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F W Hagena

Publications and source records attributed to F W Hagena.

At least 19 recordsLinked to original sources
PubMed2001

[Development of rheumatoid arthritis orthopedics in German-speaking countries].

In the realization that the cause of and thus an appropriate curative systemic therapy for rheumatoid arthritis did not and does not exist, surgical treatment of this usually destructive disease emerged as a major field in orthopedics in collaboration with internists specialized in rheumatology. The establishment of working groups within the scientific society initiated by the German Association for Orthopedics and Traumatology (DGOT) in 1971 to improve efficiency was a decisive factor for the further development in the German-speaking countries. A significant role was played by the fact that the Swiss N. Gschwend from Zurich was entrusted with the formation of the working group. This ensured that other German-speaking colleagues in Austria as well as Scandinavia also had the opportunity to add their input and influence rheumatoid orthopedics to a large extent. The DGOT also supported the creation of the ARO, which was founded as an independent association within the DGOT in 1992. The growth of rheumatoid orthopedics received considerable impetus from the fact that it was recognized in 1981 as the only subspecialty of orthopedics granted equal footing, as was the case for rheumatology in internal medicine. At the start of the 1970s, interest was focused on synovectomy for joint preservation, also with regard to its techniques and the possibility for preventive indications. Influenced by the experience gained from the development of endoprosthetic replacements, arthrodeses for rheumatic patients, e.g., in the region of the shoulder and knee joints, were almost completely ignored. The special field of reconstructive surgery on the hand and wrist employing implantation of finger joints and limited arthrodeses yielded impressive subjective and partially functional improvement for the patients. New impulses in the surgical treatment of foot deformities with joint-saving techniques for toe joints and endoprosthetic reconstruction of the ankle have brought about new trends in rheumatoid orthopedics in the past 10 years. Operative stabilization of cervical instabilities represents a special aspect in the development of rheumatoid orthopedics. Both the differential indication and the surgical technique have changed. The development of magnet resonance tomography and new implants for the cervical spine has played a significant role. Rheumatoid arthritis surgery has shown preference to integrating physical measures including in particular ergotherapy and special hand therapy into local surgical interventions. Functional treatment measures, care of braces and aids, and training in joint protection have become a firm part of the therapeutic concept. It is significant that in the German-speaking countries a treatment plan focused solely on the joints has thus far not gained general acceptance as is the case in Anglo-American countries. Preference is given to working as a team with subspecialties for upper and lower extremities and the spinal column. This guarantees that the priorities of the patients who usually present with multiple joint alterations can be dealt with by one group.

Arthritis, Rheumatoid↗
PubMed2001

[Prospective randomized study comparing the effectiveness and tolerance of various low-molecular-weight heparins in high risk patients].

INTRODUCTION: In several studies, low-molecular-weight-heparins (LMWH) have been shown to be as effective in the prevention of deep vein thrombosis (DVT) as unfractionated heparin. However, different LMWHs vary significantly in their pharmacokinetic profile and bioavailability pattern. It remains unknown, whether these pharmacological differences result in a clinically divergent behavior. METHODS: Safety and antithrombotic efficacy of three LMWHs, certoparin (18 mg), dalteparin (30 mg) and enoxaparin (24 mg), were compared in a prospective, randomized controlled trial involving 188 patients undergoing knee or hip replacement or spinal surgery. Efficacy was assessed by changes in venous flow patterns between pre- and postoperative Doppler sonography. The clinical endpoint for the assessment of safety were intra- and postoperative bleeding, changes in activated partial thromboplastin time (APTT) and thrombin clotting time (TCT), local hematoma and local infections. RESULTS: Two verified DVTs (1.1%) were observed in the study, leading to no statistical difference in the antithrombotic efficacy of the used LMWHs. In 21 patients (11.2%) local hematoma or local infections complicated the postoperative course. Of these 21 patients, 13 belonged to the certoparin group, compared to 4 patients each in the other groups (p < 0.01). An allergic reaction occurred in only one case treated with dalteparin. No differences between the groups were observed in terms of intra- and postoperative bleeding, APTT, TCT and blood count. CONCLUSION: The results of this study suggest, that all three LMWHs are equally efficacious in the prophylaxis of DVT in high risk patients after orthopedic surgery. Larger randomized controlled trials are necessary to confirm this conclusion and to evaluate the clinical relevance of the observed differences in postoperative complications.

Adult↗
PubMed1997

Surgical treatment for myeloma of the bone. A retrospective analysis of 22 cases.

In a retrospective study, 22 patients treated surgically for solitary or multiple myeloma between 1980 and 1993 were analysed. The main complaint was pain. A fracture was observed in 7 cases and motor-sensory impaired neurology due to spinal compression in 3. Apart from incisional biopsies, tumour resections, reductions (with and without stabilization by osteosynthesis) and endoprotheses were performed either at the extremities or on the spine. In addition, radiation and chemotherapy were included in the therapeutical concept. Early mobilization was achieved in all cases, and the 5-year survival rate (Kaplan-Meier method) was 48%. The results presented in this study demonstrate that a variety of surgical interventions can be of importance in the treatment of myeloma of the bone, ranging from biopsy or even curative resections in selected cases to endoprosthetic replacement. Thus, good functional results can be achieved and maintained over often long survival times.

Aged↗
PubMed1994

Retropatellar forces after rupture of the PCL and patello-tibial transfixation: an in vitro study.

Compared to injuries of the other knee ligaments, a rupture of the posterior cruciate ligament (PCL) is relatively rare. Treatment may be conservative or operative. A rupture that has been operated on temporarily can be stabilised using a Grammont patello-tibial transfixation (olecranisation). Flexion and extension between 30 degrees and 60 degrees are allowed. The advantage of this method is that it avoids complete immobilisation of the joint and also the reduction of pull on the PCL. However, patients treated with this method show long-term osteoarthritis of the retropatellar joint area. Our study aimed to show the distribution of forces at the dorsal patellar surface in the following: (1) knee with intact ligaments; (2) knee with PCL rupture; (3) knee with PCL rupture plus olecranisation. Fourteen fresh knee specimens were investigated in a Plitz/Wirth knee kinemator. The femur was fixed while the tibia was flexed between 5 degrees and 120 degrees. Pull was placed on the patella and on the dorsal side of the tibia with weights over the tendons of the quadriceps and the roots of the ischio-crural muscles. With the aid of a special measurement device in the patella, the medially laterally, proximally and distally acting forces in a movement cycle could be measured as well as the total retropatellar force in the above experimental setups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Method for in vivo measurement of intraosseous pressure of the patella].

During the development of degenerative joint disease (osteoarthritis, chondropathy), a diagnostic or even pathogenetic role is attributed to the phenomenon of intraosseous pressure (IOP). Owing to technical problems and a lack of systematic experimental or clinical studies on the control mechanisms of the IOP, the actual importance of this factor is still not known with certainty. Now, a measuring method that enables correct recording of the IOP and standardized on-line processing of the measured signal minimize artefact-related problems. The technique is evaluated for reliability in an in vitro model of the human patella and in a limited clinical study of the IOP in patients undergoing knee surgery for various reasons. Factors such as intra-articular effusion, joint position or changes in intra-articular soft tissue are examined for their influence of the primary signal.

Female↗
PubMed1992

[Thromboembolism complications in orthopedics and traumatology. A prospective study of 598 operated patients].

From 1.10.-31.12. 1989, 598 patients who underwent orthopaedic surgery in the Staatliche Orthopädische Klinik were examined by a pre-, intra- and postoperative questionnaire up to 3 months from the date of operation. All patients were separated into 4 groups corresponding to the calculated risk and duration of the operation. 46 patients in Group I, who underwent minor surgery, received 3 x 5000 I.E. Heparin subcutaneously. 243 patients in Group II received besides 3 x 5000 I.E. Heparin, 500 ml HAES 6% preoperatively. They underwent operations of greater intensity and duration at the upper and lower extremities. 302 patients of Group III were given 3 x 5000 I.E. heparin and 500 ml 6% dextrane 60 preoperatively because of severe operations (pelvis, hip). 7 high-risk patients received apart from 3 x 5000 I.E. Heparin subcutaneously 500 ml 6% dextrane 60 preoperatively and 250ml 10% dextrane 40 postoperatively for 5 days. In Group I we had 2.2% thromboembolic complications, whereas in Group II 1.7% and in Group III 3.3% complications with thrombosis and pulmonary embolism occurred. This was proved by pulmonary scintigraphy and phlebography. No such complications were seen in Group IV. The total incidence of deep vein thrombosis was 2.0% and of pulmonary embolism 0.5%. These results show the importance of preoperative risk check and individual prophylaxis of thromboembolic complications in orthopaedic and traumatologic surgery.

Adolescent↗
PubMed1992

[A tumorous chondrocalcinosis].

Calcium pyrophosphate dihydrate (CPPD) deposits are an accidental finding or they can be responsible for destructive osteoarthritis. Seldom they create a periarticular soft tissue tumour with or without bony destruction. We present a case of tumoral chondrocalcinosis that could have been mistaken for a malignant tumour without knowledge of the clinical course due to the high vascularity of the tumour.

Chondrocalcinosis↗
PubMed1992

Biterminal tenotomy for the treatment of congenital muscular torticollis. Long-term results.

Fifty-five patients who, in a twenty-eight-year period, had been managed with a biterminal open release because of congenital muscular torticollis, were re-examined at an average of fifteen years and a minimum of five years after the operation. Forty-eight patients reported no functional or cosmetic impairment. Palpable soft-tissue strands remained in twenty-nine patients, but bending toward the untreated side was limited more than 10 degrees in only one patient. The rate of recurrence was 2 per cent. Facial asymmetry improved or resolved in more than one-half of the patients. We recommend that biterminal release be performed at the age of three to five years in all patients who do not respond to non-operative treatment.

Adolescent↗
PubMed1989

The cruciate ligaments in knee replacement.

The cruciate ligaments were resected with their bony insertions during total knee arthroplasty carried out in 12 patients with severe rheumatoid or osteoarthritis. The ligaments were examined histologically and biomechanically, using ten specimens from healthy adults as a control. A significant difference was found in the tensile stiffness and viscoelastic properties of the ligaments between the arthritic and the control group. The ligaments in the rheumatoid knees had a distinctly inferior tensile strength compared with the osteoarthritic knees. Total knee replacement, which also replaces ligament function, should therefore be considered in severely damaged rheumatoid knees.

Arthritis, Rheumatoid↗
PubMed1989

[The possibilities of osteoplastic measures in mid-foot amputation and osteomyelitis of the tarsus].

Osteomyelitis after trauma or after operations and amputations at the midfoot or tarsus leads to a disadvantage in terms of motion and of weightbearing on the foot. Once local fistula, exophytic bone growth, skin defects and instability of the metatarsus have arisen, hygiene and recovery of joint function are difficult. Four patients were treated by reamputation at the midfoot and bone autografts. The osteomyelitic part was excised and the tarsal and metatarsal bones stabilized. The result at follow up showed painfree stumps without recurrence of infection within 3 years. Little support is needed in the way of orthopedic appliances, and all four patients can walk easily with no pain. This operation is recommended for the primary surgical procedure.

Adult↗
PubMed1988

[Does excessive stress play a role in the development of osteochondrosis dissecans tali?].

At the follow-up examination of 61 patients with Osteochondrosis dissecans tali (OD) we found at 48 of them one or more injuries in the anamnesia. More than 70 percent of them had as an injury mechanism a supination trauma. In case of medial OD the possible cause of an OD is given by the ratio 34 to 12 of trauma and non-trauma. The ratio in case of a lateral OD is 14 to 1 and it almost definitely points to overstress being a cause of it. Primary reasons may be here sports, especially football.

Adolescent↗
PubMed1987

[Multilocular myositis ossificans--damage caused by excessive stress in performance sports?].

This is a report of a girl of 16 years of age who complained of pain in both legs after intensive competitive sports, the main event being the 800 m race. Radiologically visualised were periostal reactions and new periostal bone formations at the femur and lower leg. Diagnosis was extremely difficult due to generalised signs and symptoms, such as temperature, associated with inappetence and a "run-down" feeling, increase of alkaline phosphatase and liver enzyme levels and of the blood sedimentation rate. Differential diagnosis of heterotopic ossifications is dealt with in detail.

Adolescent↗
PubMed1987

Pathomechanics of the femoropatellar joint following total knee arthroplasty.

Persistent discomfort in the femoropatellar joint is still one of the most disappointing aspects following total knee arthroplasty (TKA). Especially, TKA without patellofemoral replacement has a significant incidence of patellofemoral problems with a frequency between 5% and 45%. Pathomechanical factors in the development of retropatellar problems are loss of patellar thickness and retropatellar erosions. In 157 TKAs using Gschwend, Scheier, Bähler (GSB) joints without patellar resurfacing, pathomechanically postoperative vertical patellar malposition appeared to be the main cause of dysfunction. In many cases, the implantation technique leads to an artificial form of patella alta. This altered knee anatomy results in pathologic biomechanics, thus leading to reduced function. The combination of altered anatomy and reduced function leads to extensive patellar destruction and ultimately to intractable retropatellar pain.

Biomechanical Phenomena↗
PubMed1986

[The knee joint].

The knee is very important in the treatment of rheumatic diseases. Differentiating between the indications for different forms of therapy is dependent upon knowledge of the prospects for success. Synovectomy, preventive and palliative procedure, is the most important joint-saving measure, as confirmed by the long-term results presented here. Synoviorthese and arthroscopic operative procedures are alternatives and have expanded the spectrum. However, their long-term effectiveness has not yet been proved. Rheumatic, recurring synovitis has not yet been defined satisfactorily. Additional soft tissue operations should always be included in preoperative planning and determine the form of therapy. Alloarthroplasty of the knee is the foremost reconstructive measure, and excellent long-term results have already been achieved in some cases. It should be remembered, however, that modifications of individual models occasionally have a considerable influence on the results. Particularly for rheumatic knee joint deterioration, knee prosthesis models that guarantee long-term success should be given preference if the time and effort expended are justifiable. Continuous passive mobilization seems to be the most valuable postoperative measure.

Arthritis, Rheumatoid↗
PubMed1985

[Scintigraphic research on patellar changes after endoprosthetic replacement of the knee joint].

A clinical and x-ray review of 118 GSB-Knee-Protheses without resurfacing the patella--mean time of follow-up 4 years--was performed. In 50 knees of these an additional quantifying bone-scan with 99mTc-MDP ("ROI-method") indicated new aspects of the pathomechanics of the patella after knee replacement. Comparing 42 healthy knee joints and 82 knees with osteoarthrosis principles for early diagnosis of patellar changes could be set up. According to these findings the quantifying scans show the development of dystrophic patellar changes after knee replacement.

Aged↗