German Total Ankle Replacement Register of the German Foot and Ankle Society (D. A. F.) - presentation of design and reliability of the data as well as first results

INTRODUCTION Even though arthroplasty of the ankle joint is considered to be an established procedure, only about 1,300 endoprostheses are implanted in Germany annually. Arthrodeses of the ankle joint are performed almost three times more often. This may be due to the availability of the procedure - more than twice as many providers perform arthrodesis - as well as the postulated high frequency of revision procedures of arthroplasties in the literature. In those publications, however, there is often no clear differentiation between revision surgery with exchange of components, subsequent interventions due to complications and subsequent surgery not associated with complications. The German Orthopaedic Foot and Ankle Association's (D. A. F.) registry for total ankle replacement collects data pertaining to perioperative complications as well as cause, nature and extent of the subsequent interventions, and postoperative patient satisfaction. MATERIAL AND METHODS The D. A. F.'s total ankle replacement register is a nation-wide, voluntary registry. After giving written informed consent, the patients can be added to the database by participating providers. Data are collected during hospital stay for surgical treatment, during routine follow-up inspections and in the context of revision surgery. The information can be submitted in paper-based or online formats. The survey instruments are available as minimum data sets or scientific questionnaires which include patient-reported outcome measures (PROMs). The pseudonymous clinical data are collected and evaluated at the Institute for Evaluative Research in Medicine, University of Bern/Switzerland (IEFM). The patient-related data remain on the register's module server in North Rhine-Westphalia, Germany. The registry's methodology as well as the results of the revisions and patient satisfaction for 115 patients with a two year follow-up period are presented. Statistical analyses are performed with SAS™ (Version 9.4, SAS Institute, Inc., Cary, NC, USA). RESULTS About 2½ years after the register was launched there are 621 datasets on primary implantations, 1,427 on follow-ups and 121 records on re-operation available. 49 % of the patients received their implants due to post-traumatic osteoarthritis, 27 % because of a primary osteoarthritis and 15 % of patients suffered from a rheumatic disease. More than 90 % of the primary interventions proceeded without complications. Subsequent interventions were recorded for 84 patients, which corresponds to a rate of 13.5 % with respect to the primary implantations. It should be noted that these secondary procedures also include two-stage procedures not due to a complication. "True revisions" are interventions with exchange of components due to mechanical complications and/or infection and were present in 7.6 % of patients. 415 of the patients commented on their satisfaction with the operative result during the last follow-up: 89.9 % of patients evaluate their outcome as excellent or good, 9.4 % as moderate and only 0.7 % (3 patients) as poor. In these three cases a component loosening or symptomatic USG osteoarthritis was present. Two-year follow-up data using the American Orthopedic Foot and Ankle Society Ankle and Hindfoot Scale (AOFAS-AHS) are already available for 115 patients. The median AOFAS-AHS score increased from 33 points preoperatively to more than 80 points three to six months postoperatively. This increase remained nearly constant over the entire two-year follow-up period. CONCLUSION Covering less than 10 % of the approximately 240 providers in Germany and approximately 12 % of the annually implanted total ankle-replacements, the D. A. F.-register is still far from being seen as a national registry. Nevertheless, geographical coverage and inclusion of "high-" (more than 100 total ankle replacements a year) and "low-volume surgeons" (less than 5 total ankle replacements a year) make the register representative for Germany. The registry data show that the number of subsequent interventions and in particular the "true revision" procedures are markedly lower than the 20 % often postulated in the literature. In addition, a high level of patient satisfaction over the short and medium term is recorded. From the perspective of the authors, these results indicate that total ankle arthroplasty - given a correct indication and appropriate selection of patients - is not inferior to an ankle arthrodesis concerning patients' satisfaction and function. First valid survival rates can be expected about 10 years after the register's start.

The astrological works of Abraham Ibn Ezra : a literary and linguistic study with special reference to the Old French translation of Hagin

by Raphael Levy

The Construction of the Image of Peace in Ancient Greece : A few literary and Iconographic Evidences

El presente artículo busca identificar y analizar algunas de los principales tratamientos poéticos y artísticos del binomio paz / riqueza en una perspectiva diacrónica y comparativa, intentando aislar las más frecuentes imágenes, metáforas y epítetos relacionados con ese tema. El estudio de los pasajes elegidos deja claro cómo ambos, poetas y artistas plásticos, conocían y manipulaban con su arte un mismo patrimonio bastante antiguo

The Construction of the Image of Peace in Ancient Greece : A few literary and Iconographic Evidences

El presente artículo busca identificar y analizar algunas de los principales tratamientos poéticos y artísticos del binomio paz / riqueza en una perspectiva diacrónica y comparativa, intentando aislar las más frecuentes imágenes, metáforas y epítetos relacionados con ese tema. El estudio de los pasajes elegidos deja claro cómo ambos, poetas y artistas plásticos, conocían y manipulaban con su arte un mismo patrimonio bastante antiguo

The Construction of the Image of Peace in Ancient Greece : A few literary and Iconographic Evidences

El presente artículo busca identificar y analizar algunas de los principales tratamientos poéticos y artísticos del binomio paz / riqueza en una perspectiva diacrónica y comparativa, intentando aislar las más frecuentes imágenes, metáforas y epítetos relacionados con ese tema. El estudio de los pasajes elegidos deja claro cómo ambos, poetas y artistas plásticos, conocían y manipulaban con su arte un mismo patrimonio bastante antiguo

Embodied Religion and Liberal Society: The Obstacle of De Facto Established Religion

Recent scholarship suggests that religion should be conceived in terms of embodied social practices as much as (if not more than) a set of systematic beliefs. Such accounts of religion, I will argue, raise problems that have not been adequately treated in current discussion of the role of religion in liberal society.

A Divine Round Trip: the Literary and Christological Function of the Descent/Ascent Leitmotif in the Gospel of John

The thesis of this dissertation is that the Descent/Ascent Leitmotif, which includes the language of not only descending and ascending, but also going, coming, and being sent, performs a significant literary and christological function in the Gospel of John. The Evangelist's Descent/Ascent Leitmotif becomes the Gospel's organizing principal, drawing together a constellation of verbs and a number of themes, including Jesus-Son's origin, identity, relationship to God, authority, signs and works, life, and glory. In the introductory chapter, after providing a layout of the dissertation, the discussion turns to the spacial dimensions and christological importance of the vertical and horizontal depictions of the descending, ascending, coming, going, and being sent verbs. The focus of chapter two is to explain and illustrate, using a version of the Cinderella story, a method that serves to identify the Leitmotif and the verbs, motifs, and themes the Leitmotif draws within its constellation. This approach, titled a thematic structural method, integrates works from thematic scholars Horst Daemmrich and Eugene Falk with works from literary structural scholars A. J Greimas and Roland Barthes, and is a tool to analyze the influence of the Leitmotif as the Gospel's organizing principal on the relationships between the Leitmotif and numerous themes from which John's Christology emerges. The task of chapter three is to explain the rationale for the selection of the Leitmotif's verbs of descending, ascending, coming, going, and being sent. Chapters four and five investigate how the Evangelist, with the repetition of the Leitmotif, constructs his narrative to tell the story of the historical Jesus and shape the Evangelist's Christology. Additionally, the focus is to analyze the transforming influences of the Descent/Ascent Leitmotif on the themes of Jesus-Son's origin, identity, relationship to the Father, and authority, through his signs and works, life, and glory. The Descent/Ascent Leitmotif depicts a divine round trip, and the emphasis of chapter six is to examine the role of the Leitmotif in Jesus-Son's departure from the world and return to God. The Evangelist's use of the Leitmotif in Jesus' prayer to the Father (John 17) and the promise of the Paraclete are included in this chapter. Due to the Descent/Ascent Leitmotif's inherent spatial overtones, elements related to Jesus' return, including heaven, world, the hour, and his form after his resurrection, are explored from a cosmological and ontological perspective.

Transactions of the American Philosophical Society.

new ser.:v.2 (1825)

Transactions of the American Philosophical Society.

new ser.:v.16 (1890)