Der Orthopäde
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Traditional methods for evaluating the outcome of treatment in orthopaedic surgery include the assessment of clinical status, pain and radiography. For more than two decades, there has been an increasing interest in the use of health-status measures in clinical medicine. Outcome evaluation should not only consider clinical and radiographic parameters but also the patients' personal views on their health status and quality of life. ⋯ The current paper primarily addresses the orthopaedic surgeon and provides a review of quality of life and health-status measures commonly used in orthopaedic outcome studies. Generic and disease specific measures of health status can be used in orthopaedic surgery to complement an outcome assessment. Thereby, the personal view of the patient becomes an objective part of the evaluation.
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Clinical Trial
[Results and experiences of conversion of hip arthrodesis ].
With the predictably good outcome of total hip arthroplasty today (THA), hip arthrodesis currently has limited indications. Over the long term, however, most patients develop secondary degenerative arthritis in the spine, contralateral hip, and ipsilateral knee due to overloading. The deteriorating condition of these joints eventually causes the onset of pain, which often requires conversion of a fused hip to a THA. The results and experiences of conversions of a hip arthrodesis into a THA are reported. ⋯ We conclude that this operation can lead to satisfactory results even after a long duration of the arthrodesis. There is a high rate of complications after conversion of a hip arthrodesis to a total hip arthroplasty. These issues must be carefully considered and discussed with the patient before any conversion procedure.
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Recent technological advancements in microelectronics have led to the establishment of systems for restoration of basic functions in spinal cord injured (SCI) persons using functional electrical stimulation (FES). FES systems for the restoration of bladder and diaphragm function are well established in clinical practice. ⋯ The most recent developments in micromechanical engineering are aimed at providing minimally invasive, subminiature systems for functional support in incomplete SCI persons. The possibility of direct brain control of FES systems will expand the application of neuroprostheses for patients with injury of the high cervical spinal cord.
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Retrospective assessment of multistage surgery in the treatment of progressive spondylodiscitis in patients with critical physical status. ⋯ A multistep surgical procedure under protection of dorsal instrumentation can limit perioperative mortality in patients in critical general condition by avoiding an extended one stage dorsoventral spondylodesis. After eradication of further infection foci and stabilization of physical condition, ventral instrumentation is completed under elective conditions.
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Today, there is accumulating evidence from animal experiments that axonal regeneration and an enhanced level of functional repair can be induced after a spinal cord injury (SCI). Consequently, in the near future, new therapeutic approaches will be developed for the treatment of patients with SCI. ⋯ This represents a basic requirement for recognizing any improvement in the recovery of function and to monitor any significant effect of a new treatment. The paper presents objective and refined tools as a basis for monitoring the effects of new treatment strategies.