15
European Federation of National Associationsof Orthopaedics and Traumatology
European Instructional Lectures
Volume 9 2009
EFORT Executive Committee
Executive Board
Prof. Dr. Karl-Göran Thorngren, PresidentProf. Dr. Miklós Szendrői, Vice PresidentDr. Manuel Cassiano Neves, Secretary GeneralProf. Dr. Wolfhart Puhl, Immediate Past PresidentMr. Stephen R. Cannon, TreasurerProf. Dr. Enric Caceres Palou, Member at LargeProf. Dr. Pierre Hoffmeyer, Member at LargeProf. Dr. Maurilio Marcacci, Member at Large
Co-Opted Members
Mr. John AlbertProf. Dr. Thierry BéguéProf. Dr. George Bentley, Past PresidentProf. Dr. Nikolaus Böhler, Past PresidentDr. Karsten DreinhöferDr. Roberto Giacometti CeroniProf. Dr. Klaus-Peter GüntherAss. Prof. Dr. Per Kjaersgaard-AndersenProf. Dr. Karl Knahr
Scientifi c Coordination 10th EFORT Congress, Vienna 2009
Chairman
Prof. Dr. Pierre Hoffmeyer
Members
Prof. Dr. George BentleyProf. Dr. Nikolaus BöhlerProf. Dr. Enric Caceres PalouMr. Stephen R. CannonDr. Manuel Cassiano NevesProf. Dr. Alfred EngelProf. Dr. Roberto Giacometti CeroniProf. Dr. Martti HämäläinenProf. Dr. Karl KnahrProf. Dr. Philippe NeyretProf. Dr. Miklós Szendrői
Standing Committees
EAR Committee
Prof. Dr. Nikolaus Böhler,Dr. Gerold Labek
Education Committee
Prof. Dr. Enric Caceres Palou
EIL Committee
Prof. Dr. Wolfhart Puhl, Prof. Dr. Karl-Göran Thorngren
Events Committee
Dr. Manuel Cassiano Neves
Finance Committee
Mr. Stephen R. Cannon, Prof. Dr. Pierre-Paul Casteleyn
Health Service Research Committee
Dr. Karsten Dreinhöfer
Portal Steering Committee
Prof. Dr. Klaus-Peter Günther
Publishing Committee
Prof. Dr. George Bentley (Books), Prof. Dr. Klaus-Peter Günther (Portal), Prof. Dr. Wolfhart Puhl (Journal)
Scientifi c Committee
Prof. Dr. Pierre Hoffmeyer
Venue Committee
Prof. Dr. Miklós Szendrői
Task Forces and Ad Hoc Committees
Awards & Prizes Committee
Prof. Dr. George Bentley
Fora
Prof. Dr. Thierry Bégué
Liaison & Lobbying Committee
Prof. Dr. Wolfhart Puhl
Speciality Societies Committee
Dr. Roberto Giacometti Ceroni
Travelling & Visiting Fellowships
Prof. Dr. Maurilio Marcacci
European Federation of National Associationsof Orthopaedics and Traumatology
Committees and Task Forces
European Federation of National Associationsof Orthopaedics and Traumatology
European Instructional Lectures
Volume 9, 2009
10th EFORT Congress, Vienna, Austria
Edited by
George Bentley
ISBN: 978-3-642-00965-5 e-ISBN: 978-3-642-00966-2
DOI: 10.1007/978-3-642-00966-2
Springer Dordrecht Heidelberg London New York
Library of Congress Control Number: 2009926014
© EFORT 2009
This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer. Violations are liable to prosecution under the German Copyright Law.
The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
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Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)
Editor: Prof. Dr. George BentleyRoyal National Orthopaedic Hospital TrustStanmore, MiddlesexHA 7 4LP, [email protected]
EFORT Central Offi ceTechnoparkstrasse 18005 Zürich, Switzerlandwww.efort.org
v
Foreword
The 10th Congress of the European Federation of National Associations of Ortho-paedics and Traumatology (EFORT) is the most important combined congress of the national societies in Europe. At present a total of 36 societies are members of this organisation. The major goal of EFORT is to bring current knowledge of diseases and trauma of the musculoskeletal system to all European surgeons and additionally to welcome colleagues from all over the world to join us in sharing our daily work experience.
In the scientifi c programme the instructional lectures form a very basic and impor-tant part of the Congress. In Vienna a total of 25 sessions are included in the pro-gramme. The authors come from all over Europe and they discuss topics from many different fi elds of trauma and orthopaedics. These lectures not only give the opportu-nity for us to be informed about various diseases, but they are also infl uenced by the authors’ experience based on the treatment philosophy in their own country – again an opportunity to widen the European horizon. They are aimed at both the general orthopaedic surgeons and the young residents and trainees who want to widen their knowledge in different topics of orthopaedic and trauma surgery.
As the chairman of the Local Organising Committee I thank all the authors for providing their presentation for publication in this volume. I also address my special thanks to Professor George Bentley for organising this edition.
I am confi dent that this book will have the same respected place in the library of the participating orthopaedic surgeons as do all the previous ones.
Vienna, Austria Karl Knahr
vii
Preface
This is the 9th volume of the European Instructional Lectures, which contains more new material, which will be presented during the 10th EFORT Congress in Vienna by distinguished authors from across Europe.
As in former volumes the chapters cover a range of topics, concentrating on both the essentials of the subjects and the latest thinking and technology. Additionally, the authors are from different countries and centres, which refl ect the variety of modern European orthopaedic and traumatology practice and their special experience and philosophy.
Special thanks are due to these authors who have been called upon to do other tasks, such as paper reviewing and chairing Specialist Symposia and Free Paper ses-sions, and all of them have responded generously. Without this spirit of collaboration by our colleagues in the National and Specialty Societies, EFORT would not fl ourish.
The preparation and printing of this volume was by the Internationally-recognised Springer team, enthusiastically led by Gabriele Schroeder, to whom we are very grateful. I wish also to thank Larissa Welti, Régine Brühweiler, Sabrina Wolf and the EFORT Central Offi ce for their unfailing support.
EFORT has now exceeded 220 essays in the 9 volumes of Instructional Lectures since the series fi rst began at the opening Congress in Paris in 1993. With this in mind we wish to dedicate this volume to the memory of the life and work of our dear col-league Professor Frantz Langlais, tragically and prematurely taken from us in 2007.
Stanmore, UK George Bentley
Preface
ix
Contents
General Orthopaedics
Current Status of Arthroplasty Registers in Europe . . . . . . . . . . . . . . . . . . 3N. Böhler and Gerold Labek
National Registration of Hip Fractures in Sweden . . . . . . . . . . . . . . . . . . . . 11Karl-Göran Thorngren
Current Status of Articular Cartilage Repair . . . . . . . . . . . . . . . . . . . . . . . . 19Emmanuel Thienpont
Thromboprophylaxis After Major Orthopaedic Surgery: State of the Art . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Alexander G.G. Turpie
Paediatrics
DDH: Diagnosis and Treatment Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . 41R. Graf
Slipped Capital Femoral Epiphysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47C. Zilkens, M. Jäger, Y-J. Kim, M.B. Millis, and R. Krauspe
Major Joint Contractures in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61Deborah M. Eastwood
Trauma
Damage-Control Orthopaedic Surgery in Polytrauma: Infl uence on the Clinical Course and Its Pathogenetic Background . . . . . . . . . . 67Hans-Christoph Pape
Fractures and Non-Unions of the Clavicle. . . . . . . . . . . . . . . . . . . . . . . . . . . 75Patrick Simon
Proximal Humeral Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81C. Torrens
Fixation of Intertrochanteric Femoral Fractures . . . . . . . . . . . . . . . . . . . . . 91Vilmos Vécsei and Stefan Hajdu
Surgical Management of Distal Tibial Fractures in Adults . . . . . . . . . . . . . 97Mathieu Assal and Richard Stern
Upper Limb and Hand
The Distal Radio-Ulnar Joint: Functional Anatomy, Biomechanics, Instability and Management . . . . . . . . . . . . . . . . . . . . . 115Panayotis N. Soucacos and Nickolaos A. Darlis
Distal Radius Fractures: Evolution in the Treatment Standard of Care 2009 . . . . . . . . . . . . . . . 125Antonio Abramo and Philippe Kopylov
Dupuytren’s Contracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137Hanno Millesi
Spine
Low Back Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155R. Eyb and G. Grabmeier
Hip
Total Hip Arthroplasty: A Comparison of Current Approaches . . . . . . . . 163Martin Krismer
How to Do a Cemented Total Hip Arthroplasty . . . . . . . . . . . . . . . . . . . . . . 177Eduardo Garcia-Cimbrelo
How to Do a Cementless Hip Arthroplasty . . . . . . . . . . . . . . . . . . . . . . . . . . 189Klaus-Peter Günther, Firas Al-Dabouby, and Peter Bernstein
Knee
How to Treat a Meniscal Lesion? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205Olivier Charrois and The GREC Group
Soft-Tissue Balance in Total Knee Arthroplasty. . . . . . . . . . . . . . . . . . . . . . 213David E. Beverland
Revision Total Knee Arthroplasty with Bone Loss . . . . . . . . . . . . . . . . . . . . 219Josef Hochreiter and Karl Knahr
Foot and Ankle
Ankle Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227X. Crevoisier
Hallux Rigidus: Arthroplasty or Not? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239S. Giannini, F. Vannini, R. Bevoni, and D. Francesconi
x Contents
xi
PrefaceContributors
Antonio Abramo Hand and Upper Extremity Unit, Department of Orthopaedics, Lund University Hospital, Lund, Sweden
Firas Al-Dabouby Department of Orthopaedic Surgery, University Hospital Carl Gustav Carus Dresden, Fetscherstr. 74, D-01307 Dresden, Germany
Mathieu Assal Orthopaedic Surgery Service, University Hospital of Geneva, Switzerland, [email protected]
Peter Bernstein Department of Orthopaedic Surgery, University Hospital Carl Gustav Carus Dresden, Fetscherstr. 74, D-01307 Dresden, Germany
David E. Beverland Outcomes Unit, Musgrave Park Hospital, Belfast, BT9 7JB, UK, [email protected]
Roberto Bevoni Via Pupilli 1, 40136 Bologna, Italy, [email protected]
Nikolaus Böhler AKH Linz, Orthopaedic Department, Krankenhausstrasse 9, A-4020 Linz, Austria, [email protected]
Olivier Charrois Clinique Arago, 95 Boulevard Arago, 75014 Paris, France,[email protected]
Xavier Crevoisier Centre Hospitalier Universitaire Vaudois (CHUV), Site Hôpital Orthopédique, Pierre-Decker 4, 1011 Lausanne, Switzerland,[email protected]
Nickolaos A. Darlis Department of Orthopaedic Surgery, University of Athens, School of Medicine, Athens, Greece
Deborah M. Eastwood Department of Paediatric Orthopaedics, Great Ormond St Hospital for Children and the Royal National Orthopaedic Hospital, London, UK, [email protected]
Richard Eyb Donauspital, Orthopädische Abteilung, Sozialmedizinisches Zentrum Ost, Langobardenstrasse 122, 1220 Wien, Austria, [email protected]
D. Francesconi Via Pupilli 1, 40136 Bologna, Italy, [email protected]
Eduardo Garcia-Cimbrelo Hospital La Paz, Universidad Autónoma de Madrid, Paseo de la Castellana 261, Madrid 28046, Madrid, Spain, [email protected]
xii Contributors
Sandro Giannini Via Pupilli 1, 40136 Bologna, Italy, [email protected]
Georg Grabmeier Donauspital Orthopädische Abteilung Sozialmedizinisches Zentrum Ost Langobardenstrasse 122 1220 Wien, Austria
Reinhard Graf Allgemeines u. Orthopädisches Landeskrankenhaus, 8852 Stolzalpe, Austria, [email protected]
Klaus-Peter Günther Department of Orthopaedic Surgery, University Hospital Carl Gustav Carus Dresden, Fetscherstr. 74, D-01307 Dresden, Germany, [email protected]
Stefan Hajdu Department of Trauma Surgery, Vienna Medical University, Währinger Gürtel 18-20, 1090-Wien, Austria, [email protected]
Josef Hochreiter Department of Orthopaedic Surgery, St. Vincent’s Hospital, Linz, Austria, [email protected]
Marcus Jäger Department of Orthopaedic Surgery, University Hospital of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
Young-Jo Kim Children’s Hospital Boston, Harvard Medical School, Department of Orthopaedic Surgery, 300 Longwood Avenue, Boston, MA 02115, USA
Karl Knahr Department II of Orthopaedic Surgery, Orthopaedic Hospital Speising, Vienna, Austria, [email protected]
Philippe Kopylov Hand and Upper Extremity Unit, Department of Orthopaedics, Lund University Hospital, Lund Sweden, [email protected]
Rüdiger Krauspe Department of Orthopaedic Surgery, University Hospital of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany, [email protected]
Martin Krismer Department of Orthopaedics, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria, [email protected]
Gerold Labek Medical University Innsbruck, Orthopaedic Department, Anichstrasse 35, A-6020 Innsbruck, Austria
Hanno Millesi Wiener Privatklinik, Pelikangasse 15 1090 Wien, Austria, [email protected]
M.B. Millis Children’s Hospital Boston, Harvard Medical School, Department of Orthopaedic Surgery, 300 Longwood Avenue, Boston, MA 02115, USA
Hans-Christophe Pape University of Aachen, Chairman,Department of Orthopaedics, Pauwelstreet 30, 52074 Aachen, [email protected]
Patrick Simon Centre Hospitalier Saint Joseph - Saint Luc 20, quai Claude Bernard 69365 Lyon, France, [email protected]
Panayotis N. Soucacos Department of Orthopaedic Surgery, University of Athens, School of Medicine, Athens, Greece, [email protected]
Richard Stern Orthopaedic Surgery Service, University Hospital of Geneva, Switzerland
Contributors xiii
Emmanuel Thienpont University Hospital Saint Luc, U.C.L., Avenue Hippocrate 10, 1200 Brussels, Belgium, [email protected]
Karl-Göran Thorngren Department of Orthopaedics, Lund University Hospital, SE-221 85 Lund, Sweden, [email protected]
Carlos Torrens Orthopaedic Department, Hospital del Mar, Passeig Marítim 25-29, 08003 Barcelona, Spain, [email protected]
Alexander G.G. Turpie McMaster University, 237 Barton Street East, Hamilton, Canada, ON L8L 2X2, [email protected]
F. Vannini Via Pupilli 1, 40136 Bologna, Italy, [email protected]
Vilmos Vécsei Department of Trauma Surgery, Vienna Medical University,Währinger Gürtel 18-20, 1090-Wien, Austria
Christoph Zilkens Department of Orthopaedic Surgery, University Hospital of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
Part I
General Orthopaedics
G. Bentley (ed.), European Instructional Lectures. European Instructional Course Lectures 9, 3DOI: 10.1007/978-3-642-00966-2_1, © 2009 EFORT
Introduction
National Arthroplasty Registers in Scandinavia have proved to be an important and valid instrument to assess the long-term performance of joint arthroplasty procedures and to lead to an improvement in the long-term outcome of arthro-plasty [1–8]. Improved quality of joint arthroplasty effects a reduction of costs in public health care by avoiding revi-sion surgery [9]. Starting with the Swedish National Knee Register (Lund, 1975) [10] and the Swedish National Hip Register (Gothenburg, 1979) they have had a high impact on Orthopaedic procedures in Scandinavia and worldwide.
In Sweden, for instance, the revision burden as an essen-tial indicator could be substantially reduced. Due to data in the register, products with inferior performance such as Boneloc bone cement were rapidly detected [11]. The prod-uct was taken from the market wordwide in 1995. Moreover, the effects of procedures such as the mini-invasive approach, of operating experience [12] or the administration of antibi-otics could be evaluated and, as a consequence, standardised improvements could be suggested.
Even though the results obtained from arthroplasty reg-isters were accepted by the scientifi c community worldwide and were often quoted, efforts to establish similar projects in other countries were not really successful. For example,
an ambitious project in Germany, the German Arthroplasty Register e.V. in Göttingen [13], as well as the European Implant Register Committee by EFORT were discontinued after a few years. A multitude of different projects were and still are designated as registers.
As there was no commonly-accepted defi nition of a reg-ister, the defi nition of an Arthroplasty Register was worked out by close dependence on the Scandinavian experience and was fi nally determined by the European Arthroplasty Register with all European National Arthroplasty Registers participating.
These are the aims of a Register:Registration of ALL primary and revision operations in ●a defi ned area in a central database.Follow the implant until it has to be revised, the patient ●dies or emigrates.Defi nition of Revision (= Failure): at least one part of ●the implant has to be revised.
Other large-scale documentation should be considered as multi-centre studies or surveys.
The completeness of data is decisive for the quality of the results drawn from a register. Registers in Scandinavia were the fi rst to prove that area-wide data collection is possible [14–18]. The high quality of statements on activities and results within whole National territories is unique in science. One of the essential criteria is that the bias which is inevita-ble when working with samples can largely be avoided on a National scale.
Historical Review and Methods
Within the scope of an EFORT project in Romania it was decided in 1999 to found a National arthroplasty register. Afterwards, in rapid succession, the Slovak Orthopaedic Society also decided to establish a National arthroplasty
N. Böhler (�)AKH Linz, Orthopaedic Department, Krankenhausstrasse 9, A-4020 Linz, Austriae-mail: [email protected]
1International Websites of National Arthroplasty Registers inclu-d ing National Arthroplasty Register Reports and Publications are presented on the EFORT-Website: http://www.efort.org/getdoc/1b923b01-41d2-4587-bac2-7ca7a11e613e/Arthoplasty-Registers.aspx
Current Status of Arthroplasty Registers in Europe1
N. Böhler and Gerold Labek
4 N. Böhler and G. Labek4 N. Böhler and G. Labek
register and the Hungarian Register, founded in 1998, expressed its willingness to co-operate, the opportunity for supra-National co-operation became self-evident. EFORT was given responsibility for these activities, and conse-quently the EFORT Executive Committee launched the “European Arthroplasty Register” (EAR) project in June 2001. All existing National registers, at that time the Scandinavian Registers, were prepared to join the project and make their experience available to the network.
In order to be able to support the increasing number of network activities in the best possible way a non-profi t asso-ciation, EFORT-EAR, was founded in 2005. This association closely co-operates with EFORT. There are multiple organi-sational links between EFORT and EFORT-EAR.
Further information is available from the Internet on www.ear.efort.org.
Membership requires either operating a National regis-ter according to the EFORT-EAR defi nition or an exisiting project for the foundation of a National register that is sup-ported by the relevant National orthopaedic society.
The EAR network supports initiatives for the founda-tion of National arthroplasty registers by National ortho-paedic societies. These activities are primarily based on the exchange of experience, passing on information for discus-sions, for instance with health authorities, and the inter-change of solutions for common problems in organisation, documentation and evaluation.
Particular central standards are being laid down, such as Minimal Datasets, for example, that comprise all parts of information to be collected in a National register. These standardisation efforts aim at improving the supranational comparison of reports.
Where necessary central services shall help registers to fulfi l their tasks as economically as possible. A central prod-uct data base would be one example. Implant tracking is a pre-condition for any kind of evaluation. Setting up a data-base comprising all products available on the relevant mar-kets is one of the most complex and time-consuming tasks of every register that has to be carried out in co-operation with the producers. A co-operation will thus enable all partners to improve data quality at a lower expenditure.
EFORT also supports register activities through its wide range of publication facilities. Within the scope of the EFORT homepage (www.efort.org) all websites of National Arthroplasty Registers have been combined in a user-friendly way. Futhermore publication activities are supported through essential results achieved in the course of EFORT and National conferences.
Of course the EAR project also comprises scientifi c activities. These activities as with all communication within the network of National Registers are run via the
EAR Offi ce at the Orthopaedic University Hospital of Innsbruck, Austria.
The variety of projects in nearly all European countries and the rapidly growing number of register foundations within the last 10 years clearly demonstrate the value and necessity of activities of that kind (Fig. 1).
At present 27 registers in 24 countries are members of the EAR. In most of these countries register activities are carried out by one organisation. However, the splitting of activities into several centres, each dealing with a particular joint, is a promising alternative as examples in Sweden and Denmark have shown (Table 1).
Basic Requirements for the Development and Activities of a National Arthroplasty Register
Arthroplasty Registers are very complex projects requiring co-operation with a variety of experts and stakeholders. Over the past few years the development of various National registers has shown that several aspects are crucial for suc-cessful implementation.
1. The register has to be an integral part of the National health-care system. Registers exclusively based on sci-entifi c motivation and the support of academic institu-tions were not able to cope with the diverse problems and requirements alone, notwithstanding the strong personal
0
2
4
6
8
10
12
14
16
18
20
1970s
Start ofArthroplastyRegisters
1980s 1990s 2000-
Fig. 1 Number of National Arthroplasty Register projects started
