@article{ArnholdtGilbertBlanketal.2017, author = {Arnholdt, J{\"o}rg and Gilbert, Fabian and Blank, Marc and Papazoglou, Jannis and Rudert, Maximilian and N{\"o}th, Ulrich and Steinert, Andre F.}, title = {The Mayo conservative hip: complication analysis and management of the first 41 cases performed at a University level 1 department}, series = {BMC Muskoskeletal Disorders}, volume = {18}, journal = {BMC Muskoskeletal Disorders}, number = {250}, doi = {10.1186/s12891-017-1613-2}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-157812}, year = {2017}, abstract = {Background: To prevent bone loss in hip arthroplasty, several short stem systems have been developed, including the Mayo conservative hip system. While there is a plethora of data confirming inherent advantages of these systems, only little is known about potential complications, especially when surgeons start to use these systems. Methods: In this study, we present a retrospective analysis of the patients' outcome, complications and the complication management of the first 41 Mayo conservative hips performed in 37 patients. For this reason, functional scores, radiographic analyses, peri- and postoperative complications were assessed at an average follow-up of 35 months. Results: The overall HHS improved from 61.2 pre-operatively to 85.6 post-operatively. The German Extra Short Musculoskeletal Function Assessment Questionnaire (XSFMA-D) improved from 30.3 pre-operatively to 12.2 post-operatively. The most common complication was an intraoperative non-displaced fracture of the proximal femur observed in 5 cases (12.1\%). Diabetes, higher BMI and older ages were shown to be risk factors for these intra-operative periprosthetic fractures (p < 0.01). Radiographic analysis revealed a good offset reconstruction in all cases. Conclusion: In our series, a high complication rate with 12.1\% of non-displaced proximal femoral fractures was observed using the Mayo conservative hip. This may be attributed to the flat learning curve of the system or the inherent patient characteristics of the presented cohort."}, language = {en} } @article{BoelchRuecklFuchsetal.2018, author = {Boelch, Sebastian P. and Rueckl, Kilian and Fuchs, Clara and Jordan, Martin and Knauer, Markus and Steinert, Andre and Rudert, Maximilian and Luedemann, Martin}, title = {Comparison of elution characteristics and compressive strength of biantibiotic-loaded PMMA bone cement for spacers: Copal\(^®\) spacem with gentamicin and vancomycin versus Palacos\(^®\) R+G with vancomycin}, series = {BioMed Research International}, volume = {2018}, journal = {BioMed Research International}, number = {4323518}, doi = {10.1155/2018/4323518}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-177435}, year = {2018}, abstract = {Purpose. Copal\(^®\) spacem is a new PMMA bone cement for fabricating spacers. This study compares elution of gentamicin, elution of vancomycin, and compressive strength of Copal\(^®\) spacem and of Palacos\(^®\) R+G at different vancomycin loadings in the powder of the cements. We hypothesized that antibiotic elution of Copal\(^®\) spacem is superior at comparable compressive strength. Methods. Compression test specimens were fabricated using Copal\(^®\) spacem manually loaded with 0.5 g gentamicin and additionally 2 g, 4 g, and 6 g of vancomycin per 40 g of cement powder (COP specimens) and using 0.5 g gentamicin premixed Palacos\(^®\) R+G manually loaded with 2 g, 4 g, and 6 g of vancomycin per 40 g of cement powder (PAL specimens). These specimens were used for determination of gentamicin and vancomycin elution (in fetal calf serum, at 22°C) and for determination of compressive strength both prior and following the elution tests. Results. Cumulative gentamicin concentrations (p < 0.005) and gentamicin concentration after 28 days (p ≤ 0.043) were significantly lower for COP specimens compared to PAL specimens. Cumulative vancomycin concentrations were significantly higher (p ≤ 0.043) for COP specimens after the second day. Vancomycin concentrations after 28 days were not significantly higher for the Copal specimens loaded with 2 g and 4 g of vancomycin. Compressive strength was not significantly different between COP specimens and PAL specimens before elution tests. Compressive strength after the elution tests was significantly lower (p = 0.005) for COP specimens loaded with 2 g of vancomycin. Conclusion. We could not demonstrate consistent superior antibiotic elution from Copal\(^®\) spacem compared to Palacos\(^®\) R+G for fabricating gentamicin and vancomycin loaded spacers. The results do not favor Copal\(^®\) spacem over Palacos\(^®\) R+G for the use as a gentamicin and vancomycin biantibiotic-loaded spacer.}, language = {en} } @article{JakuscheitSchaeferRoedigetal.2021, author = {Jakuscheit, Axel and Schaefer, Nina and Roedig, Johannes and Luedemann, Martin and Hertzberg-Boelch, Sebastian Philipp von and Weissenberger, Manuel and Schmidt, Karsten and Holzapfel, Boris Michael and Rudert, Maximilian}, title = {Modifiable individual risks of perioperative blood transfusions and acute postoperative complications in total hip and knee arthroplasty}, series = {Journal of Personalized Medicine}, volume = {11}, journal = {Journal of Personalized Medicine}, number = {11}, issn = {2075-4426}, doi = {10.3390/jpm11111223}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-250290}, year = {2021}, abstract = {Background: The primary aim of this study was to identify modifiable patient-related predictors of blood transfusions and perioperative complications in total hip and knee arthroplasty. Individual predictor-adjusted risks can be used to define preoperative treatment thresholds. Methods: We performed this retrospective monocentric study in orthopaedic patients who underwent primary total knee or hip arthroplasty. Multivariate logistic regression models were used to assess the predictive value of patient-related characteristics. Predictor-adjusted individual risks of blood transfusions and the occurrence of any perioperative adverse event were calculated for potentially modifiable risk factors. Results: 3754 patients were included in this study. The overall blood transfusion and complication rates were 4.8\% and 6.4\%, respectively. Haemoglobin concentration (Hb, p < 0.001), low body mass index (BMI, p < 0.001) and estimated glomerular filtration rate (eGFR, p = 0.004) were the strongest potentially modifiable predictors of a blood transfusion. EGFR (p = 0.001) was the strongest potentially modifiable predictor of a complication. Predictor-adjusted risks of blood transfusions and acute postoperative complications were calculated for Hb and eGFR. Hb = 12.5 g/dL, BMI = 17.6 kg/m\(^2\), and eGFR = 54 min/mL were associated, respectively, with a 10\% risk of a blood transfusion, eGFR = 59 mL/min was associated with a 10\% risk of a complication. Conclusion: The individual risks for blood transfusions and acute postoperative complications are strongly increased in patients with a low preoperative Hb, low BMI or low eGFR. We recommend aiming at a preoperative Hb ≥ 13g/dL, an eGFR ≥ 60 mL/min and to avoid a low BMI. Future studies must show if a preoperative increase of eGFR and BMI is feasible and truly beneficial.}, language = {en} } @phdthesis{Momper2021, author = {Momper, Laurent}, title = {Interaktion der Schl{\"u}sselenzyme der Mineralisierung (AP, ENPP1, AnkH, PHOSPHO1) im Phosphatstoffwechsel in vitro}, doi = {10.25972/OPUS-23852}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-238529}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2021}, abstract = {Die Enzyme TNSALP (Tissue Non-Specific Alkaline Phosphatase), ENPP1 (Ectonucleotide Pyrophosphatase/Phosphodiesterase 1) und ANKH (Ankylosis, progressive human homolog) bilden zusammen eine zentrale Regulierungseinheit f{\"u}r den Pyrophosphat (PPi)-Stoffwechsel der Zelle [1, 2]. St{\"o}rungen dieses genau geregelten Prozesses resultieren in schwerwiegenden Erkrankungen, wie z.B. bei der Hypophosphatasie [3]. Dieser meist autosomal rezessiv vererbten Erkrankung liegt eine durch genetische Mutationen beeintr{\"a}chtigte Funktion der TNSALP zugrunde, wodurch sich die PPi- Konzentration im Microenvironment der Zelle erh{\"o}ht. Diese kann im Knochengewebe zu schweren Mineralisierungsst{\"o}rungen f{\"u}hren [1, 2]. Andere Krankheiten, mit erniedrigten PPi- Konzentrationen, werden mit pathologischen Verkalkungen in verschiedensten Geweben in Verbindung gebracht [4, 5]. Diese gehen unter anderem auf genetische Defekte von ENPP1 zur{\"u}ck[4]. Auch der Mevalonat-Pathway tr{\"a}gt zur Komposition des Microenvironments bez{\"u}glich der Hom{\"o}ostase von Phosphaten bei [6, 7]. Hier bestehen auch medizinisch relevante Einflussm{\"o}glichkeiten, zum Beispiel durch Bisphosphonate, bei der sogenannten Volkskrankheit Osteoporose. In dieser Arbeit wurden die Auswirkungen einer PPi-Belastung auf die in vitro Mineralisierung von Mesenchymalen Stammzellen untersucht, wobei Modulatoren der Enzymaktivit{\"a}t f{\"u}r ALP und ENPP1 und der Aktivit{\"a}t des PPi-Kanals ANKH sowie des Mevalonatstoffwechsels zum Einsatz kamen (PPi, Pyridoxalphosphat (PLP), Probenecid, Vitamin D, PPADS (Pyridoxalphosphat-6-azophenyl-2',4'-disulfid S{\"a}ure) und ß-γmeATP (ß-γ Methylentriphosphat)). Die Resultate zeigen, dass die Modulation der PPi-Konzentration bei der osteogenen Differenzierung von hMSCs in vitro keine eindeutigen Effekte bewirkt. Geringe {\"A}nderungen des Genexpressionsmusters sind letztlich nicht auszuschliessen, blieben jedoch aufgrund der hohen Spendervariabilit{\"a}t durch eine erh{\"o}hte Anzahl von Experimenten zu beweisen. Diese Arbeit zeigt insgesamt eine unerwartet geringe Auswirkung einer exogenen und endogenen Modulation der PPi-Konzentration sowohl mit Blick auf die rein physikalischen Ph{\"a}nomene der Mineralisierung, als auch mit Blick auf die untersuchte Genregulation der wichtigsten beteiligten Proteine, was m{\"o}glicherweise die hohe Kompensationskapazit{\"a}t der Systeme unter physiologischen Bedingungen reflektiert. Untersuchungen auf proteomischer Ebene, besonders mit Blick auf die Prozessierung von Polypeptiden mit Mineralisierungs-modulierender Wirkung w{\"u}rden m{\"o}glicherweise genaueren Einblick vermitteln. Eine genauere Untersuchung der Einfl{\"u}sse von ENPP1 erscheint f{\"u}r die Zukunft vielversprechend. Allerdings treten hier, besonders auch durch die verwendeten Hemmstoffe der ENPP1, die Ph{\"a}nomene der Vernetzung des Stoffwechsels der Phosphate (inklusive ATP und seiner Metabolite) mit dem Purinergen Signalling deutlich zutage. Diese Vernetzung generiert durch ihre Komplexit{\"a}t sowohl klinisch als auch zellbiologisch/biochemisch erhebliche Interpretationsprobleme, die zuk{\"u}nftige Arbeiten aufl{\"o}sen m{\"u}ssen. Dabei sollte besondere Aufmerksamkeit auf zwei f{\"u}r HPP-PatientInnen klinisch in Zukunft potentiell bedeutsame Ergebnisse gelegt werden, die m{\"o}glicherweise ung{\"u}nstigen Auswirkungen einer Therapie mit Probenecid auf die ALPL Expression und die Steigerung der ALPL Expression unter Hemmstoffen des Enzyms ENPP1. 1. Dympna Harmey, L.H., Sonoko Narisawa, Kirsten A. Johnson, Robert Terkeltaub, Jos{\´e} Luis Mill{\´a}n, Concerted Regulation of Inorganic Pyrophosphate and osteopontin by Akp2, Enpp1 and Ank. American Journal of Pathology, 2003. 164, No. 4: p. 1199-1209. 2. Manisha C Yadav, A.M.S.S., Sonoko Narisawa, Carmen Huesa, Marc D McKee, Colin Farquharson, Jos{\´e} Luis Mill{\´a}n, Loss of Skeletal Mineralization by the Simultaneous Ablation of PHOSPHO1 and Alkaline Phosphatase Function: A Unified Model of the Mechanisms od Initiation of Skeletal Calcification. Journal of Bone and Mineral Research, 2011. 26, No2: p. 286-297. 3. Beck, C., Hypophosphatasia. Klin Padiatr, 2009: p. 219-226. 4. Harmey, D.e.a., Concerted Regulation of Inorganic Pyrophosphate and Osteopontin by Akp2, Enpp1, and Ank. American Journal of Pathology, 2004. 164: p. 1199-1209. 5. Peter N{\"u}rnberg, H.T., David Chandler et all, Heterozygous mutations in ANKH, the human ortholog of the mouse progressive ankylosis gene, result in craniometaphyseal dysplasia. Nature Genetics, May 2001. 28: p. 37-41. 6. L{\"o}ffler, P., Heinrich, ed. Biochemie \& Pathobiochemie. Vol. 8. 2007, Springer Verlag. 7. Joseph L. Goldstein, M.S.B., Regulation of the mevalonate Pathway. Nature Genetics, 1990. 343: p. 425-430.}, subject = {Hypophosphatasie}, language = {de} } @phdthesis{Molinaro2021, author = {Molinaro, Johannes-Nils}, title = {Interaktion zwischen 1,25-Dihydroxy-Vitamin D3 und Retins{\"a}ure vermittelter Signaltransduktion in humanen mesenchymalen Stammzellen}, doi = {10.25972/OPUS-24983}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-249838}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2021}, abstract = {Die Arbeit stellt m{\"o}gliche Einfl{\"u}sse durch 1,25- Dihydroxy-Vitamin D3 (1,25-VitD3) und Retins{\"a}ure (RA) in humanen mesenchymalen Stammzellen (hMSC) sowohl w{\"a}hrend der adipogenen und osteogenen Differenzierung als auch w{\"a}hrend der Kurzzeit- und Langzeitstimulation auf das Mikromilieu dar. Die Stimulation mit 1,25-VitD3 und RA verlangsamt das Wachstumsverhalten und ver{\"a}ndert die Zellmorphologie von hMSC. Effekte auf die Genexpression werden auf mRNA-Ebene mittels RT-PCR dargestellt. Der Ph{\"a}notyp als auch teilweise die Genexpression der osteogenen und adipogenen Differenzierung wird durch 1,25-VitD3 induziert und durch RA inhibiert. Zudem wird sowohl die „Mikromilieu-Zusammensetzung" als auch das „Transkriptionssignal" von 1,25-VitD3 und RA gegenseitig beeinflusst.}, subject = {Vitamin D}, language = {de} } @article{HerrmannDiederichsMelniketal.2021, author = {Herrmann, Marietta and Diederichs, Solvig and Melnik, Svitlana and Riegger, Jana and Trivanović, Drenka and Li, Shushan and Jenei-Lanzl, Zsuzsa and Brenner, Rolf E. and Huber-Lang, Markus and Zaucke, Frank and Schildberg, Frank A. and Gr{\"a}ssel, Susanne}, title = {Extracellular Vesicles in Musculoskeletal Pathologies and Regeneration}, series = {Frontiers in Bioengineering and Biotechnology}, volume = {8}, journal = {Frontiers in Bioengineering and Biotechnology}, issn = {2296-4185}, doi = {10.3389/fbioe.2020.624096}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-222882}, year = {2021}, abstract = {The incidence of musculoskeletal diseases is steadily increasing with aging of the population. In the past years, extracellular vesicles (EVs) have gained attention in musculoskeletal research. EVs have been associated with various musculoskeletal pathologies as well as suggested as treatment option. EVs play a pivotal role in communication between cells and their environment. Thereby, the EV cargo is highly dependent on their cellular origin. In this review, we summarize putative mechanisms by which EVs can contribute to musculoskeletal tissue homeostasis, regeneration and disease, in particular matrix remodeling and mineralization, pro-angiogenic effects and immunomodulatory activities. Mesenchymal stromal cells (MSCs) present the most frequently used cell source for EV generation for musculoskeletal applications, and herein we discuss how the MSC phenotype can influence the cargo and thus the regenerative potential of EVs. Induced pluripotent stem cell-derived mesenchymal progenitor cells (iMPs) may overcome current limitations of MSCs, and iMP-derived EVs are discussed as an alternative strategy. In the last part of the article, we focus on therapeutic applications of EVs and discuss both practical considerations for EV production and the current state of EV-based therapies.}, language = {en} } @phdthesis{Knoedler2019, author = {Kn{\"o}dler, Eva}, title = {Langzeitergebnisse {\"u}ber 12-16 Jahre f{\"u}r die Hybrid-Knieendoprothese PFC-Modular}, doi = {10.25972/OPUS-19101}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-191019}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2019}, abstract = {Ziel der vorliegenden Studie war, die {\"U}berlebensrate der Hybrid-PFC-Knieprothese im Langzeit-verlauf darzustellen. Insgesamt wurden 91 Patienten erfasst (50 mit klinischer und radiologischer Untersuchung und 41 anhand der Frageb{\"o}gen). Es handelt sich um 78 Frauen und 13 M{\"a}nner mit einem durchschnittlichen Alter von 79,6 Jahren zum Nachuntersuchungszeitpunkt (M{\"a}rz bis Juni 2004). Der Nachuntersuchungszeitraum umfasst 12 - 16 Jahre nach Implantation. Ausgewertet wurden die folgenden standartisierten Frageb{\"o}gen: WOMAC, SMFA-D, KSS. Die radiologische Untersuchung erfolgte gem{\"a}ß KSRESS. Die {\"U}berlebenszeitanalyse betr{\"a}gt 88\% nach 15 Jahren. In diesem Zeitraum wurden 10 Revisionen erfasst. WOMAC mit insgesamt guten Ergebnissen bez{\"u}glich Schmerz (3,2), Steife (3,6), Funktion (4,1) und Gesamtscore (3,7). SMFA-D mit eher mittelm{\"a}ßigen Werten von 42,8 im Funktionsindex und 42,4 im Beeintr{\"a}chtigungsindex und der Knee Society Score (KSS) mit einem m{\"a}ßigen Ergebnis von 78,8 im Kniescore und einem schlechten Wert 53,6 im Funktionsscore. Die radiologische Auswertung gem{\"a}ß KSRESS zeigte Aufhellungslinien > 2mm im Bereich D_16_1 1 (Femurschild Position 1) und gr{\"o}ßere Osteolysen (1 x 8mm und 1 x 10mm) im Bereich D16_4_2 (dorsales Tibiaplateau seitlich), jedoch keine Komponentenlockerung. Die vorliegende Studie zeigt mittelgradige Ergebnisse in den erhobenen Scores bei h{\"o}herem Durchschnittsalter der erhobenen Studienteilnehmer gegen{\"u}ber Vergleichs-studien. Die Langzeit-{\"U}berlebensrate von 88\% zeigt sich ebenb{\"u}rtig gegen{\"u}ber anderen Verfahren. Die k{\"u}rzere OP-Zeit beim Hybridverfahren ist als Vorteil zu sehen. Somit bietet die Hybridtechnik eine gute zus{\"a}tzliche chirurgische Option in der Knieendoprothetik. Zusammenfassend kann hier berichtet werden das die PFC-Modular Hybrid-Knieendo-prothese insgesamt eine gute Haltbarkeit {\"u}ber einen Zeitraum bis zu 16 Jahre bietet. Die eher m{\"a}ßigen Scores der Frageb{\"o}gen wurden vermutlich durch das hohe Alter der Patienten beeinflußt.}, subject = {Knieendoprothese}, language = {de} } @phdthesis{Volk2021, author = {Volk, Simone}, title = {Prospektiv-randomisierte, kontrollierte Evaluation der Auswirkungen zweier postoperativer Nachbehandlungskonzepte auf die Rerupturrate nach operativer Rekonstruktion der Rotatorenmanschette}, doi = {10.25972/OPUS-24954}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-249547}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2021}, abstract = {Aufgrund der divergierenden Studienlage bez{\"u}glich der physiotherapeutischen Nachbehandlung nach operativer Rotatorenmanschettenrefixation erfolgte im Rahmen einer prospektiv randomisierten Studie die Evaluation zweier Nachbehandlungsmodelle nach operativer Refixation vollschichtiger RM-Rupturen in Mini-Open-Technik. Hierf{\"u}r wurden 57 Patienten pr{\"a}operativ, 3 Wochen, 6 Wochen sowie 6 Monate postoperativ nachuntersucht und ausgewertet. Die Scores beinhalteten den NRS-Score, Constant-Score, DASH-Score, ASES-Score, NHP-Score, SF-36-Score sowie eine sonographische Untersuchung zur Beurteilung der Reruptur nach 6 Monaten postoperativ. Einheitlich erfolgte die Ruhigstellung im Gilchrist-Verband f{\"u}r 6 Wochen. In der konservativen Nachbehandlungsgruppe wurden bis 6 Wochen postoperativ lediglich Pendel{\"u}bungen durchgef{\"u}hrt, in der progressiven Nachbehandlungsgruppe erfolgte eine passive Be{\"u}bung direkt postoperativ bis an die Schmerzgrenze mit Ausnahme der Adduktion. Im Gesamtkollektiv war eine Rerupturrate von 5,3\% zu verzeichnen mit 3,7\% in der konservativen und 6,7\% in der progressiven Nachbehandlungsgruppe ohne signifikanten Gruppenunterschied (p=0,540). Bez{\"u}glich der klinischen und psychischen Ergebnisse zeigte sich 6 Monate postoperativ lediglich eine Einschr{\"a}nkung der aktiven Außenrotation in der konservativen Nachbehandlungsgruppe (46,2∘ vs. 39,7∘, p=0,031), sonst war kein signifikanter Gruppenunterschied zu sehen. Weiterhin erfolgten Subgruppenanalysen insbesondere hinsichtlich Alter und Geschlecht der Patienten. Dabei haben Patienten {\"u}ber 65 Jahren unabh{\"a}ngig von der Nachbehandlungsgruppe k{\"u}rzer Analgetika eingenommen und waren 6 Wochen postoperativ weniger bewegungseingeschr{\"a}nkt. Aufgrund einer Tendenz zu vermehrten Rerupturen nach progressiver Nachbehandlung in der Literatur werden daher weiterf{\"u}hrende Studien ben{\"o}tigt um zu evaluieren, ob {\"a}ltere Patienten von einer vermehrten Ruhigstellung profitieren k{\"o}nnten. Diese Studie pr{\"a}sentiert im Gegensatz zu der {\"u}berwiegend in der Literatur verwendeten arthroskopischen OP-Technik Ergebnisse nach RM-Refixation in Mini-Open-Technik. Damit liefert sie eine gute Grundlage f{\"u}r weiterf{\"u}hrende Studien insbesondere in der Behandlung von gr{\"o}ßeren RM-Rupturen, welche ein erh{\"o}htes Rerupturrisiko besitzen und von einer konservativen Nachbehandlung profitieren k{\"o}nnten.}, subject = {Rotatorenmanschettenruptur}, language = {de} } @article{BoelchJakuscheitDoerriesetal.2018, author = {Boelch, S. P. and Jakuscheit, A. and Doerries, S. and Fraissler, L. and Hoberg, M. and Arnholdt, J. and Rudert, M.}, title = {Periprosthetic infection is the major indication for TKA revision - experiences from a university referral arthroplasty center}, series = {BMC Musculoskeletal Disorders}, volume = {19}, journal = {BMC Musculoskeletal Disorders}, number = {395}, doi = {10.1186/s12891-018-2314-1}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-176983}, year = {2018}, abstract = {Background: We hypothesized, that periprosthetic joint infection (PJI) accounts for the major proportion of first (primary) and repeated (secondary) Total Knee Arthroplasty revisions at our university referral arthroplasty center. Methods: One thousand one hundred forty-three revisions, performed between 2008 and 2016 were grouped into primary (55\%) and secondary (45\%) revisions. The rate of revision indications was calculated and indications were categorized by time after index operation. The odds ratios of the indications for primary versus secondary revision were calculated. Results: In the primary revision group PJI accounted for 22.3\%, instability for 20.0\%, aseptic loosening for 14.9\% and retropatellar arthrosis for 14.2\%. PJI (25.6\%) was the most common indication up to 1 year after implantation, retropatellar arthrosis (26.8\%) 1-3 years and aseptic loosening (25.6\%) more than 3 years after implantation. In the secondary revision group PJI accounted for 39.7\%, aseptic loosening for 16.2\% and instability for 13.2\%. PJI was the most common indication at any time of revision with 43.8\% up to one, 35.4\% 1-3 years and 39.4\% more the 3 years after index operation. The odds ratios in repeated revision were 2.32 times higher (p = 0.000) for PJI. For instability and retropatellar arthrosis the odds ratios were 0.60 times (p = 0.006) and 0.22 times (p = 0.000) lower. Conclusions: PJI is the most common indication for secondary TKA revision and within one year after primary TKA. Aseptical failures such as instability, retropatellar arthrosis and aseptical loosening are the predominant reasons for revision more than one year after primary TKA.}, language = {en} } @article{AchenbachLeHanneurCamenzindetal.2022, author = {Achenbach, Leonard and Le Hanneur, Malo and Camenzind, Roland S. and Bouyer, Michael and Pottecher, Pierre and Lafosse, Thibault}, title = {Systematic bifocal decompression for isolated long thoracic nerve paresis: A case series of 12 patients}, series = {Interdisciplinary Neurosurgery}, volume = {27}, journal = {Interdisciplinary Neurosurgery}, doi = {10.1016/j.inat.2021.101384}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-265085}, year = {2022}, abstract = {To date, no consensus exists regarding the best surgical management of isolated, micro-traumatic long thoracic nerve (LTN) paresis. Our hypothesis was that a combined decompression of the LTN at two potential locations for entrapment would be effective in the management of dynamic LTN paresis. We report on twelve patients with isolated LTN parersis, with tenderness at two entrapment sites, who underwent bifocal LTN decompression after undergoing unsuccessful conservative treatment for at least 6 months; all patients had preoperative electrodiagnostic studies that confirmed the paresis and ruled out peripheral neuritis. Clinical and electrical improvements were observed in eight patients (67\%) regarding shoulder flexion, shoulder abduction, and Quick-DASH scores. Four patients (33\%) did not improve after surgery. The results corroborate our hypothesis that a bifocal LTN decompression can be an effective and reliable therapeutic option in more than half of a very selective patient population suffering from serratus anterior muscle deficiency.}, language = {en} } @article{HerrmannHildebrandMenzeletal.2019, author = {Herrmann, Marietta and Hildebrand, Maria and Menzel, Ursula and Fahy, Niamh and Alini, Mauro and Lang, Siegmund and Benneker, Lorin and Verrier, Sophie and Stoddart, Martin J. and Bara, Jennifer J.}, title = {Phenotypic characterization of bone marrow mononuclear cells and derived stromal cell populations from human iliac crest, vertebral body and femoral head}, series = {International Journal of Molecular Sciences}, volume = {20}, journal = {International Journal of Molecular Sciences}, number = {14}, issn = {1422-0067}, doi = {10.3390/ijms20143454}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-285054}, year = {2019}, abstract = {(1) In vitro, bone marrow-derived stromal cells (BMSCs) demonstrate inter-donor phenotypic variability, which presents challenges for the development of regenerative therapies. Here, we investigated whether the frequency of putative BMSC sub-populations within the freshly isolated mononuclear cell fraction of bone marrow is phenotypically predictive for the in vitro derived stromal cell culture. (2) Vertebral body, iliac crest, and femoral head bone marrow were acquired from 33 patients (10 female and 23 male, age range 14-91). BMSC sub-populations were identified within freshly isolated mononuclear cell fractions based on cell-surface marker profiles. Stromal cells were expanded in monolayer on tissue culture plastic. Phenotypic assessment of in vitro derived cell cultures was performed by examining growth kinetics, chondrogenic, osteogenic, and adipogenic differentiation. (3) Gender, donor age, and anatomical site were neither predictive for the total yield nor the population doubling time of in vitro derived BMSC cultures. The abundance of freshly isolated progenitor sub-populations (CD45-CD34-CD73+, CD45-CD34-CD146+, NG2+CD146+) was not phenotypically predictive of derived stromal cell cultures in terms of growth kinetics nor plasticity. BMSCs derived from iliac crest and vertebral body bone marrow were more responsive to chondrogenic induction, forming superior cartilaginous tissue in vitro, compared to those isolated from femoral head. (4) The identification of discrete progenitor populations in bone marrow by current cell-surface marker profiling is not predictive for subsequently derived in vitro BMSC cultures. Overall, the iliac crest and the vertebral body offer a more reliable tissue source of stromal progenitor cells for cartilage repair strategies compared to femoral head.}, language = {en} } @article{RuecklRunerBechleretal.2019, author = {Rueckl, Kilian and Runer, Armin and Bechler, Ulrich and Faschingbauer, Martin and Boelch, Sebastian Philipp and Keyes Sculco, Peter and Boettner, Friedrich}, title = {The posterior-anterior-flexed view is essential for the evaluation of valgus osteoarthritis. A prospective study on 134 valgus knees}, series = {BMC Muscoskeletal Disorders}, volume = {20}, journal = {BMC Muscoskeletal Disorders}, doi = {10.1186/s12891-019-3012-3}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-200536}, pages = {636}, year = {2019}, abstract = {Background Radiographic imaging is an important tool to assess osteoarthritis (OA). Lateral compartment osteoarthritis (valgus OA) usually starts with cartilage degeneration along the posterior aspect of the lateral femoral condyle. There is evidence that the posterior-anterior (PA)-flexed view is more sensitive when diagnosing early stages of valgus OA compared to the anterior-posterior (AP) view. The current paper analyzes the value of the PA-flexed view for patients scheduled for total knee arthroplasty (TKA). Methods Radiographs of 134 valgus knees were assessed prior to TKA. The minimal joint space width (minJSW) was measured on AP and PA-flexed views. The extent of mechanical deformity was measured on hip to ankle standing films. Results 49 (36.6\%) AP views showed Kellgren and Lawrence (K/L)-grade 4 osteoarthritis in the lateral compartment, 82 (63.4\%) showed grade 3 or less. The PA-flexed view resulted in an increased K/L-grading to grade 4 for 53 knees (62.4\%) that were considered grade 3 or less on standard AP-radiographs. There was a significant differences between lateral minJSW on AP and PA-flexed view for patients with up to 10 degrees of mechanical valgus deformity (p < 0.001), as well as 11 to 15 degrees of mechanical deformity (p = 0.021). Only knees with severe deformity of more than 15 degrees did not show a difference in minJSW between PA-flexed view and AP view (p = 0.345). Conclusions The PA-flexed view is superior to the standard AP view in quantifying the extent of valgus OA in patients with zero to fifteen degrees of valgus deformity. It is recommended for the initial assessment of patients with valgus osteoarthritis and better documents the extent of osteoarthritis prior to TKA.}, language = {en} } @phdthesis{Hausmann2022, author = {Hausmann, Johannes Stephan}, title = {Schmerzverlauf, k{\"o}rperliche Aktivit{\"a}t und Funktion pr{\"a}operativ, drei, sechs und zw{\"o}lf Monate nach minimal-invasiver H{\"u}fttotalendoprothetik mittels direktem anterioren Zugang}, doi = {10.25972/OPUS-27248}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-272486}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {Hintergrund: Die vorgestellten Daten demonstrieren das klinische Ergebnis von Patienten, die sich eine H{\"u}fttotalendoprothese (THA) unterzogen haben. Als Zugangsweg wurde der minimal-invasive, direkt anteriore Zugang in Einzelschnitttechnik gew{\"a}hlt (MIS-DAA). Die Patientin wurden bis zw{\"o}lf Monate nach Operation beobachtet. Methoden: Es wurden die Daten von 73 Probanden mittels der folgenden Fragebogen ausgewertet: Harris Hip Score (HHS), eXtra Short Musculoskeletal Functional Assessment questionnaire (XSFMA), Short Form 36 (SF-36) health survey und Patient Health Questionaire 9 „deutsch" (PHQ-9 D). Zur Schmerzmessung kam eine visuelle Analogskala (VAS von 0-4) zum Einsatz. Daneben wurde die Aktivit{\"a}t mit Hilfe des Schrittz{\"a}hlers Stepwatch™ Activity Monitor (SAM) und eines 25m Gehtests auf Zeit (T25-FW) erfasst. W{\"a}hrend der gesamten Aufzeichnung wurden auch Komplikationen erfasst. Ergebnisse: Zw{\"o}lf Monate nach der Operation verbesserten sich die HHS-Werte signifikant von 55,2 pr{\"a}operativ auf 92,4 (Werte 0 - 100). Der FSFMA Funktionsscore fiel ebenfalls signifikant von 39,4 auf 10,3 und der Beeintrachtigungsscore von 47,0 auf 15,8. Der Score f{\"u}r die Physis (PCS) stieg im SF 36 signifikant von 27,5 pr{\"a}operativ auf 47,5 nach zw{\"o}lf Monaten. Der Score f{\"u}r mentale Gesundheit (MCS) fiel dagegen sogar leicht von 57,6 auf 55,0. Dagegen fiel die Pr{\"a}valenz der mittels PHQ-9 D gemessenen Somatisierungsst{\"o}rungen von elf auf einen Fall. Die Schmerzreduktion durch die Operation zeigte sich durch einen R{\"u}ckgang auf der VAS von 2,41 auf 0,35 zw{\"o}lf Monate postoperativ. Die durchschnittlich t{\"a}glich absolvierten Lastwechsel nahmen laut Schrittz{\"a}hlermessung signifikant von 5113 pr{\"a}operativ auf 6402 zu. Außerdem stieg die Gehgeschwindigkeit im T25-FW signifikant von 22,06 s (= 1,13 m/s) auf 18,14 s (= 1,38 m/s). Es wurden keine schwerwiegenden Komplikationen, wie z.B. Transplantatlockerungen, festgestellt. Zusammenfassung: In der Zusammenschau der Ergebnisse zeigt sich ein Jahr nach MIS-DAA-THA, dass die Patienten eine signifikant bessere Funktion, Aktivit{\"a}t und weniger Schmerzen aufweisen. Der MIS-DA-Zugang ist sicher und weist keine erh{\"o}hte Komplikationsrate auf.}, subject = {H{\"u}ftgelenkprothese}, language = {de} } @article{KemmlerKohlFroehlichetal.2020, author = {Kemmler, Wolfgang and Kohl, Matthias and Fr{\"o}hlich, Michael and Jakob, Franz and Engelke, Klaus and von Stengel, Simon and Schoene, Daniel}, title = {Effects of High-Intensity Resistance Training on Osteopenia and Sarcopenia Parameters in Older Men with Osteosarcopenia—One-Year Results of the Randomized Controlled Franconian Osteopenia and Sarcopenia Trial (FrOST)}, series = {Journal of Bone and Mineral Research}, volume = {35}, journal = {Journal of Bone and Mineral Research}, number = {9}, doi = {10.1002/jbmr.4027}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-214609}, pages = {1634 -- 1644}, year = {2020}, abstract = {Dynamic resistance exercise (DRT) might be the most promising agent for fighting sarcopenia in older people. However, the positive effect of DRT on osteopenia/osteoporosis in men has still to be confirmed. To evaluate the effect of low-volume/high-intensity (HIT)-DRT on bone mineral density (BMD) and skeletal muscle mass index (SMI) in men with osteosarcopenia, we initiated the Franconian Osteopenia and Sarcopenia Trial (FrOST). Forty-three sedentary community-dwelling older men (aged 73 to 91 years) with osteopenia/osteoporosis and SMI-based sarcopenia were randomly assigned to a HIT-RT exercise group (EG; n = 21) or a control group (CG; n = 22). HIT-RT provided a progressive, periodized single-set DRT on machines with high intensity, effort, and velocity twice a week, while CG maintained their lifestyle. Both groups were adequately supplemented with whey protein, vitamin D, and calcium. Primary study endpoint was integral lumbar spine (LS) BMD as determined by quantitative computed tomography. Core secondary study endpoint was SMI as determined by dual-energy X-ray absorptiometry. Additional study endpoints were BMD at the total hip and maximum isokinetic hip-/leg-extensor strength (leg press). After 12 months of exercise, LS-BMD was maintained in the EG and decreased significantly in the CG, resulting in significant between-group differences (p < 0.001; standardized mean difference [SMD] = 0.90). In parallel, SMI increased significantly in the EG and decreased significantly in the CG (p < 0.001; SMD = 1.95). Total hip BMD changes did not differ significantly between the groups (p = 0.064; SMD = 0.65), whereas changes in maximum hip-/leg-extensor strength were much more prominent (p < 0.001; SMD = 1.92) in the EG. Considering dropout (n = 2), attendance rate (95\%), and unintended side effects/injuries (n = 0), we believe our HIT-RT protocol to be feasible, attractive, and safe. In summary, we conclude that our combined low-threshold HIT-RT/protein/vitamin D/calcium intervention was feasible, safe, and effective for tackling sarcopenia and osteopenia/osteoporosis in older men with osteosarcopenia.}, language = {en} } @article{HeinzMellerLuetkensetal.2022, author = {Heinz, Tizian and Meller, Felix and Luetkens, Karsten Sebastian and Horas, Konstantin and Sch{\"a}fer, Thomas and Rudert, Maximilian and Reppenhagen, Stephan and Weißenberger, Manuel}, title = {Can the MRI based AMADEUS score accurately assess pre-surgery chondral defect severity according to the ICRS arthroscopic classification system?}, series = {Journal of Experimental Orthopaedics}, volume = {9}, journal = {Journal of Experimental Orthopaedics}, number = {1}, issn = {2197-1153}, doi = {10.1186/s40634-022-00511-w}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-300781}, year = {2022}, abstract = {Purpose The AMADEUS (Area Measurement And DEpth and Underlying Structures) scoring and grading system has been proposed for the MRI based evaluation of untreated focal chondral defects around the knee. The clinical practicability, its correlation with arthroscopically assessed grading systems (ICRS - International Cartilage Repair Society) and thereby its clinical value in terms of decision making and guiding prognosis was yet to determine. Methods From 2008 to 2019 a total of 89 individuals were indicated for high tibial valgus osteotomy (HTO) due to tibial varus deformity and concomitant chondral defects of the medial compartment of the knee. All patients received a preoperative MRI (1.5 Tesla or 3.0 Tesla) and pre-osteotomy diagnostic arthroscopy. Chondral defects of the medial compartment were scored and graded with the MRI based AMADEUS by three independent raters and compared to arthroscopic defect grading by the ICRS system. Interrater and intrarater reliability as well as correlation analysis with the ICRS classification system were assessed. Results Intraclass correlation coefficients for the various subscores of the AMADEUS showed an overall good to excellent interrater agreement (min: 0.26, max: 0.80). Intrarater agreement turned out to be substantially inferior (min: 0.08, max: 0.53). Spearman correlation revealed an overall moderate correlative association of the AMADEUS subscores with the ICRS classification system, apart from the defect area subscore. Sensitivity of the AMADEUS to accurately identify defect severity according to the ICRS was 0.7 (0.69 for 3.0 Tesla MRI, 0.67 for 1.5 Tesla MRI). The mean AMADEUS grade was 2.60 ± 0.81 and the mean ICRS score 2.90 ± 0.63. Conclusions Overall, the AMADEUS with all its subscores shows moderate correlation with the arthroscopic chondral grading system according to ICRS. This suggests that chondral defect grading by means of the MRI based AMADEUS is well capable of influencing and guiding treatment decisions. Interrater reliability shows overall good agreement.}, language = {en} } @phdthesis{Cetindere2023, author = {Cetindere, Rojan}, title = {Klinische und radiologische Ergebnisse nach offener Schultergelenksstabilisierung mittels Beckenkammspan}, doi = {10.25972/OPUS-31314}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-313148}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2023}, abstract = {Im Rh{\"o}n-Klinikum wurden von 2012 bis 2015 49 Patient*innen wegen eines Glenoiddefektes mittels offenem Beckenkammspantransfer mit Kapselshift bei anteriorer Schulterinstabilit{\"a}t behandelt. 27 Patienten konnten in dieser Studie eingeschlossen werden (Einschlusskriterien: Follow-up von mindestens 12 Monaten, kompletter pr{\"a}operativer 3D-CT-Datensatz / Ausschlusskriterien: traumatische Schulterluxation oder Voroperation der kontralateralen Schulter). Ziel der Studie war es, das kurz- bis mittelfristige klinische Outcome dieser Kohorte zu erfassen, der Vergleich mit Ergebnissen anderer Arbeitsgruppen und der Vergleich von pr{\"a}operativ verwendeten Messmethoden (Chuang- bzw. Wambacher-Methode) f{\"u}r den Glenoiddefekt. Bei einem mittleren Follow-up von 27,11 Monaten zeigten sich {\"u}berwiegend gute bis exzellente kurz- bis mittelfristige OP-Ergebnisse (Rowe-Score: 84,81, Oxford-Shoulder-Score: 20,56, WOSI-Score: 371, Constant-Score: 86,74). Die OP-Methode eignet sich gut f{\"u}r Patient*innen, die mehrfach voroperiert sind, multiple Luxationsereignisse hatten sowie f{\"u}r diejenigen mit relevanter Hyperlaxizit{\"a}t, bei denen eine Latarjet-Operation kontraindiziert ist. Die OP-Methode ist gut anwendbar bei Patient*innen mit subkritischem Glenoidverlust < 20 \%, wenn zus{\"a}tzliche Sekund{\"a}rfaktoren vorliegen. Eine postoperative Omarthrose ist ein Risikofaktor f{\"u}r ein signifikant schlechteres Outcome. Die Gesamtkomplikationsrate lag bei 25,9\%, der Großteil hiervon (18,3\%) waren innerhalb kurzer Zeit reversibel. Die Reluxationsrate lag bei 3,7\%. Bei allen Studienteilnehmenden kam es zum Span-Remodelling ohne Schraubenlockerung oder Spanbruch. Eine {\"u}berm{\"a}ßige Spanresorbtion erfolgt antero-inferior, w{\"a}hrend um die Osteosyntheseschrauben eine {\"U}berkontur persistiert. Die Glenoiddefekte lagen bei 23,39 \% (Chuang) bzw. 22,06 \% (Wambacher). Es zeigte sich eine gute {\"U}bereinstimmung der Messergebnisse beider Methoden, allerdings lagen die Werte nach Chuang signifikant h{\"o}her.}, subject = {Orthop{\"a}die}, language = {de} } @phdthesis{Wagenbrenner2021, author = {Wagenbrenner, Mike Helmut}, title = {In vitro-Charakterisierung mesenchymaler Stromazellen aus dem menschlichen H{\"u}ftgelenk}, doi = {10.25972/OPUS-23711}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-237110}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2021}, abstract = {In dieser Arbeit konnte erstmals gezeigt werden, dass plastik-adh{\"a}rent wachsende, multipotente Vorl{\"a}uferzellen, die eine f{\"u}r MSCs charakteristische Kombination von Oberfl{\"a}chenantigenen tragen, aus allen vier untersuchten Geweben des arthrotischen H{\"u}ftgelenks isoliert werden konnten. MSC-{\"a}hnliche Zellen k{\"o}nnen somit nicht nur in der Spongiosa und im Gelenkknorpel, sondern auch in der anterioren Gelenkkapsel und dem Ligamentum capitis femoris (LCF) des arthrotisch ver{\"a}nderten menschlichen H{\"u}ftgelenks nachgewiesen werden. Die FACS Analyse der Oberfl{\"a}chenantigene auf Zellen, die aus den vier unterschiedlichen Geweben eines beispielhaft gew{\"a}hlten Spenders isoliert wurden, zeigte eine deutliche Expression der Antigene CD44, CD73, CD90 und CD105. Unabh{\"a}ngig vom Nativgewebe zeigten somit alle untersuchten Zellen ein f{\"u}r MSCs charakteristisches, aber nicht spezifisches Profil an Antigenen auf ihrer Oberfl{\"a}che. Eine {\"U}bereinstimmung mit den ISCT Kriterien f{\"u}r MSCs war aufgrund der fehlenden Kontrolle h{\"a}matopoetischer Marker nicht m{\"o}glich. Die multipotente Differenzierung der isolierten Zellen erfolgte mithilfe spezifischer Differenzierungsmedien in Monolayer-Kulturen oder f{\"u}r die chondrogene Differenzierung in dreidimensionalen Pellet-Kulturen. Nach 21 Tagen konnten in allen differenzierten Kulturen histologisch und immunhistochemisch klare Zeichen der Osteo- und Adipogenese detektiert werden, w{\"a}hrend die Auswertung spezifischer Markergene eine klare Steigerung der Expression dieser im Vergleich zu den Negativkontrollen zeigte. Histologische und immunhistochemische Auswertungen best{\"a}tigten auch eine erfolgreiche chondrogene Differenzierung der Zell-Pellets aus Spongiosa, Knorpel und Kapsel. Lediglich in den chondrogen differenzierten Zell-Pellets aus dem LCF konnte immunhistochemisch keine Bildung des knorpelspezifischen Matrixproteins Col II nachgewiesen werden. Mikroskopisch zeigten vor allem die differenzierten MSC-Pellets aus Spongiosa und Knorpel morphologisch eine starke {\"A}hnlichkeit zu hyalinem Knorpelgewebe. Trotz dieser Abstufungen zeigten sich f{\"u}r die relative Expression der chondrogenen Markergene AGG, Col II und Sox-9 keine signifikanten Unterschiede zwischen den differenzierten MSC-Kulturen der vier unterschiedlichen Nativgewebe. Ein positiver Nachweis des Markers Col X wies nach 27 Tagen sowohl in differenzierten als auch in undifferenzierten Pellet-Kulturen auf eine leichte chondrogene Hypertrophie hin. Zusammenfassend zeigten sich keine signifikanten Unterschiede im Hinblick auf das osteogene und adipogene Differenzierungspotential aller untersuchten Zellen. W{\"a}hrend das chondrogene Differenzierungspotential der Zellen aus Spongiosa, Knorpel und Kapsel sich aus histologischer und immunhistochemischer Sicht {\"a}hnelte, zeigten Pellets aus dem LCF ein schw{\"a}cheres chondrogenes Differenzierungspotential in vitro. Obwohl somit erstmals MSC-{\"a}hnliche Zellen aus dem LCF und Gewebsproben, die neben dem Stratum synoviale auch das Stratum fibrosum der H{\"u}ftgelenkskapsel beinhalteten, charakterisiert wurden, sind weitere wissenschaftliche Arbeiten notwendig, um das multipotente Differenzierungspotential dieser Zellen zu optimieren.}, subject = {H{\"u}ftgelenk}, language = {de} } @article{GenestRakPetryketal.2020, author = {Genest, Franca and Rak, Dominik and Petryk, Anna and Seefried, Lothar}, title = {Physical Function and Health-Related Quality of Life in Adults Treated With Asfotase Alfa for Pediatric-Onset Hypophosphatasia}, series = {JBMR Plus}, volume = {4}, journal = {JBMR Plus}, number = {9}, doi = {10.1002/jbm4.10395}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-218410}, year = {2020}, abstract = {Hypophosphatasia (HPP) is a rare, inherited, metabolic disease characterized by tissue-nonspecific alkaline phosphatase deficiency resulting in musculoskeletal and systemic clinical manifestations. This observational study evaluated the effectiveness of enzyme replacement therapy with asfotase alfa on physical function and health-related quality of life (HRQoL) among adults with pediatric-onset HPP who received asfotase alfa for 12 months at a single center (ClinicalTrial.gov no.: NCT03418389). Primary outcomes evaluated physical function with the 6-minute walk test (6MWT), timed up-and-go (TUG) test, Short Physical Performance Battery (SPPB), and handheld dynamometry (HHD). Secondary outcome measures included the Lower Extremity Functional Scale (LEFS), pain prevalence/intensity, and pain medication use; HRQoL was evaluated using the 36-Item Short-Form Health Survey version 2 (SF-36v2). Safety data were collected throughout the study. All 14 patients (11 women) had compound heterozygous ALPL gene mutations and ≥1 HPP bone manifestation, including history of ≥1 fracture. Mean (min, max) age was 51 (19 to 78) years. From baseline to 12 months of treatment, median 6MWT distance increased from 267 m to 320 m (n = 13; p = 0.023); median TUG test time improved from 14.4 s to 11.3 s (n = 9; p = 0.008). Specific components of the SPPB also improved significantly: median 4-m gait speed increased from 0.8 m/s to 1.1 m/s (n = 10; p = 0.007) and median repeated chair-rise time improved from 22 s to 13 s (n = 9; p = 0.008). LEFS score improved from 24 points to 53 points (n = 10; p = 0.002). Improvements in HHD were not clinically significant. SF-36v2 Physical Component Score (PCS) improved after 12 months of treatment (n = 9; p = 0.010). Pain level did not change significantly from baseline to 12 months of treatment. There were significant improvements on chair-rise time and SF-36v2 PCS by 3 months, and on TUG test time after 6 months. No new safety signals were identified. These results show the real-world effectiveness of asfotase alfa in improving physical functioning and HRQoL in adults with pediatric-onset HPP. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.}, language = {en} } @article{KaiserBrambrinkBenditzetal.2022, author = {Kaiser, Moritz and Brambrink, Sara and Benditz, Achim and Achenbach, Leonard and Gehentges, Matthias and K{\"o}nig, Matthias Alexander}, title = {Increase in lower limb strength after multimodal pain management in patients with low back pain}, series = {Medicina}, volume = {58}, journal = {Medicina}, number = {7}, issn = {1648-9144}, doi = {10.3390/medicina58070837}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-284264}, year = {2022}, abstract = {Background and Objectives: The aim of the present study was to evaluate the efficacy of a multimodal pain therapy (MPM) regarding the objective parameter muscle strength of segment-dependent lower limb muscle groups before and after such a treatment. Materials and Methods: 52 patients with a history of low back pain and/or leg pain received standardized multimodal pain management. Strength of segment indicating lower limb muscles were assessed for each patient before and after ten days of treatment by handheld dynamometry. Results: Overall strength increased significantly from 23.6 kg ± 6.6 prior to treatment to 25.4 ± 7.3 after treatment, p ≤ 0.001. All muscle groups significantly increased in strength with exception of great toe extensors. Conclusions: Despite lower basic strength values at the beginning of treatment, all investigated muscle groups, except for the great toe extensors, showed a significant increase of overall strength after completion of the multimodal pain management concept. Increased overall strength could help with avoiding further need of medical care by supporting patients' autonomy in daily life activities, as well as maintaining working abilities. Thus, our study is the first to show a significant positive influence on lower limb strength in patients with low back pain after a conservative MPM program.}, language = {en} } @phdthesis{Keicher2024, author = {Keicher, Franca}, title = {Muskul{\"a}re Einfl{\"u}sse der Rotatorenmanschette auf die Early Onset Arthrose der Schulter}, doi = {10.25972/OPUS-36055}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-360557}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Introduction: The etiology of early onset shoulder arthritis (EOA) remains unclear. Due to the influence of the muscles of the rotator cuff (RC) on glenohumeral kinematics, muscular causes are being discussed. The aim of the study was to identify corresponding factors on EOA based on volume measurements of the RC and examinations of the adjacent bony structures in MRI imaging, as well as the collection of patient-specific characteristics. Methods: In a case-control study, shoulders of 15 patients (14 men, 1 woman) with shoulder arthritis before the age of 60 and 13 control subjects (13 men) were examined. Anthropometric body measurements and clinical characteristics were collected. The volumes of the RC were calculated using manual tracing of the individual muscle cross- sections on MRI scans. In addition, the angles between the coracoid or scapular spine and scapular body were measured. The position of the scapula to the thorax was determined by recording the angle of the scapula to the plane of the table. The glenoid retroversion, morphological types, and humeral head subluxation were also collected. The analysis was conducted using descriptive and comparative statistical methods, as well as logistic and linear regression analyses. Results: The volumes of the RC did not differ significantly between the patients with EOA and the control subjects, either in absolute terms or in relative proportions. However, significantly higher values of thorax circumference and diameter, body weight, and BMI were found in the diseased individuals compared to the controls. Furthermore, these individuals were significantly more likely to have occupations that expended more than 1400 kcal per day. The risk of EOA increased with the steeper angle of the scapula to the thorax. Patients with B2-glenoid had significantly larger angles between the coracoid and scapular body as well as higher values of transverse thorax diameter, than those with B1-glenoid. Regardless of whether EOA was present or not, engaging in overhead sports was associated with a higher subluxation index. Conclusion: While the RC did not show any abnormalities in EOA patients, male gender, BMI, thoracic shape and scapular position, as well as certain occupations and sports, were associated with EOA. Further studies are needed to investigate these risk factors in EOA more precisely and develop possible treatment concepts. Peripheral shoulder muscles (such as teres major or pectoralis major) should also be included in the investigations.}, subject = {Arthrose}, language = {de} } @article{SolimandoBrandlMattenheimeretal.2018, author = {Solimando, A G and Brandl, A and Mattenheimer, K and Graf, C and Ritz, M and Ruckdeschel, A and St{\"u}hmer, T and Mokhtari, Z and Rudelius, M and Dotterweich, J and Bittrich, M and Desantis, V and Ebert, R and Trerotoli, P and Frassanito, M A and Rosenwald, A and Vacca, A and Einsele, H and Jakob, F and Beilhack, A}, title = {JAM-A as a prognostic factor and new therapeutic target in multiple myeloma}, series = {Leukemia}, volume = {32}, journal = {Leukemia}, doi = {10.1038/leu.2017.287}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-239069}, pages = {736-743}, year = {2018}, abstract = {Cell adhesion in the multiple myeloma (MM) microenvironment has been recognized as a major mechanism of MM cell survival and the development of drug resistance. Here we addressed the hypothesis that the protein junctional adhesion molecule-A (JAM-A) may represent a novel target and a clinical biomarker in MM. We evaluated JAM-A expression in MM cell lines and in 147 MM patient bone marrow aspirates and biopsies at different disease stages. Elevated JAM-A levels in patient-derived plasma cells were correlated with poor prognosis. Moreover, circulating soluble JAM-A (sJAM-A) levels were significantly increased in MM patients as compared with controls. Notably, in vitro JAM-A inhibition impaired MM migration, colony formation, chemotaxis, proliferation and viability. In vivo treatment with an anti-JAM-A monoclonal antibody (αJAM-A moAb) impaired tumor progression in a murine xenograft MM model. These results demonstrate that therapeutic targeting of JAM-A has the potential to prevent MM progression, and lead us to propose JAM-A as a biomarker in MM, and sJAM-A as a serum-based marker for clinical stratification.}, language = {en} } @article{TylekSchillingSchlegelmilchetal.2019, author = {Tylek, Tina and Schilling, Tatjana and Schlegelmilch, Katrin and Ries, Maximilian and Rudert, Maximilian and Jakob, Franz and Groll, J{\"u}rgen}, title = {Platelet lysate outperforms FCS and human serum for co-culture of primary human macrophages and hMSCs}, series = {Scientific Reports}, volume = {9}, journal = {Scientific Reports}, doi = {10.1038/s41598-019-40190-9}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-229174}, year = {2019}, abstract = {In vitro co-cultures of different primary human cell types are pivotal for the testing and evaluation of biomaterials under conditions that are closer to the human in vivo situation. Especially co-cultures of macrophages and mesenchymal stem cells (MSCs) are of interest, as they are both present and involved in tissue regeneration and inflammatory reactions and play crucial roles in the immediate inflammatory reactions and the onset of regenerative processes, thus reflecting the decisive early phase of biomaterial contact with the host. A co-culture system of these cell types might thus allow for the assessment of the biocompatibility of biomaterials. The establishment of such a co-culture is challenging due to the different in vitro cell culture conditions. For human macrophages, medium is usually supplemented with human serum (hS), whereas hMSC culture is mostly performed using fetal calf serum (FCS), and these conditions are disadvantageous for the respective other cell type. We demonstrate that human platelet lysate (hPL) can replace hS in macrophage cultivation and appears to be the best option for co-cultivation of human macrophages with hMSCs. In contrast to FCS and hS, hPL maintained the phenotype of both cell types, comparable to that of their respective standard culture serum, as well as the percentage of each cell population. Moreover, the expression profile and phagocytosis activity of macrophages was similar to hS.}, language = {en} } @phdthesis{Schaefer2024, author = {Schaefer, Bastian}, title = {Eigenschaften von synthetischen Bandersatzmaterialien zum MPFL-Ersatz - biomechanische in vitro Studie am porcinen Modell}, doi = {10.25972/OPUS-36139}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-361396}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Der MPFL-Ersatz ist ein g{\"a}ngiges Therapieverfahren zur Behandlung einer patellofemoralen Instabilit{\"a}t. Die Operationstechniken unterscheiden sich zumeist an der patellaren Fixationsmethode und der Auswahl der Transplantate. Biomechanische Studien, welche sich mit den Eigenschaften implantatfreier oss{\"a}rer Fixationsmethoden beim MPFL-Ersatz unter Verwendung k{\"u}nstlicher Transplantate besch{\"a}ftigen gibt es nach aktueller Recherche nicht. Ziel dieser Arbeit war es, die biomechanischen Eigenschaften zweier patellarer Bohrkanalfixationstechniken beim MPFL-Ersatz mit unterschiedlichem k{\"u}nstlichen Bandersatzmaterial zu ermitteln. Die Hypothese war, dass die biomechanischen Eigenschaften in Elongation, Steifigkeit, Prim{\"a}rstabilit{\"a}t und maximaler Ausreißkraft mit denen der bereits etablierten Verfahren und dem nativen MPFL vergleichbar sind. Hierzu wurden 80 porcine Kniescheiben randomisiert in 8 Gruppen aufgeteilt und getestet. In den Gruppen 1-4 wurden parallele, transpatellare Bohrkan{\"a}le mit Tapes der Breiten 2 mm, 3 mm, 4 mm und 5 mm getestet. In den Gruppen 5-8 wurden V-Kanal-Fixationsmethoden mit B{\"a}ndern der Breite von 2 mm, 3 mm, 4 mm und 5 mm untersucht. Zus{\"a}tzlich wurden die biomechanischen Grundeigenschaften der nativen Tapes ermittelt. Alle Tests durchliefen jeweils drei Messabschnitte. Hierbei fand zun{\"a}chst eine Pr{\"a}konditionierung mit 10 Zyklen zwischen 5 N und 20 N statt. Daraufhin folgte eine zyklische Belastung mit 1000 Zyklen zwischen 5 N und 50 N. Am Ende wurde eine maximale Kraftapplikation bis zum Versagen der Fixationskomplexe durchgef{\"u}hrt. Im Rahmen der Messungen wurden Elongation, Steifigkeit, Yield Load und Maximum Load bestimmt. Es konnten Unterschiede zwischen den beiden Fixationsmethoden und den verwendeten Tapes festgestellt werden. Alle acht Gruppen zeigten eine h{\"o}here Prim{\"a}rstabilit{\"a}t als das humane MPFL. Bezogen auf die biomechanischen Eigenschaften und den Versagensmechanismus konnte in dieser Studie ein Vorteil der parallelen transpatellaren Bohrkan{\"a}le gegen{\"u}ber den V- Kanaltechniken festgestellt werden. Die Werte mit der h{\"o}chsten maximalen Ausreißkraft wurden in Gruppe 3 (631,6 ± 83,1 N) und Gruppe 1 (592,9 ± 170,1 N) gemessen. Diese zeigten eine h{\"o}here Prim{\"a}rstabilit{\"a}t mit geringerer Elongation und Steifigkeit im Vergleich zu den in der aktuellen Literatur beschriebenen biomechanischen Studien, welche sich mit unterschiedlichen und teilweise bereits etablierten MPFL-Ersatzverfahren besch{\"a}ftigten. Eine implantatfreie MPFL-Rekonstruktion mit transpatellaren parallelen Bohrkan{\"a}len unter Verwendung eines 2 mm Fiber Tapes (Fa. Arthrex) oder eines 4 mm Tapes (Fa. Topester) k{\"o}nnten dementsprechend eine gute Alternative zur operativen Therapie einer patellofemoralen Instabilit{\"a}t sein.}, subject = {Patellaluxation}, language = {de} }