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INTRODUCTION: Standard straight stems have been recognized as a gold standard implant in the field of hip replacement surgery. However, lately uncemented bone-preserving short stems started to gain more and more popularity. This was reflected in the increasing variety of available models. Up till now, short and mid-term results are available. PATIENTS AND METHODS: In 2002, the cementless short stemmed GHEs was introduced. 380 patients were included in our study between 2002 and 2008. Only GHEs short stems were implanted. The clinical and radiological evaluations were performed in the Orthopaedic Department, Leipzig University Hospitals, on the average of 24 months (3 to 60 months) postoperatively. RESULTS: 365 primary implantations and 15 revision implantations were carried out. Average age 60 years. Favourable clinical and radiological outcome was seen in 361/380 patients (95%). Postoperative complications were seen in 19/380 patients (5%): 8 fissures/fractures (2.1%), 5 infections (1.3%), 4 aseptic loosenings (1.1%), 2 dislocations (0.5%). CONCLUSIONS: Short stem implants, including our own experience with GHEs model, are satisfying and promising. They represent a valuable supplementation of the treatment modalities in hip replacement surgery. However, long term results are still awaited.

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Short-stemmed endoprostheses in total hip arthroplasty are anchored exclusively in the metaphysis and the proximal part of the diaphysis. Therefore, they are much shorter than the classic standard stems. These implants are specially favourable in terms of eventual revision surgery, and also due to the fact that with close diaphyseal bone marrow spaces a sufficient proximal size dimensioning is possible. In this study, the best known short-stemmed systems in clinical use are introduced. Positive long-term results are so far available only with the Pipino and Mayo stems, short and partially medium-term experience with the remaining short stems (C.F.P.(R), Metha, PROXIMA, ESKA) are--with the available learning curve--encouraging. Despite the call for sufficient experience and scientific evaluation, short-stemmed endoprostheses already represent a valuable alternative in endoprosthetics for younger patients.

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Over the last 15 years, interbody metal implants have become commonly used worldwide for lumbar interbody fusion. The so called "cages" are made of metal or absorbable materials. By using different surgical techniques, they can be implanted either regularly or via endoscopy. The published results on surgical techniques using cages for the lumbar spine show, in most cases and with or without additional instrumentation, rates of fusion of more than 90%. It seems that the use of osteoinductive substances (especially BMP) leads to even better results. Dorsoventral fusion with internal fixation and bone show the same rate of consolidation, but the advantages of cages are primarily in the maintenance of the distraction and the possibility of a single surgical procedure without additional instrumentation (including endoscopy), and in a lower donor side morbidity.

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Various operative techniques are available for the treatment of lumbar disc herniation. The conventional lumbar discotomy is currently considered to be the standard procedure. Several large statistical studies have shown that the results in the majority of cases are very good and the complication rate is low if it is carried out correctly. A particular advantage of this technique is that almost all indications can be handled with a procedure that can be extended if necessary. Despite the availability of newer refined techniques (microdiscectomy or percutaneous procedures), the open lumbar discotomy still has an outstanding role in the management of lumbar disc herniation. Failure results more frequently from false indications or inadequate preoperative planning and less from technical variations.

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Injuries of M. biceps brachii are rare, in most cases (greater than 90%) the long tendon is involved, seldom the distal tendon. The long tendon usually ruptures in the sulcus intertubercularis, preexisting degenerative changes play an important role. The distal tendon most often ruptures traumatically at its radial insertion. Injuries of the short tendon do not require operative treatment, whereas complete ruptures of the venter of the muscle and of the distal tendon have to be operated on, in doing so the distal tendon should be reinserted at the radius. Ruptures of the long tendon may be treated conservatively, operation is indicated in young and active patients with painful functional lesion. In these cases proximal refixation under good tension should be realized. In accordance with bibliographical data our case material (11 operations) shows satisfying results in about 75%, though persistent pain or some functional lesion following operative treatment of ruptures of the long tendon has been observed in half of the patients. Finally general conclusions concerning indication and methods of operative treatment are made.

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In this paper a review is given first on the various techniques in the operative treatment of the idiopathic necrosis of the femoral head in the adult. Because of the high rate of pseudarthrosis (50%) arthrodesis is rarely done today. Decompression of the medullary space is highly successful in 80-90%, but only in stage I and II. For stage III of the disease different osteotomies of the proximal femur are recommended. Artificial joint replacement is usually done in stage IV. Our case material consists of 46 operations in 37 patients (27 endoprostheses, 16 osteotomies of the proximal femur, 3 fillings with spongiosa), artificial joint replacement was always done in stage IV, the other operations in stage III of the disease. The clinical results are better than the radiological ones; in 50% of the intertrochanteric osteotomies necrosis was progressive within 4 years after operation, in 1/3 of the endoprostheses radiological loosening and periarticular calcification developed within the same period. In consideration of the unfavorable radiological findings in our case material we are going to initiate functional examination of the femoral head, because this might lead to earlier diagnosis and because central decompression of the medullary space - which is combined with this procedure - brings about a healing quotient of 80-90% in stage I and II (Arlet und Ficat, 1968; Ficat, 1983).

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With the decrease of tuberculous spondylitis non-specific bacterial spondylitis has got more importance. Regarding the difficult differential diagnosis between non-specific spondylitis, tuberculous spondylitis and tumor the question arises about the role of primary surgical procedure. 32 cases of the orthopedic departments of Brno and Lübeck are demonstrated, in whom surgical intervention has been chosen without exception (exposure with or without spondylodesis). In 19 cases the bacteriological and in all cases the histological findings ensured the diagnosis "non-specific bacterial spondylitis". Diagnostic proceedings corresponded to the descriptions in literature, x-rays (incl. tomograms) and scintigraphy had superior importance, CT had to show the expansion of the inflammatory process into the vertebral canal. Concerning diagnosis, course of disease and duration of therapy blood sedimentation rate and leucocyte count were the dominant parameters. Time of bed-rest and corset-wearing depends on clinical and laboratory findings, antibiotic treatment should be continued until mobilisation and normalisation of clinical and laboratory findings. In one case we had a grave complication during the operation (lesion of v. iliaca), apart from this healing up occurred in all cases within one year, in the course of which radiological stabilisation followed normalisation of clinical and laboratory parameters.

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Fèvre-Languepin syndrome is a rare congenital malformation syndrome characterized in particular by the presence of a labio-maxillo-palatal cleft, anomalies of the reproductive organs and a bilateral popliteal pterygium. Findings in a boy who is now four years old are reported. As a result of 14 operations, as well as other therapy, a cosmetically and functionally satisfactory result has been achieved. The principal orthopedic surgical procedures and the postoperative management are described.

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At the orthopedic clinic of Lübeck College of Medicine surgical treatment of disorders of the metatarsophalangeal joint of the big toe has, since 1975, included arthrodesis of this joint using a small bone chip. In the light of experience gathered in 150 arthrodeses performed to date, this paper aims to point out major considerations in surgical technique and postoperative treatment; keeping these in mind should help to prevent unsatisfactory courses and optimize results.

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