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Biomedical subjects

M Rittmeister

Publications and source records attributed to M Rittmeister.

At least 19 recordsLinked to original sources
PubMed2006

[Comparison of total hip arthroplasty via a posterior mini-incision versus a classic anterolateral approach].

Surgical approaches to the hip for total hip arthroplasty (THA) are termed minimally invasive when allowing for a skin incision length of 10 cm or less. The aim of this study was to explore if a minimally invasive posterior approach compared to a classic anterolateral approach negatively influenced surgical time, blood loss, implant position, or perioperative complications. Two groups of THA patients mainly differing with respect to the surgical approach were compared. Results of 76 consecutive THA via a posterior mini-incision approach were recorded prospectively and those of 76 controls operated via a classic anterolateral approach were recorded retrospectively. THA was performed by the same surgeon in every case. Surgical time or intraoperative blood loss were not different among the groups. Total 24-h blood loss was significantly less in patients undergoing THA via minimally invasive posterior approaches. Median cup inclination was 45 degrees in both groups. Cup anteversion was 15 degrees (classic anterolateral) and 12 degrees (minimally invasive posterior), respectively. Stem position was regarded as neutral in 80% of THA through classic anterolateral and in 76 % through minimally invasive dorsal incisions. Complications occurred in 8% (classic anterolateral) and 9% (minimally invasive posterior) of THA patients. Surgical time, blood loss, risk of malpositioned implants, or complications were not increased for THA patients operated through minimally invasive posterior incisions compared to those operated via classic anterolateral approaches.

Adult↗
PubMed2006

Factors influencing cup orientation in 500 consecutive total hip replacements.

UNLABELLED: We sought to establish the percentage of acetabular components used in total hip arthroplasties that were located outside a presumed safe range of cup orientation. Data were analyzed to assess whether dislocation in this series was different inside and outside that presumed safe zone. We also asked whether acetabular cup orientation depended on patient body mass index, the amount of preoperative acetabular head coverage, the surgeon, or the use of minimally invasive technique. We assessed cup orientation in 500 total hip arthroplasties performed at one institution. Of these 500 total hip arthroplasties, 400 were done using conventional approaches whereas mini-incisions were used in 100. We found 19.8% of cups were oriented outside the presumed safe range for inclination, and 11.2% of cups were oriented outside the presumed safe range for anteversion. Dislocation was not greater in the group with inclination and anteversion outside the presumed safe. Cup orientation was influenced by pre-operative acetabular head coverage, the surgeon, and minimally invasive technique, but not body mass index. Cup variability was greater than expected. It was not confined to one surgeon, but to the entire group of surgeons experienced in doing total hip replacements. Variability points toward continuous refinement in surgical technique and instrumentation to promote consistency in cup placement. LEVEL OF EVIDENCE: Prognostic study, Level IV (case series).

Acetabulum↗
PubMed2005

Triple osteotomy of the pelvis for acetabular dysplasia: age at operation and the incidence of nonunions and other complications influence outcome.

We investigated the variables which determine the outcome after triple osteotomy of the pelvis for the treatment of congenital dysplasia of the hip. We reviewed 51 patients (61 hips) with a median age at operation of 23 years who were treated with a Tönnis triple osteotomy. The median follow-up was six years with a minimum of two years. Eight patients (eight hips) required a revision procedure. Of the remaining 53 hips, the results were good or excellent in 36 (68%) when evaluated according to the Harris hip score (median 90 points), and 33 patients (65%) were satisfied with the procedure. Logistic regression analysis indicated that the incidence of complications such as nonunion at an osteotomy site influenced patient satisfaction (p = 0.079). The incidence of complications correlated positively with increasing patient age at operation (p = 0.004). The amount of acetabular correction did not correlate with patient satisfaction. In univariate analysis, the groups of 'satisfied' and 'not satisfied' patients differed significantly in Harris hip score, age, incidence of nonunion at the osteotomy sites, complications and late revisions. In conclusion, the patient's age at operation and the incidence of complications influence patient satisfaction after triple osteotomy, but the amount of radiologically evident acetabular correction shows no correlation to outcome.

Adolescent↗
PubMed2004

[The use of regional anesthesia in orthopedics].

Regional anesthesia has its place in the perioperative pain management of orthopedic patients. A reduction in postoperative mortality and morbidity with regional anesthesia is acknowledged for subsets of patient populations. Single shot and continuous applications are techniques for providing regional analgesia. Continuous infusion of local anesthetics with catheter techniques provides for uninterrupted postoperative analgesia. The combination of regional and general anesthesia reduces the consumption of systemic anesthetics. The side effects of opioid therapy are thereby reduced. The inhibition of intraoperative stress reaction, especially with epidural anesthesia, helps to prevent or lower unwanted metabolic changes. Patient contentment with analgesic quality differs with the technique with which the regional anesthesia is applied (PDA, PCEA, IVRA, peripheral block, i.a. injection), and the medication (LA, opioid) used.

Anesthesia, Conduction↗
PubMed2004

[Drug therapy in complex regional pain syndrome type I].

Pharmacologic treatment options for complex regional pain syndrome (CRPS) type I are discussed and drug effectiveness is graded according to the level of evidence available. Various drug strategies in the treatment of CRPS type I, i.e. NSAIDs, corticosteroids, free radical scavengers, antidepressants, anticonvulsants, local anesthetics, opioid analgesics, clonidine, capsaicin, NMDA receptor antagonists, calcitonin, bisphosphonates, GABA(B)-agonists, alpha-blockers, IVRA (bretylium/ketanserin), IVRA (clonidine), IVRSB, local anesthetics sympathetic blockade, GLOA and iloprost are discussed.

Analgesics↗
PubMed2004

[Minimally invasive approaches to hip and knee joints for total joint replacement].

The manuscript features the different minimally invasive approaches to the hip for joint replacement. These include medial, anterior, anterolateral, and posterior approaches. The concept of minimally invasive hip arthroplasty makes sense if it is an integral part of a larger concept to lower postoperative morbidity. Besides minimal soft tissue trauma, this concept involves preoperative patient education, preemptive analgesia, and postoperative physiotherapy. It is our belief that minimal incision techniques for the hip are not suited for all patients and all surgeons. The different minimally invasive approaches to the knee joint for implantation of a knee arthroplasty are described and discussed. There have been no studies published yet that fulfill EBM criteria. The data so far show that minimally invasive approaches and implantation techniques for total knee replacements lead to quicker rehabilitation of patients.

Arthroplasty, Replacement, Hip↗
PubMed2003

[Arthroscopic elbow surgery in rheumatoid arthritis].

The technique of arthroscopic elbow surgery and its possibilities in the rheumatoid arthritic elbow is discussed. Emphasis is placed on the description of arthroscopic anterior (anterolateral, anteromedial, superomedial) and posterior approaches (straight lateral, posterolateral, straight posterior) to the elbow and the surrounding neurovascular anatomy. Technical hints for elbow arthroscopy especially with relevance to the rheumatoid population are given.

Arthritis, Rheumatoid↗
PubMed2003

[Evidence-based antibiotic prophylaxis in aseptic orthopedic surgery].

Disagreement exists on the topic of antibiotic prophylaxis in aseptic orthopedic surgery. No evidence on the usefulness of prophylactic antibiotic administration exists with regard to non-complex aseptic surgeries without placement of osteosynthetic material. Likewise, no undisputed evidence exists on the usefulness of antibiotic prophylaxis with regard to aseptic orthopedic surgeries involving placement of osteosynthetic material. However, the majority of experts agree on antibiotic prophylaxis in the latter cases. In contrast clear evidence does exist regarding the usefulness of antibiotic prophylaxis with first- or second-generation cephalosporins for surgeries of the hip involving fracture treatment or prosthetic replacement. The prophylactic use of glycopeptides should be confined to cases of high MRSA or MRSE risk. Administration of prophylactic antibiotics should precede incision time by around 30 min and tourniquet inflation by at least 10 min. Antibiotic administration may be repeated in the OR when surgery lasts longer than 3 h. The use of local antibiotics in bone cement has not proven useful as a prophylactic measure.

Anti-Bacterial Agents↗
PubMed2003

[Drug therapy of rheumatoid arthritis].

Nowadays undisputed is the effectiveness of early and long-standing DMARD therapy in the presence of active rheumatoid arthritis on disease progression and avoidance of structural joint changes. "Early" is defined as immediate initiation of drug therapy after diagnosis of rheumatoid arthritis. "Long-term" refers to a mostly life-long therapy, which even in the case of remission should be continued for at least 1 year. Clinical and laboratory routine controls during DMARD therapy are absolutely necessary. "DMARDs" summarize disease-modifying antirheumatic drugs such as methotrexate, sulfasalazine, leflunomide, hydroxychloroquine, aurum but also the TNF-blockers infliximab and etanercept. In cases of disease remission with combination drug therapy, corticosteroids and NSAID should be discontinued in a timely manner ahead of DMARDs to ensure that the reduction of clinical symptoms is not steroid controlled. DMARD therapy should end at least 6 months prior to conception.

Anti-Inflammatory Agents↗
PubMed2003

[Postoperative pain therapy in orthopedics].

Postoperative pain management adheres to the principles of a three-step routine according to the WHO recommendations. This routine suggests the combination of a basic non-opioid (step I) with an opioid of low potency (step II) or high potency (step III). Non-opioids are routinely administered prior to an opioid. While i.v. application is the treatment of choice in the immediate postoperative course, a switch to oral pain medication is preferred as early as possible. With oral opioid therapy preference should be given to slow release drugs. Intramuscular application of pain medication has little place in postoperative pain management. In order to lower the need for systemic pain medication, postoperative pain management is supplemented by regional anesthesia administered pre- or intraoperatively. Requirement for pain medication beyond normal or increasing with postoperative time is suggestive of a postsurgical complication. Among the numerous drugs available for postoperative pain management, the physician is advised to confine his selection of pain medication to a limited number in order to gain superior knowledge of effects and side effects of the drugs administered.

Administration, Oral↗
PubMed2003

[Intra-articular injection. Substances and techniques].

Intra-articular injections are widely used in the treatment of joint pain and/or inflammation. Low costs, effectiveness, and safety are offered as possible reasons. The method remains controversial, as the evidence supporting the efficacy of these procedures has been poor. To evaluate intra-articular therapy, a meta-analysis of the efficacy of various agents injected intra-articularly was performed. Furthermore, indications and medications are discussed.

Adjuvants, Immunologic↗
PubMed2002

[Rehabilitation after anterior cruciate ligament reconstruction].

The "Frankfurt rehabilitation regimen" following anterior cruciate ligament reconstruction is presented. ACL rehabilitation is discussed in the light of knowledge on knee biomechanics and proprioception as well as clinical results of reconstruction. Special emphasis is given to exercise therapy.

Anterior Cruciate Ligament↗
PubMed2002

[The influence of rheumatoid and degenerative disease on hospital resources in the operative treatment of cervical spine instability].

The aim of this study was to compare perioperative diagnostic and therapeutic measures in the treatment of cervical spine instability in patients with rheumatoid arthritis or degenerative disease. Twenty patients (ten in each group) were evaluated and compared with regard to age, sex, surgery time, total operating room time, intensive care time, extent of physical therapy, nursing requirements, costs of medication and radiography. Rheumatoid arthritis patients required more resources with regard to surgery, nursing and rehabilitation than the patients with degenerative disease. Significant differences existed with regard to patient age (P=0.0005), surgery time (P=0.0021), total operating room time (P=0.0001), duration of intensive care (P=0.0005), nursing requirements (P=0.0000), costs of medication (P=0.0000), costs of radiography (P=0.0015) and the duration of hospitalisation (P=0.0115). The data suggest that it is necessary to distinguish patients with rheumatoid or degenerative cervical spine instability from an economic point of view, as the treatment of the rheumatoid cervical spine requires more resources.

Aged↗
PubMed2002

[Differences between rheumatoid and degenerative disease in total hip replacement].

The aim of this study was to compare total hip replacement (THR) in rheumatoid and osteoarthritic patients. Ten rheumatoid and ten osteoarthritic patients undergoing THR were compared with respect to preoperative diagnostics, operative therapy, nursing and rehabilitation. Statistically significant differences existed between the groups: In rheumatoid patients, radiographic diagnostics were more extensive ( P=0.0021), surgery time was extended ( P=0.0355), referrals to non-orthopedic subspecialties were more frequent ( P=0.0524) and rehabilitation was more extensive ( P=0.0000). The groups were not significantly different with respect to the duration of hospitalisation, preoperative hemoglobin, perioperative blood loss, transfusion requirements, duration of intensive care and nursing requirements. THR in the rheumatoid population required additional resources during inpatient therapy in comparison to THR in osteoarthritic patients.

Adult↗
PubMed2002

[A comparison of total knee replacement in patients with rheumatoid arthritis and those with degenerative arthritis].

This article aims at determining the differences in resources needed for the treatment of patients with rheumatoid arthritis as opposed to osteoarthritis. Data on ten patients for each of these diagnoses, all of whom had been subject to the implantation of a knee arthroplasty,were compared. We looked at parameters such as the duration of surgery, further diagnoses, costs of radiological measures and medical treatment, simultaneous operations, need of nursing care,physical and occupational therapy and complications. Patients presenting with rheumatoid arthritis in many respects required substantially more clinical and/or financial resources than osteoarthritis patients. This statement holds true at least for the period of hospital care during which the knee-prosthesis was implanted.

Arthritis, Rheumatoid↗
PubMed2001

[Atlanto-axial kyphosis].

Atlantoaxial kyphosis (AAK) is a rare sagittal deformity of the occiptoatlantoaxial junction. It is defined as a subgroup of anterior translatory atlantoaxial instability. AAK is a symptom of several ligamentours or bony disorders of the craniocervical junction; however, rheumatoid arthritis and trauma are the most common causes for AAK. AAK can be diagnosed on lateral radiographic views of the upper cervical spine if the angle between McGregor's line and the atlas plane is less than-15 degrees or the atlas-axis angle is greater 105 degrees. Treatment modalities for AAK depend on the ability to reduce the deformity. If closed reduction is achieved, posterior atlantoaxial fusion by sublaminar wiring according to Brooks or transarticular screw fixation according to Magerl are possible choices. Irreducible AAK can be treated with a combined transoral decompression, anterior plating according to Harms, and posterior wiring according to Brooks. This staged therapy for AAK was successful in our rheumatoid patient population with AAK.

Atlanto-Axial Joint↗