Publications by authors named "Dietmar Hager"

9 Publications

  • Page 1 of 1

Proximal Row Carpectomy with Total Scapoidectomy vs. Conventional Carpal Resection for ReMotion Total Wrist Arthroplasty.

J Clin Med 2021 Apr 26;10(9). Epub 2021 Apr 26.

Faculty of Medicine, Johannes Kepler University Linz, Altenbergerstraße 69, 4020 Linz, Austria.

High complication rates in total wrist arthroplasty (TWA) still lead to controversy in the medical literature, and novel methods for complication reduction are warranted. In the present retrospective cohort study, we compare the outcomes of the proximal row carpectomy (PRC) method including total scaphoidectomy ( = 22) to the manufacturer's conventional carpal resection (CCR) technique, which retains the distal pole of the scaphoid ( = 25), for ReMotion prosthesis implantation in non-rheumatoid patients. Mean follow-up was 65.8 ± 19.8 and 80.0 ± 28.7 months, respectively. Pre- and postoperative clinical assessment included wrist flexion-extension and radial-ulnar deviation; Disability of Arm, Shoulder, and Hand scores; and pain via visual analogue scale. At final follow-up, grip strength and satisfaction were evaluated. All complications, re-operations, and revision surgeries were noted. Clinical complications were significantly lower in the PRC group ( = 0.010). Radial impaction was detected as the most frequent complication in the CCR group ( = 10), while no PRC patients suffered from this complication ( = 0.0008). Clinical assessment, grip strength measurements, and the log rank test evaluating the re-operation as well as revision function showed no significant difference. All functional parameters significantly improved compared to preoperative values in both cohorts. In conclusion, we strongly recommend PRC for ReMotion prosthesis implantation.
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http://dx.doi.org/10.3390/jcm10091865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8123469PMC
April 2021

Elektra prosthesis versus resection-suspension arthroplasty for thumb carpometacarpal osteoarthritis: a long-term cohort study.

J Hand Surg Eur Vol 2020 Jun 11;45(5):452-457. Epub 2019 Sep 11.

Department for Trauma Surgery and Sportstraumatology, Johannes Kepler University Linz, Linz, Austria.

The present study compares 34 patients with thumb carpometacarpal osteoarthritis (37 thumbs) treated with the Elektra® prosthesis, with 18 patients (18 thumbs) treated with resection-suspension arthroplasty, with an overall mean follow-up period of 13.3 years. Evaluation with disability of arm and shoulder scores, pain via visual analogue scale and range of motion (radial and palmar abduction, and opposition) indicated no significant difference. However, the cohort with a surviving prosthesis showed significantly better subjective grip strength (  =  0.04). Complications occurred in 23 of the 37 thumbs in the prosthesis group compared with two in the resection-suspension arthroplasty patients. Seventeen prostheses required revision. At revision operations, we observed local signs of metallosis in 15 of 17 cases. The patients receiving resection-suspension arthroplasty were more satisfied with their treatment (  =  0.003). Therefore, we cannot recommend the implantation of Elektra® prosthesis and we speculate that the key problem of aseptic cup loosening is a result of the metal-on-metal bearing. III.
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http://dx.doi.org/10.1177/1753193419873230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7232778PMC
June 2020

Re-motion total wrist arthroplasty: 39 non-rheumatoid cases with a mean follow-up of 7 years.

J Hand Surg Eur Vol 2019 Nov 12;44(9):946-950. Epub 2019 Aug 12.

Department for Trauma Surgery and Sports Traumatology, Medical Faculty, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria.

We evaluated the outcomes of the Re-motion total wrist arthroplasty in 39 non-rheumatoid patients. The mean follow-up was 7 years (range 3-12). Postoperative wrist flexion-extension and radial-ulnar deviation as well as the scores of the Disability of Arm Shoulder and Hand questionnaire and the visual analogue scale pain scores improved significantly. Complications occurred in 13 wrists, five of which required further surgery. The most frequent complication was impingement between the scaphoid and the radial implant (n = 5), which can be avoided by complete or almost complete scaphoid resection. Periprosthetic radiolucency developed around the radial component in three cases and three radial screws loosened. Despite the incidence of high implant survival in 38 of 39 wrists over 7 years (97%), the complication rate is not satisfying. Knowledge of the risk of complications and patient selection are essential when making the decision to choose wrist arthroplasty over arthrodesis. IV.
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http://dx.doi.org/10.1177/1753193419866117DOI Listing
November 2019

Prospective observation of Clostridium histolyticum collagenase for the treatment of Dupuytren's disease in 788 patients: the Austrian register.

Arch Orthop Trauma Surg 2019 Sep 17;139(9):1315-1321. Epub 2019 Jul 17.

Department of Trauma Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.

Introduction: Since March 2011, the microbial collagenase of Clostridium histolyticum (Xiapex®, Swedish Orphan Biovitrum AB, Stockholm, Sweden) has become available in the European Union for treatment of Dupuytren's disease. The purpose of this study was to evaluate potential safety risks of Xiapex® and to contribute to a better understanding for its use.

Methods: A prospective, non-interventional, observational study using Xiapex® for Dupuytren's disease named XIANIS was conducted between 1.10.2011 and 01.10.2017. Treatment was conducted in accordance to the manufacturer information. Patients were invited for follow-up after 1 week, 1 month, 3 months and 1 year. Demographic data, treatment data, pain levels, anaesthetic application during passive manipulation, subjective function improvement, subjective satisfaction and adverse events were recorded.

Results: 788 patients with 814 treatments were included who suffered from Dupuytren's contracture for a mean of 64 months. The metacarpophalangeal joint was affected in 57% of cases and the PIP joint in 40.8% with a mean contracture of 39° and 56°, respectively. A change in the contracture down to 0°-5° was reported in 66.5% of cases, while 25.5% achieved a partial improvement. The pain during the injection was rated 4.5 and 3.3 during passive manipulation. Adverse events were reported in the majority of treated patients with skin tears being one main common event (26%). Further adverse outcomes were bleeding/hematoma, joint swelling, injection-site swelling, pressure sensitivity, erythema, injection-site pain, peripheral edema, blood blisters, blisters, painless lymphadenopathy, painful lymphadenopathy, axillary pain, arthralgia and sensory abnormality. There were no reported tendon ruptures, anaphylactic reactions or ligament injuries. On 1-year follow-up, 29% showed an increased contracture of a mean of 24° with the need for surgical treatment in 2% of patients. 74% of patients were very satisfied and 72% showed a high functional improvement.

Conclusion: The injectable collagenase Clostridium histolyticum (Xiapex®) proved to be effective and safe in patients with Dupuytren's disease. Minor adverse events disappeared within 30 days and the need for surgical treatment within 1 year was very low (2%). No major complications or rare side effects were seen in this prospective observational study.
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http://dx.doi.org/10.1007/s00402-019-03226-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689902PMC
September 2019

[Therapy of Dupuytren's contracture with collagenase - Evidence-based Consensus Statement of Austrian Surgical Societies].

Handchir Mikrochir Plast Chir 2019 Aug 17;51(4):262-274. Epub 2018 Oct 17.

Univ.-Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie Innsbruck.

Dupuytren's contracture (DC) or Dupuytren's disease (DD) is a progressive fibro-proliferative disease of palmoplantar connective tissue, resulting in characteristic nodal and/or cord formation from collagen disposition. When the disease progresses, the thickening and shortening of the cords eventually leads the affected fingers to being pulled into flexion, which may be associated with marked disability, especially with bilateral disease. DD is relatively common in Europe, with the highest prevalence in Nordic countries. In Austria approx. 200 000 people are affected. The incidence increases with increasing age, with men being more often and earlier affected than women. The aetiology of DC is not completely clear, but it seems to be multifactorial; twin and familial studies confirm a genetic predisposition. The natural course of the disease can vary between relatively benign and massive progression and recurrence. In most cases, there is a fluctuating course. The DC is not curable; treatment methods range from minimally invasive to open surgical procedures. Collagenase Clostridium histolyticum (CCH) is a nonsurgical, enzymatic injection treatment for adult patients (≥ 18 years) with a palpable cord and has been approved in Europe since 2011. Clinical studies and practical experience of individual centres confirm the efficacy and safety of CCH treatment of DC. The present consensus statement was prepared under the auspices of the Austrian Society of Hand Surgery with the participation of the Austrian Society for Trauma Surgery, the Society of Orthopaedics and Orthopaedic Surgery as well as the Society for Plastic, Aesthetic and Reconstructive Surgery. On the basis of current literature and the experts' experience, it describes the various surgical procedures, with particular reference to collagenase treatment and provides guidance for their use. The statement is intended not only to illustrate the state of the art of current treatment, but also to support the achievement of uniform high quality standards in the treatment of DC in surgical centres and specialised medical practices throughout Austria.
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http://dx.doi.org/10.1055/a-0627-7333DOI Listing
August 2019

Strategies for the reduction of live animal use in microsurgical training and education.

Altern Lab Anim 2008 May;36(2):153-60

Department of Trauma Surgery, Allgemeines Krankenhaus Linz, Linz, Austria.

Education and training in microsurgical techniques have historically relied on the use of live animal models. Due to an increase in the numbers of microsurgical operations in recent times, the number of trainees in this highly-specialised surgical field has continued to grow. However, strict legislation, greater public awareness, and an increasing sensitivity toward the ethical aspects of scientific research and medical education, emphatically demand a significant reduction in the numbers of animals used in surgical and academic education. Hence, a growing number of articles are reporting on the use of alternatives to live animals in microsurgical education and training. In this review, we report on the current trends in the development and use of microsurgical training models, and on their potential to reduce the number of live animals used for this purpose. We also share our experiences in this field, resulting from our performance of numerous microsurgical courses each year, over more than ten years. The porcine heart, in microvascular surgery training, and the fresh chicken leg, in microneurosurgical and microvascular surgery training, are excellent models for the teaching of basic techniques to the microsurgical novice. Depending on the selected level of expertise of the trainee, these alternative models are capable of reducing the numbers of live animals used by 80-100%. For an even more enhanced, "closer-to-real-life" scenario, these non-animated vessels can be perfused by a pulsatile pump. Thus, it is currently possible to provide excellent and in-depth training in microsurgical techniques, even when the number of live animals used is reduced to a minimum. With these new and innovative techniques, trainees are able to learn and prepare themselves for the clinical situation, with the sacrifice of considerably fewer laboratory animals than would have occurred previously.
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http://dx.doi.org/10.1177/026119290803600206DOI Listing
May 2008

Intraluminal endoscopic evaluation of microvascular anastomosis.

J Plast Reconstr Aesthet Surg 2008 7;61(4):388-92. Epub 2007 Nov 7.

maz - Mikrochirurgisches Ausbildungs- und Forschungszentrum, Garnisonstrasse 21, 4020 Linz, Austria.

Microsurgery is an established technique in different surgical disciplines. Training in the laboratory remains the mainstay for delivering optimal performance in the operating room. Routine evaluation of microsurgical anastomosis during training usually consists of longitudinal splitting of the performed anastomosis. We present our initial experiences with endoluminal evaluation of microvascular anastomosis by endoscopy. In all experimental settings flexible miniature endoscopes with diameters of 1 and 2mm were used. All experiments were conducted in porcine coronary arteries or artificial vessels such as silastic tubes. The endoscope was introduced into the vessel lumen via an i.v. cannula. Specialised digital software was developed to enhance the displayed image. This so-called round-scan system delivers a two-dimensional picture of the endoluminal surface of a microvascular anastomosis. With the developed scanning software we were able to overcome technical limitations in microvascular endoscopy. Good results were obtained in 1.7 mm artificial vessels and technical errors in microvascular anastomosis were revealed. Endoluminal microvascular endoscopy offers great potential in evaluating skills in microvascular surgery in training settings but theoretically can also be employed in clinical situations. Main limitations encountered include fluids such as blood within vessels and the slow but steady pace by which the endoscope has to be withdrawn from within the vessel lumen.
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http://dx.doi.org/10.1016/j.bjps.2007.09.034DOI Listing
June 2008

Giant lipoma of the thenar.

Wien Klin Wochenschr 2007 ;119(5-6):149

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http://dx.doi.org/10.1007/s00508-006-0750-7DOI Listing
August 2007

Pulsatile perfused porcine coronary arteries for microvascular training.

Ann Plast Surg 2006 Aug;57(2):213-6

Department of Trauma Surgery, Allgemeines Krankenhaus Linz, Austria.

Microsurgery is today an established technique in specialties such as plastic surgery, neurosurgery, and trauma surgery. However, specialized training is a prerequisite for mastering anastomosis of small-diameter vessels or coaptation of nerves in the operating room. The training should be as realistic as possible and thus, laboratory animals such as the rat are preferably used as a substitute. In an attempt to minimize the use of living animals without jeopardizing a realistic training setting, we developed a pulsatile perfused porcine coronary artery model for microsurgical education. The training model consists of a membrane pump that generates a pulsatile flow within a coronary artery of a porcine heart. The pump is commercially available with a dimension of approximately 130 x 100 x 60 mm and a weight of 190 g. The pump is energized by 220 B and the motor is run on a transformed power of approximately 12 V (range, 1.5-12 V). Different fluids from simple saline solution to theoretically whole blood can be used for perfusion. The membrane pump proved to be very reliable during microvascular training because of its convenient size and wide range of feed rate providing a very realistic training setting. A maximum fluid output of 850 mL/min can be achieved. The pump has a high acceptance in microsurgical trainees evaluated by questionnaires during several microsurgical courses. The pulsatile perfused porcine coronary artery system for microsurgical training enables the trainee to work under the most realistic training settings. It proved to be a valuable tool during microsurgical education, reducing the costs and sparing living laboratory animals. Thus, we can recommend this system to anyone who is involved in training and teaching microsurgical skills.
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http://dx.doi.org/10.1097/01.sap.0000215248.70308.aeDOI Listing
August 2006