TY - JOUR A1 - Pereira, Ana Rita A1 - Trivanović, Drenka A1 - Stahlhut, Philipp A1 - Rudert, Maximilian A1 - Groll, Jürgen A1 - Herrmann, Marietta T1 - Preservation of the naïve features of mesenchymal stromal cells in vitro: Comparison of cell- and bone-derived decellularized extracellular matrix JF - Journal of Tissue Engineering N2 - The fate and behavior of bone marrow mesenchymal stem/stromal cells (BM-MSC) is bidirectionally influenced by their microenvironment, the stem cell niche, where a magnitude of biochemical and physical cues communicate in an extremely orchestrated way. It is known that simplified 2D in vitro systems for BM-MSC culture do not represent their naïve physiological environment. Here, we developed four different 2D cell-based decellularized matrices (dECM) and a 3D decellularized human trabecular-bone scaffold (dBone) to evaluate BM-MSC behavior. The obtained cell-derived matrices provided a reliable tool for cell shape-based analyses of typical features associated with osteogenic differentiation at high-throughput level. On the other hand, exploratory proteomics analysis identified native bone-specific proteins selectively expressed in dBone but not in dECM models. Together with its architectural complexity, the physico-chemical properties of dBone triggered the upregulation of stemness associated genes and niche-related protein expression, proving in vitro conservation of the naïve features of BM-MSC. KW - decellularization KW - bone model KW - stem cell niche KW - stemness KW - osteogenesis KW - 3D models Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-268835 VL - 13 ER - TY - JOUR A1 - von Hertzberg-Boelch, Sebastian Philipp A1 - Luedemann, Martin A1 - Rudert, Maximilian A1 - Steinert, Andre F. T1 - PMMA bone cement: antibiotic elution and mechanical properties in the context of clinical use JF - Biomedicines N2 - This literature review discusses the use of antibiotic loaded polymethylmethacrylate bone cements in arthroplasty. The clinically relevant differences that have to be considered when antibiotic loaded bone cements (ALBC) are used either for long-term implant fixation or as spacers for the treatment of periprosthetic joint infections are outlined. In this context, in vitro findings for antibiotic elution and material properties are summarized and transferred to clinical use. KW - spacer KW - bone cement KW - PMMA KW - polymethylmethacrylate KW - periprosthetic infection KW - antibiotic elution Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-281708 SN - 2227-9059 VL - 10 IS - 8 ER - TY - JOUR A1 - Stratos, Ioannis A1 - Rinas, Ingmar A1 - Schröpfer, Konrad A1 - Hink, Katharina A1 - Herlyn, Philipp A1 - Bäumler, Mario A1 - Histing, Tina A1 - Bruhn, Sven A1 - Müller-Hilke, Brigitte A1 - Menger, Michael D. A1 - Vollmar, Brigitte A1 - Mittlmeier, Thomas T1 - Effects on bone and muscle upon treadmill interval training in hypogonadal male rats JF - Biomedicines N2 - Testosterone deficiency in males is linked to various pathological conditions, including muscle and bone loss. This study evaluated the potential of different training modalities to counteract these losses in hypogonadal male rats. A total of 54 male Wistar rats underwent either castration (ORX, n = 18) or sham castration (n = 18), with 18 castrated rats engaging in uphill, level, or downhill interval treadmill training. Analyses were conducted at 4, 8, and 12 weeks postsurgery. Muscle force of the soleus muscle, muscle tissue samples, and bone characteristics were analyzed. No significant differences were observed in cortical bone characteristics. Castrated rats experienced decreased trabecular bone mineral density compared to sham-operated rats. However, 12 weeks of training increased trabecular bone mineral density, with no significant differences among groups. Muscle force measurements revealed decreased tetanic force in castrated rats at week 12, while uphill and downhill interval training restored force to sham group levels and led to muscle hypertrophy compared to ORX animals. Linear regression analyses showed a positive correlation between bone biomechanical characteristics and muscle force. The findings suggest that running exercise can prevent bone loss in osteoporosis, with similar bone restoration effects observed across different training modalities. KW - osteoporosis KW - muscle KW - force KW - bone KW - micro-CT KW - training Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-319266 SN - 2227-9059 VL - 11 IS - 5 ER - TY - THES A1 - Seiler, Jonas T1 - Die Expression des Vitamin-D-Rezeptors und der 24-Hydroxylase in Knochenmetastasen unterschiedlicher Entität T1 - Vitamin-D-receptor- and CYP24A1- expression in bone metastases of different primary origin N2 - Knochenmetastasen sind unter den drei häufigsten Manifestationsorten metastatischer Absiedelungen von fortgeschrittenen Tumorerkrankungen. Dabei sind insbesondere Patientinnen und Patienten mit Prostata- und Mammakarzinom von Knochenmetastasen betroffen. Diese Knochenmetastasen führen häufig zu einer deutlichen Verschlechterung der Lebensqualität und zu einer Begrenzung der Therapieoptionen auf lediglich palliative Ansätze. Die biologisch aktive Form von Vitamin D3, 1,25(OH)2-Vitamin D3, zeigt in präklinischen Studien antiproliferative und differenzierende Effekte auf Tumorzellen (101, 102, 104), die haupsächlich durch die Bindung an den Vitamin D-Rezeptor (VDR) vermittelt werden. Darüberhinaus konnte präklinisch gezeigt werden, dass eine niedrige Expression des VDRs, ligandenunabhängig, die Knochenmetastasierung und das Tumorwachstum begünstigt (118). Eine niedrige VDR-Expression ist in Primärtumoren in klinischen Studien mit aggressiven Tumoreigenschaften assoziiert (111, 113, 115) und kann zudem mit einer erhöhten/früheren ossären Metastasierung einhergehen (167). Zudem gibt es Hinweise auf einen dysregulierten 1,25(OH)2-Vitamin D3-Katabolismus durch eine erhöhte Expression des 1,25(OH)2-Vitamin D3 katabolisierenden Enzyms CYP24A1/24-Hydroxylase in primärem Tumorzellen (70, 121, 122). Durch die Untersuchungen der Primärtumoren ist damit zu hypothetisieren, dass die Expression des VDRs und von CYP24A1 bei der Tumorprogression und Knochenmetastasierung von Bedeutung sein könnte. Entsprechende Untersuchungen des VDRs und der 24-Hydroxylase in Knochenmetastasen fehlen allerdings. Deshalb wurde in dieser Arbeit die Expression des VDRs und von CYP24A1 in Knochenmetastasen unterschiedlicher Primärtumoren von 66 Patientinnen und Patienten untersucht und mögliche Assoziationen mit aggressiven Tumoreigenschaften analysiert. Der VDR konnte sowohl im Zytoplasma als auch im Nukleus nachgewiesen werden, während CYP24A1 nur im Zytoplasma lokalisiert war. Dabei wiesen insgesamt 71 % der Knochenmetastasen eine hohe VDR-Expression im Nukleus und 56 % im Zytoplasma auf. 59 % der Knochenmetastasen wiesen eine hohe Expression des VDRs insgesamt auf. CYP24A1 war ebenso in 59 % der Knochenmetastasen hoch exprimiert. Bei der Auswertung des Zusammenhangs zwischen den TNM-Stadien und des Gradings zeigte sich ein nicht signifikanter Trend von schlecht differenzierten Tumoren hin zu einer niedrigeren nukleären VDR-Expression (p=0.07, siehe Abbildung 33). Bezüglich der T-Stadien zeigten sich keine Unterschiede der Expression des VDRs und von CYP24A1 in den Knochenmetastasen zwischen lokal fortgeschrittenen und kleinen Primärtumoren. Weiterhin hatten Patientinnen und Patienten mit Lymphknotenmetastasen tendenziell eine verminderte VDR- und auch CYP24A1-Expression in den Knochenmetastasen im Vergleich zu Patienten und Patientinnen ohne Lymphknotenmetastasen (pVDR=0.15, pCYP24A1=0.06, siehe Abbildung 35). Außerdem hatten Patientinnen und Patienten mit multiple metastasierten Tumoren eine signifikant niedrigere nukleäre VDR- und auch CYP24A1-Expression im Vergleich zu Patientinnen und Patienten mit ausschließlich ossärer Metastasierung (pVDR=0.03, pCYP24A1=0.01, Abbildung 36). Die Proteinexpression des VDRs- und von CYP24A1 korrelierten signifikant (p=0.001). Somit konnte mit dieser Arbeit die Proteinexpression des VDRs und von CYP24A1 in Knochenmetastasen durch Immunhistologie nachgewiesen werden. Insgesamt wurde der VDR und CYP24A1 von Knochenmetastasen diverser Entität unterschiedlich stark exprimiert. Jedoch könnten insbesondere Patienten mit VDR-exprimierenden Knochenmetastasen von einer Vitamin D3-Supplementierung profitieren, die häufig einen 25-OH-Vitamin D3 Mangel zeigen (165, 166). Ebenso könnte eine Untersuchung auf einen niedrigen VDR-Status in Primärtumoren dabei helfen, Krebspatienten mit einem hohen Metastasierungsrisiko zu identifizieren. Allerdings sind weitere und größere Studien inbesondere mit Evaluation des gesamten Vitamin D-Metabolismus und -Signalwegs notwendig, um diesen Zusammenhang weiter zu untersuchen. N2 - Bone metastases are among the three most frequent sites of metastatic manifestation of late-stage cancers, particularly of prostate and breast cancers. Bone metastases often reduce patient’s quality of life due to skeletal-related events. Additionally, bone metastatic tumor treatment is predominantly restricted to palliative measures. In preclinical studies, the biologically active form of vitamin D3, 1,25(OH)2-vitamin D3, has been demonstrated to have antiproliferative and differentiating effects on cancer cells (101, 102, 104), which are mostly mediated by binding to the vitamin D receptor (VDR). Moreover, the VDR expression itself may affect cancer growth and the metastatic potential to bone. For example, preclinically, it has been shown that VDR knockdown promotes bone metastases manifestation and growth (118). Furthermore, low VDR expression is associated to aggressive cancer characteristics in primary cancers (111, 113, 115) and also linked to earlier bone metastasis manifestation in breast cancer (120). In addition, there is evidence that 1,25(OH)2-vitamin D3- catabolism is altered in cancer cells. Thus, inactivation of local 1,25(OH)2-vitamin D3-levels in cancer cells may be increased (70, 121, 122). VDR and CYP24A1 expression could therefore be important concerning cancer progression and bone metastases manifestation and growth. However, there are currently no reports of studies investigating VDR expression and vitamin D-metabolism in bone metastases. The aim of this study was hence to assess VDR and CYP24A1 (vitamin D-catabolizing enzyme) expression in bone metastases of 66 patients secondary to prostate-, breast-, kidney-, lung-, follicular thyroid- and colorectal cancers using immunohistochemistry (132). While the VDR was localised in the nucleus and cytoplasm, CYP24A1 was identified in the cytoplasm only. A high VDR nuclear protein expression was detected in 47/66 (71 %) and cytoplasmatic in 37/66 (56 %). 39/66 (59 %) of bone metastases had a high total VDR expression. CYP24A1 was also strongly expressed in 39/66 (59 %) of bone metastases. Expression levels were correlated to patient data and cancer characteristics. There was a non-significant trend of high-grade cancers towards low nuclear VDR expression (p=0.07, see figure 33). Additionally, patients with lymph node metastases (N-stage) tended to have a reduced bone metastatic VDR and CYP24A1 expression compared to patients without lymph node metastases (pVDR=0.15, pCYP24A1=0.06, see figure 35). There was no difference of VDR and CYP24A1 expression in bone metastases between locally advanced and small primary cancers (T-stage). Interestingly, patients with further metastases other than bone metastases had reduced nuclear VDR and CYP24A1 levels compared to patients without other distant metastases (pVDR=0.03, pCYP24A1=0.01, see figure 36). Nuclear VDR and CYP24A1 expression showed a significant positive correlation (p=0.001). In conclusion, this study demonstrated that the VDR and CYP24A1 are widely expression in bone metastases of various origin. Therefore, patients with VDR-expressing bone metastases could, in particular, benefit from vitamin D3-supplementation, as vitamin D deficiency is frequent in patients with bone metastases (165, 166). Additionally, screening for a low VDR status in primary cancers could help to identify cancer patients at a high risk of metastasis. However, further and larger studies, that evaluate the entire vitamin D metabolism and signalling pathway, are needed to investigate this association. KW - Vitamin D3 KW - Vitamin D KW - Vitamin D-Rezeptor KW - Knochenmetastasen KW - CYP24A1 KW - vitamin d KW - vitamin d receptor KW - bone metastases KW - vdr KW - Knochenmetastase KW - Metastase Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-321827 ER - TY - JOUR A1 - Wang, Chenglong A1 - Stöckl, Sabine A1 - Li, Shushan A1 - Herrmann, Marietta A1 - Lukas, Christoph A1 - Reinders, Yvonne A1 - Sickmann, Albert A1 - Grässel, Susanne T1 - Effects of extracellular vesicles from osteogenic differentiated human BMSCs on osteogenic and adipogenic differentiation capacity of naïve human BMSCs JF - Cells N2 - Osteoporosis, or steroid-induced osteonecrosis of the hip, is accompanied by increased bone marrow adipogenesis. Such a disorder of adipogenic/osteogenic differentiation, affecting bone-marrow-derived mesenchymal stem cells (BMSCs), contributes to bone loss during aging. Here, we investigated the effects of extracellular vesicles (EVs) isolated from human (h)BMSCs during different stages of osteogenic differentiation on the osteogenic and adipogenic differentiation capacity of naïve (undifferentiated) hBMSCs. We observed that all EV groups increased viability and proliferation capacity and suppressed the apoptosis of naïve hBMSCs. In particular, EVs derived from hBMSCs at late-stage osteogenic differentiation promoted the osteogenic potential of naïve hBMSCs more effectively than EVs derived from naïve hBMSCs (naïve EVs), as indicated by the increased gene expression of COL1A1 and OPN. In contrast, the adipogenic differentiation capacity of naïve hBMSCs was inhibited by treatment with EVs from osteogenic differentiated hBMSCs. Proteomic analysis revealed that osteogenic EVs and naïve EVs contained distinct protein profiles, with pro-osteogenic and anti-adipogenic proteins encapsulated in osteogenic EVs. We speculate that osteogenic EVs could serve as an intercellular communication system between bone- and bone-marrow adipose tissue, for transporting osteogenic factors and thus favoring pro-osteogenic processes. Our data may support the theory of an endocrine circuit with the skeleton functioning as a ductless gland. KW - extracellular vesicles KW - mesenchymal stem cells KW - osteogenic potential KW - osteogenic differentiation KW - adipogenic differentiation KW - ECM remodeling KW - bone regeneration Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-286112 SN - 2073-4409 VL - 11 IS - 16 ER - TY - JOUR A1 - Nedopil, Alexander J. A1 - Howell, Stephen M. A1 - Hull, Maury L. T1 - A TKA insert with a lateral flat articular surface maximizes external and internal tibial orientations without anterior lift-off relative to low- and ultracongruent surfaces JF - Journal of Personalized Medicine N2 - Background: In total knee arthroplasty (TKA), inserts can have different levels of medial and lateral congruency determined by the acuteness of the upslopes of the anterior and posterior articular surfaces. The present study evaluated an insert with different levels of lateral congruency and a medial ball-in-socket congruency to test the hypothesis that a lateral flat (F) insert maximizes external tibial orientation at extension and internal orientation at 90° flexion and lowers the incidence of anterior lift-off relative to low-congruent (LC) and ultracongruent (UC) lateral inserts. Methods: Two surgeons treated 23 patients with unrestricted caliper-verified kinematic alignment (KA) and posterior cruciate ligament (PCL) retention. They randomly trialed inserts with a medial radial dial that functioned as a built-in goniometer by measuring the tibial orientation relative to a sagittal line on the femoral trial component. Anterior lift-off of the insert from the baseplate indicated PCL tightness. Results: The F insert’s mean of 9° of external tibial orientation was higher than that of the LC (5°, p < 0.0001) and UC inserts (2°, p < 0.0001). The −13° of internal tibial orientation at 90° flexion was higher than that of the LC (−9°, p < 0.0001) and UC inserts (−7°, p < 0.0001). The 0% incidence of anterior lift-off was less than that of the LC (26%) and UC inserts (57%) (p < 0.0001). Conclusions: Surgeons and implant manufacturers should know that adding congruency to the lateral articular surface limits external tibial orientation in extension and internal tibial orientation at 90° flexion and overtightens the PCL. These rotational limitations and flexion space tightness can adversely affect patellofemoral tracking and knee flexion. KW - total knee arthroplasty KW - kinematic alignment KW - implant design KW - PCL retention KW - congruency Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-286142 SN - 2075-4426 VL - 12 IS - 8 ER - TY - JOUR A1 - Nedopil, Alexander J. A1 - Howell, Stephen M. A1 - Hull, Maury L. T1 - Measurement of tibial orientation helps select the optimal insert thickness to personalize PCL tension in a medial ball-in-socket TKA JF - Journal of Personalized Medicine N2 - As the conformity of a medial ball-in-socket total knee arthroplasty (TKA) provides intrinsic anterior-posterior (A-P) stability, surgeons cannot rely on the manual examination of sagittal laxity to identify the optimal insert thickness. Instead, the present study determined whether measuring tibial axial orientation in extension and 90° flexion with an insert goniometer could identify the optimal thickness that, when implanted, provides high postoperative function. In twenty-two patients that underwent unrestricted caliper-verified kinematic alignment (KA) with a PCL retaining implant, two surgeons measured tibial orientation in extension and 90° flexion with 10, 11, 12, and 13 mm thick insert goniometers. Each TKA had one insert thickness that restored either the maximum external tibial orientation in extension, the maximum internal tibial orientation at 90° flexion, or both relative to 1 mm thinner and thicker inserts. In addition, the 6-month median [interquartile range] Forgotten Joint Score of 73 (54–87) and Oxford Knee Score of 42 (38–45) indicated high satisfaction and function. In conclusion, surgeons using a medial ball-in-socket TKA design can measure external tibial orientation in extension and internal tibial orientation at 90° flexion with an insert goniometer. Furthermore, implanting an insert with the thickness that provided the maximum orientation values resulted in high postoperative function, thereby personalizing PCL tension. KW - posterior cruciate ligament KW - tibial rotation KW - medial pivot KW - total knee arthroplasty KW - kinematic alignment Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-286232 SN - 2075-4426 VL - 12 IS - 9 ER - TY - JOUR A1 - Dhaliwal, Anand A1 - Zamora, Tomas A1 - Nedopil, Alexander J. A1 - Howell, Stephen M. A1 - Hull, Maury L. T1 - Six commonly used postoperative radiographic alignment parameters do not predict clinical outcome scores after unrestricted caliper-verified kinematically aligned TKA JF - Journal of Personalized Medicine N2 - Background: Unrestricted caliper-verified kinematically aligned (KA) TKA restores patient’s prearthritic coronal and sagittal alignments, which have a wide range containing outliers that concern the surgeon practicing mechanical alignment (MA). Therefore, knowing which radiographic parameters are associated with dissatisfaction could help a surgeon decide whether to rely on them as criteria for revising an unhappy patient with a primary KA TKA using MA principles. Hence, we determined whether the femoral mechanical angle (FMA), hip–knee–ankle angle (HKAA), tibial mechanical angle (TMA), tibial slope angle (TSA), and the indicators of patellofemoral tracking, including patella tilt angle (PTA) and the lateral undercoverage of the trochlear resection (LUCTR), are associated with clinical outcome scores. Methods: Forty-three patients with a CT scan and skyline radiograph after a KA TKA with PCL retention and medial stabilized design were analyzed. Linear regression determined the strength of the association between the FMA, HKA angle, PTS, PTA, and LUCTR and the forgotten joint score (FJS), Oxford knee score (OKS), and KOOS Jr score obtained at a mean of 23 months. Results: There was no correlation between the FMA (range 2° varus to −10° valgus), HKAA (range 10° varus to −9° valgus), TMA (range 10° varus to −0° valgus), TSA (range 14° posterior to −4° anterior), PTA (range, −10° medial to 14° lateral), and the LUCTR resection (range 2 to 9 mm) and the FJS (median 83), the OKS (median 44), and the KOOS Jr (median 85) (r = 0.000 to 0.079). Conclusions: Surgeons should be cautious about using postoperative FMA, HKAA, TMA, TSA, PTA, and LUCTR values within the present study’s reported ranges to explain success and dissatisfaction after KA TKA. KW - total knee arthroplasty KW - kinematic alignment KW - reoperation KW - revision KW - phenotype Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-288186 SN - 2075-4426 VL - 12 IS - 9 ER - TY - JOUR A1 - Heinz, Tizian A1 - Wild, Moritz A1 - Eidmann, Annette A1 - Weißenberger, Manuel A1 - Rak, Dominik A1 - Nedopil, Alexander Johannes A1 - Rudert, Maximilian A1 - Stratos, Ioannis T1 - Impact of COVID-19 on fracture incidence in germany: a comparative age and gender analysis of pre- and post-outbreak periods JF - Healthcare N2 - In March 2020, Germany imposed a nationwide lockdown to curb the spread of COVID-19, prompting questions about the impact on the incidence of common fractures. This study examined 15 fracture types in pre-outbreak (2010–2019) and post-outbreak (2020–2021) periods, using data categorized by age (18–64 years, 65 years) and sex (male, female). Linear regression assessed annual growth rates, and mean fracture numbers were compared across periods for significant differences. Results indicated a positive correlation between fracture incidence rates and time for various types, such as cervical, thoracic, lumbar, and pelvic spine fractures, rib fractures, femoral neck, pertrochanteric femur, femoral shaft, and ankle fractures. Frequencies of proximal humerus, distal radius, femoral neck, pertrochanteric femur, femoral shaft, and ankle fractures in 2020 and 2021 were within predicted ranges from previous years. However, rib fractures and spinal fractures (cervical, thoracic, lumbar, and pelvic spine) occurred less frequently during this time. Notably, this study found a consistent decline in most fracture types for individuals aged 18–64 after the pandemic’s onset, while the fracture incidence of hip fractures, often referred to as fragility fractures, for those over 65 remained unchanged. Fibula fractures showed the most considerable decrease in both age groups. In conclusion, the COVID-19 pandemic substantially impacted fracture incidence, with lower rates among individuals under 65 and unchanged fragility fractures in the elderly population. KW - COVID-19 KW - fracture incidence KW - age and gender analysis KW - pre- and post-outbreak comparison KW - fragility fractures KW - linear regression Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-362686 SN - 2227-9032 VL - 11 IS - 15 ER - TY - JOUR A1 - Eidmann, Annette A1 - Heinz, Tizian A1 - Oberfeld, Jan A1 - Weißenberger, Manuel A1 - Rudert, Maximilian A1 - Stratos, Ioannis T1 - Epidemiology and trends in cartilage surgery of the foot and ankle in Germany: an analysis of national healthcare billing and reporting data from 2006 to 2020 JF - Medicina N2 - Background and objectives: Cartilage surgery constitutes a standard intervention in foot and ankle procedures. Currently, there is a lack of epidemiological data on its frequency, age distribution, and surgical options for cartilage surgery. This study aimed to investigate the current landscape of cartilage surgery in Germany and identify the most common procedures from an epidemiological standpoint. Materials and methods: Medical billing and reporting data from the Federal Statistical Office of Germany, encompassing the period 2006–2020, was examined, including all foot and ankle cartilage surgical procedures (summarized under OPS codes 5-812 and 5-801). The dataset incorporated information on the affected joint, patient age and sex, and surgery type. Each surgical procedure was categorized as “debridement”, “regeneration” or “refixation”. Linear and nonlinear regression analyses were employed, with a statistical significance threshold of 0.05. Results: From the total of 136,501 procedures conducted during the study period, the most frequently performed interventions were microfracture (58,252) and chondroplasty (56,135), and thus, debridement procedures were in the leading position. The use of acellular membranes was the most used regenerative technique (n = 11,414). At the ankle joint, interventions were mostly arthroscopic and in men, while foot cartilage surgeries were preferably performed via open surgery and mostly in women. Age distribution analysis revealed two primary peaks: the first in the 20–25-year-old group (ankle and foot) and the second in the 45–50-year-old group (ankle) and 55–60-year-old group (foot). Refixation and regenerative procedures were more frequent among younger individuals, while debriding procedures were more frequent among older individuals. Regenerative procedures, particularly in the ankle, significantly increased over time. Conclusions: Cartilage surgery of the foot and ankle was common, with two primary age groups predominantly affected. Notably, recent years have witnessed a considerable rise in cartilage regenerative procedures. KW - cartilage surgery KW - foot and ankle procedures KW - epidemiological analysis KW - regenerative therapies KW - age distribution Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-362835 SN - 1648-9144 VL - 59 IS - 7 ER - TY - JOUR A1 - Borojević, Ana A1 - Jauković, Aleksandra A1 - Kukolj, Tamara A1 - Mojsilović, Slavko A1 - Obradović, Hristina A1 - Trivanović, Drenka A1 - Živanović, Milena A1 - Zečević, Željko A1 - Simić, Marija A1 - Gobeljić, Borko A1 - Vujić, Dragana A1 - Bugarski, Diana T1 - Vitamin D3 stimulates proliferation capacity, expression of pluripotency markers, and osteogenesis of human bone marrow mesenchymal stromal/stem cells, partly through SIRT1 signaling JF - Biomolecules N2 - The biology of vitamin D3 is well defined, as are the effects of its active metabolites on various cells, including mesenchymal stromal/stem cells (MSCs). However, the biological potential of its precursor, cholecalciferol (VD3), has not been sufficiently investigated, although its significance in regenerative medicine — mainly in combination with various biomaterial matrices — has been recognized. Given that VD3 preconditioning might also contribute to the improvement of cellular regenerative potential, the aim of this study was to investigate its effects on bone marrow (BM) MSC functions and the signaling pathways involved. For that purpose, the influence of VD3 on BM-MSCs obtained from young human donors was determined via MTT test, flow cytometric analysis, immunocytochemistry, and qRT-PCR. Our results revealed that VD3, following a 5-day treatment, stimulated proliferation, expression of pluripotency markers (NANOG, SOX2, and Oct4), and osteogenic differentiation potential in BM-MSCs, while it reduced their senescence. Moreover, increased sirtuin 1 (SIRT1) expression was detected upon treatment with VD3, which mediated VD3-promoted osteogenesis and, partially, the stemness features through NANOG and SOX2 upregulation. In contrast, the effects of VD3 on proliferation, Oct4 expression, and senescence were SIRT1-independent. Altogether, these data indicate that VD3 has strong potential to modulate BM-MSCs' features, partially through SIRT1 signaling, although the precise mechanisms merit further investigation. KW - bone marrow mesenchymal stromal cells (BM-MSCs) KW - vitamin D3 (cholecalciferol, VD3) KW - SIRT1 KW - regenerative potential KW - stemness KW - osteogenesis Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-262203 SN - 2218-273X VL - 12 IS - 2 ER - TY - JOUR A1 - Achenbach, Leonard A1 - Klein, Christian A1 - Luig, Patrick A1 - Bloch, Hendrik A1 - Schneider, Dominik A1 - Fehske, Kai T1 - Collision with opponents - but not foul play - dominates injury mechanism in professional men's basketball JF - BMC Sports Science Medicine and Rehabilitation N2 - Background To identify injury patterns and mechanisms in professional men’s basketball by means of video match analysis. Methods In Germany, injuries are registered with the statutory accident insurance for professional athletes (VBG) by clubs or club physicians as part of occupational accident reporting. Moderate and severe injuries (absence of > 7 days) sustained during basketball competition in one of four seasons (2014–2017 and 2018–2019) in the first or second national men’s league in Germany were prospectively analyzed using a newly developed standardized observation form. Season 2017–2018 was excluded because of missing video material. Results Video analysis included 175 (53%) of 329 moderate and severe match injuries. Contact patterns categorized according to the different body sites yielded eight groups of typical injury patterns: one each for the head, shoulders, and ankles, two for the thighs, and three for the knees. Injuries to the head (92%), ankles (76%), shoulders (70%), knees (47%), and thighs (32%) were mainly caused by direct contact. The injury proportion of foul play was 19%. Most injuries (61%) occurred in the central zone below the basket. More injuries occurred during the second (OR 1.8, p = 0.018) and fourth quarter (OR 1.8, p = 0.022) than during the first and third quarter of the match. Conclusion The eight identified injury patterns differed substantially in their mechanisms. Moderate and severe match injuries to the head, shoulders, knees, and ankles were mainly caused by collision with opponents and teammates. Thus, stricter rule enforcement is unlikely to facilitate safer match play. KW - epidemiology KW - mechanism KW - contact KW - non-contact´ KW - injury prevention KW - match load Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-261765 VL - 13 ER - TY - JOUR A1 - Schmalzl, J. A1 - Plumhoff, P. A1 - Gilbert, F. A1 - Gohlke, F. A1 - Konrads, C. A1 - Brunner, U. A1 - Jakob, F. A1 - Ebert, R. A1 - Steinert, AF T1 - The inflamed biceps tendon as a pain generator in the shoulder: A histological and biomolecular analysis JF - Journal of Orthopaedic Surgery N2 - Introduction: The long head of the biceps (LHB) is often resected in shoulder surgery. However, its contribution to inflammatory processes in the shoulder remains unclear. In the present study, inflamed and noninflamed human LHBs were comparatively characterized for features of inflammation. Materials and methods: Twenty-two resected LHB tendons were classified into inflamed (n = 11) and noninflamed (n = 11) samples. For histological examination, samples were stained with hematoxylin eosin, Azan, van Gieson, and Masson Goldner trichrome. Neuronal tissue was immunohistochemically visualized. In addition, specific inflammatory marker gene expression of primary LHB-derived cell cultures were analyzed. Results: Features of tendinopathy, such as collagen disorganization, infiltration by inflammatory cells, neovascularization, and extensive neuronal innervation were found in the tendinitis group. Compared to noninflamed samples, inflamed LHBs showed a significantly increased inflammatory marker gene expression Conclusion: Structural and biomolecular differences of both groups suggest that the LHB tendon acts as an important pain generator in the shoulder joint. These findings can, on the one hand, contribute to the understanding of the biomolecular genesis of LHB tendinitis and, on the other hand, provide possibilities for new therapeutic approaches. KW - biceps tendinitis KW - biomolecular processes KW - inflammatory gene KW - interleukin KW - long head of biceps tendon KW - pain generator KW - shoulder pain Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-228611 VL - 27 IS - 1 ER - TY - JOUR A1 - Shekhar, Adithya A1 - Howell, Stephen M. A1 - Nedopil, Alexander J. A1 - Hull, Maury L. T1 - Excellent and good results treating stiffness with early and late manipulation after unrestricted caliper-verified kinematically aligned TKA JF - Journal of Personalized Medicine N2 - Manipulation under anesthesia (MUA) for stiffness within 6 to 12 weeks after mechanically aligned total knee arthroplasty (TKA) generally yields better outcome scores than an MUA performed later. However, the timing of MUA after unrestricted, caliper-verified, kinematically aligned (KA) TKA remains uncertain. A retrospective review identified 82 of 3558 (2.3%) KA TKA patients treated with an MUA between 2010 and 2017. Thirty patients treated with an MUA within 3 months of the TKA (i.e., early) and 24 in the late group (i.e., >3 months) returned a questionnaire after a mean of 6 years and 5 years, respectively. Mean outcome scores for the early vs. late group were 78 vs. 62 for the Forgotten Joint Score (FJS) (p = 0.023) and 42 vs. 39 for the Oxford Knee Score (OKS) (p = 0.037). Subjectively, the early vs. late group responses indicated that 83% vs. 67% walked without a limp, 73% vs. 54% had normal extension, and 43% vs. 25% had normal flexion. An MUA within 3 months after unrestricted KA TKA provided excellent FJS and OKS at final follow-up relative to a late MUA. A late MUA performed after 3 months is worth consideration because of the good FJS and OKS scores, albeit with a risk of a persistent limp and limitation in knee extension and flexion. KW - reoperation KW - revision KW - implant survival KW - forgotten joint score KW - Oxford knee score Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-262094 SN - 2075-4426 VL - 12 IS - 2 ER - TY - JOUR A1 - Wagenbrenner, Mike A1 - Heinz, Tizian A1 - Horas, Konstantin A1 - Jakuscheit, Axel A1 - Arnholdt, Jörg A1 - Hermann, Marietta A1 - Rudert, Maximilian A1 - Holzapfel, Boris M. A1 - Steinert, Andre F. A1 - Weißenberger, Manuel T1 - The human arthritic hip joint is a source of mesenchymal stromal cells (MSCs) with extensive multipotent differentiation potential JF - BMC Musculoskeletal Disorders N2 - Background While multiple in vitro studies examined mesenchymal stromal cells (MSCs) derived from bone marrow or hyaline cartilage, there is little to no data about the presence of MSCs in the joint capsule or the ligamentum capitis femoris (LCF) of the hip joint. Therefore, this in vitro study examined the presence and differentiation potential of MSCs isolated from the bone marrow, arthritic hyaline cartilage, the LCF and full-thickness samples of the anterior joint capsule of the hip joint. Methods MSCs were isolated and multiplied in adherent monolayer cell cultures. Osteogenesis and adipogenesis were induced in monolayer cell cultures for 21 days using a differentiation medium containing specific growth factors, while chondrogenesis in the presence of TGF-ss1 was performed using pellet-culture for 27 days. Control cultures were maintained for comparison over the same duration of time. The differentiation process was analyzed using histological and immunohistochemical stainings as well as semiquantitative RT-PCR for measuring the mean expression levels of tissue-specific genes. Results This in vitro research showed that the isolated cells from all four donor tissues grew plastic-adherent and showed similar adipogenic and osteogenic differentiation capacity as proven by the histological detection of lipid droplets or deposits of extracellular calcium and collagen type I. After 27 days of chondrogenesis proteoglycans accumulated in the differentiated MSC-pellets from all donor tissues. Immunohistochemical staining revealed vast amounts of collagen type II in all differentiated MSC-pellets, except for those from the LCF. Interestingly, all differentiated MSCs still showed a clear increase in mean expression of adipogenic, osteogenic and chondrogenic marker genes. In addition, the examination of an exemplary selected donor sample revealed that cells from all four donor tissues were clearly positive for the surface markers CD44, CD73, CD90 and CD105 by flow cytometric analysis. Conclusions This study proved the presence of MSC-like cells in all four examined donor tissues of the hip joint. No significant differences were observed during osteogenic or adipogenic differentiation depending on the source of MSCs used. Further research is necessary to fully determine the tripotent differentiation potential of cells isolated from the LCF and capsule tissue of the hip joint. KW - Hip joint KW - Osteoarthritis KW - MSCs KW - Cartilage regeneration KW - Tissue engineering KW - Ligamentum capitis femoris KW - Joint capsule KW - Bone marrow Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-229497 VL - 21 IS - 1 ER - TY - JOUR A1 - Howell, Stephen M. A1 - Gill, Manpreet A1 - Shelton, Trevor J. A1 - Nedopil, Alexander J. T1 - Reoperations are few and confined to the most valgus phenotypes 4 years after unrestricted calipered kinematically aligned TKA JF - Knee Surgery, Sports Traumatology, Arthroscopy N2 - Purpose The present study determined the postoperative phenotypes after unrestricted calipered kinematically aligned (KA) total knee arthroplasty (TKA), whether any phenotypes were associated with reoperation, implant revision, and lower outcome scores at 4 years, and whether the proportion of TKAs within each phenotype was comparable to those of the nonarthritic contralateral limb. Methods From 1117 consecutive primary TKAs treated by one surgeon with unrestricted calipered KA, an observer identified all patients (N = 198) that otherwise had normal paired femora and tibiae on a long-leg CT scanogram. In both legs, the distal femur–mechanical axis angle (FMA), proximal tibia–mechanical axis angle (TMA), and the hip–knee–ankle angle (HKA) were measured. Each alignment angle was assigned to one of Hirschmann’s five FMA, five TMA, and seven HKA phenotype categories. Results Three TKAs (1.5%) underwent reoperation for anterior knee pain or patellofemoral instability in the subgroup of patients with the more valgus phenotypes. There were no implant revisions for component loosening, wear, or tibiofemoral instability. The median Forgotten Joint Score (FJS) was similar between phenotypes. The median Oxford Knee Score (OKS) was similar between the TMA and HKA phenotypes and greatest in the most varus FMA phenotype. The phenotype proportions after calipered KA TKA were comparable to the contralateral leg. Conclusion Unrestricted calipered KA’s restoration of the wide range of phenotypes did not result in implant revision or poor FJS and OKS scores at a mean follow-up of 4 years. The few reoperated patients had a more valgus setting of the prosthetic trochlea than recommended for mechanical alignment. Designing a femoral component specifically for KA that restores patellofemoral kinematics with all phenotypes, especially the more valgus ones, is a strategy for reducing reoperation risk. KW - phenotype KW - total knee arthroplasty KW - total knee replacement KW - kinematic alignment KW - calipered KW - reoperation Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-265291 VL - 30 IS - 3 ER - TY - JOUR A1 - Kemmler, Wolfgang A1 - Kohl, Matthias A1 - Jakob, Franz A1 - Engelke, Klaus A1 - Stengel, Simon von T1 - Effects of high intensity dynamic resistance exercise and whey protein supplements on osteosarcopenia in older men with low bone and muscle mass. Final results of the randomized controlled FrOST study JF - Nutrients N2 - The present study aimed to evaluate the effect of high intensity dynamic resistance exercise (HIT-DRT) and whey protein supplementation (WPS) on bone mineral density (BMD) and sarcopenia parameters in osteosarcopenic men. Men ≥ 72 years with osteosarcopenia (n = 43) were randomly assigned to a HIT-RT (HIT-RT: n = 21) or a non-training control group (n = 22). Supervised HIT-RT twice/week was applied for 18 months, while the control group maintained their habitual lifestyle. Supplying WPS, total protein intake amounted to 1.5–1.6 (HIT-RT) and 1.2 g/kg/body mass/d (control). Both groups were supplied with calcium and vitamin D. Primary study outcomes were BMD and the sarcopenia Z-score. After adjusting for multiplicity, we observed significant positive effects for sarcopenia Z-score (standardized mean difference (SMD): 1.40), BMD at lumbar spine (SMD: 0.72) and total hip (SMD: 0.72). In detail, effect sizes for skeletal muscle mass changes were very pronounced (1.97, p < 0.001), while effects for functional sarcopenia parameters were moderate (0.87, p = 0.008; handgrip strength) or low (0.39, p = 0.209; gait velocity). Apart from one man who reported short periods of temporary worsening of existing joint pain, no HIT-RT/WPS-related adverse effects or injuries were reported. We consider HIT-RT supported by whey protein supplementation as a feasible, attractive, safe and highly effective option to fight osteosarcopenia in older men. KW - resistance exercise KW - osteopenia KW - sarcopenia KW - bone mineral density Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-211108 SN - 2072-6643 VL - 12 IS - 8 ER - TY - JOUR A1 - Krstic, Jelena A1 - Herrmann, Marietta A1 - Gadjanski, Ivana A1 - Mojsilovic, Slavko T1 - Editorial: Microenvironment-derived stem cell plasticity JF - Frontiers in Cell and Developmental Biology N2 - No abstract available. KW - plasticity KW - stem cells KW - microenvironment KW - imaging KW - extracellular vesicles (EVs) KW - oxygen tension KW - tissue regeneration KW - immunomodulation Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-197424 SN - 2296-634X VL - 5 ER - TY - JOUR A1 - Herrmann, Marietta A1 - Engelke, Klaus A1 - Ebert, Regina A1 - Müller-Deubert, Sigrid A1 - Rudert, Maximilian A1 - Ziouti, Fani A1 - Jundt, Franziska A1 - Felsenberg, Dieter A1 - Jakob, Franz T1 - Interactions between muscle and bone — Where physics meets biology JF - Biomolecules N2 - Muscle and bone interact via physical forces and secreted osteokines and myokines. Physical forces are generated through gravity, locomotion, exercise, and external devices. Cells sense mechanical strain via adhesion molecules and translate it into biochemical responses, modulating the basic mechanisms of cellular biology such as lineage commitment, tissue formation, and maturation. This may result in the initiation of bone formation, muscle hypertrophy, and the enhanced production of extracellular matrix constituents, adhesion molecules, and cytoskeletal elements. Bone and muscle mass, resistance to strain, and the stiffness of matrix, cells, and tissues are enhanced, influencing fracture resistance and muscle power. This propagates a dynamic and continuous reciprocity of physicochemical interaction. Secreted growth and differentiation factors are important effectors of mutual interaction. The acute effects of exercise induce the secretion of exosomes with cargo molecules that are capable of mediating the endocrine effects between muscle, bone, and the organism. Long-term changes induce adaptations of the respective tissue secretome that maintain adequate homeostatic conditions. Lessons from unloading, microgravity, and disuse teach us that gratuitous tissue is removed or reorganized while immobility and inflammation trigger muscle and bone marrow fatty infiltration and propagate degenerative diseases such as sarcopenia and osteoporosis. Ongoing research will certainly find new therapeutic targets for prevention and treatment. KW - muscle KW - bone KW - mechanosensing KW - mechanotransduction KW - myokines KW - osteokines adaptation Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-203399 SN - 2218-273X VL - 10 IS - 3 ER - TY - THES A1 - Braag, Aaron T1 - 10 Jahres Ergebnisse nach muskelschonendem modifiziertem Watson Jones Zugang bei der Implantation von Hüfttotalendoprothesen T1 - 10-year results after a muscle-sparing modified Watson Jones approach in total hip arthroplasty N2 - Bei der Implantation von Hüfttotalendoprothesen (HTEP) finden seit etwa 15 Jahren minimalinvasive muskelschonende Zugänge zunehmend Verwendung. Langfristige Daten der Zugänge, insbesondere des minimalinvasiven anterolateralen Zuganges nach Watson-Jones (ALMI) sind in der Literatur bisher nur unzureichend vorhanden. Methodik: Ziel dieser Studie war es ein Kollektiv nach HTEP Implantation mit ALMI Zugang mit einem Kollektiv nach HTEP Implantation mit lateralem Zugang nach 10 Jahren hinsichtlich Gelenksfunktion, Muskelfunktion, Zufriedenheit und radiologischer Parameter zu vergleichen und etwaige Unterschiede in der Langzeitbilanz zu detektieren. Zwei Kollektive mit jeweils 29 operierten Hüftgelenken, Erstimplantation durch die gleichen Operateure in den Jahren 2005 bis 2008, wurden im Diakoniewerk München-Maxvorstadt nachuntersucht. Die dafür herangezogenen Parameter waren Harris Hip Score, Forgotten Joint Score-12, klinische Prüfung des Trendelenburg Zeichens, postoperative Röntgenbildgebung, Auftreten von Komplikationen und Narbenlänge. Ergebnisse & Schlussfolgerungen: Die beiden Kollektive zeigten in den Parametern Harris Hip Score, Forgotten Joint Score und klinische Prüfung des Trendelenburg Zeichens geringfügige Unterschiede zugunsten des ALMI Kollektivs, die jedoch nicht signifikant waren. Beide Kollektive erreichten in den beschriebenen Scores sehr gute bis exzellente Ergebnisse nach 10 Jahren. Das geringere Auftreten eines auffälligen Trendelenburg Zeichens im ALMI Kollektiv (13,8 vs. 6,9 %) gibt Hinweise auf eine verbesserte Funktion der Glutealmuskulatur durch die intraoperative Muskelschonung. Die beiden Zugänge zeigten in den radiologischen Parametern und der Komplikationsrate ebenbürtige Ergebnisse. Vermehrte Fehlpositionierungen wurden im ALMI Kollektiv nicht beobachtet. Unsere Beobachtungen passen zu den wenigen vorhandenen in der Literatur beschriebenen Ergebnissen von minimalinvasiven muskelschonenden Zugängen in der Langzeitbilanz. N2 - Minimally invasive, muscle-sparing approaches have been increasingly used for the implantation of total hip endoprostheses (HTEP) for about 15 years. Long-term data on the approaches, in particular the minimally invasive anterolateral approach according to Watson-Jones (ALMI), is currently absent in the literature. Methods: The aim of this study was to compare a collective after THA implantation with ALMI approach with a collective after THA implantation with lateral approach after 10 years regarding joint function, muscle function, satisfaction and radiological parameters and detect any differences in the long-term period. Two collectives, each with 29 operated hip joints, first implantation by the same surgeons in the years 2005 to 2008, were followed up in the Diakoniewerk Munich-Maxvorstadt. The parameters used were Harris Hip Score, Forgotten Joint Score-12, clinical assessment of the Trendelenburg sign, postoperative X-ray imaging, occurrence of complications and scar length. Results & Conclusions: The two collectives showed slight differences in favor of the ALMI collective in the parameters Harris Hip Score, Forgotten Joint Score and clinical examination of the Trendelenburg sign, but these were not significant. Both collectives achieved very good to excellent results in the described scores after 10 years. The lower occurrence of a noticeable Trendelenburg sign in the ALMI collective (13.8 vs. 6.9%) indicates an improved function of the gluteal muscles through intraoperative muscle protection. The two approaches showed equal results in the radiological parameters and the complication rate. Increased incorrect positioning was not observed in the ALMI collective. Our observations match the few existing results of minimally invasive, muscle-sparing approaches in the long-term period, which are described in the literature. KW - Minimalinvasiv KW - Hüftgelenkprothese KW - Hüft-TEP KW - anterolateral KW - MIS KW - Langzeit Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-281416 ER - TY - JOUR A1 - Nedopil, Alexander J. A1 - Delman, Connor A1 - Howell, Stephen M. A1 - Hull, Maury L. T1 - Restoring the patient's pre-arthritic posterior slope is the correct target for maximizing internal tibial rotation when implanting a PCL retaining TKA with calipered kinematic alignment JF - Journal of Personalized Medicine N2 - Introduction: The calipered kinematically-aligned (KA) total knee arthroplasty (TKA) strives to restore the patient's individual pre-arthritic (i.e., native) posterior tibial slope when retaining the posterior cruciate ligament (PCL). Deviations from the patient's individual pre-arthritic posterior slope tighten and slacken the PCL in flexion that drives tibial rotation, and such a change might compromise passive internal tibial rotation and coupled patellofemoral kinematics. Methods: Twenty-one patients were treated with a calipered KA TKA and a PCL retaining implant with a medial ball-in-socket and a lateral flat articular insert conformity that mimics the native (i.e., healthy) knee. The slope of the tibial resection was set parallel to the medial joint line by adjusting the plane of an angel wing inserted in the tibial guide. Three trial inserts that matched and deviated 2°> and 2°< from the patient's pre-arthritic slope were 3D printed with goniometric markings. The goniometer measured the orientation of the tibia (i.e., trial insert) relative to the femoral component. Results: There was no difference between the radiographic preoperative and postoperative tibial slope (0.7 ± 3.2°, NS). From extension to 90° flexion, the mean passive internal tibial rotation with the pre-arthritic slope insert of 19° was greater than the 15° for the 2°> slope (p < 0.000), and 15° for the 2°< slope (p < 0.000). Discussion: When performing a calipered KA TKA with PCL retention, the correct target for setting the tibial component is the patient's individual pre-arthritic slope within a tolerance of ±2°, as this target resulted in a 15–19° range of internal tibial rotation that is comparable to the 15–18° range reported for the native knee from extension to 90° flexion. KW - total knee replacement KW - total knee arthroplasty KW - kinematic alignment KW - slope KW - rotation Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-240996 SN - 2075-4426 VL - 11 IS - 6 ER - TY - JOUR A1 - Meyer, Till Jasper A1 - Stöth, Manuel A1 - Moratin, Helena A1 - Ickrath, Pascal A1 - Herrmann, Marietta A1 - Kleinsasser, Norbert A1 - Hagen, Rudolf A1 - Hackenberg, Stephan A1 - Scherzad, Agmal T1 - Cultivation of head and neck squamous cell carcinoma cells with wound fluid leads to cisplatin resistance via epithelial-mesenchymal transition induction JF - International Journal of Molecular Sciences N2 - Locoregional recurrence is a major reason for therapy failure after surgical resection of head and neck squamous cell carcinoma (HNSCC). The physiological process of postoperative wound healing could potentially support the proliferation of remaining tumor cells. The aim of this study was to evaluate the influence of wound fluid (WF) on the cell cycle distribution and a potential induction of epithelial-mesenchymal transition (EMT). To verify this hypothesis, we incubated FaDu and HLaC78 cells with postoperative WF from patients after neck dissection. Cell viability in dependence of WF concentration and cisplatin was measured by flow cytometry. Cell cycle analysis was performed by flow cytometry and EMT-marker expression by rtPCR. WF showed high concentrations of interleukin (IL)-6, IL-8, IL-10, CCL2, MCP-1, EGF, angiogenin, and leptin. The cultivation of tumor cells with WF resulted in a significant increase in cell proliferation without affecting the cell cycle. In addition, there was a significant enhancement of the mesenchymal markers Snail 2 and vimentin, while the expression of the epithelial marker E-cadherin was significantly decreased. After cisplatin treatment, tumor cells incubated with WF showed a significantly higher resistance compared with the control group. The effect of cisplatin-resistance was dependent on the WF concentration. In summary, proinflammatory cytokines are predominantly found in WF. Furthermore, the results suggest that EMT can be induced by WF, which could be a possible mechanism for cisplatin resistance. KW - cell proliferation KW - wound fluid KW - epithelial-mesenchymal transition KW - cisplatin resistance KW - Interleukin KW - head and neck squamous cell carcinoma Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-258722 SN - 1422-0067 VL - 22 IS - 9 ER - TY - JOUR A1 - Prodinger, Peter Michael A1 - Lazic, Igor A1 - Horas, Konstantin A1 - Burgkart, Rainer A1 - von Eisenhart-Rothe, Rüdiger A1 - Weissenberger, Manuel A1 - Rudert, Maximilian A1 - Holzapfel, Boris Michael T1 - Revision Arthroplasty Through the Direct Anterior Approach Using an Asymmetric Acetabular Component JF - Journal of Clinical Medicine N2 - Despite increasing numbers of primary hip arthroplasties performed through the direct anterior approach (DAA), there is a lack of literature on DAA revision arthroplasty. The present study was performed in order to evaluate outcomes and revision rates after revision through the DAA using an asymmetric acetabular component with optional intra- and extramedullary fixation. In a retrospective cohort study, we analyzed prospectively collected data of 57 patients (61 hips, 43 female, 18 male) who underwent aseptic acetabular component revision through the DAA with the abovementioned implant system between January 2015 and December 2017. The mean follow-up was 40 months (12–56). Survival rates were estimated using the Kaplan–Meier method. All complications were documented and functional outcomes were assessed pre- and postoperatively. Kaplan–Meier analysis revealed an estimated five-year implant survival of 97% (confidence interval CI 87–99%). The estimated five-year survival with revision for any cause was 93% (CI 83–98%). The overall revision rate was 6.6% (n = 4). Two patients had to undergo revision due to periprosthetic infection (3.3%). In one patient, the acetabular component was revised due to aseptic loosening four months postoperatively. Another patient suffered from postoperative iliopsoas impingement and was treated successfully by arthroscopic iliopsoas tenotomy. Two (3.3%) of the revised hips dislocated postoperatively. The mean Harris Hip Score improved from 35 (2–66) preoperatively to 86 (38–100) postoperatively (p < 0.001). The hip joint’s anatomical center of rotation was restored at a high degree of accuracy. Our findings demonstrate that acetabular revision arthroplasty through the DAA using an asymmetric acetabular component with optional intra- and extramedullary fixation is safe and practicable, resulting in good radiographic and clinical midterm results. KW - anterior approach KW - revision arthroplasty KW - hip joint KW - acetabular bone defect KW - asymmetric implant KW - anatomic center of rotation Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-213184 SN - 2077-0383 VL - 9 IS - 9 ER - TY - JOUR A1 - Reichel, Thomas A1 - Herz, Stefan A1 - el Tabbakh, Mohammed A1 - Bley, Thorsten Alexander A1 - Plumhoff, Piet A1 - Rueckl, Kilian T1 - Less than 9.5-mm coracohumeral distance on axial magnetic resonance imaging scans predicts for subscapularis tear JF - JSES International N2 - Background Diagnosis of subscapularis (SSC) tendon lesions on magnetic resonance imaging (MRI) can be challenging. A small coracohumeral distance (CHD) has been associated with SSC tears. This study was designed to define a specific threshold value for CHD to predict SSC tears on axial MRI scans. Methods This retrospective study included 172 shoulders of 168 patients who underwent arthroscopic surgery for rotator cuff tear or glenohumeral instability. Diagnostic arthroscopy confirmed an SSC tear in 62 cases (36.0%, test group a), rotator cuff tear tears other than SSC in 71 cases (41.3%, control group b) and glenohumeral instability without any rotator cuff tear in 39 cases (22.7%, zero-sample group c). All patients had a preoperative MRI of the shoulder (1.5T or 3T). Minimum CHD was measured on axial fat-suppressed proton density-, T2-, or T1-weigthed sequences. Receiver operating characteristics analysis was used to determine the threshold value for CHD, and sensitivity and specificity were calculated. Results CHD measurement had a good interobserver reliability (Intraclass correlation coefficient 0.799). Mean CHD was highly significantly (P < .001) less for test group a (mean 7.3 mm, standard deviation ± 2.2) compared with control group b (mean 11.1 mm, standard deviation ± 2.3) or zero-sample group c (mean 13.6 mm, standard deviation ± 2.9). A threshold value of CHD <9.5 mm had a sensitivity of 83.6% and a specificity of 83.9% to predict SSC tears. Conclusion A CHD <9.5 mm on MRI is predictive of SSC lesions and a valuable tool to diagnose SSC tears. KW - subscapularis tear KW - coracohumeral distance KW - rotator cuff tear KW - coracohumeral impingement Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-259118 VL - 5 IS - 3 ER - TY - JOUR A1 - Ramírez-Rodríguez, Gloria Belén A1 - Pereira, Ana Rita A1 - Herrmann, Marietta A1 - Hansmann, Jan A1 - Delgado-López, José Manuel A1 - Sprio, Simone A1 - Tampieri, Anna A1 - Sandri, Monica T1 - Biomimetic mineralization promotes viability and differentiation of human mesenchymal stem cells in a perfusion bioreactor JF - International Journal of Molecular Sciences N2 - In bone tissue engineering, the design of 3D systems capable of recreating composition, architecture and micromechanical environment of the native extracellular matrix (ECM) is still a challenge. While perfusion bioreactors have been proposed as potential tool to apply biomechanical stimuli, its use has been limited to a low number of biomaterials. In this work, we propose the culture of human mesenchymal stem cells (hMSC) in biomimetic mineralized recombinant collagen scaffolds with a perfusion bioreactor to simultaneously provide biochemical and biophysical cues guiding stem cell fate. The scaffolds were fabricated by mineralization of recombinant collagen in the presence of magnesium (RCP.MgAp). The organic matrix was homogeneously mineralized with apatite nanocrystals, similar in composition to those found in bone. X-Ray microtomography images revealed isotropic porous structure with optimum porosity for cell ingrowth. In fact, an optimal cell repopulation through the entire scaffolds was obtained after 1 day of dynamic seeding in the bioreactor. Remarkably, RCP.MgAp scaffolds exhibited higher cell viability and a clear trend of up-regulation of osteogenic genes than control (non-mineralized) scaffolds. Results demonstrate the potential of the combination of biomimetic mineralization of recombinant collagen in presence of magnesium and dynamic culture of hMSC as a promising strategy to closely mimic bone ECM. KW - scaffold KW - perfusion bioreactor KW - collagen KW - apatite nanoparticles KW - magnesium KW - human mesenchymal stem cell KW - osteogenesis Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-285804 SN - 1422-0067 VL - 22 IS - 3 ER - TY - JOUR A1 - Streck, Laura Elisa A1 - Seefried, Lothar A1 - Genest, Franca A1 - Reichel, Thomas A1 - Rudert, Maximilian A1 - Rueckl, Kilian T1 - Insuffizienzfraktur der Klavikula nach Implantation einer inversen Schulterendoprothese JF - Der Orthopäde N2 - Wir stellen den seltenen Fall einer Insuffizienzfraktur der Klavikula nach Implantation einer inversen Schulterendoprothese (RSA) vor. Als Ursache solcher Frakturen wird eine vermehrte Zugbelastung durch den Musculus deltoideus nach RSA diskutiert. In den wenigen verfügbaren Fallberichten zeigten die betroffenen Patienten deutliche Funktionseinschränkungen. Die Versorgung erfolgte im vorliegenden Fall mit Plattenosteosynthese. Trotz intraoperativ gutem Korrekturergebnis kam es im Verlauf ohne Trauma zum Osteosyntheseversagen mit weiterer Dislokation der Fraktur. KW - Schulterendoprothetik KW - Glenohumeralgelenk KW - Osteoporose KW - Osteosynthese KW - Fraktur KW - postoperative Komplikationen Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-265286 VL - 51 IS - 3 ER - TY - JOUR A1 - Streck, Laura Elisa A1 - Gaal, Chiara A1 - Forster, Johannes A1 - Konrads, Christian A1 - Hertzberg-Boelch, Sebastian Philipp von A1 - Rueckl, Kilian T1 - Defining a synovial fluid white blood cell count threshold to predict periprosthetic infection after shoulder arthroplasty JF - Journal of Clinical Medicine N2 - Background: The diagnosis of periprosthetic shoulder infection (PSI) requires a thorough diagnostic workup. Synovial fluid aspiration has been proven to be a reliable tool in the diagnosis of joint infections of the lower extremity, but shoulder specific data is limited. This study defines a threshold for synovial fluid white blood cell count (WBC) and assesses the reliability of microbiological cultures. Methods: Retrospective study of preoperative and intraoperative fluid aspiration of 31 patients who underwent a revision of a shoulder arthroplasty (15 with PSI defined by IDSA criteria, 16 without infection). The threshold for WBC was calculated by ROC/AUC analysis. Results: WBC was significantly higher in patients with PSI than in other patients. A threshold of 2800 leucocytes/mm\(^3\) showed a sensitivity of 87% and a specificity of 88% (AUROC 0.92). Microbiological cultures showed a sensitivity of 76% and a specificity of 100%. Conclusions: A threshold of 2800 leucocytes/mm\(^3\) in synovial fluid can be recommended to predict PSI. Microbiological culture has an excellent specificity and allows for targeted antibiotic therapy. Joint aspiration presents an important pillar to diagnose PSI. KW - upper extremity KW - joint infection KW - joint aspiration KW - leucocyte count KW - cutibacteria KW - ICM KW - MSIS KW - IDSA KW - WBC Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-252275 SN - 2077-0383 VL - 11 IS - 1 ER - TY - JOUR A1 - Boelch, Sebastian Philipp A1 - Weissenberger, Manuel A1 - Spohn, Frederik A1 - Rudert, Maximilian A1 - Luedemann, Martin T1 - Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers JF - Journal of Orthopedic Surgery and Research N2 - Background: Evaluation of infection persistence during the two-stage exchange of the hip is challenging. Joint aspiration before reconstruction is supposed to rule out infection persistence. Sensitivity and specificity of synovial fluid culture and synovial leucocyte count for detecting infection persistence during the two-stage exchange of the hip were evaluated. Methods: Ninety-two aspirations before planned joint reconstruction during the two-stage exchange with spacers of the hip were retrospectively analyzed. Results: The sensitivity and specificity of synovial fluid culture was 4.6 and 94.3%. The sensitivity and specificity of synovial leucocyte count at a cut-off value of 2000 cells/μl was 25.0 and 96.9%. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values were significantly higher before prosthesis removal and reconstruction or spacer exchange (p = 0.00; p = 0.013 and p = 0.039; p = 0.002) in the infection persistence group. Receiver operating characteristic area under the curve values before prosthesis removal and reconstruction or spacer exchange for ESR were lower (0.516 and 0.635) than for CRP (0.720 and 0.671). Conclusions: Synovial fluid culture and leucocyte count cannot rule out infection persistence during the two-stage exchange of the hip. KW - two-stage exchange KW - hip KW - periprosthetic infection KW - joint aspiration KW - spacer Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-175576 VL - 13 IS - 7 ER - TY - JOUR A1 - Liedtke, Daniel A1 - Hofmann, Christine A1 - Jakob, Franz A1 - Klopocki, Eva A1 - Graser, Stephanie T1 - Tissue-Nonspecific Alkaline Phosphatase—A Gatekeeper of Physiological Conditions in Health and a Modulator of Biological Environments in Disease JF - Biomolecules N2 - Tissue-nonspecific alkaline phosphatase (TNAP) is a ubiquitously expressed enzyme that is best known for its role during mineralization processes in bones and skeleton. The enzyme metabolizes phosphate compounds like inorganic pyrophosphate and pyridoxal-5′-phosphate to provide, among others, inorganic phosphate for the mineralization and transportable vitamin B6 molecules. Patients with inherited loss of function mutations in the ALPL gene and consequently altered TNAP activity are suffering from the rare metabolic disease hypophosphatasia (HPP). This systemic disease is mainly characterized by impaired bone and dental mineralization but may also be accompanied by neurological symptoms, like anxiety disorders, seizures, and depression. HPP characteristically affects all ages and shows a wide range of clinical symptoms and disease severity, which results in the classification into different clinical subtypes. This review describes the molecular function of TNAP during the mineralization of bones and teeth, further discusses the current knowledge on the enzyme’s role in the nervous system and in sensory perception. An additional focus is set on the molecular role of TNAP in health and on functional observations reported in common laboratory vertebrate disease models, like rodents and zebrafish. KW - TNAP KW - hypophosphatasia KW - HPP KW - zebrafish KW - mineralization KW - ALPL KW - craniosynostosis KW - teeth KW - nervous system Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-220096 SN - 2218-273X VL - 10 IS - 12 PB - MDPI ER - TY - JOUR A1 - Schmalzl, Jonas A1 - Plumhoff, Piet A1 - Gilbert, Fabian A1 - Gohlke, Frank A1 - Konrads, Christian A1 - Brunner, Ulrich A1 - Jakob, Franz A1 - Ebert, Regina A1 - Steinert, Andre F. T1 - Tendon-derived stem cells from the long head of the biceps tendon JF - Bone & Joint Research N2 - Objectives The long head of the biceps (LHB) is often resected in shoulder surgery and could therefore serve as a cell source for tissue engineering approaches in the shoulder. However, whether it represents a suitable cell source for regenerative approaches, both in the inflamed and non-inflamed states, remains unclear. In the present study, inflamed and native human LHBs were comparatively characterized for features of regeneration. Methods In total, 22 resected LHB tendons were classified into inflamed samples (n = 11) and non-inflamed samples (n = 11). Proliferation potential and specific marker gene expression of primary LHB-derived cell cultures were analyzed. Multipotentiality, including osteogenic, adipogenic, chondrogenic, and tenogenic differentiation potential of both groups were compared under respective lineage-specific culture conditions. Results Inflammation does not seem to affect the proliferation rate of the isolated tendon-derived stem cells (TDSCs) and the tenogenic marker gene expression. Cells from both groups showed an equivalent osteogenic, adipogenic, chondrogenic and tenogenic differentiation potential in histology and real-time polymerase chain reaction (RT-PCR) analysis. Conclusion These results suggest that the LHB tendon might be a suitable cell source for regenerative approaches, both in inflamed and non-inflamed states. The LHB with and without tendinitis has been characterized as a novel source of TDSCs, which might facilitate treatment of degeneration and induction of regeneration in shoulder surgery. KW - biceps tendon KW - tendon-derived stem cell KW - mesenchymal stem cell KW - tissue engineering KW - shoulder Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-200370 VL - 8 IS - 9 ER - TY - JOUR A1 - Meyer, Julian S. A1 - Hessenauer, Florian M. A1 - Reichel, Thomas A1 - Pham, Mirko A1 - Plumhoff, Piet A1 - Rueckl, Kilian T1 - Isolated mononeuropathy of the suprascapular nerve: traumatic traction injury as an important differential diagnosis to the entrapment syndrome JF - JSES International N2 - No abstract available. KW - MR neurography KW - Suprascapular nerve KW - compression syndrome KW - neuropathy KW - shoulder neurolysis KW - suprascapular notch Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-229322 VL - 4 IS - 3 ER - TY - THES A1 - Heinz, Tizian T1 - Das Knorpelregister DGOU zur systematischen Patientenerfassung nach knorpelchirurgischen Eingriffen des Kniegelenkes - Analyse und wissenschaftliche Aufarbeitung der ersten 100 Patienten an der Orthopädischen Klinik König-Ludwig-Haus T1 - The cartilage registry DGOU for a systematic patient evaluation after cartilage repair surgery of the knee joint - An analysis and scientific work up of the first 100 patients at the orthopedic clinic König-Ludwig-Haus N2 - Die stark limitierte intrinsische Regenerationsfähigkeit des hyalinen Gelenkknorpels stellt auch in der modernen Medizin eine große Herausforderung dar. Während eine Vielzahl von knorpelchirurgischen Techniken am Kniegelenk koexistieren, bleibt die Selektion des am besten geeigneten Therapieverfahrens eine zentrale Herausforderung des orthopädischen Chirurgen. Hierzu bieten in Zeiten evidenzbasierter Medizin medizinische Register die Möglichkeit, klinische Behandlungsdaten systematisch in einem breiten Patientenkollektiv zu erfassen, die klinische Versorgungsrealität adäquat abzubilden sowie neue Behandlungsstrategien und Hypothesen zu generieren. Das Knorpelregister der DGOU bietet als webbasierte Registerform eine besonders moderne, effiziente und unbürokratische Form der Patientennachverfolgung über subjektiv bewertete und validierte Funktionsscores. Für das gesamte Registerkollektiv von 100 Patienten an der Orthopädischen Klinik-König-Ludwig Haus ergaben sich bereits sechs Monate nach dem knorpelchirurgischen Eingriff signifikant höhere Funktionsscores im IKDC und KOOS, welche sich auch im mittelfristigen Verlauf von zwölf Monaten noch signifikant erhöht gegenüber ihren präoperativen Werten zeigten. Die mediale Femurkondyle und knorpelige Patellarückfläche waren im Registerkollektiv am häufigsten von Defekten betroffen. Meist handelte es sich hierbei um drittgradige Defekte nach ICRS degenerativer Genese. Während das mechanische Débridement bei großflächigem, arthrotischem Gelenkknorpelverschleiß keine suffiziente Therapieoption bietet, ist zum Nutzen und Effektivität des Débridements bei fokalen, umschriebenen Gelenkknorpeldefekten bisher nur wenig bekannt. Im Registerkollektiv zeigte sich für das isoliert mechanische Débridement von Gelenkknorpeldefekten eine signifikante Verbesserung der subjektiven Funktionsscores. Im Falle begleitend durchgeführter meniskuschirurgischer Eingriffe zeigt sich die Datenlage deutlich heterogener und bietet Anlass für weiteren wissenschaftlichen Diskurs. N2 - The very limited ability for intrinsic regeneration of the hyaline cartilage poses an enormous challenge even in the days of modern medicine. While there exists a plethora of surgical techniques for cartilage repair, the orthopedic surgeon is regularly faced with the challenge of selecting the most appropriate therapeutic modality. Therefore, in times of evidence-based medicine, medical registries provide the ability of systematic patient evaluation, thereby reflecting data of real word clinical care in the routine setting, which allows for the development of new treatment strategies and hypotheses. The cartilage registry DGOU as a fully web based organized registry provides a particularly modern, efficient and unbureaucratic way for systematic patient evaluation and follow-up with the use of patient reported outcome measures. With respect to the included collective of a total of 100 patients at the orthopedic department König-Ludwig-Haus, significantly improved patient reported outcome measures of the KOOS and IKDC were observed as early as six months after the initial surgical procedure. Patient reported outcomes were still improved significantly in the mid-term follow-up of twelve months after the initial surgery. The medial femoral condyle and the patellar surface turned out to be the most frequent site of cartilage defects. Most of the times, cartilage defects were graded as grade III defects according to ICRS. Cartilage damage was mostly due to degenerative deterioration. According to the literature available, the usage of the mechanical debridement cannot be recommended for the extensive, arthritic type of cartilage defect. However, data on the efficiency of mechanical debridement for focal, non-arthritic cartilage defects are sparse and controversial. In this study, for the patients evaluated, a significant improvement of the patient reported outcome measures were observed after the mechanical debridement of focal cartilage defects. In the cases of concomitantly performed meniscal surgery, data turned out to be of a more heterogenous appearance which gives cause for further scientific discourse. KW - Hyaliner Knorpel KW - Kniegelenk KW - Knorpeldegeneration KW - Débridement KW - Knorpelchirurgie KW - Chondroplastik KW - Register KW - DGOU Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-282882 ER - TY - JOUR A1 - Prasse, Tobias A1 - Stratos, Ioannis A1 - Niehoff, Anja A1 - Christ, Hildegard A1 - Heck, Vincent A1 - Meyer, Carolin A1 - Mittlmeier, Thomas T1 - Bisphenol A-related effects on bone morphology and biomechanical properties in an animal model JF - Toxics N2 - Bisphenol A (BPA), which is contained in numerous plastic products, is known to act as an endocrine-disruptive, toxic, and carcinogenic chemical. This experimental series sought to determine the influence of BPA exposure on the femoral bone architecture and biomechanical properties of male and female Wistar rats. BPA was applied subcutaneously by using osmotic pumps. After 12 weeks, the bones were analyzed by micro-computed tomography (micro-CT) and a three-point bending test. Comparing the female low- and high-dose groups, a significantly greater marrow area (p = 0.047) was identified in the group exposed to a higher BPA concentration. In addition, the trabecular number tended to be higher in the female high-dose group when compared to the low-dose group (p > 0.05). The area moment of inertia also tended to be higher in the male high-dose group when compared to the male low-dose group (p > 0.05). Considering our results, BPA-related effects on the bone morphology in female Wistar rats are osteoanabolic after high-dose exposure, while, in male rats, a tendency toward negative effects on the bone morphology in terms of a reduced cross-sectional cortical area and total area could be demonstrated. KW - bisphenol A KW - endocrine disruption KW - bone morphology KW - micro-computed tomography KW - mechanical property KW - three-point bending Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-262216 SN - 2305-6304 VL - 10 IS - 2 ER - TY - THES A1 - Lörler [geb. Sichermann], Anna Ramona T1 - Versagensanalyse primärer Hüftendoprothesen T1 - Failure analysis of primary hip arthroplasty N2 - Einleitung: Der endoprothetische Hüftgelenksersatz zählt in Deutschland und weltweit zu den am häufigsten praktizierten operativen Eingriffen, wobei die Erfolgszahlen gleichzeitig sehr hoch sind bei stetiger Verbesserung der verwendeten alloplastischen Materialien und angewandten operativen Technik. Daher ist in Zukunft weiter mit einer steigenden Implantationszahl zu rechnen, was das Gesundheitssystem vor weitere sozioökonomische Herausforderungen stellt. Vor diesem Hintergrund ist es bedeutsam, die Ursachen für das Versagen von Hüftendoprothesen weiter im Auge zu behalten und näher zu erläutern. Material und Methoden: Es handelt sich um eine retrospektive Datenanalyse. Eingeschlossen wurden Daten von 785 Patienten, davon 440 weiblich und 345 männlich, die im Zeitraum von 2007 bis 2016 im König-Ludwig-Haus, der orthopädischen Klinik der Universität Würzburg, eine primäre Revision ihrer Hüftendoprothese erhielten. Folgende Daten wurden erhoben: Patientenalter, Standzeit der Prothese, Indexdiagnose, Revisionsgrund, Prothesentyp und Art der Revision. Ergebnisse: Das mittlere Alter bei der Indexdiagnose der Gesamtpopulation betrug 62,2 Jahre, bei der Revision 69,5 Jahre. Es ergab sich eine durchschnittliche Standzeit der Prothese von 88,0 Monaten im Gesamtkollektiv. Die häufigste Indexdiagnose, die zur Implantation der Hüftprothese führte, war Coxarthrose mit 81,4%. Der häufigste Grund für ein Versagen der Prothese war mit 39,4% die Lockerung der Prothese. Zu 67,7% wurde die Prothese zementfrei implantiert. Am häufigsten wurde eine Revision am femoralen Prothesenanteil durchgeführt mit 34,1%. Zusammenfassung: Insgesamt ergab sich aus den Daten, dass die Prothesen eine vergleichbar gute Standzeit im internationalen Vergleich aufwiesen. Es zeigte sich, dass die meisten Versagensursachen bereits früh nach Implantation der primären Prothese in Erscheinung treten, jedoch die Prothesenlockerung als häufigster Grund erst später im Verlauf bedeutsam für die Revisionsendoprothetik wird. N2 - Introduction: Primary hip replacement is one of the most frequently performed surgeries in Germany and international and at once very successful while there is still a continuous improvement in used alloplastic materials and surgical techniques. Therefore, an increasing number of implantations is to be expected for future years, which poses further socio-economic challenges for our healthcare system. So, it is important to keep the reasons for failures of hip prosthesis in mind and explicate them more. Material and methods: Retrospective Data from 785 patients, 440 female and 345 male, were included, who were treated for primary revision surgery of their hip prosthesis during 2007 to 2016 at the orthopedic clinic König-Ludwig-Haus in Würzburg. The following data were collected: patients age, time interval to revision, index diagnosis, reason for revision, type of prosthesis and type of revision. Results: The mean age at the index surgery of the total population was 62.2 years, at revision 69.5 years. The overall time interval to revision was at 88.0 months in the whole population. The most common index diagnosis leading to primary hip arthroplasty was osteoarthritis of the hip with 81.4%. The most common reason for failure of the prosthesis was loosening of the implant with 39.4%. 67.7% of the prosthesis were implanted as cementless type. The most common revision procedure was performed on the femoral implant part with 34.1% Summary: Overall, the data showed that the survival of the implants in comparison to other international studies was similar. It turned out that most causes of failure appeared early after implantation of the primary prosthesis but loosening as the most common reason became relevant after a longer period since primary implantation. KW - Hüftendoprothese KW - Hüftgelenk KW - Hüftgelenkersatz KW - Versagen KW - Revisionsgründe KW - Revisionsursachen KW - Versagensgründe KW - Primäre Hüftprothese KW - Failure KW - Primary hip arthroplasty KW - primary hip prosthesis KW - Reason for revision KW - Revision in hip arthroplasty Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-275331 ER - TY - JOUR A1 - Seefried, Lothar A1 - Genest, Franca A1 - Baumann, Jasmin A1 - Heidemeier, Anke A1 - Meffert, Rainer A1 - Jakob, Franz T1 - Efficacy of Zoledronic Acid in the Treatment of Nonmalignant Painful Bone Marrow Lesions: A Triple‐Blind, Randomized, Placebo‐Controlled Phase III Clinical Trial (ZoMARS) JF - Journal of Bone and Mineral Research N2 - Bone marrow lesions (BML) represent areas of deteriorated bone structure and metabolism characterized by pronounced water‐equivalent signaling within the trabecular bone on magnetic resonance imaging (MRI). BML are associated with repair mechanisms subsequent to various clinical conditions associated with inflammatory and non‐inflammatory injury to the bone. There is no approved treatment for this condition. Bisphosphonates are known to improve bone stability in osteoporosis and other bone disorders and have been used off‐label to treat BML. A randomized, triple‐blind, placebo‐controlled phase III trial was conducted to assess efficacy and safety of single‐dose zoledronic acid (ZOL) 5 mg iv with vitamin D 1000 IU/d as opposed to placebo with vitamin D 1000 IU/d in 48 patients (randomized 2:1) with BML. Primary efficacy endpoint was reduction of edema volume 6 weeks after treatment as assessed by MRI. After treatment, mean BML volume decreased by 64.53% (±41.92%) in patients receiving zoledronic acid and increased by 14.43% (±150.46%) in the placebo group (p = 0.007). A decrease in BML volume was observed in 76.5% of patients receiving ZOL and in 50% of the patients receiving placebo. Pain level (visual analogue scale [VAS]) and all categories of the pain disability index (PDI) improved with ZOL versus placebo after 6 weeks but reconciled after 6 additional weeks of follow‐up. Six serious adverse events occurred in 5 patients, none of which were classified as related to the study drug. No cases of osteonecrosis or fractures occurred. Therefore, single‐dose zoledronic acid 5 mg iv together with vitamin D may enhance resolution of bone marrow lesions over 6 weeks along with reduction of pain compared with vitamin D supplementation only. KW - bone biology KW - osteoporosis KW - bone marrow lesion/edema KW - bisphosphonates KW - zoledronic acid Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-276368 VL - 37 IS - 3 SP - 420 EP - 427 ER - TY - JOUR A1 - Weider, Margareta A1 - Schlagenhauf, Ulrich A1 - Seefried, Lothar T1 - Oral health status of adult hypophosphatasia patients: A cross‐sectional study JF - Journal of Clinical Periodontology N2 - Aim This study evaluated the oral health status of adult patients with hypophosphatasia (HPP). Materials and Methods Parameters of oral health assessment comprised decayed/missing/filled teeth (DMFT) index, probing pocket depth and clinical attachment level (CAL) as well as documentation of tooth loss and periodontal health status according to CCD/AAP criteria. Findings were compared with national reference data (DMS V survey) reporting oral health status in age‐related controls. Within‐group comparisons were made between the HPP patients harbouring one versus two alkaline phosphatase liver/bone/kidney type (ALPL) gene variants. Results Of 80 HPP patients (64 female) with a mean age of 46.4 years (range 24–78) and one (n = 55) or two (n = 18) variants (n = 7 lacking testing) within the ALPL gene, those with two variants displayed substantially higher tooth loss rate (14.0 ± 9.3) than those affected by only one ALPL variant (4.1 ± 5.4), who did not differ substantially from healthy DMS V controls. While DMFT score and severe periodontal diseases (PDs) of HPP patients with one variant only increased with progressing age, the two‐variant sub‐cohort age independently exhibited increased DMFT scores and a higher rate of severe PDs. Conclusions HPP patients affected by two variants of the ALPL gene exhibited a higher risk of periodontitis and tooth loss than the general population, while patients with one variant developed clinically relevant oral disease symptoms with progressing ageing. KW - dental status KW - hypophosphatasia KW - inflammation KW - periodontal disease KW - tooth loss Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-293777 VL - 49 IS - 12 SP - 1253 EP - 1261 ER - TY - JOUR A1 - Arnholdt, Jörg A1 - Kamawal, Yama A1 - Horas, Konstantin A1 - Holzapfel, Boris M. A1 - Gilbert, Fabian A1 - Ripp, Axel A1 - Rudert, Maximilian A1 - Steinert, Andre F. T1 - Accurate implant fit and leg alignment after cruciate-retaining patient-specific total knee arthroplasty JF - BMC Musculoskeletal Disorders N2 - Background For improved outcomes in total knee arthroplasty (TKA) correct implant fitting and positioning are crucial. In order to facilitate a best possible implant fitting and positioning patient-specific systems have been developed. However, whether or not these systems allow for better implant fitting and positioning has yet to be elucidated. For this reason, the aim was to analyse the novel patient-specific cruciate retaining knee replacement system iTotal (TM) CR G2 that utilizes custom-made implants and instruments for its ability to facilitate accurate implant fitting and positioning including correction of the hip-knee-ankle angle (HKA). Methods We assessed radiographic results of 106 patients who were treated with the second generation of a patient-specific cruciate retaining knee arthroplasty using iTotal\(^{TM}\) CR G2 (ConforMIS Inc.) for tricompartmental knee osteoarthritis (OA) using custom-made implants and instruments. The implant fit and positioning as well as the correction of the mechanical axis (hip-knee-ankle angle, HKA) and restoration of the joint line were determined using pre- and postoperative radiographic analyses. Results On average, HKA was corrected from 174.4 degrees +/- 4.6 degrees preoperatively to 178.8 degrees +/- 2.2 degrees postoperatively and the coronal femoro-tibial angle was adjusted on average 4.4 degrees. The measured preoperative tibial slope was 5.3 degrees +/- 2.2 degrees (mean +/- SD) and the average postoperative tibial slope was 4.7 degrees +/- 1.1 degrees on lateral views. The joint line was well preserved with an average modified Insall-Salvati index of 1.66 +/- 0.16 pre- and 1.67 +/- 0.16 postoperatively. The overall accuracy of fit of implant components was decent with a measured medial overhang of more than 1 mm (1.33 mm +/- 0.32 mm) in 4 cases only. Further, a lateral overhang of more than 1 mm (1.8 mm +/- 0.63) (measured in the anterior-posterior radiographs) was observed in 11 cases, with none of the 106 patients showing femoral notching. Conclusion The patient-specific iTotal\(^{TM}\) CR G2 total knee replacement system facilitated a proper fitting and positioning of the implant components. Moreover, a good restoration of the leg axis towards neutral alignment was achieved as planned. Nonetheless, further clinical follow-up studies are necessary to validate our findings and to determine the long-term impact of using this patient- specific system. KW - total knee replacement KW - knee axis KW - patient-specific knee arthroplasty KW - knee osteoarthritis KW - implant positioning Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-230012 VL - 21 ER - TY - JOUR A1 - Fuchs, Konrad F. A1 - Heilig, Philipp A1 - McDonogh, Miriam A1 - Boelch, Sebastian A1 - Gbureck, Uwe A1 - Meffert, Rainer H. A1 - Hoelscher-Doht, Stefanie A1 - Jordan, Martin C. T1 - Cement-augmented screw fixation for calcaneal fracture treatment: a biomechanical study comparing two injectable bone substitutes JF - Journal of Orthopaedic Surgery and Research N2 - Background The role of cement-augmented screw fixation for calcaneal fracture treatment remains unclear. Therefore, this study was performed to biomechanically analyze screw osteosynthesis by reinforcement with either a calcium phosphate (CP)-based or polymethylmethacrylate (PMMA)-based injectable bone cement. Methods A calcaneal fracture (Sanders type IIA) including a central cancellous bone defect was generated in 27 synthetic bones, and the specimens were assigned to 3 groups. The first group was fixed with four screws (3.5 mm and 6.5 mm), the second group with screws and CP-based cement (Graftys (R) QuickSet; Graftys, Aix-en-Provence, France), and the third group with screws and PMMA-based cement (Traumacem (TM) V+; DePuy Synthes, Warsaw, IN, USA). Biomechanical testing was conducted to analyze peak-to-peak displacement, total displacement, and stiffness in following a standardized protocol. Results The peak-to-peak displacement under a 200-N load was not significantly different among the groups; however, peak-to-peak displacement under a 600- and 1000-N load as well as total displacement exhibited better stability in PMMA-augmented screw osteosynthesis compared to screw fixation without augmentation. The stiffness of the construct was increased by both CP- and PMMA-based cements. Conclusion Addition of an injectable bone cement to screw osteosynthesis is able to increase fixation strength in a biomechanical calcaneal fracture model with synthetic bones. In such cases, PMMA-based cements are more effective than CP-based cements because of their inherently higher compressive strength. However, whether this high strength is required in the clinical setting for early weight-bearing remains controversial, and the non-degradable properties of PMMA might cause difficulties during subsequent interventions in younger patients. KW - arthritis KW - bone KW - calcaneus KW - cement KW - fracture KW - fixation KW - osteoporosis KW - sanders KW - screw Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-230336 VL - 15 ER - TY - JOUR A1 - Jakubietz, Rafael G. A1 - Schmidt, Karsten A1 - Holzapfel, Boris M. A1 - Meffert, Rainer H. A1 - Jakubietz, Michael G. T1 - Pedicled perforator flaps for mid-tibial soft tissue reconstruction in medically compromised patients JF - JPRAS Open N2 - Background: The soft tissue of the central pretibial area is difficult to reconstruct often requiring free tissue transfer. Especially medi- cally compromised patients are not ideal candidates for free tissue transfer and may benefit from expeditiously harvested local flaps with limited donor site morbidity. As muscle flaps are rare, pedi- cled flaps based on lateral perforators represent an alternative as the arc of rotation can often be limited to 90 °. Material and Methods: A retrospective analysis of patient data was conducted to identify patients over the age of 60 years with comor- bidities that underwent pretibial soft tissue reconstruction with a single-pedicle perforator flap. Patient demographics, size and cause of the defect, flap dimension, arc of rotation and complications were recorded. Results: Five patients with an average age of 71.4 years were in- cluded. The arc of rotation was 69 °, all flaps healed. There were two recurrences of osteomyelitis. Conclusion: Lateral perforators originating from the anterior tib- ial artery or peroneal artery are adequate source vessels for single pedicled perforator flaps even in medically compromised patients. A perforator located proximal to the defect allows limiting the arcof rotation to less than 90 °, which increases the safety of the flap. Patients benefit from a simple procedure without a microvascular anastomosis and a donor site confined to one extremity KW - Propeller flap KW - Pedicled perforator flap KW - Lower extremity reconstruction KW - Elderly patients Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-229473 VL - 24 ER - TY - JOUR A1 - Lüdemann, Martin A1 - Jakuscheit, Axel A1 - Ewald, Andrea A1 - Frühmann, Leena A1 - Hölscher-Doht, Stefanie A1 - Rudert, Maximilian A1 - von Hertzberg-Boelch, Sebastian Philipp T1 - Influence of Tranexamic Acid on Elution Characteristics and Compressive Strength of Antibiotic-Loaded PMMA-Bone Cement with Gentamicin JF - Materials N2 - Purpose: The topical application of tranexamic acid (TXA) into the joint space during total joint arthroplasty (TJA) with no increase of complications, has been widely reported. We investigated the influence of TXA on antibiotic release, activity of the released antibiotic against a clinical isolate of S. aureus, and compressive strength of a widely used commercially prepared gentamicin-loaded cement brand (PALACOS R + G). Method: 12 bone cement cylinders (diameter and height = 6 and 12 mm, respectively) were molded. After curing in air for at least 1 h, six of the cylinders were completely immersed in 5 mL of fetal calf serum (FCS) and the other six were completely immersed in a solution consisting of 4.9 mL of FCS and 0.1 mL (10 mg) of TXA. Gentamicin elution tests were performed over 7 d. Four hundred µL of the gentamicin eluate were taken every 24 h for the first 7 d without renewing the immersion fluid. The gentamicin concentration was determined in a clinical analyzer using a homogeny enzyme immuno-assay. The antimicrobial activity of the eluate, obtained after day 7, was tested. An agar diffusion test regime was used with Staphylococcus aureus. Bacteria were grown in a LB medium and plated on LB agar plates to get a bacterial lawn. Fifty µL of each eluate were pipetted on 12-mm diameter filter discs, which were placed in the middle of the agar gel. After 24 h of cultivation at 37 °C, the zone of inhibition (ZOI) for each specimen was measured. The compressive strength of the cements was determined per ISO 5833. Results: At each time point in the gentamicin release test, the difference in gentamicin concentration, obtained from specimens immersed in the FCS solution only and those immersed in the FCS + TXA solution was not significant (p = 0.055–0.522). The same trend was seen in each of the following parameters, after 7 d of immersion: (1) Cumulative gentamicin concentration (p < 0.297); (2) gentamicin activity against S. aureus (strongly visible); (3) ZOI size (mostly > 20 mm) (p = 0.631); and (4) compressive strength (p = 0.262). Conclusions: For the PALACOS R + G specimens, the addition of TXA to FCS does not produce significant decreases in gentamicin concentration, in the activity of the gentamicin eluate against a clinical isolate of S. aureus, the zone of inhibition of S. aureus, and in the compressive strength of the cement, after 7 d of immersion in the test solution. KW - gentamicin-loaded poly (methyl methacrylate) bone cement KW - total joint arthroplasty KW - total knee arthroplasty KW - tranexamic acid Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-246236 SN - 1996-1944 VL - 14 IS - 19 ER - TY - JOUR A1 - Arnholdt, Jörg A1 - Gilbert, Fabian A1 - Blank, Marc A1 - Papazoglou, Jannis A1 - Rudert, Maximilian A1 - Nöth, Ulrich A1 - Steinert, Andre F. T1 - The Mayo conservative hip: complication analysis and management of the first 41 cases performed at a University level 1 department JF - BMC Muskoskeletal Disorders N2 - 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." KW - total hip arthroplasty KW - short hip stem KW - mayo stem KW - minimal invasive surgery Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-157812 VL - 18 IS - 250 ER - TY - JOUR A1 - Boelch, Sebastian P. A1 - Rueckl, Kilian A1 - Fuchs, Clara A1 - Jordan, Martin A1 - Knauer, Markus A1 - Steinert, Andre A1 - Rudert, Maximilian A1 - Luedemann, Martin T1 - 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 JF - BioMed Research International N2 - 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. KW - Copal\(^®\) spacem KW - PMMA bone cement KW - elution KW - compressive strength Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-177435 VL - 2018 IS - 4323518 ER - TY - JOUR A1 - Jakuscheit, Axel A1 - Schaefer, Nina A1 - Roedig, Johannes A1 - Luedemann, Martin A1 - Hertzberg-Boelch, Sebastian Philipp von A1 - Weissenberger, Manuel A1 - Schmidt, Karsten A1 - Holzapfel, Boris Michael A1 - Rudert, Maximilian T1 - Modifiable individual risks of perioperative blood transfusions and acute postoperative complications in total hip and knee arthroplasty JF - Journal of Personalized Medicine N2 - 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. KW - patient blood management KW - total joint arthroplasty KW - haemoglobin KW - perioperative management Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-250290 SN - 2075-4426 VL - 11 IS - 11 ER - TY - THES A1 - Momper, Laurent T1 - Interaktion der Schlüsselenzyme der Mineralisierung (AP, ENPP1, AnkH, PHOSPHO1) im Phosphatstoffwechsel in vitro T1 - Interaction of the Key Enzymes of Mineralization (AP, ENPP1, AnkH, PHOSPHO1) in the Phosphate Metabolism in vitro N2 - Die Enzyme TNSALP (Tissue Non-Specific Alkaline Phosphatase), ENPP1 (Ectonucleotide Pyrophosphatase/Phosphodiesterase 1) und ANKH (Ankylosis, progressive human homolog) bilden zusammen eine zentrale Regulierungseinheit für den Pyrophosphat (PPi)-Stoffwechsel der Zelle [1, 2]. Störungen 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 beeinträchtigte Funktion der TNSALP zugrunde, wodurch sich die PPi- Konzentration im Microenvironment der Zelle erhöht. Diese kann im Knochengewebe zu schweren Mineralisierungsstörungen führen [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 zurück[4]. Auch der Mevalonat-Pathway trägt zur Komposition des Microenvironments bezüglich der Homöostase von Phosphaten bei [6, 7]. Hier bestehen auch medizinisch relevante Einflussmöglichkeiten, 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 Enzymaktivität für ALP und ENPP1 und der Aktivität des PPi-Kanals ANKH sowie des Mevalonatstoffwechsels zum Einsatz kamen (PPi, Pyridoxalphosphat (PLP), Probenecid, Vitamin D, PPADS (Pyridoxalphosphat-6-azophenyl-2‘,4‘-disulfid Säure) 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 Änderungen des Genexpressionsmusters sind letztlich nicht auszuschliessen, blieben jedoch aufgrund der hohen Spendervariabilität durch eine erhöhte 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 Phänomene der Mineralisierung, als auch mit Blick auf die untersuchte Genregulation der wichtigsten beteiligten Proteine, was möglicherweise die hohe Kompensationskapazität der Systeme unter physiologischen Bedingungen reflektiert. Untersuchungen auf proteomischer Ebene, besonders mit Blick auf die Prozessierung von Polypeptiden mit Mineralisierungs-modulierender Wirkung würden möglicherweise genaueren Einblick vermitteln. Eine genauere Untersuchung der Einflüsse von ENPP1 erscheint für die Zukunft vielversprechend. Allerdings treten hier, besonders auch durch die verwendeten Hemmstoffe der ENPP1, die Phänomene der Vernetzung des Stoffwechsels der Phosphate (inklusive ATP und seiner Metabolite) mit dem Purinergen Signalling deutlich zutage. Diese Vernetzung generiert durch ihre Komplexität sowohl klinisch als auch zellbiologisch/biochemisch erhebliche Interpretationsprobleme, die zukünftige Arbeiten auflösen müssen. Dabei sollte besondere Aufmerksamkeit auf zwei für HPP-PatientInnen klinisch in Zukunft potentiell bedeutsame Ergebnisse gelegt werden, die möglicherweise ungünstigen 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, José Luis Millán, 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, José Luis Millán, 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 Nürnberg, 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. Löffler, 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. N2 - Together, the enzymes TNSALP (Tissue Non-Specific Alkaline Phosphatase), ENPP1 (Ectonucleotide Pyrophosphatase/Phosphodiesterase 1) and ANKH (Ankylosis, progressive human homolog) form a central regulation entity for the cellular metabolism of pyrophosphate (PPi)[1, 2]. Dysregulation of these coordinated processes result in severe diseases, such as Hypophosphatasia (HPP) [3]. This condition is caused by an autosomal recessive inheritance pattern, which restricts the function of TNSALP, thus resulting in an increased concentration of PPi in the micro-environment of the cell. This can lead to severe disruption of skeletal mineralization [1, 2]. Other diseases with low PPi concentrations are associated with the pathological calcification of different tissues [1, 5] and can be traced back to genetic defects of ENPP1 [1]. The mevalonate pathway contributes to the composition of the micro-environment and hence to the homeostasis of phosphates [6, 7]. This constitutes a medically relevant possibility of influence, for example through bisphosphonates as a treatment for widespread diseases like Osteoporosis. This study analyzed the impact of a PPi exposure on the in vitro mineralization of human mesenchymal stem cells (hMSCs) in the process of osteogenic differentiation. For this purpose, we used enzymatic activity modulators for ALP, ENPP1 as well as for ANKH and the Mevalonate pathway (PPi, Pyridoxalphosphate, Probenecid, Vitamine D, PPADS (Pyridoxalphosphate-6-azophenyl-2‘,4‘-disulfid acid) and ß-γmeATP (ß-γ Methylentriphosphate)). The results show no clear effects due to the modulation of the PPi concentration during osteogenic differentiation of hMSCs in vitro. Minor changes in genetic expression patterns cannot be ruled out due to an elevated variability among the donor cells, said discrepancy would have to be consolidated through an increased number of experiments. Altogether, this study shows unexpectedly low impacts of exogenic an endogenic modulation of the PPi concentration, in regards to the physical effects of mineralization as well as the genetic regulation of the key proteins involved. This could be a reflection of the compensation capacity of these mechanisms under physiological circumstances. In order to provide indepth insight into this matter, further examination on a proteomic level would be necessary, especially with an outlook onto the processing of polypeptides with mineralization-modulating effects. A promising strategy for future studies seems to be a further investigation of the effects of ENPP1. However, this approach will be confronted, especially due to inhibitors of ENPP1, with the complex networking of the phosphate metabolism (included ATP and his metabolites) with purinerg signaling. Due to its complexity, this interconnectedness generates considerable interpretation issues on a clinical as well as a cell biological level, which would have to be investigated further in future studies. The focus here should be put on two results of potential clinical significance for HPP-patients, namely the unfavorable effects on the ALPL-expression of a Probenecid therapy as well as the increased expression of ALPL during ENPP1 inhibition. 1. Dympna Harmey, L.H., Sonoko Narisawa, Kirsten A. Johnson, Robert Terkeltaub, José Luis Millán, 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, José Luis Millán, 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 Nürnberg, 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. Löffler, 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. KW - Hypophosphatasie KW - Hypophosphatasia Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-238529 ER - TY - THES A1 - Molinaro, Johannes-Nils T1 - Interaktion zwischen 1,25-Dihydroxy-Vitamin D3 und Retinsäure vermittelter Signaltransduktion in humanen mesenchymalen Stammzellen T1 - Interaction between 1,25-dihydroxy-vitamin D3 und retinoic acid mediated signal transduction in human mesenchymal stem cells N2 - Die Arbeit stellt mögliche Einflüsse durch 1,25- Dihydroxy-Vitamin D3 (1,25-VitD3) und Retinsäure (RA) in humanen mesenchymalen Stammzellen (hMSC) sowohl während der adipogenen und osteogenen Differenzierung als auch während der Kurzzeit- und Langzeitstimulation auf das Mikromilieu dar. Die Stimulation mit 1,25-VitD3 und RA verlangsamt das Wachstumsverhalten und verändert die Zellmorphologie von hMSC. Effekte auf die Genexpression werden auf mRNA-Ebene mittels RT-PCR dargestellt. Der Phänotyp 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. N2 - The paper reports about possible effects of 1,25-dihydroxy-vitamin D3 (1,25-VitD3) und retinoic acid (RA) in human mesenchymal stem cells (hMSC) during adipogenic and osteogenic differentiation as well as effects on the microenvironment during a short and long time stimulation. Stimulation with 1,25-VitD3 and RA slows down the growth rate and alters cell morphology of hMSC. Effects on gene expression are shown at the mRNA level by means of RT-PCR. The phenotype and partly the gene expression of adipogenic and osteogenic differentiation are stimulated by 1,25-VitD3 and are inhibited by RA. In addition, both the “microenvironment composition” and the “transcription signal” of 1,25-VitD3 and RA are mutually influenced. KW - Vitamin D KW - Retinsäure KW - Vitamin D3 KW - all-trans-Retinsäure KW - 9-cis-Retinsäure KW - humane mesenchymle Stammzellen KW - osteogene Differenzierung KW - adipogene Differenzierung Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-249838 ER - TY - JOUR A1 - Herrmann, Marietta A1 - Diederichs, Solvig A1 - Melnik, Svitlana A1 - Riegger, Jana A1 - Trivanović, Drenka A1 - Li, Shushan A1 - Jenei-Lanzl, Zsuzsa A1 - Brenner, Rolf E. A1 - Huber-Lang, Markus A1 - Zaucke, Frank A1 - Schildberg, Frank A. A1 - Grässel, Susanne T1 - Extracellular Vesicles in Musculoskeletal Pathologies and Regeneration JF - Frontiers in Bioengineering and Biotechnology N2 - 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. KW - extracellular vesicles KW - exosomes KW - musculoskeletal diseases KW - MSC KW - iMP KW - cell-free therapeutics Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-222882 SN - 2296-4185 VL - 8 ER - TY - THES A1 - Knödler, Eva T1 - Langzeitergebnisse über 12-16 Jahre für die Hybrid-Knieendoprothese PFC-Modular T1 - Longterm results over 12-16 years for Hybrid-TKA PFC-Modular N2 - Ziel der vorliegenden Studie war, die Überlebensrate der Hybrid-PFC-Knieprothese im Langzeit-verlauf darzustellen. Insgesamt wurden 91 Patienten erfasst (50 mit klinischer und radiologischer Untersuchung und 41 anhand der Fragebögen). Es handelt sich um 78 Frauen und 13 Männer mit einem durchschnittlichen Alter von 79,6 Jahren zum Nachuntersuchungszeitpunkt (März bis Juni 2004). Der Nachuntersuchungszeitraum umfasst 12 - 16 Jahre nach Implantation. Ausgewertet wurden die folgenden standartisierten Fragebögen: WOMAC, SMFA-D, KSS. Die radiologische Untersuchung erfolgte gemäß KSRESS. Die Überlebenszeitanalyse beträgt 88% nach 15 Jahren. In diesem Zeitraum wurden 10 Revisionen erfasst. WOMAC mit insgesamt guten Ergebnissen bezüglich Schmerz (3,2), Steife (3,6), Funktion (4,1) und Gesamtscore (3,7). SMFA-D mit eher mittelmäßigen Werten von 42,8 im Funktionsindex und 42,4 im Beeinträchtigungsindex und der Knee Society Score (KSS) mit einem mäßigen Ergebnis von 78,8 im Kniescore und einem schlechten Wert 53,6 im Funktionsscore. Die radiologische Auswertung gemäß KSRESS zeigte Aufhellungslinien > 2mm im Bereich D_16_1 1 (Femurschild Position 1) und größere 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 höherem Durchschnittsalter der erhobenen Studienteilnehmer gegenüber Vergleichs-studien. Die Langzeit-Überlebensrate von 88% zeigt sich ebenbürtig gegenüber anderen Verfahren. Die kürzere OP-Zeit beim Hybridverfahren ist als Vorteil zu sehen. Somit bietet die Hybridtechnik eine gute zusätzliche chirurgische Option in der Knieendoprothetik. Zusammenfassend kann hier berichtet werden das die PFC-Modular Hybrid-Knieendo-prothese insgesamt eine gute Haltbarkeit über einen Zeitraum bis zu 16 Jahre bietet. Die eher mäßigen Scores der Fragebögen wurden vermutlich durch das hohe Alter der Patienten beeinflußt. N2 - This thesis shows the results of the survivorship analysis of PFC-Modular TKA in hybrid-technique over 12-16 years. KW - Knieendoprothese KW - Langzeitstudie Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-191019 ER - TY - THES A1 - Volk, Simone T1 - Prospektiv-randomisierte, kontrollierte Evaluation der Auswirkungen zweier postoperativer Nachbehandlungskonzepte auf die Rerupturrate nach operativer Rekonstruktion der Rotatorenmanschette T1 - Prospective randomized controlled evaluation of the effects of two rehabilitation protocols on the retear rate after surgical repair of the rotator cuff N2 - Aufgrund der divergierenden Studienlage bezüglich 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. Hierfür wurden 57 Patienten präoperativ, 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 für 6 Wochen. In der konservativen Nachbehandlungsgruppe wurden bis 6 Wochen postoperativ lediglich Pendelübungen durchgeführt, in der progressiven Nachbehandlungsgruppe erfolgte eine passive Beübung 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). Bezüglich der klinischen und psychischen Ergebnisse zeigte sich 6 Monate postoperativ lediglich eine Einschränkung 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 über 65 Jahren unabhängig von der Nachbehandlungsgruppe kürzer Analgetika eingenommen und waren 6 Wochen postoperativ weniger bewegungseingeschränkt. Aufgrund einer Tendenz zu vermehrten Rerupturen nach progressiver Nachbehandlung in der Literatur werden daher weiterführende Studien benötigt um zu evaluieren, ob ältere Patienten von einer vermehrten Ruhigstellung profitieren könnten. Diese Studie präsentiert im Gegensatz zu der überwiegend in der Literatur verwendeten arthroskopischen OP-Technik Ergebnisse nach RM-Refixation in Mini-Open-Technik. Damit liefert sie eine gute Grundlage für weiterführende Studien insbesondere in der Behandlung von größeren RM-Rupturen, welche ein erhöhtes Rerupturrisiko besitzen und von einer konservativen Nachbehandlung profitieren könnten. N2 - Due to divergent studies regarding physiotherapeutic treatment after surgical rotator cuff repair, two rehabilitation protocols after surgical rotator cuff repair using the mini-open technique were evaluated in a prospective randomized study. For this purpose, 57 patients were examined and evaluated preoperatively, 3 weeks, 6 weeks and 6 months postoperatively. The scores included the NRS-Score, Constant-Score, DASH-Score, ASES-Score, NHP-Score, SF-36-Score as well as a sonographic examination to assess the retear rate after 6 months postoperatively. In both groups patients were immobilized with a Gilchrist sling for 6 weeks. In the delayed group only pendulum exercises were allowed until 6 weeks postoperatively. In the early group, passive exercises were carried out directly postoperatively up to the pain threshold with the exception of adduction. The retear rate was 5.3% respectively with 3.7% in the delayed and 6.7% in the early group with no significant group difference (p = 0.540). Regarding the clinical and psychological results 6 months postoperatively, there was only a restriction of the active external rotation in the delayed group (46.2∘ vs. 39.7∘, p = 0.031). Otherwise there was no significant group difference. Subgroup analyzes were also carried out, particularly with regard to age and gender of the patients. Patients over 65 years of age had less and shorter use of analgetics postoperatively and were better in their mobility 6 weeks postoperatively. Due to the tendency towards increased retears after early aggressive rehabilitation in literature, further studies are required to evaluate whether older patients could benefit from immobilization. In contrast to the arthroscopic surgical technique mainly used in literature, this study presents results after RM refixation in the mini-open technique. It thus provides a good basis for further studies, particularly in the treatment of larger RM ruptures, which have an increased risk of retear and could benefit from longer immobilization. KW - Rotatorenmanschettenruptur KW - Rotatorenmanschette KW - Nachbehandlung KW - Reruptur KW - Mini-Open Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-249547 ER - TY - JOUR A1 - Boelch, S. P. A1 - Jakuscheit, A. A1 - Doerries, S. A1 - Fraissler, L. A1 - Hoberg, M. A1 - Arnholdt, J. A1 - Rudert, M. T1 - Periprosthetic infection is the major indication for TKA revision – experiences from a university referral arthroplasty center JF - BMC Musculoskeletal Disorders N2 - 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. KW - knee arthroplasty KW - revision KW - failure KW - periprosthetic infection Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-176983 VL - 19 IS - 395 ER - TY - JOUR A1 - Achenbach, Leonard A1 - Le Hanneur, Malo A1 - Camenzind, Roland S. A1 - Bouyer, Michael A1 - Pottecher, Pierre A1 - Lafosse, Thibault T1 - Systematic bifocal decompression for isolated long thoracic nerve paresis: A case series of 12 patients JF - Interdisciplinary Neurosurgery N2 - 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. KW - entrapment, traction KW - serratus anterior KW - scapular winging KW - scapula alata KW - dyskinesia KW - peripheral nerve KW - nerve compression KW - micro-traumatic KW - neurolysis Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-265085 VL - 27 ER -