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  1. Article: What is the difference between the first and the second/third wave of Covid-19? - German perspective.

    Graichen, Heiko

    Journal of orthopaedics

    2021  Volume 24, Page(s) A1–A3

    Abstract: Now it has been more than 12 months since the first cases of the new Corona virus variant SARS Cov 2 have been detected in China. The first wave of the pandemic hit a lot of countries hard and many patients died. Not enough specialized equipment and ... ...

    Abstract Now it has been more than 12 months since the first cases of the new Corona virus variant SARS Cov 2 have been detected in China. The first wave of the pandemic hit a lot of countries hard and many patients died. Not enough specialized equipment and limited knowledge of the disease added to the severity of this first phase. We all learned from our mistakes made during this first wave of the pandemic and due to that the confidence to be able to manage the second wave a lot better was high. Nevertheless, much higher infection numbers, more patients in ICUs and in some countries also more deaths were seen during the second wave. In this editorial we will describe the differences between the first and second wave from a European-German perspective and look at the impact it had on different parts of our lives. In general, some shortcomings were relatively easy to prevent from happening again. Basic equipment such as face masks, FFP2 masks and disinfectant is not an issue anymore. The respective political systems have solved that problem. Some countries also have learned from the first wave that prevention is the only option to reduce patient numbers hitting the hospitals and especially the ICUs. Due to those facts, most of the European countries now thought they could deal with higher infection numbers. This, however, was an erroneous belief. Theoretical constructs such as a "Lockdown light" have failed to prove successful. Finally, only a hard Lockdown can bring down numbers sufficiently. In Hospitals, the experience from the first wave helped to treat patients more effectively, leading to an improved infection number/death ratio. However, the political decision to react slow and sometimes only in increments and not with full force led to a huge increase in patient numbers and consecutively soaring numbers of cases needing treatment in hospitals and ICUs. While some countries managed this second wave a lot better than the first, Germany for example did not. Meanwhile more than 20 000 deaths compared to less than 10 000 in the entire first wave is a sure indication and it was certainly not caused by the medical performance in Hospitals being poorer the second time around. For Orthopaedic surgeons, the second wave led to the same restrictions as the first one. Again, they became part of the interdisciplinary COVID-19 teams on the wards and again, the numbers of elective surgeries plummeted dramatically. Financial consequences will remain throughout 2021. The second wave was a hard test for society, particularly as it hit its peak around Christmas time. Contact restrictions, closed hotels, forbidden fireworks at New Year all that is a challenge in particular for the younger people in the societies. All those restrictions, however, can never be an excuse for people delivering abstruse theories via social media or during demonstrations. Scientists all over the world deliver reliable information, these are the people to trust - they are the only experts. Some of them also successfully developed what we all hoped for - a vaccine. Although vaccination started some days back, it will take at least until autumn 2021 to have our normal lives back. Hopefully we all learned a lesson.
    Language English
    Publishing date 2021-01-27
    Publishing country India
    Document type Editorial
    ZDB-ID 2240839-3
    ISSN 0972-978X
    ISSN 0972-978X
    DOI 10.1016/j.jor.2021.01.011
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Reopening phase in Covid19 pandemic and it's changes for Orthopaedic Surgeons - A German perspective.

    Graichen, Heiko

    Journal of orthopaedics

    2020  Volume 20, Page(s) A1–A3

    Abstract: Covid-19 is affecting our societies for more than just one, two or three months, maybe for even longer depending on where we live. In Germany, where I am located we have meanwhile ended the lockdown phase and started reopening. In this Editorial, I will ... ...

    Abstract Covid-19 is affecting our societies for more than just one, two or three months, maybe for even longer depending on where we live. In Germany, where I am located we have meanwhile ended the lockdown phase and started reopening. In this Editorial, I will try to describe the different aspects of the changes for an Orthopaedic Surgeon in this second phase of reopening. As numbers are the main basis for decision-making in this pandemic, I will try to give you a bit of background information on them first. As situations differ depending on the country you live in, you as a reader are probably in a different situation than I am right now, but hopefully you will still get some useful information for your daily routine. Although the numbers have improved a lot, the pandemic is still affecting all aspects of our lives, therefore this editorial is again divided into 4 sections: Role as surgeon, as doctor, as teacher, and as family/society member. As of a few days ago in Germany elective surgeries are allowed to be performed again. Although processes in the OR are very similar to what we have been used to, outside the OR a lot has changed. Testing and patients, maintaining distance, wearing face masks the entire day and so on is heavily affecting our practice. Patients are still nervous to visit the doctor and enter the Hospital although a lot of them are in great pain and have restricted mobility. Even testing all of them is not diffusing the anxiety completely. Objective information by the media, the politicians and us is important to overcome this anxiety. The part of interdisciplinary work became a lot smaller in this phase of reopening. Still pathways and regulations need to be developed but now Orthopaedic work is again the centre of our day in the Hospital. In our role as teacher, we are meanwhile used to all those webinars and digital options of education. However, getting used to it does not mean that we don't miss dearly the additional value of face to face discussions. We have further experienced that building up professional relationships and networks is not only based on facts but also on social factors. Something that we still miss. Reopening has improved life in families a lot. Grandchildren can meet their grandparents again and so on. This positive effect cannot be regarded high enough. Within the society reopening, however, is more demanding than the lockdown was. Protests and conspiracy theories are numerous and it is our mission as educated scientists to inform as many people around us as possible about the facts. Overall, it has to be stated, that all parts of our lives as Orthopaedic Surgeons remain affected by the Covid-19 pandemic. Life became better in a lot of ways; however, it is still a long way back to normal and we need to be patient.
    Keywords covid19
    Language English
    Publishing date 2020-08-07
    Publishing country India
    Document type Editorial
    ZDB-ID 2240839-3
    ISSN 0972-978X
    ISSN 0972-978X
    DOI 10.1016/j.jor.2020.08.004
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: The role of an Orthopaedic Surgeon in the time of Covid-19 Pandemic-a German perspective.

    Graichen, Heiko

    Journal of orthopaedics

    2020  Volume 19, Page(s) A1–A3

    Abstract: Covid-19 is a non-orthopaedic disease but is affecting the community of Orthopaedics as much as every part of our daily living. In this Editorial the different aspects of changes in our routine are described, based on the experience of this Editor in ... ...

    Abstract Covid-19 is a non-orthopaedic disease but is affecting the community of Orthopaedics as much as every part of our daily living. In this Editorial the different aspects of changes in our routine are described, based on the experience of this Editor in Germany. I will try to give you a bit of background information first, as the situation is very much dependent on the specific phase of the pandemic and your place of work. The experience for an Orthopaedic Surgeon in New York or Madrid may differ from that of an Orthopaedic Surgeon in Singapore, or South Korea. As Europe is, at least at the moment, the most affected continent, it hopefully is an interesting topic for all of you. The Covid-19 pandemic is affecting all aspects of our lives, therefore this editorial is divided into 4 sessions: Role as surgeon, as doctor, as teacher, and as family member. Most countries have stopped elective surgeries and by that relegated Orthopaedic surgeons to a minimum of work. Keeping contact to patients with digital tools might be an option to achieve an organised restart after the end of the lock down period and to keep treating patients through that phase. For many Orthopaedic surgeons, the principal task now is being part of an interdisciplinary team that is headed by colleagues from Internal Medicine or Anaesthesiology. Wards from the Orthopaedic department are reorganised as quarantine wards for Covid-19 patients. Worldwide all conferences have been cancelled and nobody knows for how long this will continue. Education now has become fully digital, allowing to present and communicate without real limitations compared to conventional conferences. Some teaching options, such as hands-on workshops, fellowships, etc. are ceased and cannot be replaced by digital options. Due to social distancing families are spending much more time together than before, while some family members, especially the people at risk (elders, ones with a fragile health) cannot be visited for a long time. Get togethers with friends as well as community meetings are completely suspended. For some of them, digital technology is the only option to minimize the problem of social distancing. Overall, it has to be stated, that all parts of our lives as an Orthopaedic Surgeon are affected by the Covid-19 pandemic. As nobody knows how long these restrictions need to remain in place we have to accept them and work on improving this specific situation by following the rules. Hopefully, a vaccine will be developed in the near future, allowing us to return to a "normal" life. Nevertheless, it will never be like it was before.
    Keywords covid19
    Language English
    Publishing date 2020-05-13
    Publishing country India
    Document type Editorial
    ZDB-ID 2240839-3
    ISSN 0972-978X
    ISSN 0972-978X
    DOI 10.1016/j.jor.2020.05.010
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Tibia-first, gap-balanced patient-specific alignment technique achieves well-balanced gaps in 90% of cases by rebuilding bony anatomy within boundaries.

    Strauch, Marco / Kaufmann, Verena / Graichen, Heiko

    Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA

    2024  Volume 32, Issue 2, Page(s) 381–388

    Abstract: Purpose: Patient-specific alignment (PSA) technique tries to achieve balanced gaps and simultaneously rebuild the individual bony phenotype. The hypothesis was: PSA technique achieves balanced knees in a high percentage with more anatomical resections ... ...

    Abstract Purpose: Patient-specific alignment (PSA) technique tries to achieve balanced gaps and simultaneously rebuild the individual bony phenotype. The hypothesis was: PSA technique achieves balanced knees in a high percentage with more anatomical resections than adjusted mechanical alignment (AMA).
    Methods: Three hundred sixty-seven patients underwent navigated total knee arthroplasty (TKA) with a tibia-first gap-balanced PSA technique. Resection boundaries for medial proximal tibia angle (MPTA) of 86-92°, mechanical lateral distal femoral angle (mLDFA) of 86-92°, and hip-knee-ankle angle (HKA) of 175-185° were defined. Preoperative and intraoperative parameters of HKA, MPTA, mLDFA, and gap widths were recorded. Depending on the coronal deformity, the patients were divided into three groups: varus HKA < 178°; straight 178-182° and valgus HKA > 182°. The stability was analysed by assessing the difference between medial and lateral extension and flexion gaps as well as between flexion and extension gaps. All PSA measurements were compared with data from a previously published AMA series.
    Results: PSA achieved balanced gaps in extension, flexion and between flexion/extension in over 90% of cases, being similar to AMA. In PSA, MPTA and mLDFA were restored within 1°, except in extreme varus (MPTA difference 2°) and valgus knees (mLDFA difference 3°). This was caused by the defined boundaries of the alignment technique. This individualised reconstruction led to significantly more anatomical resections of all tibia and femur resections.
    Conclusion: A tibia-first, gap-balanced PSA technique achieves balanced joints in more than 90% of cases. By maintaining preoperative MPTA and mLDFA to a high extent, far more anatomical resections, compared to AMA were performed. Future studies need to be conducted to investigate whether those promising intraoperative results correlate with postoperative patient outcomes and whether patients outside the 5° corridor have higher failure rates.
    Level of evidence: Level III, retrospective cohort study.
    MeSH term(s) Humans ; Tibia/surgery ; Retrospective Studies ; Knee Joint/surgery ; Knee Joint/anatomy & histology ; Arthroplasty, Replacement, Knee/methods ; Femur/surgery ; Osteoarthritis, Knee/surgery
    Language English
    Publishing date 2024-01-25
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 1159064-6
    ISSN 1433-7347 ; 0942-2056
    ISSN (online) 1433-7347
    ISSN 0942-2056
    DOI 10.1002/ksa.12056
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: The role of an Orthopaedic Surgeon in the time of Covid-19 Pandemic–a German perspective

    Graichen, Heiko

    Journal of Orthopaedics

    2020  Volume 19, Page(s) A1–A3

    Keywords covid19
    Language English
    Publisher Elsevier BV
    Publishing country us
    Document type Article ; Online
    ZDB-ID 2240839-3
    ISSN 0972-978X
    ISSN 0972-978X
    DOI 10.1016/j.jor.2020.05.010
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article ; Online: Reopening phase in Covid19 pandemic and it's changes for Orthopaedic Surgeons – A German perspective

    Graichen, Heiko

    Journal of Orthopaedics

    2020  Volume 20, Page(s) A1–A3

    Keywords covid19
    Language English
    Publisher Elsevier BV
    Publishing country us
    Document type Article ; Online
    ZDB-ID 2240839-3
    ISSN 0972-978X
    ISSN 0972-978X
    DOI 10.1016/j.jor.2020.08.004
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article: The role of an Orthopaedic Surgeon in the time of Covid-19 Pandemic–a German perspective

    Graichen, Heiko

    J. Orthop.

    Abstract: Covid-19 is a non-orthopaedic disease but is affecting the community of Orthopaedics as much as every part of our daily living. In this Editorial the different aspects of changes in our routine are described, based on the experience of this Editor in ... ...

    Abstract Covid-19 is a non-orthopaedic disease but is affecting the community of Orthopaedics as much as every part of our daily living. In this Editorial the different aspects of changes in our routine are described, based on the experience of this Editor in Germany. I will try to give you a bit of background information first, as the situation is very much dependent on the specific phase of the pandemic and your place of work. The experience for an Orthopaedic Surgeon in New York or Madrid may differ from that of an Orthopaedic Surgeon in Singapore, or South Korea. As Europe is, at least at the moment, the most affected continent, it hopefully is an interesting topic for all of you. The Covid-19 pandemic is affecting all aspects of our lives, therefore this editorial is divided into 4 sessions: Role as surgeon, as doctor, as teacher, and as family member. Most countries have stopped elective surgeries and by that relegated Orthopaedic surgeons to a minimum of work. Keeping contact to patients with digital tools might be an option to achieve an organised restart after the end of the lock down period and to keep treating patients through that phase. For many Orthopaedic surgeons, the principal task now is being part of an interdisciplinary team that is headed by colleagues from Internal Medicine or Anaesthesiology. Wards from the Orthopaedic department are reorganised as quarantine wards for Covid-19 patients. Worldwide all conferences have been cancelled and nobody knows for how long this will continue. Education now has become fully digital, allowing to present and communicate without real limitations compared to conventional conferences. Some teaching options, such as hands-on workshops, fellowships, etc. are ceased and cannot be replaced by digital options. Due to social distancing families are spending much more time together than before, while some family members, especially the people at risk (elders, ones with a fragile health) cannot be visited for a long time. Get togethers with friends as well as community meetings are completely suspended. For some of them, digital technology is the only option to minimize the problem of social distancing. Overall, it has to be stated, that all parts of our lives as an Orthopaedic Surgeon are affected by the Covid-19 pandemic. As nobody knows how long these restrictions need to remain in place we have to accept them and work on improving this specific situation by following the rules. Hopefully, a vaccine will be developed in the near future, allowing us to return to a “normal” life. Nevertheless, it will never be like it was before.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #311971
    Database COVID19

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  8. Article: Reopening phase in Covid19 pandemic and it's changes for Orthopaedic Surgeons - A German perspective

    Graichen, Heiko

    Abstract: Covid-19 is affecting our societies for more than just one, two or three months, maybe for even longer depending on where we live. In Germany, where I am located we have meanwhile ended the lockdown phase and started reopening. In this Editorial, I will ... ...

    Abstract Covid-19 is affecting our societies for more than just one, two or three months, maybe for even longer depending on where we live. In Germany, where I am located we have meanwhile ended the lockdown phase and started reopening. In this Editorial, I will try to describe the different aspects of the changes for an Orthopaedic Surgeon in this second phase of reopening. As numbers are the main basis for decision-making in this pandemic, I will try to give you a bit of background information on them first. As situations differ depending on the country you live in, you as a reader are probably in a different situation than I am right now, but hopefully you will still get some useful information for your daily routine. Although the numbers have improved a lot, the pandemic is still affecting all aspects of our lives, therefore this editorial is again divided into 4 sections: Role as surgeon, as doctor, as teacher, and as family/society member. As of a few days ago in Germany elective surgeries are allowed to be performed again. Although processes in the OR are very similar to what we have been used to, outside the OR a lot has changed. Testing and patients, maintaining distance, wearing face masks the entire day and so on is heavily affecting our practice. Patients are still nervous to visit the doctor and enter the Hospital although a lot of them are in great pain and have restricted mobility. Even testing all of them is not diffusing the anxiety completely. Objective information by the media, the politicians and us is important to overcome this anxiety. The part of interdisciplinary work became a lot smaller in this phase of reopening. Still pathways and regulations need to be developed but now Orthopaedic work is again the centre of our day in the Hospital. In our role as teacher, we are meanwhile used to all those webinars and digital options of education. However, getting used to it does not mean that we don't miss dearly the additional value of face to face discussions. We have further experienced that building up professional relationships and networks is not only based on facts but also on social factors. Something that we still miss. Reopening has improved life in families a lot. Grandchildren can meet their grandparents again and so on. This positive effect cannot be regarded high enough. Within the society reopening, however, is more demanding than the lockdown was. Protests and conspiracy theories are numerous and it is our mission as educated scientists to inform as many people around us as possible about the facts. Overall, it has to be stated, that all parts of our lives as Orthopaedic Surgeons remain affected by the Covid-19 pandemic. Life became better in a lot of ways; however, it is still a long way back to normal and we need to be patient.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #695750
    Database COVID19

    Kategorien

  9. Article ; Online: Any technology assisting total knee arthroplasty (TKA) will fail without the correct 3D alignment and balancing target.

    Hirschmann, Michael T / von Eisenhart-Rothe, Rüdiger / Graichen, Heiko

    Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA

    2023  Volume 31, Issue 3, Page(s) 733–735

    MeSH term(s) Humans ; Arthroplasty, Replacement, Knee ; Knee Joint/surgery ; Osteoarthritis, Knee/surgery ; Technology
    Language English
    Publishing date 2023-02-17
    Publishing country Germany
    Document type Editorial
    ZDB-ID 1159064-6
    ISSN 1433-7347 ; 0942-2056
    ISSN (online) 1433-7347
    ISSN 0942-2056
    DOI 10.1007/s00167-023-07345-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: Balance and constraint in revision TKR: A classification for instability management.

    Morgan-Jones, Rhidian / Graichen, Heiko

    Journal of orthopaedics

    2021  Volume 24, Page(s) 19–25

    Abstract: Instability is an increasingly common cause and symptom of failure of Total Knee Arthroplasty (TKA). Patients seek 'Functional Stability', which is the sum of both a balanced joint and, if necessary, mechanical constraint. The objective of this paper is ... ...

    Abstract Instability is an increasingly common cause and symptom of failure of Total Knee Arthroplasty (TKA). Patients seek 'Functional Stability', which is the sum of both a balanced joint and, if necessary, mechanical constraint. The objective of this paper is to classify the different types of TKA instability and their causes. Based on this classification, the authors give methodical recommendations for instability management.
    Instability classification: Instability in revision TKA can be classified into 3 types based on the management of bone loss and ligamentous deficiency which directs the level of constraint required to achieve functional stability.
    Type 1: Bone deficiency: Revision with restoration of joint line and rebuilding the bony anatomy results in a balanced joint. No increased constraint is needed.
    Type 2: Ligament and soft tissue deficiency: Requires increased constraint to overcome instability.
    Type 3: Composite (Total) deficiency: (combined Type 1 and 2).The multiple causes of instability are outlined for each Instability type along with an algorithm for restoring the joint line and adding titrated constraint to restore functional stability.
    Language English
    Publishing date 2021-02-04
    Publishing country India
    Document type Journal Article
    ZDB-ID 2240839-3
    ISSN 0972-978X
    ISSN 0972-978X
    DOI 10.1016/j.jor.2021.01.016
    Database MEDical Literature Analysis and Retrieval System OnLINE

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