Orthopaedics Medical and Health News Headlines

[Value of adjuvant physiotherapy in postoperative pain management.]

Orthopade. 2008 Aug 23;

Authors: Bullmann V, Weber TP, Kienle B, Schulte TL

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. It is intended to minimize complications and to mobilize and motivate the patients early. 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.

PMID: 18719884 [PubMed - as supplied by publisher]

[On the biomechanics of the hip : Relevance of femoral anteversion for hip contact force and loading using a short-stemmed prostheses.]

Orthopade. 2008 Aug 23;

Authors: Tohtz SW, Heller MO, Taylor WR, Perka C, Duda GN

Short-stemmed hip implants were established in total hip arthroplasty in the last years. Also patients with secondary osteoarthritis of the hip with pathological anteversion of the femoral neck are treated increasingly using this method. Therefore an investigation was performed to analyze the resulting hip contact force and femoral loading in the proximal femur at the solid model of the "standardized femur". Two different situations of femoral component anteversion were simulated. Increased hip contact forces and an increase of medial and lateral cortex loads result in the anteverted model. With present level of knowledge about the influence of the hip contact force the use of short-stemmed implants is not uncritically in patients with degenerative osteoarthritis of the hip combined with rotational disorders of the proximal femur. The selection of the tribological pairing is to be considered more strongly regarding the wear behavior.

PMID: 18719885 [PubMed - as supplied by publisher]

[Clinical examination for patellofemoral problems.]

Orthopade. 2008 Aug 23;

Authors: Pagenstert GI, Bachmann M

Patellofemoral pain and instability account for 25% of all sports-related knee problems. However, definitive analysis seems to be difficult. Descriptive findings like "anterior knee pain", "patellofemoral pain syndrome", or "chondromalacia" are used instead of diagnosis. One reason may be the complex pathomechanics of the patellofemoral joint which is suspended between the pelvis, the femur, and the tibia and subsequently is influenced by the whole lower extremity from the hip down to the foot. On the other hand, different signs and functional tests are in use with at times lack of quantification and ambiguous interpretation. The current manuscript reviews the commonly used signs and functional tests, analyzes them based on the current literature, and arranges them in a practical manner for physical examination. A MEDLINE literature search and special textbooks regarding patellofemoral disorders were used; 43 signs and tests were found. The examiner can quantify 18 of these findings on a nominal and 15 on an ordinal scale. Thus, this manuscript provides a standardized algorithm for physical examination with a collection of quantifiable findings, which are of growing importance to justify adequate diagnostics and treatment.

PMID: 18719886 [PubMed - as supplied by publisher]

[Lateral retinacular release.]

Orthopade. 2008 Aug 23;

Authors: Verdonk R, Verdonk P, Bonte F

This overview of numerous studies discusses, based on short-term and long-term results, which diagnoses are indications for lateral retinacular release. No significant differences in outcome between arthroscopic and open lateral release could be documented. Isolated lateral release offers a good success rate for treating a stable patella with excessive lateral pressure. In patellar instability, the results are less favorable in long-term follow-up evaluation. Hyperlaxity with hypermobility of the patella is an absolute contraindication. Lateral release provides only temporary benefit for patellofemoral osteoarthritis. Proximal and/or distal realignment of the extensor mechanism gives better results than isolated lateral release.

PMID: 18719887 [PubMed - as supplied by publisher]