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Ziegenhorn J, Kirschberg J, Heinecke M, von Eisenhart-Rothe R, Matziolis G. Significant difference in femoral torsion between coronal plane alignment of the knee type 1 and 4. Knee Surg Sports Traumatol Arthrosc 2024; 32:1199-1206. [PMID: 38511851 DOI: 10.1002/ksa.12149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE The purpose of this study was to find out whether the torsions of the femur and tibia are dependent on the coronal plane alignment of the knee (CPAK) type. METHODS Five hundred patients (1000 legs) were included, who received a whole leg standing three-dimensional (3D) radiograph using EOS imaging (EOS Imaging, Paris, France). SterEOS software was used for digital reconstruction. Femoral and tibial torsions were determined by analysing 3D reconstructions of each leg. Femoral torsion was defined as the angle between the femoral neck axis (FNA) and the posterior condylar axis (PCA). Tibial torsion was defined as the angle between the axis tangent to the posterior part of the tibia plateau and the transmalleolar axis. Arithmetic hip-knee-ankle angle (aHKA) and joint-line obliquity (JLO) were also determined, allowing each leg to be assigned one of nine possible phenotypes according to CPAK. RESULTS The mean femoral torsion in CPAK type 1 was significantly higher (+ 2.6° ± 0.8°) than in CPAK type 4 (p = 0.02). All other CPAK types did not differ in the degree of femoral torsions. No differences could be demonstrated for the tibial torsion. CONCLUSION There is a correlation between the coronal alignment of the lower limb and femoral torsion. This may provide the basis for extending the CPAK classification beyond the coronal plane. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jonas Ziegenhorn
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Germany
| | - Julia Kirschberg
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Germany
- German Knee Society (DKG), Munich, Germany
| | - Markus Heinecke
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Germany
- German Knee Society (DKG), Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- German Knee Society (DKG), Munich, Germany
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Georg Matziolis
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Germany
- German Knee Society (DKG), Munich, Germany
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Maslaris A, Grimberg A, Melsheimer O, Tsiridis E, Matziolis G. Aseptic midterm survival rates between different cemented tibial stem designs in hinged total knee arthroplasty: a 6-year evaluation from the German Arthroplasty Registry. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05273-x. [PMID: 38625551 DOI: 10.1007/s00402-024-05273-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/05/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION The rate of revision TKA and thus the use of hinged implants (HI) steadily rises. Aseptic loosening lies on the top of the failure patterns. However, no evidence exists until now based on national scale high-caseloads that analyzes the impact of cemented HI stem-design on aseptic survival rates. METHODS Data on aseptic HI-revisions with full-cemented tibia-stems were conducted from the German Arthroplasty Registry. Cases were divided in primary HI (PHI) and HI used in revision operations (RHI). Endpoint was a new revision following either a PHI or an RHI. The impact of stem conicity (conical vs. cylindrical), diameter (≤ 13 mm vs. > 13 mm), length (≤ 90 mm vs. > 90 mm) and offset on the 6-Year-Cumulative-Aseptic-Revision-Rate (6Y-CARR) was estimated via Kaplan-Meier curve and compared between groups via Log-Rank-Tests. RESULTS 3953 PHI and 2032 RHI fulfilled inclusion-criteria. Stem conicity had no impact on 6Y-CARR (p = 0.08 and p = 0.8). Diameter > 13 mm hat an impact on PHI (p = 0.05) with lower 6Y-CARR but not on RHI (p = 0.2). Length > 90 mm showed significantly worst 6Y-CARR in PHI (p = 0.0001) but not in RHI (p = 0.3). Offset-stems showed significantly better 6Y-CARR in PHI (p = 0.04), but not in RHI (p = 0.7). CONCLUSION There was no significant impact of the cemented tibia-stem conicity on 6Y-CARR, neither in PHI nor in RHI. The effect of length, diameter and offset on the 6Y-CARR observed in the PHI, was not detectable in the more complex RHI-cases reflecting its limited clinical relevance by itself in more multifactorial backgrounds. Therefore, results must be interpreted with caution due to considerable system-effects and different utilization-scenarios.
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Affiliation(s)
- Alexander Maslaris
- Orthopaedic Department at Campus Eisenberg, University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany.
| | - Alexander Grimberg
- German Arthroplasty Registry gGmbH (EPRD), EPRD Deutsche Endoprothesenregister gGmbH, Straße des 17. Juni 106-108 (Eingang Bachstraße), 10623, Berlin, Germany
| | - Oliver Melsheimer
- German Arthroplasty Registry gGmbH (EPRD), EPRD Deutsche Endoprothesenregister gGmbH, Straße des 17. Juni 106-108 (Eingang Bachstraße), 10623, Berlin, Germany
| | - Elefterios Tsiridis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloníki, Greece
| | - Georg Matziolis
- Orthopaedic Department at Campus Eisenberg, University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
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Rohe S, Böhle S, Matziolis G, Layher F, Brodt S. Elastic Compression Dressing after Total Hip Replacement Slightly Reduces Leg Swelling: A Randomized Controlled Trial. J Clin Med 2024; 13:2207. [PMID: 38673482 PMCID: PMC11050482 DOI: 10.3390/jcm13082207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/01/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Even minor adverse reactions after total hip replacement (THR), including lymphedema, postoperative leg swelling, and blood loss, compromise patient comfort in times of minimally invasive fast-track surgery. Compression dressings are commonly used in surgical practice to reduce swelling or blood loss. However, the use of spica hip compression dressings after primary THR is controversial, and prospective studies are lacking. Methods: We conducted a prospective, single-center, two-arm, randomized controlled trial (RCT) of patients undergoing THR for primary osteoarthritis. A total of 324 patients were enrolled; 18 patients were excluded, and 306 patients were finally analyzed. Leg swelling as primary endpoint was measured pre- and postoperatively with a rotating 3D infrared body scanner. Secondary endpoints were transfusion rate and blood loss, estimated by Nadler and Gross formulas. Results: Postoperative leg swelling was lower in the compression group (241 ± 234 mL vs. 307 ± 287 mL; p = 0.01), even after adjustment for surgery time and Body-Mass-Index (BMI) (p = 0.04). Estimated blood loss was also lower in the compression group on the first (428 ± 188 mL vs. 462 ± 178 mL; p = 0.05) and third (556 ± 247 mL vs. 607 ± 251 mL; p = 0.04) postoperative days and leveled off on the fifth postoperative day, but lost significance after adjustment for BMI and surgery time. Neither group received a transfusion. Conclusions: Compression dressing after THR in the context of minimally invasive surgery slightly reduces leg swelling, but has no effect on blood loss or blood transfusion rate. So, this method could not generally be recommended in primary hip replacement.
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Affiliation(s)
- Sebastian Rohe
- Orthopedic Department of the Waldkliniken Eisenberg, Professorship of the University Hospital Jena, 07607 Eisenberg, Germany; (S.B.); (G.M.); (F.L.); (S.B.)
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Matziolis G, Layher F, Vogt S, Bergner L, Wassilew G, Kirschberg J. Spacer rotation technique allows precise evaluation of gap balance in total knee arthroplasty. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05253-1. [PMID: 38587669 DOI: 10.1007/s00402-024-05253-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/17/2024] [Indexed: 04/09/2024]
Abstract
The symmetry of the flexion and extension gap influences the functional and long-term outcome after total knee arthroplasty (TKA). Most surgeons check it by applying varus and valgus stress using spacers. This technique has limited accuracy and could be easily extended by rotational movement of the spacer. The objective was to determine the detection threshold and interobserver reliability of this technique. In an in vitro setting with a human cadaveric knee, gap asymmetries were simulated by different medially and laterally applied forces. Using an optical measurement system, the pivot point of the spacer was calculated as a function of the gap symmetry in the first part of the experiment. In the second part, the detection threshold and interobserver reliability of 4 surgeons were determined. For this purpose, gap asymmetries were adjusted to between 0 and 120N in a blinded trial. With a symmetrical gap, the centre of rotation of the spacer was located in the centre of the tibia. With increasing gap asymmetry, the centre of rotation of the spacer shifted to the tight side. This shift was approximately linearly dependent on the force difference. A perfectly balanced gap was detected by the examiners in 50% of the cases. From a force difference of 40N, all examiners identified the gap asymmetry in all cases (ICC = 1.0). The method of spacer rotation described is suitable for reliably detecting gap differences at ≥ 40N, independently of the examiner.
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Affiliation(s)
- Georg Matziolis
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany.
| | - Frank Layher
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Sophia Vogt
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Leah Bergner
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Georgi Wassilew
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, 17475, Greifswald, Germany
| | - Julia Kirschberg
- Orthopaedic Department, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
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Heinecke M, Layher F, Matziolis G. Optimized reamer geometry for controlled reaming of the proximal femur. Sci Rep 2024; 14:4546. [PMID: 38402230 PMCID: PMC10894259 DOI: 10.1038/s41598-024-55067-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/20/2024] [Indexed: 02/26/2024] Open
Abstract
Preparation of the femoral proximal medullary cavity by reaming is essential for intramedullary nail osteosynthesis and hip revision arthroplasty. The use of reamers sometimes exerts high torsional forces on the bone. Design and direction of rotation of the reamer are potential influencing factors. The aim of this biomechanical study is to evaluate the best combination of a right- or left-cutting reamer with a clockwise- or counterclockwise-rotating insert in terms of preparation and safety. Right- and left-cutting reamers with conical design were each introduced into five synthetic femurs in both clockwise and counterclockwise rotation with constant feed force. A specially constructed test system was used for this series of tests, with which the respective intramedullary channel were reamed step by step. This was then used to determine the required torque. In addition, the feed rate measurement was analyzed using a modified digital caliper. The feed rates of the reamers with rotation in the same direction as the cutting direction were significantly increased compared to rotation in the opposite cutting direction (CCRLC vs. CCRRC 76.8 ± 9.0 mm/s vs. 25.2 ± 8.3 mm/s and CRRC vs. CRLC 54.3 ± 12.3 mm/s vs. 19.3 ± 0.6 mm/s; p < 0.01). In contrast, the mean torque during the reaming process was identical in all four groups. When preparing the proximal femoral medullary cavity, especially in cases with fragile bone structure, the available reamers should be introduced in opposite rotation to the cutting direction to achieve a more controllable feed of the reamer. Left-cutting reamers represent an alternative, using them in the usual clockwise-rotating technique to reduce the risk of complications during reaming.
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Affiliation(s)
- Markus Heinecke
- German Center for Orthopedics, Campus Eisenberg, Chair of Orthopedics of Jena University Hospital, Klosterlausnitzer Street 81, 07607, Eisenberg, Germany.
| | - Frank Layher
- German Center for Orthopedics, Campus Eisenberg, Chair of Orthopedics of Jena University Hospital, Klosterlausnitzer Street 81, 07607, Eisenberg, Germany
| | - Georg Matziolis
- German Center for Orthopedics, Campus Eisenberg, Chair of Orthopedics of Jena University Hospital, Klosterlausnitzer Street 81, 07607, Eisenberg, Germany
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Nistor M, Schmidt M, Klingner C, Klingner C, Matziolis G, Shayganfar S, Schiffner R. Effect of Low-Frequency Renal Nerve Stimulation on Renal Glucose Release during Normoglycemia and a Hypoglycemic Clamp in Pigs. Int J Mol Sci 2024; 25:2041. [PMID: 38396718 PMCID: PMC10888375 DOI: 10.3390/ijms25042041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
Previously, we demonstrated that renal denervation in pigs reduces renal glucose release during a hypoglycemic episode. In this study we set out to examine changes in side-dependent renal net glucose release (SGN) through unilateral low-frequency stimulation (LFS) of the renal plexus with a pulse generator (2-5 Hz) during normoglycemia (60 min) and insulin-induced hypoglycemia ≤3.5 mmol/L (75 min) in seven pigs. The jugular vein, carotid artery, renal artery and vein, and both ureters were catheterized for measurement purposes, blood pressure management, and drug and fluid infusions. Para-aminohippurate (PAH) and inulin infusions were used to determine side-dependent renal plasma flow (SRP) and glomerular filtration rate (GFR). In a linear mixed model, LFS caused no change in SRP but decreased sodium excretion (p < 0.0001), as well as decreasing GFR during hypoglycemia (p = 0.0176). In a linear mixed model, only hypoglycemic conditions exerted significant effects on SGN (p = 0.001), whereas LFS did not. In a Wilcoxon signed rank exact test, LFS significantly increased SGN (p = 0.03125) and decreased sodium excretion (p = 0.0017) and urinary flow rate (p = 0.0129) when only considering the first instance LFS followed a preceding period of non-stimulation during normoglycemia. To conclude, this study represents, to our knowledge, the first description of an induction of renal gluconeogenesis by LFS.
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Affiliation(s)
- Marius Nistor
- Orthopaedic Department, Jena University Hospital, 07747 Jena, Germany (G.M.)
| | - Martin Schmidt
- Institute for Biochemistry II, Jena University Hospital, 07747 Jena, Germany;
| | - Carsten Klingner
- Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (C.K.); (C.K.)
| | - Caroline Klingner
- Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (C.K.); (C.K.)
| | - Georg Matziolis
- Orthopaedic Department, Jena University Hospital, 07747 Jena, Germany (G.M.)
| | - Sascha Shayganfar
- Emergency Department, Helios University Clinic Wuppertal, 42283 Wuppertal, Germany;
- Faculty of Health/School of Medicine, Lehrstuhl für Klinische Akut- und Notfallmedizin, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - René Schiffner
- Orthopaedic Department, Jena University Hospital, 07747 Jena, Germany (G.M.)
- Emergency Department, Helios University Clinic Wuppertal, 42283 Wuppertal, Germany;
- Faculty of Health/School of Medicine, Lehrstuhl für Klinische Akut- und Notfallmedizin, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
- Emergency Department, Otto-von-Guericke University, 39120 Magdeburg, Germany
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Brodt S, Schulze M, Jacob B, Wassilew G, Nowack D, Rohe S, Matziolis G. Validity of leg length measurement in the supine and standing position compared with pelvic survey X-ray after total hip arthroplasty. Arch Orthop Trauma Surg 2024; 144:433-438. [PMID: 37530843 PMCID: PMC10774217 DOI: 10.1007/s00402-023-05014-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/23/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION The correct adjustment of leg length is a major goal in the implantation of total hip replacements (THRs). Differences in leg length can lead to functional impairment and patient dissatisfaction. By determining leg length at an early stage, before the patient is discharged from hospital, compensatory measures such as the production of special insoles or orthopaedic footwear can be initiated promptly if there is a difference in leg length. Due to shortening of the period of time spent in hospital, the traditional measurement of leg length in a standing position may be increasingly subject to error. A protective posture immediately after surgery or the presence of a twisted pelvis, for example, due to scoliotic spinal misalignments, falsifies the measurement result in the standing position. Here, the measurement of leg length in the supine position may prove to be accurate immediately postoperatively, regardless of potential sources of error, and is to be compared with measurement in the standing position versus radiological measurement on the AP pelvic survey. MATERIAL AND METHODS The present retrospective study included 190 patients who had undergone primary total hip arthroplasty. The leg length difference (LLD) of the patients was determined pre- and postoperatively both in the supine and standing position and compared with the postoperative radiological pelvic survey image. RESULTS Postoperatively, it was shown that the mean length measured was 0.35 mm too long in the supine position and 0.68 mm too short in the standing position (p value < 0.001). Determination of the average absolute measurement error produces a deviation of 4.06 mm in the standing and 4.51 mm in the supine position (p value 0.126). CONCLUSIONS It is shown that the postoperative measurement of LLD in the supine and standing position is equally valid and sufficiently accurate, compared with the gold standard of measurement on a radiograph.
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Affiliation(s)
- Steffen Brodt
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany.
| | - Marcel Schulze
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Benjamin Jacob
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Georgi Wassilew
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Dimitri Nowack
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Sebastian Rohe
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Georg Matziolis
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
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Rohe S, Böhle S, Matziolis G, Jacob B, Brodt S. Plain radiographic indices are reliable indicators for quantitative bone mineral density in male and female patients before total hip arthroplasty. Sci Rep 2023; 13:19886. [PMID: 37963967 PMCID: PMC10645725 DOI: 10.1038/s41598-023-47247-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 11/10/2023] [Indexed: 11/16/2023] Open
Abstract
Osteoporosis is underdiagnosed in patients undergoing total hip arthroplasty (THA). Bone mineral density measurement by dual-energy X-ray absorptiometry (DXA) is the gold standard, but indices on plain hip radiographs also seemed to be reliable screening tools in female or Asian ethnicities in previous studies. Given the lack of knowledge about male patients and Caucasian ethnicities, this study was conducted to evaluate plane hip radiographic indices as a screening tool for osteopenia and osteoporosis in Caucasian female and also male patients before undergoing THA. A retrospective analysis of 216 elderly patients with pre-existing DXA before hip arthroplasty was performed and four indices were calculated on plain hip radiographs: Canal-Flare-Index (CFI), Canal-Calcar-Ratio (CCR), Canal-Bone-Ratio (CBR) 7 and 10 cm below the lesser trochanter. They were correlated with femoral neck DXA T-scores by Pearson's correlation and intraclass correlation coefficient, and a ROC analysis was performed. A total of 216 patients (49.5% male) were included. CBR-7 and -10 were highly correlated (p < 0.001) with femoral neck T-score in males (Pearson's correlation CBR-7 r = - 0.60, CBR-10 r = - 0.55) and females (r = - 0.74, r = - 0.77). CBR-7 and -10 also showed good diagnostic accuracy for osteoporosis in the ROC analysis in males (CBR-7: AUC = 0.75, threshold = 0.51; CBR-10: 0.63; 0.50) and females (CBR-7: AUC = 0.87, threshold = 0.55; CBR-10: 0.90; 0.54). Indices such as the Canal Bone Ratio (CBR) 7 or 10 cm below the lesser trochanter on plain hip radiographs are a good screening tool for osteopenia and osteoporosis on plain hip radiographs and can be used to initiate further diagnostics like the gold standard DXA. They differ between male and female patients.
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Affiliation(s)
- Sebastian Rohe
- Orthopaedic Department of the Waldkliniken Eisenberg, Professorship of the University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany.
| | - Sabrina Böhle
- Orthopaedic Department of the Waldkliniken Eisenberg, Professorship of the University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Georg Matziolis
- Orthopaedic Department of the Waldkliniken Eisenberg, Professorship of the University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Benjamin Jacob
- Orthopaedic Department of the Waldkliniken Eisenberg, Professorship of the University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Steffen Brodt
- Orthopaedic Department of the Waldkliniken Eisenberg, Professorship of the University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
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Heinz K, Nowack D, von Eisenhart-Rothe R, Wassilew G, Matziolis G, Brodt S. "Koehlers teardrop is not a reliable landmark for assessing the centre of rotation after Total hip arthroplasty" - a retrospective radiological study. Arch Orthop Trauma Surg 2023; 143:5671-5676. [PMID: 37099164 PMCID: PMC10449955 DOI: 10.1007/s00402-023-04859-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/25/2023] [Indexed: 04/27/2023]
Abstract
PURPOSE Various anatomical landmarks have become established in radiography for the assessment of cup positioning after total hip arthroplasty (THA). The most important one is Koehler's teardrop figure (KTF). However, there is a lack of data on the validity of this landmark, which is widely used clinically for assessing the centre of rotation of the hip. METHOD A retrospective measurement of the lateral and cranial distance of the KTF to the centre of hip rotation was performed on the basis of 250 X-ray images of patients who had undergone THA. In addition, the dependence of these distances on pelvic tilt was determined in 16 patients by means of virtual X-ray projections based on pelvic CTs. RESULTS It was shown that the distance of the KTF from the centre of hip rotation in the horizontal plane is gender-dependent (men: 42.8 ± 6.0 mm vs. women: 37.4 ± 4.7 mm; p < 0.001) and age-dependent (Pearson correlation - 0.114; p < 0.05). Furthermore, the vertical and horizontal distances are subject to variation depending on height (Pearson correlation 0.14; p < 0.05 and 0.40; p < 0.001, respectively) and weight (Pearson correlation 0.158; p < 0.05). The distance between the KTF and the centre of hip rotation varies slightly depending on pelvic tilt. CONCLUSION The KTF is not a sufficiently valid landmark for assessing the centre of rotation after THA. It is influenced by many different disturbance variables. However, it is largely robust against changes in pelvic tilt, so that it can be used as a reference point when comparing different intraindividual radiographs to assess the change in the centre of rotation due to implantation or to detect cup migration.
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Affiliation(s)
- Kristian Heinz
- Orthopaedic Department, Jena Universitiy Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany.
| | - Dimitri Nowack
- Orthopaedic Department, Jena Universitiy Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | | | - Georgi Wassilew
- Orthopaedic Department, Greifswald Universitiy, Greifswald, Germany
| | - Georg Matziolis
- Orthopaedic Department, Jena Universitiy Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Steffen Brodt
- Orthopaedic Department, Jena Universitiy Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
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Nistor M, Schmidt M, Klingner C, Klingner C, Schwab M, Bischoff SJ, Matziolis G, Rodríguez-González GL, Schiffner R. Renal Glucose Release after Unilateral Renal Denervation during a Hypoglycemic Clamp in Pigs with an Altered Hypothalamic Pituitary Adrenal Axis after Late-Gestational Dexamethasone Injection. Int J Mol Sci 2023; 24:12738. [PMID: 37628918 PMCID: PMC10454812 DOI: 10.3390/ijms241612738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Previously, we demonstrated in pigs that renal denervation halves glucose release during hypoglycaemia and that a prenatal dexamethasone injection caused increased ACTH and cortisol concentrations as markers of a heightened hypothalamic pituitary adrenal axis (HPAA) during hypoglycaemia. In this study, we investigated the influence of an altered HPAA on renal glucose release during hypoglycaemia. Pigs whose mothers had received two late-gestational dexamethasone injections were subjected to a 75 min hyperinsulinaemic-hypoglycaemic clamp (<3 mmol/L) after unilateral surgical denervation. Para-aminohippurate (PAH) clearance, inulin, sodium excretion and arterio-venous blood glucose difference were measured every fifteen minutes. The statistical analysis was performed with a Wilcoxon signed-rank test. PAH, inulin, the calculated glomerular filtration rate and plasma flow did not change through renal denervation. Urinary sodium excretion increased significantly (p = 0.019). Side-dependent renal net glucose release (SGN) decreased by 25 ± 23% (p = 0.004). At 25 percent, the SGN decrease was only half of that observed in non-HPAA-altered animals in our prior investigation. The current findings may suggest that specimens with an elevated HPAA undergo long-term adaptations to maintain glucose homeostasis. Nonetheless, the decrease in SGN warrants further investigations and potentially caution in performing renal denervation in certain patient groups, such as diabetics at risk of hypoglycaemia.
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Affiliation(s)
- Marius Nistor
- Orthopaedic Department, Jena University Hospital, Campus Eisenberg, 07607 Eisenberg, Germany; (M.N.)
| | - Martin Schmidt
- Institute for Biochemistry II, Jena University Hospital, 07743 Jena, Germany
| | - Carsten Klingner
- Department of Neurology, Jena University Hospital, 07747 Jena, Germany (M.S.)
| | - Caroline Klingner
- Department of Neurology, Jena University Hospital, 07747 Jena, Germany (M.S.)
| | - Matthias Schwab
- Department of Neurology, Jena University Hospital, 07747 Jena, Germany (M.S.)
| | | | - Georg Matziolis
- Orthopaedic Department, Jena University Hospital, Campus Eisenberg, 07607 Eisenberg, Germany; (M.N.)
| | | | - René Schiffner
- Orthopaedic Department, Jena University Hospital, Campus Eisenberg, 07607 Eisenberg, Germany; (M.N.)
- Emergency Department, Otto-von-Guericke University, 39120 Magdeburg, Germany
- Emergency Department, Helios University Clinic Wuppertal, 42283 Wuppertal, Germany
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11
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Fischer M, Nonnenmacher L, Möller A, Hofer A, Reichert J, Matziolis G, Zimmerer A, Wassilew G. Psychological Factors as Risk Contributors for Poor Hip Function after Periacetabular Osteotomy. J Clin Med 2023; 12:4008. [PMID: 37373700 DOI: 10.3390/jcm12124008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Psychologic comorbidities have been identified as risk factors for poor outcomes in orthopedic procedures, but their influence on the outcome of hip-preserving periacetabular osteotomy (PAO) remains uncertain. This retrospective cohort study aimed to assess the impact of patients' psychological health on the outcome of PAO in patients with hip dysplasia (HD) and acetabular retroversion (AR). The study included 110 patients undergoing PAO for HD or AR between 2019 and 2021. Standardized questionnaires were administered to assess psychological factors, postoperative hip function, and activity level (mean follow-up: 25 months). Linear regression analyses were used to examine the associations between psychological factors and postoperative hip function and activity level. Both HD and AR patients showed improved postoperative hip function and activity levels. Linear regression analyses revealed that depression significantly impaired postoperative outcomes in both groups, whereas somatization negatively influenced the outcome in AR patients. General health perceptions significantly contributed to an improved postoperative outcome. These findings highlight the importance of concomitantly addressing psychologically relevant factors in order to improve patient outcomes after PAO procedures. Future prospective studies should continue to investigate the impact of various psychological factors and explore possibilities of incorporating psychological support into routine postoperative care for these patient cohorts.
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Affiliation(s)
- Maximilian Fischer
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Lars Nonnenmacher
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Alexander Möller
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | - André Hofer
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Johannes Reichert
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Georg Matziolis
- Orthopedic Department, Jena University Hospital, Campus Eisenberg, 07607 Eisenberg, Germany
| | - Alexander Zimmerer
- Diakonieklinikum Stuttgart, Department of Orthopaedic and Trauma Surgery, Orthopädische Klinik Paulinenhilfe, 70176 Stuttgart, Germany
| | - Georgi Wassilew
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
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12
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Brodt S, Maurer J, Nowack D, Brodt G, Strube P, Matziolis G. A Retrospective Analysis of the Association Between Male Facial Hair and the Incidence of Peri-Prosthetic Infections. Surg Infect (Larchmt) 2023. [PMID: 37222729 DOI: 10.1089/sur.2023.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Abstract Background: The wearing of male facial hair has been undergoing something of a renaissance for a number of years, with medical colleagues in the surgical disciplines being no exception. Meanwhile, there are a few reports in the literature that beards might have an increased bacterial colonization. This study aims to determine if wearing a beard leads to an increased rate of infection in total hip or knee arthroplasty. Patients and Methods: A retrospective analysis was performed on 20,394 primary hip and knee replacements that were implanted at a single university hospital. The rate of infections that occurred within one year after surgery and the surgeons performing the surgery were recorded. The surgeons were classified into clean-shaven and beard wearers. The beard wearers were further classified by individual facial hair styles, namely a moustache, chin beard, round beard, or full beard. Results: The overall rate of surgical site infections 365 days after surgery is 0.75%. There was no statistically significant association between surgical site infection and the presence of facial hair (p = 0.774) or specific beard types (p = 0.298). Conclusions: The results presented in this study show no differences in infection rates across different facial hair styles of male surgeons.
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Affiliation(s)
- Steffen Brodt
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Germany
| | - Jürgen Maurer
- Department of Economics, Faculty of Business and Economics (HEC), University of Lausanne, Lausanne, Switzerland
| | - Dimitri Nowack
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Germany
| | - Grit Brodt
- Department of Pediatrics, Jena University Hospital, Jena, Germany
| | - Patrick Strube
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Germany
| | - Georg Matziolis
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Germany
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13
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Nonnenmacher L, Zimmerer A, Hofer A, Bohorc M, Matziolis G, Wassilew G. [Complication management after periacetabular osteotomy]. Orthopadie (Heidelb) 2023; 52:272-281. [PMID: 36939881 PMCID: PMC10063494 DOI: 10.1007/s00132-023-04359-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Hip dysplasia is the most common cause of secondary hip osteoarthritis. The Ganz periacetabular osteotomy (PAO) is a well-established procedure that allows a reliable and reproducible correction of the complex pathology. The promising medium and long-term good treatment results are offset by the potential risk of complications from an invasive pelvic procedure. Considering the mainly young age of the patients, knowledge of the possible complications and the resulting adequate therapy is crucial. TREATMENT DEVELOPMENT The continuous development of surgical techniques and increase in overall surgical experience alongside the appreciation of critical surgical steps have led to a substantial reduction of serious complications. In addition, to improve patient outcome, a greater understanding of the associated pathologies that may be related to hip dysplasia is essential.
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Affiliation(s)
- Lars Nonnenmacher
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Deutschland
| | - Alexander Zimmerer
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Deutschland
| | - André Hofer
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Deutschland
| | - Manuela Bohorc
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Deutschland
| | - Georg Matziolis
- Deutsches Zentrum für Orthopädie, Waldkliniken Eisenberg, 07607, Eisenberg, Deutschland
| | - Georgi Wassilew
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Deutschland.
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Maslaris A, Tsiridis E, Schoeneberg C, Pass B, Spyrou G, Maris A, Matziolis G. Does stem profile have an impact on the failure patterns in revision total knee arthroplasty? Arch Orthop Trauma Surg 2023; 143:1549-1569. [PMID: 36450936 PMCID: PMC9957861 DOI: 10.1007/s00402-022-04683-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 10/23/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Revision total knee arthroplasty (RTKA) has been increasing continuously. The results of RTKA still remain unsatisfactory. Failure patterns and risk factors in RTKA were thoroughly analyzed, with periprosthetic joint infections (PJI) and aseptic loosening remaining at the forefront of re-revision (ReRTKA) causes. While there is evidence that stem profile impacts the revisability of cemented implants, its association with the modes of RTKA failure is unknown. METHODS 50 consecutive ReRTKA performed in a single orthopedic center during 2016-2017 were retrospectively analyzed. The cases were stratified according to age, sex, number of preexisting revisions, fixation technique, stem design and causes of re-revision. All explanted implants with conical vs. cylindrical stem profiles were compared. RESULTS Mean age was 67 ± 11.5, and 54% were females. 72% of the cases had ≥ 3 previous revisions. 88% were full-cemented, 3% hybrid and 9% press-fit stems. 36% of the RTKA had conical, 58% cylindrical and 6% combined stem profiles. 92% of the RTKA components were removed. Removal causes were: PJI (52.2%), aseptic loosening (34.8%), implant malposition (9.8%), painful knee (1.1%) and instability (2.2%). While the overall RTKA failure patterns were equally distributed between conical and cylindrical stems, subgroup analysis of only cemented ReRTKA revealed a higher incidence of aseptic loosening within cylindrical stem profiles (46.7% vs. 25.7%, P = 0.05). CONCLUSION Stem profile may have an impact on the process of aseptic loosening in cemented non-metaphyseal engaging RTKA, with cylindrical designs tending to worse outcomes than conical designs. Large cohort studies could provide more clarity on current observation.
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Affiliation(s)
- Alexander Maslaris
- Department of Orthopedics, Waldkliniken Eisenberg, Jena University Hospital, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany. .,Department of Orthopedics and Trauma Surgery, Alfried-Krupp Hospital Essen, Alfried-Krupp-Straße 21, 45131, Essen, Germany.
| | - Eleftherios Tsiridis
- grid.4793.90000000109457005Academic Orthopedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, GRC Greece
| | - Carsten Schoeneberg
- grid.476313.4Department of Orthopedics and Trauma Surgery, Alfried-Krupp Hospital Essen, Alfried-Krupp-Straße 21, 45131 Essen, Germany
| | - Bastian Pass
- grid.476313.4Department of Orthopedics and Trauma Surgery, Alfried-Krupp Hospital Essen, Alfried-Krupp-Straße 21, 45131 Essen, Germany
| | - Georgios Spyrou
- grid.476313.4Department of Orthopedics and Trauma Surgery, Alfried-Krupp Hospital Essen, Alfried-Krupp-Straße 21, 45131 Essen, Germany
| | - Alexandros Maris
- grid.420468.cDepartment of Orthopedics, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH UK
| | - Georg Matziolis
- grid.275559.90000 0000 8517 6224Department of Orthopedics, Waldkliniken Eisenberg, Jena University Hospital, Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany
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Richter J, Matziolis G, Kahl U. [Knee flexion after hospitalisation is no predictor for functional outcome one year after total knee arthroplasty]. Orthopadie (Heidelb) 2023; 52:159-164. [PMID: 36449049 PMCID: PMC9908663 DOI: 10.1007/s00132-022-04327-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVE In total knee arthroplasty (TKA), range of motion has become established as an important factor. The criterion of quality is set to flexion of 90° after hospitalisation. Currently, it is supposed to be a predictor for 1‑year postoperative outcome. However, as this correlation has not been proven, this clinical trial was performed. METHODS A total of 182 TKA recipients were analysed retrospectively. Outcomes were assessed before surgery, after hospitalization, 6 weeks and 1 year post surgery. They included knee range of motion (ROM) to answer the main hypothesis, but also KSS, SF-36, WOMAC, EQ-5D and VAS to evaluate knee function and quality of life. The patients were divided into two groups differing in achieving 90° flexion after hospitalisation and compared 6 weeks and 1 year after surgery. RESULTS Knee flexion differed significantly between groups from 91 to 70° in the group without the aim of 90° flexion after hospitalisation (E) (p < 0.001). After 6 weeks, flexion was improved to 112° ± 13° (E > 90°) vs. 106° ± 14° (E < 90°; p = 0.001). One year post surgery, knee flexion averaged 122° ± 10° (E > 90°) vs. 120° ± 10° (E < 90°) with no difference between the groups (p = 0.57) and no significant difference in all other scores concerning knee function and quality of life. CONCLUSION Flexion of 90° after hospitalisation is not adequate to predict medium-term outcomes after TKA. There is no advantage or disadvantage regarding whether the aim of 90° flexion is achieved.
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Affiliation(s)
- Janice Richter
- Deutsches Zentrum für Orthopädie Waldkliniken Eisenberg, Universitätsklinikum Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Deutschland.
| | - Georg Matziolis
- Deutsches Zentrum für Orthopädie Waldkliniken Eisenberg, Universitätsklinikum Jena, Klosterlausnitzer Str. 81, 07607 Eisenberg, Deutschland
| | - Uwe Kahl
- Orthopädisches Zentrum, Sportklinik Erfurt, Erfurt, Deutschland Am Urbicher Kreuz 7, 99099
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Matziolis G, Jacob B, Eijer H, von Eisenhart-Rothe R, Jacob N. Less soft tissue release in total knee arthroplasty for anteromedial compared to posteromedial knee osteoarthritis. Arch Orthop Trauma Surg 2023; 143:489-493. [PMID: 35037995 PMCID: PMC9886609 DOI: 10.1007/s00402-021-04260-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/12/2021] [Indexed: 02/03/2023]
Abstract
In total knee arthroplasty (TKA), the aim of achieving a mechanically straight leg axis as well as symmetrical and equally wide gaps has become established as the gold standard in terms of surgical technique. In contrast to TKA unicompartmental knee arthroplasty (UKA) is performed in anteromedial osteoarthritis (AMOA) and does not normally require releases. This raises the hypothesis whether the type of osteoarthritis (AMOA vs. posteromedial osteoarthritis (PMOA)) determines the requirement for soft tissue releases in TKA.In this retrospective study, 114 patients with medial osteoarthritis of the knee who had been treated with a navigated total knee replacement were consecutively included. On the basis of the preoperative lateral radiographs, the patients were divided into two groups: AMOA and PMOA. The incidence and the extent of releases performed were recorded using the navigation records.Patient-specific data (gender, age) did not differ between the groups (NS). Knees with AMOA presented an overall varus alignment of 5.3 ± 3.5°, knees with PMOA 8.0 ± 4.0° (p < 0.001). 30 cases (44%) had to be released in the AMOA group, compared with 33 cases (72%) in the PMOA group (p = 0.004). In the case of medial release, the extension gap increased 3.3 ± 2.4 mm in the AMOA compared to 5.3 ± 3.7 mm in the PMOA group (p = 0.006). The medial flexion gap was released 2.2 ± 2.6 mm in the AMOA and 2.9 ± 3.0 mm in the PMOA group (p = 0.008).To achieve a neutral mechanical alignment, a release has to be performed due to asymmetry of the extension gap more often if PMOA is present than in AMOA. Surgeons should be prepared to perform more frequent and extensive medial releases in PMOA. Higher constrained implants should be available in case of unintended over release in PMOA.
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Affiliation(s)
- Georg Matziolis
- grid.275559.90000 0000 8517 6224University Hospital Jena, Campus Eisenberg, Orthopaedic Department, Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany ,grid.491777.b0000 0004 7589 8636Endoprosthetics Committee of the German Knee Society (DKG), Munich, Germany
| | - Benjamin Jacob
- grid.275559.90000 0000 8517 6224University Hospital Jena, Campus Eisenberg, Orthopaedic Department, Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany
| | - Henk Eijer
- Department of Orthopaedic Surgery, Spital Emmental, Burgdorf, Switzerland
| | - Rüdiger von Eisenhart-Rothe
- grid.6936.a0000000123222966Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany ,grid.491777.b0000 0004 7589 8636Endoprosthetics Committee of the German Knee Society (DKG), Munich, Germany
| | - Nadja Jacob
- grid.275559.90000 0000 8517 6224University Hospital Jena, Campus Eisenberg, Orthopaedic Department, Klosterlausnitzer Str. 81, 07607 Eisenberg, Germany
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Jacob B, Wassilew G, von Eisenhart-Rothe R, Brodt S, Matziolis G. Topical vancomycin powder does not affect patella cartilage degeneration in primary total knee arthroplasty and conversion rate for secondary patella resurfacing. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04721-w. [PMID: 36538161 PMCID: PMC10374468 DOI: 10.1007/s00402-022-04721-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Vancomycin powder (VP) is an antibiotic first introduced in pediatric spinal surgery to prevent surgical site infections (SSI). Recently its topical application was expanded to total hip and knee arthroplasty (THA, TKA) and anterior cruciate ligament reconstruction (ACLR). Toxicity to cartilage is the subject of current research. The aim of this study was to prove the hypothesis that topical application of VP in TKA does not result in a degeneration of patella cartilage. We propagate that the conversion rate for secondary patella resurfacing is not influenced by its use. MATERIALS AND METHODS Between 2014 and 2021, 4292 joints were included in this monocentric retrospective cohort study. All patients underwent TKA without primary patella resurfacing. After a change of the procedure in the hospital, one group (VPG) was administered VP intraoperatively. The other group (nVPG) received no VP during surgery (nVPG). The remaining perioperative procedure was constant over the investigation period. Conversion rates for secondary patella resurfacing for both groups were determined without making distinctions in the indication. A second cohort was composed of patients presenting for follow-up examination 12 months after TKA and included 210 joints. Retrospective radiographic evaluations were performed preoperatively, before discharge and at follow-up examination. Patella axial radiographs were analyzed for patella tracking (lateral patellar tilt, patellar displacement) and patella degeneration (Sperner classification, patellofemoral joint space). RESULTS There was no significant difference in the conversion rate for secondary patella resurfacing (4.24% VPG, 4.97% nVPG). Patella tracking and patella degeneration did not differ significantly between both groups. CONCLUSIONS The topical application of VP does not influence the conversion rate for secondary patella resurfacing. Moreover, it does not result in a degeneration of patella cartilage in TK. LEVEL OF EVIDENCE Retrospective case series, Level III.
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Affiliation(s)
- Benjamin Jacob
- Orthopaedic Department Waldkliniken Eisenberg, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany.
| | - Georgi Wassilew
- Department of Orthopaedic Surgery, University Hospital Greifswald, Greifswald, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopaedics and Sports Orthopaedics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Steffen Brodt
- Orthopaedic Department Waldkliniken Eisenberg, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Georg Matziolis
- Orthopaedic Department Waldkliniken Eisenberg, University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
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Böhle S, Vogel AM, Matziolis G, Strube P, Rohe S, Brodt S, Mastrocola M, Eijer H, Rödel J, Lindemann C. Comparison of two different antiseptics regarding intracutaneous microbial load after preoperative skin cleansing in total knee and hip arthroplasties. Sci Rep 2022; 12:18246. [PMID: 36309598 PMCID: PMC9617848 DOI: 10.1038/s41598-022-23070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/25/2022] [Indexed: 12/31/2022] Open
Abstract
Periprosthetic infections (PPIs) are a serious concern in total knee and hip arthroplasty, and they have an increasing incidence. To prevent PPI, preoperative skin disinfection, as a key element of antisepsis, represents an important part of infection prevention. However, no specific antiseptic agent is endorsed by the relevant guidelines. The purpose of this retrospective, not randomized study was to investigate the difference in the residual bacteria load between an approved antiseptic with an alcohol-based solution with additional benzalkonium chloride (BAC) and an alcohol-based solution with additional octenidine dihydrochloride (OCT) at two different time periods. In 200 consecutive patients with total knee or hip arthroplasty, skin samples from the surgical sites were collected after skin disinfection with BAC (100 g solution contain: propan-2-ol 63.0 g, benzalkonium chloride 0.025 g) or OCT (100 g solution contain: octenidine dihydrochloride 0.1 g, propan-1-ol, 30.0 g, propan-2-ol 45.0 g) (100 patients per group). Following the separation of cutis and subcutis and its processing, culture was performed on different agar plates in aerobic and anaerobic environments. In the case of bacteria detection, the microbial identification was determined by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), and the number of contaminated samples was compared between the groups. Additionally, multiple regression analysis was performed to examine the effect of the type of disinfectant, BMI, age, sex, rheumatoid arthritis, diabetes mellitus, skin disorders, smoking status, and localization of skin samples on positive bacteria detection. A total of 34 samples were positive for bacteria in the BAC group, while only 17 samples were positive in the OCT group (p = 0.005). Disinfectant type was the only significant parameter in the multiple regression analysis (p = 0.006). A significantly higher contamination rate of the subcutis was shown in the BAC group compared to the OCT group (19 vs. 9, p = 0,003). After the change from BAC to OCT in preoperative skin cleansing in the hip and knee areas, the number of positive cultures decreased by 50%, which might have been caused by a higher microbicidal activity of OCT. Therefore, the use of OCT in preoperative cleansing may reduce the risk of PPI in hip and knee surgery. Randomized controlled trials are required to confirm the effect and to evaluate if it reduces the risk of PPI.
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Affiliation(s)
- Sabrina Böhle
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany
| | - Anna-Maria Vogel
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany
| | - Georg Matziolis
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany
| | - Patrick Strube
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany
| | - Sebastian Rohe
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany
| | - Steffen Brodt
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany
| | - Mario Mastrocola
- Department of Orthopaedic Surgery, Spital Emmental, Oberburgstrasse 54, 3400 Burgdorf, Switzerland
| | - Henk Eijer
- Department of Orthopaedic Surgery, Spital Emmental, Oberburgstrasse 54, 3400 Burgdorf, Switzerland
| | - Jürgen Rödel
- grid.275559.90000 0000 8517 6224Institute of Medical Microbiology, Jena University Hospital, 07747 Jena, Germany
| | - Chris Lindemann
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany
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Brodt S, Boersch V, Strube P, Wassilew G, Matziolis G. Defining the canal for ischial and pubic screws in cup revision surgery. International Orthopaedics (SICOT) 2022; 46:2547-2552. [PMID: 35994066 PMCID: PMC9556370 DOI: 10.1007/s00264-022-05552-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/11/2022] [Indexed: 12/03/2022]
Abstract
Purpose When revising acetabular cups, it is often necessary to provide additional stabilisation with screws. In extensive defect situations, the placement of screws caudally in the ischium and/or pubis is biomechanically advantageous. Especially after multiple revision operations, the surgeon is confronted with a reduced bone stock and unclear or altered anatomy. In addition, screw placement caudally is associated with greater risk. Therefore, the present study aims to identify and define safe zones for the placement of caudal acetabular screws. Methods Forty-three complete CT datasets were used for the evaluation. Sixty-three distinctive 3D points representing bone landmark of interests were defined. The coordinates of these points were then used to calculate all the parameters. For simplified visualisation and intra-operative reproducibility, an analogue clock was used, with 12 o’clock indicating cranial and 6 o’clock caudal. Results A consistent accumulation was found at around 4.5 ± 0.3 hours for the ischium and 7.9 ± 0.3 hours for the pubic bone. Conclusions The anatomy of the ischium and pubis is sufficiently constant to allow the positioning of screws in a standardised way. The interindividual variation is low — regardless of gender — so that the values determined can be used to position screws safely in the ischium and pubis. The values determined can provide the surgeon with additional orientation intra-operatively when placing caudal acetabular screws.
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Affiliation(s)
- Steffen Brodt
- German Center for Orthopaedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany
| | - Vincent Boersch
- Clinic for Traumatology and Orthopedic Surgery, Klinikum Kassel, Kassel, Germany
| | - Patrick Strube
- German Center for Orthopaedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany
| | - Georgi Wassilew
- Clinic for Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Georg Matziolis
- German Center for Orthopaedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607 Eisenberg, Germany
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Rohe S, Böhle S, Matziolis G, Jacob B, Wassilew G, Brodt S. C-reactive protein during the first 6 postoperative days after total hip arthroplasty cannot predict early periprosthetic infection. Arch Orthop Trauma Surg 2022; 143:3495-3503. [PMID: 35943586 DOI: 10.1007/s00402-022-04565-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) remains a serious complication in orthopaedic surgery. C-reactive protein (CRP) is widely used as a marker to screen for inflammatory complications. The early postoperative course is well known, but knowledge about the predictive value of CRP in the first 6 postoperative days for detecting an acute postoperative PJI is lacking. METHODS We retrospectively analyzed the inpatient course of CRP of all primary THA and THA with acute PJI within 28 days in our hospital from 2013 to 2021. A receiver-operating curve (ROC) analysis was performed and the best CRP threshold for detecting an acute PJI based on Youden's-index was calculated and an area-under-the curve (AUC) analysis of the threshold was performed. RESULTS 33 of 7042 patients included had an acute PJI within 28 days. Patients with acute PJI were older, had a higher BMI and longer operation time and suffered more often from diabetes mellitus. A preoperatively elevated CRP was a risk factor for PJI. CRP was significantly higher in the PJI group on postoperative days 3 and 5. Threshold values were calculated to be 152 mg/l on day 3 and 73 mg/l on day 5. However, these values had a low sensitivity (75%, 76%) and specificity (67%, 61%). CONCLUSION Especially considering the decreasing length of stay after THA, the question of the usefulness of regular inpatient CRP checks arises. AUC analysis of the ROC showed a poor diagnostic accuracy in almost all cases. Only the dynamic analysis of the maximum CRP value to the lowest CRP value with a decrease of 102.7 mg/l showed a fair accuracy. This calls into question the clinical relevance of CRP in the first postoperative week for detection of acute postoperative PJI.
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Affiliation(s)
- Sebastian Rohe
- Orthopaedic Department of the Waldkliniken Eisenberg, University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany.
| | - Sabrina Böhle
- Orthopaedic Department of the Waldkliniken Eisenberg, University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Georg Matziolis
- Orthopaedic Department of the Waldkliniken Eisenberg, University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Benjamin Jacob
- Orthopaedic Department of the Waldkliniken Eisenberg, University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Georgi Wassilew
- Department of Orthopaedic Surgery, University Hospital Greifswald, 17475, Greifswald, Germany
| | - Steffen Brodt
- Orthopaedic Department of the Waldkliniken Eisenberg, University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
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21
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Rohe S, Dörr N, Böhle S, Matziolis G, Brodt S, Röhner E. Mid-term results in revision hip arthroplasty with impaction bone grafted cup reconstruction for acetabular defects. Sci Rep 2022; 12:13322. [PMID: 35922465 PMCID: PMC9349309 DOI: 10.1038/s41598-022-17526-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 07/26/2022] [Indexed: 11/25/2022] Open
Abstract
Acetabular defects are a challenging condition for surgeons in revision THA. A crucial aim is an anatomical restoration of the centre of rotation (COR) through grafts. The aim of this study was to determine the cup survival after biological restoration of acetabular defects in THA and the effect of Paprosky classification, age, BMI, and number of previous operations on cup survival. Retrospectively patients with a cup exchange and an impaction of cortico-cancellous or bulk grafts between 2009 and 2012 were included with a follow up with a minimum of 5 year. Implant failure was defined as radiographic loosening or explantation of the cup. The acetabular defect situation was classified to Paprosky. 82 patients (58 female 70.7%) were included. 26 patients were not available to contact. 56 patients (40 female 71.4%) remained for survival analysis with mean age of 75.6 ± 8 years. Survival of the cup after 5 years was 90% and after 7.8 years 88%. There was no difference in survival concerning defect classification, type of implant or graft, age, BMI, and number of previous operations. Patients on the follow up reached an HHS of 67.4 ± 19, a WOMAC Score of 33.4 ± 25.4 points and an unsatisfactory result in the SF-36. Impaction bone grafting of acetabular defects is a good option with satisfactory biomechanical results and survival for small defects. Predictive factors for cup survival could not be clarified in our study. So, the correct indication, knowing the limits of the methods and the correct choice of implant allow a defect-oriented approach and are decisive for the success of the operation.
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Affiliation(s)
- Sebastian Rohe
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany.
| | - Nicoletta Dörr
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Sabrina Böhle
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Georg Matziolis
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Steffen Brodt
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Waldkliniken Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Eric Röhner
- Orthopaedic Department of the Heinrich-Braun-Hospital Zwickau, 08060, Zwickau, Germany
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22
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Hertling S, Hertling D, Matziolis G, Schleußner E, Loos F, Graul I. Digital teaching tools in sports medicine: A randomized control trial comparing the effectiveness of virtual seminar and virtual fishbowl teaching method in medical students. PLoS One 2022; 17:e0267144. [PMID: 35709198 PMCID: PMC9202876 DOI: 10.1371/journal.pone.0267144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 04/01/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Since the COVID-19 pandemic, the demand for online courses has increased enormously. Therefore, finding new methods to improve medical education is imperative.
Objective
The aim of this study was to compare the self-reports of the individual student-centered virtual teaching techniques (seminar versus fishbowl) in a group of medical students.
Methods
During the second semester of 2020, students in the clinical phase of the study (n = 144) participated in the optional subject of Sports Medicine. The students were divided into 2 groups. One group (n = 72) received the knowledge transfer in the form of a virtual seminar, the other group (n = 72) in the form of a virtual fishbowl.
Results
Virtual seminar and virtual fishbowl students gave insights into these teaching techniques. Most of the students from the virtual fishbowl group believed that the virtual fishbowl format allowed them to be more actively involved in learning. The mean quiz scores were statistically higher for students in the virtual fishbowl group than students in the virtual seminar group (p < 0. 001).
Conclusion
This study concluded that virtual seminars and virtual fishbowl formats could be served as structured learning and teaching formats. At the same time, the virtual fishbowl format can promote an active exchange of knowledge from students’ perspectives.
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Affiliation(s)
- Stefan Hertling
- Department of Gynecology and Obstetrics, University Hospital Jena, Jena, Germany
- Orthopaedic Department, Campus Eisenberg, University Hospital Jena, Jena, Eisenberg, Germany
- Fakultät für Gesundheit (Department für Humanmedizin), Lehrstuhl für Medizintheorie, Integrative und Anthroposophische Medizin, Witten/Herdecke, Germany
- Department of Obstetrics, University Hospital Jena, Jena, Germany
| | - Doreen Hertling
- Department of Gynecology, Hospital Rummelsberg, Schwarzenbruck, Germany
| | - Georg Matziolis
- Orthopaedic Department, Campus Eisenberg, University Hospital Jena, Jena, Eisenberg, Germany
| | | | - Franziska Loos
- Practice for Orthopaedics and Shoulder Surgery, Leipzig, Germany
| | - Isabel Graul
- Orthopaedic Department, Campus Eisenberg, University Hospital Jena, Jena, Eisenberg, Germany
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
- Department für Orthopädie, Unfall - Universitätsklinikum Halle, Halle, Germany
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23
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Wagener N, Böhle S, Kirschberg J, Rohe S, Heinecke M, Di Fazio P, Matziolis G, Röhner E. Knee Arthrodesis Affects Gait Kinematics More in the Ankle Than in the Hip Joint. Medicina (Kaunas) 2022; 58:medicina58060696. [PMID: 35743959 PMCID: PMC9230178 DOI: 10.3390/medicina58060696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/10/2022] [Accepted: 05/21/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: No gold standard exists for treating persistent periprosthetic knee infections. Knee arthrodesis represents one treatment concept for extensive bone defects and extensor system insufficiencies. It has already been shown that knee arthrodesis leads to a significant reduction in one's quality of life. The aim of this survey was to assess the influence of knee arthrodesis on the neighboring joints on the basis of gait analysis data. Our hypothesis is that the hip and ankle joints are negatively influenced by knee arthrodesis in the process of walking. Materials and methods: We performed six pedobarographic and four gait analytical measurements in six patients 2.4 ± 1.6 years after receiving knee arthrodesis at the operating ages of 69.1 ± 9.2 years. Gait analysis consisted of time-distance parameters/minute (number of steps, double support, cycle time, standing phase, step length, gait speed). A healthy group of test subjects (n = 52) was included as the control cohort. Gait analysis was conducted using a three-dimensional movement system and three force-measuring platforms to determine the ground reaction force. Foot pressure was measured using a pedography platform. Results: Five of six patients presented an incomplete rolling movement over the toes on the side that was operated on, presenting with a gait line ending in the forefoot area. All of the patients bore less weight on the side that was operated on. Three of six patients demonstrated a pathological gait line with a healthy opposite side ending in the forefoot area. All of the patients exhibited a reduction in gait speed and step length and a lower number of steps. All of the patients had a prolonged double support/cycle time. Conclusions: Isolated knee arthrodesis is associated with reduced forefoot repulsion, restricted movement on the side receiving the operation, and reduced movement in the ankle/knee joint. The hip showed norm deviations in the hip moment/angle. Knee arthrodesis causes reduced gait kinetics/kinematics. Our survey shows that the relative joint moments of the ankle joint and hip are often reduced. The ankle joint is more affected compared to the hip.
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Affiliation(s)
- Nele Wagener
- Department of Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center Goettingen, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- Orthopaedic Professorship of the University Hospital Jena, Orthopaedic Department Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (S.B.); (J.K.); (S.R.); (M.H.); (G.M.); (E.R.)
- Correspondence:
| | - Sabrina Böhle
- Orthopaedic Professorship of the University Hospital Jena, Orthopaedic Department Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (S.B.); (J.K.); (S.R.); (M.H.); (G.M.); (E.R.)
| | - Julia Kirschberg
- Orthopaedic Professorship of the University Hospital Jena, Orthopaedic Department Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (S.B.); (J.K.); (S.R.); (M.H.); (G.M.); (E.R.)
| | - Sebastian Rohe
- Orthopaedic Professorship of the University Hospital Jena, Orthopaedic Department Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (S.B.); (J.K.); (S.R.); (M.H.); (G.M.); (E.R.)
| | - Markus Heinecke
- Orthopaedic Professorship of the University Hospital Jena, Orthopaedic Department Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (S.B.); (J.K.); (S.R.); (M.H.); (G.M.); (E.R.)
| | - Pietro Di Fazio
- Department of Visceral Thoracic and Vascular Surgery, Philipps University Marburg, Baldingerstraße, 35043 Marburg, Germany;
| | - Georg Matziolis
- Orthopaedic Professorship of the University Hospital Jena, Orthopaedic Department Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (S.B.); (J.K.); (S.R.); (M.H.); (G.M.); (E.R.)
| | - Eric Röhner
- Orthopaedic Professorship of the University Hospital Jena, Orthopaedic Department Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (S.B.); (J.K.); (S.R.); (M.H.); (G.M.); (E.R.)
- Klinik für Orthopädie, Heinrich-Braun-Klinikum Zwickau, Karl-Keil-Straße 35, 08060 Zwickau, Germany
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24
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Böhle S, Rohe S, Kirschberg J, Brinkmann O, Seeger J, Zippelius T, Matziolis G, Röhner E. Poor Outcome of Above-Knee Amputation after Septic Failure of Revision Total Knee Arthroplasty. J Knee Surg 2022; 35:645-652. [PMID: 32906158 DOI: 10.1055/s-0040-1716416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Persistent periprosthetic infection following total knee arthroplasty is one of the most dreaded complications of orthopaedic surgery. Treatment strategies include arthrodesis of the knee joint, stable fistula, long-lasting antibiotic therapy, or above-knee amputation. The advantage of amputation in comparison to other treatment options is the possible cure of infection, because the source of infection is removed and no foreign material left in situ. The aim of the study is to examine whether a septic amputation of the femur in case of persistent periprosthetic infection at the knee joint leads to the healing of the patient. Moreover, the physical and mental state should be evaluated. All patients with above-knee amputation because of periprosthetic joint infection after primary total knee arthroplasty between 2016 and 2018 were included in this retrospective study. A questionnaire with the clinical scores visual analog scale, modified Lysholm, Western Ontario and McMaster Universities Osteoarthritis Index and 36-Item Short Form Survey has been designed. In addition, all characteristics and perioperative data were documented. Eleven patients were included in the study. One patient died after above-knee amputation; all other patients live with a marked impairment of quality of life but with absence of the infection of the leg. Two out of ten are able to walk regularly with an exoprosthesis with forearm crutches, 50% are in a wheelchair, while 30% are bedridden. Patients with above-knee amputation after persistent periprosthetic infections were free of infection and without signs of inflammation. However, this is associated with worse mobility and high mortality rate.
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Affiliation(s)
- Sabrina Böhle
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Eisenberg, Germany
| | - Sebastian Rohe
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Eisenberg, Germany
| | - Julia Kirschberg
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Eisenberg, Germany
| | - Olaf Brinkmann
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Eisenberg, Germany
| | - Jörn Seeger
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg, Giessen, Germany
| | - Timo Zippelius
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Eisenberg, Germany
| | - Georg Matziolis
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Eisenberg, Germany
| | - Eric Röhner
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Eisenberg, Germany
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Hinterwimmer F, Lazic I, Langer S, Suren C, Charitou F, Hirschmann MT, Matziolis G, Seidl F, Pohlig F, Rueckert D, Burgkart R, von Eisenhart-Rothe R. Prediction of complications and surgery duration in primary TKA with high accuracy using machine learning with arthroplasty-specific data. Knee Surg Sports Traumatol Arthrosc 2022; 31:1323-1333. [PMID: 35394135 PMCID: PMC10050062 DOI: 10.1007/s00167-022-06957-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/18/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The number of primary total knee arthroplasties (TKA) is expected to rise constantly. For patients and healthcare providers, the early identification of risk factors therefore becomes increasingly fundamental in the context of precision medicine. Others have already investigated the detection of risk factors by conducting literature reviews and applying conventional statistical methods. Since the prediction of events has been moderately accurate, a more comprehensive approach is needed. Machine learning (ML) algorithms have had ample success in many disciplines. However, these methods have not yet had a significant impact in orthopaedic research. The selection of a data source as well as the inclusion of relevant parameters is of utmost importance in this context. In this study, a standardized approach for ML in TKA to predict complications during surgery and an irregular surgery duration using data from two German arthroplasty-specific registries was evaluated. METHODS The dataset is based on two initiatives of the German Society for Orthopaedics and Orthopaedic Surgery. A problem statement and initial parameters were defined. After screening, cleaning and preparation of these datasets, 864 cases of primary TKA (2016-2019) were gathered. The XGBoost algorithm was chosen and applied with a hyperparameter search, a cross validation and a loss weighting to cope with class imbalance. For final evaluation, several metrics (accuracy, sensitivity, specificity, AUC) were calculated. RESULTS An accuracy of 92.0%, sensitivity of 34.8%, specificity of 95.8%, and AUC of 78.0% were achieved for predicting complications in primary TKA and 93.4%, 74.0%, 96.3%, and 91.6% for predicting irregular surgery duration, respectively. While traditional statistics (correlation coefficient) could not find any relevant correlation between any two parameters, the feature importance revealed several non-linear outcomes. CONCLUSION In this study, a feasible ML model to predict outcomes of primary TKA with very promising results was built. Complex correlations between parameters were detected, which could not be recognized by conventional statistical analysis. Arthroplasty-specific data were identified as relevant by the ML model and should be included in future clinical applications. Furthermore, an interdisciplinary interpretation as well as evaluation of the results by a data scientist and an orthopaedic surgeon are of paramount importance. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Florian Hinterwimmer
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany. .,Institute for AI and Informatics in Medicine, Technical University of Munich, Munich, Germany.
| | - Igor Lazic
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Severin Langer
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Suren
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Fiona Charitou
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology-Liestal, Kantonsspital Baselland, Bruderholz, Laufen, Switzerland.,Endoprosthetics Committee of the German Knee Society (DKG), Munich, Germany
| | - Georg Matziolis
- Orthopaedic Department Campus Eisenberg, University Hospital Jena, Eisenberg, Germany.,Endoprosthetics Committee of the German Knee Society (DKG), Munich, Germany
| | - Fritz Seidl
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Florian Pohlig
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniel Rueckert
- Institute for AI and Informatics in Medicine, Technical University of Munich, Munich, Germany
| | - Rainer Burgkart
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Endoprosthetics Committee of the German Knee Society (DKG), Munich, Germany
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26
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Wagener N, Di Fazio P, Böker KO, Matziolis G. Osteogenic Effect of Pregabalin in Human Primary Mesenchymal Stem Cells, Osteoblasts, and Osteosarcoma Cells. Life (Basel) 2022; 12:life12040496. [PMID: 35454987 PMCID: PMC9032037 DOI: 10.3390/life12040496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/06/2022] [Accepted: 03/26/2022] [Indexed: 02/07/2023] Open
Abstract
Seventy million patients worldwide are suffering from epilepsy. The long-term use of antiepileptic drugs causes the alteration of the bone tissue and its metabolism, thus increasing the risk of fractures. Clinical and pre-clinical studies have highlighted conflicting data on the influence of the relatively new antiepileptic drug pregabalin (Lyrica®). The objective of the present study was therefore to investigate its cytotoxicity in primary human osteoblasts (hOB). HOB and human mesenchymal stem cells (hMSC) were isolated from patients. The human osteosarcoma cells MG63 were included as established cell line. Cells were incubated with pregabalin at concentrations ranging from 0 to 40 μg/mL. Time-dependent cell proliferation was measured by automatic cell counting, and metabolism was determined by XTT assay and osseous differentiation by alkaline phosphatase (ALP) activity. Histological examinations of calcium deposit were performed with ALP, Alizarin Red, and von Kossa staining. A concentration-dependent increase in the proliferation of hOB and hMSC was observed after treatment with pregabalin. All cells showed a significant increase in cell metabolism. The osteogenic differentiation, confirmed by the increase of calcium deposit, was promoted by the administration of pregabalin. This effect was already significant at the therapeutic plasma concentration of pregabalin (10 μg/mL). In contrast to the other antiepileptic drugs, pregabalin showed no osteocatabolic effects. Conflicting in-vivo data must therefore be attributed to systemic effects of pregabalin.
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Affiliation(s)
- Nele Wagener
- Department of Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center Goettingen, Robert-Koch-Str. 40, 37099 Göttingen, Germany;
- Correspondence: ; Tel.: +49-1717255663
| | - Pietro Di Fazio
- Department of Visceral Thoracic and Vascular Surgery, Philipps University Marburg, Baldingerstraße, 35043 Marburg, Germany;
| | - Kai Oliver Böker
- Department of Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center Goettingen, Robert-Koch-Str. 40, 37099 Göttingen, Germany;
| | - Georg Matziolis
- Orthopaedic Professorship of the University Hospital Jena, Orthopaedic Department Waldkliniken Eisenberg, 07607 Eisenberg, Germany;
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Schnoeder TM, Schwarzer A, Jayavelu AK, Hsu CJ, Kirkpatrick J, Döhner K, Perner F, Eifert T, Huber N, Arreba-Tutusaus P, Dolnik A, Assi SA, Nafria M, Jiang L, Dai YT, Chen Z, Chen SJ, Kellaway SG, Ptasinska A, Ng ES, Stanley EG, Elefanty AG, Buschbeck M, Bierhoff H, Brodt S, Matziolis G, Fischer KD, Hochhaus A, Chen CW, Heidenreich O, Mann M, Lane SW, Bullinger L, Ori A, von Eyss B, Bonifer C, Heidel FH. PLCG1 is required for AML1-ETO leukemia stem cell self-renewal. Blood 2022; 139:1080-1097. [PMID: 34695195 PMCID: PMC8854675 DOI: 10.1182/blood.2021012778] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/07/2021] [Indexed: 11/20/2022] Open
Abstract
In an effort to identify novel drugs targeting fusion-oncogene-induced acute myeloid leukemia (AML), we performed high-resolution proteomic analysis. In AML1-ETO (AE)-driven AML, we uncovered a deregulation of phospholipase C (PLC) signaling. We identified PLCgamma 1 (PLCG1) as a specific target of the AE fusion protein that is induced after AE binding to intergenic regulatory DNA elements. Genetic inactivation of PLCG1 in murine and human AML inhibited AML1-ETO dependent self-renewal programs, leukemic proliferation, and leukemia maintenance in vivo. In contrast, PLCG1 was dispensable for normal hematopoietic stem and progenitor cell function. These findings are extended to and confirmed by pharmacologic perturbation of Ca++-signaling in AML1-ETO AML cells, indicating that the PLCG1 pathway poses an important therapeutic target for AML1-ETO+ leukemic stem cells.
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MESH Headings
- Animals
- Cell Self Renewal
- Core Binding Factor Alpha 2 Subunit/genetics
- Core Binding Factor Alpha 2 Subunit/metabolism
- Gene Expression Regulation, Leukemic
- Hematopoietic Stem Cells/metabolism
- Hematopoietic Stem Cells/pathology
- Humans
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/pathology
- Mice
- Neoplastic Stem Cells/metabolism
- Neoplastic Stem Cells/pathology
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/metabolism
- Phospholipase C gamma/genetics
- Phospholipase C gamma/metabolism
- Proteome
- RUNX1 Translocation Partner 1 Protein/genetics
- RUNX1 Translocation Partner 1 Protein/metabolism
- Transcriptome
- Translocation, Genetic
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Affiliation(s)
- Tina M Schnoeder
- Innere Medizin C, Hämatologie, Onkologie, Stammzelltransplantation und Palliativmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Adrian Schwarzer
- Department of Hematology, Hemostaseology, Oncology and Stem Cell Transplantation, and
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
| | | | - Chen-Jen Hsu
- Innere Medizin C, Hämatologie, Onkologie, Stammzelltransplantation und Palliativmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Joanna Kirkpatrick
- Leibniz Institute on Aging, Fritz-Lipmann Institute (FLI), Jena, Germany
| | - Konstanze Döhner
- Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Florian Perner
- Innere Medizin C, Hämatologie, Onkologie, Stammzelltransplantation und Palliativmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
- Department of Pediatric Oncology, Dana Farber Cancer Institute, Harvard University, Boston, MA
| | - Theresa Eifert
- Innere Medizin C, Hämatologie, Onkologie, Stammzelltransplantation und Palliativmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Nicolas Huber
- Innere Medizin C, Hämatologie, Onkologie, Stammzelltransplantation und Palliativmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Patricia Arreba-Tutusaus
- Department of Oncology, Hematology, Immunology, and Rheumatology, University Hospital Tübingen, Tübingen, Germany
| | - Anna Dolnik
- Hematology, Oncology and Tumor Immunology, Charité University Medicine, Berlin, Germany
| | - Salam A Assi
- Institute for Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Monica Nafria
- Institute for Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Lu Jiang
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine, Ruijin Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu-Ting Dai
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine, Ruijin Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhu Chen
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine, Ruijin Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sai-Juan Chen
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine, Ruijin Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sophie G Kellaway
- Institute for Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Anetta Ptasinska
- Institute for Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Elizabeth S Ng
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Edouard G Stanley
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne Parkville, VIC, Australia
| | - Andrew G Elefanty
- Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
| | | | - Holger Bierhoff
- Institute of Biochemistry and Biophysics, Center for Molecular Biomedicine, Friedrich-Schiller University, Jena, Germany
| | - Steffen Brodt
- University Hospital Jena, Orthopaedic Department at Campus Eisenberg, Eisenberg, Germany
| | - Georg Matziolis
- University Hospital Jena, Orthopaedic Department at Campus Eisenberg, Eisenberg, Germany
| | - Klaus-Dieter Fischer
- Institute for Cell Biology and Biochemistry, Otto-von-Guericke University, Magdeburg, Germany
| | - Andreas Hochhaus
- Innere Medizin 2, Hämatologie und Onkologie, Universitätsklinikum Jena, Germany
| | - Chun-Wei Chen
- Department of Systems Biology, Beckman Research Institute of City of Hope, Duarte, CA
| | - Olaf Heidenreich
- Northern Institute for Cancer Research, University of Newcastle, Newcastle upon Tyne, United Kingdom
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands; and
| | - Matthias Mann
- Max-Planck-Institute of Biochemistry, Munich, Germany
| | - Steven W Lane
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Lars Bullinger
- Hematology, Oncology and Tumor Immunology, Charité University Medicine, Berlin, Germany
| | - Alessandro Ori
- Leibniz Institute on Aging, Fritz-Lipmann Institute (FLI), Jena, Germany
| | - Björn von Eyss
- Leibniz Institute on Aging, Fritz-Lipmann Institute (FLI), Jena, Germany
| | - Constanze Bonifer
- Institute for Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Florian H Heidel
- Innere Medizin C, Hämatologie, Onkologie, Stammzelltransplantation und Palliativmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
- Leibniz Institute on Aging, Fritz-Lipmann Institute (FLI), Jena, Germany
- Innere Medizin 2, Hämatologie und Onkologie, Universitätsklinikum Jena, Germany
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Graul I, Strube P, Vogt S, Matziolis G, Brodt S, Hölzl A. Does Total Hip Arthroplasty Influence the Development and Localization of Sacral Insufficiency Fractures? J Bone Joint Surg Am 2022; 104:139-144. [PMID: 34807876 DOI: 10.2106/jbjs.21.00218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Sacral insufficiency fractures (SIFs) are fractures related to reduced bone strength. In a previous study, we noticed that many patients with SIF had undergone total hip arthroplasty (THA). Therefore, the purpose of the present study was to research the localization of clinically apparent SIFs in relation to unilateral THA as well as the influence of unilateral THA on bone mineral density changes in the sacrum. METHODS In this retrospective study, 171 patients with SIFs were screened for unilateral THA. In the group of patients with SIF and THA, the rate of SIF ipsilateral and contralateral to the side of the THA was determined. In a second cohort of 39 THA patients with healthy bone, changes in bone mineral density at the sacral alae ipsilateral and contralateral to the THA were analyzed by use of computed tomography immediately postoperatively and at the 1-year follow-up. RESULTS Of the 171 patients with SIF, 50 (40 female; mean age, 79 years; range, 54 to 101 years) were previously treated with THA. Of the 50, 31 patients were treated with unilateral THA. The proportion of patients with an SIF contralateral to the THA was 42% (13 of 31) and ipsilateral to the THA was 19% (6 of 31). Twelve patients had bilateral SIFs. The mean age of the THA group without SIF was 62 years (range, 49 to 79 years); 17 were female. The median bone mineral density decreased significantly (p = 0.023), from 35.0 to 13.0 HU, at the sacral ala contralateral to the THA, whereas the decrease of ipsilateral bone mineral density, from 24.0 to 17.0 HU, was not significant (p = 0.361). CONCLUSIONS The proportion of patients with an SIF contralateral to a THA was twice as high as that of patients with an SIF ipsilateral to a THA. These findings are supported by the second cohort's decrease in bone mineral density at the sacral ala contralateral to the THA at 1 year after surgery. We conclude that THA can lead to spatially different remodeling of the sacrum, possibly affecting the development of SIFs. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Isabel Graul
- Department of Orthopedics, Campus Eisenberg, University of Jena, Eisenberg, Germany
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Fischer LT, Heinecke M, Röhner E, Schlattmann P, Matziolis G. Cones and sleeves present good survival and clinical outcome in revision total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:2824-2837. [PMID: 34389876 PMCID: PMC9309140 DOI: 10.1007/s00167-021-06670-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The fixation of revision total knee arthroplasties (rTKA) tends to be difficult, leading to a reduction in implant survival. One option for achieving a more stable anchorage is to use metaphyseal cones and sleeves. The objective of the present paper is to provide a current comparative meta-analysis on survival and clinical results of cones vs. sleeves, with a differentiation between the short- and long-term outcome. METHODS A search of the literature was conducted systematically to include original papers from 2010 to June 2021. The following parameters were taken into account: revision for aseptic loosening, revision for any reason, periprosthetic joint infections (PJI), KSS as well as KSFS. Studies with a mean follow-up of at least 60 months were defined to be long-term follow-up studies (LT). All other studies were included in the short-term (ST) study analysis. A pooled incidence was used as a summary statistic using a random intercept logistic regression model. RESULTS The present meta-analysis included 43 publications with 3008 rTKA. Of these, 23 publications with 1911 cases were allocated to the sleeve group (SG) and 20 papers with 1097 cases to the cone group (CG). CG showed overall numerically higher complication rates in short- and long-term follow-up, compared with SG. Aseptic loosening occurred at a rate of 0.4% in SG (LT) and 4.1% in CG (LT) (p = 0.09). Periprosthetic joint infection (PJI) was more frequent in the cone group (7% in ST and 11.7% in LT) than in the sleeve group (3.4% in ST and 4.9% in LT, p = 0.02 both). The total revision rate was 5.5% in SG (LT) and 14.4% in CG (LT) (p = 0.12). The clinical scores were also comparable between the two groups. Hinged prothesis were used more frequent in the cone group (ST p < 0.001; LT p = 0.10), whereas CC type protheses were used more frequently in the sleeve group (ST p < 0.001; LT p < 0.11). CONCLUSIONS This meta-analysis takes into account the longest follow-up periods covered to date. Both cones and sleeves represent a reliable fixation method in the case of severe bone loss in rTKA, although the higher rate of PJI after cone fixation remains a source of concern. A metaphyseal fixation of hinged implants should be taken into account. LEVEL OF EVIDENCE II (meta-analysis).
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Affiliation(s)
- Laura Theresa Fischer
- Orthopaedic Department Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany.
| | - Markus Heinecke
- Orthopaedic Department Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Eric Röhner
- Orthopaedic Department Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Peter Schlattmann
- Department of Medical Statistics, Informatics and Data Science, Jena University Hospital Jena, Bach Str. 18, 07743, Jena, Germany
| | - Georg Matziolis
- Orthopaedic Department Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
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Maslaris A, Brinkmann O, Lindemann C, Layher F, Pateronis K, Liodakis E, Zippelius T, Matziolis G, Bungartz M. Reliability analysis of CT torsion assessment after closed cephalomedullary nailing of trochanteric femoral fractures. A comparison study of six established methods. J Orthop Sci 2022; 27:146-152. [PMID: 33309404 DOI: 10.1016/j.jos.2020.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/11/2020] [Accepted: 10/31/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Posttraumatic maltorsion and implant failure after closed reduction of proximal femoral fractures remain a cause of concern. Although the reproducibility of torsion measuring techniques on CT for femoral shaft fractures has been thoroughly analyzed, little is known about the trochanteric fractures. Apart from the well-known CT limitations, posttraumatic alteration of bony landmarks makes torsional assessment even more challenging. Main goal of this study was to examine the reliability of different CT techniques on trochanteric femoral fractures after closed nail fixation. Secondary goal was to see whether the measurements within the examined population were influenced by the fracture type and patient age or BMI. METHODS 20 cases (AO.31-A1 or -A2) were retrospectively examined. Six established CT techniques for torsional assessment were performed from three different investigators twice at different time points. The intraclass correlation coefficient (ICC for 95% CI) was used to analyze the interobserver and intraobserver reliability. RESULTS The Hernandez method (0.986) followed by the Jend method (0.982) by a mean difference of <1° showed the highest reliability. Although increasing fracture complexity from A1 to A2 led to an overall worsening of the measurement precision, the Hernandez and Jend techniques revealed a very good consistency. Within the examined population, age and BMI had no impact on the precision of the measurements. CONCLUSIONS The Hernandez and Jend methods represent reliable alternatives for torsional assessment of trochanteric femur fractures treated with closed nail fixation when compared to the other measurement techniques here involved. Documentation of the torsion measuring method used in each case constitutes an essential element of the radiological reports.
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Affiliation(s)
- Alexander Maslaris
- Department of Orthopaedics, Friedrich-Schiller-University of Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, D-07607, Eisenberg, Germany; Department of Orthopaedics and Trauma Surgery, Alfried Krupp Hospital, Campus Rüttenscheid, Essen, Germany.
| | - Olaf Brinkmann
- Department of Orthopaedics, Friedrich-Schiller-University of Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, D-07607, Eisenberg, Germany.
| | - Chris Lindemann
- Department of Orthopaedics, Friedrich-Schiller-University of Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, D-07607, Eisenberg, Germany.
| | - Frank Layher
- Department of Orthopaedics, Friedrich-Schiller-University of Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, D-07607, Eisenberg, Germany.
| | - Konstantinos Pateronis
- Department of Ophthalmology, Friedrich-Schiller-University of Jena, Am Klinikum 1, D-07747, Jena, Germany.
| | - Emmanouil Liodakis
- Trauma Department, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany.
| | - Timo Zippelius
- Department of Orthopaedics, Friedrich-Schiller-University of Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, D-07607, Eisenberg, Germany.
| | - Georg Matziolis
- Department of Orthopaedics, Friedrich-Schiller-University of Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, D-07607, Eisenberg, Germany.
| | - Matthias Bungartz
- Department of Orthopaedics, Friedrich-Schiller-University of Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, D-07607, Eisenberg, Germany.
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Rohe S, Röhner E, Windisch C, Matziolis G, Brodt S, Böhle S. Sex Differences in Serum C-Reactive Protein Course after Total Hip Arthroplasty. Clin Orthop Surg 2022; 14:48-55. [PMID: 35251541 PMCID: PMC8858890 DOI: 10.4055/cios21110] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/26/2021] [Accepted: 09/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background Gender-specific medicine has become an important part in investigating the course of various diseases. C-reactive protein (CRP) is used as an inflammatory marker for detecting inflammations and even infections after total hip arthroplasty (THA). The general course of CRP after THA is well known, but there is controversy about its association with sex. Therefore, we aimed to investigate if there is an influence of sex on the CRP after THA in the first 10 days after operation in a complication-free course in male and female patients and to re-evaluate the specific postoperative CRP course with its maximum on the second to third postoperative days. Methods We retrospectively reviewed patients who had been treated with THA due to primary osteoarthritis through the same approach using an equal model of a cementless stem and a cup and complication-free between 2013 and 2016. Patients with active inflammation, rheumatoid arthritis, secondary arthrosis, active cancer disease, and documented postoperative complications were not included. The CRP values before THA and up to 10 days after THA were recorded and tested for sex discrepancy. Factor analyses were performed, and CRP values were adjusted for confounders (age, operation time, diabetes mellitus, and body mass index [BMI]). Results A total of 1,255 patients (728 women and 527 men) were finally analyzed. Men were younger and had a longer operation time and a higher BMI compared to women. The prevalence of overweight was higher in men, while obesity (BMI > 40 kg/m2), diabetes mellitus, renal failure, and American Society of Anaesthesiologists status showed no significant difference between men and women. Men had significantly higher CRP values than women between the 2nd and the 7th postoperative days, with the largest difference on the 4th postoperative day (men, 130.48 mg/L; women, 87.26 mg/L; p = 0.018). Conclusions Based on the results of more precise sex-specific evaluation of the postoperative CRP course after THA, the present study showed for the first time that there was a gender discrepancy in the CRP course after complication-free THA in the first 7 postoperative days. Furthermore, this study confirmed the postoperative CRP course with its maximum on the third postoperative day.
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Affiliation(s)
- Sebastian Rohe
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | - Eric Röhner
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | | | - Georg Matziolis
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | - Steffen Brodt
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | - Sabrina Böhle
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
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Hertling S, Loos F, Matziolis G, Kirschner I, Graul I. [The influence of occupational activity on diseases of the musculoskeletal system of the upper extremity]. Orthopade 2021; 51:669-676. [PMID: 34939146 PMCID: PMC9352613 DOI: 10.1007/s00132-021-04199-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/03/2022]
Abstract
Einleitung Erkrankungen des Bewegungsapparates der oberen Extremität sind Grund für zunehmende krankheitsbedingte Fehlzeiten bei Erwerbspersonen. Zielsetzung Ziel dieser Studie ist es, den Einfluss der Berufsabhängigkeit auf die Entstehung von Erkrankungen des Bewegungsapparates der oberen Extremität zu untersuchen und neben berufsspezifischen Faktoren, gesundheitsbezogene Risiken darzustellen. Material und Methoden Es wurden 1070 Patienten eingeschlossen, bei denen zwischen 2016 und 2019 bei einer Läsion der Rotatorenmanschette (RM) eine operative RM-Rekonstruktion durchgeführt wurde. Die relevanten Daten wurden retrospektiv aus dem Krankenhausinformationssystem dokumentiert. Die Berufszweige der Patienten wurden nach der Klassifikation der Berufe 2010 (KldB 2010) eingeteilt und mit routinemäßig erfassten und anonymisierten, frei verfügbaren Daten (Statistisches Bundesamt, Bundesagentur für Arbeit) verglichen. Ergebnisse Von den 1070 Patienten waren 844 Patienten im arbeitsfähigen Alter. Die Altersstruktur der einzelnen Bereiche zeigten keine signifikanten Unterschiede. Anhand der Vergleiche der Patientendaten mit der Bevölkerung ergaben sich signifikant höhere RM-Erkrankungsraten in den Bereichen Land‑, Forst- und Tierwirtschaft sowie Gartenbau (p = 0,003); Bau, Architektur, Vermessung und Gebäudetechnik (p < 0,001); Verkehr, Logistik, Schutz und Sicherheit (p < 0,001) und Unternehmensorganisation, Buchhaltung, Recht und Verwaltung (p < 0,001). Ein signifikant reduziertes Risiko bestand in Naturwissenshaft, Geografie und Informatik (p = 0,015); kaufmännische Dienstleistungen, Warenhandel, Vertrieb, Hotel und Tourismus (p < 0,001); Gesundheit, Soziales, Lehre und Erziehung (p < 0,001). Schlussfolgerung Die Prävalenz von RM-Läsionen zeigt einen statistischen Zusammenhang zur ausgeführten Berufstätigkeit in Abhängigkeit von den Berufszweigen. Neben der Berufsabhängigkeit spielen geschlechtsspezifische Arbeitsfaktoren eine Rolle. Schulterschmerzen bei Erwerbstätigkeiten sollten differenzierter betrachtet werden. Dadurch sollen gezielt Präventivmaßnahmen eingeleitet werden können, um vorzubeugen.
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Affiliation(s)
- Stefan Hertling
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland. .,Waldkliniken Eisenberg, Deutsches Zentrum für Orthopädie, Campus Eisenberg, Universitätsklinikum Jena, Eisenberg, Deutschland. .,, Heinrich-Schütz-Straße 16, 07548, Gera, Deutschland.
| | - Franziska Loos
- Praxis für Orthopädie und Schulterchirurgie, 04177, Leipzig, Deutschland
| | - Georg Matziolis
- Waldkliniken Eisenberg, Deutsches Zentrum für Orthopädie, Campus Eisenberg, Universitätsklinikum Jena, Eisenberg, Deutschland
| | - Isabella Kirschner
- Waldkliniken Eisenberg, Deutsches Zentrum für Orthopädie, Campus Eisenberg, Universitätsklinikum Jena, Eisenberg, Deutschland
| | - Isabel Graul
- Waldkliniken Eisenberg, Deutsches Zentrum für Orthopädie, Campus Eisenberg, Universitätsklinikum Jena, Eisenberg, Deutschland.,Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
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Jacob B, Makarewicz O, Hartung A, Brodt S, Roehner E, Matziolis G. In vitro additive effects of dalbavancin and rifampicin against biofilm of Staphylococcus aureus. Sci Rep 2021; 11:23425. [PMID: 34873186 PMCID: PMC8648795 DOI: 10.1038/s41598-021-02709-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/08/2021] [Indexed: 02/04/2023] Open
Abstract
Dalbavancin is a novel glycopeptide antibiotic approved for the treatment of acute bacterial skin and skin structure infections (ABSSSIs). It is characterized by a potent activity against numerous Gram-positive pathogens, a long elimination half-life and a favorable safety profile. Most recently, its application for the treatment of periprosthetic joint infections (PJIs) was introduced. The aim of this study was to proof our hypothesis, that dalbavancin shows superior efficacy against staphylococcal biofilms on polyethylene (PE) disk devices compared with vancomycin and additive behavior in combination with rifampicin. Staphylococcus aureus biofilms were formed on PE disk devices for 96 h and subsequently treated with dalbavancin, vancomycin, rifampicin and dalbavancin-rifampicin combination at different concentrations. Quantification of antibacterial activity was determined by counting colony forming units (CFU/ml) after sonification of the PE, serial dilution of the bacterial suspension and plating on agar-plates. Biofilms were additionally life/dead-stained and visualized using fluorescence microscopy. Dalbavancin presented superior anti-biofilm activity compared to vancomycin. Additive effects of the combination dalbavancin and rifampicin were registered. Dalbavancin combined with rifampicin presents promising anti-biofilm activity characteristics in vitro. Further in vivo studies are necessary to establish recommendations for the general use of dalbavancin in the treatment of PJIs.
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Affiliation(s)
- Benjamin Jacob
- Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany.
| | - Oliwia Makarewicz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, 07747, Jena, Germany
| | - Anita Hartung
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, 07747, Jena, Germany
| | - Steffen Brodt
- Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Eric Roehner
- Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Georg Matziolis
- Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
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Layher F, Matziolis G, Kayhan LN, Bungartz M, Brinkmann O. Minimally Invasive Internal Fixation of Femoral Shaft Fractures-A Biomechanical Study with a Disruptive Technique. Life (Basel) 2021; 11:life11111254. [PMID: 34833130 PMCID: PMC8620013 DOI: 10.3390/life11111254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/24/2022] Open
Abstract
(1) Background: In polytrauma patients, femur fractures are usually stabilised by external fixation for damage control, later being treated with definitive plate or nail osteosynthesis. Screw/rod systems established in spinal surgery might be inserted for internal fixation, providing sufficient fracture stability that subsequent intervention is unnecessary. This was to be investigated biomechanically. (2) Methods: The unilaterally applied spinal internal fixator (IF) was subjected to load and deformation analysis on artificial femurs with 32-A3 fracture according to AO classification. Distance of screws to fracture and rod to cortical bone were analysed as parameters influenced surgically as stiffness and deformation of the treated fracture. In addition, the stability of another construct with a second screw/rod system was determined. The axial load in stance phase during walking was simulated. The results were compared against an established fixed-angle plate osteosynthesis (IP). (3) Results: There were no implant failures in the form of fractures, avulsions or deformations. All unilateral IF combinations were inferior to IP in terms of stability and stiffness. The bilateral construct with two screw/rod systems achieved biomechanical properties comparable to IP. 4) Conclusion: Biomechanically, a biplanar screw/rod system is suitable for definitive fracture stabilisation of the femur, despite a damage control approach.
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Affiliation(s)
- Frank Layher
- Orthopaedic Department Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, 07607 Eisenberg, Germany; (F.L.); (G.M.); (M.B.)
| | - Georg Matziolis
- Orthopaedic Department Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, 07607 Eisenberg, Germany; (F.L.); (G.M.); (M.B.)
| | - Leos N. Kayhan
- Schulthess Clinic, Lengghalde 2, 8008 Zürich, Switzerland;
| | - Matthias Bungartz
- Orthopaedic Department Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, 07607 Eisenberg, Germany; (F.L.); (G.M.); (M.B.)
| | - Olaf Brinkmann
- Orthopaedic Department Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, 07607 Eisenberg, Germany; (F.L.); (G.M.); (M.B.)
- Correspondence:
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Brodt S, Bischoff K, Schulze M, Nowack D, Roth A, Matziolis G. The use of acetabular screws in total hip arthroplasty and its influence on wear and periacetabular osteolysis in the long-term follow-up. Int Orthop 2021; 46:717-722. [PMID: 34581866 PMCID: PMC8930858 DOI: 10.1007/s00264-021-05219-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/13/2021] [Indexed: 11/25/2022]
Abstract
Purpose The cementless implantation of hip replacement cups may be performed with and without the additional use of acetabular screws. If the surgeon uses screws or not depends on variable factors. In general, the use of screws is intended to increase the primary stability of the cup. Whether screws increase the initial stability of the cup construct, or even reduce it in part, is the subject of considerable debate in the literature. It is also unclear whether the additional screws lead to increased wear or increased periacetabular osteolysis over the long-term course. Methods Two hundred eleven patients from a previous study with a minimum follow-up of 10.7 years were included. Of these, 68 patients with 82 total hip arthroplasties (THA) were given clinical and radiological follow-up examinations. Of these, 52 had been fitted without screws and 30 with screws. On the basis of radiographs, annual wear and osteolysis were quantified. The clinical results were recorded by means of VAS, HHS, and WOMAC scores. Results Significantly more periacetabular osteolysis was found if additive acetabular screws had been used. No difference was found in relation to the volumetric wear per year. Likewise, no difference was found with regard to the clinical scores. Conclusions The use of additive acetabular screws leads to increased osteolysis in the periacetabular bone stock. Insofar as the primary stability of the cementless cup construct allows it, no additional acetabular screws should be used. Supplementary Information The online version contains supplementary material available at 10.1007/s00264-021-05219-7.
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Affiliation(s)
- Steffen Brodt
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany.
| | - Kathleen Bischoff
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Marcel Schulze
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Dimitri Nowack
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Andreas Roth
- Department Endoprosthesis/Orthopedics, Clinic of Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Georg Matziolis
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
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Mastrocola M, Matziolis G, Böhle S, Lindemann C, Schlattmann P, Eijer H. Meta-analysis of the efficacy of preoperative skin preparation with alcoholic chlorhexidine compared to povidone iodine in orthopedic surgery. Sci Rep 2021; 11:18634. [PMID: 34545135 PMCID: PMC8452611 DOI: 10.1038/s41598-021-97838-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/25/2021] [Indexed: 01/02/2023] Open
Abstract
Preoperative skin preparation is an effective method to prevent surgical site infections (SSI). Alcoholic chlorhexidine (CHG) and povidone iodine (PV-I) are the most widely used antiseptic agents. This meta-analysis aims to determine their efficacy in reducing natural bacterial skin flora in clean orthopedic surgery. A systematic search was conducted through current literature up to June 2021 to identify clinical randomized trials that compared the efficacy of alcoholic chlorhexidine and povidone iodine in reducing bacterial skin colonization after preoperative skin preparation. A meta-analysis was conducted. Of 235 screened articles, 8 randomized controlled trials were included. The results of the meta-analysis demonstrate a significantly lower positive culture rate in the chlorhexidine group than in the povidone iodine group (RR = 0.53, 95% Cl: 0.32-0.88). The present data show the superiority of chlorhexidine in reducing the normal bacterial flora compared to povidone iodine in clean orthopedic surgery.
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Affiliation(s)
- Mario Mastrocola
- Department of Orthopaedic Surgery, Spital Emmental, Oberburgstrasse 54, 3400, Burgdorf, Switzerland
| | - Georg Matziolis
- Orthopaedic Department, Campus Eisenberg, Jena University Hospital, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany.
| | - Sabrina Böhle
- Orthopaedic Department, Campus Eisenberg, Jena University Hospital, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Chris Lindemann
- Orthopaedic Department, Campus Eisenberg, Jena University Hospital, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Peter Schlattmann
- Department of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Bachstr. 18, 07743, Jena, Germany
| | - Henk Eijer
- Department of Orthopaedic Surgery, Spital Emmental, Oberburgstrasse 54, 3400, Burgdorf, Switzerland
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Brodt S, Jacob B, Nowack D, Zippelius T, Strube P, Matziolis G. An Isoelastic Monoblock Cup Retains More Acetabular and Femoral Bone Than a Modular Press-Fit Cup: A Prospective Randomized Controlled Trial. J Bone Joint Surg Am 2021; 103:992-999. [PMID: 33617161 DOI: 10.2106/jbjs.19.00787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND For cup revision after total hip arthroplasty, sufficiently good periacetabular bone stock is a prerequisite for fixation of the revision implant. Cementless cups can lead to a relevant reduction of peri-implant bone mineral density (BMD) through stress-shielding. METHODS Fifty patients were included in this prospective randomized controlled trial. Group 1 (RM group) received an isoelastic monoblock cup (RM Pressfit vitamys; Mathys). Group 2 (IT group) received a modular titanium cup (Allofit-S IT Alloclassic with a polyethylene liner; Zimmer). Periacetabular BMD was determined and subdivided into 4 regions of interest by dual x-ray absorptiometry at 1 week (baseline) and at 4 years postoperatively. Our primary outcome was reduction in periacetabular BMD. RESULTS Periacetabular BMD was reduced by an average of 15.1% in the RM group and 16.5% in the IT group at 4 years postoperatively. No significant difference was found between the 2 groups over the periacetabular structure as a whole. However, the decrease of BMD in the polar region was significantly different in the RM group (4.9% ± 10.0%) compared with the IT group (15.9% ± 14.9%, p = 0.005). Use of the isoelastic RM cup showed significantly less bone loss than the modular IT cup. CONCLUSIONS Relevant loss of BMD at 4 years after surgery was identified in the periacetabular region in both groups. No differences between the 2 cup systems were found when looking at the overall periacetabular region. As a secondary outcome, less postoperative periacetabular bone loss occurred in the polar region when an isoelastic cup was used. Longer follow-up is required to allow for conclusions to be drawn about the long-term course of the 2 cup systems. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Steffen Brodt
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Germany
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Röhner E, Mayfarth A, Sternitzke C, Layher F, Scheidig A, Groß HM, Matziolis G, Böhle S, Sander K. Mobile Robot-Based Gait Training after Total Hip Arthroplasty (THA) Improves Walking in Biomechanical Gait Analysis. J Clin Med 2021; 10:jcm10112416. [PMID: 34072524 PMCID: PMC8198188 DOI: 10.3390/jcm10112416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/27/2021] [Indexed: 12/15/2022] Open
Abstract
There are multiple attempts to decrease costs in the healthcare system while maintaining a high treatment quality. Digital therapies receive increasing attention in clinical practice, mainly relating to home-based exercises supported by mobile devices, eventually in combination with wearable sensors. The aim of this study was to determine if patients following total hip arthroplasty (THA) could benefit from gait training on crutches conducted by a mobile robot in a clinical setting. METHOD This clinical trial was conducted with 30 patients following total hip arthroplasty. Fifteen patients received the conventional physiotherapy program in the clinic (including 5 min of gait training supported by a physiotherapist). The intervention group of 15 patients passed the same standard physiotherapy program, but the 5-min gait training supported by a physiotherapist was replaced by 2 × 5 min of gait training conducted by the robot. Length of stay of the patients was set to five days. Biomechanical gait parameters of the patients were assessed pre-surgery and upon patient discharge. RESULTS While before surgery no significant difference in gait parameters was existent, patients from the intervention group showed a significant higher absolute walking speed (0.83 vs. 0.65 m/s, p = 0.029), higher relative walking speed (0.2 vs. 0.16 m/s, p = 0.043) or shorter relative cycle time (3.35 vs. 3.68 s, p = 0.041) than the patients from the control group. CONCLUSION The significant higher walking speed of patients indicates that such robot-based gait training on crutches may shorten length of stay (LOS) in acute clinics. However, the number of patients involved was rather small, thus calling for further studies.
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Affiliation(s)
- Eric Röhner
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (F.L.); (G.M.); (S.B.); (K.S.)
- Correspondence: ; Tel.: +49-36691-8-1254; Fax: +49-36691-8-1807
| | - Anke Mayfarth
- Tediro GmbH, Ehrenbergstr. 11, 98693 Ilmenau, Germany; (A.M.); (C.S.)
| | | | - Frank Layher
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (F.L.); (G.M.); (S.B.); (K.S.)
| | - Andrea Scheidig
- TU Ilmenau, Neuroinformatics and Cognitive Robotics Lab, PF 100565, 98684 Ilmenau, Germany; (A.S.); (H.-M.G.)
| | - Horst-Michael Groß
- TU Ilmenau, Neuroinformatics and Cognitive Robotics Lab, PF 100565, 98684 Ilmenau, Germany; (A.S.); (H.-M.G.)
| | - Georg Matziolis
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (F.L.); (G.M.); (S.B.); (K.S.)
| | - Sabrina Böhle
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (F.L.); (G.M.); (S.B.); (K.S.)
| | - Klaus Sander
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (F.L.); (G.M.); (S.B.); (K.S.)
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Rohe S, Brodt S, Windisch C, Matziolis G, Böhle S. [Patient safety during endoprosthetic training : Does the training of surgeons in primary hip arthroplasty at certified endoprosthesis centres lead to increased complications?]. Orthopade 2021; 51:52-60. [PMID: 33929552 PMCID: PMC8766393 DOI: 10.1007/s00132-021-04110-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 11/30/2022]
Abstract
Hintergrund Ziel der Studie war die Untersuchung, ob sich das perioperative Outcome und operationsspezifische Prozessgrößen bei Patienten mit Hüftgelenksersatz signifikant verschlechtern, wenn die Operation durch einen unerfahrenen Operateur, assistiert durch einen erfahrenen Operateur, im Kontext eines zertifizierten Endoprothesenzentrums durchgeführt wird. Material und Methoden Es wurden 1480 Patienten eingeschlossen, die zwischen 2013 und 2016 bei primärer Koxarthrose mit einer primären zementfreien Hüfttotalendoprothese (HTEP) versorgt wurden. Die relevanten Daten wurden retrospektiv aus dem Krankenhausinformationssystem, dem Entlassungsbrief und aus dem EndoCert-Bogen dokumentiert. Die Operateure wurden nach ihrer Qualifikation in erfahrene (Senior, > 50 HTEP pro Jahr) und unerfahrene Operateure (Junior, < 50 HTEP pro Jahr) unterteilt. Anschließend erfolgte der Vergleich der erhobenen Daten anhand dieser Unterteilung. Resultate Es zeigte sich bei unerfahrenen Operateuren eine signifikante Verlängerung der Operationsdauer um 20,7 min (Senior 62,6 ± 20,4 min; Junior 83,3 ± 19,5 min; p ≤ 0,001), der Krankenhausverweildauer um 0,25 Tage (Senior 8,8 ± 0,9 d; Junior 9,0 ± 0,9 d; p ≤ 0,001) und eine Erhöhung der Transfusionshäufigkeit von Erythrozytenkonzentraten (Senior 0,6 ± 1,1 Stk.; Junior 0,9 ± 1,4 Stk.; p ≤ 0,001). Dagegen zeigte sich kein Unterschied bei perioperativen Komplikationen (p = 0,682) und beim perioperativen Blutverlust (Senior 1,3 ± 0,5 l; Junior 1,3 ± 0,5 l; p = 0,097). Zwischen Operationsdauer und Blutverlust bestand allerdings eine positive Korrelation (Senior r = 0,183; Junior r = 0,214; jeweils p ≤ 0,01). Schlussfolgerung Die Ausbildung von unerfahrenen Operateuren an einem zertifizierten Endoprothesenzentrum führt bei Assistenz durch erfahrene Operateure nicht zur Reduktion der Patientensicherheit mit vermehrten Komplikationen. Aufgrund der Operationszeitverlängerung kommt es allerdings zu einer Mehrbelastung der Kliniken im Wettbewerb mit nichtausbildenden Kliniken, die nicht im DRG-System abgebildet ist.
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Affiliation(s)
- S Rohe
- Waldklinken Eisenberg, Campus für Orthopädie, Medizinische Fakultät, Friedrich-Schiller-Universität Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Deutschland.
| | - S Brodt
- Waldklinken Eisenberg, Campus für Orthopädie, Medizinische Fakultät, Friedrich-Schiller-Universität Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Deutschland
| | - C Windisch
- Abteilung für Orthopädie und Unfallchirurgie, Helios Klinikum Blankenhain, Wirthstr. 5, 99444, Blankenhain, Deutschland
| | - G Matziolis
- Waldklinken Eisenberg, Campus für Orthopädie, Medizinische Fakultät, Friedrich-Schiller-Universität Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Deutschland
| | - S Böhle
- Waldklinken Eisenberg, Campus für Orthopädie, Medizinische Fakultät, Friedrich-Schiller-Universität Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Deutschland
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Böhle S, Röhner E, Zippelius T, Jacob B, Matziolis G, Rohe S. Cytotoxic effect of sodium hypochlorite (Lavanox 0.08%) and chlorhexidine gluconate (Irrisept 0.05%) on human osteoblasts. Eur J Orthop Surg Traumatol 2021; 32:81-89. [PMID: 33738603 PMCID: PMC8741695 DOI: 10.1007/s00590-021-02907-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/08/2021] [Indexed: 11/30/2022]
Abstract
Purpose Soft tissue, bone and joint infections are severe complications in orthopedic and traumatological surgery. Lavanox (0.08% NaOCl) and Irrisept (0.05% chlorhexidine gluconate, CHG) are industrially produced antiseptic solutions commonly used in infection treatment. Regarding this clinical indication, the microbicidal effect is often investigated, but toxicity to osteoblasts has rarely been examined. This is important to decide whether these solutions should be used in septic situations in which bone healing must take place. The hypothesis of the present study is that NaOCl and CHG are cytotoxic to osteoblasts even after a short exposure time. Methods Human osteoblasts were isolated from donors with osteoarthritis during total knee and hip arthroplasty. Cells were cultivated and treated with both antiseptic solutions for 2, 5 and 10 min in different dilutions. Toxicity was quantified by counting cells, lactate dehydrogenase (LDH) expression, spectrophotometric quantification via XTT assay and FDA/PI fluorescence microscopy. Results Analyzing viable cells after treatment with both antiseptics showed a significant decrease in viable cells through LDH expression test, XTT assay, fluorescence microscopy and light microscopy, depending on concentration. The time dependence showed a trend to more cell death at longer exposure times, without significance. Conclusion Toxic effects on osteoblasts were shown after treatment with 0.08% NaOCl and 0.05% CHG after an exposure time of 2 min which also was concentration dependent. There was no difference in cytotoxicity between both antiseptics. In conclusion, these antiseptic solutions may be used with caution in situations requiring bone healing. Trial registration number Local ethics committee registration number: 5176–07/16 Supplementary Information The online version contains supplementary material available at 10.1007/s00590-021-02907-3.
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Affiliation(s)
- Sabrina Böhle
- Orthopedic Department of the Waldkliniken Eisenberg, Orthopedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany.
| | - Eric Röhner
- Orthopedic Department of the Waldkliniken Eisenberg, Orthopedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Timo Zippelius
- Orthopedic Department of the Waldkliniken Eisenberg, Orthopedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Benjamin Jacob
- Orthopedic Department of the Waldkliniken Eisenberg, Orthopedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Georg Matziolis
- Orthopedic Department of the Waldkliniken Eisenberg, Orthopedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Sebastian Rohe
- Orthopedic Department of the Waldkliniken Eisenberg, Orthopedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
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Abstract
INTRODUCTION Vancomycin powder (VP) is a well-established topical antibiotic used in spinal surgery to prevent surgical site infections. More recently its extension to hip and knee arthroplasty was introduced. The aim of this study was to examine toxic effects of VP on the viability of human chondrocytes. Our hypothesis was that VP damages human chondrocytes in vitro with increasing concentration and length of exposure. MATERIAL AND METHODS Primary human chondrocytes were isolated and cultured from donated human knee joints. VP was added to these cultures with increasing concentrations (0-50 mg/ml) and length of exposure (0-336 h). Toxicity and viability were analyzed using LDH und XTT Elisa assays. Cell structure and determination of vital versus dead cells were visualized using light microscopy and fluorescence microscopy. RESULTS Light microscopy and fluorescence microscopy visualized defect cell structures and cell death proportional to increasing dose and length of exposure to VP. The analysis of LDH activity data showed toxic effects on chondrocytes as early as 2,5 min after exposure to VP. XTT activity data revealed a significant toxic threshold of a VP concentration above 12.5 mg/ml. CONCLUSIONS These results show that exposure to high VP concentrations yields to a damage of human chondrocytes in vitro. Chondrotoxicity is an immediate effect that is proportional to VP concentration. Therefore, the intraarticular use of high concentrations of vancomycin powder in the presence of native cartilage tissue must be considered critically.
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Affiliation(s)
- Eric Röhner
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany.
| | - Timo Zippelius
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Sabrina Böhle
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Sebastion Rohe
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Georg Matziolis
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Benjamin Jacob
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
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Beckmann J, Hirschmann MT, Matziolis G, Holz J, V Eisenhart-Rothe R, Becher C. [Recommendations for unicondylar knee replacement in the course of time : A current inventory]. Orthopade 2021; 50:104-111. [PMID: 33346867 DOI: 10.1007/s00132-020-04054-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND A higher patient satisfaction stands in contrast to higher revision rates of unicondylar knee joint endoprosthetics (UKE) compared to total knee joint endoprosthetics (TKE). Furthermore, old "dogmas" regarding indications and contraindications persist, which is still reflected in the significantly different case numbers. AIM The aim of this article is to provide an overview of the current literature regarding 1. indication and contraindication (BMI, age, sport, arthrosis of other compartments, ligament status) and 2. the "eternal rival" fixed or mobile bearing for UKE. RESULTS The choice of the right patient remains essential, even if all the old "dogmas" of contraindications have been relativized or even outdated. Arthroses of the contralateral (in medial UKE correspondingly lateral) compartment and advanced arthroses of the lateral patella facet remain the only persistent contraindications. In contrast, a high BMI, age, chondrocalcinosis, medial patella facet and a defective (but particularly functionally stable) ACL are not contraindications; however, severe obesity is responsible for a significantly higher complication rate and probably a higher rate of loosening. Rather, the experience and thus the number of UKEs of the individual surgeon is decisive for the outcome, to which the discussion about mobile or fixed inlays must also be completely subordinated. CONCLUSION The indications for UKE can, therefore, be extended with a clear conscience on the basis of literature, and the current 1:10 UKE:TKE ratio in Germany can be shifted significantly.
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Affiliation(s)
- J Beckmann
- Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland.
| | | | - G Matziolis
- Waldkliniken Eisenberg, Eisenberg, Deutschland
| | - J Holz
- OrthoCentrum Hamburg, Hamburg, Deutschland
| | - R V Eisenhart-Rothe
- Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - C Becher
- IZO - Internationales Zentrum für Orthopädie, ATOS Klinik Heidelberg, Heidelberg, Deutschland
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Guo S, Silge A, Bae H, Tolstik T, Meyer T, Matziolis G, Schmitt M, Popp J, Bocklitz T. FLIM data analysis based on Laguerre polynomial decomposition and machine-learning. J Biomed Opt 2021; 26:JBO-200186SSR. [PMID: 33415850 PMCID: PMC7790506 DOI: 10.1117/1.jbo.26.2.022909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/11/2020] [Indexed: 05/03/2023]
Abstract
SIGNIFICANCE The potential of fluorescence lifetime imaging microscopy (FLIM) is recently being recognized, especially in biological studies. However, FLIM does not directly measure the lifetimes, rather it records the fluorescence decay traces. The lifetimes and/or abundances have to be estimated from these traces during the phase of data processing. To precisely estimate these parameters is challenging and requires a well-designed computer program. Conventionally employed methods, which are based on curve fitting, are computationally expensive and limited in performance especially for highly noisy FLIM data. The graphical analysis, while free of fit, requires calibration samples for a quantitative analysis. AIM We propose to extract the lifetimes and abundances directly from the decay traces through machine learning (ML). APPROACH The ML-based approach was verified with simulated testing data in which the lifetimes and abundances were known exactly. Thereafter, we compared its performance with the commercial software SPCImage based on datasets measured from biological samples on a time-correlated single photon counting system. We reconstructed the decay traces using the lifetime and abundance values estimated by ML and SPCImage methods and utilized the root-mean-squared-error (RMSE) as marker. RESULTS The RMSE, which represents the difference between the reconstructed and measured decay traces, was observed to be lower for ML than for SPCImage. In addition, we could demonstrate with a three-component analysis the high potential and flexibility of the ML method to deal with more than two lifetime components. CONCLUSIONS The ML-based approach shows great performance in FLIM data analysis.
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Affiliation(s)
- Shuxia Guo
- University of Jena, Institute of Physical Chemistry, Abbe Center of Photonics, Jena, Germany
- Leibniz Institute of Photonic Technology, Member of Leibniz Health Technologies, Jena, Germany
| | - Anja Silge
- University of Jena, Institute of Physical Chemistry, Abbe Center of Photonics, Jena, Germany
- Leibniz Institute of Photonic Technology, Member of Leibniz Health Technologies, Jena, Germany
| | - Hyeonsoo Bae
- University of Jena, Institute of Physical Chemistry, Abbe Center of Photonics, Jena, Germany
- Leibniz Institute of Photonic Technology, Member of Leibniz Health Technologies, Jena, Germany
| | - Tatiana Tolstik
- University of Jena, Institute of Physical Chemistry, Abbe Center of Photonics, Jena, Germany
- Leibniz Institute of Photonic Technology, Member of Leibniz Health Technologies, Jena, Germany
| | - Tobias Meyer
- University of Jena, Institute of Physical Chemistry, Abbe Center of Photonics, Jena, Germany
- Leibniz Institute of Photonic Technology, Member of Leibniz Health Technologies, Jena, Germany
| | | | - Michael Schmitt
- University of Jena, Institute of Physical Chemistry, Abbe Center of Photonics, Jena, Germany
- Leibniz Institute of Photonic Technology, Member of Leibniz Health Technologies, Jena, Germany
| | - Jürgen Popp
- University of Jena, Institute of Physical Chemistry, Abbe Center of Photonics, Jena, Germany
- Leibniz Institute of Photonic Technology, Member of Leibniz Health Technologies, Jena, Germany
| | - Thomas Bocklitz
- University of Jena, Institute of Physical Chemistry, Abbe Center of Photonics, Jena, Germany
- Leibniz Institute of Photonic Technology, Member of Leibniz Health Technologies, Jena, Germany
- Address all correspondence to Thomas Bocklitz,
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Heinrich A, Reinhold M, Güttler FV, Matziolis G, Teichgräber UKM, Zippelius T, Strube P. MRI following scoliosis surgery? An analysis of implant heating, displacement, torque, and susceptibility artifacts. Eur Radiol 2020; 31:4298-4307. [PMID: 33277671 PMCID: PMC8128815 DOI: 10.1007/s00330-020-07546-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/21/2020] [Accepted: 11/19/2020] [Indexed: 12/01/2022]
Abstract
Objectives The implant constructs used in scoliosis surgery are often long with a high screw density. Therefore, it is generally believed that magnetic resonance imaging (MRI) should not be carried out after scoliosis surgery, with the result that computed tomography is often preferred despite the ionizing radiation involved. The objective of this study was to evaluate the MRI compatibility of long pedicle-screw-rod constructs at 1.5 T and 3 T using standardized methods of the American Society for Testing and Materials (ASTM). Methods Constructs between 130 and 430 mm long were systematically examined according to the ASTM standards F2182 (radio frequency–induced heating), F2119 (susceptibility artifacts), F2213 (magnetically induced torque), and F2052 (magnetically induced displacement force). Results The maximum heating in the magnetic field was 1.3 K. Heating was significantly influenced by magnetic field strength (p < 0.001), implant length (p = 0.048), and presence of cross-links (p = 0.001). The maximum artifact width for different lengths of the anatomically bent titanium rods with CoCr alloy ranged between 14.77 ± 2.93 mm (TSE) and 17.49 ± 1.82 mm (GRE) for 1.5 T and between 23.67 ± 2.39 mm (TSE) and 27.77 ± 2.37 mm (GRE) for 3 T. TiCP and TiAl showed the smallest and CoCr and CoCr Plus the largest artifact widths. The magnetically induced torque and displacement force were negligible. Conclusions MRI following scoliosis surgery with long implant constructs is safe with the patient in supine position. Although susceptibility artifacts can severely limit the diagnostic value, the examination of other regions is possible. Key Points • Large spinal implants are not necessarily a contraindication for MRI; MR conditional status can be examined according to the ASTM standards F2182, F2119, F2213, and F2052. • A metallic pedicle-screw-rod system could be reliably and safely examined in all combinations of length (130 to 430 mm), configuration, and material in a B0at 1.5 T and 3 T. • According to ASTM F2503, the examined pedicle-screw-rod system is MR conditional and especially the young patients can benefit from a non-ionizing radiation MRI examination.
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Affiliation(s)
- Andreas Heinrich
- Department of Radiology, Jena University Hospital - Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany.
| | - Maximilian Reinhold
- Department of Radiology, Jena University Hospital - Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
| | - Felix V Güttler
- Department of Radiology, Jena University Hospital - Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
| | - Georg Matziolis
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Ulf K-M Teichgräber
- Department of Radiology, Jena University Hospital - Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
| | - Timo Zippelius
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Patrick Strube
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
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Zippelius T, Bürger J, Schömig F, Putzier M, Matziolis G, Strube P. Clinical presentation and diagnosis of acute postoperative spinal implant infection (PSII). J Spine Surg 2020; 6:765-771. [PMID: 33447681 DOI: 10.21037/jss-20-587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Acute postoperative infections after surgical interventions on the spinal column are associated with prolonged treatment duration, poor patient outcomes, and a high socioeconomic burden. In the field of joint replacement, guidelines have been established with recommendations for the diagnosis and treatment of such complications, but in spinal surgery there are no definitions permitting distinction between early and late infections and no specific instructions for their management. Various factors increase the risk of acute postoperative infection, including blood transfusions, leakage of cerebrospinal fluid, urinary tract infection, injury of the dura mater, an American Society of Anesthesiologists (ASA) score >2, obesity, diabetes mellitus, and surgical revision. We suggest defining all infections occurring within the first 4 weeks after spinal surgery as early infections. The symptoms are pain at rest, on motion, and/or pressure pain, abnormal warmth, local erythema, circumscribed swelling of the wound, and newly occurring secretion. Together with laboratory parameters such as C-reactive protein (CRP) and leukocytes, a central role is played by imaging in the form of magnetic resonance imaging (MRI), although diagnosis can be hampered by the presence of postoperative fluid collections such as edema or hematoma or by artifacts from an implant. Once an infection has been confirmed, immediate wound revision with debridement and rinsing (sodium hypochlorite) is essential. Intraoperatively it may prove advantageous to use jet lavage and administer vancomycin. We recommend leaving the implant in place in cases of acute postoperative infection. Patients who are not conditional for surgery can first receive antibiotic suppression treatment before surgery at a later date. In such cases initial computed tomography (CT)-guided aspiration or drain insertion can take place.
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Affiliation(s)
- Timo Zippelius
- Orthopaedic Professorship of the University Hospital Jena, Orthopaedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | - Justus Bürger
- Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin, Germany
| | - Friederike Schömig
- Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin, Germany
| | - Michael Putzier
- Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin, Germany
| | - Georg Matziolis
- Orthopaedic Professorship of the University Hospital Jena, Orthopaedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | - Patrick Strube
- Orthopaedic Professorship of the University Hospital Jena, Orthopaedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
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Röhner E, Jacob B, Böhle S, Rohe S, Löffler B, Matziolis G, Zippelius T. Sodium hypochlorite is more effective than chlorhexidine for eradication of bacterial biofilm of staphylococci and Pseudomonas aeruginosa. Knee Surg Sports Traumatol Arthrosc 2020; 28:3912-3918. [PMID: 32034427 DOI: 10.1007/s00167-020-05887-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/24/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Periprosthetic infection is a common reason for surgical revision. Given the increasing resistance of bacteria to antibiotics (e.g., VRE, 4-MRGN) local antiseptic treatment is gaining in importance. However, no standard guideline-based treatment recommendation is yet available. The aim of this study was to investigate the effectiveness of sodium hypochlorite and chlorhexidine against bacterial biofilms. Furthermore, the toxicity of both antiseptics towards human chondrocytes was examined. METHODS Human chondrocytes were isolated, cultivated and treated with sodium hypochlorite and chlorhexidine. The viability of cultures was assessed by determination of cell count, XTT and MTT ELISAs, and fluorescent staining with propidium iodide. Bacterial strains of Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa were added to liquid media and incubated overnight. After determination of bacterial concentrations polyethylene (PE) devices were inoculated with bacteria for 48 h until biofilms formed. The devices were then washed, treated with antiseptics for 2 and 5 min and subsequently spread on agar plates. RESULTS Sodium hypochlorite is more effective than chlorhexidine in penetrating biofilms of S. aureus, S. epidermidis and P. aeruginosa. Both antiseptics are chondrotoxic, but sodium hypochlorite damages human chondrocytes less than chlorhexidine in vitro. CONCLUSIONS The findings confirm the effectiveness of sodium hypochlorite and chlorhexidine against bacterial biofilms. Both antiseptics can be recommended for the treatment of periprosthetic infections. The toxic effects of sodium hypochlorite and chlorhexidine towards chondrocytes may mean there is a risk of damage to cartilage tissue. LEVEL OF EVIDENCE Controlled experimental study.
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Affiliation(s)
- E Röhner
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany.
| | - B Jacob
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - S Böhle
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - S Rohe
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - B Löffler
- Institute of Medical Microbiology, Jena University Hospital, 07747, Jena, Germany
| | - G Matziolis
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - T Zippelius
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
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Zippelius T, Strube P, Matziolis G, Röhner E, Böhle S, Brodt S. Cone beam-navigated core decompression of bone marrow edema syndrome. Arch Orthop Trauma Surg 2020; 140:1603-1609. [PMID: 31960167 DOI: 10.1007/s00402-020-03339-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The aim of the study was to compare decompression of bone-marrow edema or osteonecrosis of the proximal femur by means of a cone beam-based imaging and navigation system (cone beam-navigated decompression, CBND) with decompression by the conventional technique of drilling using fluoroscopy (FD). MATERIALS AND METHODS The data of patients with bone-marrow edema syndrome treated between 2016 and 2018 by drilling of the proximal femur in CBND or FD technique were compared retrospectively. RESULTS Each treatment group included 20 patients. The mean operating time for CBND was 16.4 ± 5.8 min, compared with 29.1 ± 20.8 min for FD (p = 0.018). The lesion was definitely reached by CBND in 19/20 patients. Eighteen of the 20 patients in the CBND group reported that their pain decreased after the treatment, compared with 12/20 patients in the FD group (p = 0.065). The radiation dosage was significantly higher (p < 0.001) for CBND than for FD. CONCLUSION Decompression by CBND can be carried out safely and without complications. The advantages of CBND over FD are the minimally invasive access and the ability to address the affected area precisely with only one drilling maneuver. The high radiation dose of CBND can be reduced using low-dose protocols.
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Affiliation(s)
- Timo Zippelius
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany.
| | - Patrick Strube
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Georg Matziolis
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Eric Röhner
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Sabrina Böhle
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Steffen Brodt
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
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Butler Ransohoff C, Matziolis G, Eijer H. Calcium dobesilate (Doxium®) in bone marrow edema syndrome and suspected osteonecrosis of the hip joint - A case series. J Orthop 2020; 21:449-452. [PMID: 32982099 DOI: 10.1016/j.jor.2020.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/15/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022] Open
Abstract
Osteonecrosis of the femoral head is a disease that leads to gradual degeneration of the hip joint causing immobility and a devastating impairment of quality of life. Early stage disease is characterised by a bone marrow edema of the proximal femur, a sight it shares with bone marrow edema syndrome. Although total hip arthroplasty offers quick symptom relief and functionally appealing results the treatment remains challenging, with its particularly young patients and considering limited non-invasive treatment options. We treated 6 patients with bone marrow edema in MRI and suspected osteonecrosis of the hip joint with calcium dobesilate, a vasoactive agent used in the treatment of diabetic retinopathy. We could demonstrate rapid symptom relief and concomitant disease remission on control MRI in early stage disease without any adverse events. Patients at advanced stages benefited in terms of pain reduction, but the treatment failed to halt disease progression. To the best of our knowledge, this is the first report of the therapeutic administration of calcium dobesilate in patients with bone marrow edema syndrome or osteonecrosis of the hip joint.
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Affiliation(s)
| | - Georg Matziolis
- Orthopaedic Department of the Waldkliniken Eisenberg, Orthopaedic Professorship of the University Hospital Jena, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Henk Eijer
- Regionalspital Emmental, Orthopaedic Department, Oberburgstrasse 54, 3400, Burgdorf, Switzerland
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Midic D, Rinke J, Perner F, Müller V, Hinze A, Pester F, Landschulze J, Ernst J, Gruhn B, Matziolis G, Heidel FH, Hochhaus A, Ernst T. Prevalence and dynamics of clonal hematopoiesis caused by leukemia-associated mutations in elderly individuals without hematologic disorders. Leukemia 2020; 34:2198-2205. [PMID: 32457355 PMCID: PMC7387320 DOI: 10.1038/s41375-020-0869-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/29/2020] [Accepted: 05/11/2020] [Indexed: 12/18/2022]
Abstract
Clonal hematopoiesis is frequently observed in elderly people. To investigate the prevalence and dynamics of genetic alterations among healthy elderly individuals, a cohort of 50 people >80 years was genotyped for commonly mutated leukemia-associated genes by targeted deep next-generation sequencing. A total of 16 somatic mutations were identified in 13/50 (26%) individuals. Mutations occurred at low variant allele frequencies (median 11.7%) and remained virtually stable over 3 years without development of hematologic malignancies in affected individuals. With DNMT3A mutations most frequently detected, another cohort of 160 healthy people spanning all age groups was sequenced specifically for DNMT3A revealing an overall mutation rate of 6.2% (13/210) and an age-dependent increase of mutation prevalence. A significant difference (p = 0.017) in the DNMT3A expression pattern was detected between younger and healthy elderly people as determined by qRT-PCR. To evaluate the selection of clonal hematopoietic stem cells (HSCs), bone marrow of two healthy individuals with mutant DNMT3A was transplanted in a humanized mouse model. Xenografts displayed stable kinetics of DNMT3A mutations over 8 months. These findings indicate that the appearance of low-level clones with leukemia-associated mutations is a common age-associated phenomenon, but insufficient to initiate clonal selection and expansion without the additional influence of other factors.
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Affiliation(s)
- Danica Midic
- Abteilung Hämatologie und Internistische Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Jenny Rinke
- Abteilung Hämatologie und Internistische Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Florian Perner
- Abteilung Hämatologie und Internistische Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Violetta Müller
- Abteilung Hämatologie und Internistische Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Anna Hinze
- Abteilung Hämatologie und Internistische Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | | | | | - Jana Ernst
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Bernd Gruhn
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Georg Matziolis
- Orthopädische Klinik der Waldkliniken Eisenberg, Eisenberg, Germany
| | - Florian H Heidel
- Abteilung Hämatologie und Internistische Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
- Leibniz Institute on Aging, Fritz-Lipmann-Institute, Jena, Germany
| | - Andreas Hochhaus
- Abteilung Hämatologie und Internistische Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | - Thomas Ernst
- Abteilung Hämatologie und Internistische Onkologie, Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany.
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Röhner E, Böhle S, Matziolis G. [Implantation of a tantalum patella during revision surgery]. Oper Orthop Traumatol 2020; 32:359-366. [PMID: 32699995 DOI: 10.1007/s00064-020-00668-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/06/2019] [Accepted: 10/19/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The reconstruction or restoration of a functioning patella for active extension and flexion by implantation of a tantalum patella. In spite of larger osseous defects of the patella, the goal is to achieve sufficient extensor mechanism function. INDICATIONS Patients who have such a large bone defect in the area of the patella that implantation of a traditional patella replacement is not possible. In addition, patients with a peri-implant fracture of the patella can be treated with a tantalum patella and additional plate osteosynthesis. CONTRAINDICATIONS Absence of a cortical basic structure of the patella. Complete loss of the patella or the extensor mechanism. Periprosthetic infection. SURGICAL TECHNIQUE The patella is completely excised. Subsequently, the back surface of the patella is milled to anchor the tantalum structure as accurately as possible without cement. This is fixed circularly after desired positioning by means of nonresorbable suture. Finally, the polyethylene back surface replacement is cemented onto the back surface of the tantalum structure. POSTOPERATIVE MANAGEMENT The patients have a limitation of flexion of 0-0-90° at 20 kilogram partial weight bearing for 12 weeks after surgery. RESULTS A total of 10 patients who received a tantalum patella between 2013 and 2019 were retrospectively included. A tantalum patella was implanted in 9 patients with a large patellar defect. In one case a tantalum patella with additional plate osteosynthesis was implanted to treat a peri-implant fracture of the patella. Loosening of the tantalum patella was observed in 1 patient, while in another patient postoperative arthrofibrosis was observed. In 2 cases a postoperative superficial wound healing disorder was detected. Two patients had a persistent infection with subsequent complete explantation of the prosthesis.
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Affiliation(s)
- E Röhner
- Deutsches Zentrum für Orthopädie, Professur für Orthopädie des Universitätsklinikum Jena, Waldkliniken Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Deutschland.
| | - S Böhle
- Deutsches Zentrum für Orthopädie, Professur für Orthopädie des Universitätsklinikum Jena, Waldkliniken Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Deutschland
| | - G Matziolis
- Deutsches Zentrum für Orthopädie, Professur für Orthopädie des Universitätsklinikum Jena, Waldkliniken Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Deutschland
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