Markus Kuster

Sir Charles Gairdner Hospital | SCGH · Orthopaedics

(1) Background: Bone healing is influenced by various mechanical factors, such as stability, interfragmentary motion, strain rate, and direction of loading. Far cortical locking (FCL) is a novel screw design that promotes bone healing through controlled fracture motion. (2) Methods: This study compared the outcome of distal femur fractures treated...

Total hip arthroplasty (THA) is one of the most successful types of surgical operation, with some considering it “the operation of the century” [...]

Background: Non-unions after intramedullary nailing of femoral shaft fractures are a significant problem. Treatment options such as augmenting with plates or exchange nailing have been proposed. The ideal treatment remains controversial. Methods: Augmentative plating using a 4.5 mm LCP or a 3.2 mm LCP leaving the nail in situ was tested biomecha...

Introduction Distal tibia fractures often occur in younger, high demand patients, though the literature surrounding management remains contentious. This study sought to quantitatively determine differences in kneeling ability and self-reported knee function in patients managed with either intramedullary nailing (IMN) or open reduction internal fixa...

Aim The ideal route of tranexamic acid (TXA) administration in total hip arthroplasty (THA) or total knee arthroplasty (TKA) remains controversial. This study aims to identify the optima route of TXA administration in THA or TKA. Methods PUBMED, EMBASE, MEDLINE and CENTRAL database were systematically searched until 4 August 2021 for randomised st...

Objectives: To investigate the mechanical properties of cephalomedullary nailing of intertrochanteric OTA/AO 31-A3.1 (reverse oblique) fractures and to test the hypothesis that anatomical reduction and augmentation with cerclage wire produces a more stable construct. Methods: A standardized fracture model in composite saw bone was created to sti...

Introduction: Patients frequently have discomfort or difficulty with kneeling following anterior cruciate ligament reconstruction (ACLR). This study aimed to report the prevalence of, and reasons for, kneeling difficulty after ACLR with a hamstring autograft; and to investigate the association between the degree of kneeling difficulty, presence of...

Background Anterior hip pain after total hip replacement (THR) can be caused by iliopsoas impingement (IPI). Validation of CT measured cup version is well published; however quantification of the anterior cup prominence has not been validated. Therefore, we did an in vitro study aiming to: 1) assess the accuracy of the current method of measuring t...

Background: Anterior hip pain after total hip replacement (THR) can be caused by iliopsoas impingement (IPI). Validation of CT measured cup version is well published; however quantification of the anterior cup prominence has not been validated. Therefore, we did an in vitro study aiming to: (1) assess the accuracy of the current method of measurin...

Purpose No quantitative test exists to reliably assess kneeling tolerance before and after surgery. The aim of this study was to validate a kneeling test, designed to quantify kneeling tolerance. Method A total of 179 participants (324 knees) were enrolled into the study, including 124 asymptomatic knees, 98 with osteoarthritis (OA), 85 following...

Background: Intraoperative femur fractures are a common complication of revision hip arthroplasty. This study examined the use of a prophylactic cable in stopping a crack from propagating beyond the cable. Methods: Seventy sheep femora were prepared. A 5-mm vertical incision was performed. Using a force-controlled materials testing machine, a Wa...

Background: The Forgotten Joint Score-12 (FJS-12) is a patient-reported outcome questionnaire of joint awareness in patients with hip and knee pathologies. To improve interpretability of values derived from this measure, we collected normative values for the US general population. Methods: A sample of 2000 participants, representative of US gene...

Purpose: This study was designed to determine whether perioperative supplementation of vitamin C (VC) improves range of motion (ROM) and reduces the risk of arthrofibrosis (AF) following total knee arthroplasty (TKA). Methods: Ninety-five patients undergoing TKA were randomized to either oral VC (1000 mg daily) or placebo for 50 days (48 VC grou...

Full open-access article here: https://rdcu.be/3qlv Background: The current practice in elective orthopaedics does not routinely include psychological interventions despite evidence that psychological factors such as personality, anxiety, depression and negative thinking styles can influence outcomes and recovery from surgery. The objective of thi...

Background The anatomy of the articularis genus muscle has prompted speculation that it elevates the suprapatellar bursa during extension of the knee joint. However, its architectural parameters indicate that this muscle is not capable of generating enough force to fulfill this function. The purpose of the present study was to investigate the anato...

Purpose: Although the vastus medialis (VM) is closely associated with the vastus intermedius (VI), there is a lack of data regarding their functional relationship. The purpose of this study was to investigate the anatomical interaction between the VM and VI with regard to their origins, insertions, innervation and function within the extensor appa...

Kneeling is often impaired following total knee replacement. There is no clinical study comparing a lateral to a midline skin incision with regard to kneeling. Patients with a well-functioning total knee replacement enrolled in the trial. The participants with a lateral skin incision were matched with those with a standard midline incision. Twenty-...

Introduction: Preoperative discontinuation of aspirin (acetylsalicylic acid) can reduce bleeding risk but may increase the risk of perioperative cardiovascular events. Materials and methods: We retrospectively assessed the impact of preoperative continuation versus discontinuation of aspirin compared with a control group in a cohort of 739 conse...

Background Published data regarding the structure of the quadriceps tendon are diverse. Dissection of the quadriceps muscle group revealed that beside the rectus femoris, vastus lateralis, vastus intermedius and vastus medialis a fifth muscle component– named the tensor vastus intermedius consistently fused into quadriceps tendon. It can be hypothe...

Background: Modern knee designs do not fully restore the anatomy and kinematics of the natural knee. This study evaluates the kinematic and kinetic changes of well-functioning patients with total knee arthroplasty (TKA) in comparison to a healthy age-matched control group while descending stairs and level walking. The aim was to have a baseline fo...

Background: Angular stable plate fixation is a widely accepted treatment option for interprosthetic or periprosthetic femoral fractures with stable implants. This biomechanical study tries to establish a safe distance of the plate from the tip of a femoral prosthesis. Methods: A total of 38 composite femurs were reamed to an inner diameter of 23...

Methods: A cadaveric study using 8 knee specimens was conducted using a lateral subvastus approach to the knee. Standardised pictures were taken of the exposure, the tibial tubercle osteotomy was performed and pictures were taken of the new exposed area. These images were compared using a computer program that calculated the area of exposure befor...

Purpose Increased range of motion (ROM) while maintaining joint stability is the goal of modern total knee arthroplasty (TKA). A biomechanical study has shown that small increases in flexion gap result in decreased tibiofemoral force beyond 90° flexion. The purpose of this paper was to investigate clinical implications of controlled increased flexi...

The quadriceps femoris is traditionally described as a muscle group composed of the rectus femoris and the three vasti. However, clinical experience and investigations of anatomical specimens are not consistent with the textbook description. We have found a second tensor-like muscle between the vastus lateralis (VL) and the vastus intermedius (VI),...

Background: The anterior approach to the hip joint is widely used in pediatric and adult orthopaedic surgery, including hip arthroplasty. Atrophy of the tensor fasciae latae muscle has been observed in some cases, despite the use of this internervous approach. We evaluated the nerve supply to the tensor fasciae latae and its potential risk for inj...

The anterior approach to the hip gained popularity for total hip arthroplasty in recent years. Distal extension of the anterior approach, sometimes needed intraoperatively, potentially endangers neurovascular structures to the quadriceps. The aim of this study was to determine the anatomical structures placed at risk by distal extension of the ante...

Periprosthetic fractures around the knee are challenging, and a sound knowledge of arthroplasty and trauma techniques are required for optimal treatment. The basic principles are the same for all fractures. Key questions are as follows: Is the prosthesis well fixed or loose? Where is the fracture in relation to the prosthesis and what is the availa...

Copyright: © 2014 Fenner V, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract The ability to climb stairs is a highly demanding task for the musculo...

The present disclosure relates to an implant for refixation of the greater trochanter on which an osteotomy has been performed or which is fractured. The implant comprises a plate that can be fixed on the proximal femur, and a device that can hold the greater trochanter with a form fit or force fit on the femur. This holding device preferably has b...

The invention relates to a bone anchoring device for the operative repair of fractures, comprising a fracture fixation plate which has at least one opening and at least one anchoring element for the fastening of the fracture fixation plate on the bone, wherein the anchoring element has a shaft and a head, and wherein at least one part of the shaft...

Bone ingrowth into uncemented acetabular components requires intimate cup-bone contact and rigid fixation, which can be difficult to achieve in revision hip arthroplasty. This study compares polyaxial compression locking screws with non-locked and cancellous screw constructs for acetabular cup fixation. An acetabular cup modified with screw holes t...

The noncontact bridging system is a true hybrid and polyaxial locking plate. Each screw is first inserted into the screw hole of the plate using a conventional technique and can be locked at any time during the procedure with a locking cap. This allows the surgeon to use the plate for fracture reduction, to assess bone quality when tightening the s...

Objectives: To compare physical activity levels, subject-reported function, and knee strength in 21 arthroscopic partial meniscectomy (APM) patients (age 45.7 (6.06) years, BMI 27.3 (5.96) female 60%) 3 months post-surgery with 21 healthy controls (age 43.6 (5.71) years, BMI 24.5(4.2) female 60%) matched at the cohort level for age, gender and BMI...

Background Patient-reported outcome measures have become a well-recognised part of outcome assessment in orthopaedic surgery. These questionnaires claim to measure joint-specific dimensions like pain, function in activities of daily living, joint awareness or stiffness. Interference of the patient’s psychological status with these orthopaedic quest...

COI Kuster JOA.

COI Holzner JOA.

COI Giesinger JOA.

COI Giesinger KM JOA.

Patient-reported outcomes (PROs) are an important endpoint in orthopedics providing comprehensive information about patients' perspectives on treatment outcome. Computer-adaptive test (CAT) measures are an advanced method for assessing PROs using item sets that are tailored to the individual patient. This provides increased measurement precision an...

Purpose: The aim of the present study was to compare primary stability in ACL reconstruction and ultimate load to failure of a mesh augmented hamstring tendon graft fixed with two cross pins to established hamstrings and bone-patellar-tendon-bone (BTB) graft fixation methods. Methods: Forty fresh porcine femora were divided into four groups: (A)...

With improving patient outcome after joint arthroplasty, new assessment tools with increased discriminatory power especially in well-performing patients are desirable. The goal of the present study was to develop and validate a new score ("Forgotten Joint Score," or FJS) introducing a new aspect of patient-reported outcome: the patient's ability to...

: Screw perforation of the humeral head in locking plate osteosynthesis occurs in up to 30% of cases. The current study compared different fixation possibilities (eg, number and position of screws) to reduce screw perforation in the humeral head. : A humeral head fracture with a missing medial support was created in 30 fresh-frozen cadavers and fix...

Overlap between the distal tibia and fibula has always been quoted to be positive. If the value is not positive then an injury to the syndesmosis is thought to exist. Our null hypothesis is that it is a normal variant in the adult population. We looked at axial CT scans of the ankle in 325 patients for the presence of overlap between the distal tib...

Restricted range of motion and excessive laxity are both potential complications of total knee arthroplasty (TKA). During TKA surgery, the surgeon is frequently faced with the question of how tightly to implant the prosthesis. The most common method of altering implantation tightness is to vary the thickness of the polyethylene inlay after the bone...

Computer-assisted surgery (CAS) for total knee arthroplasty (TKA) has become increasingly common over the last decade. There are several reports including meta-analyses that show improved alignment, but the clinical results do not differ. Most of these studies have used a bone referencing technique to size and position the prosthesis. The question...

This study evaluates a proximally angulated cortical screw forming a triangular construct in lateral locking plates of comminuted intraarticular tibial plateau fractures. Sixteen composite tibiae were used for the fracture model and a complete articular fracture of the proximal tibia (AO 41.C2) was performed. A compression force was applied to the...

Die Knochen sind das tragende Gerüst des Körpers und bilden Hebel, an denen die Muskulatur ansetzt. Zudem schützen sie das zentrale Nervensystem, beherbergen die Zellen der Hämatopoese und regulieren den Kalzium-Phosphat-Haushalt des Körpers; sie enthalten 99% des gesamten Kalziums und 90% des Phosphats. Das Periost umhüllt den Knochen, und das End...

Die Prävalenz dieser Frakturen ist steigend, und sie sind daher bereits der dritthäufigste Grund für die Revision einer Hüftprothese. Periprothetische Frakturen werden in peri- und postoperative Frakturen unterteilt. Unzementierte Schäfte sind mit einem großen Risiko für eine periprothetische Fraktur verbunden. Daten aus der Mayo-Klinik zeigen ein...

Weichteilinfektionen entstehen endogen durch Erreger der patienteneigenen Flora oder exogen mit neu erworbenen Erregern aus der Umgebung des Patienten. Die Gefahr einer Infektion ist abhängig von der Erregervirulenz, dem Immunsystem des Patienten, der Beschaffenheit des befallenen Gewebes und der sog. kritischen Keimmasse. Die Ausbreitung einer Inf...

Wie der Begriff schon sagt, ist bei diesem Krankheitsbild nicht ein einzelnes Organ betroffen. Vielmehr handelt es sich um multiple Störungen, die nicht nur den Bewegungsapparat betreffen. Gemeinsam ist diesen Erkrankungen, dass sie mit nur wenigen Ausnahmen erblich sind und somit als Heredopathien bezeichnet werden und dass sie in aller Regel mit...

Bereits in der Antike sind Schienungstechniken zur Frakturbehandlung beschrieben worden (Hippokrates, Celsus, El Zahawari, Gooch). Meist resultierte daraus eine Verkürzung der betroffenen Extremität. Die kontinuierliche Traktion kam erstmals im 19. Jahrhundert zur Anwendung. Offene Frakturen waren bis vor 150 Jahren lebensgefährlich und bedeuteten...

Die Funktion der Schulter ist als Leistung einer Gelenkkette zu sehen. Sie basiert auf der Anatomie und dem Zusammenspiel des eigentlichen Schultergelenks (Glenohumeralgelenk), den Schultergürtelgelenken (Akromioklavikular- und Sternoklavikulargelenk) und den »Nebengelenken« der skapulothorakalen und der subakromialen Gleitschicht.

Das Facharztbuch für Ihre Weiterbildung Auf dem neuesten Stand: Didaktisch, umfassend und ausführlich vermitteln die renommierten Herausgeber und ihr Autorenteam das erforderliche Wissen in der Orthopädie und Unfallchirurgie. Systematisch: • Grundlagen des therapeutischen Vorgehens • Systemerkrankungen • Traumatologie • Regionale Orthopädie und U...

Während die Variabilität beim Gehen in der Ebene durch viele Studien untersucht wurde [1], fehlen Studien zur Variabilität beim Treppensteigen. Der Anforderungscharakter beim Treppensteigen ist höher [2, 3] und die Treppenneigung beeinflusst die kinematischen und kinetischen Parameter [3]. Es ist zu vermuten, dass sich die Variabilität bei höheren...

The demographic developments and an increasing number of total knee replacements will lead to more periprosthetic fractures in the future. These fractures can be classified into intraoperative and postoperative. Revisions in particular are associated with a higher incidence of intra-operative fractures, specifically for the tibia and patella. Most...

This report describes a case of spontaneous recurrent hemarthrosis of the knee that presented 4 weeks after total knee arthroplasty. Femoral arteriography showed a false aneurysm of a branch of the inferior lateral geniculate artery. Therapeutic embolization of the arterial branch was performed using three platinum coils with good clinical result a...

The lateral subvastus approach combined with an osteotomy of the tibial tubercle is a recognised, but rarely used approach for total knee replacement (TKR). A total of 32 patients undergoing primary TKR was randomised into two groups, in one of which the lateral subvastus approach combined with a tibial tubercle osteotomy and in the other the media...

Surgical treatment of most displaced proximal humerus fractures is challenging due to osteoporosis. Locking plates are intended to provide superior mechanical stability. In a prospective multicentre study 131 patients were treated with second generation locked plating (NCB-PH, Zimmer, Inc.). The open procedure (n = 78) was performed using a deltope...

Plate osteosynthesis is one treatment option for the stabilization of long bones. It is widely accepted to achieve bone healing with a dynamic and biological fixation where the perfusion of the bone is left intact and micromotion at the fracture gap is allowed. The indications for a dynamic plate osteosynthesis include distal tibial and femoral fra...

Früher war das Ziel bei der Frakturversorgung eine anatomisch perfekte, rigide Osteosynthese mit exakter Reposition aller Fragmente (Abb. 44.1). Eine primäre Frakturheilung wurde angestrebt. Zugschrauben kamen zum Einsatz, das Periost und Muskelgewebe musste zur exakten Reposition im Bereich der Fraktur entfernt werden. Die Folge war neben dem Ausb...

The demographic developments and an increasing number of total knee replacements will lead to more periprosthetic fractures in the future. These fractures can be classified into intraoperative and postoperative. Revisions in particular are associated with a higher incidence of intra-operative fractures, specifically for the tibia and patella. Most...

Periprosthetic fractures after cemented hip replacement are a challenging problem to manage. Biomechanical studies have suggested the benefit of using locking screws for plate fixation, but there are concerns whether screws damage the cement mantle and promote crack propagation leading to construct failure. In this biomechanical study, different sc...

We report early results using a second generation locking plate, non-contact bridging plate (NCB PH((R)), Zimmer Inc. Warsaw, IN, USA), for the treatment of proximal humeral fractures. The NCB PH combines conventional plating technique with polyaxial screw placement and angular stability. Prospective case series. A single level-1 trauma center. A t...

Total knee arthroplasty (TKA) relies on soft tissue to regulate joint stability after surgery. In practice, the exact balance of the gaps can be difficult to measure, and various methods including intra-operative spreaders or distraction devices have been proposed. While individual ligament strain patterns have been measured, no data exist on the i...

We report the application of a new fixed angle plate (NCB DF, Zimmer inc. USA, Warsaw, IN) in the treatment of periprosthetic femur fractures. The NCB DF combines conventional plating technique with polyaxial screw placement and angular stability. Prospective cohort study. A single level-1 trauma center. From May 2003 to December 2005, a total of 2...

ACL-reconstruction aims to restore joint stability and prevent osteoarthritis; however, malfunction and osteoarthritis are often the sequelae. Our study asks whether ACL-reconstruction or conservative treatment lead to better long-term results. In this retrospective cohort study, 136 patients with isolated ACL-rupture who had been treated by bone-l...

Fractures of the osteoporotic proximal femur are a significant source of mortality and morbidity in today's ageing population. Even with modern fixation techniques such as the sliding hip screw, a certain percentage of fixations will fail due to cut-out of the screw. This study presents a new method for augmenting hip screws with cement to reinforc...

Achieving deep flexion after total knee replacement remains a challenge. In this study we compared the soft-tissue tension and tibiofemoral force in a mobile-bearing posterior cruciate ligament-sacrificing total knee replacement, using equal flexion and extension gaps, and with the gaps increased by 2 mm each. The tests were conducted during passiv...

The authors have inadvertently left out several acknowledgments and wish to add them here This study was supported by DePuy International, the University of Western Australia, the Fremantle Hospital, and Mrs. Huggler. We would like to thank Dr. Hilaire Jacob for his help with the development of the mini‐force platform. We would also like to thank t...

Patella infera is a known complication of high tibial osteotomy (HTO) that can cause anterior knee pain due to excessive stresses associated with abnormal patellofemoral (PF) joint biomechanics. However, the translation of these abnormal biomechanics to native cartilage pressure has not been explored. The present study was designed to compare the P...

We compared the biomechanical stability of bone-plate constructs using a compression plate (CP), an internal fixator (IF), and a combination plate (CP/IF). Standardized simulated shaft fractures with a segmental defect in composite bones (n=60) and intraarticular distal femur fractures with a comminuted supracondylar zone in fresh frozen cadaveric...

The bone remodeling sequence after bone fracture changes the concentrations of biochemical bone markers, but the relationships of fracture size and of healing time to changes in biomarkers are unclear. The present pilot study was undertaken to determine the changes found in serum bone markers after plate osteosynthesis of closed distal tibial and m...

Internal fixation of displaced intraarticular calcaneal fractures in patients older than 50 years remains controversial. This is, in many cases, due to fear of loss of fixation and the risk of implant failure in osteoporotic bone. It is the objective of this study to compare the fixation strength obtained using calcaneal plates with and without loc...

To compare the stability and stiffness of dorsal and volar fixed-angle distal radius constructs in a cadaveric model. A locking distal radius system was used in a combination of a dorsal and styloid plate (group 1), a single volar plate (group 2), and a combination of a volar and styloid plate (group 3) configuration. In addition a single volar 3.5...

Like no other joint of the human body the knee depends on intact ligaments. Knee instability due to ligament injuries will cause abnormal joint kinematics, and thereby is made responsible for secondary damage to other important knee joint structures. Diagnosis of knee ligament injuries is based on the detailed history with often typical injury patt...

Correct placement of the femoral and tibial bone tunnels is decisive for a successful anterior cruciate ligament (ACL) reconstruction. Our method of tunnel placement was evaluated as part of quality control at a teaching hospital. The emphasis was placed mainly on investigating the influence of surgical experience on tunnel placement, and the effec...

Das Kniegelenk ist wie kein anderes Gelenk auf einen intakten Bandapparat angewiesen. Bandinsuffizienzen führen zu einer Dissoziation der Roll-Gleit-Bewegung zwischen Tibia und Femur und auf lange Sicht mit grosser Wahrscheinlichkeit zu Sekundärschäden. Die Diagnose von Kapselbandverletzungen ergibt sich zum einen aus der genauen Anamnese mit oft t...

Die femorale Insertion der Sehne des Musculus glutaeus maximus ist eine seltene, aber mehrfach beschriebene Lokalisation einer Tendinosis calcarea [1] [2] [3]. Die extrakorporale Stoßwellentherapie hat sich zur Behandlung verschiedener orthopädischer Krankheitsbilder etabliert [4]. Wir berichten über die erfolgreiche Behandlung eines 50-jährigen Ma...

Patella complications are recognized sequelae of total knee arthroplasty (TKA). Disruption of blood flow to the patella and adjacent soft tissues during surgery may contribute to reduced viability of the bone and patella ligament tissue. The effect on genicular blood flow to the medial and lateral patella was compared for a medial (MA) and lateral...

To determine the biomechanical properties of different fixation methods for high tibial medial opening wedge osteotomy in order to determine appropriate surgical and rehabilitation guidelines. A biomechanical testing examined the construct stiffness and the fixation strength of two different plates. Although medial opening wedge techniques for high...