Der Orthopäde
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Besides the number of annual total hip arthroplasty (THA) surgeries (11,978 primary THA, 148 implantations per 10(5) inhabitants), little is known about the state of total hip replacement in Austria. We collected information about different aspects of THA treatment regimens. A questionnaire was developed and sent to all chairmen of orthopedic and traumatology departments posing 22 questions regarding type of THA, surgical technique, number of surgeries, data collection, physical therapy and mobilization, length of hospital stay, and recommendations on sport activities as well as activities of daily life. ⋯ Austria ranks among the top nations in Europe regarding the number of total hip arthroplasty implantations. Documentation is insufficient and needs to be improved. In some aspects of managing patients with total hip arthroplasties there are remarkable differences between orthopedic and traumatology departments.
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Spinal infections are rare, occurring most often in elderly patients with urinary tract infections or diabetes. With the increasing number of patients with immune suppression, and also the increasing number of immigrants in the population, spinal infections are seen more frequently, especially in young adults. Typically spinal infections are monomicrobial, Staphylococcus aureus being the most common organism. ⋯ Important diagnostic measurements are laboratory studies, radiological evaluation including MR image scans, and CT-guided percutaneous biopsy of the lesion for microbiological studies. The management of spinal infections consists of antimicrobial therapy over 6-8 weeks. Surgical intervention is indicated in neurologically compromised patients for spinal instability and abscesses.
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Joint infections represent a surgical emergency. For diagnosis, clinical, sonographic, and radiographic examinations are required. ⋯ Therapy consists in administration of antibiotics, arthroscopic or open debridement with joint lavage, postoperative drainage and early active and passive mobilization of the joint without weight bearing. Early surgical revision is recommended in cases of insufficient recovery.
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Osteotomies in the knee region for incipient osteoarthritis in active patients have become increasingly popular in recent years. A computer-guided navigation system should help increase the surgeon's accuracy and lower the risk of intraoperative complications for this technically demanding type of surgery. Furthermore, computer navigation might be a powerful research and educational tool. The technical principles and the clinical implications of this system for knee osteotomies are described in the following article.
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The present review analyzes the rare indications for sagittal knee osteotomies either for some complex cases of capsular and ligamentous laxities in combination with or without bony deformities in the sagittal plane. A thorough clinical and radiological analysis of the patients' knees is mandatory. We routinely recommend lateral standing X-rays to assess not only the bony structures, but also an abnormal knee laxity in the sagittal plane. We present different surgical options and preliminary results of these technically demanding procedures.