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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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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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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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.
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In high tibial closing-wedge osteotomies (HTO), closure of an osteotomy gap after resection of a bony wedge can be associated with a fissure of the medial cortex of the tibial head (MCT). The effect of a broken MCT on the recurrence of varus deformity is disputed. In this study, serial roentgen stereometric analysis (RSA) was used to determine the fixation stability of a rigid internal "L" plate after HTO. ⋯ Twelve weeks after HTO, translations between tibial segments were below the accuracy of the RSA setup in the majority of patients. Group 1 patients demonstrated a higher initial fixation stability, less occurrence of varus deformity, and a higher HSS score compared to patients with larger wedge sizes and frequent fracture of the MCT (group 2). Before bone healing is achieved, the integrity of the MCT plays a crucial role for the clinical and radiological outcome after HTO.