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Zürich, Switzerland

Zaltz I.,William Beaumont Hospital | Leunig M.,Schulthess Klinik
Clinical Orthopaedics and Related Research | Year: 2012

Background: Cam-type, pincer, and mixed femoroacetabular impingement (FAI) are accepted causes of labral and acetabular rim injury; however, the abnormal contact stresses associated with motion may damage other areas of the hip. Although cartilage damage to the femoral head has been reported previously in athletes, FAI-associated focal parafoveal chondral defects differ from previously reported lesions and represent a rare manifestation of the complex pathomechanics associated with FAI. Questions/Purposes: We describe the clinical, radiographic, and surgical characteristics of a rare focal anterolateral parafoveal femoral chondral defect associated with FAI. Methods: We retrospectively reviewed 10 patients with symptomatic FAI diagnosed with this unique focal defect confirmed at the time of surgical dislocation. Patients presented with hip pain, clinical findings of FAI, and, frequently, with an identifiable lesion on MRI arthrography. The minimum clinical followup was 12 months (mean, 29 months; range, 12-72 months). Results: The consistent characteristics of these lesions associated with FAI differ from previously reported femoral chondral damage reported after hip dislocation or lateral impact in that there was no discrete injury such as a fall or dislocation/subluxation, no associated traumatic femoral lesion, and all were localized to the posterosuperior femoral head. Eight of 10 were diagnosed preoperatively using MR arthrography. Conclusions: Despite radiographic similarities to findings of osteoarthritis and osteonecrosis, these FAI-associated femoral chondral defects were amenable to surgical reconstruction using first- or second-generation cartilage repair techniques during surgical treatment of impingement. The etiology of these lesions may be related to complex intraarticular forces generated by FAI-associated transient hip subluxation or forceful nonconcentric motion. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. © The Association of Bone and Joint Surgeons® 2012. Source


Sink E.L.,Hospital for Special Surgery | Leunig M.,Schulthess Klinik | Zaltz I.,Oakland Orthopaedic Surgeons | Gilbert J.C.,Hospital for Special Surgery | Clohisy J.,Washington University in St. Louis
Clinical Orthopaedics and Related Research | Year: 2012

Background: Quality of health care and safety have been emphasized by various professional and governmental groups. However, no standardized method exists for grading and reporting complications in orthopaedic surgery. Conclusions regarding outcomes are incomplete without a standardized, objective complication grading scheme applied concurrently. The general surgery literature has the Clavien-Dindo classification that meets the above criteria. Questions/purposes: We asked whether a previously reported classification would show high intraobserver and interobserver reliabilities when modified for orthopaedic surgery specifically looking at hip preservation surgery. We therefore determined the interreader and intrareader reliabilities of the adapted classification scheme as applied to hip preservation surgery. Methods: We adapted the validated Clavien-Dindo complication classification system and tested its reliability for orthopaedic surgery, specifically hip preservation surgery. There are five grades based on the treatment required to manage the complication and the potential for long-term morbidity. Forty-four complication scenarios were created from a prospective multicenter database of hip preservation procedures and from the literature. Ten readers who perform hip surgery at eight centers in three countries graded the scenarios at two different times. Fleiss' and Cohen's κ statistics were performed for interobserver and intraobserver reliabilities, respectively. Results: The overall Fleiss' κ value for interobserver reliability was 0.887 (95% CI, 0.855-0.891). The weighted κ was 0.925 (95% CI, 0.894-0.956) for Grade I, 0.838 (95% CI, 0.807-0.869) for Grade II, 0.87 (95% CI, 0.835-0.866) for Grade III, and 0.898 (95% CI, 0.866-0.929) for Grade IV. The Cohen's κ value for intraobserver reliability was 0.891 (95% CI, 0.857-0.925). Conclusions: The adapted classification system shows high interobserver and intraobserver reliabilities for grading of complications when applied to orthopaedic surgery looking at complications of hip preservation surgery. This grading scheme may facilitate standardization of complication reporting and make outcome studies more comparable. © 2012 The Association of Bone and Joint Surgeons®. Source


Eschertzhuber S.,Innsbruck Medical University | Brimacombe J.,Cairns Base Hospital | Kaufmann M.,Innsbruck Medical University | Keller C.,Schulthess Klinik | Tiefenthaler W.,Innsbruck Medical University
Anaesthesia | Year: 2012

The i-gel TM and LMA Supreme TM are extraglottic airway devices with non-inflatable and inflatable cuffs, respectively. We hypothesised that directly measured mucosal pressures would differ between these devices in anesthetised paralysed patients. Thirty patients were randomly allocated to receive one of these two devices. Four pressure sensors were attached to all airway devices used to measure mucosal pressure at the base of the tongue, the distal oropharynx, the hypopharynx and the pyriform fossa. At these four places, median (IQR [range]) i-gel mucosal pressures were 8.0 (2.7-10.7 [0-26.7]), 5.0 (2.7-7 [1.0-37.3]), 9.3 (2.7-13.3 [0-22.7] and 8.0 (2.7-10.7 [0-25.3]) cmH 2O, respectively, and for the LMA Supreme, these were 5.0 (0.5-8.0 [0-33]), 4.0 (1.3-9.3 [0-24]), 10.7 (4-17.3 [0-26.7]) and 8.0 (0-10.7 [0-36]) cmH 2O, respectively. Mucosal pressures were low and similar for both devices. The LMA Supreme mucosal pressures were higher in the hypopharynx than in the distal oropharynx (p = 0.04) and base of the tongue (p = 0.011). There were no pressure differences between the locations for the i-gel. © 2012 The Association of Anaesthetists of Great Britain and Ireland. Source


Background: Although reconstruction methods have improved, tendon retears remain a major complication associated with rotator cuff repair. With the application of patches, either by interposition or by augmentation, surgeons can attempt to close an irreparable cuff defect or improve the mechanical and biological properties of tendons respectively. Objectives: Which factors need to be considered when using a patch and what outcome can be expected? Materials and methods: Based on the current literature, an overview of the techniques and materials in use and biomechanical and clinical experience is provided. Results: The literature shows clear improvements in the biomechanical properties of a repair with patch augmentation; in particular, weakened tendons of the anterior supraspinatus and superior infraspinatus benefit most. It is important to keep in mind that each patch material has its own individual properties, which makes comparison of the various patch types difficult. The current scientific evidence is promising, although larger level 1 studies are still required. Conclusions: The general use of patches cannot be recommended at this time. Nevertheless, the use of a patch should be considered in patients who are at a high risk of recurrent retears. In future, patches will probably be applied mainly as part of a combined effort, together with biological measures to further reduce retear rates. © 2015, Springer-Verlag Berlin Heidelberg. Source


Huber M.,Schulthess Klinik
Foot and Ankle Clinics | Year: 2013

Cavovarus deformity results from an imbalance of the foot's extrinsic musculature. Conditions leading to weakness of an isolated muscle result from nerve injury or sequelae of a compartment syndrome. When weakness of a muscle group presents, an underlying neurologic disorder must be suspected. Patients with hereditary sensory motor neuropathy present with a progressive pattern of imbalance and deformity. The deformity starts out flexible but becomes rigid over time. Rebalance muscle pull to realign the foot and ankle is important. Osteotomies and arthrodesis to realign the hindfoot will not maintain alignment as long as the agonist-antagonist pattern is not re-established. © 2013 Elsevier Inc. Source

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