TY - JOUR A1 - Steinert, Andre F. A1 - Schröder, Lennart A1 - Sefrin, Lukas A1 - Janßen, Björn A1 - Arnholdt, Jörg A1 - Rudert, Maximilian T1 - The impact of total knee replacement with a customized cruciate-retaining implant design on patient-reported and functional outcomes JF - Journal of Personalized Medicine N2 - Purpose: To treat patients with tricompartimental knee osteoarthritis (OA), a customized cruciate-retaining total knee arthroplasty (CCR-TKA) system can be used, including both individualized instrumentation and implants. The objective of this monocentric cohort study was to analyze patient-reported and functional outcomes in a series of patients implanted with the second generation of this customized implant. Methods: At our arthroplasty center, we prospectively recruited a cohort of patients with tricompartmental gonarthrosis to be treated with total knee replacement (TKA) using a customized cruciate-retaining (CCR) implant design. Inclusion criteria for patients comprised the presence of intact posterior cruciate and collateral ligaments and a knee deformity that was restricted to <15° varus, valgus, or flexion contracture. Patients were assessed for their range of motion (ROM), Knee Society Score (KSS), Western Ontario and McMaster University osteoarthritis index (WOMAC), and short form (SF)-12 physical and mental scores, preoperatively, at 3 and 6 months, as well as at 1, 2, 3, and 5 years of follow-up (FU) postoperatively. Results: The average age of the patient population was 64 years (range: 40–81), the average BMI was 31 (range: 23–42), and in total, 28 female and 45 male patients were included. Implant survivorship was 97.5% (one septic loosening) at an average follow-up of 2.5 years. The KSS knee and function scores improved significantly (p < 0.001) from, respectively, 41 and 53 at the pre-operative visit, to 92 and 86, respectively, at the 5-year post-operative time point. The SF-12 Physical and Mental scores significantly (p < 0.001) improved from the pre-operative values of 28 and 50, to 50 and 53 at the 5-year FU, respectively. Patients experienced significant improvements in their overall knee range of motion, from 106° at the preoperative visit to 122°, on average, 5 years postoperatively. The total WOMAC score significantly (p < 0.001) improved from 49.1 preoperatively to 11.4 postoperatively at 5-year FU. Conclusions: Although there was no comparison to other implants within this study, patients reported high overall satisfaction and improvement in functional outcomes within the first year from surgery, which continued over the following years. These mid-term results are excellent compared with those reported in the current literature. Comparative long-term studies with this device are needed. Level of evidence 3b (individual case–control study). KW - patient-specific KW - custom-made implant KW - total knee arthroplasty KW - TKA KW - knee replacement KW - tricompartmental knee osteoarthritis KW - iTotal Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-312746 SN - 2075-4426 VL - 12 IS - 2 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 - Dotterweich, Julia A1 - Tower, Robert J. A1 - Brandl, Andreas A1 - Müller, Marc A1 - Hofbauer, Lorenz C. A1 - Beilhack, Andreas A1 - Ebert, Regina A1 - Glüer, Claus C. A1 - Tiwari, Sanjay A1 - Schütze, Norbert A1 - Jakob, Franz T1 - The KISS1 Receptor as an In Vivo Microenvironment Imaging Biomarker of Multiple Myeloma Bone Disease JF - PLoS One N2 - Multiple myeloma is one of the most common hematological diseases and is characterized by an aberrant proliferation of plasma cells within the bone marrow. As a result of crosstalk between cancer cells and the bone microenvironment, bone homeostasis is disrupted leading to osteolytic lesions and poor prognosis. Current diagnostic strategies for myeloma typically rely on detection of excess monoclonal immunoglobulins or light chains in the urine or serum. However, these strategies fail to localize the sites of malignancies. In this study we sought to identify novel biomarkers of myeloma bone disease which could target the malignant cells and/or the surrounding cells of the tumor microenvironment. From these studies, the KISS1 receptor (KISS1R), a G-protein-coupled receptor known to play a role in the regulation of endocrine functions, was identified as a target gene that was upregulated on mesenchymal stem cells (MSCs) and osteoprogenitor cells (OPCs) when co-cultured with myeloma cells. To determine the potential of this receptor as a biomarker, in vitro and in vivo studies were performed with the KISS1R ligand, kisspeptin, conjugated with a fluorescent dye. In vitro microscopy showed binding of fluorescently-labeled kisspeptin to both myeloma cells as well as MSCs under direct co-culture conditions. Next, conjugated kisspeptin was injected into immune-competent mice containing myeloma bone lesions. Tumor-burdened limbs showed increased peak fluorescence compared to contralateral controls. These data suggest the utility of the KISS1R as a novel biomarker for multiple myeloma, capable of targeting both tumor cells and host cells of the tumor microenvironment. KW - multiple myeloma Lesions KW - fluorescence microscopy KW - biomarkers Myelomas KW - bone imaging KW - myeloma cells KW - fluorescent dyes Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-146960 VL - 11 IS - 5 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 - Rueckl, Kilian A1 - Runer, Armin A1 - Bechler, Ulrich A1 - Faschingbauer, Martin A1 - Boelch, Sebastian Philipp A1 - Keyes Sculco, Peter A1 - Boettner, Friedrich T1 - The posterior-anterior-flexed view is essential for the evaluation of valgus osteoarthritis. A prospective study on 134 valgus knees JF - BMC Muscoskeletal Disorders N2 - Background Radiographic imaging is an important tool to assess osteoarthritis (OA). Lateral compartment osteoarthritis (valgus OA) usually starts with cartilage degeneration along the posterior aspect of the lateral femoral condyle. There is evidence that the posterior-anterior (PA)-flexed view is more sensitive when diagnosing early stages of valgus OA compared to the anterior-posterior (AP) view. The current paper analyzes the value of the PA-flexed view for patients scheduled for total knee arthroplasty (TKA). Methods Radiographs of 134 valgus knees were assessed prior to TKA. The minimal joint space width (minJSW) was measured on AP and PA-flexed views. The extent of mechanical deformity was measured on hip to ankle standing films. Results 49 (36.6%) AP views showed Kellgren and Lawrence (K/L)-grade 4 osteoarthritis in the lateral compartment, 82 (63.4%) showed grade 3 or less. The PA-flexed view resulted in an increased K/L-grading to grade 4 for 53 knees (62.4%) that were considered grade 3 or less on standard AP-radiographs. There was a significant differences between lateral minJSW on AP and PA-flexed view for patients with up to 10 degrees of mechanical valgus deformity (p < 0.001), as well as 11 to 15 degrees of mechanical deformity (p = 0.021). Only knees with severe deformity of more than 15 degrees did not show a difference in minJSW between PA-flexed view and AP view (p = 0.345). Conclusions The PA-flexed view is superior to the standard AP view in quantifying the extent of valgus OA in patients with zero to fifteen degrees of valgus deformity. It is recommended for the initial assessment of patients with valgus osteoarthritis and better documents the extent of osteoarthritis prior to TKA. KW - Valgus osteoarthritis KW - Knee KW - PA-flexed view KW - View KW - Radiographs Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-200536 VL - 20 ER - TY - JOUR A1 - Streck, Laura Elisa A1 - Forster, Johannes A1 - von Hertzberg-Boelch, Sebastian Philipp A1 - Reichel, Thomas A1 - Rudert, Maximilian A1 - Rueckl, Kilian T1 - The role of synovial fluid aspiration in shoulder joint infections JF - BMC Musculoskeletal Disorders N2 - Background Joint aspiration with analysis of synovial fluid white blood cell count (WBC) and microbiological culture is a widely established aspect in the diagnosis of shoulder joint infections (SJI). In case of a two stage revision for SJI, joint aspiration before re−/implantation of a total shoulder arthroplasty (TSA) was used to rule out persistent infection for years but its value is under debate. Shoulder specific data on all aspects is rare. The current study aims to answer the following research questions: Does joint aspiration have an insufficient predictive value in the diagnosis of SJI in (1) initial workup and (2) before definite arthroplasty with polymethylmethacrylate (PMMA)-Spacer in place? Methods This retrospective evaluation investigates 35 patients that were treated for SJI with a two staged implantation of a TSA after debridement and implantation of an PMMA-Spacer. Joint aspirations were performed preoperatively (PA) and before re−/implantation of the prosthesis while spacer was in place (interstage aspiration, IA). Samples were taken for microbiological culture and analysis of WBC. Sensitivity and specificity were calculated with reference to intraoperative microbiological samples. Receiver Operating Characteristic (ROC), Area-Under-Curve analysis (AUC) and calculation of the Youden index were performed to find optimum cut-off for WBC. Results The sensitivity of microbiological cultures from PA was 58.3% and the specificity was 88.9%. The mean WBC was 27,800 leucocytes/mm3 (range 400-96,300). The maximum Youden index (0.857) was a cut-off of 2600 leucocytes/mm3 with a sensitivity of 85.7% and a specificity of 100.0%. The sensitivity and specificity of IA were 0.0% and 88.5%, respectively. Conclusions Preoperative aspiration is likely to miss Cutibacteria spp. and CoNS and cannot rule out infection for sure. However, we recommend it for its advantages of targeted antibiotic therapy in case of germ identification. Empiric antibiotic therapy should cover Cutibacteria and CoNS even if aspiration showed negative microbiological cultures. In contrast, the diagnostic value of interstage aspiration does not qualify for its routine use. KW - revision arthroplasty KW - periprosthetic joint infection KW - white blood cell count KW - septic KW - microbiological culture KW - interstage aspiration Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300795 VL - 23 ER - TY - JOUR A1 - Benisch, Peggy A1 - Schilling, Tatjana A1 - Klein-Hitpass, Ludger A1 - Frey, Sönke P. A1 - Seefried, Lothar A1 - Raaijmakers, Nadja A1 - Krug, Melanie A1 - Regensburger, Martina A1 - Zeck, Sabine A1 - Schinke, Thorsten A1 - Amling, Michael A1 - Ebert, Amling A1 - Jakob, Franz T1 - The Transcriptional Profile of Mesenchymal Stem Cell Populations in Primary Osteoporosis Is Distinct and Shows Overexpression of Osteogenic Inhibitors JF - PLoS One N2 - Primary osteoporosis is an age-related disease characterized by an imbalance in bone homeostasis. While the resorptive aspect of the disease has been studied intensely, less is known about the anabolic part of the syndrome or presumptive deficiencies in bone regeneration. Multipotent mesenchymal stem cells (MSC) are the primary source of osteogenic regeneration. In the present study we aimed to unravel whether MSC biology is directly involved in the pathophysiology of the disease and therefore performed microarray analyses of hMSC of elderly patients (79-94 years old) suffering from osteoporosis (hMSC-OP). In comparison to age-matched controls we detected profound changes in the transcriptome in hMSC-OP, e.g. enhanced mRNA expression of known osteoporosis-associated genes (LRP5, RUNX2, COL1A1) and of genes involved in osteoclastogenesis (CSF1, PTH1R), but most notably of genes coding for inhibitors of WNT and BMP signaling, such as Sclerostin and MAB21L2. These candidate genes indicate intrinsic deficiencies in self-renewal and differentiation potential in osteoporotic stem cells. We also compared both hMSC-OP and non-osteoporotic hMSC-old of elderly donors to hMSC of similar to 30 years younger donors and found that the transcriptional changes acquired between the sixth and the ninth decade of life differed widely between osteoporotic and non-osteoporotic stem cells. In addition, we compared the osteoporotic transcriptome to long term-cultivated, senescent hMSC and detected some signs for pre-senescence in hMSC-OP. Our results suggest that in primary osteoporosis the transcriptomes of hMSC populations show distinct signatures and little overlap with non-osteoporotic aging, although we detected some hints for senescence-associated changes. While there are remarkable inter-individual variations as expected for polygenetic diseases, we could identify many susceptibility genes for osteoporosis known from genetic studies. We also found new candidates, e.g. MAB21L2, a novel repressor of BMP-induced transcription. Such transcriptional changes may reflect epigenetic changes, which are part of a specific osteoporosis-associated aging process. KW - alkaline-phosphatase KW - in vitro KW - bone-mineral density KW - age-related osteoporosis KW - WNT signaling pathway KW - replicative senescence KW - morphogenetic protein KW - parathyroid-hormone KW - growth factor KW - skeletal overexpression Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-133379 VL - 7 IS - 9 ER - TY - JOUR A1 - Sappey-Marinier, Elliot A1 - Howell, Stephen M. A1 - Nedopil, Alexander J. A1 - Hull, Maury L. T1 - The trochlear groove of a femoral component designed for kinematic alignment is lateral to the quadriceps line of force and better laterally covers the anterior femoral resection than a mechanical alignment design JF - Journal of Personalized Medicine N2 - Background: A concern about kinematically aligned (KA) total knee arthroplasty (TKA) is that it relies on femoral components designed for mechanical alignment (MAd-FC) that could affect patellar tracking, in part, because of a trochlear groove orientation that is typically 6° from vertical. KA sets the femoral component coincident to the patient’s pre-arthritic distal and posterior femoral joint lines and restores the Q-angle, which varies widely. Relative to KA and the native knee, aligning the femoral component with MA changes most distal joint lines and Q-angles, and rotates the posterior joint line externally laterally covering the anterior femoral resection. Whether switching from a MAd- to a KAd-FC with a wider trochlear groove orientation of 20.5° from vertical results in radiographic measures known to promote patellar tracking is unknown. The primary aim was to determine whether a KAd-FC sets the trochlear groove lateral to the quadriceps line of force (QLF), better laterally covers the anterior femoral resection, and reduces lateral patella tilt relative to a MAd-FC. The secondary objective was to determine at six weeks whether the KAd-FC resulted in a higher complication rate, less knee extension and flexion, and lower clinical outcomes. Methods: Between April 2019 and July 2022, two surgeons performed sequential bilateral unrestricted caliper-verified KA TKA with manual instruments on thirty-six patients with a KAd- and MAd-FC in opposite knees. An observer measured the angle between a line best-fit to the deepest valley of the trochlea and a line representing the QLF that indicated the patient’s Q-angle. When the trochlear groove was lateral or medial relative to the QLF, the angle is denoted + or −, and the femoral component included or excluded the patient’s Q-angle, respectively. Software measured the lateral undercoverage of the anterior femoral resection on a Computed Tomography (CT) scan, and the patella tilt angle (PTA) on a skyline radiograph. Complications, knee extension and flexion measurements, Oxford Knee Score, KOOS Jr, and Forgotten Joint Score were recorded pre- and post-operatively (at 6 weeks). A paired Student’s T-test determined the difference between the KA TKAs with a KAd-FC and MAd-FC with a significance set at p < 0.05. Results: The final analysis included thirty-five patients. The 20.5° trochlear groove of the KAd-FC was lateral to the QLF in 100% (15 ± 3°) of TKAs, which was greater than the 69% (1 ± 3°) lateral to the QLF with the 6° trochlear groove of the MAd-FC (p < 0.001). The KAd-FC’s 2 ± 1.9 mm lateral undercoverage of the anterior femoral resection was less than the 4.4 ± 1.5 mm for the MAd-FC (p < 0.001). The PTA, complication rate, knee extension and flexion, and clinical outcome measures did not differ between component designs. Conclusions: The KA TKA with a KAd-FC resulted in a trochlear groove lateral to the QLF that included the Q-angle in all patients, and negligible lateral undercoverage of the anterior femoral resection. These newly described radiographic parameters could be helpful when investigating femoral components designed for KA with the intent of promoting patellofemoral kinematics. KW - total knee arthroplasty KW - lateral trochlear undercoverage KW - prosthetic design KW - kinematic alignment KW - patellofemoral relationship Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-290482 SN - 2075-4426 VL - 12 IS - 10 ER - TY - JOUR A1 - Rudert, Maximilian A1 - Horas, Konstantin A1 - Hoberg, Maik A1 - Steinert, Andre A1 - Holzapfel, Dominik Emanuel A1 - Hübner, Stefan A1 - Holzapfel, Boris Michael T1 - The Wuerzburg procedure: the tensor fasciae latae perforator is a reliable anatomical landmark to clearly identify the Hueter interval when using the minimally-invasive direct anterior approach to the hip joint JF - BMC Musculoskeletal Disorders N2 - Background The key for successful delivery in minimally-invasive hip replacement lies in the exact knowledge about the surgical anatomy. The minimally-invasive direct anterior approach to the hip joint makes it necessary to clearly identify the tensor fasciae latae muscle in order to enter the Hueter interval without damaging the lateral femoral cutaneous nerve. However, due to the inherently restricted overview in minimally-invasive surgery, this can be difficult even for experienced surgeons. Methods and Surgical Technique In this technical note, we demonstrate for the first time how to use the tensor fasciae latae perforator as anatomical landmark to reliably identify the tensor fasciae latae muscle in orthopaedic surgery. Such perforators are used for flaps in plastic surgery as they are constant and can be found at the lateral third of the tensor fasciae latae muscle in a direct line from the anterior superior iliac spine. Conclusion As demonstrated in this article, a simple knowledge transfer between surgical disciplines can minimize the complication rate associated with minimally-invasive hip replacement. KW - anatomical landmark KW - direct anterior approach KW - Hueter interval KW - minimally-invasive KW - hip replacement KW - perforator Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-146031 VL - 17 IS - 57 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 - Graser, Stephanie A1 - Liedtke, Daniel A1 - Jakob, Franz T1 - TNAP as a new player in chronic inflammatory conditions and metabolism JF - International Journal of Molecular Sciences N2 - This review summarizes important information on the ectoenzyme tissue-nonspecific alkaline phosphatase (TNAP) and gives a brief insight into the symptoms, diagnostics, and treatment of the rare disease Hypophosphatasia (HPP), which is resulting from mutations in the TNAP encoding ALPL gene. We emphasize the role of TNAP beyond its well-known contribution to mineralization processes. Therefore, above all, the impact of the enzyme on central molecular processes in the nervous system and on inflammation is presented here. KW - TNAP KW - Hypophosphatasia KW - HPP KW - mineralization KW - nervous system KW - inflammation Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-258888 SN - 1422-0067 VL - 22 IS - 2 ER - TY - THES A1 - Schilling, Tatjana T1 - Transdifferentiation of Human Mesenchymal Stem Cells T1 - Transdifferenzierung humaner Mesenchymaler Stammzellen N2 - With ageing, the loss of bone mass correlates with the expansion of adipose tissue in human bone marrow thus facilitating bone-related diseases like osteopenia and osteoporosis. The molecular mechanisms underlying these events are still largely unknown. Reduced osteogenesis and concurrently enhanced adipogenesis might not only occur due to the impairment of conventional osteogenic differentiation originating from mesenchymal stem cells (MSCs). Additionally, transdifferentiation of (pre-)osteoblasts into adipocytes could contribute to the fatty conversion. Therefore, the aim of the present study was to prove the existence of transdifferentiation between the adipogenic and osteogenic lineage and to elucidate molecular mechanisms underlying this phenomenon. At first, a cell culture system of primary human MSCs was established that allowed for differentiation into the adipogenic and osteogenic lineage and proved that the MSC-derived adipocytes and pre-osteoblasts were capable of transdifferentiation (reprogramming) from one into the other lineage. Thereby, lineage-specific markers were completely reversed after reprogramming of pre-osteoblasts into adipocytes. The osteogenic transdifferentiation of adipocytes was slightly less efficient since osteogenic markers were present but the adipogenic ones partly persisted. Hence, plasticity also reached into the differentiation pathways of both lineages and the better performance of adipogenic reprogramming further supported the assumption of its occurrence in vivo. The subsequent examination of gene expression changes by microarray analyses that compared transdifferentiated cells with conventionally differentiated ones revealed high numbers of reproducibly regulated genes shortly after initiation of adipogenic and osteogenic reprogramming. Thereof, many genes were correlated with metabolism, transcription, and signal transduction as FGF, IGF, and Wnt signalling, but only few of the established adipogenesis- and none of the osteogenesis-associated marker genes were detected within 24 h after initiation of transdifferentiation. To find possible key control factors of transdifferentiation amongst the huge amount of regulated genes, a novel bioinformatic scoring scheme was developed that ranked genes due to their potential relevance for reprogramming. Besides the reproducibility and level of their regulation, also the possible reciprocity between the adipogenic and osteogenic transdifferentiation pathway was taken into account. Fibroblast growth factor 1 (FGF1) that ranked as one of the leading candidates to govern reprogramming was proven to inhibit adipogenic differentiation as well as adipogenic transdifferentiation in our cell culture system. Further examination of the FGF signalling pathway and other highly ranked genes could help to better understand the age-related fatty degeneration at the molecular level and therefore provide target molecules for therapeutic modulation of the plasticity of both lineages in order to inhibit adipogenic degeneration and to enhance osteogenesis. N2 - Der Verlust an Knochenmasse im Alter ist mit der Ausbreitung von Fettgewebe im menschlichen Knochenmark assoziiert und fördert daher auch knochenspezifische Erkrankungen wie Osteopenie und Osteoporose. Die diesen Ereignissen zu Grunde liegenden Mechanismen sind immer noch weitgehend unbekannt. Die abnehmende Osteogenese und die gleichzeitig zunehmende Adipogenese treten wahrscheinlich nicht nur wegen der Beeinträchtigung der konventionellen osteogenen Differenzierung von mesenchymalen Stammzellen (MSZ) auf. Zusätzlich könnte auch die Transdifferenzierung (Reprogrammierung) von Osteoblasten(vorläufern) zu Adipozyten zur fettigen Umwandlung beitragen. Das Ziel der vorliegenden Studie war es daher, die Existenz der Transdifferenzierung zwischen dem adipogenen und osteogenen Differenzierungsweg nachzuweisen und die molekularen Mechanismen aufzuklären, die diesem Phänomen zu Grunde liegen. Zunächst wurde ein Zellkultursystem primärer mesenchymaler Stammzellen etabliert, in dem eine Differenzierung zu Adipozyten und Osteoblasten durchgeführt werden konnte, und nachgewiesen, dass aus MSZ erhaltene Adipozyten und Osteoblastenvorläufer von einer zur anderen Zelllinie transdifferenziert (reprogrammiert) werden können. Dabei wurden die zelllinienspezifischen Marker nach der Reprogrammierung von Osteoblastenvorläufern zu Adipozyten vollständig umgekehrt. Die osteogene Transdifferenzierung von Adipozyten war etwas weniger effizient, da die osteogenen Marker zwar vorhanden waren, aber auch die adipogenen Marker weiterhin auftraten. Die Plastizität erstreckte sich also auch auf die Differenzierungswege der beiden Zellpopulationen, wobei das bessere Ergebnis bezüglich der adipogenen Reprogrammierung die Annahme ihres Auftretens in vivo weiter unterstützte. Die nachfolgende Untersuchung von Genexpressionsänderungen mittels Mikroarray-Analysen, die transdifferenzierte mit konventionell differenzierten Zellen verglichen, führte kurz nach Initiation der adipogenen und osteogenen Transdifferenzierung zum Auffinden zahlreicher, reproduzierbar regulierter Gene. Viele dieser Gene standen mit Metabolismus, Transkription und Signaltransduktion wie dem FGF-, IGF- und Wnt-Signalweg in Zusammenhang, es wurden allerdings nur einige Adipogenese- und keinerlei Osteogenese-assoziierte Markergene innerhalb 24 h nach Initiation der Transdifferenzierung detektiert. Um unter der großen Zahl an regulierten Genen mögliche Schlüsselkontrollfaktoren der Transdifferenzierung zu finden, wurde ein neuartiges, bioinformatisches Punktesystem entwickelt, das Gene entsprechend ihrer potenziellen Relevanz für die Reprogrammierung auflistete. Dabei wurde neben der Reproduzierbarkeit und dem Ausmaß ihrer Regulation auch eine mögliche Reziprozität der Regulation zwischen dem adipogenen und osteogenen Transdifferenzierungsweg berücksichtigt. Es konnte nachgewiesen werden, dass der Fibroblastenwachstumsfaktor 1 (FGF1), der als einer der Hauptkandidaten für die Steuerung der Reprogrammierung eingeordnet worden war, in unserem Zellkultursystem sowohl die adipogene Differenzierung als auch die adipogene Transdifferenzierung hemmt. Die weitere Untersuchung des FGF-Signalwegs und anderer, hoch gelisteter Gene könnte zum besseren Verständnis der altersbezogenen fettigen Degeneration auf molekularer Ebene beitragen und daher Zielmoleküle liefern, die eine therapeutische Beeinflussung der Plastizität zwischen beiden Zelllinien zur Verhinderung der fettigen Degeneration und zur Förderung der Osteogenese erlauben. KW - Zelldifferenzierung KW - Metaplasie KW - Mesenchymale Stammzellen KW - Transdifferenzierung KW - Osteoblasten KW - Adipozyten KW - Mesenchymal Stem Cells KW - transdifferentiation KW - osteoblasts KW - adipocytes Y1 - 2007 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-24299 ER - TY - JOUR A1 - Heinz, Tizian A1 - Eidmann, Annette A1 - Anderson, Philip A1 - Weißenberger, Manuel A1 - Jakuscheit, Axel A1 - Rudert, Maximilian A1 - Stratos, Ioannis T1 - Trends in computer-assisted surgery for total knee arthroplasty in Germany: an analysis based on the operative procedure classification system between 2010 to 2021 JF - Journal of Clinical Medicine N2 - Alignment strategies for primary total knee arthroplasty (TKA) have changed significantly over time with a shift towards a more individualized alignment goal. At the same time, computer-assisted surgery (CAS) has gained interest for intraoperative control and accuracy in implant positioning and limb alignment. Despite the often discussed benefits and drawbacks of robotics and navigation for TKA, the routine use of these new devices on a day-to-day basis remains obscure. Therefore, nationwide hospital billing data based on the Operation Procedure Classification System (OPS) were retrieved from the Federal Statistical Office of Germany for the period from 2010 to 2021. OPS codes for primary total knee arthroplasty (OPS code: 5-822*) were further analyzed regarding the usage of computer navigation (additional OPS code: 5-988) or robotic devices (additional OPS code: 5-987). Gender and age at the time of surgery were also assessed. The results show a total of 2,226,559 primary TKAs were implanted between 2010 and 2021, of which 2,044,914 were performed conventionally (91.84% of all TKAs). A total of 170,276 TKAs were performed using navigation technique (7.65% of all TKAs) and another 11,369 TKAs were performed using robotics (0.51% of all TKAs). For the period from 2018 to 2021, a substantial increase in robot-assisted TKA (R-TKA) was observed, with an average increase rate of 84.74% per year, while the number of navigated TKAs declined (−3.67% per year). Computer-assisted surgery, and particularly robotics for TKA, are seeing growing popularity and stepwise translation into routine clinical use in Germany, with a steep increase rate of more than 80% per year since 2018. Nevertheless, the majority of TKAs are still performed using manual instrumentation, rendering conventional TKA the currently unchanged gold standard. KW - robotic KW - TKA KW - knee replacement KW - computer navigation KW - Germany Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-304879 SN - 2077-0383 VL - 12 IS - 2 ER - TY - JOUR A1 - Luetkens, Karsten Sebastian A1 - Grunz, Jan-Peter A1 - Kunz, Andreas Steven A1 - Huflage, Henner A1 - Weißenberger, Manuel A1 - Hartung, Viktor A1 - Patzer, Theresa Sophie A1 - Gruschwitz, Philipp A1 - Ergün, Süleyman A1 - Bley, Thorsten Alexander A1 - Feldle, Philipp T1 - Ultra-high-resolution photon-counting detector CT arthrography of the ankle: a feasibility study JF - Diagnostics N2 - This study was designed to investigate the image quality of ultra-high-resolution ankle arthrography employing a photon-counting detector CT. Bilateral arthrograms were acquired in four cadaveric specimens with full-dose (10 mGy) and low-dose (3 mGy) scan protocols. Three convolution kernels with different spatial frequencies were utilized for image reconstruction (ρ\(_{50}\); Br98: 39.0, Br84: 22.6, Br76: 16.5 lp/cm). Seven radiologists subjectively assessed the image quality regarding the depiction of bone, hyaline cartilage, and ligaments. An additional quantitative assessment comprised the measurement of noise and the computation of contrast-to-noise ratios (CNR). While an optimal depiction of bone tissue was achieved with the ultra-sharp Br98 kernel (S ≤ 0.043), the visualization of cartilage improved with lower modulation transfer functions at each dose level (p ≤ 0.014). The interrater reliability ranged from good to excellent for all assessed tissues (intraclass correlation coefficient ≥ 0.805). The noise levels in subcutaneous fat decreased with reduced spatial frequency (p < 0.001). Notably, the low-dose Br76 matched the CNR of the full-dose Br84 (p 0.999) and superseded Br98 (p < 0.001) in all tissues. Based on the reported results, a photon-counting detector CT arthrography of the ankle with an ultra-high-resolution collimation offers stellar image quality and tissue assessability, improving the evaluation of miniscule anatomical structures. While bone depiction was superior in combination with an ultra-sharp convolution kernel, soft tissue evaluation benefited from employing a lower spatial frequency. KW - photon-counting CT KW - arthrography KW - ankle KW - cartilage KW - radiation dosage Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-362622 SN - 2075-4418 VL - 13 IS - 13 ER - TY - JOUR A1 - Wirtz, Dieter C. A1 - Gravius, Sascha A1 - Ascherl, Rudolf A1 - Thorweihe, Miguel A1 - Forst, Raimund A1 - Noeth, Ulrich A1 - Maus, Uwe M. A1 - Wimmer, Matthias D. A1 - Zeiler, Guenther A1 - Deml, Moritz C. T1 - Uncemented femoral revision arthroplasty using a modular tapered, fluted titanium stem 5-to 16-year results of 163 cases JF - Acta Orthopaedica N2 - Background and purpose - Due to the relative lack of reports on the medium- to long-term clinical and radiographic results of modular femoral cementless revision, we conducted this study to evaluate the medium- to long-term results of uncemented femoral stem revisions using the modular MRP-TITAN stem with distal diaphyseal fixation in a consecutive patient series. Patients and methods - We retrospectively analyzed 163 femoral stem revisions performed between 1993 and 2001 with a mean follow-up of 10 (5-16) years. Clinical assessment included the Harris hip score (HHS) with reference to comorbidities and femoral defect sizes classified by Charnley and Paprosky. Intraoperative and postoperative complications were analyzed and the failure rate of the MRP stem for any reason was examined. Results - Mean HHS improved up to the last follow-up (37 (SD 24) vs. 79 (SD 19); p < 0.001). 99 cases (61%) had extensive bone defects (Paprosky IIB-III). Radiographic evaluation showed stable stem anchorage in 151 cases (93%) at the last follow-up. 10 implants (6%) failed for various reasons. Neither a breakage of a stem nor loosening of the morse taper junction was recorded. Kaplan-Meier survival analysis revealed a 10-year survival probability of 97% (95% CI: 95-100). Interpretation - This is one of the largest medium- to longterm analyses of cementless modular revision stems with distal diaphyseal anchorage. The modular MRP-TITAN was reliable, with a Kaplan-Meier survival probability of 97% at 10 years. KW - follow-up KW - distal fixation KW - bone loss KW - replacement KW - register KW - junction KW - cement KW - prosthesis KW - roentgenographic assessment KW - total HIP-arthroplasty Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-114555 SN - 1745-3674 VL - 85 IS - 6 ER - TY - THES A1 - Flegler, Katharina T1 - Untersuchung der Expression von Knochensialoprotein (BSP) an Gewebe von Knochenmetastasen mittels Immunhistologie : Vergleich eines Antikörpers gegen nicht-glykosyliertes BSP mit einem Antikörper gegen glykosyliertes BSP T1 - Expression of bone sialoprotein (BSP) in bone metastases : antibodies against normal BSP compared to antibodies against BSP which bind epitopes that are incomplete in their posttranslational glycosylation N2 - Knochensialoprotein (BSP) ist ein Protein der extrazellulären Matrix im Knochen und mineralisierten Geweben, wird aber auch von verschiedenen Tumorzellen exprimiert (Bellahcene et al., 1994, 1997, 1998). Dies ist assoziiert mit einer schlechten Prognose und einem erhöhten Risiko für eine spätere Entwicklung von Knochenmetastasen. Diel et al. (1999) konnte zeigen, dass ein erhöhter Serum-BSP-Wert bei Patientinnen mit Mammakarzinom zu einem gehäuften Auftreten von Knochenmetastasen im Laufe der Erkrankung führt. BSP scheint ein Marker für die Entstehung von Knochenmetastasen zu sein. In der Literatur ist ein Antikörper beschrieben, der ein Epitop des BSP erkennt, welches im BSP aus Tumorzellen nicht glykosyliert ist, im BSP aus mineralisiertem Gewebe allerdings schon (Armbruster et al., 2009). Im Tiermodell konnte gezeigt werden, dass Knochenmetastasen verhindert werden können bei gleichzeitiger Gabe von Tumorzellen und Antikörpern gegen BSP beziehungsweise, dass bei vorhandenen Knochenmetastasen eine Behandlung der Tiere mit einem Anti-BSP-Antikörper die Metastasen zurückbildet (Bäuerle et al., 2005, 2006). In der aktuellen Arbeit wird die Expression von BSP an menschlichem Gewebe von Knochenmetastasen mit unterschiedlichen Primärtumoren mittels Immunhistochemie untersucht. Insgesamt wurden 35 Fälle von Knochenmetastasen mit Primärtumor eines Mammakarzinoms untersucht, wobei 22,9% eine BSP Expression aufweisen, davon 5,7% eine starke. Knochenmetastasen mit dem Primärtumor Prostatakarzinom sind mit 8 Fällen repräsentiert, wobei 75% positiv für BSP sind, davon 25% stark positiv. Die einzelnen Fälle zeigen eine starke BSP Expression im Stroma und eine schwache BSP Expression der Tumorzellen. Diese Ergebnisse des Antikörpers gegen normal glykosyliertes BSP wurden verglichen mit dem Antikörper gegen nicht glykosyliertes BSP. Der Nachweis von BSP in Tumorzellen zeigt dasselbe Ergebnis, BSP im Stroma wird durch den Antikörper gegen nicht- glykosyliertes BSP intensiver dargestellt. Daraus lässt sich folgern, dass der Antikörper gegen nicht- glykosyliertes BSP nicht spezifisch für die Isoform des BSP aus Tumorzellen ist, sondern gleichermaßen in der Routinediagnostik von BSP eingesetzt werden kann. Die Untersuchung könnte sogar darauf hinweisen, dass dieser Antikörper die nicht- glykosylierte Isoform im Stroma erkennt und damit bei Untersuchung des Stromas die bessere Alternative darstellt. N2 - Bone sialoprotein (BSP) is a bone matrix protein that is also expressed by breast cancer and prostate cancer cells (Bellahcene et al., 1994, 1997, 1998). The BSP expression in primary breast and prostate carcinomas is associated with a poor prognosis and an increased risk to develop bone metastases. Serum BSP was found to be a prognostic marker for the development of bone metastases (Diel et al. 1999). There are antibodies that specifically bind epitopes present in BSP produced in tumor cells, wherein the posttranslational glycosylation of BSP is incomplete in comparison with the posttranslational glycosylation of BSP produced in normal bone cells (Armbruster et al., 2009). In nude rats, incubation of breast cancer cells and anti-BSP antibodies prior to inoculation reduced the osteolytic lesion size. The treatment of bone metastases with an anti-BSP antibody resulted in a significantly smaller lesion size (Bäuerle et al., 2005, 2006). In the present study, 84 patient cases with bone metastases of different primary tumours were investigated by immunohistochemistry in order to assess the level of BSP and to compare two different anti-BSP antibodies. There are 35 cases of breast cancer bone metastases and 8 cases of prostate cancer bone metastases. BSP expression was found in 22, 9 % of all breast cancer bone metastases and 75% of all prostate cancer bone metastases. In nearly all cases a strong staining for BSP was found in stroma, a weak staining for BSP was observed in tumour cells. We compared antibodies against normal BSP with anti-BSP antibodies that bind epitopes that are incomplete in their posttranslational glycosylation. The expression of BSP in tumour cells was exactly the same, the expression of BSP in tumour stroma was different. A stronger staining was found with the antibodies that bind epitopes that are incomplete in their posttranslational glycosylation. In conclusion, these antibodies do not only stain for BSP produced by tumour cells. Both antibodies can be used for the detection of BSP. KW - Knochensialoprotein KW - Knochenmetastase KW - Mammakarzinom KW - bone sialoprotein KW - bone metastases KW - breast cancer Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-71642 ER - TY - THES A1 - Gurok, Anna T1 - Untersuchung der postoperativen Ergebnisse nach Rekonstruktion des medialen-patellofemoralen Ligamentes (MPFL) nach 5 Jahren T1 - Investigation of five-year follow-up results of medial patellofemoral ligament (MPFL) reconstruction N2 - Patellaluxationen sind eine vor allem bei jungen, aktiven Patienten häufige Verletzung komplexer Ätiologie. Die Rekonstruktion des medialen patellofemoralen Ligaments (MPFL) ist die aktuell etablierte Operationstechnik bei strecknaher patellofemoraler Instabilität, zu der in der Literatur eine Vielzahl an patellaren Fixationstechniken des autologen Sehnentransplantates beschrieben werden. In dieser Studie wurden 71 Patienten 5 Jahre nach Rekonstruktion des MPFLs mit patellarer Fixation in Weichteiltechnik nachuntersucht und die klinischen Ergebnisse der Operationsmethode und die Zufriedenheit der Patienten ermittelt. Dafür wurde die Reluxationsrate ermittelt und die Funktion der Kniegelenke im Alltag mithilfe des Kujala- und des Lysholm-Fragebogens, das Aktivitätsniveau der Patienten mit der Tegner-Aktivitätsskala erfasst. Im Rahmen einer Nachuntersuchung wurden die Beweglichkeit des Kniegelenks und die Stabilität der Kniescheibe klinisch untersucht. Die Ergebnisse wurden unter Berücksichtigung klinischer und radiologischer Risikofaktoren ausgewertet. Die Studie ergab eine Reluxationsrate von 5,6% und ist somit vergleichbar mit der Rate anderer in der Literatur beschriebener Techniken. Die Ergebnisse der klinischen Untersuchung ergaben eine stabile ligamentäre Führung der Kniescheibe bei insgesamt guter Beweglichkeit der Kniegelenke, die Auswertung der Fragebögen zeigten signifikante Verbesserungen der Funktion der operierten Kniegelenke im Alltag bei unverändertem Aktivitätsniveau. Im Ergebnis kann durch die vorliegende Studie belegt werden, dass durch die Rekonstruktion des MPFL mit weichteiliger patellarer Fixation langfristig gute Ergebnisse bei einer niedrigen Komplikationsrate erzielt werden können. Allerdings erhöht das Zusammentreffen verschiedener Pathologien wie eine Patella alta mit einer ausgeprägten Dysplasie der Trochlea das Risiko für eine persistierende Instabilität und eine erneute Luxation. N2 - Patellar luxation is an injury of young and active patients with a complex etiology. The reconstruction of the medial patellofemoral ligament (MPFL) is a well-established surgical technique for patellar instability. Lots of different patellar fixation techniques for the autologous transplant are described. This study investigated the redislocation rate and functional outcome at a minimum follow-up of five years after medial patellofemoral ligament reconstruction with soft tissue patellar fixation. 71 patients were included and the daily knee function was measured with Kujala and Lysholm questionnaires and the level of activity with Tegner Score. The knee joints were examined clinically. The results were analyzed in consideration of clinical and radiology risk factors. This study showed a redislocation rate of 5.6 % after a mean follow up of 5.8 years, the clinical examination of the knee a satisfying patellar stability and a good range of motion. The operation leads to an increased daily knee function, the activity remains on the same level. In summary, this technique of MPFL reconstruction with soft tissue patellar fixation leads to significant improvement of the knee function and has a low long term redislocation and complication rate. However, patients with high-grade trochlear dysplasia and patella alta have a higher risk for persistent patellar instability or redislocation. KW - Patella KW - MPFL KW - Patellaluxation KW - Patellofemorale Instabilität Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-240585 ER - TY - THES A1 - Pawlakowitsch, Peter T1 - Untersuchung des Einflusses der Akupunktur in der frühen postoperativen Phase auf die Schmerzintensität und auf das funktionelle Ergebnis drei Monate nach Implantation einer Kniegelenks-Totalendoprothese T1 - Analysis of the influence of acupuncture in the early postoperative period on pain intensity and the functional outcome three months after total knee arthroplasty N2 - Die Implantation von Kniegelenks-Totalendoprothesen stellt heutzutage einen Routineeingriff dar, ist allerdings mit postoperativen Schmerzen und einer langwierigen Rehabilitation verbunden. In den letzten Jahren haben alternative Heilmethoden wie etwa die Traditionelle Chinesische Medizin eine zunehmende Verbreitung erfahren und speziell für die Akupunktur konnte auch eine schmerzlindernde Wirkung gezeigt werden. Inwieweit eine Akupunktur-behandlung in der postoperativen Situation das funktionelle Ergebnis verbessern kann ist unklar. Im Rahmen dieser Studie wurde deshalb der Einfluss einer Akupunktur auf das funktionelle Ergebnis zwischen dem zweiten postoperativen Tag und drei Monate nach der Operation untersucht. Dazu wurde eine randomisierte, kontrollierte und dreifach verblindete Monozenterstudie mit 60 Teilnehmern durchgeführt. Die Kontrollgruppe erhielt dabei die postoperative Standardtherapie, während die Interventionsgruppe vom 2. bis 6. Tag nach der Operation einmal täglich zusätzlich akupunktiert wurde. Im gleichen Zeitraum wurde eine dritte Studiengruppe, die Placebogruppe, scheinakupunktiert. Vom 2. bis 6. Tag nach der Operation sowie drei Monate später wurden die postoperativen Schmerzintensitäten abgefragt. Weiterhin wurden die maximal mögliche, passive Kniebeugung und die maximal mögliche Kniebelastung drei Monate nach der Operation ermittelt und das funktionelle Ergebnis der Operation mittels Fragebögen durch die Patienten bewertet. Dabei zeigten sich keine statistisch signifikanten Unterschiede zwischen den Studiengruppen. Aufgrund der Limitationen dieser sowie vergleichbarer Studien und angesichts uneinheitlicher Studienergebnisse bei insgesamt unzureichender Vergleichbarkeit der verschiedenen Akupunkturstudien ist eine abschließende Bewertung zur Wirksamkeit der Akupunktur nach Implantation einer Kniegelenks-Totalendoprothese jedoch nicht möglich. Dazu bedarf es weiterer, qualitativ hochwertiger und größerer Studien zu diesem Thema. N2 - Total knee arthroplasty is a common procedure marked by intense postoperative pain and prolonged rehabilitation. During the last years complementary medicine such as acupuncture has become increasingly popular. It has been shwon that acupuncture can alleviate pain. However, it remains unclear if acupuncture is beneficial for the outcome after surgery. This randomized, controlled, three armed study with 60 participants tried to examine the effects of scupuncture on the functional outcome three months after total knee arthroplasty. The control group received standardized postoperative care. The intervention group additionally received acupuncture on 2. - 6. day after surgery. A third study group received sham acupuncture. This study evaluated pain intensity on 2.-6. postoperative day and three months after surgery. Furthermore passive range of motion and max. load of the knee joint as well as patient reported outcome measures were evaluated. There was no statistically significant difference between the study group KW - Akupunktur KW - Kniegelenkprothese KW - Kontrollierte klinische Studie KW - TCM Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-181018 ER - TY - THES A1 - Lobmüller, Andreas T1 - Untersuchung zum Management der postoperativen Schmerztherapie nach orthopädisch-chirurgischen Eingriffen T1 - Implementation of standardized postoperative pain therapy for orthopaedic patients. Comparison between unsystematic and standardized pain therapy N2 - Hintergrund. Die „schmerzfreie Klinik" sowie die postoperative Schmerztherapie sind ein zentrales Thema in der heutigen Zeit. Im Bezug zu den ständigen Diskussionen zur Verbesserung der postoperativen Schmerztherapie und den unzähligen Forderungen nach einem Akutschmerzdienst, scheinen in Anbetracht der gegenwärtigen Kostenentwicklungen, preisgünstige oder kostenneutrale Alternativen zur schnellen und einfachen Verbesserung der Schmerztherapieversorgung ein „heiliger Gral“51 zu sein. Kliniken der Grund- und Regelversorgung, denen im Gegensatz zu Kliniken der Maximalversorgung nur beschränkte Ressourcen zur Verfügung stehen, ist die Einrichtung eines ASD oft nicht möglich2. Ziel dieser Studie war es, die Auswirkung der Implementierung einer standardisierten Schmerztherapie auf den postoperativen Schmerzverlauf nach orthopädischen Operationen zu untersuchen. Patienten und Methoden. Es wurden zwei orthopädische Patientengruppen untersucht, die sich einem operativen Eingriff unterzogen haben. Gruppe I (n = 249) erhielt eine unsystematische Schmerztherapie, die individuell und indikationsspezifisch erfolgte, Gruppe II (n = 243) erhielt eine standardisierte Schmerztherapie. Der Effekt der Schmerztherapie wurde mit einem Schmerzerfassungsprotokoll regelmäßig dokumentiert. Ergebnisse. Die Schmerzmessung ergab eindeutige Unterschiede im Schmerzerleben der beiden Gruppen. Patienten der Gruppe II gaben bis zum 9. postoperativen Tag signifikant weniger Schmerzen an. Im Gegenzug traten jedoch bei Gruppe II bis Tag 3 signifikant mehr unerwünschte Nebenwirkungen auf, insbesondere aus dem gastrointestinalen Formenkreis. Mobilität und Stimmung konnten durch die standardisierte analgetische Therapie ebenfalls signifikant verbessert werden. Schlussfolgerung. Unsere Ergebnisse zeigen, dass die Einführung eines standardisierten Schmerztherapieschemas für ein Haus mittlerer Größe (150 Betten) und einem Operationsspektrum, welches zum großen Teil sehr schmerzhafte knochenchirurgische Eingriffe beinhaltet, ein geeignetes Organisationsmodell zur Verbesserung der postoperativen Schmerztherapie darstellt. Die Implementierung einer standardisierten Schmerztherapie ist mit geringem personellem und überschaubarem zeitlichem Aufwand verbunden und ermöglicht auch ohne die Einführung eines Akutschmerzdienstes bei gleich bleibenden Ressourcen eine signifikante Verbesserung. Sie wurde vom ärztlichen Dienst und insbesondere vom Pflegepersonal positiv aufgenommen und ist im Hinblick auf die Reduzierung der postoperativen Schmerzen erfolgreich. Auch Mobilität und Stimmung der Patienten wurden positiv beeinflusst. Als Folge stieg jedoch die Inzidenz der Nebenwirkungen. N2 - Background. The painless clinic and postoperative pain therapy are currently major issues in the management of surgical procedures. The aim of this study was to evaluate the benefit of a standardized pain therapy on the postoperative pain level after orthopaedic procedures. Patients and methods. We investigated two different groups of patients who underwent an orthopaedic surgical procedure. Group 1 (n = 249) received a pain therapy which was based on an individual and surgery- dependent concept whereas group 2 (n = 243) was treated with a standardized pain therapy concept. The effect of the treatment was monitored with a VAS-based protocol. Results. Up to day 9 after surgery there was a significant difference between the two groups in regard to the postoperative pain. The patients of group 2 had less pain but had more unwanted side effects caused by the pain therapy during the first 3 days after surgery. Mobility and mental disposition were positively affected. Conclusion. The implementation of a standardized pain therapy is successful in reducing postoperative pain. Mobility and mental disposition are also influenced positively. As a consequence the incidence of unwanted side effects is rising. KW - Analgesie KW - Schmerztherapie KW - Schmerzfreie Klinik KW - Visuelle Analogskala KW - Postoperative Schmerztherapie KW - Standardisierte Schmerztherapie KW - Qualitätsmanagement KW - Painless clinic KW - Visual analogue scale KW - Postoperative pain therapy KW - Standardized pain therapy KW - Quality management Y1 - 2009 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-38506 ER - TY - THES A1 - Fensky, Florian T1 - Untersuchungen zur chondrogenen Prädifferenzierung von humanen mesenchymalen Stammzellen in Kollagen Typ I Hydrogelen unter dem Einfluss von TGF-ß1 T1 - Chondrogenic predifferentiation of human mesenchymal stem cells (MSC) in collagen type I hydrogels under the influence of TGF-ß1 N2 - Der hyaline Gelenkknorpel ist auf Grund seines sehr eingeschränkten Selbstheilungspotentiales nicht in der Lage, auf Verletzungen mit adäquaten Regenerationsmechanismen zu reagieren. So hat sich in der Orthopädischen Klinik König-Ludwig-Haus zur Behandlung von fokalen Gelenkknorpelläsionen die matrixgekoppelte autologe Chondrozytentransplantation unter Verwendung eines Kollagen Typ I Hydrogel (CaReS®, Arthro Kinetics, Esslingen) etabliert. In der Zukunft könnten möglicherweise humane mesenchymale Stammzellen (hMSZ) eine alternative Zellquelle darstellen. In der vorliegenden Arbeit wurde in Anlehnung an die im klinischen Alltag befindliche matrixgekoppelte ACT der Frage nachgegangen, ob eine ex vivo Prädifferenzierung von hMSZ mit TGF-ß1 für 10 Tage zu einer chondrogenen Differenzierung führt. Durch den Nachweis chondrogener Markergene wie Kollagen II und Aggrekan konnte gezeigt werden, dass eine chondrogene Differenzierung von hMSZ unter Zugabe von TGF-ß1 über 10 Tage induziert werden kann. Ob diese 10-tägige Prädifferenzierung zu einem ausreichend stabilen Gelenkknorpelregenerat führen kann, muss letztendlich im Tierversuch überprüft werden. N2 - Due to the very restricted self-healing potential articular cartilage is not able to react to injuries with adequate regeneration mechanisms. Concerning this problem the matrix-based autologous chondrocyte transplantation (ACT) using a collagen type I hydrogel as a three-dimensional scaffold (CaReS®, Arthro Kinetics, Esslingen) is currently established in the Orthopaedic Institute, König-Ludwig-Haus to treat focal cartilage defects. In the future human mesenchymal stem cells (MSC) can form an alternative cell source for tissue engineering. With reference to the matrix-based ACT, the objective of this study was to determine whether an ex vivo predifferentiation with TGF-ß1 over 10 days leads to a chondrogenic differentiation of MSC. The proof of the decisive chondrogenic marker genes, like collagen type II and aggrecan, demonstrated that a chondrogenic differentiation of human mesenchymal stem cells can be induced under the influence TGF-ß1 over a period of 10 days. Further animal experiments will reveal whether this 10-day ex vivo predifferentiation can lead to a sufficiently stable articular cartilage. KW - Chondrogene Differenzierung KW - Mesenchymale Stammzellen KW - Kollagen Hydrogel KW - Chondrogenic Differentiation KW - Mesenchymal Stem Cells KW - Collagen Hydrogel Y1 - 2009 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-36622 ER -