-
V Krenn,
L Morawietz,
H Kienapfel,
R Ascherl,
G Matziolis,
J Hassenpflug,
M Thomsen,
P Thomas,
M Huber,
C Schuh,
D Kendoff,
D Baumhoer,
M G Krukemeyer,
G Perino,
J Zustin,
I Berger, W Rüther,
C Poremba,
T Gehrke
[show abstract]
[hide abstract]
ABSTRACT: The revised classification of the periprosthetic membrane (synovial-like interface membrane SLIM) encompasses all pathological alterations which can occur as a result of endoprosthetic replacement of major joints and lead to a reduction in durability of prostheses. This also includes the established consensus classification of SLIM by which aseptic and septic prosthetic loosening can be subdivided into four histological types and histopathological criteria for additional pathologies: endoprosthesis-associated arthrofibrosis, immunological/allergic alterations and osseous pathologies. This revision represents the foundation for the histopathological diagnostics of the total spectrum of diseases associated with joint prostheses, is a suitable basis for a standardized diagnostic procedure and etiological clarification of endoprosthesis failure and also as a data standard for endprosthesis registers, in particular for registers based on routine data (e.g. German endoprosthesis register).
Zeitschrift für Rheumatologie 02/2013; · 0.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Der endoprothetische Schultergelenkersatz gehört heute zum Standardrepertoire der chirurgischen Versorgungsoptionen schwerer
Schultergelenkerkrankungen. Fortgeschrittene primäre und sekundäre Omarthrosen können in der Regel sehr erfolgreich durch
Schultergelenkendoprothesen behandelt werden. Die Indikation zur Operation beruht auf schmerzhafter Bewegungseinschränkung,
konsekutivem Funktionsverlust der Extremität sowie häufig ausgeprägten Ruheschmerzen. In den meisten Fällen, insbesondere
bei Patienten mit rheumatoider Arthritis, ist der Schmerz das wesentliche Kriterium für die Indikationsstellung. Die präoperativen
Schmerzen werden durch den Eingriff wesentlich reduziert bis dauerhaft eliminiert. Auch bei Rheumakranken mit deutlichen strukturellen
Schäden des Gelenks und Defekten der Rotatorenmanschette kann die Funktionsfähigkeit durch den Eingriff deutlich verbessert
werden. Es stehen verschiedene Prothesentypen zur Verfügung, die in Abhängigkeit von Alter, Funktionsanspruch, Ätiologie der
Schultererkrankung sowie vorbestehenden strukturellen Schäden insbesondere der Rotatorenmanschette und des Glenoids sorgfältig
differenzialindikatorisch in Erwägung gezogen werden sollten.
Shoulder arthroplasty has become an essential component of the standard surgical repertoire for the treatment of severe primary
and secondary glenohumeral arthritis and has been shown to provide reliable long-term pain relief with satisfactory functional
results. In most cases, in particular in patients with rheumatoid arthritis (RA), the indications for arthroplasty are primarily
based on pain, which often includes severe pain at rest. Despite poor bone stock and impaired soft tissue quality in RA which
frequently results in massive, irreparable rotator cuff tears, shoulder arthroplasty has been shown to be an effective means
of improving shoulder function. Several different types of prostheses are now available for different indications determined
by age, functional demand, etiology and structural deficits. For optimal outcome, the most suitable type of prosthesis needs
to be selected by an experienced shoulder surgeon who is familiar with the entire spectrum of treatment options.
SchlüsselwörterSchulterprothese–Oberflächenersatz–Anatomische Schulterprothese–Inverse Schulterprothese–Rheumatoide Arthritis
KeywordsTotal shoulder prosthesis–Humeral head resurfacing–Anatomical total shoulder replacement–Reverse shoulder arthroplasty–Rheumatoid arthritis
Zeitschrift für Rheumatologie 05/2012; 70(5):380-387. · 0.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Bei 85–100% der Patienten mit rheumatoider Arthritis (RA) besteht eine Fußbeteiligung. Stadienhaft kommt es im Verlauf zu
charakteristischen Fehlstellungen unterschiedlicher anatomischer Strukturen. Hierbei sind Faktoren zu unterscheiden, die von
anderen Regionen (Knie) aus Einfluss haben und solche, die direkt an den Fußgelenken wirken (Synovialitis), wobei meist negative
Wechselwirkungen bestehen, nach denen immer zu forschen ist. Lokal treten im Frühstadium schmerzhafte Gelenkergüsse auf, die
knorpelzerstörend wirken („stiff-type“), aber auch Bänder und Kapseln destruieren („loose-type“). Zusätzliche Beachtung verdienen
die medial und lateral hinter den Malleoli ziehenden Sehnen, die mit fatalen Auswirkungen insuffizient oder zerstört werden
können. Die Verminderung der Gehstrecke, Schmerzen, Instabilitätsgefühl und erhebliche Schwierigkeiten bei der Schuhversorgung
beeinträchtigen die soziale Mobilität der Patienten. Das Talonavikulargelenk und die rheumatische Vorfußdestruktion stehen
vielfach im Vordergrund der Problematik. Neben der suffizienten Basistherapie sollten konservative Therapiemöglichkeiten der
rheumatischen Fußdeformität frühzeitig genutzt werden und sind bei operativem Vorgehen adjuvant hilfreich. Kenntnisse der
speziellen stadienadaptierten rheumaorthopädischen operativen Vorgehensweise am Fuß sind unabdingbar.
Rheumatoid arthritis is a systemic disease that often affects the foot and ankle (85%–100% of patients). There are characteristic
deformities in relation to the stage of disease. Clinical assessment of both lower limbs is important, since factors such
as valgus deformity of the knee can cause malposition of the foot and ankle. In the early stages, patients present with joint
effusion which causes destruction of the cartilage (“stiff type”) and distends ligaments and capsules (“loose type”). Medial
and lateral ankle tendons are destroyed and become insufficient. A reduction in walking distance, pain, instability and difficulties
with footwear lead to reduced quality of life. The talonavicular joint and rheumatoid forefoot destruction are in most cases
the central problem in the foot deformity. Adequate medical therapy of the rheumatic disease is mandatory. Conservative treatment
such as orthotic shoe devices should be used in the early stages and are concomitantly used after surgical treatment. Rheumatoid
arthritis is a systemic disease requiring careful, stage-specific perioperative management.
SchlüsselwörterFußdeformität–Rheumatoide Arthritis–Operative Therapie–Vorfußkorrektur–Rückfußarthrodese
KeywordsFoot deformity–Rheumatoid arthritis–Surgical treatment–Forefoot correction–Rearfoot arthrodesis
Zeitschrift für Rheumatologie 04/2012; 70(1):26-33. · 0.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Die primäre artikuläre synoviale Chondromatose ist eine monoartikuläre, gutartige, neoplastische und selbstlimitierende Erkrankung
der Synovialis mit metaplastischer Transformation subsynovialer Zellen in Knorpelzellen. Am häufigsten tritt die Erkrankung
am Kniegelenk auf, gefolgt von dem Befall des Ellenbogengelenks. Männer sind häufiger betroffen als Frauen. Die transformierten
synovialen Chondroblasten bilden kleine Inseln und Knoten aus Knorpel, die sich kontinuierlich vergrößern und im weiteren
Verlauf in die Gelenkhöhle geboren werden. Dort können die multiplen freien Gelenkkörper, ernährt durch die Synovia, weiter
wachsen, verkalken oder auch im Sinne einer enchondralen Ossifikation verknöchern. Die operative Therapie richtet sich nach
dem Stadium der Erkrankung: Besteht Aktivität in der Synovialis mit persistierender Knorpelbildung ist eine Gelenkkörperentfernung
mit radikaler Synovektomie erforderlich, in späten inaktiven Stadien ohne pathologische Veränderungen in der Synovialis ist
die Entfernung der freien Gelenkkörper ausreichend. Die maligne sarkomatöse Transformation ist selten, bereitet aber unter
Umständen Schwierigkeiten in der Abgrenzung zu einem benignen Verlauf.
Primary articular synovial chondromatosis is a benign, self-limiting neoplastic process in which hyaline cartilage nodules
form in the synovial tissue. The disease most frequently affects the knee in men, followed by the elbow. The basic feature
of this disease is a metaplastic maturation of the mesenchymal cells in the synovial membrane of a joint into cartilage. These
cells mature into chondroblasts and form small nodules of cartilage in the synovial membrane. These nodules subsequently enlarge
and detach to lie within the joint space. They become free within the joint as multiple small cartilaginous loose bodies nourished
by the synovial fluid. The chondrocytes in the loose bodies continue to multiply, and the loose bodies grow in diameter. Calcification
appears in the central zone of the loose bodies, and in some cases, enchondral ossification takes place. The operative therapy
depends on the stage of the disease: synovectomy with removal of chondral fragments if active intrasynovial disease is present,
and removal of the multiple chondral bodies alone in cases of late inactive disease with no synovial abnormalities. Malignant
transformation is unusual and can be difficult to distinguish from benign disease.
Der Orthopäde 04/2012; 38(6):511-519. · 0.51 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Die Beteiligung der Halswirbelsäule (HWS) im Rahmen der rheumatoiden Arthritis (RA) ist häufig und hat zunehmend an Bedeutung
gewonnen. Am Anfang steht dabei meist die isolierte atlantoaxiale Subluxation. Durch eine knöcherne Destruktion der Gelenke
kann es zu einer vertikalen Instabilität kommen. Eine Beteiligung der mittleren und unteren HWS wird als subaxiale Instabilität
bezeichnet. Neurologische Störungen können zu jedem Zeitpunkt der Erkrankung auftreten. Der Beginn der zervikalen Myelopathie
wird beim Rheumatiker aufgrund der zusätzlichen Manifestationen an Händen und Füßen leider häufig übersehen.Hat sich eine
Myelopathie bereits klinisch eindeutig manifestiert, so ist der weitere progressive Verlauf mit konservativen Mitteln nicht
mehr aufzuhalten.
Eine Operationsindikation besteht neben der beginnenden Myelopathie auch bei therapierefraktären Schmerzzuständen, sowie dem
radiologischen Nachweis einer progredienten Instabilität. Im Falle einer isolierten atlantoaxialen Subluxation kann die Fusion
auf dieses Segment beschränkt werden,was häufig einer weiteren rheumatischen Destruktion der HWS vorbeugt.
Im Falle einer vertikalen Instabilität oder einer subaxialen Beteiligung ist eine kraniozervikale Fusion notwendig.Dabei sollte
präoperativ sorgfältig nach einer potentiellen subaxialen Instabilität gefahndet werden. Lässt sich eine solche nachweisen,
ist die Fusion auf die gesamte HWS auszudehnen. Im Falle einer anhaltenden Weichteilkompression oder knöchernen ventralen
Raumforderung ist gelegentlich eine zusätzliche transorale Dekompression notwendig. Besteht bereits eine fortgeschrittene
neurologische Schädigung mit Verlust der Gehfähigkeit erhöhen sich die perioperative Morbidität und Mortalität erheblich.
Das vorrangige Ziel des betreuenden Arztes sollte deshalb die Vermeidung solcher fortgeschrittenen zervikalen Destruktionen
sein. Dies ist jedoch nur durch eine rechtzeitige und konsequente operative Behandlung möglich.
The involvement of the cervical spine in patients with rheumatoid arthritis (RA) is common,and has recently received growing
attention. In the early stage of the disease, there is an isolated atlantoaxial subluxation (AAS). With further progression,
osseous destruction of the joints can lead to vertical instability. While the involvement of the middle and lower cervical
spine can cause a subaxial instability, neurological deficits can occur at any time. The onset of cervical myelopathy in patients
with RA is often missed because of additional problems related to the hands and feet. If patients show clear symptoms of cervical
myelopathy, the progression of the disease cannot be stopped by conservative treatment.
Other indications for operative treatment are severe pain and radiological evidence of progressive instability. In the case
of an isolated AAS, fusion can be restricted to the C1/C2 segment. If there is evidence for vertical or subaxial instability,
an occipitocervical fusion has to be performed.
To avoid instability adjacent to the fusion, the surgeon must check for signs of potential subaxial instability. If this is
the case, fusion should include the entire cervical spine. Additional transoral decompression may be necessary when there
is persistent retrodental pannus or osseous compression by an irreducible transverse dislocation or cranial migration of the
dens. Non-ambulatory myelopathic patients are more likely to present severe surgical complications with limited prospects
of functional recovery. Therefore, it is important to avoid the development of severe cervical myelopathy by early surgical
intervention.
Der Orthopäde 04/2012; 31(12):1114-1122. · 0.51 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In der Literatur finden sich sehr unterschiedliche Komplikations- und Lockerungsraten von Hüftendoprothesen bei Patienten
mit Hüftkopfnekrose (HKN). Diese Schwankungen sind v. a. durch die inhomogene Zusammensetzung der Patientengruppen hinsichtlich
der Ätiologie der Hüftkopfnekrose bedingt. Untersucht man die Ergebnisse der Hüftendoprothesen für die verschiedenen HKN-Ätiologien
gesondert, so kristallisiert sich eine höhere Lockerungsrate bei steroidinduzierten Hüftkopfnekrosen und bei Hüftkopfnekrosen
mit einer biologischen und biomechanischen Knochenalteration (z. B. der renalen Osteopathie oder der Sichelzellanämie) heraus.
Grunderkrankungen, die einer Immunsuppression bedürfen und die Sichelzellanämie weisen höhere Infektionsraten von Hüftprothesen
auf. Somit spielt die Ätiologie der Hüftkopfnekrose eine entscheidende Rolle für Langzeitergebnisse von Hüftendoprothesen.
Moderne Zementiertechniken der 2. Generation und zementlose Hüfttotalendoprothesen scheinen bessere Ergebnisse zu liefern
als früher verwendete Prothesenmodelle bzw. Zementiertechniken. In einer prospektiven Studie konnten wir bisher 52 Druckscheibenprothesen
bei 45 Patienten mit Hüftkopfnekrosen und einem Mindestnachuntersuchungszeitraum von 2 (3,7 ± 1,6) Jahren postoperativ verfolgen.
Es ergab sich eine Versagerquote von 9,6 % (je eine aseptische Lockerung bei renaler Osteopathie und Alkoholismus sowie 3
Infektionen bei Alkoholismus und renaler Osteopathie). Zusätzlich zeigten 5 Prothesen (9,6 %) Röntgensäume von mindestens
2 mm Breite. Inwieweit dieses Prothesenmodell mit metaphysärer Fixierung gegenüber den herkömmlichen Stielprothesen bei den
jungen Hüftkopfnekrosepatienten Vorteile erbringen, müssen zukünftige Studien mit längeren Beobachtungszeiten zeigen.
In literature, the results of hip arthroplasty in patients with avascular osteonecrosis of the femoral head vary. The main
reason may be the nonhomogeneous patient groups concerning etiology of the femoral head necrosis (FHN). Analyzing the results
of hip endoprosthesis in relation to the etiology of FHN leads to the assumption that steroid-induced FHN and FHN with underlying
systemic bone diseases (renal osteodystrophy, sickle-cell hemoglobinopathy) have the highest loosening rates. Diseases with
immunosuppressive medication and sickle-cell hemoglobinopathy have the highest risk of joint infection. Therefore etiology
plays an important role in the long-term results of hip endoprostheses in FHN. Modern cement techniques of the second generation
and new non-cemented total hip endoprostheses seem to have better results than older prostheses and cement techniques. We
followed-up 52 non-cemented thrust plate prostheses in 45 patients with FHN, prospectively, for at least 2 years (3.7 ± 1.6
years). The revision rate was 9.6 % (two aseptic loosenings in one patient with renal osteodystrophy and one patient with
alcohol abuse, as well as three late infections in one patient with alcohol abuse and two patients with renal osteodystrophy).
Additionally, five prostheses showed radiologic lines of a minimum of 2 mm. Future studies with longer follow-up are needed
to find out whether these prosthetic designs with proximal fixation of the femoral component preserving the diaphysial bone
have advantages in young FHN patients.
Der Orthopäde 04/2012; 29(5):449-456. · 0.51 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Die periartikuläre Mineralisation ist eine Erkrankung, die häufig an den Schultergelenken, Knie- und Hüftgelenken und nur
selten an den Fingergelenken anzutreffen ist. Sie muss von der periartikulären Ossifikation unterschieden werden. Typische
Symptome sind akute Schmerzen und Schwellungen, welche nach 3–6 Monaten spontan reversibel sein können.
Wir berichten über einen Fall einer periartikulären Mineralisation am MCP-II-Gelenk der linken Hand einer 39-jährigen Patientin.
Das Röntgenbild zeigte die typischen opaken Verschattungen periartikulär. Die Symptome waren auf konservativem Weg nicht zu
beherrschen, sodass eine operative Entfernung der Mineralisation erfolgte. Die histologische und elektronenmikroskopische
Aufarbeitung der entfernten Mineralisationen zeigte Hydroxylapatit-Ablagerungen im periartikulären Gewebe in Verbindung mit
einer chondrogenen Metaplasie der Bindegewebszellen.
Postoperativ wurde die Patientin schnell beschwerdefrei.
Die Therapie der periartikulären Mineralisation ist im Regelfall konservativ, nur in Ausnahmefällen ist ein operatives Vorgehen
erforderlich. Die periartikuläre Mineralisation der Fingergelenke hat insbesondere differenzialdiagnostische Bedeutung, da
der akute Verlauf mit starken Schmerzen und Schwellungen z.B. dem der infektiösen Arthritis sehr ähnelt.
Periarticular mineralization is a clinical disorder, which is typically found at the shoulder, knee and hip joint and only
rarely diagnosed at the finger joints. Periarticular ossification is a different entity and has to be distinguished from periarticular
mineralization.
The typical symptoms of this disorder are pain and swelling of the joint that resolves spontaneously within 3–6 months.
We report on a case of periarticular mineralization of the metacarpophalangeal (MCP) joint of a 39-year-old woman. Diagnosis
was made by X-ray based on findings in the form of opaque mineralizations.
There was no pain relief with conservative treatment and operative treatment was performed. Histological and electron microscope
analysis of the mineralization showed hydroxyapatite crystals and chondrogenic metaplasia of the surrounding fibroblasts.
The patient was symptom-free soon after treatment.
Usually, the therapy of the periarticular mineralization is conservative; only exceptional cases with persistent pain and
swelling need operative treatment. Acute periarticular mineralization of the hand is rare and often misdiagnosed as infectious
arthritis.
Zeitschrift für Rheumatologie 04/2012; 67(4):327-331. · 0.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: HintergrundDie Meniskusdegeneration (MD), definiert als eine morphologische Veränderung der Faserknorpelstruktur, ist eine wichtige diagnostische
Fragestellung in der Orthopädie und Gegenstand versicherungsrelevanter Gutachten. Bislang liegen weder ein standardisiertes
Graduierungssystem noch ein immunhistochemischer Marker für die MD vor.
Material und MethodeIn einer retrospektiven Untersuchung wurde Meniskusgewebe von Patienten (n=60) immunhistologisch auf eine NITEGE-Expression
(G1-Fragment des Proteoglykans Aggrecan) analysiert. Die NITEGE-Expression wurde mit definierten Graden der Degeneration korreliert:
geringe (Grad0/1), mäßige (Grad2) oder schwergradige MD (Grad3).
ErgebnisseDas Auftreten extrazellulärer NITEGE-Ablagerungen zeigte bei MD vom Grad2 und 3 einen positiven Vorhersagewert und eine Spezifität
von 100%, wohingegen in Grad0/1 keine NITEGE-Ablagerungen detektiert werden konnten. Die Sensitivität beim Nachweis schwergradiger
MD betrug 55%. Positiv korrelierten das Auftreten extrazellulären NITEGE und der Degenerationsgrad, sowie das Patientenalter
und der Degenerationsgrad: Das Alter der Gruppe0/1 unterschied sich hochsignifikant von dem der Gruppe3 (p<0,0001).
SchlussfolgerungDas durch definierte Kriterien gekennzeichnete Graduierungssystem der MD (Grad1–3) eignet sich, um das Ausmaß der MD darzustellen.
Extrazelluläres NITEGE kann in Verbindung mit den Degenerationsgraden2 und 3 als ein immunhistochemischer Marker für die
fortgeschrittene, schwergradige MD angesehen werden.
BackgroundMeniscal degeneration (MD) is a structural change of fibrous cartilage that is common in orthopaedic diagnostics and relevant
for health insurance matters. So far, there has been neither a standardised scoring system nor an immunohistochemical marker
for MD.
Material and methodIn this retrospective trial, the meniscal tissue of 60patients was assessed immunohistochemically for NITEGE (G1 fragment
of the proteoglycan aggrecan) expression. NITEGE expression was correlated with defined grades of MD: little (grade0/1),
medium (grade2), or severe (grade3).
ResultsDetection of extracellular NITEGE deposits in grade2 or 3 MD had a positive predictive value and specificity of 100%, whereas
no deposits were found in grade0/1 MD. Sensitivity in advanced MD was 55%. Detection of extracellular NITEGE correlated positively
with the gradeof degeneration, as did patient age and the gradeof degeneration. The patient age of those with grade 0/1
MD was significantly lower than for grade3 (p<0.0001).
ConclusionThe thoroughly defined degeneration score (grade1 – grade3 MD) is suitable to assess the severity of degeneration. Extracellular
NITEGE deposits can be regarded as an immunohistochemical marker for advanced (grades2 and 3) MD.
SchlüsselwörterNITEGE-Aggrecan-Meniskus-Meniskusdegeneration-Marker
KeywordsNITEGE-Aggrecan-Meniscus-Meniscal degeneration-Marker
Der Orthopäde 04/2012; 39(5):475-485. · 0.51 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Basische Calciumphosphate (BCP) und Calciumpyrophosphatdihydrat (CPPD) sind die häufigsten pathologischen intraartikulären
Kristalle, gefolgt von Mononatriumuratkristallen (MNU) und, in sehr seltenen Fällen, Calciumoxalatkristallen. Diese Kristalle
sind die Ursache äußerst unterschiedlicher rheumatischer Gelenkpathologien. Sie sind in unterschiedlichem Maße verantwortlich
für akute oder chronische Gelenkentzündungen, Knorpelschädigungen und Knochenerosionen. Obwohl die molekularen Mechanismen,
die zu einer kristallinduzierten Gelenkzerstörung führen immer besser verstanden werden, ist die genaue Rolle der Kristalle
(insbesondere der BCP) nicht vollständig geklärt. Die klinische und pathologische Bedeutung der BCP bei Arthrose ist unbekannt.
Diese Arbeit soll einen Überblick über die unterschiedlichen klinischen und pathologischen Aspekte der unterschiedlichen Kristalle
liefern.
Basic calcium phosphate (BCP) and calcium pyrophosphate dihydrate crystals are the most common types of pathologic crystals,
followed by monosodium urate crystals and, in rare cases, calcium oxalate crystals. These crystals have been associated with
a variety of quite different rheumatic syndromes. They are responsible for acute synovial inflammation and also contribute
to cartilage degradation and bone lesions within the joint. Although understanding of the molecular mechanisms involved in
generating the pathologic effects of these crystals has increased, the role of BCP crystals in particular remains poorly understood.
The clinical implication of articular deposits of calcium-containing crystals in osteoarthritis is unknown. This review provides
an overview of the clinical and pathological changes of these four different types of crystals.
Der Orthopäde 04/2012; 38(6):501-510. · 0.51 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Shoulder arthroplasty has become an essential component of the standard surgical repertoire for the treatment of severe primary and secondary glenohumeral arthritis and has been shown to provide reliable long-term pain relief with satisfactory functional results. In most cases, in particular in patients with rheumatoid arthritis (RA), the indications for arthroplasty are primarily based on pain, which often includes severe pain at rest. Despite poor bone stock and impaired soft tissue quality in RA which frequently results in massive, irreparable rotator cuff tears, shoulder arthroplasty has been shown to be an effective means of improving shoulder function. Several different types of prostheses are now available for different indications determined by age, functional demand, etiology and structural deficits. For optimal outcome, the most suitable type of prosthesis needs to be selected by an experienced shoulder surgeon who is familiar with the entire spectrum of treatment options.
Zeitschrift für Rheumatologie 06/2011; 70(5):380, 382-7. · 0.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Crystal arthropathies represent a heterogenic group of skeletal diseases associated with the deposition of mineralised material within joints and periarticular soft tissues. Gout is the most common and pathogenetically best understood crystal arthropathy, followed by basic calcium phosphate and calcium pyrophosphate dihydrate deposition diseases, and, in very rare cases, calcium oxalate crystal arthropathy. These crystals are responsible for different rheumatic syndromes, including acute or chronic synovial inflammation, and also contribute to cartilage degeneration. This review gives an overview of the pathological and clinical changes of these arthropathies.
Der Pathologe 05/2011; 32(3):193-9. · 0.67 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Rheumatoid arthritis is a systemic disease that often affects the foot and ankle (85%-100% of patients). There are characteristic deformities in relation to the stage of disease. Clinical assessment of both lower limbs is important, since factors such as valgus deformity of the knee can cause malposition of the foot and ankle. In the early stages, patients present with joint effusion which causes destruction of the cartilage ("stiff type") and distends ligaments and capsules ("loose type"). Medial and lateral ankle tendons are destroyed and become insufficient. A reduction in walking distance, pain, instability and difficulties with footwear lead to reduced quality of life. The talonavicular joint and rheumatoid forefoot destruction are in most cases the central problem in the foot deformity. Adequate medical therapy of the rheumatic disease is mandatory. Conservative treatment such as orthotic shoe devices should be used in the early stages and are concomitantly used after surgical treatment. Rheumatoid arthritis is a systemic disease requiring careful, stage-specific perioperative management.
Zeitschrift für Rheumatologie 01/2011; 70(1):26-33. · 0.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate the interactions of chondrocyte metabolism by synovial cells and synovial supernatants in a new perfusion co-culture system.
Chondrocytes and synovial fibroblasts were obtained from knee joints of slaughtered adult cattle. For experimental studies chondrocytes and synovial fibroblasts were placed together into a perfusion chamber (co-culture) or were placed into two different perfusion culture containers, which were connected by a silicone tube (culturing of chondrocytes with synovial supernatants). A control setup was used without synovial cells. Chondrocyte proliferation was shown by measurement of DNA content. The proteoglycan synthesis was quantified using (35)SO(4)(2-)-labelling and the dimethylmethylene blue assay. (3)H-proline incorporation was used to estimate the protein biosynthesis. Type II collagen synthesis was measured by ELISA, furthermore extracellular matrix deposition was monitored immunohistochemically (collagen types I/II). Regarding to the role of reactive oxygen species LDH release before and after stimulation with hydrogen peroxide was measured.
The proliferation of chondrocytes shows an increase in monoculture as well as in co-culture or in culture with synovial supernatants more than fivefold within 12 days. (3)H-proline incorporation as a marker for chondrocytes biosynthetic activity decreases in co-culture system and in culture with synovial supernatants. A similar effect is seen measuring total proteoglycan content as well as the (35)SO(4)(2-) incorporation in chondrocytes. Co-culturing and culturing with synovial supernatants lead to a significant decrease of proteoglycan release and content. Quantification of collagen type II by ELISA shows significant lower amounts of native collagen type II in the extracellular matrix of co-cultured chondrocytes as well as in culture with synovial supernatants. The membrane damage of chondrocytes by hydrogen peroxide is reduced when chondrocytes are co-cultured with synovial fibroblasts.
The co-culture perfusion system is a new tool to investigate interactions of different cell types with less artificial interferences. Our results suggest that synovial supernatants and synovial fibroblasts modulate the biosynthetic activity and the matrix deposition of chondrocytes as well as the susceptibility to radical attack of reactive oxygen species.
Tissue and Cell 06/2010; 42(3):151-7. · 1.04 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Meniscal degeneration (MD) is a structural change of fibrous cartilage that is common in orthopaedic diagnostics and relevant for health insurance matters. So far, there has been neither a standardised scoring system nor an immunohistochemical marker for MD.
In this retrospective trial, the meniscal tissue of 60 patients was assessed immunohistochemically for NITEGE (G1 fragment of the proteoglycan aggrecan) expression. NITEGE expression was correlated with defined grades of MD: little (grade 0/1), medium (grade 2), or severe (grade 3).
Detection of extracellular NITEGE deposits in grade 2 or 3 MD had a positive predictive value and specificity of 100%, whereas no deposits were found in grade 0/1 MD. Sensitivity in advanced MD was 55%. Detection of extracellular NITEGE correlated positively with the grade of degeneration, as did patient age and the grade of degeneration. The patient age of those with grade 0/1 MD was significantly lower than for grade 3 (p<0.0001).
The thoroughly defined degeneration score (grade 1 - grade 3 MD) is suitable to assess the severity of degeneration. Extracellular NITEGE deposits can be regarded as an immunohistochemical marker for advanced (grades 2 and 3) MD.
Der Orthopäde 03/2010; 39(5):475-85. · 0.51 Impact Factor
-
M Fuerst,
J Bertrand,
L Lammers,
R Dreier,
F Echtermeyer,
Y Nitschke,
F Rutsch,
F K W Schäfer,
O Niggemeyer,
J Steinhagen,
C H Lohmann,
T Pap, W Rüther
[show abstract]
[hide abstract]
ABSTRACT: Hypertrophic chondrocyte differentiation is a key step in endochondral ossification that produces basic calcium phosphates (BCPs). Although chondrocyte hypertrophy has been associated with osteoarthritis (OA), chondrocalcinosis has been considered an irregular event and linked mainly to calcium pyrophosphate dihydrate (CPPD) deposition. The aim of this study was to determine the prevalence and composition of calcium crystals in human OA and analyze their relationship to disease severity and markers of chondrocyte hypertrophy.
One hundred twenty patients with end-stage OA undergoing total knee replacement were prospectively evaluated. Cartilage calcification was studied by conventional x-ray radiography, digital-contact radiography (DCR), field-emission scanning electron microscopy (FE-SEM), and synovial fluid analysis. Cartilage calcification findings were correlated with scores of knee function as well as histologic changes and chondrocyte hypertrophy as analyzed in vitro.
DCR revealed mineralization in all cartilage specimens. Its extent correlated significantly with the Hospital for Special Surgery knee score but not with age. FE-SEM analysis showed that BCPs, rather than CPPD, were the prominent minerals. On histologic analysis, it was observed that mineralization correlated with the expression of type X collagen, a marker of chondrocyte hypertrophy. Moreover, there was a strong correlation between the extent of mineralization in vivo and the ability of chondrocytes to produce BCPs in vitro. The induction of hypertrophy in healthy human chondrocytes resulted in a prominent mineralization of the extracellular matrix.
These results indicate that mineralization of articular cartilage by BCP is an indissociable process of OA and does not characterize a specific subset of the disease, which has important consequences in the development of therapeutic strategies for patients with OA.
Arthritis & Rheumatism 09/2009; 60(9):2694-703. · 7.87 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: For studies on matrix mineralization in osteoarthritis (OA), a clear analytical approach is necessary to identify and to quantify mineralization in the articular cartilage. The aim of this study is to develop an effective algorithm to quantify and to identify cartilage mineralization in the experimental setting. Four patients with OA of the knee undergoing total knee replacement and four control patients were included. Cartilage calcification was studied by digital contact radiography (DCR), field emission scanning electron microscopy (FE-SEM) X-ray element analysis and Raman spectroscopy (RS). DCR revealed mineralization in all OA cartilage specimens. No mineralization was observed in the control cartilage. Patient I showed rhomboid shaped crystals with a mean Ca:P molar ratio of 1.04 indicated the presence of calcium pyrophosphate dihydrate (CPPD) crystals, while Patients II, III and IV presented carbonate-substituted hydroxyapatite (HA). RS also showed the presence of CPPD crystals in Patient I while Patients II, III and IV revealed spectra confirming the presence of HA crystals. In the corresponding chondrocyte cell culture analyzed with SEM, the presence of CPPD crystals in the culture of Patient I and HA crystals in the culture of Patient II, III and IV was confirmed. No mineralization was found in the cell culture of the controls. The differentiation between BCP and CPPD crystals plays an important role, and the techniques presented here provide an accurate differentiation of these two types of crystals. For quantification of articular cartilage mineralization, DCR is a simple and accurate method.
Rheumatology International 08/2009; 30(5):623-31. · 1.88 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Basic calcium phosphate (BCP) and calcium pyrophosphate dihydrate crystals are the most common types of pathologic crystals, followed by monosodium urate crystals and, in rare cases, calcium oxalate crystals. These crystals have been associated with a variety of quite different rheumatic syndromes. They are responsible for acute synovial inflammation and also contribute to cartilage degradation and bone lesions within the joint. Although understanding of the molecular mechanisms involved in generating the pathologic effects of these crystals has increased, the role of BCP crystals in particular remains poorly understood. The clinical implication of articular deposits of calcium-containing crystals in osteoarthritis is unknown. This review provides an overview of the clinical and pathological changes of these four different types of crystals.
Der Orthopäde 07/2009; 38(6):501-10. · 0.51 Impact Factor
-
Der Orthopäde 07/2009; 38(6):483. · 0.51 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Primary articular synovial chondromatosis is a benign, self-limiting neoplastic process in which hyaline cartilage nodules form in the synovial tissue. The disease most frequently affects the knee in men, followed by the elbow. The basic feature of this disease is a metaplastic maturation of the mesenchymal cells in the synovial membrane of a joint into cartilage. These cells mature into chondroblasts and form small nodules of cartilage in the synovial membrane. These nodules subsequently enlarge and detach to lie within the joint space. They become free within the joint as multiple small cartilaginous loose bodies nourished by the synovial fluid. The chondrocytes in the loose bodies continue to multiply, and the loose bodies grow in diameter. Calcification appears in the central zone of the loose bodies, and in some cases, enchondral ossification takes place. The operative therapy depends on the stage of the disease: synovectomy with removal of chondral fragments if active intrasynovial disease is present, and removal of the multiple chondral bodies alone in cases of late inactive disease with no synovial abnormalities. Malignant transformation is unusual and can be difficult to distinguish from benign disease.
Der Orthopäde 06/2009; 38(6):511-9. · 0.51 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The objective of the present study was to investigate whether the sonographic visualization of lateralization of the femoral head is comparable to magnetic resonance imaging (MRI) and would therefore be able to contribute to the diagnosis of containment in patients with Perthes disease.
46 patients with unilateral Perthes disease (age: 5.9 +/- 2.3 years) of Catterall group III/IV were evaluated at first presentation by means of ultrasound (US) and MRI of both hip joints to evaluate the morphology of the acetabular lip (LA) and the epiphysis (EP). The diagnosis of containment was performed in MRI as well as in US by the protrusion and deformity of the epiphysis of the femoral head with cranialization of the labrum. The evaluation of the sonographic and MRI findings was carried out independently by three observers (high experience: 1, 2, low experience: 3). Statistical analysis was performed using Cohen's non-weighted kappa kappa (kappa > 0.75 very high level of correlation). The study was conducted in accordance with the recommendations of the local ethics committee that approved our study.
There was a high to very high agreement of the morphology of the LA and EP between observers 1 and 2 (MRI: LA: kappa = 0.87; EP: kappa = 0.90; US: LA kappa = 1.0; EP: kappa = 0.57). The comparison of observers 1 and 2 with observer 3 showed only a poor to acceptable level of agreement. US agreed well with MRI in the evaluation of the containment of the femoral head (1: kappa = 0.79; 2: kappa = 0.70, 3: kappa = 0.72).
The results of our study suggest that US is a reliable examination method for monitoring the containment of the femoral head in Perthes disease. The evaluation of both methods depends on the experience of the observer.
Ultraschall in der Medizin 12/2008; 29 Suppl 5:245-9. · 2.40 Impact Factor
