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 - TY - JOUR A1 - Herrmann, Marietta A1 - Hildebrand, Maria A1 - Menzel, Ursula A1 - Fahy, Niamh A1 - Alini, Mauro A1 - Lang, Siegmund A1 - Benneker, Lorin A1 - Verrier, Sophie A1 - Stoddart, Martin J. A1 - Bara, Jennifer J. T1 - Phenotypic characterization of bone marrow mononuclear cells and derived stromal cell populations from human iliac crest, vertebral body and femoral head JF - International Journal of Molecular Sciences N2 - (1) In vitro, bone marrow-derived stromal cells (BMSCs) demonstrate inter-donor phenotypic variability, which presents challenges for the development of regenerative therapies. Here, we investigated whether the frequency of putative BMSC sub-populations within the freshly isolated mononuclear cell fraction of bone marrow is phenotypically predictive for the in vitro derived stromal cell culture. (2) Vertebral body, iliac crest, and femoral head bone marrow were acquired from 33 patients (10 female and 23 male, age range 14–91). BMSC sub-populations were identified within freshly isolated mononuclear cell fractions based on cell-surface marker profiles. Stromal cells were expanded in monolayer on tissue culture plastic. Phenotypic assessment of in vitro derived cell cultures was performed by examining growth kinetics, chondrogenic, osteogenic, and adipogenic differentiation. (3) Gender, donor age, and anatomical site were neither predictive for the total yield nor the population doubling time of in vitro derived BMSC cultures. The abundance of freshly isolated progenitor sub-populations (CD45−CD34−CD73+, CD45−CD34−CD146+, NG2+CD146+) was not phenotypically predictive of derived stromal cell cultures in terms of growth kinetics nor plasticity. BMSCs derived from iliac crest and vertebral body bone marrow were more responsive to chondrogenic induction, forming superior cartilaginous tissue in vitro, compared to those isolated from femoral head. (4) The identification of discrete progenitor populations in bone marrow by current cell-surface marker profiling is not predictive for subsequently derived in vitro BMSC cultures. Overall, the iliac crest and the vertebral body offer a more reliable tissue source of stromal progenitor cells for cartilage repair strategies compared to femoral head. KW - bone marrow stromal cells KW - MSC KW - pericytes KW - femoral head KW - vertebral body KW - iliac crest KW - chondrogenesis Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-285054 SN - 1422-0067 VL - 20 IS - 14 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 - THES A1 - Hausmann, Johannes Stephan T1 - Schmerzverlauf, körperliche Aktivität und Funktion präoperativ, drei, sechs und zwölf Monate nach minimal-invasiver Hüfttotalendoprothetik mittels direktem anterioren Zugang T1 - Pain, physical activity and functional outcome preoperative, three, six and twelve months after total hip arthroplasty using a minimally invasive direct anterior approach N2 - Hintergrund: Die vorgestellten Daten demonstrieren das klinische Ergebnis von Patienten, die sich eine Hüfttotalendoprothese (THA) unterzogen haben. Als Zugangsweg wurde der minimal-invasive, direkt anteriore Zugang in Einzelschnitttechnik gewählt (MIS-DAA). Die Patientin wurden bis zwölf Monate nach Operation beobachtet. Methoden: Es wurden die Daten von 73 Probanden mittels der folgenden Fragebogen ausgewertet: Harris Hip Score (HHS), eXtra Short Musculoskeletal Functional Assessment questionnaire (XSFMA), Short Form 36 (SF-36) health survey und Patient Health Questionaire 9 „deutsch“ (PHQ-9 D). Zur Schmerzmessung kam eine visuelle Analogskala (VAS von 0-4) zum Einsatz. Daneben wurde die Aktivität mit Hilfe des Schrittzählers Stepwatch™ Activity Monitor (SAM) und eines 25m Gehtests auf Zeit (T25-FW) erfasst. Während der gesamten Aufzeichnung wurden auch Komplikationen erfasst. Ergebnisse: Zwölf Monate nach der Operation verbesserten sich die HHS-Werte signifikant von 55,2 präoperativ auf 92,4 (Werte 0 – 100). Der FSFMA Funktionsscore fiel ebenfalls signifikant von 39,4 auf 10,3 und der Beeintrachtigungsscore von 47,0 auf 15,8. Der Score für die Physis (PCS) stieg im SF 36 signifikant von 27,5 präoperativ auf 47,5 nach zwölf Monaten. Der Score für mentale Gesundheit (MCS) fiel dagegen sogar leicht von 57,6 auf 55,0. Dagegen fiel die Prävalenz der mittels PHQ-9 D gemessenen Somatisierungsstörungen von elf auf einen Fall. Die Schmerzreduktion durch die Operation zeigte sich durch einen Rückgang auf der VAS von 2,41 auf 0,35 zwölf Monate postoperativ. Die durchschnittlich täglich absolvierten Lastwechsel nahmen laut Schrittzählermessung signifikant von 5113 präoperativ auf 6402 zu. Außerdem stieg die Gehgeschwindigkeit im T25-FW signifikant von 22,06 s (= 1,13 m/s) auf 18,14 s (= 1,38 m/s). Es wurden keine schwerwiegenden Komplikationen, wie z.B. Transplantatlockerungen, festgestellt. Zusammenfassung: In der Zusammenschau der Ergebnisse zeigt sich ein Jahr nach MIS-DAA-THA, dass die Patienten eine signifikant bessere Funktion, Aktivität und weniger Schmerzen aufweisen. Der MIS-DA-Zugang ist sicher und weist keine erhöhte Komplikationsrate auf. N2 - Background: The presented data show the clinical outcome of patients undergoing total hip arthroplasty (THA) using a minimally invasive single-incision direct anterior approach (MIS-DAA) up to twelve months after surgery. Methods: The data of 73 arthroplasties were evaluated using the following questionaires: Harris Hip Score (HHS), extra short musculoskeletal functional assessment questionnaire (XSFMA), Short Form 36 (SF-36) health survey and the Patient Health Questionaire 9 „german“ (PHQ-9 D). A visual analogue scale (VAS from 0-4) was used zu measure pain. Additionally all patients activity was monitored utilizing a Stepwatch™ Activity Monitor (SAM), and a timed 25 m foot walk (T25-FW). Also complications were monitored for the entire 12 months. Results: Twelve months after surgery the HHS Score increased significantly from 55.2 preoperatively to 92.4 (out of 100). XSFMA functional index scores droped from 39.4 to 10.3 while the bother went down form 47.0 to a score of 15.8. Both scores showing a significant improvement. The SF-36 physical component score (PCS) was 27.5 ahead of the operation and did rise significantly up to 47.5 twelve months later, while the mental component score (MCS) dropped slightly, but significantly from 57,6 to 55.0. In opposition the PHQ-9 D showed a decline oft he prevalence of somatic disorders from elven cases pre-OP to one afterwards. Pain was significantly reduced by the operation, showing values dropping from 2.41 to 0.35 on a visual analogue scale (VAS).The mean cycles per day rose significantly up to twelve months after arthroplasty from 5113 of 6402 cycles per day. Furthermore, the obtained outcome for the T25-FW showed a significant increase in walking speed from 22.06 s (=1.13m/s) to 18.14 s (= 1.38 m/s). The were no severe complications, e.g. loosening of the implant, to be found. Conclusion: In summary the outcomes show that 1 year after MIS-DAA-THA patients show a significantly better function, activity and reduction of pain. The MIS-DAA is safe and shows no increased signs of complications. KW - Hüftgelenkprothese KW - Minimal-invasive Chirurgie KW - Körperliche Aktivität KW - Funktion KW - Schmerz KW - THA KW - MIS KW - DAA KW - HHS KW - activity monitor KW - pain KW - minimally invasive total hip arthroplasty KW - SF-36 Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-272486 ER - TY - JOUR A1 - Kemmler, Wolfgang A1 - Kohl, Matthias A1 - Fröhlich, Michael A1 - Jakob, Franz A1 - Engelke, Klaus A1 - von Stengel, Simon A1 - Schoene, Daniel T1 - Effects of High‐Intensity Resistance Training on Osteopenia and Sarcopenia Parameters in Older Men with Osteosarcopenia—One‐Year Results of the Randomized Controlled Franconian Osteopenia and Sarcopenia Trial (FrOST) JF - Journal of Bone and Mineral Research N2 - Dynamic resistance exercise (DRT) might be the most promising agent for fighting sarcopenia in older people. However, the positive effect of DRT on osteopenia/osteoporosis in men has still to be confirmed. To evaluate the effect of low‐volume/high‐intensity (HIT)‐DRT on bone mineral density (BMD) and skeletal muscle mass index (SMI) in men with osteosarcopenia, we initiated the Franconian Osteopenia and Sarcopenia Trial (FrOST). Forty‐three sedentary community‐dwelling older men (aged 73 to 91 years) with osteopenia/osteoporosis and SMI‐based sarcopenia were randomly assigned to a HIT‐RT exercise group (EG; n = 21) or a control group (CG; n = 22). HIT‐RT provided a progressive, periodized single‐set DRT on machines with high intensity, effort, and velocity twice a week, while CG maintained their lifestyle. Both groups were adequately supplemented with whey protein, vitamin D, and calcium. Primary study endpoint was integral lumbar spine (LS) BMD as determined by quantitative computed tomography. Core secondary study endpoint was SMI as determined by dual‐energy X‐ray absorptiometry. Additional study endpoints were BMD at the total hip and maximum isokinetic hip−/leg‐extensor strength (leg press). After 12 months of exercise, LS‐BMD was maintained in the EG and decreased significantly in the CG, resulting in significant between‐group differences (p < 0.001; standardized mean difference [SMD] = 0.90). In parallel, SMI increased significantly in the EG and decreased significantly in the CG (p < 0.001; SMD = 1.95). Total hip BMD changes did not differ significantly between the groups (p = 0.064; SMD = 0.65), whereas changes in maximum hip−/leg‐extensor strength were much more prominent (p < 0.001; SMD = 1.92) in the EG. Considering dropout (n = 2), attendance rate (95%), and unintended side effects/injuries (n = 0), we believe our HIT‐RT protocol to be feasible, attractive, and safe. In summary, we conclude that our combined low‐threshold HIT‐RT/protein/vitamin D/calcium intervention was feasible, safe, and effective for tackling sarcopenia and osteopenia/osteoporosis in older men with osteosarcopenia. KW - exercise KW - osteoporosis KW - sarcopenia KW - aging KW - bone QCT Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-214609 VL - 35 IS - 9 SP - 1634 EP - 1644 ER - TY - JOUR A1 - Heinz, Tizian A1 - Meller, Felix A1 - Luetkens, Karsten Sebastian A1 - Horas, Konstantin A1 - Schäfer, Thomas A1 - Rudert, Maximilian A1 - Reppenhagen, Stephan A1 - Weißenberger, Manuel T1 - Can the MRI based AMADEUS score accurately assess pre-surgery chondral defect severity according to the ICRS arthroscopic classification system? JF - Journal of Experimental Orthopaedics N2 - Purpose The AMADEUS (Area Measurement And DEpth and Underlying Structures) scoring and grading system has been proposed for the MRI based evaluation of untreated focal chondral defects around the knee. The clinical practicability, its correlation with arthroscopically assessed grading systems (ICRS – International Cartilage Repair Society) and thereby its clinical value in terms of decision making and guiding prognosis was yet to determine. Methods From 2008 to 2019 a total of 89 individuals were indicated for high tibial valgus osteotomy (HTO) due to tibial varus deformity and concomitant chondral defects of the medial compartment of the knee. All patients received a preoperative MRI (1.5 Tesla or 3.0 Tesla) and pre-osteotomy diagnostic arthroscopy. Chondral defects of the medial compartment were scored and graded with the MRI based AMADEUS by three independent raters and compared to arthroscopic defect grading by the ICRS system. Interrater and intrarater reliability as well as correlation analysis with the ICRS classification system were assessed. Results Intraclass correlation coefficients for the various subscores of the AMADEUS showed an overall good to excellent interrater agreement (min: 0.26, max: 0.80). Intrarater agreement turned out to be substantially inferior (min: 0.08, max: 0.53). Spearman correlation revealed an overall moderate correlative association of the AMADEUS subscores with the ICRS classification system, apart from the defect area subscore. Sensitivity of the AMADEUS to accurately identify defect severity according to the ICRS was 0.7 (0.69 for 3.0 Tesla MRI, 0.67 for 1.5 Tesla MRI). The mean AMADEUS grade was 2.60 ± 0.81 and the mean ICRS score 2.90 ± 0.63. Conclusions Overall, the AMADEUS with all its subscores shows moderate correlation with the arthroscopic chondral grading system according to ICRS. This suggests that chondral defect grading by means of the MRI based AMADEUS is well capable of influencing and guiding treatment decisions. Interrater reliability shows overall good agreement. KW - MRI KW - knee KW - cartilage defect KW - grading system of chondral defects KW - AMADEUS KW - ICRS Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300781 SN - 2197-1153 VL - 9 IS - 1 ER - TY - THES A1 - Cetindere, Rojan T1 - Klinische und radiologische Ergebnisse nach offener Schultergelenksstabilisierung mittels Beckenkammspan T1 - Clinical and radiological results after repair of shoulder instability due to major glenoid bone loss with open iliac crest bone block reconstruction N2 - Im Rhön-Klinikum wurden von 2012 bis 2015 49 Patient*innen wegen eines Glenoiddefektes mittels offenem Beckenkammspantransfer mit Kapselshift bei anteriorer Schulterinstabilität behandelt. 27 Patienten konnten in dieser Studie eingeschlossen werden (Einschlusskriterien: Follow-up von mindestens 12 Monaten, kompletter präoperativer 3D-CT-Datensatz / Ausschlusskriterien: traumatische Schulterluxation oder Voroperation der kontralateralen Schulter). Ziel der Studie war es, das kurz- bis mittelfristige klinische Outcome dieser Kohorte zu erfassen, der Vergleich mit Ergebnissen anderer Arbeitsgruppen und der Vergleich von präoperativ verwendeten Messmethoden (Chuang- bzw. Wambacher-Methode) für den Glenoiddefekt. Bei einem mittleren Follow-up von 27,11 Monaten zeigten sich überwiegend gute bis exzellente kurz- bis mittelfristige OP-Ergebnisse (Rowe-Score: 84,81, Oxford-Shoulder-Score: 20,56, WOSI-Score: 371, Constant-Score: 86,74). Die OP-Methode eignet sich gut für Patient*innen, die mehrfach voroperiert sind, multiple Luxationsereignisse hatten sowie für diejenigen mit relevanter Hyperlaxizität, bei denen eine Latarjet-Operation kontraindiziert ist. Die OP-Methode ist gut anwendbar bei Patient*innen mit subkritischem Glenoidverlust < 20 %, wenn zusätzliche Sekundärfaktoren vorliegen. Eine postoperative Omarthrose ist ein Risikofaktor für ein signifikant schlechteres Outcome. Die Gesamtkomplikationsrate lag bei 25,9%, der Großteil hiervon (18,3%) waren innerhalb kurzer Zeit reversibel. Die Reluxationsrate lag bei 3,7%. Bei allen Studienteilnehmenden kam es zum Span-Remodelling ohne Schraubenlockerung oder Spanbruch. Eine übermäßige Spanresorbtion erfolgt antero-inferior, während um die Osteosyntheseschrauben eine Überkontur persistiert. Die Glenoiddefekte lagen bei 23,39 % (Chuang) bzw. 22,06 % (Wambacher). Es zeigte sich eine gute Übereinstimmung der Messergebnisse beider Methoden, allerdings lagen die Werte nach Chuang signifikant höher. N2 - From 2012 to 2015, 49 patients with anterior shoulder instability and a glenoid defect were treated at Rhön-Klinikum using an open iliac crest bone graft transfer with capsular shift. 27 patients were included in this study (inclusion criteria: minimum follow-up of 12 months, complete preoperative 3D CT dataset/exclusion criteria: traumatic shoulder dislocation or previous operation of the contralateral shoulder). The aim of the study was to evaluate the short- to medium-term clinical outcomes of this cohort, to compare the results with those of other research groups, and to compare preoperative measurement methods (Chuang and Wambacher methods) for the glenoid defect. At a mean follow-up of 27.11 months, predominantly good to excellent short- to medium-term surgical results were observed (Rowe score: 84.81, Oxford Shoulder Score: 20.56, WOSI Score: 371, Constant score: 86.74). The surgical method is suitable for patients who have had multiple previous operations, multiple dislocation events, and those with significant hyperlaxity in whom Latarjet surgery is contraindicated. The surgical method is also applicable to patients with subcritical glenoid loss of < 20% if additional secondary factors are present. Postoperative osteoarthritis is a risk factor for significantly worse outcomes. The overall complication rate was 25.9%, the majority of which (18.3%) were reversible within a short time. The redislocation rate was 3.7%. All study participants experienced graft remodelling without screw loosening or graft breakage. Excessive graft resorption occurred antero-inferiorly, while an overcontour persisted around the osteosynthesis screws. The glenoid defects were 23.39% (Chuang) and 22.06% (Wambacher). There was good agreement between the measurement results of both methods, although the values according to the Chuang method were significantly higher. KW - Orthopädie KW - Beckenkammtransfer KW - Kapselshift KW - iliac crest transfer KW - Schulterinstabilität Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-313148 ER - TY - THES A1 - Wagenbrenner, Mike Helmut T1 - In vitro-Charakterisierung mesenchymaler Stromazellen aus dem menschlichen Hüftgelenk T1 - In vitro characterization of mesenchymal stromal cells from the human hip joint N2 - In dieser Arbeit konnte erstmals gezeigt werden, dass plastik-adhärent wachsende, multipotente Vorläuferzellen, die eine für MSCs charakteristische Kombination von Oberflächenantigenen tragen, aus allen vier untersuchten Geweben des arthrotischen Hüftgelenks isoliert werden konnten. MSC-ähnliche Zellen können somit nicht nur in der Spongiosa und im Gelenkknorpel, sondern auch in der anterioren Gelenkkapsel und dem Ligamentum capitis femoris (LCF) des arthrotisch veränderten menschlichen Hüftgelenks nachgewiesen werden. Die FACS Analyse der Oberflächenantigene auf Zellen, die aus den vier unterschiedlichen Geweben eines beispielhaft gewählten Spenders isoliert wurden, zeigte eine deutliche Expression der Antigene CD44, CD73, CD90 und CD105. Unabhängig vom Nativgewebe zeigten somit alle untersuchten Zellen ein für MSCs charakteristisches, aber nicht spezifisches Profil an Antigenen auf ihrer Oberfläche. Eine Übereinstimmung mit den ISCT Kriterien für MSCs war aufgrund der fehlenden Kontrolle hämatopoetischer Marker nicht möglich. Die multipotente Differenzierung der isolierten Zellen erfolgte mithilfe spezifischer Differenzierungsmedien in Monolayer-Kulturen oder für die chondrogene Differenzierung in dreidimensionalen Pellet-Kulturen. Nach 21 Tagen konnten in allen differenzierten Kulturen histologisch und immunhistochemisch klare Zeichen der Osteo- und Adipogenese detektiert werden, während die Auswertung spezifischer Markergene eine klare Steigerung der Expression dieser im Vergleich zu den Negativkontrollen zeigte. Histologische und immunhistochemische Auswertungen bestätigten auch eine erfolgreiche chondrogene Differenzierung der Zell-Pellets aus Spongiosa, Knorpel und Kapsel. Lediglich in den chondrogen differenzierten Zell-Pellets aus dem LCF konnte immunhistochemisch keine Bildung des knorpelspezifischen Matrixproteins Col II nachgewiesen werden. Mikroskopisch zeigten vor allem die differenzierten MSC-Pellets aus Spongiosa und Knorpel morphologisch eine starke Ähnlichkeit zu hyalinem Knorpelgewebe. Trotz dieser Abstufungen zeigten sich für die relative Expression der chondrogenen Markergene AGG, Col II und Sox-9 keine signifikanten Unterschiede zwischen den differenzierten MSC-Kulturen der vier unterschiedlichen Nativgewebe. Ein positiver Nachweis des Markers Col X wies nach 27 Tagen sowohl in differenzierten als auch in undifferenzierten Pellet-Kulturen auf eine leichte chondrogene Hypertrophie hin. Zusammenfassend zeigten sich keine signifikanten Unterschiede im Hinblick auf das osteogene und adipogene Differenzierungspotential aller untersuchten Zellen. Während das chondrogene Differenzierungspotential der Zellen aus Spongiosa, Knorpel und Kapsel sich aus histologischer und immunhistochemischer Sicht ähnelte, zeigten Pellets aus dem LCF ein schwächeres chondrogenes Differenzierungspotential in vitro. Obwohl somit erstmals MSC-ähnliche Zellen aus dem LCF und Gewebsproben, die neben dem Stratum synoviale auch das Stratum fibrosum der Hüftgelenkskapsel beinhalteten, charakterisiert wurden, sind weitere wissenschaftliche Arbeiten notwendig, um das multipotente Differenzierungspotential dieser Zellen zu optimieren. N2 - This study showed for the first time that plastic-adherent growing multipotent progenitor cells carrying a combination of surface antigens characteristic of MSCs could be isolated from four tissues of the arthritic hip joint.MSC-like cells can thus be detected not only in cancellous bone and articular cartilage, but also in the anterior joint capsule and ligamentum capitis femoris (LCF) of the osteoarthritic human hip joint. FACS analysis of surface antigens on cells isolated from the four different tissues of an exemplarily selected donor showed a clear expression of the antigens CD44, CD73, CD90 and CD105. Thus, irrespective of the native tissue, all cells examined showed a profile of antigens on their surface that is characteristic but not specific for MSCs. However, cells did not meet the ISCT criteria since hematopoietic markers were not analyzed. Multipotent differentiation of the isolated cells was performed using specific differentiation media in monolayer cultures or three-dimensional pellet cultures for chondrogenic differentiation. After 21 days, clear signs of osteo- and adipogenesis could be detected histologically and immunohistochemically in all differentiated cultures, while evaluation of specific marker genes showed a clear increase in the expression of these compared with negative controls. Histological and immunohistochemical evaluations also confirmed successful chondrogenic differentiation of cell pellets from cancellous bone, cartilage, and capsule. Chondrogenically differentiated cell pellets from the LCF showed no formation of cartilage-specific matrix protein Col II. Microscopically the differentiated MSC pellets from cancellous bone and cartilage showed strong morphological similarity to hyaline cartilage tissue. Despite these gradations, there were no significant differences between the differentiated MSC cultures of the four different native tissues for the relative expression of the chondrogenic marker genes AGG, Col II, and Sox-9. Positive detection of the marker Col X indicated mild chondrogenic hypertrophy after 27 days in both differentiated and undifferentiated pellet cultures. In conclusion, there were no significant differences in osteogenic and adipogenic differentiation potential of all cells examined. While chondrogenic differentiation potential of progenitor cells isolated from cancellous bone, cartilage, and capsule was similar from a histological and immunohistochemical point of view, pellets from LCF showed a weaker chondrogenic differentiation potential in vitro. Although our current research proved the presence of MSC-like cells in the LCF and full-thickness tissue samples of the hip joint capsule further scientific work is required to evaluate the differentiation of the chondrogenic cells in the LCF. Histological and immunohistochemical evaluations also confirmed successful chondrogenic differentiation of cell pellets from cancellous bone, cartilage, and capsule. Only in the chondrogenically differentiated cell pellets from the LCF could no formation of the cartilage-specific matrix protein Col II be detected by immunohistochemistry. Microscopically, especially the differentiated MSC pellets from cancellous bone and cartilage showed strong morphological similarity to hyaline cartilage tissue. Despite these gradations, there were no significant differences between the differentiated MSC cultures of the four different native tissues for the relative expression of the chondrogenic marker genes AGG, Col II, and Sox-9. Positive detection of the marker Col X indicated mild chondrogenic hypertrophy after 27 days in both differentiated and undifferentiated pellet cultures. In conclusion, there were no significant differences in osteogenic and adipogenic differentiation potential of all cells examined. While the chondrogenic differentiation potential of cells from cancellous bone, cartilage, and capsule were similar from a histological and immunohistochemical point of view, pellets from LCF showed a weaker chondrogenic differentiation potential in vitro. Although our current research proved the presence of MSC-like cells in the LCF and full-thickness tissue samples of the human hip joint capsule further scientific work is required to optimize the multipotent differentiation potential of these cells. KW - Hüftgelenk KW - Arthrose KW - Mesenchymzelle KW - Knorpel KW - MSCs KW - tissue engineering KW - Hüfte KW - Arthrose KW - Regenerative Medizin KW - hip KW - Osteoarthritis Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-237110 ER - TY - JOUR A1 - Genest, Franca A1 - Rak, Dominik A1 - Petryk, Anna A1 - Seefried, Lothar T1 - Physical Function and Health‐Related Quality of Life in Adults Treated With Asfotase Alfa for Pediatric‐Onset Hypophosphatasia JF - JBMR Plus N2 - Hypophosphatasia (HPP) is a rare, inherited, metabolic disease characterized by tissue‐nonspecific alkaline phosphatase deficiency resulting in musculoskeletal and systemic clinical manifestations. This observational study evaluated the effectiveness of enzyme replacement therapy with asfotase alfa on physical function and health‐related quality of life (HRQoL) among adults with pediatric‐onset HPP who received asfotase alfa for 12 months at a single center (ClinicalTrial.gov no.: NCT03418389). Primary outcomes evaluated physical function with the 6‐minute walk test (6MWT), timed up‐and‐go (TUG) test, Short Physical Performance Battery (SPPB), and handheld dynamometry (HHD). Secondary outcome measures included the Lower Extremity Functional Scale (LEFS), pain prevalence/intensity, and pain medication use; HRQoL was evaluated using the 36‐Item Short‐Form Health Survey version 2 (SF‐36v2). Safety data were collected throughout the study. All 14 patients (11 women) had compound heterozygous ALPL gene mutations and ≥1 HPP bone manifestation, including history of ≥1 fracture. Mean (min, max) age was 51 (19 to 78) years. From baseline to 12 months of treatment, median 6MWT distance increased from 267 m to 320 m (n = 13; p = 0.023); median TUG test time improved from 14.4 s to 11.3 s (n = 9; p = 0.008). Specific components of the SPPB also improved significantly: median 4‐m gait speed increased from 0.8 m/s to 1.1 m/s (n = 10; p = 0.007) and median repeated chair‐rise time improved from 22 s to 13 s (n = 9; p = 0.008). LEFS score improved from 24 points to 53 points (n = 10; p = 0.002). Improvements in HHD were not clinically significant. SF‐36v2 Physical Component Score (PCS) improved after 12 months of treatment (n = 9; p = 0.010). Pain level did not change significantly from baseline to 12 months of treatment. There were significant improvements on chair‐rise time and SF‐36v2 PCS by 3 months, and on TUG test time after 6 months. No new safety signals were identified. These results show the real‐world effectiveness of asfotase alfa in improving physical functioning and HRQoL in adults with pediatric‐onset HPP. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research. KW - hypophosphatasia KW - enzyme replacement therapy KW - physical performance KW - clinical study KW - real-world evidence Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-218410 VL - 4 IS - 9 ER - TY - JOUR A1 - Kaiser, Moritz A1 - Brambrink, Sara A1 - Benditz, Achim A1 - Achenbach, Leonard A1 - Gehentges, Matthias A1 - König, Matthias Alexander T1 - Increase in lower limb strength after multimodal pain management in patients with low back pain JF - Medicina N2 - Background and Objectives: The aim of the present study was to evaluate the efficacy of a multimodal pain therapy (MPM) regarding the objective parameter muscle strength of segment-dependent lower limb muscle groups before and after such a treatment. Materials and Methods: 52 patients with a history of low back pain and/or leg pain received standardized multimodal pain management. Strength of segment indicating lower limb muscles were assessed for each patient before and after ten days of treatment by handheld dynamometry. Results: Overall strength increased significantly from 23.6 kg ± 6.6 prior to treatment to 25.4 ± 7.3 after treatment, p ≤ 0.001. All muscle groups significantly increased in strength with exception of great toe extensors. Conclusions: Despite lower basic strength values at the beginning of treatment, all investigated muscle groups, except for the great toe extensors, showed a significant increase of overall strength after completion of the multimodal pain management concept. Increased overall strength could help with avoiding further need of medical care by supporting patients’ autonomy in daily life activities, as well as maintaining working abilities. Thus, our study is the first to show a significant positive influence on lower limb strength in patients with low back pain after a conservative MPM program. KW - multimodal pain management KW - low back pain KW - muscle strength KW - dynamometer Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-284264 SN - 1648-9144 VL - 58 IS - 7 ER - TY - THES A1 - Keicher, Franca T1 - Muskuläre Einflüsse der Rotatorenmanschette auf die Early Onset Arthrose der Schulter T1 - Muscular Influences of the Rotator Cuff on Early Onset Shoulder Osteoarthritis N2 - Introduction: The etiology of early onset shoulder arthritis (EOA) remains unclear. Due to the influence of the muscles of the rotator cuff (RC) on glenohumeral kinematics, muscular causes are being discussed. The aim of the study was to identify corresponding factors on EOA based on volume measurements of the RC and examinations of the adjacent bony structures in MRI imaging, as well as the collection of patient-specific characteristics. Methods: In a case-control study, shoulders of 15 patients (14 men, 1 woman) with shoulder arthritis before the age of 60 and 13 control subjects (13 men) were examined. Anthropometric body measurements and clinical characteristics were collected. The volumes of the RC were calculated using manual tracing of the individual muscle cross- sections on MRI scans. In addition, the angles between the coracoid or scapular spine and scapular body were measured. The position of the scapula to the thorax was determined by recording the angle of the scapula to the plane of the table. The glenoid retroversion, morphological types, and humeral head subluxation were also collected. The analysis was conducted using descriptive and comparative statistical methods, as well as logistic and linear regression analyses. Results: The volumes of the RC did not differ significantly between the patients with EOA and the control subjects, either in absolute terms or in relative proportions. However, significantly higher values of thorax circumference and diameter, body weight, and BMI were found in the diseased individuals compared to the controls. Furthermore, these individuals were significantly more likely to have occupations that expended more than 1400 kcal per day. The risk of EOA increased with the steeper angle of the scapula to the thorax. Patients with B2-glenoid had significantly larger angles between the coracoid and scapular body as well as higher values of transverse thorax diameter, than those with B1-glenoid. Regardless of whether EOA was present or not, engaging in overhead sports was associated with a higher subluxation index. Conclusion: While the RC did not show any abnormalities in EOA patients, male gender, BMI, thoracic shape and scapular position, as well as certain occupations and sports, were associated with EOA. Further studies are needed to investigate these risk factors in EOA more precisely and develop possible treatment concepts. Peripheral shoulder muscles (such as teres major or pectoralis major) should also be included in the investigations. N2 - Einleitung: Die Ätiologie der Early Onset Arthrose (EOA) der Schulter ist bislang ungeklärt. Aufgrund des Einflusses der Muskeln der Rotatorenmanschette (RM) auf die glenohumerale Kinematik werden muskuläre Ursachen diskutiert. Ziel der Studie war es, entsprechende Faktoren anhand von Volumenmessungen der RM und Untersuchungen der angrenzenden knöchernen Strukturen in der MRT-Bildgebung sowie der Erfassung patientenspezifischer Charakteristika zu identifizieren. Methoden: In einer Fall-Kontroll-Studie wurden Schultern von 15 PatientInnen (14 Männer, 1 Frau) mit einer Omarthrose vor dem 60. Lebensjahr und 13 Kontrollpersonen (ausschließlich Männer) untersucht. Dabei wurden anthropometrische Körpermessungen sowie klinische Charakteristika erhoben. Anhand von MRT-Bildern wurden die Volumina der RM mittels manueller Umrandung der einzelnen Muskelquerschnitte berechnet. Weiterhin wurden die Winkel zwischen Coracoid bzw. Spina scapulae und Scapulakörper gemessen. Die Stellung der Scapula zum Thorax wurde anhand des Winkels der Scapula zur Tischebene erhoben. Zudem wurden die Glenoidretroversion, -morphologietypen und Humeruskopfsubluxation ermittelt. Die Auswertung erfolgte anhand deskriptiver und vergleichender statistischer Verfahren sowie logistischer und linearer Regressionsanalysen. Ergebnisse: Die Volumina der RM von PatientInnen mit EOA unterschieden sich weder absolut noch im relativen Verhältnis von denen der Kontrollpersonen. Dagegen konnten im Vergleich signifikant höhere Werte des Thoraxumfangs und -durchmessers, des Körpergewichts sowie des BMI bei erkrankten Personen nachgewiesen werden. Weiterhin übten diese signifikant häufiger Berufe aus, die mehr als 1400 kcal pro Tag verbrauchten. Das Risiko einer EOA nahm zu, je steiler die Scapula zum Thorax stand. PatientInnen mit B2-Glenoid wiesen signifikant größere Winkel zwischen Coracoid und Scapulakörper sowie höhere Werte des transversalen Thoraxdurchmessers auf, als erkrankte Personen mit einem B1-Glenoid. Unabhängig von einer Erkrankung mit EOA zeigte sich, dass das Ausüben einer Überkopfsportart mit einem höheren Subluxationsindex assoziiert war. Fazit: Während die RM keine Auffälligkeiten bei PatientInnen mit EOA zeigte, waren ein männliches Geschlecht, der BMI, die Thoraxform und Scapulastellung, sowie die Ausübung bestimmter Berufe und Sportarten mit der Erkrankung assoziiert. Weitere Studien müssen folgen, um diese Risikofaktoren bei EOA genauer zu untersuchen und mögliche Therapiekonzepte zu entwickeln. Dabei sollte auch die periphere Schultermuskulatur (z. B. M. teres major oder M. pectoralis major) in die Untersuchungen miteinbezogen werden. KW - Arthrose KW - Schultergelenk KW - Early Onset Schulterarthrose KW - Rotatorenmanschette Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-360557 ER - TY - JOUR A1 - Solimando, A G A1 - Brandl, A A1 - Mattenheimer, K A1 - Graf, C A1 - Ritz, M A1 - Ruckdeschel, A A1 - Stühmer, T A1 - Mokhtari, Z A1 - Rudelius, M A1 - Dotterweich, J A1 - Bittrich, M A1 - Desantis, V A1 - Ebert, R A1 - Trerotoli, P A1 - Frassanito, M A A1 - Rosenwald, A A1 - Vacca, A A1 - Einsele, H A1 - Jakob, F A1 - Beilhack, A T1 - JAM-A as a prognostic factor and new therapeutic target in multiple myeloma JF - Leukemia N2 - Cell adhesion in the multiple myeloma (MM) microenvironment has been recognized as a major mechanism of MM cell survival and the development of drug resistance. Here we addressed the hypothesis that the protein junctional adhesion molecule-A (JAM-A) may represent a novel target and a clinical biomarker in MM. We evaluated JAM-A expression in MM cell lines and in 147 MM patient bone marrow aspirates and biopsies at different disease stages. Elevated JAM-A levels in patient-derived plasma cells were correlated with poor prognosis. Moreover, circulating soluble JAM-A (sJAM-A) levels were significantly increased in MM patients as compared with controls. Notably, in vitro JAM-A inhibition impaired MM migration, colony formation, chemotaxis, proliferation and viability. In vivo treatment with an anti-JAM-A monoclonal antibody (αJAM-A moAb) impaired tumor progression in a murine xenograft MM model. These results demonstrate that therapeutic targeting of JAM-A has the potential to prevent MM progression, and lead us to propose JAM-A as a biomarker in MM, and sJAM-A as a serum-based marker for clinical stratification. KW - haematological cancer KW - myeloma Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-239069 VL - 32 ER - TY - JOUR A1 - Tylek, Tina A1 - Schilling, Tatjana A1 - Schlegelmilch, Katrin A1 - Ries, Maximilian A1 - Rudert, Maximilian A1 - Jakob, Franz A1 - Groll, Jürgen T1 - Platelet lysate outperforms FCS and human serum for co-culture of primary human macrophages and hMSCs JF - Scientific Reports N2 - In vitro co-cultures of different primary human cell types are pivotal for the testing and evaluation of biomaterials under conditions that are closer to the human in vivo situation. Especially co-cultures of macrophages and mesenchymal stem cells (MSCs) are of interest, as they are both present and involved in tissue regeneration and inflammatory reactions and play crucial roles in the immediate inflammatory reactions and the onset of regenerative processes, thus reflecting the decisive early phase of biomaterial contact with the host. A co-culture system of these cell types might thus allow for the assessment of the biocompatibility of biomaterials. The establishment of such a co-culture is challenging due to the different in vitro cell culture conditions. For human macrophages, medium is usually supplemented with human serum (hS), whereas hMSC culture is mostly performed using fetal calf serum (FCS), and these conditions are disadvantageous for the respective other cell type. We demonstrate that human platelet lysate (hPL) can replace hS in macrophage cultivation and appears to be the best option for co-cultivation of human macrophages with hMSCs. In contrast to FCS and hS, hPL maintained the phenotype of both cell types, comparable to that of their respective standard culture serum, as well as the percentage of each cell population. Moreover, the expression profile and phagocytosis activity of macrophages was similar to hS. KW - biomaterials – cells KW - tissue engineering Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-229174 VL - 9 ER - TY - THES A1 - Schaefer, Bastian T1 - Eigenschaften von synthetischen Bandersatzmaterialien zum MPFL-Ersatz - biomechanische in vitro Studie am porcinen Modell T1 - Properties of synthetic ligament replacement materials for MPFL replacement - biomechanical in vitro study on a porcine model N2 - Der MPFL-Ersatz ist ein gängiges Therapieverfahren zur Behandlung einer patellofemoralen Instabilität. Die Operationstechniken unterscheiden sich zumeist an der patellaren Fixationsmethode und der Auswahl der Transplantate. Biomechanische Studien, welche sich mit den Eigenschaften implantatfreier ossärer Fixationsmethoden beim MPFL-Ersatz unter Verwendung künstlicher Transplantate beschäftigen gibt es nach aktueller Recherche nicht. Ziel dieser Arbeit war es, die biomechanischen Eigenschaften zweier patellarer Bohrkanalfixationstechniken beim MPFL-Ersatz mit unterschiedlichem künstlichen Bandersatzmaterial zu ermitteln. Die Hypothese war, dass die biomechanischen Eigenschaften in Elongation, Steifigkeit, Primärstabilität und maximaler Ausreißkraft mit denen der bereits etablierten Verfahren und dem nativen MPFL vergleichbar sind. Hierzu wurden 80 porcine Kniescheiben randomisiert in 8 Gruppen aufgeteilt und getestet. In den Gruppen 1-4 wurden parallele, transpatellare Bohrkanäle mit Tapes der Breiten 2 mm, 3 mm, 4 mm und 5 mm getestet. In den Gruppen 5-8 wurden V-Kanal-Fixationsmethoden mit Bändern der Breite von 2 mm, 3 mm, 4 mm und 5 mm untersucht. Zusätzlich wurden die biomechanischen Grundeigenschaften der nativen Tapes ermittelt. Alle Tests durchliefen jeweils drei Messabschnitte. Hierbei fand zunächst eine Präkonditionierung mit 10 Zyklen zwischen 5 N und 20 N statt. Daraufhin folgte eine zyklische Belastung mit 1000 Zyklen zwischen 5 N und 50 N. Am Ende wurde eine maximale Kraftapplikation bis zum Versagen der Fixationskomplexe durchgeführt. Im Rahmen der Messungen wurden Elongation, Steifigkeit, Yield Load und Maximum Load bestimmt. Es konnten Unterschiede zwischen den beiden Fixationsmethoden und den verwendeten Tapes festgestellt werden. Alle acht Gruppen zeigten eine höhere Primärstabilität als das humane MPFL. Bezogen auf die biomechanischen Eigenschaften und den Versagensmechanismus konnte in dieser Studie ein Vorteil der parallelen transpatellaren Bohrkanäle gegenüber den V- Kanaltechniken festgestellt werden. Die Werte mit der höchsten maximalen Ausreißkraft wurden in Gruppe 3 (631,6 ± 83,1 N) und Gruppe 1 (592,9 ± 170,1 N) gemessen. Diese zeigten eine höhere Primärstabilität mit geringerer Elongation und Steifigkeit im Vergleich zu den in der aktuellen Literatur beschriebenen biomechanischen Studien, welche sich mit unterschiedlichen und teilweise bereits etablierten MPFL-Ersatzverfahren beschäftigten. Eine implantatfreie MPFL-Rekonstruktion mit transpatellaren parallelen Bohrkanälen unter Verwendung eines 2 mm Fiber Tapes (Fa. Arthrex) oder eines 4 mm Tapes (Fa. Topester) könnten dementsprechend eine gute Alternative zur operativen Therapie einer patellofemoralen Instabilität sein. N2 - MPFL reconstruction is a common surgical treatment for patellofemoral instability. The surgical techniques usually differ in patellar fixation methods and selection of grafts. According to current research, there are no biomechanical studies that deal with the physical properties of implant-free MPFL reconstructions with osseous fixation using artificial grafts. The aim of this study was to determine the biomechanical properties of two patellar drill hole techniques in MPFL reconstruction with the use of different artificial grafts. The hypothesis was that the biomechanical properties in elongation, stiffness and maximum load are comparable to native MPFL and procedures with autologous grafts. Therefore 80 porcine patellae were randomly divided into 8 groups. Group 1-4 tested, parallel, transpatellar tunnels with tapes measuring 2 mm, 3 mm, 4 mm and 5 mm. In group 5-8 a bone bridge method (V-channel) was used testing tapes of 2 mm, 3 mm, 4 mm and 5 mm. In addition, the basic physical properties of the native tapes were determined. The specimens were preconditioned with 10 cycles between 5 N and 20 N before they underwent cyclic load with 1000 cycles between 5 N and 50 N. In the end, the maximum load to failure was tested. Elongation, stiffness, yield load, maximum load and failure mode were determined. Differences could be found between the two fixation methods and the tapes used. All eight groups showed higher primary stability than human MPFL. An advantage of the parallel transpatellar tunnels over the bone bridge technique was found in this study. The results with the highest maximum load were found in group 4 (631.6 ± 83.1 N) and group 2 (592.9 ± 170.1 N). These showed a higher maximum load with lower elongation and stiffness compared to other biomechanical studies described in the current literature, which dealt with different MPFL reconstructions with autologous tendon grafts. Therefore an implant-free MPFL reconstruction with transpatellar parallel tunnels using a 2 mm fiber tape (Arthrex) or a 4 mm tape (Topester) could be a good alternative for surgical treatment of patellofemoral instability. KW - Patellaluxation KW - Patellar instability KW - MPFL reconstruction KW - FiberTape KW - Nonresorbable suture tape KW - Osseuous fixation KW - Patellainstabilität KW - MPFL Ersatz KW - FiberTape KW - Synthetisches Bandersatzmaterial KW - Knöcherne Fixation KW - Kniescheibenverrenkung KW - Synthetischer Bandersatz Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-361396 ER - TY - THES A1 - Papay, Marion T1 - Notwendigkeit der präoperativen Reposition von distalen, nach dorsal dislozierten Radiusfrakturen bei bestehender Operationsindikation im Hinblick auf das Schmerzniveau sowie postoperative Ergebnisse T1 - Necessity of preoperative closed reduction of dorsally displaced distal radius fractures with existing surgical indication with regard to the pain level and postoperative results N2 - Die distale Radiusfraktur gehört zu den häufigsten Frakturen in Deutschland mit einem Inzidenzanstieg im Alter unter Betonung des weiblichen Geschlechts. Dabei zeigt sich ein zunehmender Trend in Richtung operative Versorgung, allen voran die Versorgung mittels winkelstabiler Plattensysteme. Instabile, distale Radiusfrakturen werden dabei vor geplanter operativer Versorgung im Rahmen der Initialbehandlung üblicherweise geschlossen reponiert und im Gipsverband retiniert. Ziel der vorliegenden monozentrischen, prospektiv randomisierten Studie mit zwei Studiengruppen war es herauszufinden, ob sich das Unterlassen der Reposition vor geplanter Operation nachteilig auf das Schmerzniveau in der präoperativen Phase auswirkt und ob sich durch die Dislokation Nachteile in Bezug auf den Nervus medianus im Sinne eines Traktionsschadens sowie bezüglich des klinisch-radiologischen Ausheilungsergebnisses zeigen. Die Studie zeigte, dass das Schmerzempfinden während der präoperativen Gipsbehandlung unabhängig von einer vorherigen Reposition war. Für den primären Endpunkt an Tag 1 nach der Akutbehandlung konnte statistisch signifikante Nichtunterlegenheit der Gruppe ohne Reposition gegenüber der Gruppe mit Reposition nachgewiesen werden. Gleiches galt für Tag 2, sowohl für die absoluten Schmerzniveaus als auch für die Schmerzlinderung. Das Unterlassen der Reposition hatte zudem keine nachteiligen Effekte auf den Nervus medianus. Gleiches zeigte sich für das klinische und radiologische Ausheilungsergebnis. Für die funktionellen DASH- und Krimmer-Scores konnte ein Jahr postoperativ ebenfalls statistisch signifikante Nichtunterlegenheit der Gruppe ohne Reposition nachgewiesen werden. Diese Erkenntnisse bestätigen die in der Literatur vorhandenen Ergebnisse verschiedener Studien dahingehend, dass das Unterlassen der Reposition keine nachteiligen Effekte auf das postoperative Outcome hat. Einige Studien verdeutlichen zudem, dass es nach Reposition, insbesondere bei Vorliegen gewisser Risiko- und Instabilitätsfaktoren, ohnehin zur sekundären Dislokation kommt, sodass die generelle Notwendigkeit der Reposition vor Gipsanlage sowohl vor einer operativen als auch vor einer konservativen Weiterbehandlung angezweifelt werden muss. N2 - The distal radius fracture is one of the most common fractures in Germany, with an increase in incidence with age and an emphasis on the female sex. There is an increasing trend towards surgical treatment, above all treatments using locking plate systems. Prior to planned surgical treatment, unstable, distal radius fractures are usually reduced in a closed manner as part of the initial treatment and are retained in a plaster cast. The aim of the present monocentric, prospective randomized study with two study groups was to find out whether omitting reduction before planned surgery has a negative effect on the pain level in the preoperative phase and whether the dislocation has disadvantages with regard to the median nerve in terms of traction damage and with regard to the clinical and radiological healing result. The study showed that the sensation of pain during preoperative plaster treatment was independent of previous reduction. For the primary endpoint on day 1 after acute treatment, statistically significant non-inferiority of the group without reduction compared to the group with reduction was demonstrated. The same was true for day 2, both for absolute pain levels and pain relief. The omission of the reduction also had no adverse effects on the median nerve. The same was shown for the clinical and radiological healing results. For the functional DASH and Krimmer scores, statistically significant non-inferiority of the group without reduction was also demonstrated one year postoperatively. These findings confirm the results of various studies in the literature to the effect that omitting reduction has no detrimental effects on the postoperative outcome. Some studies also make it clear that secondary dislocation occurs anyway after reduction, especially in the presence of certain risk and instability factors, so that the general necessity of reduction prior to plaster application must be questioned both before surgical and conservative further treatment. KW - distale Radiusfraktur KW - Reposition KW - geschlossene präoperative Reposition KW - präoperatives Schmerzniveau KW - distale instabile Radiusfraktur KW - preoperative closed reduction KW - preoperative pain level KW - unstable distal radius fracture Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-363882 N1 - Erstellung der Disseration an folgendem Institut: Abteilung für Orthopädie und Unfallchirurgie Caritas Krankenhaus Bad Mergentheim Lehrkrankenhaus der Universität Würzburg ER -