W Rüther

University Medical Center Hamburg - Eppendorf, Hamburg, Hamburg, Germany

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Publications (248)429.78 Total impact

  • Osteoarthritis and Cartilage 04/2015; 23:A290. DOI:10.1016/j.joca.2015.02.527 · 4.17 Impact Factor
  • J. Bertrand · T. Gronau · I. Leifert · T. Pap · W. Rüther
    Osteoarthritis and Cartilage 04/2015; 23:A138. DOI:10.1016/j.joca.2015.02.875 · 4.17 Impact Factor
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    ABSTRACT: The purpose of our study was to analyze the distribution of the major extracellular matrix glycosaminoglycan hyaluronan (HA), its receptor CD44 and cells which influence (re)modeling of the extracellular matrix (T- and B-cells, macrophages, endothelial cells) in menisci obtained from patients suffering from rheumatoid arthritis or osteoarthritis in order to analyze whether these markers could be useful to differentiate between both arthropathies. Human menisci were sampled from patients undergoing total knee arthroplasty. Histological staining (H&E, PAS/Alcian Blue for neutral and charged carbohydrate residues) and (immuno)histochemistry were performed for detection of HA, CD44, sphingosine-1-phosphate receptor 1 (EDG-1) as a marker for endothelial cells, CD3 as a marker for T-cells, CD20 as a marker for B-cells and CD68 as a marker for macrophages. The extracellular matrix in the vascularized zone showed higher amounts of HA as well as acid carbohydrate residues in comparison to the poorly vascularized zones of the meniscus in both disease entities. EDG-1 positive endothelial cells were present in all zones, with fewer cells being detected in the inner zones of the rheumatoid menisci than in the osteoarthritic ones. Macrophages, T- and B-cells as well as CD44-positive cells were more prominent in the vascularized zone of the meniscus than in the poorly vascularized central zone. The distribution patterns of the extracellular matrix components as well as the CD44-positive cells and the inflammation markers in the peripheral zone resembled the distribution in synovial tissue, indicating that both synovia and meniscus were involved in pathological changes in osteoarthritis and rheumatoid arthritis. the distribution of extracellular glycoconjugates and of cells modulating their synthesis showed similar results in both arthropathies, not enabling a differentiation between rheumatoid arthritis and osteoarthritis but underlining the role of these markers in inflammation and degradation in human meniscus. Copyright © 2015 Elsevier GmbH. All rights reserved.
    Acta histochemica 03/2015; 117(3). DOI:10.1016/j.acthis.2014.12.009 · 1.71 Impact Factor
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    ABSTRACT: Enhanced wear resistance of ceramics in general and improved mechanical characteristics of composite ceramics in terms of strength and resistance meet the demands for application in TKA. The aim of this prospective international multi-centre study was to evaluate the 5-year clinical and radiological outcomes of an unconstrained TKA with a composite ceramic femoral component. A total of 107 patients (109 knees) underwent TKA with the MULTIGEN-PLUS Ceramic Knee at seven centres in three European countries. Clinical and radiological assessments were performed preoperatively and postoperatively at 3, 12, 24 and 60months, using HSS, WOMAC, SF-36 and standardised radiographs. Mean HSS and WOMAC increased significantly from 55.1±11.5 (21-83) and 48.1±16.6 (3-90) preoperatively to 85.6±9.6 (49-98) and 73.3±20.4 (17-100) at 60months. Mean SF-36 showed significant improvements in patients' quality of life (49.1±17.6 (12-96) preoperatively versus 67.7±23.1 (12-100) at 60months). Non-progressive radiolucent lines (<1mm) were observed around the femoral component in four cases. Neither implant migration nor loosening were registered. Kaplan-Meier survivorship was 96.0% at 60months (92.1-100%, CI 95%). Five-year implant survival rate of the ceramic knee is comparable to other metallic and ceramic unconstrained TKA systems. Although the assessment of long-term implant survivorship is still pending, the ceramic implants represent a promising solution for patients with allergies against metallic components and furthermore for the general osteoarthritis population due to enhanced wear resistance. Copyright © 2015 Elsevier B.V. All rights reserved.
    The Knee 03/2015; 22(3). DOI:10.1016/j.knee.2015.02.003 · 1.94 Impact Factor
  • M Seller · S Kahl · S Seitz · W Rüther
    Zeitschrift für Rheumatologie 12/2014; 74(4). DOI:10.1007/s00393-014-1517-6 · 0.61 Impact Factor
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    ABSTRACT: This extended classification of joint implant related pathology is a practical histopathologic classification based on defined morphological criteria covering the complete spectrum of pathohistologic changes in periprosthetic tissues. These changes may occur as a consequence of endoprosthetic replacement of large joints and may lead to a reduction in the prosthesis survival rate. We describe the established consensus classification of the periprosthetic membrane, in which aseptic and septic prosthetic loosening can be subdivided into four histological types, as well as histopathological criteria for additional significant pathologies including endoprosthetic-associated arthrofibrosis, particle-induced immunological, inflammatory and toxic mechanisms (adverse reactions), and bone tissue pathologies. These characteristic tissue alterations and their relationships are summarized in the extended classification. Since particle heterogeneity in periprosthetic tissue is high and particle identification is a necessary part of diagnosis, the identification of different types of particles is described in the histopathological particle algorithm. The morphological qualities of prosthetic material particles and the demarcation between abrasion and non-abrasion endogenous particles are also summarized. This feasible classification which is based on low cost standard tissue processing and examination and on well-defined diagnostic criteria is a solid platform for the histological diagnosis of implant associated pathologies providing a stable and reproducible tool for the surgical pathologist. Since this classification is suitable for standardized histopathological diagnostics, it might also provide a useful data set for joint arthroplasty registers, particularly for registers based on so-called routine data.
    Pathology - Research and Practice 12/2014; 210(12). DOI:10.1016/j.prp.2014.09.017 · 1.40 Impact Factor
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    ABSTRACT: The term rapid destructive hip disease (RDHD) designates a rare coxarthropathy characterized by a rapid destruction of the femoral head within a few weeks to several months. The etiology and pathogenesis of RDHD are not understood. The goal of this study was to define the histological and histomorphometric hallmarks of RDHD to provide a basis for a deeper understanding of the underlying mechanisms. Fifteen consecutive RDHD patients (mean age 78.9 ± 6.4 years, 14 females) demonstrated the characteristic radiographic appearance of vanishing femoral head bone stock without signs of reactive anabolic changes. Histologic and histomorphometric analyses revealed severe bone resorption with significantly increased numbers of morphologically altered giant osteoclasts, the formation of giant cell granulomas both in bone marrow and the synovium and significantly increased osteoblast numbers and osteoid as compared to controls with primary osteoarthritis (OA). These results suggest that in RDHD, an unknown stimulus leads to a massive activation of osteoclasts and this in turn provokes a reactive increase in osteoblast activity that is too weak to counteract the rapid destruction of the hip, thus providing a rationale for a prospective systematic search for the stimuli upstream of the massively increased osteoclast activation in RDHD. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
    Journal of Orthopaedic Research 05/2014; 32(5). DOI:10.1002/jor.22573 · 2.99 Impact Factor
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    ABSTRACT: Chronic environmental fluoride exposure under calcium stress causes fragility fractures due to osteoporosis and bone quality deterioration, at least in sheep. Proof of skeletal fluorosis, presenting without increased bone density, calls for a review of fracture incidence in areas with fluoridated groundwater, including an analysis of patients with low bone mass. Understanding the skeletal effects of environmental fluoride exposure especially under calcium stress remains an unmet need of critical importance. Therefore, we studied the skeletal phenotype of sheep chronically exposed to highly fluoridated water in the Kalahari Desert, where livestock is known to present with fragility fractures. Dorper ewes from two flocks in Namibia were studied. Chemical analyses of water, blood and urine were executed for both cohorts. Skeletal phenotyping comprised micro-computer tomography (μCT), histological, histomorphometric, biomechanical, quantitative backscattered electron imaging (qBEI) and energy-dispersive X-ray (EDX) analysis. Analysis was performed in direct comparison with undecalcified human iliac crest bone biopsies of patients with fluoride-induced osteopathy. The fluoride content of water, blood and urine was significantly elevated in the Kalahari group compared to the control. Surprisingly, a significant decrease in both cortical and trabecular bones was found in sheep chronically exposed to fluoride. Furthermore, osteoid parameters and the degree and heterogeneity of mineralization were increased. The latter findings are reminiscent of those found in osteoporotic patients with treatment-induced fluorosis. Mechanical testing revealed a significant decrease in the bending strength, concurrent with the clinical observation of fragility fractures in sheep within an area of environmental fluoride exposure. Our data suggest that fluoride exposure with concomitant calcium deficit (i) may aggravate bone loss via reductions in mineralized trabecular and cortical bone mass and (ii) can cause fragility fractures and (iii) that the prevalence of skeletal fluorosis especially due to groundwater exposure should be reviewed in many areas of the world as low bone mass alone does not exclude fluorosis.
    Osteoporosis International 04/2014; 25(7). DOI:10.1007/s00198-014-2707-4 · 4.17 Impact Factor
  • S. Seitz · W. Rüther
    Aktuelle Rheumatologie 04/2014; 39(02):96-99. DOI:10.1055/s-0034-1367070 · 0.06 Impact Factor
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    ABSTRACT: A number of unexpected molecules were recently identified as products of osteoblasts, linking bone homeostasis to systemic energy metabolism. Here we identify the lipolytic enzyme hepatic lipase (HL, encoded by Lipc) as a novel cell-autonomous regulator of osteoblast function. In an unbiased genome-wide expression analysis, we find Lipc to be highly induced upon osteoblast differentiation, verified by quantitative Taqman analyses of primary osteoblasts in vitro and of bone samples in vivo. Functionally, loss of HL in vitro leads to increased expression and secretion of osteoprotegerin (OPG), while expression of some osteoblast differentiation makers is impaired. When challenging energy metabolism in a diet-induced obesity (DIO) study, lack of HL leads to a significant increase in bone formation markers and a decrease in bone resorption markers. Accordingly, in the DIO setting, we observe in Lipc(-/-) animals but not in wild-type controls a significant increase in lumbar vertebral trabecular bone mass and formation rate as well as in femoral trabecular bone mass and cortical thickness. Taken together, we demonstrate that HL expressed by osteoblasts has an impact on osteoblast OPG expression and that lack of HL leads to increased bone mass in DIO. These data provide a novel and completely unexpected molecular link in the complex interplay of osteoblasts and systemic energy metabolism.
    Bone 01/2014; 62. DOI:10.1016/j.bone.2014.01.001 · 3.97 Impact Factor
  • T R Liebs · L Nasser · W Herzberg · W Rüther · J Hassenpflug
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    ABSTRACT: Several factors have been implicated in unsatisfactory results after total hip replacement (THR). We examined whether femoral offset, as measured on digitised post-operative radiographs, was associated with pain after THR. The routine post-operative radiographs of 362 patients (230 women and 132 men, mean age 70.0 years (35.2 to 90.5)) who received primary unilateral THRs of varying designs were measured after calibration. The femoral offset was calculated using the known dimensions of the implants to control for femoral rotation. Femoral offset was categorised into three groups: normal offset (within 5 mm of the height-adjusted femoral offset), low offset and high offset. We determined the associations to the absolute final score and the improvement in the mean Western Ontario and McMaster Universities osteoarthritis index (WOMAC) pain subscale scores at three, six, 12 and 24 months, adjusting for confounding variables. The amount of femoral offset was associated with the mean WOMAC pain subscale score at all points of follow-up, with the low-offset group reporting less WOMAC pain than the normal or high-offset groups (six months: 7.01 (sd 11.69) vs 12.26 (sd 15.10) vs 13.10 (sd 16.20), p = 0.006; 12 months: 6.55 (sd 11.09) vs 9.73 (sd 13.76) vs 13.46 (sd 18.39), p = 0.010; 24 months: 5.84 (sd 10.23) vs 9.60 (sd 14.43) vs 13.12 (sd 17.43), p = 0.004). When adjusting for confounding variables, including age and gender, the greatest improvement was seen in the low-offset group, with the normal-offset group demonstrating more improvement than the high-offset group. Cite this article: Bone Joint J 2014;96-B:36-42.
    Bone and Joint Journal 01/2014; 96(1):36-42. DOI:10.1302/0301-620X.96B1.31530 · 1.96 Impact Factor
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    ABSTRACT: When it comes to endoprosthesis pathologies, for example implant-allergic/toxic problems, as a cause of implant failure, particle identification has an important role to play in the histopathological diagnostics of the neosynovial/periprosthetic membrane (synovial-like interface membrane, SLIM). The variability of materials in endoprosthetics and differences in particle pathogenesis explain the particle heterogeneity that hampers the diagnostic identification of particles. For this reason, a histopathological particle algorithm has been developed that, with minimal methodical complexity, offers a guide to particle identification. Light microscopic-morphological as well as enzyme-histochemical characteristics and polarization-optical proporties have been defined. Particles are characterized in accordance with a dichotomous principle. Based on these criteria, identification and validation of the particles was carried out in 105 joint endoprosthesis pathological cases. A particle score is proposed that summarizes the most important information for the orthopedist.
    Seminars in Arthroplasty 01/2014; 24(4). DOI:10.1053/j.sart.2014.01.013
  • 12/2013; 4(4). DOI:10.1007/s12570-013-0179-1
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    ABSTRACT: Ceramic components in total knee arthroplasty (TKA) are evolving. We analyze the first case of BIOLOX delta ceramic femoral component fracture. A longitudinal midline fracture in the patellar groove was present, with an intact cement mantle and no bony defects. Fractographic analysis with laser scanning microscopy and white light interferometry showed no evidence of arrest lines, hackles, wake hackles, material flaws, fatigue or crack propagation. Analysis of periprosthetic tissues with Fourier-transform infrared (FT-IR) microscopy, contact radiography, histology, and subsequent digestion and high-speed centrifugation did not show ceramic debris. A macrophage-dominated response was present around polyethylene debris. We conclude that ceramic femoral component failure in this case was related to a traumatic event. Further research is needed to determine the suitability of ceramic components in TKA.
    The Journal of arthroplasty 11/2013; 29(5). DOI:10.1016/j.arth.2013.11.003 · 2.67 Impact Factor
  • Andreas Niemeier · Björn Behrmann · Bernd Fink · Wolfgang Rüther
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    ABSTRACT: Hintergrund Zu den Ergebnissen der Schulterendoprothetik im Langzeitverlauf bei Patienten mit rheumatoider Arthritis (RA) ist wenig bekannt. Das Ziel dieser Studie war die Evaluation der Ergebnisse nach zementiertem Oberflächenersatz des proximalen Humerus als Hemiprothese bei Patienten mit RA nach mindestens 10 Jahren postoperativ. Patienten und Methoden Im Zeitraum 1997–2000 wurden 42 zementierte Oberflächenersatz-Hemiprothesen bei 35 Patienten (Durchschnittsalter 61 Jahre) implantiert und in eine prospektive Verlaufsbeobachtungsstudie mit Follow-up nach 3, 12, > 60 und > 120 Monaten eingeschlossen. Nach 131 ± 21 Monaten konnten 16 Schultern (14 Patienten, Durchschnittsalter 70,9 Jahre) radiologisch und klinisch mittels Constant Murley Score (CMS) evaluiert werden. Sieben Patienten waren nicht reisefähig und wurden mittels CMS-Selbstevaluationsbogen sowie übermittelten Röntgenaufnahmen radiologisch erfasst. Ergebnisse Der mittlere CMS betrug 62,6 ± 10,6 Punkte (präoperativ 20,8 ± 8,3). Mit dem Behandlungsergebnis „zufrieden“ oder „sehr zufrieden“ waren 88 % der Patienten. Radiologisch zeigte sich eine deutliche Zunahme der proximalen Migration des Drehzentrums sowie der zentralen Glenoidarrosion (Glenoidtiefe). Die radiologischen Veränderungen korrelierten weder mit dem CMS noch mit der subjektiven Patientenzufriedenheit. Schlussfolgerung Der zementierte Oberflächenersatz des proximalen Humerus als Hemiprothese stellt für ältere Patienten mit RA der Schulter eine sinnvolle Versorgungsoption dar.
    Obere Extremität 09/2013; 8(3):150-156. DOI:10.1007/s11678-013-0219-z
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    ABSTRACT: Die Pathophysiologie der palmaren Fibromatose (Morbus Dupuytren) ist bis heute nicht vollständig verstanden. In den meisten Fällen jedoch können reaktive und reparative Prozesse des sehnenartigen Gewebes klinisch und histopathologisch ausgeschlossen werden. Vorgestellt wird der Fall eines 62-jährigen Patienten, bei dem eine palmare Fibromatose diagnostiziert wurde, nachdem es durch die Zerstörung einer 30 Jahre zuvor implantierten Silikonspacerprothese des Os lunatum zur Ausbildung eines Silikonoms kam. Obwohl Silikonabriebpartikel deutlich distal der ursprünglichen Lokalisation des Lunatumsilikonspacers histologisch identifiziert werden konnten, zeigte das resezierte Gewebe der Palmaraponeurose morphologische Befunde wie bei einer palmaren Fibromatose mit starken degenerativen Veränderungen. Diskutiert werden soll dieser Fall vor dem Hintergrund der aktuell verfügbaren Literatur zum Morbus Dupuytren.
    Der Orthopäde 08/2013; 42(8). DOI:10.1007/s00132-013-2137-6 · 0.36 Impact Factor
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    C von Domarus · F T Beil · S Seitz · W Rüther · J Zustin
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    ABSTRACT: The pathophysiological mechanisms of palmar fibromatosis (Dupuytren's contracture) are still not yet fully understood. In the vast majority of cases, however, reactive changes and reparative processes of tendon tissue can easily be ruled out by clinical and histopathological investigations. This article presents the case of a 62-year-old male patient suffering from palmar fibromatosis associated with a failed silicon spacer of the lunate bone 30 years after index surgery. Although silicon wear particles were observed in distal locations, proximal tendon tissues showed changes consistent with a degenerative palmar fibromatosis in the absence of a pathological wear reaction. The findings are discussed in the light of the current literature on Dupuytren's contracture.
    Der Orthopäde 06/2013; · 0.36 Impact Factor
  • B Fink · A Niemeier · W Rüther
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    ABSTRACT: Cup resurfacing of the humeral head is one of the possible prosthetic solutions for severe destruction of the glenohumeral joint. Because neurological complications are not uncommon after total shoulder arthroplasty using surface replacement, these cups are indicated when hemiarthroplasty is possible. The advantages of humeral head resurfacing are bone preservation and the technically easy exchange if revision is necessary; therefore, young patients are candidates for this type of endoprosthesis. At present humeral head resurfacing is indicated for osteoarthritic destruction of Walch types A1 and C, for rheumatic destruction with deficient cuff in younger patients, cuff arthropathy in younger patients with Seebauer types 1A and 1B, humeral head necrosis with normal glenoid and necrotic bone in less than one third of the humeral head and dislocation arthropathy in younger patients.
    Der Orthopäde 05/2013; 42(7). DOI:10.1007/s00132-012-2019-3 · 0.36 Impact Factor
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    ABSTRACT: We investigated whether an asymmetric extension gap seen on routine post-operative radiographs after primary total knee replacement (TKR) is associated with pain at three, six, 12 and 24 months' follow-up. On radiographs of 277 patients after primary TKR we measured the distance between the tibial tray and the femoral condyle on both the medial and lateral sides. A difference was defined as an asymmetric extension gap. We considered three groups (no asymmetric gap, medial-opening and lateral-opening gap) and calculated the associations with the Western Ontario and McMaster Universities osteoarthritis index pain scores over time. Those with an asymmetric extension gap of ≥ 1.5 mm had a significant association with pain scores at three months' follow-up; patients with a medial-opening extension gap reported more pain and patients with a lateral-opening extension gap reported less pain (p = 0.036). This effect was still significant at six months (p = 0.044), but had lost significance by 12 months (p = 0.924). When adjusting for multiple cofounders the improvement in pain was more pronounced in patients with a lateral-opening extension gap than in those with a medial-opening extension gap at three (p = 0.037) and six months' (p = 0.027) follow-up. Cite this article: Bone Joint J 2013;95-B:472-7.
    Bone and Joint Journal 04/2013; 95-B(4):472-7. DOI:10.1302/0301-620X.95B4.31080 · 1.96 Impact Factor
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    ABSTRACT: Object: Disc-related disorders such as herniation and chronic degenerative disc disease (DDD) are often accompanied by acute or chronic pain. Different mediators have been identified in the development of radicular pain and DDD. Previous studies have not analyzed individual cytokine profiles discriminating between acute sciatic and chronic painful conditions, nor have they distinguished between different anatomical locations within the disc. The aim of this study was to elucidate the protein biochemical mechanisms in DDD. Methods: The authors determined expression levels of matrix metalloproteinase-3, transforming growth factor-β (TGF-β), tumor necrosis factor-α, interleukin-1α, and pro-substance P using enzyme-linked immunosorbent assay and Western blot analyses in patients suffering from DDD (n = 7), acute back pain due to herniated discs with radiculopathy (n = 7), and a control group (n = 7). Disc tissue samples from the anulus fibrosus (AF) and nucleus pulposus (NP) were analyzed. Statistical analysis was performed using nonparametric tests. Results: A distinct distribution of cytokines was found in different anatomical regions of intervertebral discs in patients with DDD and herniated NP. Increased TGF-β levels were predominantly found in DDD. Matrix metalloproteinase-3 was increased in acute herniated disc material. Increased levels of substance P were found in patients suffering from DDD but not in patients with disc herniation. The data showed significantly higher levels of proinflammatory cytokines in the AF and NP of patients with DDD, and the expression levels in the AF were even higher than in the NP, suggesting that the inflammatory response initiates from the AF. Conclusions: These results highlight the complex mechanisms involved during disc degeneration and the need to distinguish between acute and chronic processes as well as different anatomical regions, namely the AF and NP. They also highlight potential problems in disc nucleus replacement therapies because the results suggest a biochemical link between AF and NP cytokine expression.
    Journal of neurosurgery. Spine 03/2013; 18(5). DOI:10.3171/2013.1.SPINE12483 · 2.38 Impact Factor

Publication Stats

2k Citations
429.78 Total Impact Points


  • 1997–2015
    • University Medical Center Hamburg - Eppendorf
      • Department of Orthopaedics
      Hamburg, Hamburg, Germany
  • 2013–2014
    • University Medical Center Schleswig-Holstein
      Kiel, Schleswig-Holstein, Germany
    • Orthopädische Klinik Markgröningen
      Ludwigsburg, Baden-Württemberg, Germany
  • 2011–2013
    • University Hospital Magdeburg
      Magdeburg, Saxony-Anhalt, Germany
    • Asklepios Klinikum Bad Abbach
      Abach, Bavaria, Germany
  • 1997–2013
    • University of Hamburg
      • Department of Orthopaedics
      Hamburg, Hamburg, Germany
  • 2003–2011
    • Schön Klinik Bad Bramstedt
      Chiemsee, Bavaria, Germany
    • Orthopädische Universitätsklinik Friedrichsheim
      Frankfurt, Hesse, Germany
  • 2010
    • University of Rostock
      • Orthopädische Klinik und Poliklinik
      Rostock, Mecklenburg-Vorpommern, Germany
  • 2006
    • Evangelisches Waldkrankenhaus Spandau
      Berlin, Germany
  • 2004
    • Universitätsklinikum Schleswig - Holstein
      Kiel, Schleswig-Holstein, Germany
    • Charité Universitätsmedizin Berlin
      • Institute of Pathology
      Berlin, Land Berlin, Germany
  • 1995–2003
    • Heinrich-Heine-Universität Düsseldorf
      • Orthopädische Klinik
      Düsseldorf, North Rhine-Westphalia, Germany
  • 2001
    • Aarhus University Hospital
      Aarhus, Central Jutland, Denmark