Reconstruction of mechanical leg axis using non-modular cemented hinged prosthesis in complex primary total knee arthroplasty.

PURPOSE: Modular cementless knee arthroplasty systems are capable of precise reconstruction of the mechanical axis. However, they are considered more susceptible to complications. In contrast, non-modular cemented systems are said to be more forgiving and show good long-term results. The aim of this study was to investigate the resulting leg axis after implantation of a non-modular cemented rotating hinged knee prosthesis. Furthermore, potential risk factors for the occurrence of malalignment and complications should be identified. METHODS: Between 2005 and 2015, 115 patients could be included in this monocentric retrospective cohort study. All patients underwent primary hinged non-modular cemented total knee arthroplasty. Preoperative and postoperative standardized long radiographs were analysed to determine resulting leg axis. Furthermore, epidemiological and intraoperative data as well as perioperative complications were surveyed. RESULTS: Average leg axis was 5.8° varus preoperatively and 0.6° valgus postoperatively. Considering an axis deviation of 3° as the target corridor, 27% of all cases examined were outside the desired range. 21% cases showed a femoral deviation from the target corridor and 15% showed a tibial deviation. There was a significant relationship between the preoperative mLDFA and the mechanical alignment of the femoral component (R = 0.396, p < 0.001) as well as between the preoperative mMPTA and the mechanical alignment of the tibial component (R = 0.187, p = 0.045). The mean operative duration was 96 min. No periprosthetic fractures were observed within the study cohort. CONCLUSION: The main result of the present work is that a non-modular cemented rotating hinged knee arthroplasty system can reconstruct the mechanical leg axis precisely and comparable to modular cementless and unconstrained total knee prostheses. Component malalignment is primarily dependent upon extraarticular deformity preoperatively. Periprosthetic fracture rates and duration of surgery were lower compared with current literature. LEVEL OF EVIDENCE: Level III: Retrospective cohort study.

Incidence of Secondary Osteoarthritis after Primary Shoulder and Knee Empyema and Its Risk Factors.

Empyema of the joint is an orthopedic emergency that is associated with a prolonged healing process despite adequate surgical and medical therapy. The risk of developing postinfectious osteoarthritis (OA) after successfully treated joint empyema is unknown. Both incidence and risk factors are important for prognostication and would therefore be clinically relevant for the selection of an adequate infectious therapy as well as for the individual follow-up of patients. The aim of this retrospective clinical study was to describe the risk of secondary OA after empyema based on knee and shoulder joint infections after successful primary infection treatment and its risk factors. Thirty-two patients were examined clinically and radiographically after completion of treatment for primary empyema of the knee or shoulder joint. Patients with previous surgery or injections in the affected joint were excluded from the study. The cumulative incidence of new-onset radiographic OA was 28.6%, representing a 5.5-fold increased risk of developing OA compared to the normal population. A figure of 25% of patients underwent total knee arthroplasty after knee empyema. Identified risk factors for primary empyema were obesity, hyperuricemia, and rheumatoid arthritis. Only about 60% of the patients tested positive for bacteria. Staphylococcus aureus, the most common pathogen causing joint empyema, was present in approximately 40% of cases. Secondary osteoarthritis, as a possible secondary disease after joint empyema, could be demonstrated and several risk factors for the primary empyema were identified.

Chondral/Desmal Osteogenesis in 3D Spheroids Sensitized by Psychostimulants.

Attention deficit hyperactivity disorder (ADHD) affects 6.4 million children in the United States of America. Children and adolescents, the main consumers of ADHD medication, are in the bone growth phase, which extends over a period of up to two decades. Thus, impaired proliferation and maturation of chondrocytes and osteoblasts can result in impaired bone formation. The aim of this study is to investigate, for the first time, the effects of the ADHD-medication modafinil, atomoxetine and guanfacine on bone growth and repair in vitro. Using two-dimensional and three-dimensional cell models, we investigated the chondrogenic/osteogenic differentiation, proliferation and viability of human mesenchymal progenitor cells. Real-time cell proliferation was measured by xCELLigence. Live/dead staining and size measurement of hMSC- and MG63 monolayer and spheroids were performed after administration of therapeutic plasma concentrations of modafinil, atomoxetine and guanfacine. Chondrogenic differentiation was quantified by RTqPCR. The chondrogenic and osteogenic differentiation was evaluated by histological cryo-sections. Modafinil, atomoxetine and guanfacine reduced chondrogenic and osteogenic differentiation terms of transcript expression and at the histological level. Cell viability of the MG63- and hMSC monolayer was not impeded by ADHD-medication. Our in vitro results indicate that modafinil, atomoxetine and guanfacine may impair chondrogenic and osteogenic differentiation in a 3D model reflecting the in vivo physiologic condition.

Mid-term results in revision hip arthroplasty with impaction bone grafted cup reconstruction for acetabular defects.

Acetabular defects are a challenging condition for surgeons in revision THA. A crucial aim is an anatomical restoration of the centre of rotation (COR) through grafts. The aim of this study was to determine the cup survival after biological restoration of acetabular defects in THA and the effect of Paprosky classification, age, BMI, and number of previous operations on cup survival. Retrospectively patients with a cup exchange and an impaction of cortico-cancellous or bulk grafts between 2009 and 2012 were included with a follow up with a minimum of 5 year. Implant failure was defined as radiographic loosening or explantation of the cup. The acetabular defect situation was classified to Paprosky. 82 patients (58 female 70.7%) were included. 26 patients were not available to contact. 56 patients (40 female 71.4%) remained for survival analysis with mean age of 75.6 ± 8 years. Survival of the cup after 5 years was 90% and after 7.8 years 88%. There was no difference in survival concerning defect classification, type of implant or graft, age, BMI, and number of previous operations. Patients on the follow up reached an HHS of 67.4 ± 19, a WOMAC Score of 33.4 ± 25.4 points and an unsatisfactory result in the SF-36. Impaction bone grafting of acetabular defects is a good option with satisfactory biomechanical results and survival for small defects. Predictive factors for cup survival could not be clarified in our study. So, the correct indication, knowing the limits of the methods and the correct choice of implant allow a defect-oriented approach and are decisive for the success of the operation.

Knee Arthrodesis Affects Gait Kinematics More in the Ankle Than in the Hip Joint.

Background and Objectives: No gold standard exists for treating persistent periprosthetic knee infections. Knee arthrodesis represents one treatment concept for extensive bone defects and extensor system insufficiencies. It has already been shown that knee arthrodesis leads to a significant reduction in one's quality of life. The aim of this survey was to assess the influence of knee arthrodesis on the neighboring joints on the basis of gait analysis data. Our hypothesis is that the hip and ankle joints are negatively influenced by knee arthrodesis in the process of walking. Materials and methods: We performed six pedobarographic and four gait analytical measurements in six patients 2.4 ± 1.6 years after receiving knee arthrodesis at the operating ages of 69.1 ± 9.2 years. Gait analysis consisted of time-distance parameters/minute (number of steps, double support, cycle time, standing phase, step length, gait speed). A healthy group of test subjects (n = 52) was included as the control cohort. Gait analysis was conducted using a three-dimensional movement system and three force-measuring platforms to determine the ground reaction force. Foot pressure was measured using a pedography platform. Results: Five of six patients presented an incomplete rolling movement over the toes on the side that was operated on, presenting with a gait line ending in the forefoot area. All of the patients bore less weight on the side that was operated on. Three of six patients demonstrated a pathological gait line with a healthy opposite side ending in the forefoot area. All of the patients exhibited a reduction in gait speed and step length and a lower number of steps. All of the patients had a prolonged double support/cycle time. Conclusions: Isolated knee arthrodesis is associated with reduced forefoot repulsion, restricted movement on the side receiving the operation, and reduced movement in the ankle/knee joint. The hip showed norm deviations in the hip moment/angle. Knee arthrodesis causes reduced gait kinetics/kinematics. Our survey shows that the relative joint moments of the ankle joint and hip are often reduced. The ankle joint is more affected compared to the hip.

Sex Differences in Serum C-Reactive Protein Course after Total Hip Arthroplasty.

BACKGROUND: Gender-specific medicine has become an important part in investigating the course of various diseases. C-reactive protein (CRP) is used as an inflammatory marker for detecting inflammations and even infections after total hip arthroplasty (THA). The general course of CRP after THA is well known, but there is controversy about its association with sex. Therefore, we aimed to investigate if there is an influence of sex on the CRP after THA in the first 10 days after operation in a complication-free course in male and female patients and to re-evaluate the specific postoperative CRP course with its maximum on the second to third postoperative days. METHODS: We retrospectively reviewed patients who had been treated with THA due to primary osteoarthritis through the same approach using an equal model of a cementless stem and a cup and complication-free between 2013 and 2016. Patients with active inflammation, rheumatoid arthritis, secondary arthrosis, active cancer disease, and documented postoperative complications were not included. The CRP values before THA and up to 10 days after THA were recorded and tested for sex discrepancy. Factor analyses were performed, and CRP values were adjusted for confounders (age, operation time, diabetes mellitus, and body mass index [BMI]). RESULTS: A total of 1,255 patients (728 women and 527 men) were finally analyzed. Men were younger and had a longer operation time and a higher BMI compared to women. The prevalence of overweight was higher in men, while obesity (BMI > 40 kg/m2), diabetes mellitus, renal failure, and American Society of Anaesthesiologists status showed no significant difference between men and women. Men had significantly higher CRP values than women between the 2nd and the 7th postoperative days, with the largest difference on the 4th postoperative day (men, 130.48 mg/L; women, 87.26 mg/L; p = 0.018). CONCLUSIONS: Based on the results of more precise sex-specific evaluation of the postoperative CRP course after THA, the present study showed for the first time that there was a gender discrepancy in the CRP course after complication-free THA in the first 7 postoperative days. Furthermore, this study confirmed the postoperative CRP course with its maximum on the third postoperative day.

Poor Outcome of Above-Knee Amputation after Septic Failure of Revision Total Knee Arthroplasty.

Persistent periprosthetic infection following total knee arthroplasty is one of the most dreaded complications of orthopaedic surgery. Treatment strategies include arthrodesis of the knee joint, stable fistula, long-lasting antibiotic therapy, or above-knee amputation. The advantage of amputation in comparison to other treatment options is the possible cure of infection, because the source of infection is removed and no foreign material left in situ. The aim of the study is to examine whether a septic amputation of the femur in case of persistent periprosthetic infection at the knee joint leads to the healing of the patient. Moreover, the physical and mental state should be evaluated. All patients with above-knee amputation because of periprosthetic joint infection after primary total knee arthroplasty between 2016 and 2018 were included in this retrospective study. A questionnaire with the clinical scores visual analog scale, modified Lysholm, Western Ontario and McMaster Universities Osteoarthritis Index and 36-Item Short Form Survey has been designed. In addition, all characteristics and perioperative data were documented. Eleven patients were included in the study. One patient died after above-knee amputation; all other patients live with a marked impairment of quality of life but with absence of the infection of the leg. Two out of ten are able to walk regularly with an exoprosthesis with forearm crutches, 50% are in a wheelchair, while 30% are bedridden. Patients with above-knee amputation after persistent periprosthetic infections were free of infection and without signs of inflammation. However, this is associated with worse mobility and high mortality rate.

Cytotoxic effect of sodium hypochlorite (Lavanox 0.08%) and chlorhexidine gluconate (Irrisept 0.05%) on human osteoblasts.

PURPOSE: Soft tissue, bone and joint infections are severe complications in orthopedic and traumatological surgery. Lavanox (0.08% NaOCl) and Irrisept (0.05% chlorhexidine gluconate, CHG) are industrially produced antiseptic solutions commonly used in infection treatment. Regarding this clinical indication, the microbicidal effect is often investigated, but toxicity to osteoblasts has rarely been examined. This is important to decide whether these solutions should be used in septic situations in which bone healing must take place. The hypothesis of the present study is that NaOCl and CHG are cytotoxic to osteoblasts even after a short exposure time. METHODS: Human osteoblasts were isolated from donors with osteoarthritis during total knee and hip arthroplasty. Cells were cultivated and treated with both antiseptic solutions for 2, 5 and 10 min in different dilutions. Toxicity was quantified by counting cells, lactate dehydrogenase (LDH) expression, spectrophotometric quantification via XTT assay and FDA/PI fluorescence microscopy. RESULTS: Analyzing viable cells after treatment with both antiseptics showed a significant decrease in viable cells through LDH expression test, XTT assay, fluorescence microscopy and light microscopy, depending on concentration. The time dependence showed a trend to more cell death at longer exposure times, without significance. CONCLUSION: Toxic effects on osteoblasts were shown after treatment with 0.08% NaOCl and 0.05% CHG after an exposure time of 2 min which also was concentration dependent. There was no difference in cytotoxicity between both antiseptics. In conclusion, these antiseptic solutions may be used with caution in situations requiring bone healing. Trial registration number Local ethics committee registration number: 5176-07/16.

Cones and sleeves present good survival and clinical outcome in revision total knee arthroplasty: a meta-analysis.

PURPOSE: The fixation of revision total knee arthroplasties (rTKA) tends to be difficult, leading to a reduction in implant survival. One option for achieving a more stable anchorage is to use metaphyseal cones and sleeves. The objective of the present paper is to provide a current comparative meta-analysis on survival and clinical results of cones vs. sleeves, with a differentiation between the short- and long-term outcome. METHODS: A search of the literature was conducted systematically to include original papers from 2010 to June 2021. The following parameters were taken into account: revision for aseptic loosening, revision for any reason, periprosthetic joint infections (PJI), KSS as well as KSFS. Studies with a mean follow-up of at least 60 months were defined to be long-term follow-up studies (LT). All other studies were included in the short-term (ST) study analysis. A pooled incidence was used as a summary statistic using a random intercept logistic regression model. RESULTS: The present meta-analysis included 43 publications with 3008 rTKA. Of these, 23 publications with 1911 cases were allocated to the sleeve group (SG) and 20 papers with 1097 cases to the cone group (CG). CG showed overall numerically higher complication rates in short- and long-term follow-up, compared with SG. Aseptic loosening occurred at a rate of 0.4% in SG (LT) and 4.1% in CG (LT) (p = 0.09). Periprosthetic joint infection (PJI) was more frequent in the cone group (7% in ST and 11.7% in LT) than in the sleeve group (3.4% in ST and 4.9% in LT, p = 0.02 both). The total revision rate was 5.5% in SG (LT) and 14.4% in CG (LT) (p = 0.12). The clinical scores were also comparable between the two groups. Hinged prothesis were used more frequent in the cone group (ST p < 0.001; LT p = 0.10), whereas CC type protheses were used more frequently in the sleeve group (ST p < 0.001; LT p < 0.11). CONCLUSIONS: This meta-analysis takes into account the longest follow-up periods covered to date. Both cones and sleeves represent a reliable fixation method in the case of severe bone loss in rTKA, although the higher rate of PJI after cone fixation remains a source of concern. A metaphyseal fixation of hinged implants should be taken into account. LEVEL OF EVIDENCE: II (meta-analysis).

[Bone defect management in revision knee arthroplasty]. / Knochendefektmanagement in der Revisionsknieendoprothetik.

BACKGROUND: In 2019, 124,677 primary total knee arthroplasties and 14,462 revision TKA were performed in Germany. This corresponds to a percentage of 11.6%. According to the EPRD, the probability of further revision surgery after the first exchange operation is around 15%. REASONS: The most common reason for revision surgery is still aseptic loosening with 23.9%. One possible cause could be the difficult fixation of revision total knee arthroplasty. If the bone quality is insufficient, cement-free or cemented diaphyseal anchoring of the prosthesis is often not sufficient to ensure adequate fixation. As a rule, defect management and fixation of the implant are based on the defect situation and the quality of the bone. Therefore, revision total knee arthroplasties based on the fixation principle of Jones et al. should be sufficiently fixed in at least 2 zones. TECHNIQUES: There are various techniques for stable anchoring of revision implants. In addition to cemented or cementless stem anchoring, bone allografts, wedges and blocks and, in recent years, cones and sleeves have become increasingly popular. In the present work, the various options for a stable anchoring of revision implants are presented and evaluated. In addition, the clinical and radiological outcome of cones vs. sleeves in bone defect management in revision knee arthroplasty will be compared.

Robot-Assisted Gait Self-Training: Assessing the Level Achieved.

This paper presents the technological status of robot-assisted gait self-training under real clinical environment conditions. A successful rehabilitation after surgery in hip endoprosthetics comprises self-training of the lessons taught by physiotherapists. While doing this, immediate feedback to the patient about deviations from the expected physiological gait pattern during training is important. Hence, the Socially Assistive Robot (SAR) developed for this type of training employs task-specific, user-centered navigation and autonomous, real-time gait feature classification techniques to enrich the self-training through companionship and timely corrective feedback. The evaluation of the system took place during user tests in a hospital from the point of view of technical benchmarking, considering the therapists' and patients' point of view with regard to training motivation and from the point of view of initial findings on medical efficacy as a prerequisite from an economic perspective. In this paper, the following research questions were primarily considered: Does the level of technology achieved enable autonomous use in everyday clinical practice? Has the gait pattern of patients who used additional robot-assisted gait self-training for several days been changed or improved compared to patients without this training? How does the use of a SAR-based self-training robot affect the motivation of the patients?

Mobile Robot-Based Gait Training after Total Hip Arthroplasty (THA) Improves Walking in Biomechanical Gait Analysis.

There are multiple attempts to decrease costs in the healthcare system while maintaining a high treatment quality. Digital therapies receive increasing attention in clinical practice, mainly relating to home-based exercises supported by mobile devices, eventually in combination with wearable sensors. The aim of this study was to determine if patients following total hip arthroplasty (THA) could benefit from gait training on crutches conducted by a mobile robot in a clinical setting. METHOD: This clinical trial was conducted with 30 patients following total hip arthroplasty. Fifteen patients received the conventional physiotherapy program in the clinic (including 5 min of gait training supported by a physiotherapist). The intervention group of 15 patients passed the same standard physiotherapy program, but the 5-min gait training supported by a physiotherapist was replaced by 2 × 5 min of gait training conducted by the robot. Length of stay of the patients was set to five days. Biomechanical gait parameters of the patients were assessed pre-surgery and upon patient discharge. RESULTS: While before surgery no significant difference in gait parameters was existent, patients from the intervention group showed a significant higher absolute walking speed (0.83 vs. 0.65 m/s, p = 0.029), higher relative walking speed (0.2 vs. 0.16 m/s, p = 0.043) or shorter relative cycle time (3.35 vs. 3.68 s, p = 0.041) than the patients from the control group. CONCLUSION: The significant higher walking speed of patients indicates that such robot-based gait training on crutches may shorten length of stay (LOS) in acute clinics. However, the number of patients involved was rather small, thus calling for further studies.

[Knee realignment osteotomy in adults]. / Kniegelenksnahe Umstellungsosteotomien des Erwachsenen.

BACKGROUND: Nowadays, osteotomy near the knee joint for axial deformities has become an indispensable surgical procedure for joint preservation in the orthopaedic-surgical spectrum. The exact localization and analysis of the deformity are crucial to restoring physiological loading conditions of the entire leg by means of a suitable osteotomy. PROCEDURES: Thus, above all, the medial "open-wedge" osteotomy has established itself as a standard procedure for the treatment of gonarthrosis caused by varus malalignment. Furthermore, the varus closed-wedge osteotomy of the distal femur also shows very good long-term results. Basically, osteotomies close to the knee are causal corrections in which biological and mechanical aspects must be taken into account. Thus, the correct indication, attention to risk factors, and surgical technique determine the long-term success of the procedure. The doctrine of femoral valgus deformity and the resulting lateral arthrosis, on the other hand, must be reconsidered according to the latest knowledge.

The bactericidal effect of vancomycin is not altered by tranexamic acid, adrenalin, dexamethasone, or lidocaine in vitro.

One of the most challenging complications of total knee arthroplasty (TKA) is periprosthetic joint infection (PJI). There is growing evidence of a good anti-infective effect of intrawound vancomycin powder in total joint arthroplasty. At the same time, various different locally applied substances have become popular in total joint arthroplasty. The objective of this study was therefore to investigate a possible inhibition of the bactericidal effect of vancomycin by tranexamic acid, adrenalin, lidocaine, or dexamethasone. The bactericidal effect of vancomycin was quantified using the established method of the agar diffusion test. The plates were incubated with Staphylococcus aureus or Staphylococcus epidermidis and four wells were stamped out. The wells were filled with vancomycin alone, the tested substance alone or a mixture of the two. The fourth well remained empty as a control. The plates were incubated overnight at 37 °C and the zone of inhibition in each field was measured on the next day. All tests were run three times for each pathogen and mean values and standard deviations of the measurements were calculated. Differences between the substances were tested using the t-test at a level of significance of 0.05. The bacterial growth was homogeneous on all plates. The baseline value for the zone of inhibition of vancomycin was on average 6.2 ± 0.4 mm for Staphylococcus aureus and 12 ± 0.3 mm for Staphylococcus epidermidis. In all other substances, no inhibition was detected around the well. The combination of vancomycin and each other substance did not show any different result compared to vancomycin alone. The bactericidal effect of vancomycin on staphylococci is not altered by tranexamic acid, adrenalin, dexamethasone, or lidocaine in vitro.

Vancomycin is toxic to human chondrocytes in vitro.

INTRODUCTION: Vancomycin powder (VP) is a well-established topical antibiotic used in spinal surgery to prevent surgical site infections. More recently its extension to hip and knee arthroplasty was introduced. The aim of this study was to examine toxic effects of VP on the viability of human chondrocytes. Our hypothesis was that VP damages human chondrocytes in vitro with increasing concentration and length of exposure. MATERIAL AND METHODS: Primary human chondrocytes were isolated and cultured from donated human knee joints. VP was added to these cultures with increasing concentrations (0-50 mg/ml) and length of exposure (0-336 h). Toxicity and viability were analyzed using LDH und XTT Elisa assays. Cell structure and determination of vital versus dead cells were visualized using light microscopy and fluorescence microscopy. RESULTS: Light microscopy and fluorescence microscopy visualized defect cell structures and cell death proportional to increasing dose and length of exposure to VP. The analysis of LDH activity data showed toxic effects on chondrocytes as early as 2,5 min after exposure to VP. XTT activity data revealed a significant toxic threshold of a VP concentration above 12.5 mg/ml. CONCLUSIONS: These results show that exposure to high VP concentrations yields to a damage of human chondrocytes in vitro. Chondrotoxicity is an immediate effect that is proportional to VP concentration. Therefore, the intraarticular use of high concentrations of vancomycin powder in the presence of native cartilage tissue must be considered critically.

Intraarticular vancomycin powder is effective in preventing infections following total hip and knee arthroplasty.

Locally applied vancomycin is increasingly being used in primary hip and knee arthroplasty to reduce the risk of infection. Despite encouraging initial results, considerable debate remains on the basis of the data currently available. In particular, it has been unclear up to now whether local vancomycin is suitable to further reduce the risk of infection even if the rate of infection is already low (< 1%). In this monocentric retrospective cohort study, all primary total hip and knee arthroplasties performed between 2013 and 2018 were included. After a change in procedure at the hospital, 1 g vancomycin powder was applied intraarticularly before wound closure. The remaining perioperative procedure was constant over the investigation period. The follow-up was one year. The presence of an infection according to the currently valid MSIS criteria was defined as the endpoint. In patients with TKA two infections (0.3%) were observed under vancomycin prophylaxis in contrast to 44 infections (1.3%) in the control group (p = 0.033). In patients with THA two infections (0.5%) were observed under vancomycin prophylaxis and 48 infections (1.1%) in the control group without local vancomycin but this difference was statistically not significant. No wound complications requiring revision were observed as a result of the vancomycin. On the basis of the results of this study, intraarticular application of vancomycin powder in total hip and knee arthroplasty may be considered. Prospective randomized studies have to confirm this promising results prior a common recommendation.Level of Evidence III Retrospective cohort study.

Tranexamic acid is toxic on human chondrocytes, in vitro.

The aim of this study was to examine toxic effects of tranexamic acid (TXA) on the viability of human chondrocytes. Our hypothesis was that TXA damages human chondrocytes. Chondrocytes were cultured from donated human knee joints. TXA was added to these cultures. Toxicity were analyzed by using LDH und XTT Elisa assays, light microscopy and fluorescence microscopy. The results show that TXA damages human chondrocytes in vitro. We cannot recommend the use of TXA in hemiarthroplasty of the hip or unicompartmental knee arthroplasty in higher concentrations.

Cone beam-navigated core decompression of bone marrow edema syndrome.

INTRODUCTION: The aim of the study was to compare decompression of bone-marrow edema or osteonecrosis of the proximal femur by means of a cone beam-based imaging and navigation system (cone beam-navigated decompression, CBND) with decompression by the conventional technique of drilling using fluoroscopy (FD). MATERIALS AND METHODS: The data of patients with bone-marrow edema syndrome treated between 2016 and 2018 by drilling of the proximal femur in CBND or FD technique were compared retrospectively. RESULTS: Each treatment group included 20 patients. The mean operating time for CBND was 16.4 ± 5.8 min, compared with 29.1 ± 20.8 min for FD (p = 0.018). The lesion was definitely reached by CBND in 19/20 patients. Eighteen of the 20 patients in the CBND group reported that their pain decreased after the treatment, compared with 12/20 patients in the FD group (p = 0.065). The radiation dosage was significantly higher (p < 0.001) for CBND than for FD. CONCLUSION: Decompression by CBND can be carried out safely and without complications. The advantages of CBND over FD are the minimally invasive access and the ability to address the affected area precisely with only one drilling maneuver. The high radiation dose of CBND can be reduced using low-dose protocols.

Psychological distress and health-related quality of life in patients with bone marrow edema syndrome.

BACKGROUND: The aim of the study was to investigate psychological distress and health-related quality of life (HrQoL) in patients with bone marrow edema syndrome (BMES) of the hip or knee joint. METHODS: This retrospective study included patients with the diagnosis BMES treated in the period 2016-2017. As well as analyzing the epidemiological data (age, sex, vascular disease, hypertension, etc.), we used the Hospital Anxiety and Depression Scale (HADS) to document anxiety and depression and the five-level version of the EuroQol Group's EQ-5D instrument (EQ-5D-5L) to assess HrQoL and compared it to historical controls of the healthy population. RESULTS: The study group comprised 56 patients (26 females, 30 males) with a mean age of 55.8 (range, 15-84) years. HADS: there was no difference between the study and control cohorts in the rates of anxiety (P=0.595) or depression (P=0.241). EQ-5D-5L: the HrQoL was significantly lower in the patients with BMES than in the healthy controls both for parameters of the EQ-5D-5L index and in the various age groups. No difference in HrQoL was seen between BMES of the hip and the knee or among the different radiological stages of BMES. CONCLUSIONS: The patients with BMES displayed a clear reduction in HrQoL, but this was not associated with psychological distress with regard to significant anxiety and depression. Patients with BMES and a high score for anxiety and depression are at great risk of chronic pain, and we recommend they should receive psychological counseling.

Effects of iloprost on human mature osteoblasts in vitro.

BACKGROUND AND OBJECTIVES: Bone marrow oedema is a multifactorial conditioned illness. Alongside any strain relief of an affected joint, treatment with Iloprost also belongs to the choice of cures. In past studies, a modulatory effect on bone could be shown. The hypothesis of the present work is that Iloprost has a growth-stimulating effect on osteoblasts in vitro. METHODS: Human osteoblasts were isolated and cultivated. Subsequently, the cells were treated with Iloprost in bioavailable concentrations. Alterations of the cell structure were examined by means of light microscopy. A regulation of the number of vital cells was carried out by using a CASY cell counter. Possible cell impairment after Iloprost treatment was analysed by means of XTT Elisa as well as FDA and PI staining via fluorescence microscopy. RESULTS: Using light microscopy, no changes in cell structure could be observed. With the CASY cell counter, no increase in the numbers of osteoblasts appeared after Iloprost treatment. Also, XTT Elisas and fluorescence microscopy did not reveal any cell impairment due to Iloprost. CONCLUSION: Our results could not confirm a modulatory effect in mature osteoblasts. On the basis of the present work we could not verify any growth-stimulating effect by Iloprost in mature osteoblasts in vitro. Admittedly, effects had been shown previously during osteogenesis, but we do exclude an effect on mature osteoblasts which have already differentiated.