nach oben

Archives of Orthopaedic and Trauma Surgery

Erschienen in:

09.04.2017 | Orthopaedic Surgery

Why does total elbow arthroplasty fail today? A systematic review of recent literature

verfasst von: Ante Prkic, Chantal Welsink, Bertram The, Michel P. J. van den Bekerom, Denise Eygendaal

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 6/2017

Einloggen, um Zugang zu erhalten

Abstract

Background

Total elbow arthroplasty is a relatively uncommon type of arthroplasty, which has undergone several design changes in the past four decades. However, research on improvement requires knowledge of failure mechanisms that can be addressed. Therefore, we conducted a systematic review on modes of failure of total elbow arthroplasty.

Methods

We conducted searches on PubMed/Medline, Embase and Cochrane databases to identify studies describing modes of failure of primary total elbow arthroplasties. The results were coupled per type of total elbow arthroplasty and individual arthroplasty models.

Results

A total of 70 articles were included in this systematic review. 9308 individual total elbow arthroplasties were identified with 1253 revisions (13.5%). Aseptic loosening was the most prevalent reason for revision (38%), followed by deep infection (19%) and periprosthetic fractures (12%).

Conclusion

Revision rates have been found similar to a systematic review published in 2003. The revision percentage of total elbow arthroplasty for rheumatoid arthritis is significantly higher than for trauma and post-traumatic osteoarthritis. Aseptic loosening was seen less in linked implants. Infections and periprosthetic fractures did not differ between linkage design groups. Aseptic loosening remains the most frequent cause for revision of primary total elbow arthroplasty. Therefore, more research on the occurrence, progression and risk factors of aseptic loosening should be performed and lead to higher implant survival.

Wadsworth TG (2008) Surgery of arthritis. Churchill Livingstone, London, UK

Little CP, Graham AJ, Karatzas G et al (2005) Outcomes of total elbow arthroplasty for rheumatoid arthritis: comparative study of three implants. J Bone Jt Surg Am 87:2439–2448. doi:10.2106/jbjs.d.02927

Prkic A, van Bergen CJA, The B, Eygendaal D (2016) Total elbow arthroplasty is moving forward: review on past, present and future. World J Orthop 7:44. doi:10.5312/wjo.v7.i1.44 CrossRefPubMedPubMedCentral

Jenkins PJ, Watts AC, Norwood T et al (2013) Total elbow replacement: outcome of 1146 arthroplasties from the Scottish Arthroplasty Project. Acta Orthop 84:119–123. doi:10.3109/17453674.2013.784658 CrossRefPubMedPubMedCentral

Triplet JJ, Kurowicki J, Momoh E et al (2016) Trends in total elbow arthroplasty in the Medicare population: a nationwide study of records from 2005 to 2012. J Shoulder Elb Surg 25:1848–1853. doi:10.1016/j.jse.2016.04.021 CrossRef

Mäkelä KT, Matilainen M, Pulkkinen P et al (2014) Countrywise results of total hip replacement. An analysis of 438,733 hips based on the Nordic Arthroplasty Register Association database. Acta Orthop 85:107–116. doi:10.3109/17453674.2014.893498 CrossRefPubMedPubMedCentral

Little CP, Graham J, Carr J (2005) Total elbow arthroplasty: a systematic review of the literature in the English language until the end of 2003. J Bone Jt Surg Br 87:437–444. doi:10.1302/0301-620X.87B4.15692 CrossRef

Fevang BTS, Lie S a., Havelin LI et al (2009) Results after 562 total elbow replacements: a report from the Norwegian Arthroplasty Register. J Shoulder Elb Surg 18:449–456. doi:10.1016/j.jse.2009.02.020 CrossRef

Skyttä ET, Eskelinen A, Paavolainen P et al (2009) Total elbow arthroplasty in rheumatoid arthritis: a population-based study from the Finnish Arthroplasty Register. Acta Orthop 80:472–477. doi:10.3109/17453670903110642 CrossRefPubMedPubMedCentral

10.

Plaschke HC, Thillemann TM, Brorson S, Olsen BS (2014) Implant survival after total elbow arthroplasty: a retrospective study of 324 procedures performed from 1980 to 2008. J Shoulder Elb Surg 23:829–836. doi:10.1016/j.jse.2014.02.001 CrossRef

11.

Krenek L, Farng E, Zingmond D, SooHoo NF (2011) Complication and revision rates following total elbow arthroplasty. J Hand Surg Am 36:68–73. doi:10.1016/j.jhsa.2010.09.036 CrossRefPubMed

12.

Ali A, Shahane S, Stanley D (2010) Total elbow arthroplasty for distal humeral fractures: Indications, surgical approach, technical tips, and outcome. J Shoulder Elb Surg 19:53–58. doi:10.1016/j.jse.2009.12.013 CrossRef

13.

Amirfeyz R, Blewitt N (2009) Mid-term outcome of GSB-III total elbow arthroplasty in patients with rheumatoid arthritis and patients with post-traumatic arthritis. Arch Orthop Trauma Surg 129:1505–1510. doi:10.1007/s00402-009-0876-y CrossRefPubMed

14.

Baghdadi YMK, Veillette CJH, Malone AA et al (2014) Total elbow arthroplasty in obese patients. J Bone Jt Surg Am 96:e70. doi:10.2106/JBJS.M.00364 CrossRef

15.

Baksi DP, Pal AK, Baksi D (2011) Prosthetic replacement of elbow for intercondylar fractures (recent or ununited) of humerus in the elderly. Int Orthop 35:1171–1177. doi:10.1007/s00264-010-1122-5 CrossRefPubMed

16.

Barthel PY, Mansat P, Sirveaux F et al (2014) Is total elbow arthroplasty indicated in the treatment of traumatic sequelae? 19 cases of Coonrad-Morrey? reviewed at a mean follow-up of 5.2 years. Orthop Traumatol Surg Res 100:113–118. doi:10.1016/j.otsr.2013.10.012 CrossRefPubMed

17.

Cesar M, Roussanne Y, Bonnel F et al (2007) GSB III total elbow replacement in rheumatoid arthritis Patients and Methods. J Bone Jt Surg [Br] 89:330–334. doi:10.1302/0301-620X.89B3 CrossRef

18.

Chalidis B, Dimitriou C, Papadopoulos P et al (2009) Total elbow arthroplasty for the treatment of insufficient distal humeral fractures. A retrospective clinical study and review of the literature. Injury 40:582–590. doi:10.1016/j.injury.2009.01.123 CrossRefPubMed

19.

Cross MB, Cicalese E, Nam D et al (2014) Results of custom-fit, noncemented, semiconstrained total elbow arthroplasty for inflammatory arthritis at an average of eighteen years of follow-up. J Shoulder Elb Surg 23:1368–1373. doi:10.1016/j.jse.2014.02.026 CrossRef

20.

Ducrot G, Ehlinger M, Adam P et al (2013) Complex fractures of the distal humerus in the elderly: Is primary total elbow arthroplasty a valid treatment alternative? A series of 20 cases. Orthop Traumatol Surg Res 99:10–20. doi:10.1016/j.otsr.2012.10.010 CrossRefPubMed

21.

Egol KA, Tsai P, Vazques O, Tejwani NC (2011) Comparison of functional outcomes of total elbow arthroplasty vs plate fixation for distal humerus fractures in osteoporotic elbows. Am J Orthop (Belle Mead NJ) 40:67–71

22.

Espiga X, Antuna S a, Ferreres a (2011) Linked total elbow arthroplasty as treatment of distal humerus nonunions in patients older than 70 years. Acta Orthop Belg 77:304–310PubMed

23.

Giannicola G, Scacchi M, Polimanti D, Cinotti G (2014) Discovery elbow system: 2- to 5-year results in distal humerus fractures and posttraumatic conditions: a prospective study on 24 patients. J Hand Surg Am 39:1746–1756. doi:10.1016/j.jhsa.2014.05.027 CrossRefPubMed

24.

Jensen CH, Jacobsen S, Ratchke M, Sonne-Holm S (2006) The GSB III elbow prosthesis in rheumatoid arthritis: a 2- to 9-year follow-up. Acta Orthop 77:143–148. doi:10.1080/17453670610045830 CrossRefPubMed

25.

Kelly EW, Coghlan J, Bell S (2004) Five- to thirteen-year follow-up of the GSB III total elbow arthroplasty. J Shoulder Elb Surg 13:434–440. doi:10.1016/j.jse.2004.01.028 CrossRef

26.

Kodde IF, Van Riet RP, Eygendaal D (2013) Semiconstrained total elbow arthroplasty for posttraumatic arthritis or deformities of the elbow: a prospective study. J Hand Surg Am 38:1377–1382. doi:10.1016/j.jhsa.2013.03.051 CrossRefPubMed

27.

Large R, Tambe A, Cresswell T et al (2014) Medium-term clinical results of a linked total elbow replacement system. Bone Jt J 96B:1359–1365. doi:10.1302/0301-620X.96B10.33815 CrossRef

28.

Lo CY, Lee KB, Wong CK, Chang YP (2003) Semi-constrained total elbow arthroplasty in Chinese rheumatoid patients. Hand Surg 8:187–192CrossRefPubMed

29.

Lee KT, Singh S, Lai CH (2005) Semi-constrained total elbow arthroplasty for the treatment of rheumatoid arthritis of the elbow. Singap Med J 46:718–722

30.

Maheshwari R, Vaziri S, Helm RH (2012) Total elbow replacement with the Coonrad-Morrey prosthesis: our medium to long-term results. Ann R Coll Surg Engl 94:189–192. doi:10.1308/003588412X13171221589775 CrossRefPubMedPubMedCentral

31.

Mansat P, Bonnevialle N, Rongières M et al (2013) Experience with the Coonrad-Morrey total elbow arthroplasty: 78 consecutive total elbow arthroplasties reviewed with an average 5 years of follow-up. J Shoulder Elb Surg 22:1461–1468. doi:10.1016/j.jse.2013.07.042 CrossRef

32.

McKee MD, Veillette CJH, Hall JA et al (2009) A multicenter, prospective, randomized, controlled trial of open reduction-internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients. J Shoulder Elb Surg 18:3–12. doi:10.1016/j.jse.2008.06.005 CrossRef

33.

Mighell MA, Dunham RC, Rommel EA, Frankle MA (2005) Primary semi-constrained arthroplasty for chronic fracture-dislocations of the elbow. J Bone Jt Surg Br 87:191–195. doi:10.1302/0301-620X.87B2.15130 CrossRef

34.

Park SE, Kim JY, Cho SW et al (2013) Complications and revision rate compared by type of total elbow arthroplasty. J Shoulder Elb Surg 22:1121–1127. doi:10.1016/j.jse.2013.03.003 CrossRef

35.

Patil N, Cheung EV, Mow CS (2009) High revision rate after total elbow arthroplasty with a linked semiconstrained device. Orthop May 32:5–10. doi:10.3928/01477447-20090501-11

36.

Prasad N, Dent C (2008) Outcome of total elbow replacement for distal humeral fractures in the elderly: a comparison of primary surgery and surgery after failed internal fixation or conservative treatment. J Bone Jt Surg Br 90:343–348. doi:10.1302/0301-620X.90B3.18971 CrossRef

37.

Schöni M, Drerup S, Angst F et al (2013) Long-term survival of GSB III elbow prostheses and risk factors for revisions. Arch Orthop Trauma Surg 133:1415–1424. doi:10.1007/s00402-013-1815-5 CrossRefPubMed

38.

Shi LL, Zurakowski D, Jones DG et al (2007) Semiconstrained primary and revision total elbow arthroplasty with use of the Coonrad-Morrey prosthesis. J Bone Jt Surg Am 89:1467–1475. doi:10.2106/JBJS.F.00715

39.

Szyluk K, Widuchowski W, Jasiński A et al (2013) Comparison of short- to medium-term results of Coonrad-Morrey elbow replacement in patients with rheumatoid arthritis versus patients after elbow injuries. Med Sci Monit 19:18–27. doi:10.12659/MSM.883725 CrossRefPubMedPubMedCentral

40.

Kiran M, Jariwala A, Wigderowitz C (2015) Medium term outcomes of primary and revision Coonrad-Morrey total elbow replacement. Indian J Orthop 49:233–238CrossRefPubMedPubMedCentral

41.

Baghdadi YMK, Jacobson JA, Duquin TR et al (2014) The outcome of total elbow arthroplasty in juvenile idiopathic arthritis (juvenile rheumatoid arthritis) patients. J Shoulder Elb Surg 23:1374–1380. doi:10.1016/j.jse.2014.03.012 CrossRef

42.

Antuña SA, Laakso RB, Barrera JL et al (2012) Linked total elbow arthroplasty as treatment of distal humerus fractures. Acta Orthop Belg 78:465–472PubMed

43.

Mukka S, Berg G, Hassany HRH et al (2015) Semiconstrained total elbow arthroplasty for rheumatoid arthritis patients: clinical and radiological results of 1–8 years follow-up. Arch Orthop Trauma Surg Arch für orthopädische und Unfall-Chirurgie 135:595–600. doi:10.1007/s00402-015-2191-0

44.

Sørensen BW, Brorson S, Olsen BS (2014) Primary total elbow arthroplasty in complex fractures of the distal humerus. World J Orthop 5:368–372. doi:10.5312/wjo.v5.i3.368 CrossRefPubMedPubMedCentral

45.

Bassi RS, Simmons D, Ali F et al (2007) Early results of the Acclaim elbow replacement. J Bone Jt Surg Br 89:486–489. doi:10.1302/0301-620X.89B4.18197 CrossRef

46.

Brinkman J-M, de Vos MJ, Eygendaal D (2007) Failure mechanisms in uncemented Kudo type 5 elbow prosthesis in patients with rheumatoid arthritis: 7 of 49 ulnar components revised because of loosening after 2–10 years. Acta Orthop 78:263–270. doi:10.1080/17453670710013780 CrossRefPubMed

47.

Dos Remedios C, Chantelot C, Giraud F et al (2005) Results with Kudo elbow prostheses in non-traumatic indications: a study of 36 cases. Acta Orthop Belg 71:273–288PubMed

48.

Ikävalko M, Tiihonen R, Skyttä ET, Belt E a (2010) Long-term survival of the Souter-Strathclyde total elbow replacement in patients with rheumatoid arthritis. J Bone Jt Surg Br 92:656–660. doi:10.1302/0301-620X.92B5.22613 CrossRef

49.

Ikävalko M, Belt E a, Kautiainen H, Lehto MU (2004) Souter arthroplasty for elbows with severe destruction. Clin Orthop Relat Res 421:126–133. doi:10.1097/01.blo.0000126339.83964.55 CrossRef

50.

Kalogrianitis S, Sinopidis C, El Meligy M et al (2008) Unlinked elbow arthroplasty as primary treatment for fractures of the distal humerus. J Shoulder Elb Surg 17:287–292. doi:10.1016/j.jse.2007.06.011 CrossRef

51.

Khatri M, Stirrat a N (2005) Souter-Strathclyde total elbow arthroplasty in rheumatoid arthritis: medium-term results. J Bone Jt Surg Br 87:950–954. doi:10.1302/0301-620X.87B7.15588 CrossRef

52.

Kleinlugtenbelt Ij V, Bakx PAGM, Huij J (2010) Instrumented bone preserving elbow prosthesis in rheumatoid arthritis: 2–8 year follow-up. J Shoulder Elb Surg 19:923–928. doi:10.1016/j.jse.2010.05.003 CrossRef

53.

Landor I, Vavrik P, Jahoda D et al (2006) Total elbow replacement with the Souter- Strathclyde prosthesis in rheumatoid arthritis LONG-TERM FOLLOW-UP. J Bone Jt Surg [Br] 88:1460–1463. doi:10.1302/0301-620X.88B11 CrossRef

54.

Malone AA, Taylor AJN, Fyfe IS (2004) Successful outcome of the Souter-Strathclyde elbow arthroplasty. J Shoulder Elb Surg 13:548–554. doi:10.1016/j.jse.2004.02.015 CrossRef

55.

Mori T, Kudo H, Iwano K, Juji T (2006) Kudo type-5 total elbow arthroplasty in mutilating rheumatoid arthritis: a 5- to 11-year follow-up. J Bone Jt Surg Br 88:920–924. doi:10.1302/0301-620X.88B7.17356 CrossRef

56.

Nishida K, Hashizume K, Nasu Y et al (2014) A 5-22-year follow-up study of stemmed alumina ceramic total elbow arthroplasties with cement fixation for patients with rheumatoid arthritis. J Orthop Sci 19:55–63. doi:10.1007/s00776-013-0492-0 CrossRefPubMed

57.

Qureshi F, Draviaraj KP, Stanley D (2010) The Kudo 5 total elbow replacement in the treatment of the rheumatoid elbow: results at a minimum of ten years. J Bone Jt Surg Br 92:1416–1421. doi:10.1302/0301-620X.92B10.22476 CrossRef

58.

Rauhaniemi J, Tiusanen H, Kyro A (2006) Kudo total elbow arthroplasty in rheumatoid arthritis. Clinical and radiological results. J Hand Surg Br 31:162–167. doi:10.1016/j.jhsb.2005.07.010 CrossRefPubMed

59.

Samijo SK, Van Den Berg ME, Verburg AD, Tonino AJ (2003) Souter-Strathclyde total elbow arthroplasty: medium-term results. Acta Orthop Belg 69:501–506PubMed

60.

Tachihara A, Nakamura H, Yoshioka T et al (2008) Postoperative results and complications of total elbow arthroplasty in patients with rheumatoid arthritis: three types of nonconstrained arthroplasty. Mod Rheumatol 18:465–471. doi:10.1007/s10165-008-0082-8 CrossRefPubMed

61.

Talwalkar SC, Givissis PK, Trail I a et al (2005) Survivorship of the Souter-Strathclyde elbow replacement in the young inflammatory arthritis elbow. J Bone Jt Surg Br 87:946–949. doi:10.1302/0301-620X.87B7.15970 CrossRef

62.

Tanaka N, Sakahashi H, Ishii S, Kudo H (2006) Comparison of two types of ulnar component in type-5 Kudo total elbow arthroplasty in patients with rheumatoid arthritis: a long-term follow-up. J Bone Jt Surg Br 88:341–344. doi:10.1302/0301-620X.88B3.17017 CrossRef

63.

Thillemann TM, Olsen BS, Johannsen HV, Søjbjerg JO (1998) Long-term results with the Kudo type 3 total elbow arthroplasty. J Shoulder Elbow Surg 15:495–499. doi:10.1016/j.jse.2005.09.002 CrossRef

64.

van der Heide HJL, de Vos MJ, Brinkman J-M et al (2007) Survivorship of the KUDO total elbow prosthesis–comparative study of cemented and uncemented ulnar components: 89 cases followed for an average of 6 years. Acta Orthop 78:258–262. doi:10.1080/17453670710013771 CrossRefPubMed

65.

van der Lugt JCT, Geskus RB, Rozing PM (2005) Primary Souter-Strathclyde total elbow prosthesis in rheumatoid arthritis. J Bone Jt Surg Am 87:67–77. doi:10.2106/JBJS.D.02734 CrossRef

66.

Willems K, De Smet L (2004) The Kudo total elbow arthroplasty in patients with rheumatoid arthritis. J Shoulder Elb Surg 13:542–547. doi:10.1016/j.jse.2004.02.017 CrossRef

67.

Prasad N, Dent C (2010) Outcome of total elbow replacement for rheumatoid arthritis: Single surgeon’s series with Souter-Strathclyde and Coonrad-Morrey prosthesis. J Shoulder Elb Surg 19:376–383. doi:10.1016/j.jse.2009.09.016 CrossRef

68.

Sorbie C, Saunders G, Carson P et al (2011) Long-term effectiveness of Sorbie-QUESTOR elbow arthroplasty: single surgeon’s series of 15 years. Orthopedics 9:561–569. doi:10.3928/01477447-20110714-08

69.

Skyttä ET, Remes V, Nietosvaara Y et al (2008) Similar results with 21 Kudo and 21 Souter-Strathclyde total elbow arthroplasties in patients with rheumatoid arthritis. Arch Orthop Trauma Surg 128:1201–1208. doi:10.1007/s00402-008-0652-4 CrossRefPubMed

70.

Chapman-Sheath PJ, Giangrande P, Carr a J (2003) Arthroplasty of the elbow in haemophilia. J Bone Jt Surg Br 85:1138–1140. doi:10.1302/0301-620X.85B8.13986 CrossRef

71.

Vochteloo AJ, Roche SJ, Dachs RP, Vrettos BC (2015) Total elbow arthroplasty in bleeding disorders: an additional series of 8 cases. J Shoulder Elb Surg 24:773–778. doi:10.1016/j.jse.2015.01.004 CrossRef

72.

Ishii K, Mochida Y, Harigane K et al (2012) Clinical and radiological results of GSB III total elbow arthroplasty in patients with rheumatoid arthritis. Mod Rheumatol 22:223–227. doi:10.1007/s10165-011-0509-5 CrossRefPubMed

73.

Naqui SZ, Rajpura A, Nuttall D et al (2010) Early results of the Acclaim total elbow replacement in patients with primary osteoarthritis. J Bone Jt Surg Br 92:668–671. doi:10.1302/0301-620X.92B5.22979 CrossRef

74.

Wagener ML, De Vos MJ, Hannink G et al (2015) Mid-term clinical results of a modern convertible total elbow arthroplasty. Bone Jt J 97–B:681–688. doi:10.1302/0301-620X.97B5.34841 CrossRef

75.

Thillemann TM, Olsen BS, Johannsen HV, Sojbjerg JO (2006) Long-term results with the Kudo type 3 total elbow arthroplasty. J Shoulder Elb Surg 15:495–499. doi:10.1016/j.jse.2005.09.002 CrossRef

76.

Welsink CL, Lambers KTA, van Deurzen DFP, Eygendaal D, van den Bekerom MPJ (2017) Total elbow arthroplasty a systematic review. JBJS Rev. doi:10.2106/JBJS.RVW.16.00089

77.

King GJ, Glauser SJ, Westreich A et al (1993) In vitro stability of an unconstrained total elbow prosthesis. Influence of axial loading and joint flexion angle. J Arthroplast 8:291–298. doi:10.1016/S0883-5403(06)80092-6 CrossRef

78.

Bode LGM, Rijen MML van, Wertheim HFL et al (2015) Long-term mortality after rapid screening and decolonization of Staphylococcus aureus carriers. Ann Surg 263:511–515. doi:10.1097/SLA.0000000000001060 CrossRef

Titel: Why does total elbow arthroplasty fail today? A systematic review of recent literature
verfasst von: Ante Prkic
Chantal Welsink
Bertram The
Michel P. J. van den Bekerom
Denise Eygendaal
Publikationsdatum: 09.04.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 6/2017
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-017-2687-x

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

25.04.2024 | Hypertonie | Nachrichten

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Why does total elbow arthroplasty fail today? A systematic review of recent literature

Abstract

Background

Methods

Results

Conclusion

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Update Orthopädie und Unfallchirurgie

Springer Medizin

Abstract

Background

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 6/2017

Radiographic outcomes of single versus dual plate fixation of acute mid-shaft clavicle fractures

A modified Matti–Russe technique of grafting scaphoid non-unions

Unusual cause of the thumb basal joint pain: osteoid osteoma of the trapezium

Impingement of the patellar component against the tibial post after posterior stabilized and constrained TKA: a pilot study

Outcome and revision rate of uncemented glenohumeral resurfacing (C.A.P.) after 5–8 years

Do clinical outcomes correlate with bone density after open reduction and internal fixation of tibial plateau fractures

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Update Orthopädie und Unfallchirurgie