-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND:Lumbar facet joint degeneration is a source of chronic low back pain, with an incidence of 15% to 45% among patients with low back pain. Various therapeutic techniques in the treatment of facet-related pain have been described in the literature, including intraarticular lumbar facet joint steroid injections and radiofrequency denervation. In this study, we compared the effectiveness of intraarticular facet joint steroid injections and radiofrequency denervation.METHODS:Our randomized, double-blind, controlled study included patients who received intraarticular steroid infiltrations in the lumbar facet joints (L3/L4-L5/S1) and patients who underwent radiofrequency denervation of L3/L4-L5/S1 segments. The inclusion criteria were based first on magnetic resonance imaging findings showing hypertrophy of the facet joints L3/L4-L5/S1 and a positive response to an intraarticular test infiltration of the facet joints L3/L4-L5/S1 with local anesthetics. The primary end point was the Roland-Morris Questionnaire. Secondary end points were the visual analog scale and the Oswestry Disability Index. All outcome assessments were performed at baseline and at 6 months.RESULTS:Fifty-six patients were randomized; 24 of 29 patients in the steroid injection group and 26 of 27 patients in the denervation group completed the 6-month follow-up. Pain relief and functional improvement were observed in both groups. There were no significant differences between the 2 groups for the primary end point (95% confidence interval [CI], -3 to 4) and for both secondary end points (95% CI for visual analog scale, -2 to 1; 95% CI for Oswestry Disability Index, -18 to 0).CONCLUSIONS:Intraarticular steroid infiltration or radiofrequency denervation appear to be a managing option for chronic function-limiting low back pain of facet origin with favorable short- and midterm results in terms of pain relief and function improvement, but improvements were similar in both groups.
Anesthesia and analgesia 04/2013; · 3.08 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Assessment of shoulder mobility is essential for diagnosis and clinical follow-up of shoulder diseases. Only a few highly sophisticated instruments for objective measurements of shoulder mobility are available. The recently introduced DynaPort MiniMod TriGyro ShoulderTest-System (DP) was validated earlier in laboratory trials. We aimed to assess the precision (repeatability) and agreement of this instrument in human subjects, as compared to the conventional goniometer. METHODS: The DP is a small, light-weight, three-dimensional gyroscope that can be fixed on the distal upper arm, recording shoulder abduction, flexion, and rotation. Twenty-one subjects (42 shoulders) were included for analysis. Two subsequent assessments of the same subject with a 30-minute delay in testing of each shoulder were performed with the DP in two directions (flexion and abduction), and simultaneously correlated with the measurements of a conventional goniometer. All assessments were performed by one observer. Repeatability for each method was determined and compared as the statistical variance between two repeated measurements. Agreement was illustrated by Bland-Altman-Plots with 95% limits of agreement. Statistical analysis was performed with a linear mixed regression model. Variance for repeated measurements by the same method was also estimated and compared with the likelihood-ratio test. RESULTS: Evaluation of abduction showed significantly better repeatability for the DP compared to the conventional goniometer (error variance: DP = 0.89, goniometer = 8.58, p = 0.025). No significant differences were found for flexion (DP = 1.52, goniometer = 5.94, p = 0.09). Agreement assessment was performed for flexion for mean differences of 0.27[degree sign] with 95% limit of agreement ranging from -7.97[degree sign] to 8.51[degree sign]. For abduction, the mean differences were 1.19[degree sign] with a 95% limit of agreement ranging from -9.07[degree sign] to 11.46[degree sign]. CONCLUSION: In summary, DP demonstrated a high precision even higher than the conventional goniometer. Agreement between both methods is acceptable, with possible deviations of up to greater than 10[degree sign]. Therefore, static measurements with DP are more precise than conventional goniometer measurements. These results are promising for routine clinical use of the DP.
BMC Musculoskeletal Disorders 02/2013; 14(1):72. · 1.58 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Purpose
The present study was designed to evaluate the penetration of diclofenac sodium 4 % spray gel in synovial tissue, synovial fluid and blood plasma after topical application in subjects with joint effusions and planned total knee arthroplasty (TKA) due to osteoarthritis.
Methods
A total of 39 patients were randomised to two- or three-times daily application of diclofenac sodium 4 % spray gel to knees requiring surgery over a treatment period of 3 days. Within 8 h after the last application, TKA was conducted, and the diclofenac concentrations in synovial tissue, synovial fluid and blood plasma were measured by liquid chromatography.
Results
The median diclofenac concentration was approximately 10–20-fold higher in synovial tissue (36.2 and 42.8 ng/g) than in synovial fluid (2.6 and 2.8 ng/mL) or plasma (3.9 and 4.1 ng/mL) in both treatment groups. Dose proportionality for any compartment or treatment groups could not be detected. Treatment-related adverse events were noted in two cases and limited to skin reactions.
Conclusion
Diclofenac sodium 4 % spray gel was found to penetrate the skin locally in substantial amounts and thus reach the desired target tissue. Concentrations were not dose-dependent, and application was well tolerated by 97.4 % of patients. Topical application of diclofenac should be considered a valuable alternative to systemic NSAID therapy in the initial treatment of osteoarthritis.
Knee Surgery Sports Traumatology Arthroscopy 01/2013; · 2.21 Impact Factor
-
Markus D Schofer,
Lisa Tünnermann,
Hendric Kaiser,
Philip P Roessler,
Christina Theisen,
Johannes T Heverhagen,
Jacqueline Hering,
Maximilian Voelker,
Seema Agarwal,
Turgay Efe, Susanne Fuchs-Winkelmann,
Jürgen R J Paletta
[show abstract]
[hide abstract]
ABSTRACT: The reconstruction of large bone defects after injury or tumor resection often requires the use of bone substitution. Artificial scaffolds based on synthetic biomaterials can overcome disadvantages of autologous bone grafts, like limited availability and donor side morbidity. Among them, scaffolds based on nanofibers offer great advantages. They mimic the extracellular matrix, can be used as a carrier for growth factors and allow the differentiation of human mesenchymal stem cells. Differentiation is triggered by a series of signaling processes, including integrin and bone morphogenetic protein (BMP), which act in a cooperative manner. The aim of this study was to analyze whether these processes can be remodeled in artificial poly-(l)-lactide acid (PLLA) based nanofiber scaffolds in vivo. Electrospun matrices composed of PLLA-collagen type I or BMP-2 incorporated PLLA-collagen type I were implanted in calvarial critical size defects in rats. Cranial CT-scans were taken 4, 8 and 12 weeks after implantation. Specimens obtained after euthanasia were processed for histology and immunostainings on osteocalcin, BMP-2 and Smad5. After implantation the scaffolds were inhomogeneously colonized and cells were only present in wrinkle- or channel-like structures. Ossification was detected only in focal areas of the scaffold. This was independent of whether BMP-2 was incorporated in the scaffold. However, cells that migrated into the scaffold showed an increased ratio of osteocalcin and Smad5 positive cells compared to empty defects. Furthermore, in case of BMP-2 incorporated PLLA-collagen type I scaffolds, 4 weeks after implantation approximately 40 % of the cells stained positive for BMP-2 indicating an autocrine process of the ingrown cells. These findings indicate that a cooperative effect between BMP-2 and collagen type I can be transferred to PLLA nanofibers and furthermore, that this effect is active in vivo. However, this had no effect on bone formation. The reason for this seems to be an unbalanced colonization of the scaffolds with cells, due to insufficient pore size.
Journal of Materials Science Materials in Medicine 06/2012; 23(9):2227-33. · 2.32 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Ultrasonography of the hip has gained wide acceptance as reliable method for diagnosing developmental hip dysplasia in infants. This blinded study was conducted to investigate the influence of two linear probes with different frequency on diagnostic accuracy and reproducibility. In 206 consecutive newborns, the bony roof angle (α-angle) and cartilage roof angle (β-angle) were assessed by three investigators according to Graf. The hips were measured twice both with a 7.5 MHz and a 12 MHz linear transducer (Sonoline G60S(®) ultrasound system; Siemens, Erlangen, Germany). Each investigator evaluated his sonograms 6 weeks later. Depending on the mean values for α-angle and β-angle, the hips were classified. Reproducibility of the Graf classification was not found to be influenced. In two of three investigators, we observed significant improvement concerning variation of the β-angle with the 12 MHz probe. The use of high-resolution transmitters may improve diagnostic accuracy in ultrasonography of the newborn's hip.
Ultrasound in medicine & biology 05/2012; 38(7):1116-20. · 2.02 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: PURPOSE: The aim of this study was to assess the reproducibility of using magnetic resonance imaging (MRI) to analyze the preserved anatomic knee compartments following unicondylar knee arthroplasty (UKA) with zirconium femoral components. It was hypothesized that evaluation of the cartilage, ligaments, meniscus, and tendons would result in a high rate of inter-observer reliability. SCOPE: Ten patients underwent MRI of the knee tailored to reduce metallic artifact following medial UKA with zirconium femoral implants. Cartilage, external meniscus, collateral and cruciate ligaments, the quadriceps and patellar tendons, and the presence of joint effusion were evaluated by two independent investigators. The reviewers provided degrees of confidence with their evaluation of each parameter through the use of a five-point scale. Inter-observer agreement was calculated and inter-observer reliability was determined by use of Cohen's Kappa. Artifacts originating from the implants were rarely observed. There was excellent inter-observer reliability (i.e., high Cohen's Kappa) for all assessed structures, and a high level of observer confidence for the evaluation of the cartilage, meniscus, tendons, ligaments, and joint effusion. CONCLUSION: In this study tailored MRI allows for reproducible analysis of the preserved knee joint compartment after UKA for zirconium implants. This technique might prove helpful in the assessment of painful knee joints after UKA with other metallic materials as new MRI software programs, which suppress metal artifacts, are developed.
The Knee 05/2012; · 1.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: STUDY DESIGN:: Immunohistological study. OBJECTIVE:: To elucidate the role of matrix metalloproteinases (MMPs), hypoxia-inducible factor-1α (HIF), and vascular endothelial growth factor (VEGF) in the hypertrophied ligamentum flavum (LF) obtained from patients with lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA:: The most common spinal disorder in the elderly is LSS, which results in part from LF hypertrophy. Although prior histologic and immunochemical studies have been performed in this area, the pathophysiology of loss of elasticity and hypertrophy is not completely understood. METHODS:: LF samples of 38 patients with LSS were harvested during spinal decompression. Twelve LF samples obtained from patients with disk herniation and no visible degeneration on preoperative magnetic resonance imaging were obtained as controls. Samples were dehydrated and paraffin embedded. For immunohistochemical determination of VEGF, HIF, and MMPs 1, 3, and 9 expression, slices were stained with VEGF, HIF, and MMP antibody dilution. Neovessel density and number of elastic fibers were counted after Masson-Goldner staining. LF hypertrophy and cross-sectional area (CSA) were measured on T1-weighted magnetic resonance imaging. RESULTS:: MMPs 1, 3, 9 and VEGF expression were significantly increased in the hypertrophy group (P<0.05). HIF expression was negative in both groups. Vessel density was increased in the hypertrophy group, although this was not statistically significant. The number of elastic fibres was significantly higher in the control group. In the hypertrophy group, LF thickness was significantly increased, whereas CSA was significantly decreased. There was a statistical correlation between LF thickness, CSA, MMP, and VEGF expression in the hypertrophy group (P<0.05). CONCLUSIONS:: LF hypertrophy is accompanied by increased MMPs 1, 3, 9 and VEGF expression. Neovessel density is increased in hypertrophied LF. HIF is not expressed in hypertrophied LF.
Journal of spinal disorders & techniques 02/2012; · 1.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Several operative techniques have been described for recurrent patellar dislocation. Clinical results vary depending on the procedure and indication. The present study aimed to evaluate the clinical outcome of Insall's proximal realignment for recurrent patellar dislocation at mid-term follow-up. Forty-five patients were reviewed with a mean follow-up period of 49 months after having undergone Insall's procedure. Outcome measures included reports of redislocations, complications, patient-reported outcome scores (Kujala, Tegner activity scale) and subjective assessment. No statistically significant improvements (p < 0.05) in patient-reported outcome measures were noted. Sixteen patients (35%) had poor to fair results using the Kujala score. Subjective assessment revealed that 12 patients (27%) were dissatisfied with the outcome of their surgery and would not undergo the same procedure. Ten patients (22%) had suffered from redislocation at the latest follow-up. In 4 cases (9%), intra-articular knee hematoma occurred which required arthroscopic intervention. The overall mid-term outcome of the present study shows low patient satisfaction. Non-anatomic realignment for recurrent patellar dislocation does not adequately prevent redislocation.
The Open Orthopaedics Journal 01/2012; 6:114-7.
-
[show abstract]
[hide abstract]
ABSTRACT: The affect of anterior cruciate ligament (ACL) integrity on the early postoperative stability of a collagen type-I gel scaffold was investigated. The value of fibrin glue for graft fixation in ACL deficient porcine knees over a simulated early postoperative period was also studied.
Full-thickness articular cartilage defects (11 × 6 mm) were created on the medial femoral condyle of 80 porcine knees. The ACL was left intact or completely transected in each of 40 knees. Gel plugs were tested in each group: press-fitting only in 20 specimens and press-fitting plus fibrin glue in 20 specimens. Each knee underwent 2,000 cycles in a validated ex-vivo continuous passive motion model.
Press-fit-only fixation grafts in knee specimens with an intact ACL showed significantly superior stability than that in ACL deficient knees (p = 0.01). In ACL deficient knees, grafts fixed with press-fitting plus fibrin glue showed significantly superior stability than those using press-fit only fixation (p = 0.01). Press-fitting plus fibrin glue fixation showed no significant differences in worn surface area between knee specimens with intact and deficient ACL.
ACL deficiency led to early scaffold instability in an ex-vivo porcine knee model. Fibrin glue in ACL deficient knees led to additional graft stability. These findings indicated that cartilage regenerative techniques may give optimum results in ACL intact knees.
International Orthopaedics 12/2011; 36(6):1315-20. · 2.03 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Several well-described techniques are available for the treatment of chondral and osteochondral defects. The aim of the study was to assess the efficacy of a single-stage procedure incorporating a new cell-free collagen type I gel for the treatment of small chondral and osteochondral defects in the knee evaluated at 2-year follow-up.
Fifteen patients were treated with a cell-free collagen type I gel matrix of 11 mm diameter. The grafts were implanted in the debrided cartilage defect and fixed by press-fit only. The clinical outcome was assessed preoperatively and at 6 weeks, and 6, 12 and 24 months after surgery using the International Knee Documentation Committee (IKDC) score, Tegner activity scale and visual analogue scale (VAS). Graft attachment rate was assessed 6 weeks postoperatively using magnetic resonance imaging (MRI). Cartilage regeneration was evaluated using the Magnetic Observation of Cartilage Repair Tissue (MOCART) score at 6, 12 and 24 months after implantation. Clinical results were correlated with MRI findings.
Six male and nine female patients were included in this study, with a mean age of 26 (range: 19-40). No complications were reported. The mean VAS values after 6 weeks and the mean IKDC patient values after 6 months were significantly improved from the preoperative values (P = 0.005 and P = 0.009, respectively). This improvement remained up to the latest follow-up. There were no significant differences between the median preoperative and postoperative Tegner values (n.s.). Significant improvement of the mean MOCART score was observed after 12 months and remained by 24 months (P < 0.001). MR images showed that in 14 of the 15 patients, the graft was completely attached by 6 weeks postoperatively. At 24 months after implantation, MRI demonstrated complete filling in all cases with a mainly smooth surface, complete integration of the border zone, homogenous structure of the repaired tissue and nearly normal signal intensity. No correlation between any variables of the MOCART score and the clinical scores was observed.
The present study reveals that the new method produces both good clinical and magnetic resonance imaging results. Use of press-fit only implanted grafts of a smaller diameter leads to a high attachment rate at 24-month follow-up.
IV.
Knee Surgery Sports Traumatology Arthroscopy 11/2011; 20(10):1911-8. · 2.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Meniscal loss is associated with an increased risk of developing osteoarthritis. Tissue engineering solutions, which include the development of novel material scaffolds, are being utilised to aid the regeneration of meniscal tissue. The purpose of this study was to monitor the safety profile and the short-term efficacy of a novel polyurethane meniscal scaffold in the treatment of patients with painful knees following partial medial meniscectomy.
Ten consecutive patients with segmental tissue loss from the medial meniscus were treated with the arthroscopic implantation of an Actifit(®) (Orteq Sports Medicine) polyurethane meniscal scaffold. Patients were followed up at 2 and 6 weeks, then again at 6 and 12 months. Primary outcome measures included reporting of complications and patient-reported outcome scores (KOOS, KSS, UCLA Activity scale, VAS pain). Secondary outcome was MRI assessment at 6 and 12 months looking at scaffold morphology, integration and associated joint injury/inflammation.
Eight male and 2 female patients were included in the study with a mean age of 29 (range 18-45). No complications were reported. All patients were happy with their surgery. At 6 months, a statistically significant improvement (P < 0.05) in all PROMS except the UCLA activity scale and VAS pain scale were noted. The improvement remained at 12 months. MRI analysis revealed the presence of scaffolds at 6 months, with evidence of some tissue integration in many improvements in scaffold morphology and ICRS classification of cartilage in the medial compartment were noted at 12 months. No synovitis was noted in the joint or adverse reactions in the other compartments.
The new Actifit(®) polyurethane scaffold has been shown to be a safe, effective implant, for the treatment of patients with pain as a result of segmental medial meniscus loss at 1 year.
IV.
Knee Surgery Sports Traumatology Arthroscopy 11/2011; 20(9):1822-30. · 2.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The most common spinal disorder in the elderly is lumbar spinal stenosis (LSS), which results in part from ligamentum flavum (LF) hypertrophy. Although prior histologic and immunochemical studies have been performed in this area, the pathophysiology of loss of elasticity and hypertrophy is not completely understood. The purpose of this immunohistological study is to elucidate the role of CD44 and its splice variants CD44v5 and CD44v6 in the hypertrophied LF obtained from patients with lumbar spinal stenosis (LSS).
LF samples of 38 patients with LSS were harvested during spinal decompression. Twelve LF samples obtained from patients with disc herniation and no visible degeneration on preoperative MRI were obtained as controls. Samples were dehydrated and embedded in paraffin. For immunohistochemical determination, slices were stained with antibodies against CD44, Cd44v4, and CD44v6 stained with DAB. LF hypertrophy and cross-sectional area (CSA) were measured with T1-weighted MRI.
CD44 and CD44v5 expression were significantly increased in the hypertrophy group (p < 0.05). CD44v6 expression was not significantly increased. The number of elastic fibers was significantly higher in the hypertrophy group. In the hypertrophy group, LF thickness was significantly increased while CSA was significantly decreased. There was a statistical correlation between LF thickness, CSA, CD44, and CD44v5 expression in the hypertrophy group (p < 0.05).
LF hypertrophy is accompanied by increased CD44 and CD44v5 expression. CD44v6 expression is not enhanced in LF hypertrophy.
Acta Neurochirurgica 11/2011; 154(2):359-65; discussion 365. · 1.52 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of the present study was to evaluate the precision of digital templating in total hip arthroplasty (THA) and the influence of the surgeons' level of experience on the accuracy of preoperative planning. A retrospective review of digital computer planned THA's was performed on 169 hips. The preoperatively planned component sizes were compared to the sizes used in the operation. An exact agreement between planned and actually used size was achieved in 33.7% of the hips for the acetabular cups and 36% for the femoral stems. A prediction of +/- 1 size was reached in 77.5% for acetabular components and 82.3% for the femoral stem. On average, the acetabular components were planned approximately 0.9 sizes too large, the femoral stems 0.3 sizes too small. The accuracy of preoperative planning showed no differences according to the level of training of the planning surgeon. We state that the digital templating is useful to predict the implant size. However, 15 of the 169 planned components showed a difference of more than 2 sizes. Therefore, digital templating cannot fully replace intraoperative X-ray use.
Acta orthopaedica Belgica 10/2011; 77(5):616-21. · 0.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to assess the reproducibility of magnet resonance imaging (MRI) analysis of preserved anatomic structures of the knee after patellofemoral replacement (PFR). It was hypothesized that evaluation of cartilage, ligaments, meniscus and tendons would result in high inter-observer reliability after PFR.
MRI, tailored to reduce metallic artefacts of the knee, after PFR was performed in seven patients. Two independent investigators evaluated cartilage, menisci, collateral and cruciate ligaments, the quadriceps and patellar tendons and the presence of joint effusion. The reviewers used a five-point scale to give a degree of confidence to their evaluation of each parameter. Inter-observer reliability was determined by calculation of Cohen's Kappas.
Artefact provoked by the implants was not observed. For all assessed structures, there was excellent inter-observer reliability, with high Cohen's Kappas. There were also high levels of inter-observer agreement and observer confidence in the evaluation of cartilage, meniscus, tendons, ligaments and joint effusion.
Tailored MRI allows reproducible analysis of the preserved knee joint structures after PFR. It might prove helpful in assessment of painful knee joints after PFR.
European journal of radiology 06/2011; 81(9):2313-7. · 2.65 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Adequate graft fixation over a certain time period is necessary for successful cartilage repair and permanent integration of the graft into the surrounding tissue. The aim of the present study was to test the primary stability of a new cell-free collagen gel plug (CaReS(®)-1S) with two different graft fixation techniques over a simulated early postoperative period.
Isolated chondral lesions (11 mm diameter by 6 mm deep) down to the subchondral bone plate were created on the medial femoral condyle in 40 porcine knee specimens. The collagen scaffolds were fixed in 20 knees each by press-fit only or by press-fit + fibrin glue. Each knee was then put through 2,000 cycles in an ex vivo continuous passive motion model. Before and after the 2,000 motions, standardized digital pictures of the grafts were taken. The area of worn surface as a percentage of the total collagen plug surface was evaluated using image analysis software.
No total delamination of the scaffolds to leave an empty defect site was recorded in any of the knees. The two fixation techniques showed no significant difference in worn surface area after 2,000 cycles (P = n.s.).
This study reveals that both the press-fit only and the press-fit + fibrin glue technique provide similar, adequate, stability of a type I collagen plug in the described porcine model. In the clinical setting, this fact may be particularly important for implantation of arthroscopic grafts.
Knee Surgery Sports Traumatology Arthroscopy 06/2011; 20(2):210-5. · 2.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Mesenchymal stem cell differentiation of osteoblasts is triggered by a series of signaling processes including integrin and bone morphogenetic protein (BMP), which therefore act in a cooperative manner. The aim of this study was to analyze whether these processes can be remodeled in an artificial poly-(L)-lactide acid (PLLA) based nanofiber scaffold. Matrices composed of PLLA-collagen type I or BMP-2 incorporated PLLA-collagen type I were seeded with human mesenchymal stem cells (hMSC) and cultivated over a period of 22 days, either under growth or osteoinductive conditions. During the course of culture, gene expression of alkaline phosphatase (ALP), osteocalcin (OC) and collagen I (COL-I) as well as Smad5 and focal adhesion kinase (FAK), two signal transduction molecules involved in BMP-2 or integrin signaling were analyzed. Furthermore, calcium and collagen I deposition, as well as cell densities and proliferation, were determined using fluorescence microscopy. The incorporation of BMP-2 into PLLA-collagen type I nanofibers resulted in a decrease in diameter as well as pore sizes of the scaffold. Mesenchymal stem cells showed better adherence and a reduced proliferation on BMP-containing scaffolds. This was accompanied by an increase in gene expression of ALP, OC and COL-I. Furthermore the presence of BMP-2 resulted in an upregulation of FAK, while collagen had an impact on the gene expression of Smad5. Therefore these different strategies can be combined in order to enhance the osteoblast differentiation of hMSC on PLLA based nanofiber scaffold. By doing this, different signal transduction pathways seem to be up regulated.
Journal of Materials Science Materials in Medicine 05/2011; 22(7):1753-62. · 2.32 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The theoretical superiority of mobile-bearing total knee arthroplasties (TKAs) has not yet been proven in clinical studies. The aim of the current study was to compare and to analyse in a patient population that had received either a fixed or a mobile TKA differences in gait analysis electromyography and clinical scores.
In a prospective, randomized, patient- and observer-blinded clinical study, 33 patients with primary osteoarthritis of the knee were included. All patients received a Genesis II total knee replacement. Sixteen patients received a mobile and 17 a fixed-bearing cruciate retaining Genesis II TKA. Clinical and quality-of-life scores, electromyography and gait analysis were applied preoperatively and postoperatively with a follow-up of 24 months.
In both groups, improvements from pre- to postoperative were detected. whereas the results of gait analysis and electromyography did not show any differences. The results from the clinical and the quality-of-life scores improved from pre- to postoperative, while the Knee Society Score showed a superiority of the mobile-bearing group (mean 159 ± 28) over the fixed-bearing group (mean 134 ± 41).
No functional advantage of mobile over fixed-bearing TKA was detected, although the mobile-bearing group had better clinical results for which a reason could not be found. These results only apply to cruciate retaining mobile-bearing TKA with a bearing which allows both rotation and anteroposterior translation.
Knee Surgery Sports Traumatology Arthroscopy 05/2011; 19(12):2052-9. · 2.21 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The use of highly conforming polyethylene inlays in total knee arthroplasty (TKA) provides improved anteroposterior stability. The aim of this fluoroscopic study was to investigate the in vivo kinematics during unloaded and loaded active extension with a highly conforming inlay and a flat inlay after cruciate retaining (CR) total knee arthroplasty (TKA). Thirty one patients (50 knees) received a fixed-bearing cruciate retaining total knee arthroplasty (Genesis II, Smith & Nephew, Schenefeld, Germany) for primary knee osteoarthritis. Twenty two of them received a flat polyethylene inlay (PE), nine a deep dished PE and 19 were in the control group (physiological knees). The mean age at the time of surgery was 62 years. Dynamic examination with fluoroscopy was performed to assess the "patella tendon angle" in relation to the knee flexion angle (measure of anteroposterior translation) and the "kinematic index" (measure of reproducibility). Fluoroscopy was performed under active extension and flexion, during unloaded movement, and under full weight bearing, simulated by step climbing. No significant difference was observed between both types of polyethylene inlay designs and the physiological knee during unloaded movement. Anteroposterior (AP) instability was found during weight-bearing movement. The deep-dish inlay resulted in lower AP translation and a non-physiological rollback. Neither inlay types could restore physiological kinematics of the knee. Despite the fact that deep dished inlays reduce the AP translation, centralisation of contact pressure results in non-physiological rollback. The influence of kinematic pattern variability on clinical results warrants further investigation.
The Knee 05/2011; 19(4):260-5. · 1.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Safety and efficacy of unicompartmental knee arthroplasty (UKA) in unicompartmental osteoarthritis (OA) has been shown in large patient series. It has been matter of discussion whether or not spontaneous osteonecrosis of the knee (SONK) can successfully be treated with UKA.
A retrospective approach included 52 cases of UKA for SONK of the femoral condyles. Four implants were revised (7.7%), and seven patients had died. Nine patients were interviewed by telephone, 28 followed the invitation for clinical examination including clinical scores (KSS and WOMAC) and radiographs. Satisfaction of patients was recorded in four categories. Four patients (7.7%) were lost to follow-up.
Average follow-up was 10.9 ± 4.8 years (4-25). Average age at operation was 66.6 ± 9.7 years. The KSS score increased from a preoperative 85 ± 30 to 173 ± 27 (p < 0.0001) at latest follow-up. WOMAC was 7.7 ± 11.4 at latest follow-up. Of the patients with implants still in place, most patients were satisfied (21.6%) or very satisfied (75.7%) with the outcome of this surgical procedure. One patient was dissatisfied (2.7%). Kaplan-Meier analysis with implant revision as endpoint revealed a survival rate of 93.1% at 10 years and 90.6% at 15 years.
This study shows that spontaneous osteonecrosis of the knee (SONK) can successfully be treated with UKA at a good mid- to long-term follow-up.
Archives of Orthopaedic and Trauma Surgery 05/2011; 131(5):613-7. · 1.37 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A case report to describe the first case of an acute central canal dilatation after minimally invasive lateral cervical decompression.
To emphasize the need of being aware of this rare spinal disorder.
A holocord syrinx is known as a complication of Chiari malformation. Furthermore, it can occur spontaneously, after trauma or infection.
A 63-year-old patient with a left-sided nerve root stenosis, C3/C4, because of uncovertebral and intervertebral joint osteoarthritis with paresis of the left deltoid muscle, underwent minimally invasive decompression of the C4 nerve root according to the Frykholm approach.
An immediately postoperative recognizably complete paresis of the right arm was because of hydromyelia from the fourth ventricle down to the thoracic spine. A minimal edema of the spinal cord was present. No abnormality of the spinal cord had been detected on preoperative magnetic resonance imaginary (MRI).At revision surgery high pressure was found within the hydromyelia. Subarachnoid drainage did not improve the neurologic deficits. On account of increasing edema of the spinal cord paraplegia developed, which almost completely resolved after further revision.
The reason for the hydromyelia is unclear. Routinely used MRI is not able to detect a collapsed central canal of the spinal cord. Acute hydromyelia causes permanent neurologic deficits whereas edema might lead to transient disturbances.
Journal of spinal disorders & techniques 05/2011; 24(3):208-11. · 1.21 Impact Factor
