Hamburg, Germany
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Burghardt R.D.,Helios Endo Klinik Hamburg
Chinese journal of traumatology = Zhonghua chuang shang za zhi / Chinese Medical Association | Year: 2013

Compartment syndrome of the thigh is a rare condition, potentially resulting in devastating functional outcome. Increasing intracompartmental pressure which suppresses microcirculation and capillary perfusion may lead to cellular anoxia and muscle ischemia. The muscle compartments in the thigh have a more compliant fascia and blend anatomically into the open compartments of the pelvis, thus compensating higher volumes than the compartments in the lower leg. We present a previously unreported case in which the limb of a 36-year-old man was run over by a 25-ton truck. He presented with a sensomotor deficit in his left lower leg with full paralysis of the shank muscles and absence of all foot pulses. CT scan showed a huge haematoma in the thigh with active bleeding out of the popliteal artery into the haematoma which has already expanded into the muscle compartments of the lower leg. The limb had a disastrous compartment syndrome of the thigh and lower leg with disruption of the popliteal neurovascular bundle; however, no bones in the limb were fractured. A complete fasciotomy of all the lower limb muscle compartments was immediately performed. The artery was reconstructed with interposition of the smaller saphenous vein, which was already interrupted through the initial trauma.

Parvizi J.,Thomas Jefferson University | Gehrke T.,Helios Endo Klinik Hamburg | Chen A.F.,Rothman Institute
Bone and Joint Journal | Year: 2013

Louis Pasteur once said that: "Fortune favours the prepared mind." As one of the great scientists who contributed to the fight against infection, he emphasised the importance of being prepared at all times to recognise infection and deal with it. Despite the many scientific discoveries and technological advances, such as the advent of antibiotics and the use of sterile techniques, infection continues to be a problem that haunts orthopaedic surgeons and inflicts suffering on patients. The medical community has implemented many practices with the intention of preventing infection and treating it effectively when it occurs. Although high-level evidence may support some of these practices, many are based on little to no scientific foundation. Thus, around the world, there is great variation in practices for the prevention and management of periprosthetic joint infection. This paper summaries the instigation, conduct and findings of a recent International Consensus Meeting on Surgical Site and Periprosthetic Joint Infection. © 2013 The British Editorial Society of Bone & Joint Surgery.

Zahar A.,HELIOS ENDO Klinik Hamburg | Rastogi A.,Banaras Hindu University | Kendoff D.,HELIOS ENDO Klinik Hamburg
Current Reviews in Musculoskeletal Medicine | Year: 2013

Dislocation remains one of the most common complications after total hip arthroplasty, regardless of the surgical approach. While multiple reasons as laxity, implant position, improper implant choice, and impingement etc. might be leading factors for dislocation, an exact identification of the exact reason is of major importance, to plan for a proper surgical or nonsurgical correction. This article describes in detail the definition, etiology, reduction, and possible treatment options for dislocation after primary and revision total hip arthroplasty that are currently used at the Endo Klinik in Hamburg. It furthermore includes a distinct overview of possible surgical treatment options, based on the main pathology leading to dislocation. © 2013 Springer Science+Business Media New York.

Klauser W.,Helios ENDO Klinik Hamburg | Dutsch M.,Helios ENDO Klinik
Musculoskeletal Surgery | Year: 2013

Within the past 5 years, the oral anticoagulants rivaroxaban, apixaban, and dabigatran etexilate have been approved for the prevention of venous thromboembolism in adult patients after elective hip or knee arthroplasty in the European Union and many other countries worldwide. These agents differ from the previously available anticoagulants because they selectively and directly inhibit a single factor in the coagulation cascade - rivaroxaban and apixaban inhibit Factor Xa, and dabigatran inhibits Factor IIa (thrombin) - potentially enhancing the predictability of their anticoagulant effect. Currently, although some guidelines provide recommendations for the use of rivaroxaban, dabigatran etexilate, and apixaban in clinical practice, there are still questions regarding the optimal practical management of patients receiving these agents. This article briefly reviews the practical limitations associated with conventional anticoagulants, discusses potential issues with the practical management of the newer oral anticoagulants, and provides clinical experience from a single institution where rivaroxaban and dabigatran etexilate have been used within their approved indications. © 2013 The Author(s).

Gehrke T.,Helios Endo Klinik Hamburg
The bone & joint journal | Year: 2013

Based on the first implementation of mixing antibiotics into bone cement in the 1970s, the Endo-Klinik has used one stage exchange for prosthetic joint infection (PJI) in over 85% of cases. Looking carefully at current literature and guidelines for PJI treatment, there is no clear evidence that a two stage procedure has a higher success rate than a one-stage approach. A cemented one-stage exchange potentially offers certain advantages, mainly based on the need for only one operative procedure, reduced antibiotics and hospitalisation time. In order to fulfill a one-stage approach, there are obligatory pre-, peri- and post-operative details that need to be meticulously respected, and are described in detail. Essential pre-operative diagnostic testing is based on the joint aspiration with an exact identification of any bacteria. The presence of a positive bacterial culture and respective antibiogram are essential, to specify the antibiotics to be loaded to the bone cement, which allows a high local antibiotic elution directly at the surgical side. A specific antibiotic treatment plan is generated by a microbiologist. The surgical success relies on the complete removal of all pre-existing hardware, including cement and restrictors and an aggressive and complete debridement of any infected soft tissues and bone material. Post-operative systemic antibiotic administration is usually completed after only ten to 14 days.

Aggarwal V.K.,Rothman Institute | Bakhshi H.,Rothman Institute | Ecker N.U.,HELIOS ENDO Klinik Hamburg | Parvizi J.,Rothman Institute | And 2 more authors.
The journal of knee surgery | Year: 2014

Infecting microorganism is a strong predictor of treatment success for periprosthetic joint infection (PJI). The purpose of this study was to compare the infecting pathogens causing PJI at two large infection referral centers in the United States and in Europe. In this study, 898 consecutive cases of PJI were identified at the HELIOS ENDO-Klinik Hamburg in Europe and 772 cases were identified at the Rothman Institute in the United States. The incidence of organisms at the HELIOS ENDO-Klinik Hamburg versus the Rothman Institute was: coagulase-negative Staphylococcus (39.3 vs. 20.2%), S. aureus (13.0 vs. 31.0%), Streptococcus (6.5 vs. 5.8%), Enterococcus (7.0 vs. 3.9%), anaerobic (9.0 vs. 0.9%), fungal (0.3 vs. 2.3%), mycobacterial (0 vs. 0.6%), polymicrobial (3.4 vs. 7.4%), culture negative (16.1 vs. 15.8%), and other organisms (0.9 vs. 5.4%). The percentage of methicillin-resistant S. aureus was significantly higher at the American center than at the European center (48.1 vs. 12.8%; p < 0.0001). Our findings show higher virulence and resistance organisms are more prevalent at a referral center in the United States compared with one in Europe. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Kendoff D.,HELIOS ENDO Klinik Hamburg | Gehrke T.,HELIOS ENDO Klinik Hamburg
The journal of knee surgery | Year: 2014

Although it does offer some advantages, the one-staged exchange in periprosthetic joint infection (PJI) remains rare in the orthopedic world. Besides the reduced number of surgical interventions for the patients, it is usually associated with a decreased in-hospital stay and quicker mobilization. Furthermore, it might be the more cost-effective approach and allows for a reduced duration of postoperative systemic antibiotics, usually less than 14 days. Technically, the presence of a positive culture by preoperative aspiration or biopsy and respective antibiogram is mandatory. A cemented implant fixation using specified topic antibiotics, based on the antibiogram, is treatment of choice for one-staged procedures. The overall success is based on the well-defined and detailed intrahospital infrastructure, including a meticulous preoperative planning, joint aspiration regime, and aggressive intraoperative surgical approach. This article describes the one-staged exchange in infected PJI of the knee joint, which has been established 40 years ago in the HELIOS ENDO-Klinik Hamburg, Germany. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Schmitz H.C.R.,Helios ENDO Klinik Hamburg | Klauser W.,Helios ENDO Klinik Hamburg | Citak M.,Helios ENDO Klinik Hamburg | Al-Khateeb H.,Royal National Orthopaedic Hospital | And 2 more authors.
Journal of Arthroplasty | Year: 2013

There still is no consensus on the treatment of choice in revision knee arthroplasty associated with severe femoral and/or tibial bone loss. A total of 44 patients underwent revision knee arthroplasty procedures using porous tantalum cones (TM cones) to reconstruct tibial and/or femoral bone defects. At latest follow up after 37. months (32-48), 38 patients remained in the study. Tibial and femoral bone loss was categorized according to the AORI-Classification. The average preoperative KSS improved from 34 (range, 6-90) to 63 points (range, 7-90 points). The VAS improved from 7.5 to 4.8. Two patients required a re-revision due to aseptic loosening. There was no correlation between the different types of knee prosthesis implanted. Our study shows favourable clinical and radiological outcomes using TM cones in managing significant bone loss in revision total knee surgery. © 2013.

Gehrke T.,Helios Endo Klinik Hamburg
The bone & joint journal | Year: 2013

Femoral revision after cemented total hip replacement (THR) might include technical difficulties, following essential cement removal, which might lead to further loss of bone and consequently inadequate fixation of the subsequent revision stem. Femoral impaction allografting has been widely used in revision surgery for the acetabulum, and subsequently for the femur. In combination with a primary cemented stem, impaction grafting allows for femoral bone restoration through incorporation and remodelling of the impacted morsellized bone graft by the host skeleton. Cavitary bone defects affecting meta-physis and diaphysis leading to a wide femoral shaft, are ideal indications for this technique. Cancellous allograft bone chips of 1 mm to 2 mm size are used, and tapered into the canal with rods of increasing diameters. To impact the bone chips into the femoral canal a prosthesis dummy of the same dimensions of the definitive cemented stem is driven into the femur to ensure that the chips are very firmly impacted. Finally, a standard stem is cemented into the neo-medullary canal using bone cement. To date several studies have shown favourable results with this technique, with some excellent long-term results reported in independent clinical centres worldwide.

Noelle S.,Helios ENDO Klinik Hamburg | Egidy C.C.,Helios ENDO Klinik Hamburg | Cross M.B.,Hospital for Special Surgery | Gebauer M.,Helios ENDO Klinik Hamburg | Klauser W.,Helios ENDO Klinik Hamburg
International Orthopaedics | Year: 2013

Introduction: Total ankle arthroplasty is increasingly used as an alternative to arthrodesis to treat advanced ankle arthritis. However, the outcomes and postoperative complications are poorly described. Patients and methods: Between March 2005 and May 2010 114 S.T.A.R. prostheses were implanted by one surgeon at our institution. We retrospectively analysed the demographics, clinical outcomes and radiographic characteristics of 100 ankle prostheses (97 patients). Results: The average follow up was 36 months. The average preoperative AOFAS score of 36.87 (22-58) significantly increased to 75.99 postoperative. A total of 87 % of the patients reported a better life quality. Twenty-seven ankles incurred complications after primary surgery, and 21 prostheses required revision surgery, including four patients who required arthrodesis. Conclusion: Our study shows a high satisfaction rate after total ankle replacement and clear pain relief. Patients with a body mass Index higher than 30 showed a higher rate of complications. Compared with ankle fusion, the rates of complications are comparable. © 2013 Springer-Verlag Berlin Heidelberg.

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