplasia, patella alta, increased tibial external torsion, increased tibial tubercle lateralization, and variations of combined deformities - may lead to patellofemoral complaints. ⋯ Osteotomy with soft tissue repair might be the best treatment, depending on the primary pathology. Surgery aims to eliminate the underlying pathomorphology.