Aim: Evaluation of clinical, electromyographic and gait analysis results after constrained revision total knee arthroplasty. Material and Methods: 14 patients (mean age 67 years, 54-78) were evaluated 28.5 months (range, 6.5 to 61.4 months) after revision arthroplasty using constrained total knee endoprostheses (Genesis, Blauth).

Clinical evaluation was carried out using HSS, Knee Society, Tegner Activity, and Patellar scores. A three-dimensional, quantitative gait analysis and simultaneous epicutaneous electromyographic recordings of 7 muscles surrounding the knee were carried out on all patients. 11 healthy volunteers (mean age 69 years, 60-75) served as control group.

Results: Patients achieved 68 points in HSS, 125 in Knee Society, 1.3 in Tegner, and 19.1 in Patellar scores. Compared to the controls, all patients showed minor functional results. Electromyographic amplitudes of 5 muscles of the operated leg were significantly decreased compared to the contralateral side as well as the control group. Besides maximum knee extension all gait analysis parameters differed significantly between patients and controls. On the other hand, operated and uninvolved patients’ legs differed only in maximum knee extension in gait analysis. Significant correlations between clinical scores and ground reaction forces as well as electromyo-graphic levels of the gastroc muscle were noticed.

Conclusion: Functional deficits may not be explained by revision arthroplasty alone, but already exist preoperatively. The gastroc muscle seems to play and especially important role, as its functional deviations are highly correlated with clinical scores. The shown results stress the demand for extensive pre- and postoperative rehabilitation to avoid or at least reduce functional deficits after revision total knee arthroplasty.

Aim of the study: The question wether there is a clinical relevance between the clinical outcome and life quality and radiological parameters.

Material and methods: 17 patients (average age 68.2 years) with total knee arthroplasty (Genesis I) were examined after a follow-up period of in average 24,6 months. The examination included the HSS-score for clinical parameters and the SF-36 for life quality. The evaluation of the radiological examinations were performed according to Ewald and Lotke and a special designed score of our unit.

Results: The HSS-Score resulted in average in 81 points and the SF-36 Fragebogens demonstrated significant worse results than in the age matched healthy population. The evaluation of the radiologic examinations according to Lotke showed an average value of 76,3. Correlations between the radilogical results and the HSS-score were not found. The correlation analysis between the SF-36 and HSS-score showed only positive values for the social functions. Correlations between the radiological evaluations according to Ewald and Lotke with the SF-36 score were found only for body pain and vitality.

Clinical relevance: This is the first study to find out the correlation between clinical and radiological parameters and also the outcome of life quality. The results of the positioning of the implants showed satisfying values in most of the cases, but some differences could be found. Because of deficits in the clinical and life quality outcome it can be supposed that the radiological parameters have significant influence. In our study we could not demonstrate correlations between the clinical and radiological examinations. Surprisingly also between the HSS and SF- 36 score no correlations were found. This findings showed us that the importance of the positioning of our implants has lower influence to the clinical results and life quality than we supposed.

Aims: Comparison of the effectiveness of the injection of hyaluronic acid (Ostenil¨) and cortisone (Volon¨) into the facet joints in the treatment of facet joint syndrome. Methods: 60 patients suffering from low back pain due to degenerative arthritis of the facet joints were included in this randomized, controlled, double-blinded, clinical trial. 30 patients received intra-articular injections of hyaluronic acid (Ostenil¨) and 30 patients received intra-articular injections of 10mg triamcinolon-hexacetonid (Volon 10¨). The facet joints of the spinal segments L3/L4, L4/L5, and L5/S1 were injected bilaterally with computed tomography guidance in intervals of one week each. Clinical evaluation was carried out one week prior þrst injection, at the day of þrst injection, after one, two, and three weeks, and after three and six months. Clinical assessment was carried out using the visual analog scale for pain, the Roland Morris Questionnaire, and the Oswestry Disability Questionnaire. Quality of life was assessed using the SF-36 health questionnaire. Radiological assessment was done according to Kellgren. Results: Pain reduction was achieved faster in the Volon 10¨group. After three months the Ostenil¨group reached better pain reduction and this effect lasted for a longer period. The Roland Morris score, the Oswestry Disability Questionaire, as well as the Low Back Pain Outcome Score showed signiþcantly better results in the Ostenil¨group after 3 and 6 months follow-up. Conclusion: Even though no signiþcant difference was found in the short-term follow-up, the results in the Ostenil¨group were comparable to the Volon 10¨group, and were signiþcantly better in the long-term follow up. Thus the intra-articular injection of hyal-uronic acid (Ostenil¨) is an effective alternative in the treatment of low back pain caused by facet joint syndrome, avoiding the known side effects of cortisone.

Objective: The purpose of this study was to investigate whether radiographic scores correlate with histomorphological grading and expression of the hyaluronan receptor splice variant CD44v5 in osteoarthritic synovia, cartilage and synovial fluid. Methods: Synovia and cartilage specimens of 19 patients with osteoarthritis of the knee were histomorphologically evaluated with the Mankin’s score, and expression of CD44v5 was analyzed by immunohistochemistry. For radiographical scoring, weight-bearing radiographs of the knee joint were evaluated according to Kellgren and Ahlback. Levels of soluble CD44v5 in synovial fluids were determined by ELISA. Results: The mean radiological scores according to Kellgren and Ahlback were 3.79 and 3.21, respectively. Histomorphological evaluation of specimens revealed a mean grade of 5.53. There was no correlation between radiographical and histomorphological data. Expression of CD44v5 in synovia and cartilage samples was detected in about 50% of the patients and was restricted to latestage osteoarthritis. The immunohistochemical data obtained from synovia correlated significantly with radiological disease progression (p< 0.05). A highly significant correlation was evident between expression of CD44v5 in synovia and cartilage (p< 0.01). Synovial fluid levels of the soluble receptor form showed no correlation. Conclusion: Overall, this study emphasizes a combination of several independent parameters including radiography, histomorphology, and immunohistochemistry for accurate assessment of osteoarthritic disease progression. In this regard, CD44v5 may be a useful additional marker for late-stage osteoarthritis

Aims: In recent years more and more studies tried to evaluate possible inßuences of different growth factors on hyaline cartilage regeneration. In a rabbit model, HGF (hepatocyte growth factor) was proven to increase the amount of hyaline-like chondrocytes in a mixed þbrocartilaginous regenerate of small defects. The present study was undertaken to evaluate, whether intraarticular administration of hepatocyte growth factor inßuences the ingrowth of osteochondral grafts in a sheep model. Methods: Both knee joints of a sheep were opened surgically and osteochondral grafts were harvested and simultaneously transplanted to the contralateral compartment. The sheeps were divided into two groups. In one group hepatocyte growth factor was administered by intraarticular injections given three times a week for four weeks. The control group received isotonic sodium chloride injections. The animals were sacriþced after three months and the received knee joints were evaluated histologically. Results: Histological evaluation showed that the autologous osteochondral grafts were healed in at the level of the subchondral bone. A healing or ingrowth at the level of the cartilage could not be observed. Anyway, histological evaluation of the transplanted grafts according to Mankin showed, that the cartilage of the HGF group showed less signs of degeneration than the control group. In the HGF group less cloning of chondrocytes and less irregularities of the articular surface were observed. Conclusion: In conclusion, HGF positively inßuenced the structure of the transplanted osteochondral graft, but could not diminish the þssures in the marginal zone of the grafts.

Aims: Prospectivemulti-centre study evaluating minimally invasive unicondylar knee arthroplasty (UKA). Methods: Between 1997 and 2001 435 UKA were performed using the minimally invasive technique according to Repicci. 420 patients with an average age of 66 years were evaluated after a follow up of 32 weeks. In 96,8% the medial and in 3,2% the lateral compartement were involved. The clinical results were evaluated with the Knee Society Clinical Rating System (KSS) and correlated with Body-Mass-Index (BMI) and pain, rated on a Visual Analogue Scale (VAS). Radiographical scoring were evaluated according to Ahlback. Results: The results of the KSS show a signiþcant postoperative increase of average 73 points. 86,8% patients were conþdent with the treatment. The statistical analysis revealed correlation between pain and patients age. BMI shows signiþcant correlation with all other parameters. Conclusion: Minimally invasive unicondylar knee arthroplasty shows very good results, espeically for pain and patientsñ conþdence. BMI and arthrosis of the patella might have the gratest inßuence for the outcome. Deþcient pre- and postoperative extension might be an unsolved problem.

Aims: Tibiotalar fusion is considered as gold standard for end-stage posttraumatic arthritis of the ankle. This study analyses the long-term results after talar joint fusions, especially the health related quality of life, correlated to the clinical and radiological results. Methods: We examined 16 males and 1 female patient, with 18 ankle fusions, clinically, radiographically and in regard of quality of life with the SF-36 Health Survey after a minimum follow-up period of 20 years (mean 23, range 20–33). Mean age at operation was 37 years (SD=8y), at follow up 61 years. Between injury and arthrodesis was an interval of six years in average. In eleven cases an external þxation was used. Results:. Subjectively 50% were not handicapped performing daily life activities and 44% were in the same job as at the time of injury. Out of 11 complications, the most frequent one was wound infection in seven cases (68%). On clinical examination þve feet were stiff at the forefoot. Eight patients had 25%, three had 50%, one had 75% and one the full range of motion. We found one valgus and seven varus deformities of the ankle. Following roentgenographic measurements with the MORREY as well as the TAKAKURA score, degenerative arthritis in the subtalar and Chopart joints was 2.7 (SD=0.77). The mean OMA score was 59.4 points, the visual analogue scale was 1.99, the radiologic score was 2.7 and the SF-36 revealed for physical functioning, emotional role functioning and bodily pain signiþcant deþcits. A signiþcant correlation was found between the OMA and the radiological score at 0.05, and between the clinical and the SF-36 score at 0.01. No correlation was found between the radiologic score and the SF-36 questionnaire. Conclusion: Ankle arthrodesis leads to deþcits in the functional outcome, to limitations in the activities of daily living and to roentgenographic changes in the adjoining joints. The clinical outcome and the SF-36 score correlate tightly.

Aims: Results of total hip replacement in consideration of quality of life and their correlation to clinical radiologic findings were examined. Methods: 46 of 61 patients with aseptic loosing and total hip replacement were examined in average 4,3 years after surgery with the Harris Hip Score, Merle d’Aubigne Score, Postel Score, WOMAC-Score and SF-36 Health Survey Score. The study of radiographs were completed by the Scores of Brooker, Lee and Gruen. Allograft were used in 38 (83,6%) cases. Results: The result of the Merle d’Aubigne Score and Postel Score in average account for 11,5 points. Harris Hip Score obtains 62,7 points. The comparison form patient and control group with the SF-36-Score shows unpropitious results particularly for physical functioning, role limitation because of physical health problems and role limitation because of physical emotional problems. The outcome for general mental health and vitality show better results for the patients as for the control. Evaluation of the physical and psychical scale applies to impairments of daily life depending on the disease. Radiographs of 33 patients were completely evaluated. In 8 cases (24,2%) there were loosening lines in femur shaft area. In 18 cases (54,55%) there were loosening lines in the area of the acetabular cup, in 3 cases (9%) a migration and in 24 cases (72,7%) an ossification. Conclusion: After a total hip replacement the physical functions are limited. Primary hip arthroplasty for young patients should be indicated reserved in consideration of above mentioned results, even if psychological results surprised.

Tibiotalar fusion is considered to be the standard treatment for end-stage post-traumatic arthritis of the ankle. We report a retrospective, objective long-term study of the quality of life of 17 patients with 18 arthrodeses of the ankle, over a period of more than 20 years. We looked particularly for correlation between clinical and radiological signs of osteoarthritis in adjoining joints. At serial physical examinations, clinical grades were awarded according to the Olerud Molander Ankle (OMA) score. Any degree of degenerative change in the adjoining joints was recorded on standing radiographs. Patients filled out a SF-36 Health Survey form.

Subjectively, 50% of patients were not handicapped in the performance of daily activities and 44% were in the same job as at the time of injury. At follow-up the mean OMA score was 59.4 points, the visual analogue scale was 1.99 and the radiological score was 2.7. The SF-36 for physical function, emotional disturbance and bodily pain revealed significant deficits. There was a significant correlation between the OMA and the radiological score (p = 0.05), and between the clinical and the SF-36 score (p = 0.01), but no significant correlation between the radiological score and the SF-36 score.

Arthrodesis of the ankle leads to deficits in the functional outcome, to limitations in the activities of daily living and to radiological changes in the adjoining joints. The clinical outcome score correlates closely with the SF-36 score.