Replacement Arthroplasty: Fink B

Fink B. · No affiliation provided · Oper Orthop Traumatol. · Pubmed #19326062 No free full text.

This publication has no abstract.

Hoffmann AH, Fink B. · Abteilung Endoprothetik, Allgemeine Orthopädie und Rheumaorthopädie, Orthopädische Klinik Markgröningen, Markgröningen, Deutschland. · Orthopade. · Pubmed #17891378 No free full text.

Abstract: Luxation and excessive wear of the mobile bearing in modern three-piece total ankle replacement (TAR) is reported. We conducted a systematic review of studies to explore and discuss the rate and causes of these complications.A systematic review of studies since 2000 showed 26 studies with altogether 1,318 followed up TARs which we analyzed. Of these 1,318 TARs, 188 (14.3%) were revised and 56 (4.2%) complications with the mobile bearing were reported. A total of 39 cases (3%), i.e., 20.7% of all revisions, were revised due to failure of the mobile bearing, including 17 cases with subluxation (1.3%), 15 with asymmetric load of the bearing (1.1%), 10 with fracture of the polyethylene (PE) inlay (0.76%), 7 with massive PE wear (0.53%), and 7 with luxation of the meniscal bearing (0.53%).Complications due to the meniscal mobile bearing in TARs such as luxation, subluxation, massive wear, and fracture of the PE inlay are rare complications. The cause of these complications is regularly not found in the design of this three-piece total ankle replacement. Causes of failure of the mobile bearing are mostly found in incorrect indication, incorrect soft tissue balancing, incorrect positioning of components, implantation in ankles with hindfoot malalignment and ankle instability.

Fink B, Fuerst M, Singer J. · Clinic of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic of Markgröningen, Germany. · Arch Orthop Trauma Surg. · Pubmed #15999276 No free full text.

Abstract: The nature of the treatment of periprosthetic fractures depends on the localisation, the stability of the prosthesis and the condition of the bone. The Vancouver fracture classification has proved to be of value in determining specific modes of treatment. The current review analyses the different therapeutic options resulting in a concept of fracture-specific treatment. In this report we propose an extended version of this classification in which periprosthetic fractures associated with endoprostheses anchored in the epiphysis or metaphysis, as well as interprosthetic fractures, are taken into consideration.

Fink B, Grossmann A, Fuerst M, Schäfer P, Frommelt L. · Department of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany. · Clin Orthop Relat Res. · Pubmed #19002539 No free full text.

Abstract: Cementless two-stage revision of infected total hip prostheses lacks the possibility of local antibiotic protection of the implant at the time of reimplantation, which leads to the concern that this protocol may not sufficiently eradicate periprosthetic infection. Moreover, early implant loosening as much as 18% and stem subsidence as much as 30% have been reported. To determine whether a cementless revision could eradicate infection and achieve sufficient implant stability, we prospectively followed 36 patients with two-stage revisions for septic hip prostheses. We used a uniform protocol of a 6-week spacer interval, specific local and systemic antibiotic therapies, and cementless modular revision stems. The minimum followup was 24 months (mean, 35 months; range, 24-60 months). In one patient, the spacer was changed when the C-reactive protein value failed to normalize after 6 weeks, and the reimplantation was performed after an additional 6 weeks. No infections recurred. There was no implant loosening and a 94% bone-ingrowth fixation of stems. Subsidence occurred in two patients. The Harris hip score increased from a preoperative mean of 41 to 90 at 12 months after reimplantation and later. Using cementless prostheses in two-stage revisions of periprosthetic infections of the hip in combination with a specific local and systemic antibiotic therapy seems to eradicate infection and provide implant stability. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Fink B, Grossmann A, Schubring S, Schulz MS, Fuerst M. · Department of Joint Replacement, General and Rheumatic Ortho paedics, Orthopaedic Clinic Markgröningen gGmbH, Markgröningen, Germany. · Clin Orthop Relat Res. · Pubmed #17496558 No free full text.

Abstract: The transfemoral approach in its traditional form, using a nonmodular Wagner self-locking revision stem, has the disadvantages of a less predictable union rate of the bony flap and a high rate of stem subsidence. To investigate whether this situation can be improved by using a modified transfemoral approach and modular curved cementless revision stems, we prospectively analyzed 68 hip revisions and followed them clinically and radiographically for a minimum of 24 months (mean +/- standard deviation, 32.4 +/- 11.2 months). One year after the operation, the osteotomy showed bony consolidation in all but one case (98.5%). We noted subsidence in six cases (8.8%) and two of these stems became loose. In all of these cases, the circular fixation zone of the stem in the isthmus of the femur was less than 3 cm. The Harris hip score improved continuously from 41.4 +/- 14.5 points preoperatively to 85.9 +/- 14.6 points 24 months postoperatively. The modified transfemoral approach in combination with a curved, modular revision stem showed reproducibly good results concerning union of the bony flap and subsidence of the stem if the fixation zone was not less than 3 cm.

Fink B, Grossmann A. · Klinik für Endoprothetik, Allgemeine und Rheumaorthopädie, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, D-71706, Markgröningen, Deutschland. · Oper Orthop Traumatol. · Pubmed #17345026 No free full text.

Abstract: OBJECTIVE: Removal of a loose or fractured stem in total hip arthroplasty. Implantation and secure fixation of a modular uncemented revision stem to restore painless joint function. INDICATIONS: Loose and/or broken prosthetic stem. Risk of intraoperative fracture or perforation of the femur when stem revision becomes unavoidable. Periprosthetic fracture. CONTRAINDICATIONS: Loose prosthetic stems that can be revised without the risk of perforation or fracture of the femur. Interprosthetic femoral fractures between the ends of hip and knee prosthetic stems that require total replacement of the femur. SURGICAL TECHNIQUE: Exposure of the femur anterior to the lateral lip of the linea aspera in the lateral intermuscular septum. 3.2-mm drill holes are made at the anterior and posterior ends of the planned bone flap. Osteotomy of the femur anterior to the junction of the vastus lateralis and the gluteus medius muscles. Posterior osteotomy as well as distal transverse osteotomy between the drill holes and distal anterior osteotomy. The anterior osteotomy is performed using a chisel passed under the vastus lateralis from distal to proximal at the anterior aspect. The osteotomized lateral femoral bone flap with muscle attachment is folded back. Implantation of a modular uncemented revision stem and fixation of the bone flap with double cerclage. POSTOPERATIVE MANAGEMENT: Thrombosis prophylaxis, physiotherapy, gait training with partial loading of the limb at 10 kg for a period of 6 weeks with hip flexion limited to 70 degrees. Then, free range of movement and increased loading by 10 kg per week. RESULTS: 74 modular uncemented revision stems were implanted in transfemoral technique and the outcomes clinically and radiologically analyzed over an average follow-up period of 20.2 +/- 12.1 months (10-43 months). The Harris Hip Score increased from a preoperative value of 42.21 to 85.97 points after 2 years. Subsidence was observed for four stems and early loosening for two stems. The press-fit anchorage of these latter two stems was < 3 cm.

Fuerst M, Fink B, Rüther W. · Rheumaklinik Bad Bramstedt, Orthopädische Krankenhausabteilung. · Z Orthop Ihre Grenzgeb. · Pubmed #15754230 No free full text.

Abstract: AIM: The accurate preoperative diagnosis of occult sepsis in endoprosthetic loosening of total knee arthroplasty is the key to successful management of revision total knee arthroplasties. The aim of this study was to evaluate the results of preoperative aspiration in comparison with preoperative arthroscopic biopsy of the synovial tissue. METHOD: From 2000 to 2004 eighty-six revision total knee arthroplasties in 86 patients were performed. 60 patients had only a knee aspiration, 15 an arthroscopic biopsy and an aspiration, 11 only arthroscopic biopsy. The results of both methods were compared with the intraoperative cultures during revision surgery. RESULTS: 69 aseptic and 17 septic knee exchange arthroplasties were performed. The preoperative aspiration of the prosthetic knee joint had a sensitivity of 68.8 %, specificity of 96.6 %, positive predictive value of 84.5 % and a negative predictive value of 92.2 %. The preoperative arthroscopic biopsy had a sensitivity of 100 %, specificity of 94.7 %, positive predictive value of 87.4 % and a negative predictive value of 100 %. CONCLUSION: Preoperative aspiration of the knee is a very helpful study for the diagnosis or exclusion of infection in a prosthetic knee joint and should be a standard procedure in the diagnosis of prosthetic loosening. If after aspiration a suspicion of infection remains, then the biopsy is an accurate procedure to diagnose or exclude periprosthetic sepsis.

Fuerst M, Fink B, Rüther W. · Department of Orthopedics, Rheumaklinik Bad Bramstedt, Bad Bramstedt, Germany. · J Bone Joint Surg Am. · Pubmed #18829941 No free full text.

Abstract: BACKGROUND: Rheumatoid arthritis often leads to severe destruction of the glenohumeral joint, including synovitis and inflammation-induced alterations of the rotator cuff. Cup arthroplasty, or surface replacement of the shoulder, was introduced in the 1980s. The aim of this study was to evaluate the midterm results of the DUROM cup surface replacement for patients with rheumatoid arthritis affecting the glenohumeral joint. METHODS: From 1997 to 2000, forty-two DUROM cup hemiprostheses were implanted in a cohort of thirty-five patients (forty-two shoulders), who were evaluated preoperatively and again at three, twelve, and more than sixty months postoperatively. Six patients (seven shoulders) were lost to follow-up. Thirty-five shoulders in twenty-nine patients (twenty-one women and eight men with an average age of 61.4 years) could be evaluated prospectively after an average follow-up period of 73.1 months. Patients were evaluated clinically with the use of the Constant score, and a detailed radiographic analysis was performed to determine the presence of endoprosthetic loosening, glenohumeral subluxation, and glenoid bone loss. RESULTS: The mean Constant score for the thirty-five shoulders increased from 20.8 points preoperatively to 64.3 points at a mean of 73.1 months postoperatively. There were three revisions: one to replace an implant that was too large, another to treat glenoid erosion, and a third due to loosening of the implant. No additional cases of loosening of the prosthesis or changes in cup position were observed radiographically. Over the five-year follow-up period, proximal migration of the cup increased in 63% of the shoulders, and glenoid depth increased in 31%. With the numbers studied, no differences in clinical outcome were identified between patients with a massive rotator cuff tear and those with a smaller or no tear. CONCLUSIONS: The midterm results of the cemented DUROM cup surface replacement for patients with advanced rheumatoid arthritis of the shoulder are very encouraging, even for patients with a massive tear of the rotator cuff. The advantage of this cup arthroplasty is the less complex bone-sparing surgery. In the event of failure of the implant, other reliable salvage options remain available.

Fink B, Grossmann A. · Klinik für Endoprothetik, Allgemeine und Rheumorthopädie, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706 Markgröningen. · Oper Orthop Traumatol. · Pubmed #18535800 No free full text.

Abstract: OBJECTIVE: Revision of loose cups of total hip arthroplasties. Implantation and solid fixation of a cementless press-fit cup to restore painless joint function. INDICATIONS: Loose cups of total hip arthroplasties. Reimplantation of a prosthetic cup after removal of an infected total hip arthroplasty. CONTRAINDICATIONS: Bone defects of the acetabulum precluding a press-fit fixation (at least three-surface fixation) of the cup. Persistent infection. SURGICAL TECHNIQUE: Exposure of the acetabulum using a standard approach. Removal of the loose cup. Cleaning of the ground with a spoon. Reaming of a new, deeper center of rotation in the acetabulum using a small reamer. Stepwise reaming of the acetabulum using increasing reamer sizes without pressure until sufficient bone contact at the rim is reached (at least three-surface fixation). Hammering in of a thin-walled cementless press-fit cup (e.g., AllofitStrade mark) of the next size as compared to the reamer chosen last to reach a 4-mm press-fit fixation. Additional screwing in of two to three cancellous screws into the os ilium. POSTOPERATIVE MANAGEMENT: Thrombosis prophylaxis, physiotherapy, gait training with partial loading of the limb at 10 kg for a period of 6 weeks. Then increased loading by 10 kg per week. RESULTS: 52 cup exchanges using an AllofitStrade mark cup were clinically and radiologically analyzed over an average period of 35.8 +/- 8.8 months (26-53 months). The Harris Hip Score increased from a preoperative value of 46.4 to 87.3 points 2 years postoperatively. Two cups showed migration and one hip dislocated. Loosening has not been observed so far.

Krohmer G, Koleganova N, Hadjicostas PT, Fink B, Berger I. · Institute of Pathology, University of Heidelberg, Heidelberg, Germany. · Histol Histopathol. · Pubmed #18498067 No free full text.

Abstract: OBJECTIVE: The aim of the present study was to perform a comparative evaluation of septic and aseptic interface membranes, assessing histological features, inflammatory infiltrate, and expression of inflammatory cytokines. METHODS: Septic and aseptic interface membranes from 102 patients were examined by histology, histochemistry, and immunohistochemistry (tissue arrays). The cell subpopulations were characterized by quantification of CD3, CD4, CD8, CD20, and CD163 positive cells. Additionally, a semiquantitative evaluation of inflammatory cytokines (TNFalpha, TGF-beta1, IL-1, IL-6, CRP, MMP-1, MMP-6) was performed to complete the analysis of inflammatory infiltrates. RESULTS: The histological analysis revealed three different types of aseptic interface membranes: wear particle, degenerative, and mixed type. The expression of inflammatory molecules did not differ between septic and wear particle interface membranes. Significantly lower expression of cytokines, MMPs and CRP was observed, however, in degenerative interface membranes compared to other types. No expression of TNFalpha was observed in the degenerative interface membranes. Over 88% of patients with degenerative interface membranes had had a clinical record of osteoarthritis. CONCLUSION: Aseptic interface membranes were represented by wear particle, degenerative and mixed type. The expression of inflammatory factors in wear particle type is similar to this in septic membranes and can contribute to the bone destruction and prosthesis loosening. These factors seem not to play a major role in the degenerative membranes.

Fink B, Grossmann A, Schubring S, Schulz MS, Fuerst M. · Clinic of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Kurt-Lindemann-Weg 10, 71706, Markgröningen, Germany. · Arch Orthop Trauma Surg. · Pubmed #18389264 No free full text.

Abstract: INTRODUCTION: A prospective study was designed to test the hypothesis that short-term results after hip revisions are in association with the surgical approach with lower clinical scores for the transfemoral approach. MATERIALS AND METHODS: A total of 120 hip revision operations with the modular cementless revision stem "Revitan Curved" (Zimmer GmbH, Winterthur, Switzerland), of which 42 replacements involved an endofemoral (posterolateral) approach and 78 implantations a transfemoral approach, were followed up over a period of at least 24 months. RESULTS: In the early post-operative stage, stems implanted transfemoral were associated with significantly lower Harris Hip Scores and a significantly more frequent appearance of Trendelenburg signs. The differences lessened at the end of the follow-up period. Within the group of transfemoral implantation, all six stems with a circular fixation zone measuring less than 3 cm had subsided and two of these had become loose; none of the stems with greater fixation zones exhibited these properties. In the case of the endofemoral implants, three stems exhibited sinking but there did not appear to be any relationship between this event and length of fixation zone. CONCLUSION: The surgical approach has an association with the short-time outcomes of hip revsions using cementless modular stems. Transfemoral implantation of the "Revitan curved" stem requires a fixation zone of at least 3 cm and a longer period of rehabilitation.

Fink B, Egl M, Singer J, Fuerst M, Bubenheim M, Neuen-Jacob E. · Orthopaedic Clinic Markgröningen, Markgröningen, Germany. · Arthritis Rheum. · Pubmed #17968889 links to  free full text

Abstract: OBJECTIVE: To investigate the frequency of structural changes in the vastus medialis muscle in patients with osteoarthritis (OA) of the knee. METHODS: Specimens of vastus medialis muscle from 78 patients with end-stage OA of the knee undergoing total joint arthroplasty were examined histopathologically. Morphologic changes were assessed in relation to clinical features that might have contributed to muscle injury. RESULTS: All muscle specimens exhibited atrophy of type 2 fibers. In 32% of the patients, atrophy of type 1 fibers was also noted. Fiber type grouping of type 1 fiber in 15% of the patients and type 2 fiber in 37%, indicating reinnervation, led to the diagnosis of neurogenic muscular atrophy in 32% of the patients; selective atrophy of type 2 fiber in 68% of the specimens was interpreted as possibly resulting from pain-associated disuse. Signs of muscle degeneration and regeneration were found in 65% and 96% of the samples, respectively. Soft tissue changes indicating long-term disease, such as calcification, fibrosis, and lipomatosis, were frequently observed (in 69%, 71%, and 94% of the patients, respectively). Statistical analysis of clinical and morphologic parameters revealed a significant association between degenerative muscle changes and the presence of a varus deviation of the leg axis. CONCLUSION: Patients with OA of the knee frequently exhibit muscle changes, with probable multifactorial etiology. Selective atrophy of type 2 fibers might reflect pain-related immobilization of a limb. Changes such as neurogenic muscular atrophy, muscle fiber degeneration, and regeneration might contribute as cofactors in the development or progression of OA.

Fink B, Wessel S, Deuretzbacher G, Protzen M, Ruther W. · Orthopaedic Department, University Hospital Hamburg-Eppendorf, Germany. · J Arthroplasty. · Pubmed #17689780 No free full text.

Abstract: The aim of this investigation was to analyze the midterm results obtained with the metaphyseal fixation principle of the thrust plate prosthesis (TPP). Survival of 214 implants in 204 patients was analyzed. Clinical (Harris hip score) and radiologic examinations were carried out on 157 of 190 TPP with a postimplantation follow-up period of at least 5 years. Failure rate was 7.0% (9 aseptic and 6 septic loosening). Harris hip score increased from 36.9 +/- 13.5 points preoperatively to 91.2 +/- 13.1 points at follow-up. Eleven TPPs showed radiolucent lines not indicating prosthetic loosening. Thrust plate prosthesis is not an alternative to stemmed endoprostheses. It may be rarely indicated in very young patients where, because of their age, several revision operations can be expected.

Fuerst M, Fink B, Rüther W. · Department of Orthopedics, Rheumaklinik Bad Bramstedt, OskarAlexander-Strasse 26, D-24576, Bad Bramstedt, Germany. · J Bone Joint Surg Am. · Pubmed #17671015 No free full text.

Abstract: BACKGROUND: Rheumatoid arthritis often leads to severe destruction of the glenohumeral joint, including synovitis and inflammation-induced alterations of the rotator cuff. Cup arthroplasty, or surface replacement of the shoulder, was introduced in the 1980s. The aim of this study was to evaluate the midterm results of the DUROM cup surface replacement for patients with rheumatoid arthritis affecting the glenohumeral joint. METHODS: From 1997 to 2000, forty-two DUROM cup hemiprostheses were implanted in a cohort of thirty-five patients (forty-two shoulders), who were evaluated preoperatively and again at three, twelve, and more than sixty months postoperatively. Six patients (seven shoulders) were lost to follow-up. Thirty-five shoulders in twenty-nine patients (twenty-one women and eight men with an average age of 61.4 years) could be evaluated prospectively after an average follow-up period of 73.1 months. Patients were evaluated clinically with the use of the Constant score, and a detailed radiographic analysis was performed to determine the presence of endoprosthetic loosening, glenohumeral subluxation, and glenoid bone loss. RESULTS: The mean Constant score for the thirty-five shoulders increased from 20.8 points preoperatively to 64.3 points at a mean of 73.1 months postoperatively. There were three revisions: one to replace an implant that was too large, another to treat glenoid erosion, and a third due to loosening of the implant. No additional cases of loosening of the prosthesis or changes in cup position were observed radiographically. Over the five-year follow-up period, proximal migration of the cup increased in 63% of the shoulders, and the glenoid depth increased in 31%. With the numbers studied, no differences in clinical outcome were identified between patients with a massive rotator cuff tear and those with a smaller or no tear. CONCLUSIONS: The midterm results of the cemented DUROM cup surface replacement for patients with advanced rheumatoid arthritis of the shoulder are very encouraging, even for patients with a massive tear of the rotator cuff. The advantage of this cup arthroplasty is the less complex bone-sparing surgery. In the event of failure of the implant, other reliable salvage options remain.

Fink B, Fuerst M, Hahn M, Thybaud L, Sieber HP, Delling G. · Klinik für Endoprothetik, Allgemeine und Rheumaorthopädie, Orthopädische Klinik Markgröningen. · Unfallchirurg. · Pubmed #16133288 No free full text.

Abstract: AIM AND METHOD: To analyse the femoral fixation of a modular cementless revision endoprosthesis, eight prosthetic combinations of the Revitan-System (Centerpulse, Winterthur, Switzerland) were implanted in four cadavers. On three cadavers a curved revision Revitan stem was implanted by an endofemoral approach on one side and by a transfemoral approach on the contralateral side. On the fourth cadaver a straight Revitan stem was implanted on one side and a curved Revitan stem on the contralateral side using a transfemoral approach. Transversal slides of 7-8 mm thickness were performed at the fixation areas of each implant and the implant-bone contact was analysed macroscopically and using contact radiography.RESULTS: The straight stem implanted by a transfemoral approach showed a double-conical press-fit fixation with cutting of the eight longitudinal fins into the cortical bone. The curved revision stems implanted by the same approach had a circular surface fixation similar to the press-fit fixation of the straight stem. In contrast, the curved stems implanted by the endofemoral approach (without a window) showed a three-surface fixation. Hereby the two distal fixation areas led to the primary implant stability by three of the four double edges of the octagonal cross-sectional area cutting into the cortical bone. At the proximal fixation zone the implant only had contact of two implant double edges to the cortical bone.CONCLUSION: Different approaches for implantation lead to different fixation techniques of a curved revision stem. This should be considered by analysing postoperative sintering rates of cementless revision stems.

Fink B, Singer J, Lamla U, Rüther W. · Department of Endoprosthetic, General Orthopaedic and Rheuma-Surgery, Orthopaedic Clinic Markgröningen, Kurt-Lindemann-Weg 10, 71703 Markgröningen, Germany. · Arch Orthop Trauma Surg. · Pubmed #15133697 No free full text.

Abstract: INTRODUCTION: The concept of a newly developed cup arthroplasty (Durom Cup) involves the replacement of the destroyed joint surface of the humeral head with minimal bone resection. In cases of additional massive cuff tear, the cup can be placed in a more valgic position to articulate with the glenoid and the acromion. The aim of this prospective study was to evaluate the results of this surface replacement as a hemiarthroplasty in rheumatoid arthritis. MATERIAL AND METHODS: Forty-five Durom Cups in 39 patients (30 women, 9 men) with rheumatoid arthritis were evaluated preoperatively and every 3 months postoperatively. Their average age was 62.7+/-12.3 years and the average follow-up 45.1+/-11.6 months with a minimum of 36 months. Concerning the cuff, 15 shoulders had an intact cuff (group A), 18 shoulders a partial tearing or a repaired rotator cuff (group B), and 12 shoulders a massive cuff tear (group C). The Constant Score was used, and the cups were examined radiologically. RESULTS: In group A rheumatic shoulders, the Constant Score increased from 21.5+/-9.6 points preoperatively to 66.1+/-9.8 points at 36 months postoperatively; in shoulders of group B, from 19.6+/-9.7 points preoperatively to 64.9+/-9.6 points at 36 months postoperatively; and in shoulders of group C, from 17.5+/-8.7 points to 56.9+/-9.8 points at the latest follow-up examination. All shoulders were pain-free at the latest examination. No complications, component loosening or changes of cup position were observed. CONCLUSION: The results of the Durom Cup are encouraging. In shoulders with additional massive cuff tear, the limited goal criteria were always achieved. Therefore, cup arthroplasty is a good alternative to other kinds of shoulder endoprostheses in rheumatic shoulders with and without massive cuff tear.

Fink B, Protzen M, Hansen-Algenstaedt N, Berger J, Rüther W. · Orthopaedic Department, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. · Arch Orthop Trauma Surg. · Pubmed #14586628 No free full text.

Abstract: INTRODUCTION: Survivorship analysis was performed on 479 Link V-type threaded cups and on 110 modified V-type Bad Bramstedt cups (a modification of the Link V-type cup since 1993 with a smaller primary coil) to evaluate the effect of the modifications. MATERIALS AND METHODS: Indication for hip arthroplasty with a Link V-type cup was an inflammatory arthritis in 310 patients, osteoarthritis in 138 patients and dysplastic hip joints in 31 patients. The average follow-up was 8.6+/-3.2 (range 3.0-15.2) years. The 110 modified V-type Bad Bramstedt cups had a mean follow-up period of 4.5+/-0.7 (range 3.0-5.9) years, including 49 with inflammatory arthritis, 49 with osteoarthritis and 12 with dysplastic hip joints. To evaluate the migration rate and radiolucent lines, radiographical examination according to the method of Nunn et al. and Delee and Charnley was performed on 264 Link V-type cups with a mean follow-up period of 8.2+/-2.7 years and 59 modified V-type Bad Bramstedt cups with a mean follow-up period of 4.6+/-0.7 years. Relevant parameters influencing cup migration were analysed. RESULTS: The cumulative survival rate of the former Link V-type acetabular cup was 94.5% after 5 years, 88.1% after 10 years and 70.2% after 15 years. The Bad Bramstedt cup showed a 5-year survivorship rate of 97.9%. Migration of more than 3 mm or tilting of the cup greater than 5 degrees was found in 73% of the former type and in 39% of the modified cup. Radiolucent lines greater than 2 mm and detectable in two zones appeared in 6.4% of the former Link V-type and in 1.7% of the Bad Bramstedt cup design. Among the influencing factors analysed, length of follow-up and primary cup positioning showed a significant correlation to cup migration. CONCLUSION: The modification of the Link V-type cup showed no satisfactory improvement in cup migration. Therefore, both threaded cups were abandoned in favour of cementless press-fit cups.

Fink B, Schneider T, Conrad S, Jaeger M, Protzen M, Rüther W. · Orthopaedic Department, University Hospital Hamburg-Eppendorf, Germany. · Arch Orthop Trauma Surg. · Pubmed #12580186 No free full text.

Abstract: BACKGROUND: The thrust plate prosthesis (TPP) is an implant with a metaphyseal fixation at the proximal femur that transmits the load forces of the hip onto the femoral neck. The osseous incorporation of the TPP and the adaptation of the bone to this force transmission depend on the bone quality, which is reduced to minor vitality and stability in patients with osteonecrosis of the femoral head. Depending on the etiology of the femoral head necrosis, the TPP might lead to early failures. METHODS: In a prospective study, 63 patients with 72 cementless TPP due to femoral head osteonecrosis were examined. A clinical and radiological evaluation was performed preoperatively, 3 and 6 months postoperatively, and every year thereafter. The average follow-up period was 4.8+/-1.3 years with a minimum of 3 years. The pathogenesis of femoral head necrosis included alcoholism (n=19), subsequent to renal transplantation (n=11), during cortisone therapy of other dyscrasia (n=9), preceding a polychemotherapy (n=4), diabetes (n=3), sickle cell anemia (n=1), and idiopathic osteonecrosis (n=25). RESULTS: The Harris Hip Score increased continuously from 50.0 points beyond 79.8 points after 3 months to 86.8 points within the 1st year, and subsequently remained stable at this level. Revision was necessary in six cases (8.3%). Of these, three had an aseptic loosening of the implant: 2 cases with renal transplantation and 1 of alcoholism with an extension of the necrotic area to the seating of the TPP. The other three patients showed septic implant loosenings: 2 cases with renal transplantation and 1 of alcoholism. Radiolucent lines were found in 9 cases (12.5%), mostly in zones 1 and 2 underneath the TPP. Of these, 1 with an idiopathic osteonecrosis was assessed to be radiologically loosened. The overall failure rate was 9.7%, with a proportion of 36.4% in patients with renal transplantation. Excluding this specific patient group, the failure rate was 4.9%.CONCLUSIONS: Femoral head necrosis following renal transplantation and extension of the necrotic area into the femoral neck are contraindications for TPP. Excluding these patients, the TPP shows comparable mid-term results to cementless stemmed prostheses and supplies advantages especially for younger patients, because of its metaphyseal, bone-preserving fixation. However, evaluation of the clinical impact of the TPP in comparison with other cementless femoral stem systems requires long-term examinations in the future.

Niggemeyer O, Fink B, Rüther W. · Department of Orthopedic Surgery, University Hospital of Hamburg, Germany. · Acta Orthop Scand. · Pubmed #12358112 links to  free full text

Abstract: We revised 6 patients with early destruction of the liner in a cementless press-fit acetabular cup. They had no signs of infection or evidence of trauma. The failures were probably due to rotation of the liner inside the metal shell and destruction of the polyethylene by the cutting edge of the metal. This early complication may be difficult to diagnose because of normal radiographs. We suggest that the manufacturer should provide the insert with a metal marker to make this complication easier to detect.

Fink B, Krey D, Schmielau G, Tillmann K, Rüther W. · Orthopaedic Department, Clinic for Rheumatology Bad Bramstedt, University of Hamburg, Germany. · J Shoulder Elbow Surg. · Pubmed #12195254 No free full text.

Abstract: Fifty-nine patients with rheumatic destruction of the elbow received 20 St Georg, 20 GSB III, 13 Souter-Strathclyde, and 13 Kudo endoprostheses. Among the various prosthetic categories, 43.9% of the joints had had preceding rheumatoid surgery (a previous synovectomy had been performed in 10 joints at a mean of 4.1 +/- 3.7 years and a resection interposition arthroplasty had been performed in 19 cases 4.2 +/- 1.8 years before endoprosthetic replacement). We examined 51 patients with 54 prostheses after a mean follow-up of 5.7 +/- 4.1 years using the Inglis score and analyzing all radiographs. Complications occurred in 20% of the St Georg prostheses, 25% of the GSB III prostheses, and 23% of the Souter-Strathclyde prostheses. Of the St Georg prostheses, 6 (30%) had to be exchanged, as well as 4 (20%) of the GSB III prostheses and 4 (30.7%) of the Souter-Strathclyde prostheses. Of the primarily implanted joints, the St Georg prostheses measured 77.7 +/- 7.7 on the Inglis score, GSB III 89.6 +/- 7.2, Souter-Strathclyde 88.4 +/- 6.5, and Kudo 89.7 +/- 4.4. Radiolucent lines greater than 1 mm were observed in 26% of the St Georg prostheses, 23% of the GSB III prostheses, 27% of the Souter-Strathclyde prostheses, and 9% of the Kudo prostheses. In contrast to the clinical results, the intraoperative and postoperative complications, as well as the rate of failure and radiolucent lines, showed a statistically significant relationship to previous operations of the joints, especially with the resection interposition arthroplasty. We conclude that resection interposition arthroplasty seems to be associated with complications and failures when a subsequent endoprosthesis is used.

Fink B, Strauss JM, Lamla U, Kurz T, Guderian H, Rüther W. · Orthopädische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg. · Orthopade. · Pubmed #11480090 No free full text.

Abstract: The concept of an endoprosthetic surface replacement of the humeral head differs from that of stemmed endoprostheses. It is the replacement of the destroyed joint surface with reconstruction of the normal anatomy and minimal bone resection. The aim of this prospective study was to evaluate the short-term results of a newly developed cup arthroplasty (Durom-Cup) for the humeral head. In a prospective study, 39 patients with 46 Durom-Cups were evaluated preoperatively and every 3 months postoperatively. The average follow-up was 15 +/- 9 months. The group included 28 shoulders with rheumatoid arthritis, 15 joints with osteoarthritis, and 3 humeral head necroses. The Constant-score and SAS-function score were used. The Constant-score increased from 20.25 +/- 9.06 points preoperatively to 46.62 +/- 14.05 at 3 months, to 48.11 +/- 14.49 at 6 months, and to 55.25 +/- 11.6 at 9 months postoperatively. The Constant-score stayed at this level during further follow-up and was 55.81 +/- 16.31 at 12 months postoperatively. The best results were seen in the group of humeral head necroses with a Constant-score of 71.0 +/- 12.2 compared to 54.66 +/- 13.89 in the group of osteoarthritis and 56.78 +/- 13.33 in patients with rheumatoid arthritis at 12 months postoperatively. The results with the Durom-Cup are encouraging so that cup arthroplasty seems to be a good alternative to stemmed prostheses. The main advantages of the humeral head resurfacing are the bone-preserving fixation and the relatively simple surgical technique.

Fink B, Rüther W. · Orthopädische Klinik und Poliklinik, Universitätskrankenhaus Hamburg-Eppendorf. · Orthopade. · Pubmed #10875139 No free full text.

Abstract: In literature, the results of hip arthroplasty in patients with avascular osteonecrosis of the femoral head vary. The main reason may be the nonhomogeneous patient groups concerning etiology of the femoral head necrosis (FHN). Analyzing the results of hip endoprosthesis in relation to the etiology of FHN leads to the assumption that steroid-induced FHN and FHN with underlying systemic bone diseases (renal osteodystrophy, sickle-cell hemoglobinopathy) have the highest loosening rates. Diseases with immunosuppressive medication and sickle-cell hemoglobinopathy have the highest risk of joint infection. Therefore etiology plays an important role in the long-term results of hip endoprostheses in FHN. Modern cement techniques of the second generation and new non-cemented total hip endoprostheses seem to have better results than older prostheses and cement techniques. We followed-up 52 non-cemented thrust plate prostheses in 45 patients with FHN, prospectively, for at least 2 years (3.7 +/- 1.6 years). The revision rate was 9.6% (two aseptic loosenings in one patient with renal osteodystrophy and one patient with alcohol abuse, as well as three late infections in one patient with alcohol abuse and two patients with renal osteodystrophy). Additionally, five prostheses showed radiologic lines of a minimum of 2 mm. Future studies with longer follow-up are needed to find out whether these prosthetic designs with proximal fixation of the femoral component preserving the diaphysial bone have advantages in young FHN patients.

Fink B, Schneider T, Tillmann K, Rüther W. · Orthopädische Abteilung der Rheumaklinik Bad Bramstedt. · Z Orthop Ihre Grenzgeb. · Pubmed #10441831 No free full text.

Abstract: PURPOSE: Aim of this study was the examination of clinical middle- and long-term results of total femoropatellar endoprostheses type Lubinus (Link, Germany). METHOD: From 1983 to 1996 12 patients (15 joints) underwent total femoropatellar joint replacement (type Lubinus, Link, Hamburg). All of them have been controlled 7.2 +/- 2.6 years (2 to 12 years) after surgery. The indication was primary osteoarthritis in 6, chondrocalcinosis in 2 and rheumatoid arthritis in 7 cases. In addition to the femoropatellar implants femorotibial endoprostheses have been used in 10 knees: 2 unicondylar medial, 1 unicondylar lateral and 7 bicondylar unicompartimental ones. RESULTS: According to a modified Hungerford knee rating scale 8 knees resulted excellent, 2 fair and 4 poor. One knee was excluded after revision surgery due to a loosened tibial component of a medial unicompartimental knee arthroplasty. The 4 poor outcomes resulted from femoropatellar replacements in chondrocalcinosis (2 cases), rheumatoid arthritis and osteoarthritis, (one case each), affecting the femorotibial joint as well. CONCLUSIONS: In those cases of simultaneous femorotibial joint affection--even if this is merely slight and beginning and if the femoropatellar complaints are actually clearly dominating--the sole femoropatellar surface replacement seems to be contraindicated according to our experiences. Providing correct and strict indications this endoprosthesis can be recommended for sole femoropatellar osteoarthritis especially since loosening of endoprosthetic components was not been found in this study.