-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the value of a built-in physical strain trainer for the monitoring of partial weight bearing with an ankle-foot orthosis.
12 healthy volunteers were asked to perform three trials. Plantar peak pressure values from normal gait (trial one) were defined as 100% (baseline). The following trials were performed with the Vacoped® dynamic vacuum ankle orthosis worn in a neutral position with full weight bearing (trial two) and a restriction to 10% body weight (BW) (trial three), as monitored with an integrated physical strain trainer. Peak plantar pressure values were obtained using the pedar® X system.
Peak pressure values were statistically significantly reduced wearing the Vacoped® shoe with full weight bearing for the hindfoot to 68% of the baseline (normal gait) and for the midfoot and forefoot to 83% and 60%, respectively. Limited weight bearing with 10% BW as controlled by physical strain trainer further reduced plantar peak pressure values for the hindfoot to 19%, for the midfoot to 43% of the baseline and the forefoot to 22% of the baseline.
The Vacoped® vacuum ankle orthosis significantly reduces plantar peak pressure. The integrated physical strain trainer seems unsuitable to monitor a limitation to 10% BW adequately for the total foot. The concept of controlling partial weight bearing with the hindfoot-addressing device within the orthosis seems debatable but may be useful when the hindfoot in particular must be off-loaded.
International Orthopaedics 02/2012; 36(7):1411-5. · 2.03 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Limited weight bearing of the lower extremity is a commonly applied procedure in orthopaedic rehabilitation after reconstructive forefoot surgery, trauma surgery and joint replacement. The most frequent limitations are given as percentage of body weight (BW) and represent 10 or 50% BW. The extent of foot loading under these graduations of partial weight bearing has not yet been described in detail. The objective of this study was to investigate forces at the foot-sole interface, which occur under graduated limitations of weight bearing. Peak pressure, maximum force, pressure-time integral and force-time integral (Pedar Cable) were assessed for a total of three trials with 10 healthy individuals. The results from limited weight bearing with 10 or 50% BW as taught by an experienced physiotherapist with a bathroom scale were referred to results of a normal gait. The limitation of weight bearing to 10% BW was equal to a bisection of peak pressure and maximum force for the total foot. Halved BW left a remaining 82% of peak pressure and 59% of maximum force for the total foot. We concluded that weight-bearing limitations to 10 and 50% BW lead to discernible differences in foot loading and may be applied to graduate forces of the lower limb for rehabilitation purposes. Foot loading with partial weight bearing exerts the percentage of BW and should be monitored to avoid an exertion of strains on the lower limb.
International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation 09/2011; 34(3):261-4. · 0.36 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the use of a physical strain trainer for the monitoring of partial weight bearing.
Case series with healthy volunteers.
Orthopedic clinic.
Healthy volunteers (N=10) with no history of foot complaints.
Volunteers were taught to limit weight bearing to 10% body weight (BW) and 50% BW, monitored by a physical strain trainer.
The parameters peak pressure, maximum force, force-time integral, and pressure-time integral were assessed by dynamic pedobarography when volunteers walked with full BW (condition 1), 50% BW (condition 2), and 10% BW (condition 3).
With 10% BW (condition 3), forces with normative gait (condition 1) were statistically significantly reduced under the hindfoot where the physical strain trainer is placed. All pedobarographic parameters were, however, exceeded when the total foot was measured. A limitation to 10% BW with the physical strain trainer (condition 3) was equal to a bisection of peak pressure and maximum force for the total foot with normative gait (condition 1). Halved BW (condition 2) left a remaining mean 82% of peak pressure and mean 59% of maximum force from full BW (condition 1).
The concept of controlling partial weight bearing with the hindfoot-addressing device does not represent complete foot loading. Such devices may be preferably applied in cases when the hindfoot in particular must be off-loaded. Other training devices (eg, biofeedback soles) that monitor forces of the total foot have to be used to control partial weight bearing of the lower limb accurately.
Archives of physical medicine and rehabilitation 08/2011; 92(11):1847-51. · 2.18 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the effect of chondromodulin 1 on the phenotype of osteochondral progenitor cells in cartilage repair tissue.
Self-complementary adeno-associated virus (AAV) vectors carrying chondromodulin 1 complementary DNA (AAV-Chm-1) were applied to cartilage lesions in the knee joints of miniature pigs that were treated by the microfracture technique. Alternatively, isolated porcine osteochondral progenitor cells were infected with AAV-Chm-1 or with AAV-GFP control vectors ex vivo prior to being transplanted into cartilage lesions in which the subchondral bone plate was left intact. The quality of the repair tissue and the degree of endochondral ossification were assessed by histochemical and immunohistochemical methods. The effects of chondromodulin 1 overexpression were also analyzed by angiogenesis assays and quantitative reverse transcriptase-polymerase chain reaction.
AAV-Chm-1-infected cells efficiently produced chondromodulin 1, which had strong antiangiogenic effects, as verified by the inhibition of tube formation of endothelial cells. Gene expression analyses in vitro revealed the cell cycle inhibitor p21WAF1/Cip1 as one target up-regulated by AAV-Chm-1. Direct application of AAV-Chm-1 vectors into microfractured porcine cartilage lesions stimulated chondrogenic differentiation of ingrowing progenitor cells, but significantly inhibited terminal chondrocyte hypertrophy, the invasion of vessel structures, and excessive endochondral ossification, which were otherwise observed in untreated lesions. Indirect gene transfer, with infection of porcine osteochondral progenitor cells by AAV-Chm-1 ex vivo, also supported chondrogenic differentiation of these transplanted cells. AAV-Chm-1-infected cells maintained a chondrocyte-like phenotype and formed a hyaline-like matrix that was superior to that formed by uninfected or AAV-GFP-infected cells.
Our findings indicate that the antiangiogenic factor chondromodulin 1 stabilizes the chondrocyte phenotype by supporting chondrogenesis but inhibiting chondrocyte hypertrophy and endochondral ossification.
Arthritis & Rheumatism 03/2011; 63(9):2721-31. · 7.87 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: For uncemented hip arthroplasty, various cup designs are available. The threaded Weill acetabular component (Weill cup; Zimmer, Winterthur, Switzerland) has been used for more than 20 years, with poor results of the smooth threaded design. Our study was intended to assess the 17-year outcome of the rough-blasted option of the threaded Weill cup.
Between 1987 and 1988, a series of 86 rough-blasted threaded Weill cups were implanted in combination with the CLS Spotorno stem (Zimmer Ltd, Germany) The patients' mean age at the time of surgery was 50 years (range 19-67 years). 67 out of 86 hips (78%) were available for a follow-up at a mean of 17 years (range 16-18 years). Radiographs were available from 55 out of 63 unrevised hips (87%) and analyzed for radiolucency and PE wear.
Two out of 86 cups (3%) were revised due to aseptic loosening and another two cups (3%) were awaiting revision for the same reason. Ten patients (10 cups, 12%) were lost to follow-up, and nine patients with nine cups (11%) had deceased without radiographic signs of cup failure. Cup survival with "revision or awaiting revision" as endpoint was 86% (95% CI 75-92%). No deep infections occurred, and no polyethylene insert was exchanged. The Harris hip score was excellent in 37 out of 67 clinically examined hips (55%), good in 18 hips (26%), satisfactory in 5 hips (8%) and moderate or poor in 5 hips (8%) and 2 hips (3%), respectively.
The rough-blasted threaded Weill cup provides a good long-term performance in cementless total hip arthroplasty. The results compare favourably to the smooth threaded cup design.
Archives of Orthopaedic and Trauma Surgery 12/2010; 131(4):557-61. · 1.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the long-term outcome of combined arthroscopic and radiation synovectomy of the knee joint in early cases of rheumatoid arthritis (RA) with regard to knee function and the need for surgical re-interventions.
Between 1993 and 1997, a consecutive series of 38 RA patients with therapy-refractory synovitis of the knee joint and only mild cartilage lesions (not exceeding Outerbridge grade II at surgery) were treated with combined arthroscopic and radiation synovectomy. Knee function was assessed preoperatively; at 6 months, 1 year, and 5 years; and finally, at a mean of 14 years with 4 different functional scores. A Kaplan-Meier survival curve was calculated with "any re-intervention" and "total knee arthroplasty" as endpoints.
Of 38 knees, 32 were available for the final 14-year follow-up with a total of 22 re-interventions: intra-articular steroid injection (n = 3), arthroscopic (n = 2) or radiation (n = 1) re-synovectomy, and total knee arthroplasty (n = 16). The remaining 10 patients with no re-intervention showed knee function not significantly different from the postoperative state. With any surgical re-intervention as the endpoint, the survival rate was 84% at 5 years (95% confidence interval [CI], 67.0% to 86.7%), 44% at 10 years (95% CI, 26.7% to 60.0%), and 32% at the 14-year assessment (95% CI, 16.0% to 49.3%). With total knee arthroplasty as the endpoint, the joint survival rate was 88.5% at 5 years (95% CI, 68.5% to 96.2%), 53.9% at 10 years (95% CI, 33.3% to 71.6%), and 39.6% at 14 years (95% CI, 18.9% to 48.6%).
Combined arthroscopic and radiation synovectomy leads to a stable improvement of knee function for a minimum of 5 years, but surgical re-interventions were frequently observed at the 14-year assessment and challenge the long-term benefit of the procedure. Patients with no interventions had a significantly shorter history of disease (7 v 11 years).
Level IV, therapeutic case series.
Arthroscopy The Journal of Arthroscopic and Related Surgery 10/2010; 27(1):52-9. · 3.02 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: For primary uncemented hip arthroplasty, various stem designs are available. The cementless CLS((R)) Spotorno stem has been used for more than 20 years. We re-evaluated a group of patients previously examined for a 10-year follow-up to assess the clinical and radiological stem performance in the long run.
Between 1987 and 1988, a consecutive series of 107 uncemented CLS((R))-Spotorno stems (Zimmer Ltd., Germany) were implanted in 94 patients. The patients' mean age at the time of surgery was 51 years (range 20-77 years); 80 hips out of 107 (86%) were available for a clinical examination [Harris Hip Score (HHS)] after a mean of 17 years (range 15-18 years). In addition, radiographs were available from 74 out of 80 examined hips (92%) and analyzed for radiolucency, stress shielding, stem migration and heterotopic ossification.
Stable stem fixation was present in 64 hips (98.5%). With "non-traumatic loosening" as an endpoint, stem survival was 100% after 17 years. Two stems (3%) showed mild subsidence already in the 10-year follow-up with no progression after 17 years. The HHS described excellent results in 47 hips (59%), good results in 16 hips (20%) and fair or poor results in 7 hips (9%) and 10 hips (13%), respectively. Radiolucency and grades II and III stress shielding were progressive at 17 years compared with the 10-year results. Grade IV stress shielding associated with osteolysis was seen in 9 hips (14%). Thigh pain was present in 20 hips (25%).
The CLS((R)) Spotorno stem allows excellent long-term results in cementless hip arthroplasty, leaving only minimal options for substantial improvements. Our findings on progressive stress shielding point towards a more diaphyseal load transfer of the CLS stem.
Archives of Orthopaedic and Trauma Surgery 09/2009; 130(2):269-75. · 1.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: There is a lack of data on the functional effect of open hip synovectomy in a large number of patients with juvenile rheumatoid arthritis evaluated with a validated assessment tool.
Between 1985 and 1997, sixty-seven open hip-joint synovectomies were carried out in fifty-six patients with juvenile rheumatoid arthritis. Fifty-five hips (82%) had radiographic changes that were stage III or higher according to the system of Larsen et al. Hip function was evaluated preoperatively and after a mean of fifty months with the Merle d'Aubigné hip score.
Sixty-five (97%) of the sixty-seven hips were available for follow-up. The mean total Merle d'Aubigné hip score (and standard error of the mean) was significantly improved from 9.5 +/- 2.5 points at baseline to 16.3 +/- 1.0 points at the time of follow-up (p < 0.001). The individual scores for pain, mobility, and walking ability were significantly increased as well (all p < 0.001). Eighty-five percent of the hips were observed to have a very great or great improvement in function. A concomitant soft-tissue release was performed in seven hips, and nine hips required surgical dislocation. Surgical complications included two superficial wound hematomas that did not require intervention; osteonecrosis of the femoral head was not observed. Five hips required total hip arthroplasty during the follow-up period. Thus, the survival rate for the hips was 94% at a mean of four years following the synovectomy.
Open hip synovectomy in patients with juvenile rheumatoid arthritis is a safe procedure that can improve hip-joint function for up to five years.
The Journal of Bone and Joint Surgery 10/2007; 89(9):1986-92. · 3.27 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Either an extensor indicis transposition (EIT) or an intercalated free tendon graft (FTG) can be used for secondary reconstruction of the extensor pollicis longus (EPL) tendon. We reviewed 1469 cases of extensor tendons repaired between 1992 and 2003 and compared the results. In only 55 patients was an isolated secondary reconstruction of the EPL done. Forty-five patients (82%) were available for clinical follow-up after a mean of 4.3 (range 2-11) years (28 (62%) who had EIT and 17 (38%) who had FTG). Thumb function was assessed postoperatively using Geldmacher's criteria, and the uninjured thumb served as control. The comparison showed no significant differences between the procedures for the single variables evaluated, or for the injured and other (uninjured) thumb in either group. For isolated secondary reconstruction of the EPL tendon, both the extensor indicis transposition and a free autologous tendon graft successfully restore thumb function. Therefore, both surgical techniques can be considered equal alternatives.
Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery 02/2007; 41(1):33-5. · 0.94 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: After reconstructive forefoot surgery, patients require complete or partial forefoot relief, which can be obtained with a variety of shoe designs. The aim of this study was to evaluate the effectiveness of two different types of forefoot-relief shoes frequently used after surgery, especially their safety against unintentional forefoot load.
Ten healthy volunteers were asked to perform five trials on a treadmill at self-selected speeds. In the first trial, mean peak pressure values in mass-produced shoes and insoles were evaluated and considered as 100%. Two different shoe designs (short heel-short sole, ii: short heel-complete sole) were compared in two trials each with appropriate and inappropriate use (attempting to put weight on the forefoot) gait pattern. Plantar pressure values were obtained using the Pedar cable system (Novel Inc., Munich, Germany). For analysis, pedobarographic pictures were subdivided into midfoot (31% to 60% of the total insole length) and forefoot (61% to 100% of the total insole length). ANOVA was used for statistical analysis, and p values less than 0.01 were considered significant.
With the short-soled shoe, forefoot and midfoot relief was 100% in both compliant and in noncompliant use. With wearing a complete sole, compliant use led to a significant reduction (p < 0.01) of mean peak pressure under the forefoot (34 +/- 13% remaining) and midfoot (47 +/- 13% remaining). Noncompliant use of the complete-sole shoe produced mean peak pressure values significantly higher (p < 0.01) than normal gait in mass produced shoes under the forefoot, but not under the midfoot.
Forefoot-relief shoes are effective in reducing both mean and peak plantar pressures. Shoes with a nonsupported midfoot and forefoot may be safer with inappropriate use than shoes with a complete sole. The kind of forefoot shoe should be carefully chosen to regulate weightbearing after reconstructive forefoot surgery.
The Foot and Ankle Online Journal 02/2006; 27(2):117-20. · 1.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To assess the intraoperative reduction of inflammatory infiltrates achieved by arthroscopic knee joint synovectomy in patients with rheumatoid arthritis (RA) with special regard to the removal site, using preoperative and postoperative synovial tissue (ST) samples.
A histologic and immunohistochemical study.
Eleven patients with treatment-refractory RA knee synovitis underwent arthroscopic synovectomy. In each patient, ST specimens were obtained immediately before and after synovectomy from 9 defined sites covering the whole joint. The samples were graded using an acute synovitis score (ASS; presence of polymorphonuclear neutrophilic leukocytes [PMN] and fibrin) and a chronic synovitis score (CSS; e.g., lining cell hyperplasia, presence of diffuse and lymphoid aggregates). Immunohistologic analyses were performed using 7 monoclonal antibodies directed against PMN, macrophages, and T-cell subsets (total of 1,584 preparations). Knee function was assessed after an average follow-up of 28 months by Lysholm score (modified by Klein and Jensen), Insall functional and knee scores, and Lequesne score.
Arthroscopic synovectomy led to an overall significant (P between .005 and .05) reduction of the acute inflammatory infiltrates (ASS) by 82.1%, but to a significant reduction of chronic inflammatory infiltrates (CSS) by only 62.5%. Accordingly, the density of PMN was reduced by 81.8%, whereas that of macrophages and different T-cell subsets was only decreased by < or = 61.6%. With respect to the anatomic regions, a significantly (P < or = .05) less marked reduction of inflammatory infiltrates was observed in the upper lateral and central recess, at the medial and lateral capsule, as well as at the femoral insertion of the anterior cruciate ligament. All knee joint scores showed a significant (P < or = .01) improvement over preoperative values at follow-up.
Arthroscopic synovectomy effectively reduces acute and chronic inflammatory infiltrates in patients with RA who have refractory synovitis of the knee joint (immediately after synovectomy) and improves knee function (28-month follow-up). However, the reduction of inflammatory infiltrates appears to depend on the anatomic region of the joint.
Level III.
Arthroscopy The Journal of Arthroscopic and Related Surgery 11/2005; 21(10):1209-18. · 3.02 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Background: Perilunate dislocations are a rare but severe entity amongst wrist injuries. The treatment of choice in cases of chronic lunate dislocations is still under debate. Case Study: An unusual case of chronic palmar lunate dislocation is reported which could be documented over almost 30 years. Therapeutic Implications: Furthermore, the implications on current therapeutic concepts for the treatment of chronic palmar lunate dislocations are highlighted.
European Journal of Trauma 01/2003; 29(2):101-104.
-
[show abstract]
[hide abstract]
ABSTRACT: We describe a case of osteomyelitis due to Mycobacterium fortuitum after open tibial fracture. Extensive wound debridement, removal of the intramedullary nail and antibiotic therapy consisting of ofloxacin, roxythromycin and trimethoprim/sulfamethoxazole cured the infection. Moreover, the literature describing infections by atypical mycobacteria is reviewed, and common clinical characteristics as well as treatment options are displayed. Immunocompromised individuals are particularly threatened by wound infections due to atypical mycobacteria. Periprosthetic infections caused by atypical mycobacteria gain importance in postoperative care after trauma surgery.
European Journal of Trauma 04/2001; 27(2):92-95.
