Herniated intervertebral disc causes in a great number of cases of lumbar nerve root compression, especially in the segment L5/S1. Other reasons responsible for stress to the lumbar spinal root are the spinal canal stenosis and the postdiscotomy syndrome. For patients without neurological deficiencies, the conservative treatment includes different epidural injection techniques. Steroids are often applied. A specific injection technique needing only a small drug amount is the epidural perineural approach using a special two-needle technique. The anatomical spaces of the nerve roots have received little attention in therapy. We have determined the anterolateral epidural space nerve volume of the nerve root L5/S1, and compared the data collected in an anatomical study with operative measurements during discectomy. The volume determination in the human cadavers was performed with liquid silicone filling the anterolateral space after dissection. The in vivo measurements were performed during surgery at the site of the anterolateral space after discectomy. The anatomical studies showed us a mean value volume of 1.1 ml. The surgical volume determinations result in a mean volume of 0.9 ml. A better understanding of the anterolateral epidural space may allow a reduction of the injection volume in the conservative nerve root compression treatment, especially using the epidural perineural technique, avoiding the risk of side effects of high doses of steroids.

Background Heterotopic ossifications (HO) are a common complication after total hip arthroplasty (THA). Nonsteroidal anti-inflammatory drugs have proven to reduce the occurrence of HO. It is still unclear when the formation of HO is finished. Aim of our study was to answer this question. Methods In a prospective study, the occurrence of periarticular HO was checked during the follow-up (FU) examinations. In total, 75 consecutive patients who underwent THA were included. To ensure a high follow-up rate, only patients with a life expectancy of at least 10 years were included. A medical ossification prophylaxis with mostly etoricoxib (90 mg once daily) was administered. Follow-up examinations were performed at 3 months, 1 year, 3, 5, and 10 years postoperatively. Each time, a clinical and radiological examination was carried out. The HO was graded according to Brooker’s method. Results Low-grade HO classified by Brooker grade I and II occurred significantly more frequent than HO grade III. In patients with present HO, a possible increase in Brooker stage could further be observed within 3 years postoperatively. After 3 years, the formation of HO was completed in all patients. Conclusion Three years after THA, the formation of HO is complete. After more than 3 years postoperatively, if HO occurs or increases, other triggering causes such as new trauma, periarticular infection, or implant loosening should be considered.

Background Heterotopic ossifications are a common complication after total hip arthroplasty. Low-dose radiation therapy and non-steroidal anti-inflammatory drugs have proven to effectively reduce the rate of heterotopic ossification after total hip arthroplasty. However, a low number of studies describe an equal efficiency of etoricoxib. This work shows first results on the examination of a larger group with 194 subjects to analyze efficiency and rate of side effects under treatment with etoricoxib. Methods Clinical examinations were performed the day before surgery and after at least 12 months. The survey of clinical and functional outcome was done with Harris Hip Score (HHS). Conventional antero-posterior radiographs and second plane in frog leg position were assessed. Results In total, 14 undesirable side effects (7.4%) and only four early terminations of therapy (2.1%) were documented. A complete 1-year follow-up examination including radiographs could be done in 143 subjects (79.4%). Only 28 subjects (19.6%) developed heterotopic ossifications from which 92.9% were classified in type 1 and 7.1% in type 2 using the method described by Brooker. The results do not show correlations with body mass index, extended treatment (more than ten days), or clinical and functional outcome (measured by “Harris Hip Score”). However, male subjects show a significantly higher rate of heterotopic ossifications. Conclusions The investigations presented in this study confirm a good efficiency of etoricoxib for the prevention of heterotopic ossifications in comparison with classical methods such as radiation or drug therapy and show a low rate of undesirable side effects.

BackgroundImplantation of total knee arthroplasty (TKA) is one of the most common operations in orthopedics. However, about 20% of all patients are not satisfied with the result after TKA. Thus, persistent postoperative limitation of range of motion, for instance in the context of arthrofibrosis is with approximately 10% one of the most frequent complications after TKA and, thus, one of the most reasons for an operative revision or a worse postoperative outcome. Some potential therapeutic strategies are described in recent literature including patient-related risk factors and models for the pathogenesis of arthrofibrosis. The weighting of individual risk factors is currently not fully understood. MethodsIn the present study, a retrospective analysis of patient data was performed using a literature-based questionnaire in 72 patients following mobilization under anesthesia due to persistent limitation of range of motion (ROM) after TKA. An existing internal data set of 72 patients without restriction of ROM after TKA was used as a control-population. The study-group was invited to a follow-up examination to assess long-term outcome by several scores “Knee osteoarthritis outcome score” (KOOS) and “Knee society score” (KSS). In addition, patient expectation and satisfaction were evaluated according to the New KSS. ResultsIn total, 144 patients were included in the retrospective analysis. Person-related risk factors described in the literature, such as gender or secondary diseases (diabetes mellitus, rheumatoid arthritis, or psychiatric diseases) could not be confirmed as risk factors in our population. There was a statistically significant difference in pre- and postoperative range of motion. The study-group showed a essentially higher preoperative flexion deficit and developed a lower postoperative range of motion in both extension and flexion deficits. Significant differences were found with respect to previous surgeries and duration of surgery. The study-population showed an increased number of previous operations, especially arthroscopic surgeries of the knee joint, as well as a prolonged operation time exceeding 90 minutes. Preoperative patient expectations were not fulfilled on average, despite this, patient satisfaction was still high in the long term examination. ConclusionsWe determined risk factors for our population. For example, the preoperative range of motion, previous operations, and the duration of surgery were relevant factors that were closely related to the postoperative outcome of our study-population. However, due to the retrospective study design, these results are limited. In order to perform an exact evaluation of the risk factors mentioned above, we would recommend to supplement a prospective investigation with regard to these aspects. In the follow-up examination, we furthermore could confirm the significant impact of patient expectation on outcome after TKA as described in the literature.