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ABSTRACT: BACKGROUND: The stemless shoulder prosthesis is a new concept in shoulder arthroplasty. To date, only a few studies have investigated the results of this prosthesis. The aim of this study was to investigate the clinical and radiological midterm results of this implant in comparison with a standard anatomic stemmed shoulder prosthesis. MATERIALS AND METHODS: The Constant score, the DASH score, the active range of motion (abduction, anteversion, external rotation), and the radiological results were examined in 82 patients with primary osteoarthritis of the shoulder treated with either the Total Evolutive Shoulder System(®) (Biomed, France) stemless shoulder prosthesis or the Affinis(®) (Mathys, Switzerland) stemmed shoulder prosthesis to detect possible differences in the functional outcome and to evaluate radiological properties of the implants. Patients were examined before and 32 ± 4 months after surgery. RESULTS: There was no significant difference in the Constant scores of the groups treated with the stemless shoulder prosthesis (65.0 ± 11.0 points) and the stemmed shoulder prosthesis (73.2 ± 11.3 points; P = 0.162). The estimated blood loss (P = 0.026) and the mean operative time (P = 0.002) were significantly lower in the group with the stemless shoulder prosthesis. CONCLUSIONS: The use of the stemless shoulder prosthesis yielded good results which, in a mid-term follow-up, were comparable with those provided by a standard anatomic shoulder prosthesis. Further investigations are needed regarding the long-term performance of this prosthesis.
Journal of Orthopaedics and Traumatology 11/2012;
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ABSTRACT: Fragestellung: In dieser Arbeit ¶erfolgte eine dezidierte Untersuchung von Therapieversagern und ihrer Revision nach subakromialer
arthroskopischer Dekompression. Methode: In der vorliegenden Studie wurden 70 Patienten mit primärem subakromialem Impingementsyndrom
Stadium II nach Neer, bei denen eine arthroskopische subakromiale Dekompression durchgeführt wurde, untersucht. Der mittlere
Nachuntersuchungszeitraum betrug 30 Monate. Ergebnisse: Revisionsoperationen nach subakromialen Dekompressionen waren bei
9 Patienten notwendig. Die Revisionsrate lag somit bei 13%. Ursache für die Revision waren ein Persistieren der Symptomatik
sowie ein funktionell unbefriedigendes Ergebnis. Nach dem Zweiteingriff waren 6 der revidierten Patienten (66%) zum Zeitpunkt
der Nachuntersuchung mit dem Ergebnis zufrieden. Der durchschnittliche Constant-Score der ¶revidierten Patienten betrug 80,3
(SD ± 15,4). Er verbesserte sich bei Patienten mit dem Impingementstadium II auf 84,7 (SD ± 16,7). Die Notwendigkeit von Rezidiveingriffen
ergab sich bei 2/3 der Patienten durch operationstechnische Fehler, bei den übrigen Patienten handelte es sich ¶um operationsunabhängige
Ursachen. Schlussfolgerungen: Bei der Therapieversagerrate stellt die Gruppe mit operationstechnischen Fehlern den weitaus
größten Anteil. Dies beweist, wie anspruchsvoll dieses Verfahren ist. Für jeden Patienten muss individuell eine Strategie
erarbeitet werden, wobei zwischen einem erneuten arthroskopischen Herangehen oder einer “offenen Intervention” entschieden
werden muss.
Problem: In the present study, we evaluated the failure and revisions rates after arthroscopic subacromial decompression (SAD).
Method: We examined 70 patients who were treated with arthroscopic subacromial decompression for primary shoulder impingement
stage II according to Neer at an average follow-up time of 30 months. Hereby, special attention was paid to the revision operations
resulting from our treatment. Results: Revision operation had to be performed in nine patients (13%). Reasons for revisions
were persisting or increasing pain as well as functional dissatisfaction. At the follow-up examination, six of these revised
patients (66%) were satisfied with the result. The mean follow-up CONSTANT score in the revised patients was 80.3 (SD ± 15.4).
In patients with impingement stage II, the mean follow-up CONSTANT score was 84.7 (SD ± 16.7). In 60% of the revised patients,
the necessity for revision operation was directly related to the technical problems of the primary operation, in 40% we found
reasons not related to the primary SAD. Conclusions: Technical failures are the most common cause for the need of revision
operations after SAD. This demonstrates how demanding this kind of operation procedure is. In case of revision operations,
individual strategies should be developed in which the decision of whether to perform arthroscopic or open revision procedures
is of special importance.
Arthroskopie 04/2012; 13(5):241-245.
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ABSTRACT: The surgical treatment of massive rotator cuff tears (RCT) is still controversial and can be based on a variety of different surgical repair methods. This study investigated the effectiveness of arthroscopic debridement or arthroscopic partial repair in patients with massive RCT.
This prospective, randomized study involved forty-two patients with massive RCT (fatty infiltration stage 3 or 4) treated with either arthroscopic partial repair or arthroscopic debridement were selected to detect possible differences in functional outcome. Both groups were matched according to age and gender. Patients were examined before, and 16 +/- 3 and 24 +/- 2 months after surgery. The status of the rotator cuff repair was determined using ultrasonographic evaluation.
Regardless of the treatment group, postoperative results demonstrated highly significant improvements compared with preoperative values in most parameters. The overall Constant score in the partial repair group was superior to the outcome in the debridement group (P < 0.01, F = 8.561), according to better results in abduction (P < 0.01, F = 13.249), activity (P < 0.01, F = 21.391) and motion (P < 0.01, F = 4.967). All treatment groups had similar pain relief (P = 0.172, F = 1.802) and satisfaction, reflected in equal values of disabilities of the arm, shoulder and hand (DASH) score (P = 0.948, F = 0.004). Ultrasonography revealed structural failure of the partial rotator cuff repair in 52% at final follow-up.
During the follow-up period all patients in our series had good or satisfactory outcome after rotator cuff surgery. Regardless of high rates of structural failure of the partial rotator cuff repair, the results of arthroscopic partial rotator cuff repair demonstrated slightly better functional outcome than debridement.
Journal of Orthopaedics and Traumatology 03/2010; 11(1):13-20.
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ABSTRACT: Previous EMG studies have shown that chronic rotator cuff tears (RCT) may be associated with an altered activation of adjacent shoulder muscles. The effect of RCT on central neuromuscular control mechanisms of hand muscles has as yet not been studied in detail. This study investigated the cortico-motor excitability of the first dorsal interosseus muscle (FDI) in patients with RCT.
The resting motor threshold (RMT) of the FDI on both sides were obtained from patients with unilateral chronic RCT and compared with healthy control subjects without any shoulder pathologies with transcranial magnetic stimulation. Analysis of variance for repeated measures was performed to detect possible differences in RMT of the FDI in patients and healthy controls.
The RMT of FDI in patients on the affected side was lower when compared to the non-affected side (p = 0.015) and to both sides in control subjects (p = 0.041, F = 4.8).
The reduced RMT of FDI in patients with unilateral RCT may be related to alterations in the sensory output from the shoulder and points toward a complete sensimotor restriction of the involved upper limb. These findings seem to be assigned to adaptive changes in the motor cortex as a consequence of chronic RCT.
Archives of Orthopaedic and Trauma Surgery 11/2009; 130(5):705-10. · 1.37 Impact Factor
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ABSTRACT: Previous surface electromyogram (EMG) studies have shown that chronic rotator cuff tears (RCT) may be associated with a altered activation of adjacent shoulder muscles. The effect of RCT on central neuromuscular control mechanisms of the shoulder girdle muscles such as the deltoideus muscle (DM), a key muscle of shoulder function, has as not yet been studied in detail.
This study investigated the corticospinal excitability of the DM to assess the effects of RCT on the central neuromuscular function of proximal upper limb muscles. The motor-evoked potentials (MEP) in response to transcranial magnetic stimulation of DM on both sides were obtained from patients with unilateral RCT and compared with healthy control subjects.
In patients, stimulus response curves of DM demonstrated a bilateral hyperexcitability at rest and a hypoexcitability during voluntary activation (F = 3.82, P = 0.007).
The DM hyperexcitability may be related to alterations in the sensory output from the shoulder. The insufficient facilitation of the DM points toward a bilateral central activation deficit. These findings seem to be assigned to adaptive changes in the motor cortex as a consequence of chronic RCT, and the neuromuscular alteration of the DM should be considered when treating patients with RCT.
Journal of Orthopaedics and Traumatology 09/2009; 10(3):135-41.
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Ingmar Meinecke, Géza Pap,
Heidi Mendoza,
Steffen Drange,
Stephan Ender,
Simon Strietholt,
Renate E Gay,
Christine Seyfert,
Barbara Ink,
Steffen Gay,
Thomas Pap,
Marvin A Peters
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ABSTRACT: To study the expression of small ubiquitin-like modifier 1 (SUMO-1) in aseptic loosening of prosthesis implants and to investigate its role in regulating the susceptibility of prosthesis-loosening fibroblast-like synoviocytes (FLS) to Fas-induced apoptosis.
Specimens of aseptically loosened tissue were obtained at revision surgery, and the expression of SUMO-1 was analyzed by in situ hybridization. SUMO-1 levels in FLS were determined by quantitative polymerase chain reaction and Western blot analysis. Immunohistochemistry and confocal microscopy were used to study the subcellular localization of SUMO-1. The functional role of SUMO-1 in Fas-induced apoptosis of prosthesis-loosening FLS was investigated by small interfering RNA-mediated knockdown of SUMO-1 and by gene transfer of the nuclear SUMO-specific protease SENP1.
SUMO-1 was expressed strongly in aseptically loosened tissue and was found prominently at sites adjacent to bone. Prosthesis-loosening FLS expressed levels of SUMO-1 similar to the levels expressed by rheumatoid arthritis (RA) FLS, with SUMO-1 being found mainly in promyelocytic leukemia protein nuclear bodies. Knockdown of SUMO-1 had no effect on spontaneous apoptosis but significantly increased the susceptibility of prosthesis-loosening FLS to Fas-induced apoptosis. Gene transfer of the nuclear SUMO-specific protease SENP1 reverted the apoptosis-inhibiting effects of SUMO-1.
These data suggest that SUMO-1 is involved in the activation of both RA FLS and prosthesis-loosening FLS by preventing these cells from undergoing apoptosis. Modification of nuclear proteins by SUMO-1 contributes to the antiapoptotic effects of SUMO-1 in prosthesis-loosening FLS, providing evidence for the specific activation of sumoylation during their differentiation. Therefore, SUMO-1 may be an interesting target for novel strategies to prevent aseptic prosthesis loosening.
Arthritis & Rheumatism 07/2009; 60(7):2065-70. · 7.87 Impact Factor
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ABSTRACT: The purpose of this study was to describe the outcome after reversed Delta III shoulder prosthesis in patients with rheumatoid arthritis (RA) and irreparable rotator cuff tear. Fifteen patients (17 joints) were prospectively analysed using the Constant-Murley score (CS). Comprehensive outcome measure was carried out by means of four widely used questionnaires as well as clinical and radiographic examinations at an average of 24.3 months postoperatively. The CS improved significantly from 19 to 59.5 points. The mental (MSC) and physical (PCS) component summary score of the Short Form 36 (SF-36) reached 108% and 77%, respectively, while the DASH (Disabilities of the Arm, Shoulder, and Hand) was 58% of a comparative norm population. Remaining deficits were documented by SPADI (Shoulder Pain and Disability; 54.4 points) and ASES (clinical and patient-orientated American Shoulder and Elbow Surgeons; 84.3 and 61.3 points, respectively). No radiological signs of loosening were found, but scapular notching occurred in four cases. Reversed arthroplasty provides a substantial improvement of shoulder function in patients with RA. The high incidence of notching is of concern.
International Orthopaedics 03/2009; 34(1):71-7. · 2.03 Impact Factor
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ABSTRACT: Both bipolar and hemiarthroplasty have been used to treat rotator cuff arthropathy (RCA) of the shoulder in patients with low functional demands. In this study, 41 patients treated with either a bipolar or hemiarthroplasty were selected retrospectively to detect possible differences in the functional outcome and to evaluate radiological properties of the implants. Patients were examined before and 30 +/- 6 months after surgery. There were no differences in the Constant scores between the groups treated with hemiarthroplasty and bipolar arthroplasty, 58.9 +/- 13.1 points and 55.8 +/- 13.5 points, respectively (P = 0.457). We found a significant increase in abduction postoperatively in both groups (P = 0.041 bipolar, P = 0.000 hemiarthroplasty) but without statistical significance between the hemiarthroplasty and bipolar arthroplasty groups (P = 0.124, F = 2.6). This result is related in the bipolar group due to movement between the shell and inner head (P = 0.042) and in the hemiarthroplasty group due to movement between the humeral head component and the glenoid (P = 0.000). In conclusion, we found that both hemiarthroplasty and bipolar arthroplasty are effective treatment options for carefully selected patients with RCA and low functional demands, with no differences between the groups.
International Orthopaedics 08/2007; 32(6):735-40. · 2.03 Impact Factor
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ABSTRACT: Die Schultergelenksendoprothetik ist ein etabliertes Verfahren zur Behandlung der konservativ nicht mehr beherrschbaren primären
und sekundären Omarthrose.Diese Studie evaluiert die frühfunktionellen Ergebnisse einer neu entwickelten anatomischen Schulterprothese.
Weiterhin wurde untersucht, inwieweit sich die Anatomie des proximalen Humerus durch den „Doppelexzenter“-Mechanismus dieser
Prothese wiederherstellen lässt. Zwischen 2004 und 2005 wurde bei 20 Patienten mit primärer Omarthrose eine Affinis® Schulterprothese implantiert. Die Patienten wurden präoperativ, sowie 3 und 9 Monate postoperativ klinisch und radiologisch
untersucht. Die postoperative Anteversion, Abduktion und Außenrotation betrug 138,2°, 104,3° und 58,2°. In Bezug auf die Abduktion
und Außenrotation zeigten sich keine signifikanten Unterschiede zwischen dem 3. und 9 Monat postoperativ (p=0,14, p=0,06).
Der mittlere, nicht alters- und geschlechtskorrelierte Constant Score verbesserte sich von 29,9±11,0 Punkte auf 60,3±10,5
Punkte postoperativ und der Dash Score verbesserte sich von 59,8±13,8 Punkte auf 31,9±17,9 Punkte postoperativ. Die Analyse
der Verteilung der erforderlichen Konus- und Kopfpositionen der Humeruskomponente zur Rekonstruktion des Drehzentrums des
Glenohumeral-Gelenkes zeigte eine hohe Variabilität der Geometrie des proximalen Humerus. Dies unterstreicht die Erfordernis
einer weiten Adjustierungsmöglichkeit des Prothesenkopfes sowohl in mediolateraler als auch in anterior-posteriorer Richtung,
um die Kopfexzentrizität wieder rekonstruieren zu können.
Shoulder arthroplasty is well established as a method to treat osteoarthritis of the shoulder. This study was designed to
report early results of a new anatomic designed shoulder prosthesis with a special designed “double excenter mechanism” for
restoration of the proximal humerus. Between 2004 and 2005, 20 patients were treated with the Affinis® shoulder prosthesis and were examined 1 day before, and at 3 and 9 months after surgery. The average postoperative anteversion,
abduction and external rotation was 138.2°, 104.3° and 58.2° respectively. With regard to abduction and external rotation
no significant improvement from 3 to 9 month after shoulder arthroplasty was found (p=0.14, p=0.06 respectively). The mean
Constant score, non adjusted related to age and gender, improved from 29.9±11.0 points preoperatively to 60.3±10.5 points
9 months after surgery and the Dash score improved from 59.8±13.5 points preoperatively to 31.9±17.9 points after surgery.
The analysis of the distribution of required humerus head and conus position to restore the motion centre demonstrated a wide
variability of the geometry of the proximal humerus and the need of a wide adjustment range in medial-lateral direction as
well as in anterior posterior direction for the anatomic reconstruction of the rotation centre.
Obere Extremität 05/2007; 2(2):73-80.
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Andreas Drynda,
Paul H A Quax,
Manfred Neumann,
Willemijn H van der Laan, Géza Pap,
Susanne Drynda,
Ingmar Meinecke,
Joern Kekow,
Wolfram Neumann,
Tom W J Huizinga,
Michael Naumann,
Wolfgang König,
Thomas Pap
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ABSTRACT: Apart from counteracting matrix metalloproteinases, tissue inhibitor of metalloproteinases-3 (TIMP-3) has proapoptotic properties. These features have been attributed to the inhibition of metalloproteinases involved in the shedding of cell surface receptors such as the TNFR. However, little is known about effects of TIMP-3 in cells that are not susceptible to apoptosis by TNF-alpha. In this study, we report that gene transfer of TIMP-3 into human rheumatoid arthritis synovial fibroblasts and MRC-5 human fetal lung fibroblasts facilitates apoptosis and completely reverses the apoptosis-inhibiting effects of TNF-alpha. Although TNF-alpha inhibits Fas/CD95-induced apoptosis in untransfected and mock-transfected cells, fibroblasts ectopically expressing TIMP-3 are sensitized most strongly to Fas/CD95-mediated cell death by TNF-alpha. Neither synthetic MMP inhibitors nor glycosylated bioactive TIMP-3 are able to achieve these effects. Gene transfer of TIMP-3 inhibits the TNF-alpha-induced activation of NF-kappaB in rheumatoid arthritis synovial fibroblasts and reduces the up-regulation of soluble Fas/CD95 by TNF-alpha, but has no effects on the cell surface expression of Fas. Collectively, our data demonstrate that intracellularly produced TIMP-3 not only induces apoptosis, but also modulates the apoptosis-inhibiting effects of TNF-alpha in human rheumatoid arthritis synovial fibroblast-like cells. Thus, our findings may stimulate further studies on the therapeutic potential of gene transfer strategies with TIMP-3.
The Journal of Immunology 06/2005; 174(10):6524-31. · 5.79 Impact Factor
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ABSTRACT: To explore the biometric and psychometric properties of clinical, generic, and condition-specific instruments and to assess quantitatively the outcome after resection interposition arthroplasty (RIAP) of the thumb saddle joint.
One hundred three patients requiring 112 arthroplasties were assessed in a 4.5-7.7-year cross-sectional catamnesis by means of 4 widely used questionnaires and clinical and radiographic examinations.
In all dimensions of the Short Form 36 (SF-36), the outcome was equal or significantly better than expected by the norm. The Disability of the Arm, Shoulder and Hand questionnaire (DASH) revealed some small, mainly functional limitations (mean score 78.4, norm 86.4). The SF-36, the DASH, and the Patient Related Wrist Evaluation form (PRWE) correlated highly and loaded on the same factor. The Hand Function Index was independent of the clinical measurements (range of motion, strength, etc. on the specially designed Custom Form) and of the self rating.
Long-term followup of 112 RIAP patients showed excellent health and quality of life. A questionnaire set consisting of the SF-36, the DASH (or alternatively the short PRWE), and the Custom Form is proposed for the comprehensive and specific assessment of thumb joint conditions.
Arthritis & Rheumatism 05/2005; 53(2):205-13. · 7.87 Impact Factor
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ABSTRACT: To assess quantitatively the outcome and to explore the physiometric and psychometric properties of clinical, generic, and condition-specific instruments after total elbow arthroplasty.
Seventy-nine patients were assessed in a 6-19-year cross-sectional catamnesis by means of 6 widely used questionnaires, clinical examinations, and radiographic examinations.
With regard to pain, general physical health, and all the mental health dimensions of the Short Form 36 (SF-36), the patients showed scores comparable to normative values. Elbow joint stability and satisfaction were both good. Significant functional limitation was evidenced by the low mean scores of the SF-36 physical functioning measure (48.7, normative 69.9) and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) function measure (51.1, normative 89.3). The SF-36 physical component summary and the DASH correlated highly (r = 0.76) and, in factor analysis, loaded on the factor "physical unspecific." The patient and clinical modified American Shoulder and Elbow Surgeons questionnaire (mASES) correlated with the Patient Related Elbow Evaluation form (r = 0.92 with the patient mASES) and loaded on "physical specific." The SF-36 mental component summary loaded on "mental quality of life."
The patients' self-rated health, quality of life, and clinical outcome were good and were not affected by impairment in some specific functional abilities. A questionnaire set comprising the SF-36 and the patient and clinical mASES is proposed for the comprehensive and specific assessment of outcome after elbow arthroplasty.
Arthritis & Rheumatism 03/2005; 53(1):73-82. · 7.87 Impact Factor
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ABSTRACT: To explore the physiometric and psychometric properties of clinical, generic, and condition-specific assessment instruments. To describe patients' outcome after total shoulder arthroplasty.
Forty-three patients were assessed in a 5-6-year cross-sectional catamnesis.
With regard to shoulder joint stability, pain, general physical health, and mental health, the patients showed scores comparative to normative scores. Significant functional limitation was evidenced by low mean scores on the specific function scales (e.g., Disability of the Arm, Shoulder and Hand questionnaire score = 64.0, normative score = 86.6). There were high correlations among the joint-specific scales (up to 0.93) and moderate correlations between these and the generic and clinical scales. Factor analysis identified 3 different assessment domains.
The patients' quality of life (QOL) was high and not affected by impairment in some specific functional abilities. Physical QOL, mental QOL, clinical assessment, condition-specific measures, and generic measures were identified as separate domains, all of which are required for a comprehensive and sophisticated assessment in practical clinical routine.
Arthritis & Rheumatism 11/2004; 51(5):819-28. · 7.87 Impact Factor
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ABSTRACT: Improvements of quadriceps motor deficits represent a major therapeutical target in knee osteoarthritis (OA). In the present study, we investigated changes in quadriceps function at different stages of osteoarthritic cartilage damage.
Measurements of quadriceps voluntary activation (VA) and maximum voluntary contraction (MVC) were performed by a twitch interpolation technique and the total muscular capacity (TMC) was calculated as the ratio of MVC and VA. We assessed 68 patients (56.7+/-9.5 years) with stage II and 154 patients (65.6+/-6.0 years) with stage IV chondropathy. As controls, we used 85 age related healthy subjects (58.1+/-8.7 years).
While TMC was significantly lower in stage IV (90.6+/-43.7 Nm) than in stage II chondropathy (109.6+/-51.0) there were no differences in the MVCs between both groups. Quadriceps VA was even higher in stage IV (77.2+/-13.2%) than in stage II chondropathy (70.8+/-16.0%). In the controls, MVC, VA and TMC were significantly higher than in both OA groups.
We assume that a decrease of TMC might occur within the course of OA and, in consequence, VA increases to maintain quadriceps MVC.
Journal of Orthopaedic Research 02/2004; 22(1):96-103. · 2.81 Impact Factor
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ABSTRACT: Functional instruments in rheumatology should use standardized procedures and should be quantifiable, valid, reliable, and responsive/sensitive to change. For most assessment tools, these aspects have been considered and tested. One of the most important questions in assessing hand involvement in patients with RA is what the single assessment should be used for. There could be a substantial difference should hand assessment be done in a routine way in a hand practice or should it be performed within scientific studies on disease progression or the effect of operative interventions. Among other points, answering this question has a significant impact on the time the patient has to spend with the tests and on the time the hand therapist or hand surgeon is involved with it. In addition to aspects such as accuracy, reliability, and validity, therefore, in some evaluation tools the time needed to perform the clinical examination and assessment of hand function has also been considered to be of importance. In addition, it has to be considered that description of the anatomic status, measurements of impairment, and assessment of disability cannot simply be replaced by each other, and even measurements of single aspects often are not sufficient. It has been stated, therefore, that the combination of different discrete hand-function assessment methods provides a more complete picture of hand ability. Moreover, although better responsiveness of disability outcome measures over impairment measures has been demonstrated previously (eg, in patients treated for Colle fracture), the relationship between disability and impairment measures is not clearly established. Although some studies reported significant correlations between impairment and disability tests, other studies showed only poor or moderate correlations between disability scores, impairment, and disease activity measures when rheumatoid hands were assessed. It has been concluded that the relationship between impairment and disability is not straightforward. The new ICF-model addresses these two levels of health-related quality of life by different concepts of assessment. Because impairment reflects the consequences of the disease at the organ level, whereas disability reflects the consequences of the disease for functional performance and activity, for comprehensive assessment of hand handicap, measurement of disability is more comprehensive and closer to the patient's needs for performing ADLs.
Hand Clinics 09/2003; 19(3):471-81. · 0.72 Impact Factor
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ABSTRACT: A proprioceptive deficit is an important determinant of disability in various shoulder disorders, such as instability and osteoarthrosis. In 15 patients with impingement syndrome stage II (Neer 1983), who were treated by arthroscopic subacromial decompression, we measured movement sense by determining threshold levels for the perception of motion of the shoulder. The patients were placed in a specially designed chair allowing continuous passive motion of the shoulder joint, while avoiding cutaneous, auditory and visual stimuli. To assess movement detection thresholds, passive abduction movements of the shoulder were performed at a starting angle of 60 degrees, an amplitude of 10 degrees and an angular velocity of 1.3 degrees/s. Before surgery, all patients had higher threshold levels for the perception of motion in their affected shoulders then in the other side. After decompression, proprioception had improved on the decompressed side, but was unchanged on the other side.
Acta Orthopaedica Scandinavica 03/2003; 74(1):85-8.
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Andreas Machner,
Anja Baier,
Aline Wille,
Susanne Drynda, Géza Pap,
Andreas Drynda,
Christian Mawrin,
Frank Bühling,
Steffen Gay,
Wolfram Neumann,
Thomas Pap
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ABSTRACT: The aim of the present study was to investigate the expression of Fas in periarticular tenocytes of patients with osteoarthritis (OA) and to study their susceptibility to Fas ligand-mediated apoptosis. Tendon samples were obtained from the quadriceps femoris muscle of patients with knee OA and used for histological evaluation, for immunohistochemical detection of Fas, and to establish tenocyte cultures. The expression of Fas mRNA was determined by quantitative PCR. Levels of soluble Fas and soluble tumour necrosis factor (TNF) receptor I were measured using ELISA. Apoptosis was induced with recombinant human Fas ligand and measured by a histone fragmentation assay and flow cytometry. The effects of TNF-alpha were studied by stimulation with TNF-alpha alone or 24 hours before the induction of apoptosis. Tendon samples from non-OA patients were used as controls. Histological evaluation revealed degenerative changes in the tendons of all OA patients but not in the controls. Fas was detected by immunohistochemistry in all specimens, but quantitative PCR revealed significantly higher levels of Fas mRNA in OA tenocytes. In contrast, lower levels of soluble Fas were found in OA tenocytes by ELISA. OA tenocytes were significantly more susceptible to Fas ligand induced apoptosis than were control cells. TNF-alpha reduced the Fas ligand induced apoptosis in OA tenocytes but had no effects on control tenocytes. These data suggest that knee OA is associated with higher susceptibility of periarticular tenocytes to Fas ligand induced apoptosis because of higher expression of Fas but lower levels of apoptosis-inhibiting soluble Fas. These changes may contribute to decreased cellularity in degenerative tendons and promote their rupturing. The antiapoptotic effects of TNF-alpha in OA tenocytes most likely reflect regenerative attempts and must be taken into account when anti-TNF strategies are considered for OA.
Arthritis research & therapy 02/2003; 5(5):R253-61. · 4.27 Impact Factor
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Thomas Pap,
Anja Claus,
Susumu Ohtsu,
Klaus M Hummel,
Peter Schwartz,
Susanne Drynda, Géza Pap,
Andreas Machner,
Bernhard Stein,
Michael George,
Renate E Gay,
Wolfram Neumann,
Steffen Gay,
Wilhelm K Aicher
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ABSTRACT: To date, mesenchymal cells have only been associated with bone resorption indirectly, and it has been hypothesized that the degradation of bone is associated exclusively with specific functions of osteoclasts. Here we show, in aseptic prosthesis loosening, that aggressive fibroblasts at the bone surface actively contribute to bone resorption and that this is independent of osteoclasts. In two separate models (a severe combined immunodeficient mouse coimplantation model and a dentin pit formation assay), these cells produce signs of bone resorption that are similar to those in early osteoclastic resorption. In an animal model of aseptic prosthesis loosening (i.e. intracranially self-stimulated rats), it is shown that these fibroblasts acquire their ability to degrade bone early on in their differentiation. Upon stimulation, such fibroblasts readily release acidic components that lower the pH of their pericellular milieu. Through the use of specific inhibitors, pericellular acidification is shown to involve the action of vacuolar type ATPases. Although fibroblasts, as mesenchymal derived cells, are thought to be incapable of resorbing bone, the present study provides the first evidence to challenge this widely held belief. It is demonstrated that fibroblast-like cells, under pathological conditions, may not only enhance but also actively contribute to bone resorption. These cells should therefore be considered novel therapeutic targets in the treatment of bone destructive disorders.
Arthritis research & therapy 02/2003; 5(3):R163-73. · 4.27 Impact Factor
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ABSTRACT: In a prospective randomised clinical study, we investigated the impact of drain-suction on the post-operative blood loss and on both clinical and laboratory parameters after knee replacement operations.
In this study, 116 patients with unilateral implantation of knee replacements were evaluated. The patients' average age was 71.2 years. The operation was carried out mostly without tourniquet application. All patients received two wound drains, 57 with and 59 without suction. The postoperative blood loss as well as clinical and laboratory parameters were assessed.
The average peri-operative blood loss amounted to 338 ml. The post-operative blood loss in the group without drain suction was 436 ml and 528 ml in the group with suction. No significant differences could be found concerning the hemoglobin values pre-operatively and on the first and seventh post-operative day, the drainage quantity 12, 24, 36, and 48 hours post-operatively, the wound healing and the CRP. Six patients in the group without and five patients in the group with drain-suction had to receive blood transfusions.
The application of suction on the drainage system had no significant impact on the post-operative blood loss and the postoperative course. In nine out of ten cases no homologous blood was needed.
Zentralblatt für Chirurgie 11/2002; 127(10):886-9. · 1.02 Impact Factor
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ABSTRACT: In patients with osteoarthritis of the knees, quadriceps muscle dysfunction is an early and common clinical feature and an important determinant of disability. In the current study, changes in quadriceps muscle strength and voluntary quadriceps muscle activation after high tibial osteotomies for primary osteoarthritis of the knee in 19 patients were investigated. Quadriceps muscle function was assessed during different degrees of isometric maximum voluntary contraction using a specially built chair. One year after surgery all patients had reexamination of their surgically treated and contralateral knees. Voluntary activation and maximum voluntary contraction values of the followup assessment were significantly lower in the surgically treated knees compared with the preoperative assessment. In the contralateral knees, there were no differences between preoperative and followup measurements. High tibial osteotomy is an extraarticular operative therapeutic approach to treatment of osteoarthritis of the knee that does not lead to improvement of quadriceps muscle function. Because there is evidence that quadriceps sensorimotor dysfunction is important not only for the disability in osteoarthritis of the knee, but also for progression of the disease, knee function may be worsened by high tibial osteotomy in some patients.
Clinical Orthopaedics and Related Research 07/2002; · 2.53 Impact Factor
