Refine
Has Fulltext
- yes (45)
Is part of the Bibliography
- yes (45)
Year of publication
- 2022 (45) (remove)
Document Type
- Journal article (33)
- Doctoral Thesis (12)
Keywords
- total knee arthroplasty (8)
- kinematic alignment (6)
- reoperation (3)
- Hüftendoprothetik (2)
- Hüftgelenkprothese (2)
- Kniegelenk (2)
- MIS (2)
- knee (2)
- osteoarthritis (2)
- osteogenesis (2)
- phenotype (2)
- revision (2)
- stemness (2)
- vitamin D (2)
- 3D models (1)
- AMADEUS (1)
- ANGPTL_4 (1)
- Angiopoetin (1)
- Asymmetrische Pfannenkomponente (1)
- Beckenchirurgie (1)
- Beckendiskontinuität (1)
- Biomechanik (1)
- Brustkrebs (1)
- CT (1)
- CYP24A1 (1)
- Chondroplastik (1)
- DAA (1)
- DGOU (1)
- Débridement (1)
- ECM remodeling (1)
- ERAS (1)
- Endoprothetik (1)
- Failure (1)
- Fast-track-program (1)
- Femoraler Offset (1)
- Fraktur (1)
- Frühmobilisierung (1)
- Funktion (1)
- Glenohumeralgelenk (1)
- HHS (1)
- Heterotope Ossifikation (1)
- Hip resurfacing (1)
- Hyaliner Knorpel (1)
- Hüft Prothese (1)
- Hüft-TEP (1)
- Hüftendoprothese (1)
- Hüftgelenk (1)
- Hüftgelenkersatz (1)
- Hüftprothese (1)
- Hüfttotalendoprothese (1)
- Hüfttotalendoprothetik (1)
- ICRS (1)
- Kniescheibe (1)
- Knochenbildung (1)
- Knorpelchirurgie (1)
- Knorpeldegeneration (1)
- Körperliche Aktivität (1)
- Langzeit (1)
- MPFL (1)
- MRI (1)
- MSCs (1)
- Minimal-invasive Chirurgie (1)
- Minimalinvasiv (1)
- Minimalinvasiver vorderer Zugang (1)
- Modell (1)
- NSAID (1)
- Nichtsteroidales Antiphlogistikum (1)
- Oberflächenersatz (1)
- Osteoporose (1)
- Osteosynthese (1)
- Oxford knee score (1)
- PCL retention (1)
- PMMA (1)
- Patella (1)
- Periprothetisch (1)
- Plasmozytom (1)
- Porcin (1)
- Primary hip arthroplasty (1)
- Primäre Hüftprothese (1)
- Prophylaxe (1)
- Reason for revision (1)
- Register (1)
- Rekonstruktion (1)
- Retrospektive Auswertung (1)
- Revision in hip arthroplasty (1)
- Revisionseingriff (1)
- Revisionsgründe (1)
- Revisionsursachen (1)
- SF-36 (1)
- SIRT1 (1)
- Schmerz (1)
- Schulterendoprothetik (1)
- Systematischer Review (1)
- THA (1)
- TKA (1)
- Total hip arthroplasty (1)
- Totalendoprothese (1)
- VDR (1)
- Versagen (1)
- Versagensgründe (1)
- XLH (1)
- accuracy (1)
- activity monitor (1)
- adipogenic differentiation (1)
- adult stem cells (1)
- anterolateral (1)
- antibiotic elution (1)
- approach (1)
- aseptic loosening (1)
- axial alignment (1)
- bisphenol A (1)
- bisphosphonates (1)
- bone (1)
- bone biology (1)
- bone cement (1)
- bone marrow edema (1)
- bone marrow lesion/edema (1)
- bone marrow mesenchymal stromal cells (BM-MSCs) (1)
- bone metastasis (1)
- bone model (1)
- bone morphology (1)
- bone regeneration (1)
- calipered (1)
- cartilage (1)
- cartilage defect (1)
- cartilage regeneration (1)
- cell-based therapies (1)
- cellular origin (1)
- congruency (1)
- custom-made implant (1)
- decellularization (1)
- dental status (1)
- drain (1)
- dual-room trauma suite (1)
- dynamometer (1)
- dyskinesia (1)
- efficiency (1)
- endocrine disruption (1)
- entrapment, traction (1)
- extracellular vesicles (1)
- fast track rehabilitation (1)
- fast-track-concepts (1)
- femur (1)
- forgotten joint score (1)
- geometry (1)
- grading system of chondral defects (1)
- handball (1)
- high tibial valgus osteotomy (1)
- hypophosphatasia (1)
- iTotal (1)
- implant design (1)
- implant survival (1)
- inflammation (1)
- infliximab (1)
- inpatient rehabilitation (1)
- interstage aspiration (1)
- knee joint (1)
- knee replacement (1)
- lateral trochlear undercoverage (1)
- learning curve (1)
- low back pain (1)
- lower extremity (1)
- mechanical property (1)
- medial pivot (1)
- mesenchymal stem cells (1)
- mesenchymal stromal cells (1)
- micro-computed tomography (1)
- micro-traumatic (1)
- microbiological culture (1)
- minimally invasive surgery (1)
- minimally invasive total hip arthroplasty (1)
- movable sliding gantry (1)
- multicomponent stretching (1)
- multimodal pain management (1)
- muscle injury (1)
- muscle strength (1)
- nerve compression (1)
- neurolysis (1)
- osteogenic differentiation (1)
- osteogenic potential (1)
- osteoporosis (1)
- pain (1)
- patellofemoral relationship (1)
- patient reported outcome measures (1)
- patient-specific (1)
- periodontal disease (1)
- peripheral nerve (1)
- periprosthetic infection (1)
- periprosthetic joint infection (1)
- personalised orthopaedic implantation (1)
- polymethylmethacrylate (1)
- posterior cruciate ligament (1)
- posterior tibial slope (1)
- postoperative Komplikationen (1)
- postoperative rehabilitation (1)
- primary hip prosthesis (1)
- prosthetic design (1)
- regeneration (1)
- regenerative capacity (1)
- regenerative potential (1)
- regional transient osteoporosis (1)
- revision arthroplasty (1)
- scapula alata (1)
- scapular winging (1)
- scoping review (1)
- senescence‐associated secretory phenotype (1)
- septic (1)
- serratus anterior (1)
- shape (1)
- shoulder injuries (1)
- spacer (1)
- stem cell niche (1)
- three-point bending (1)
- tibial rotation (1)
- tissue engineering (1)
- tooth loss (1)
- total hip arthroplasty (1)
- total knee replacement (1)
- tranexamic acid (1)
- triangle method (1)
- tricompartmental knee osteoarthritis (1)
- tumor necrosis factor alpha (1)
- vitamin C (1)
- vitamin D receptor (1)
- vitamin D3 (cholecalciferol, VD3) (1)
- weight bearing line (1)
- white blood cell count (1)
- zoledronic acid (1)
Institute
- Lehrstuhl für Orthopädie (45) (remove)
Sonstige beteiligte Institutionen
Bei der Implantation von Hüfttotalendoprothesen (HTEP) finden seit etwa 15 Jahren minimalinvasive muskelschonende Zugänge zunehmend Verwendung. Langfristige Daten der Zugänge, insbesondere des minimalinvasiven anterolateralen Zuganges nach Watson-Jones (ALMI) sind in der Literatur bisher nur unzureichend vorhanden.
Methodik: Ziel dieser Studie war es ein Kollektiv nach HTEP Implantation mit ALMI Zugang mit einem Kollektiv nach HTEP Implantation mit lateralem Zugang nach 10 Jahren hinsichtlich Gelenksfunktion, Muskelfunktion, Zufriedenheit und radiologischer Parameter zu vergleichen und etwaige Unterschiede in der Langzeitbilanz zu detektieren.
Zwei Kollektive mit jeweils 29 operierten Hüftgelenken, Erstimplantation durch die gleichen Operateure in den Jahren 2005 bis 2008, wurden im Diakoniewerk München-Maxvorstadt nachuntersucht. Die dafür herangezogenen Parameter waren Harris Hip Score, Forgotten Joint Score-12, klinische Prüfung des Trendelenburg Zeichens, postoperative Röntgenbildgebung, Auftreten von Komplikationen und Narbenlänge.
Ergebnisse & Schlussfolgerungen: Die beiden Kollektive zeigten in den Parametern Harris Hip Score, Forgotten Joint Score und klinische Prüfung des Trendelenburg Zeichens geringfügige Unterschiede zugunsten des ALMI Kollektivs, die jedoch nicht signifikant waren. Beide Kollektive erreichten in den beschriebenen Scores sehr gute bis exzellente Ergebnisse nach 10 Jahren. Das geringere Auftreten eines auffälligen Trendelenburg Zeichens im ALMI Kollektiv (13,8 vs. 6,9 %) gibt Hinweise auf eine verbesserte Funktion der Glutealmuskulatur durch die intraoperative Muskelschonung. Die beiden Zugänge zeigten in den radiologischen Parametern und der Komplikationsrate ebenbürtige Ergebnisse. Vermehrte Fehlpositionierungen wurden im ALMI Kollektiv nicht beobachtet.
Unsere Beobachtungen passen zu den wenigen vorhandenen in der Literatur beschriebenen Ergebnissen von minimalinvasiven muskelschonenden Zugängen in der Langzeitbilanz.
After starting an orthopedic practice, a surgeon with a fellowship in mechanically aligned (MA) TKA initiated this study to characterize their learning curve after they switched to unrestricted kinematic alignment (KA) TKA using manual instruments. Accordingly, the present study determined for the inexperienced (IE) surgeon the number of cases required to achieve consistent femoral resections and operating times, and whether the femoral resection accuracy, patient-reported outcome measures (PROMs), and component alignment were different from an experienced (E) surgeon. This prospective cohort study analyzed the IE surgeon's first 30 TKAs, all performed with KA, and 30 consecutive KA TKAs performed by an E surgeon. The resection accuracy or deviation was the calipered thickness of the distal and posterior medial and lateral femoral resections minus the planned resection thickness, which was the thickness of the corresponding condyle of the femoral component, minus 2 mm for cartilage wear, and 1 mm for the kerf of the blade. Independent observers recorded the femoral resection thickness, operative times, PROMs, and alignment. For each femoral resection, the deviation between three groups of patients containing ten consecutive KA TKAs, was either insignificant (p = 0.695 to 1.000) or within the 0.5 mm resolution of the caliper, which indicated no learning curve. More than three groups were needed to determine the learning curve for the operative time; however, the IE surgeon's procedure dropped to 77 min for the last 10 patients, which was 20 min longer than the E surgeon. The resection deviations of the IE and E surgeon were comparable, except for the posterolateral femoral resection, which the IE surgeon under-resected by a mean of −0.8 mm (p < 0.0001). At a mean follow-up of 9 and 17 months, the Forgotten Joint Score, Oxford Knee Score, KOOS, and the alignment of the components and limbs were not different between the IE and E surgeon (p ≥ 0.6994). A surgeon that switches to unrestricted KA with manual instruments can determine their learning curve by computing the deviation of the distal and posterior femoral resections from the planned resection. Based on the present study, an IE surgeon could have resection accuracy, post-operative patient outcomes, and component alignment comparable to an E surgeon.
Background: In total knee arthroplasty (TKA), inserts can have different levels of medial and lateral congruency determined by the acuteness of the upslopes of the anterior and posterior articular surfaces. The present study evaluated an insert with different levels of lateral congruency and a medial ball-in-socket congruency to test the hypothesis that a lateral flat (F) insert maximizes external tibial orientation at extension and internal orientation at 90° flexion and lowers the incidence of anterior lift-off relative to low-congruent (LC) and ultracongruent (UC) lateral inserts. Methods: Two surgeons treated 23 patients with unrestricted caliper-verified kinematic alignment (KA) and posterior cruciate ligament (PCL) retention. They randomly trialed inserts with a medial radial dial that functioned as a built-in goniometer by measuring the tibial orientation relative to a sagittal line on the femoral trial component. Anterior lift-off of the insert from the baseplate indicated PCL tightness. Results: The F insert’s mean of 9° of external tibial orientation was higher than that of the LC (5°, p < 0.0001) and UC inserts (2°, p < 0.0001). The −13° of internal tibial orientation at 90° flexion was higher than that of the LC (−9°, p < 0.0001) and UC inserts (−7°, p < 0.0001). The 0% incidence of anterior lift-off was less than that of the LC (26%) and UC inserts (57%) (p < 0.0001). Conclusions: Surgeons and implant manufacturers should know that adding congruency to the lateral articular surface limits external tibial orientation in extension and internal tibial orientation at 90° flexion and overtightens the PCL. These rotational limitations and flexion space tightness can adversely affect patellofemoral tracking and knee flexion.
Adult stem cells in aging
(2022)
Bisphenol A-related effects on bone morphology and biomechanical properties in an animal model
(2022)
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.
Active vitamin D (1,25(OH)2D3) is known to exert direct anti-cancer actions on various malignant tissues through binding to the vitamin D receptor (VDR). These effects have been demonstrated in breast, prostate, renal and thyroid cancers, which all have a high propensity to metastasise to bone. In addition, there is evidence that vitamin D catabolism via 24-hydroxylase (CYP24A1) is altered in tumour cells, thus, reducing local active vitamin D levels in cancer cells. The aim of this study was to assess VDR and CYP24A1 expression in various types of bone metastases by using immunohistochemistry. Overall, a high total VDR protein expression was detected in 59% of cases (39/66). There was a non-significant trend of high-grade tumours towards the low nuclear VDR expression (p = 0.07). Notably, patients with further distant metastases had a reduced nuclear VDR expression (p = 0.03). Furthermore, a high CYP24A1 expression was detected in 59% (39/66) of bone metastases. There was a significant positive correlation between nuclear VDR and CYP24A1 expression (p = 0.001). Collectively, the VDR and CYP24A1 were widely expressed in a multitude of bone metastases, pointing to a potential role of vitamin D signalling in cancer progression. This is of high clinical relevance, as vitamin D deficiency is frequent in patients with bone metastases.
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.
Angiopoetin-like 4 (ANGPTL-4) ist ein Adipokin, das in der extrazellulären Matrix lokalisiert ist und das neben seinen Aufgaben im Fettstoffwechsel auch die Zellmigration, Zellinvasion und die Angioneogenese reguliert. Da es zusätzlich auch den Knochenabbau fördert, wirkt es als Tumorpromotor speziell für Knochentumore. Aufgrund der gesteigerten Expression in Tumorgewebe ist es potenzielles Ziel für molekulare Bildgebung. Mittels Expressionsanalysen auf mRNA- und Proteinebene sollte ein besseres Verständnis der Regulation von ANGPTL-4 erreicht werden. Dexamethason und die 9-cis-Retinsäure beeinflussten die Expression von ANGPTL-4 in MDA Zellen im positiven Sinne, wohingegen der Adenylatcyclase Aktivator Forskolin die Expression supprimierte. In MCF-7 Zellen wurde ANGPTL-4 durch den Phorbolester PMA und durch den Epidermalen Wachstumsfaktor (EGF) induziert. Eine Modulation von ANGPTL-4 könnte von klinischem Nutzen sein, speziell bei der Behandlung von Knochentumoren. Zusätzlich könnte die Trennschärfe von molekularen bildgebenden Verfahren gesteigert werden.
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.
Retrospektive Untersuchung von prä- und postoperativ erhobener Datensätze von 60 Patienten, die über einen minimal-invasiven anterioren Zugang mit einer Nanos-Kurzschaftprothese versorgt wurden. Auswertung und Analyse des Outcome an Hand von 3 in der Literatur etablierten Fragebögen (PROM) WOMAC, EurQol und Harris Hip Score und Vergleich der Ergebnisse mit der Literatur.