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S Kirschner

Publications and source records attributed to S Kirschner.

At least 37 records · Page 2Linked to original sources
PubMed2003

[Long-term results in total knee arthroplasty].

The number of total knee arthroplasties performed per year has increased steadily. This increase will probably continue since the principal risk factors obesity and advanced age will increase as well. The results of total knee arthroplasty are influenced by many physical, psychological, and social factors, which are presented. These factors have not been taken into account sufficiently by most of the investigations performed so far. Therefore, very few long-term data on the quality of life and functional gain are available. Survival analyses of single centers exhibit serious methodological flaws and a simplified data presentation, which reduces the generalizability of these results considerably. A critical analysis of these results was performed. Total knee arthroplasty has positive effects on the patient's pain level, ability to walk, and quality of life. There are a number of reliable uni- and tricompartmental designs. The revision rate is influenced by age, sex, disease, fixation mode, and prosthetic design. Tricompartmental prostheses have a revision rate of about 7% after 10 years. The revision rate has continuously improved over the last decades. Studies on total knee arthroplasty can be improved considerably according to international standards in terms of methodology and presentation of the results. The results from the patient's perspective need to be taken more into account.

Aged↗
PubMed2003

[Reliability, validity and responsiveness of the German short musculoskeletal function assessment questionnaire (SMFA-D) in patients with osteoarthritis of the hip undergoing total hip arthroplasty].

BACKGROUND: The aim of the present study was to check for reliability, validity and responsiveness of the Musculoskeletal Function Assessment questionnaire (SMFA-D) in patients with coxarthrosis undergoing total hip replacement. PATIENTS AND METHOD: In a prospective clinical trial the SMFA-D, the SF-36, the Harris Hip score, test of walking speed and the functional impairment according to the physician assessment were recorded. RESULTS: The reliability of the instrument could be demonstrated by a correlation coefficient of r = 0.78 for the function index and r = 0.84 for the bother index. Patients could be distinguished by the physician's assessment to show discriminative validity. Both indices correlated significantly with the Harris Hip score, scales of the SF-36 and the walking speed supporting the construct validity. The responsiveness could be shown with large effect sizes (1.04 for the function index and 1.02 for the bother index) at the three-month follow-up. CONCLUSIONS: The SMFA-D was found to be a reliable, valid and responsive instrument in patients with coxarthrosis undergoing hip replacement and the use of this instrument can be recommended.

Activities of Daily Living↗
PubMed2002

German short musculoskeletal function assessment questionnaire (SMFA-D): comparison with the SF-36 and WOMAC in a prospective evaluation in patients with primary osteoarthritis undergoing total knee arthroplasty.

In a prospective clinical trial, the German short musculoskeletal function assessment (SMFA-D), the short form (SF)-36, and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) were evaluated in 63 patients with primary osteoarthritis undergoing total knee arthroplasty. All instruments were sensitive to change, demonstrating the effect of total knee arthroplasty at 1-year follow-up. The SMFA-D effect sizes in comparable scales were bigger than in the SF-36 and similar to those of the WOMAC. Significant correlations of the SMFA-D indices with the SF-36 and WOMAC scales preoperatively could be shown. After 1-year follow-up, all correlations between the SMFA-D indices and SF-36 scales were significant. In other comparison, only the correlation between the SMFA-D function index and the WOMAC function scales remained significant. The correlation of the SMFA-D function index with external validation criteria was higher than that using the other instruments. We recommend the SMFA-D for assessing change in functional status of patients with primary osteoarthritis of the knee following arthroplasty.

Arthroplasty, Replacement, Knee↗
PubMed2001

[Atraumatic locked posterior-inferior shoulder luxation in a child].

We report a rare case of recurrent atraumatic posterior-inferior dislocation of the shoulder in an eight year old girl. After closed reduction of the locked dislocation and conservative treatment three further dislocations occurred. Because of the recurrence of locked dislocations and functional impairment arthroscopy including partial synovectomy was performed. Postoperative rehabilitation included the use of a brace in handshake position for six weeks and strengthening exercises. Within a clinical followup of 24 months the shoulder remained stable without loss of function but atraumatic posterior-inferior dislocation of the contralateral shoulder occured. The bilateral involvement indicates a predisposing factor, predominantly gross capsular laxity, of this rare form of instability.

Arthroscopy↗
PubMed2000

Results of posterior cruciate-retaining unconstrained total knee arthroplasty after proximal tibial osteotomy for osteoarthritis. A prospective cohort study.

The purpose of the study was to investigate the results of posterior cruciate ligament (PCL)-retaining total knee arthroplasty (TKA) after previous proximal closed wedge tibial osteotomy for degenerative arthritis according to the technique recommended by Coventry and Insall. Thirty-five patients with previous proximal tibial osteotomy were matched to 35 patients without previous osteotomy according to age, sex, and Knee Society patient category. TKA after osteotomy was technically more difficult, often requiring a more extensive exposure. Complications were similar in the two groups, but an extended hematoma was more common in patients with previous osteotomies (2 patients) than in those with primary arthroplasty (1 patient). Knee Society scores were significantly lower in those with previous osteotomy, primarily because of decreased anteroposterior stability and pain. No significant differences were found in function scores, range of motion, or alignment. However, overall results of this PCL-retaining unconstrained TKA did not match those reported after PCL-substituting TKA.

Adult↗
PubMed2000

Balance sheets of knee and functional scores 5 years after total knee arthroplasty for osteoarthritis: a source for patient information.

To improve patient information on the results of total knee arthroplasty (TKA) for osteoarthritis, 253 primary TKAs of a prospective study with a mean follow-up of 5.3 years were analyzed. The increase or decrease of the individual variables of the Knee Society knee and function score and the percentage of operated knees in which these variables increased were determined. Improvement in pain rating had the largest increase of all variables, contributing 60% to the knee score increase. Pain improved in 95% of the knees. Alignment improved in about 90% of knees and accounted for 25% of knee score increase. Improvement in level walking contributed more to increase of function score than better stair-climbing abilities. Level walking improved in 80% of knees and stair climbing in 55%. Pain is the most rewarding indication for TKA, followed by deformity and poor walking ability. Key words: total knee arthroplasty, knee score, functional score, patient information.

Aged↗
PubMed1998

Hybrid total knee arthroplasty.

A prospective study of a hybrid total knee arthroplasty (TKA) with an uncemented femoral component and cemented tibial and patellar components was performed to combine the advantage of a press-fit femur while avoiding the problems in uncemented tibial and patellar implants. A total of 329 posterior cruciate-preserving TKA were studied at an average of 4.7 years after surgery: 84% of the knees had at most mild or occasional pain, 68% had good or excellent knee scores, and 62% could walk more than 1000 m. The function scores were 40% good or excellent in this collective, with an average age of 69.4 years at surgery. The component position and alignment were biomechanically correct. Radiolucent lines were observed regularly at the edges of the tibial and femoral components. There were no revisions for aseptic loosening. Hybrid TKA provides good results comparable to cemented TKA.

Aged↗
PubMed1996

The value of one.

Explore the source record for details and available documents.

Financial Management, Hospital↗
PubMed1988

Varicella pancreatitis complicated by pancreatic pseudocyst and duodenal obstruction.

Several viral infections, including mumps, coxsackie B, and infectious mononucleosis, have been associated with acute pancreatitis; however, varicella infection has not previously been associated with this complication. A 29-year-old man was admitted to the hospital with severe abdominal pain and hyperamylasemia several days following the onset of a characteristic varicella skin rash. His son had been diagnosed with varicella one week earlier. The hospital course was complicated by the development of pseudocysts in the head and tail of the pancreas which caused partial obstruction of the common bile duct and duodenum. The pancreatitis, pseudocysts, and duodenal obstruction resolved with conservative medical management. This is the first report of acute pancreatitis associated with varicella infection.

Acute Disease↗
PubMed1978

Heroin addiction as a family phenomenon: a new conceptual model.

The chronic relapsing nature of heroin addiction can be explained from a family systems viewpoint. The addiction cycle is part of a family pattern involving a complex homeostatic system of interlocking feedback mechanisms. These serve to maintain the addiction and consequently the overall family stability. Drug-taking usually starts at adolescence. It is related to an intense fear of separation experienced by the family in response to the addict's attempts at individuation. The family becomes stuck at a particular developmental stage. Heroin provides a solution at several levels to the dilemma of whether or not to allow him independence. Paradoxically, it permits him to simultaneously be both close and distant, "in" and "out", competent and incompetent, relative to his family of origin. This is pseudoindividuation. An understanding of these concepts, and their integration into a homeostatic model, can provide the basis for effective treatment.

Adolescent↗
PubMedDate not supplied

[I. Cultural adaptation, practicability and reliability evaluation of the Musculoskeletal Functional Assessment Questionnaire].

INTRODUCTION: The patient-based evaluation of outcome is gaining increased importance. The aim of the study was to translate and culturally adapt the short musculoskeletal function assessment questionnaire (SMFA) into German and to evaluate the practicability, metric properties, and distribution characteristics of the German version (SMFA-D). METHODS: The SMFA is a questionnaire on the functional status of the musculoskeletal system of patients consisting of a function index (34 items) and bother index (12 items) with a 5-point response format. The SMFA was independently translated by orthopaedic-trained, qualified German- and English-speaking translators. A consensus committee review and selection of an optimally comprehensible German version was performed. Patients checked this version for comprehensibility and time to complete the questionnaire. 40 fluently German-speaking patients with primary osteoarthritis of the knee completed the SMFA-D twice at a one week interval. The test-retest reliability and internal consistency were evaluated. The values are standardized on an scale from 0-100. High values indicate a poor function. RESULTS: The SMFA-D is comprehensible and can be completed within 20 minutes in the mean. There were no skewness and no floor or ceiling effects. The mean function index was 47 (SD 17, range 16-80). The mean bother index was 44 (SD 19, range 5-75). Test-retest reliability were 0.88 (function index) and 0.71 (bother index), respectively. Internal consistency (Cronbach's alpha) was 0.92 (function index) and 0.88 (bother index), respectively. CONCLUSIONS: The SMFA-D is a practical and reliable questionnaire for patient-based evaluation of functional problems of the musculoskeletal system.

Aged↗
PubMedDate not supplied

[II. Validity and sensitivity to change of the Musculoskeletal Functional Assessment Questionnaire in primary gonarthrosis and total endoprosthetic joint replacement].

INTRODUCTION: Scoring systems used so far in total knee arthroplasty are limited by their non-fulfillment of basic test criteria. The aim of the study was to demonstrate the validity and responsiveness of a German version of the new short musculoskeletal function assessment questionnaire (SMFA-D) in patients with primary osteoarthritis and total knee arthroplasty. METHODS: 66 patients with a tricompartmental cemented PFC-Sigma total knee arthroplasty completed the SMFA-D and the WOMAC questionnaire preoperatively and at 12 to 16 weeks follow-up. Preoperatively, physicians' rating of function of the leg, patients' self-selected walking speed, pain and arthritis severity score were registered for demonstration of criterion validity. Construct validity was evaluated with the WOMAC. Discriminant validity was assessed by comparing patients with or without previous surgery at the knee, use of pain medication and use of walking aids. The function and bother indexes of the SMFA-D were correlated with these parameters. Standardized response means were calculated. RESULTS: The function index correlated with physicians' rating (r = 0.51), walking speed (r = 0.61), pain (r = 0.36) and the arthritis severity index (r = 0.36). The bother index correlated with pain (r = 0.37) and the arthritis severity index (r = 0.25). The function and bother index correlated with the WOMAC (r = 0.77) and (r = 0.81), respectively. Patient groups with or without walking aids (p = 0.02) and with or without pain medication (p = 0.001) differed in the function index. The bother index of patients with or without pain medication (p < 0.001) and with or without walking aids (p < 0.006) differed. Function and bother index improved from 46 (SD 17) to 34 (SD 19, p < 0.001) and 43 (SD 18) to 33 (SD 22 p < 0.001), respectively. The standardized response mean was 0.86 for the function index and 0.53 for the bother index. CONCLUSIONS: The SMFA-D questionnaire is valid and responsive in patients with primary osteoarthritis of the knee and total knee arthroplasty. It measures function and bother from the perspective of these patients.

Aged↗
PubMedDate not supplied

[The role of MRI in therapy and follow-up after surgical treatment of osteochondrosis dissecans of the talus].

AIM: Our study was designed to evaluate the use of magnetic resonance imaging (MRI) in the follow-up of surgically treated osteochondrosis dissecans (OCD) of the talus. METHOD: We investigated 16 patients (18 joints) with OCD of the talus, surgically treated in our department between 1990 and 1997. All of them had preoperative MRI scans of the affected ankle. The mean follow-up was 40 months (8-82). All patients were evaluated by clinical examination, plain radiography and MRI using a standard protocol. RESULTS: The clinical Bray score improved significantly from 58 preoperative to 82 postoperative. Using a visual analogue scale we saw a significant reduction of the patients pain level post-op. In 72% of the patients the preoperative MRI was able to predict the accurate stage of the cartilage. Postoperative MRI showed no more lesion in 3, intact articular cartilage in 11, and disrupted cartilage in 4 joints. There was no correlation between clinical, plain radiographical, and MRI findings postoperative. CONCLUSION: Arthroscopy remains the golden standard in evaluating articular cartilage. Using our data, MRI is not the method of choice in the follow-up of surgically treated OCD lesions of the talus. Postoperative use of intravenous contrast media gave no additional information. Postoperative MRI should be reserved only for symptomatic patients to gather additional information about the actual state of the OCD. Afterwards a prompt arthroscopy of the symptomatic ankle should be performed.

Adolescent↗
PubMedDate not supplied

[Clinical and radiological short- and mid-term results of triple pelvic osteotomy according to Tönnis in adolescents and adults].

AIM: We report our clinical and radiological results after triple pelvic osteotomy according to Tönnis and accompanying femoral osteotomies in selected cases. METHOD: 48 patients were evaluated in a retrospective study with an average follow-up to 2 years and 9 months. RESULTS: In 68 % of our patients excellent to good results in the Harris Hip Score were achieved. We could significantly decrease pain awareness. The CE angle improved significantly from 10.6 degrees to 32.2 degrees and the acetabular angle of the weight-bearing zone according to Bombelli from 20.8 degrees to 3.8 degrees at the last follow-up. The VCA angle according to Lequesne and de Seze improved from 18.6 degrees to 33.5 degrees. Non-union of the ischial or the pubic bone developed in 7 cases as a relevant complication. CONCLUSION: On the basis of our results and the literature, the triple pelvic osteotomy according to Tönnis can be recommended for the treatment of acetabular dysplasia in adolescents and adults.

Acetabulum↗