move! - Mathys AG Bettlach

from the professional fi eld
Patients in the know:
retrieving information from the web
Medicine is becoming more democratic. Medical
information for patients has become freely
available on the internet. But not all health
information that you fi nd on the web is serious
by a long chalk and it does not always refl ect
the current status of medical research. Thus
when treating patients who have taken their
information from this source it is more vital
than ever before for physicians to be competent
in their fi eld and to know how to give the
right advice.
WPatients with a thirst for information can
drink their fi ll when it comes to the internet.
But unfortunately they do not know where the
water comes from,“ is what anaesthetist Faith
McLellan once said [1] . It is hardly possible to
give a more apt description of the problem of
quality assurance for medical information on
the internet. There are now probably more
than 25 million internet pages throughout
the world dealing with matters of health.
Many surfers are simply overwhelmed by this
vast amount of information. It is particularly
diffi cult for them to evaluate the information
they can fi nd. According to a current survey of
internet users suffering from cancer, two thirds
of the respondents frequently did not know
how accurate the information they fi nd is and
if it applies to them personally. [2]
Improving online skills
But what attracts patients to the internet? The
Swiss Health On the Net Foundation has found
that many of those who use the internet as a
source of information want to check on their
physicians. 6 out of 10 use their website visits
to seek a second independent opinion on their
[1] McLellan, F.: “Like hunger, like thirst”: patients,
journals, and the internet, The Lancet, volume 352,
Supplement 2, 3 October 1998. [2] Vgl. Kirschning, S.;
Michel, S.; von Kardoff, E.: Der online informierte Patient:
Offener Dialog gesucht; in. Deutsches Ärzteblatt
101, number 46 of 12.11.2004. [3] See Lindner, M.:
Internet macht Patienten schlauer; in: Tages-Anzeiger of
6.6.2000, page 42.
illness and roughly an equal number wish to
discuss what they have found with their doctor.
[3]
To condemn the internet generally would
therefore mean ignoring the interest that patients
have demonstrated in becoming actively
involved with their own state of health. It is
Without risks and side-effects
Check list for patients
better to demonstrate one‘s own online skills
and to give patients special assistance in their
search, showing them how they can correctly
evaluate the medical information that they fi nd
on the web. The following check list for fi nding
information on the internet, without running
any risks, can be a start.
The amount of health information around, particularly on the internet, is positively
overwhelming. Although it is good to know as much as possible about one‘s own condition
and possibilities for therapy, it is becoming increasingly more diffi cult to determine
whether the information is accurate and complete and whether it originates from a serious
source. The following 7 tips are intended as an aid in seeking the answers to medical
questions without “risks and side-effects“.
Transparency
Operators of websites and authors of articles that are published on the internet should
always identify themselves. Was the article written by a trained physician, an independent
author, a pharmaceutical company or a health insurance fund? As a rule this
information can be found under headings such as Wmasthead“, Wcontact“ or similar.
Healthy mistrust
You should generally be suspicious of sensational healing promises, superlatives and
claims to exclusivity.
Crosschecking
Always consult several sources for medical information. In this way you can fi nd out
whether there are any differing opinions.
State of the art
Find out how “up to date“ the information is. Make sure that the publication date,
the author and the sources are given.
Contents
The following questions will help you to check the quality and the seriousness of the
contents:
Is the information understandable and clear?
Are the suggested therapies clearly described?
Are the advantages and disadvantages of the therapy described?
Are there any indications of further studies and forms of treatment?
Is it indicated where the information comes from?
Is there any mention of further sources?
Have all your questions been answered?
Consultation
When you fi nd medical information that makes you feel uneasy or makes you want to
discuss it with your doctor, then print it out and take it with you when you go to your
next appointment.
No substitute for a doctor
The internet can help you to fi nd information or to prepare for your appointment with
your doctor, but it cannot replace a talk with a doctor that you trust!
For your use
Mobile X-ray
made easy
With the Mobilett XP, Siemens Medical Solutions
offers what is currently the most lightweight
mobile X-ray system in its class.
A user-friendly piece of equipment for use
in the intensive care unit, in the hospital ward
and in paediatrics; its “giraffe design“ takes
away children‘s fear of being examined.
Up to ten times more effi cient in taking images.
Thanks to its excellent imaging with very
short exposure times, it can also be used in the
neonatal ward.
Optimised weight; a motorised drive for
narrow passages, thresholds and slopes; Mobilett
XP hybrid version with a rechargeable,
powerful, long-life battery for cable-free operation.
The revolving double arm with its fully rotating
X-ray tube assembly can be optimally positioned
in the smallest space. It is also ideally
suited for demanding clinical applications.
During the examination the patient can sit,
lie down or adopt a different position.
Siemens AG
Siemensstraße 1
91301 Forchheim
Telephone +49 9191 18-0
Fax +49 9191 18-99 65
More information at
www.siemens.com/medical
Masthead
Publisher:
Mathys Ltd Bettlach Güterstrasse 5 2544 Bettlach Switzerland
Telephone No.: +41 (0)32 644 1 497 E-Mail: move@mathysmedical.com
Editor responsible for the magazine:
Regula Haag Corporate and Market Communication Mathys Ltd Bettlach
Concept and design:
IFAM Institut für angewandte Marketing-Wissenschaften GmbH D-40545 Düsseldorf
DVD for physiotherapy
With the “Professional Physio at Home” DVD
patients can undergo an individual course of
physiotherapy in the comfort of their own
homes under the expert guidance of a physiotherapist.
A 50-minute DVD with a complete course of
physiotherapy in 5 languages; 30 physiotherapy
exercises put together by the Reha-Hospital
Medical Park St. Hubertus in Bad Wiessee,
introduced and explained by a trained physiotherapist.
The physiotherapy course is intended for
rehabilitation after injuries and surgery, as a
therapy for wear on the joints and for preventing
the malfunctioning of the musculoskeletal
system.
The four training blocks, Shoulders/Arm,
Rump, Knees/Hips and Stretching, can be selected
to fi t the needs of the patient; depending
on their complaints and the time available,
patients can put together their own individual
course of physiotherapy.
Send for your free copy
move! is published by Mathys Ltd Bettlach
– your competent partner for total endoprosthetic
treatment in orthopaedics. With
new, useful information, move! is addressed
to specialists in orthopaedics and traumatology
in hospitals and practices, as well as all
specialist and management staff in the
medical fi eld, nursing staff and general management
in hospitals. We would like to
thank all of those who have helped us in re-
Armacell GmbH
Robert-Bosch-Str. 10
D-48 153 Münster
Telephone +49 (0)2 51 76 03 333
Fax +49 (0)2 51 76 03 263
Email armasport.de@armacell.com
More information at www.armasport.com
Doctor www.
The internet guide for your patients
It does exist: good information on the internet
with sound and up-to-date information about
health for your patients. We have conscientiously
searched the web and put together a list
of “healthy“ and trustworthy internet addresses.
By specifically drawing the attention of your patients
to these pages, you reduce the risk that they
will take their information from websites of poor
quality. You can send for this small internet guide
free of charge and pass it on to your patients
Simply fax the form to: +41 (0)32 644 1 460
Or just send an e-mail to move@mathysmedical.com
alising the publication of move! by making
individual contributions, or providing information
and photographs. Do you have some
news or tips about orthopaedics and or clinical
practice for us? You would like to make
your own contribution to move! We would
be pleased to hear from you. Please use the
enclosed fax form. Or, you can contact us
directly by telephone or using email.
move! a new way of thinking about everyday life
Avoiding errors through better communication
Is it more dangerous to stay at a clinic than
to fl y across the Atlantic? In terms of pure sta-
tistics it is. In contrast to plane crashes avoid-
able medical errors are regarded as being one
of the most frequent causes of death.
Dr Christian Husek, a physician and an enthu-
siastic pilot, believes that medicine can learn a
number of things from aviation when it comes
to avoiding errors.
Dr Husek, according to a study carried out
by the University of Texas, 60% of surgeons,
specialists in intensive care medicine
and anaesthetists believe that they
can work effi ciently even if they are tired
and suffering from stress. Are physicians
really more resistant to stress than other
people?
Unfortunately they are not. However physicians
have a special self-image as far as their
work is concerned. They make great demands
on themselves. They want to be ready at hand
and always there for the patient. In this way
they push themselves beyond their own limits.
This pronounced altruism and their enormous
sense of responsibility makes many physicians
work to the point of exhaustion. This can lead
to burnout or even to alcoholism. It can also
cause them to make mistakes.
What makes you think that physicians can
learn from pilots?
in medicine and in the clinic
Stimuli from orthopaedics and the professional field – For physicians, specialists and executives
As I have a lot to do with fl ying, I have witnessed
the strategies that have been used
successfully in aviation for more than 30 years.
Because of major catastrophes pilots have
learned to recognise the typical causes and to
draw the necessary conclusions. Besides great
physical and psychological stress, communication,
for example, is also a risk factor. This is
why special training is given in communication
in aviation. This ranges from the use of certain
standard phrases to the conscious avoidance
of terms that could be misunderstood. In
medicine, on the other hand, the abbreviation
“HWI”, as it is used in German, can mean an
“acute myocardial infarction” or a “urinary
tract infection”.
»
Cockpit communication
guidelines are good assistance
in the operating theatre.
«
So you think that an effi cient error and risk
management system should be institutionalised
in a similar way in medicine?
I am primarily concerned with introducing into
medicine the type of thinking used to avoid
errors in aviation and thus triggering a new
attitude among physicians. First of all we need
to be conscious of how errors can be avoided
through communication. This not only includes
accepting errors and criticism, but also letting
others take part and learning from one‘s own
mistakes. Besides this, it is necessary to improve
communication and to give training in commu-
nication techniques in the medical profession
and within teams. During our training we learn
how to converse with patients, but nothing at
all about communication among ourselves or
with other members of the team.
Continued on next page > > > >
Dr. Christian Husek
Issue 14 / February 2005
Dr. Christian Husek is a physician for general
medicine and has been established in his own
practice in Vienna for 20 years. He has additional
training in sport and aviation medicine
and examines professional pilots to determine
whether they are fi t to fl y.
After medicine, fl ying is his second greatest
passion. As a qualifi ed pilot for gliders and
powered aircraft with a licence to fl y multiengine
aeroplanes and a teaching certifi cate,
he is familiar with human capabilities and their
limits. He teaches what physicians can learn
from pilots during special training courses on
medical resource management. “The calm,
concentration, precise communication and
cool-headedness that fl ying demands of me
helped me in my medical practice,“ he says.
More information at www.medtraining.at
94607_12_MOVE14E_RZ_2 1 20.01.2005, 12:35:07 Uhr

Continuation
Further approaches are system improvements,
for example concerning
working hours and budgets,
user-friendly layouts for medical
equipment and materials or the
introduction of check lists and
standard operating procedures.
Physicians themselves must think
about how they can avoid errors
and risks in their own fi elds.
Using the model of crew resource
management for pilots,
you and a colleague have developed
resource management
training for individual physicians
and teams. What does
this entail?
We are mainly concerned with
improving the action and communication
processes of physicians
amongst each other and within
their teams. We teach the course
participants how to apply concepts
that are successfully used in aviation
to their own situation at the
hospital. Cockpit communication
guidelines, for example, are also
of good assistance in the operating
theatre. This also means that the
co-pilot, or the assistant physician,
can provide valuable input and his
advice is heeded by the captain,
the head of the medical team. After
all, it is not a question of who is
right, but of what is right.
As far as I know, there are also
similar training programmes in
Switzerland and Germany. They
are particularly suitable for surgical
teams, anaesthetists, specialists in
intensive care medicine and teams
working in casualty, but also for
colleagues in established practices
who often show a considerable
lack of skill in communicating with
specialists and for physicians who
work in clinics.
Dr. Husek, thank you for this interview.__//
focus on science
The RM Cup
A success story through changing times
Hardly any endoprosthetic product can look
back on such a long history, but it has lost
nothing of its relevance for the present day
and its results remain excellent. Developed
by Robert Mathyssen at the beginning of
the 70s as an “isoelastic cup“ made of poly-
acetal, the RM Cup was implanted for the
fi rst time in 1973 by Professor Morscher.
From 1977 the RM Cup was manufactured
from high-density polyethylene. Because clinical
experiences showed that uncoated RM cups
produced no osseo integration, from 1984 they
had either a hydroxyapatite coating (HA, Ceros
80) or a coating of cp titanium powder (TiCP)
and were manufactured from UHWPE. From
1996 gamma sterilisation was carried out in
nitrogen and no longer in air, as had previously
been the case. The cup was given credit when
a dedicated book, “Die RM Pfanne“ [1] was
published by the Einhorn Verlag in 1997. The
book describes the basics, the bio-mechanical
concept and the medium-term results.
Excellent clinical results
All the more modern data attest that the RM
Cup has good to very good survival rates, both
in the medium term and in the long term (table
1). In this respect the RM Cup has some of
the best results of those listed in the Swedish
Hip Register [1] . It also has signifi cantly less migration
during the fi rst 2 years in comparison
with a modular cup [3] . It has been found to
have very good abrasion fi gures in a post-surgical
examination phase of approx. 8 years [1] .
The RM Cup as a subject
of scientifi c debate
The RM Cup has naturally come in for some
criticism as well. For example there are always
studies now and again that give it poor results
[5,6] . However, without exception these
studies dealt with the uncoated cup which
has not been produced since 1984. The clinical
work carried out by Professor Morscher [7] regarding
the storage of intra-articular hydroxyapatite
grains that might possibly have accelerated
the abrasion gave rise to some debate at
the time. However, on closer analysis, his work
attests that the RM Cup also has excellent survival
rates. Young et al [8] and McCombe et al [9]
have found that there was both less abrasion
and less osteolysis in the case of non-modular
cup systems.
This phenomenon could be attributed to a
number of factors. While Young sees “backside
wear“ as the cause of osteolysis and
attributes the increased abrasion to the micromovements,
McCombe mainly sees isoelastic-
ity as the reason for the better results achieved
by non-modular systems.
New insights and developments
A comprehensive study of more than 2300
patients operated on between 1984 and 2000
is currently being carried out by a team headed
by Dr Thilo John from the Benjamin Franklin
Clinic in Berlin. Without exception, the fi rst
insights confi rm the good results in relation to
aseptic loosening and revisions.
The prostheses with a polyethylene ceramic
pair have better abrasion characteristics than
the polyethylene metal pairs, an observation
that was recently confi rmed by Blencke [10]
.These insights provided the basis for the
most recent development in the RM family,
the RM pressfi t, cup. This no longer achieves
its primary stability through pegs, but through
the over-dimensioning of the basic structure.
The proven concepts of isoelasticity and the
particle coating were rigorously maintained.
The pressfi t cup is also excellent for minimally
TabelTable 1: Survival of the RM Cup in percent according to the number of years
(in brackets, in as far as available, the fi gures for purely aseptic loosening)
[1] Bergmann E. G. Die RM-Pfanne, Monographie eines beschichteten Hüftgelenkimplantates.
Einhorn-Presse Verlag. ISBN 3-88756-493-9. 1997. [2] Annual Report 2002 The Swedish National
Hip Arthroplasty Register. www.jru.orthop.gu.se. [3] Krismer M, Fischer M, Mayrhofer P,
Stockl F, Bittner C, Trojer C, Stockl B. A prospective study of the migration of two acetabular
components. PCA versus RM cups. Int Orthop. 1994 Feb;18(1):23-8. [4] Young AM, Sychterz
CJ, Hopper RH Jr, Engh CA. Effect of acetabular modularity on polyethylene wear and osteolysis
in total hip arthroplasty. J Bone Joint Surg Am. 2002 Jan;84-A(1):58-63. [5] Guther D,
Pap G, Bamert P, Eggli S. [Long-term results with the cementless CLS stem in hip replacement]
Z Orthop Ihre Grenzgeb. 2003 May-Jun;141(3):309-15. German. [6] Llinas A, Sarmiento A,
Ebramzadeh E, Park SH, Campbell P, McKellop HA. Mechanism of failure in hips with an
uncemented, all polyethylene socket. Clin Orthop. 1999 May(362):145-55. [7] Morscher EW,
Hefti A, Aebi U. Severe osteolysis after third-body wear due to hydroxyapatite particles from
acetabular cup coating. J Bone Joint Surg Br. 1998 Mar;80(2):267-72. [8] Young AM, Sychterz
CJ, Hopper RH Jr, Engh CA. Effect of acetabular modularity on polyethylene wear and osteolysis
in total hip arthroplasty. J Bone Joint Surg Am. 2002 Jan;84-A(1):58-63. [9] McCombe,
Williams SA. A comparison of polyethylene wear rates between cemented and cementless
cups. A prospective, randomised trial. J Bone and Joint Surg. 2004 86-B:344-349. [10] Blencke
B.A. Mittelfristige Ergebnisse der Implatation beschichteter RM-Pfannen (12-Jahres-Ergebnisse).
Orthopädische Praxis 40, 9 (2004)
Author and year N 5 years 6 - 10 years 11 - 15 years Remarks
Blencke (talk) 1235 97,5 HA and TiCP
Staudte, 1997 (RM book) 150 98.6 TiCP
Flückiger, 1997 (RM book) 150 96.6 (98) HA
Morscher 1998 (publication) 460 94.8 (97.5) HA with 32-type head
Roffmann 1999 (publication) 29 100 TiCP
Roffmann 1999 (publication) 96 100 100 HA
Täger 2001 (publication) 60 97.0 (98.3) TiCP
Danilyak, 2003 (talk) 876 99.2 (99.7) TiCP
Salman Ali, 2003 (publication) 127 97.7 HA
Diks 2004 in press 630 91 (99) TiCP
Horne 2004 in press 130 99.0 TiCP
Blencke 2004 (publication) 307 96.4 TiCP
MEMI register data 2004 277 98.0 96.5 TiCP
MEMI register data 2004 555 98.5 98.1 HA
Mean survival TiCP 3077 98.6 97.0 (98.6) 96.7 (97.4)
Mean survival HA 2005 99.2 97.5 (98.3) 94.8 (97.5)
invasive implantation. The fi rst clinical results
give grounds to be confi dent that a new chapter
has thus been opened in the success story
of the RM Cup.
move!-events in 2005
This is where you can meet us personally
13 to 14 January 2005, Netherlands
NOV jaarcongres / NOV yearly congress in Velthoven
more at www.nov2005.nl
Paul van der Wielen telephone: +31 (0) 30 693 45 90
10 to 12 February 2005, Austria
4th Wiener Zukunftssymposium Unfallchirurgie - Sporttraumatologie
in Vienna, AKH Hörsaalzentrum more at www.viennasymposium.com
Susanne Veit telephone: +43 (0) 1 706 25 25-22
25 to 26 February 2005, Austria
4th Viennese Int. Shoulder Replacement Course in Vienna
in connection with Affi nis workshop, Anatomisches Institut
more at www.arthroskopie.at
Susanne Veit telephone: +43 (0) 1 706 25 25-22
4 to 5 March 2005, Germany
AMOU, 9th annual conference of Arbeitskreis Mitteldeutscher
Orthopädischer Universitätskliniken in Halle more at www.amou.de
Anne Arnold telephone: +49 (0) 36428 494-12
28 April to 1 May 2005, Germany
53rd annual conference of Vereinigung Süddeutscher Orthopäden e.V.
in Baden-Baden in connection with the UNI-Knie workshop
more at www.vso-ev.de
Anne Arnold telephone: +49 (0) 36428 494-12
18 to 20 May 2005, Belgium
Orthopaedica Belgica Congrès in Liège
Michèle Ysenbrant telephone: +32 (0) 16 38 81 23
20 May 2005, Netherlands
NOV Spring Meeting Nederlandse Orthopaeden Vereniging
Paul van der Wielen telephone: +31 (0) 30 693 45 90
26 to 28 May 2005, Austria
46th Oesterreichischer Chirurgenkongress in Vienna, Hofburg
more at www.chirurgenkongress.at
Susanne Veit telephone: +43 (0) 1 706 25 25-22
27 May 2005, Germany
Lunchworkshop, 1.5 hours News and Basics of the Mathys
Schulterendoprothetik in Weimar PD Dr. Irlenbusch, PD Dr. Wahl
Anne Arnold telephone: +49 (0) 36428 494-12
27 to 28 May 2005, Germany
DVSE, 12th annual conference of Deutsche Vereinigung
für Schulter- und Ellenbogenchirurgie e.V. in Weimar
more at www.schulterkongress2005.de
Anne Arnold telephone: +49 (0) 36428 494-12
8 to 10 June 2005, Switzerland
3. SGC Schweiz in Zürich
Franziska Fontana telephone: +41 (0) 32 644 1 282
16 to 18 June 2005, Germany
NOV, 54th annual conference of Norddeutsche
Orthopädenvereinigung e.V. in Hamburg
Anne Arnold telephone: +49 (0) 36428 494-12
1 to 2 September 2005, Switzerland
Bieler Fortbildungstage SGAUC in Biel
Franziska Fontana telephone: + 41 (0) 32 644 1 282
7 to 9 September 2005, Switzerland
SGO, annual conference of the Swiss Society for Orthopaedics
in Zürich more at www.sgosso.ch
Franziska Fontana telephone: +41 (0) 32 644 1 282
21 to 23 September 2005, United Kingdom
BOA Annual Congress, ICC Birmingham
more at www.boa.ac.uk
Sue Williams telephone: + 44 (0) 8450 580938
6 to 8 October 2005, Austria
ÖGU – annual conference of Ges. für Unfallchirurgie
in Salzburg, Renaissance Hotel
more at www.unfallchirurgen.at/aerzte_events_oegu.php3
Susanne Veit telephone: +43 (0) 1 706 25 25-22
9 to 14 October 2005, Australia
Annual Scientifi c Meeting Australian Orthopaedic Association
Mathys Australia telephone: +61 2 9310 7053
14 October 2005, Netherlands (date is not certifi ed yet)
NOV Autumn Meeting Nederlandse orthopaeden Vereniging
Paul van der Wielen telephone: +31 (0) 30 693 45 90
19 to 22 October 2005, Germany
DGU, 69th annual conference of Deutsche Gesellschaft
für Unfallchirurgie e.V. in Berlin
Anne Arnold telephone: +49 (0) 36428 494-12
19 to 22 October 2005, Germany
DGOOC, 91st conference of Deutsche Gesellschaft für
Orthopädie und Orthopädische Chirurgie e.V. in Berlin
Anne Arnold telephone: +49 (0) 36428 494-12
19 to 22 October 2005, Germany
BVO, 46th conference of Berufsverband der Fachärzte
für Orthopädie e.V. in Berlin
Anne Arnold telephone: +49 (0) 36428 494-12
9 to 13 October 2005, Italy
S.I.O.T. in Florenz more at www.oic.it
Fabrizio Sardanelli e-mail: info.it@mathysmedical.com
26 to 28 October 2005, Russia
6. Congress of Russian Arthroscopic Society in Moscow
Irina Medvedeva telephone: +7 (0) 95 232 22 02
3 to 4 November 2005, Netherlands
Trauma dagen / Trauma days
Paul van der Wielen telephone: +31 (0) 30 693 45 90
7 to 11 November 2005, France
SOFCOT, Société française de chirurgie orthopédique et
traumatologique in Paris more at www.sofcot.com.fr
Corinne Coutard telephone: +33 (0) 473 23 95 95
30 November to 3 December 2005, Austria
ÖGO – annual congress of Ges. für Orthopädie in Innsbruck, Congress
more at www.orthopaedics.or.at/kongress.htm
Susanne Veit telephone: +43 (0) 1 706 25 25-22
Further events are listed at our website www.mathysmedical.com
94607_12_MOVE14E_RZ_2 2 20.01.2005, 12:35:11 Uhr