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1.
J Orthop ; 43: 93-100, 2023 Sep.
Article in English | MEDLINE | ID: mdl-37575949

ABSTRACT

Background: Metaphyseal fixation of short stem THA allows for minimally invasive surgery, less bone removal, improved bone load transfer and reduced stress shielding. Short stems facilitate the anatomic restoration i.a. of leg length, femoroacetabular offset, and center of rotation. However, metaphyseal fixation might cause impaired primary and/or secondary stability resulting in an inherent tendency for early axial migration and aseptic loosening eventually. The objective of this study was to investigate the long-term outcome and migration pattern of a calcar-guided short stem. Methods: In a prospective multicenter study, 213 patients (224 THAs) were enrolled. Patients were followed for up to 84 months postoperatively. Clinical outcome was assessed using the Harris Hip Score and the VAS for pain and satisfaction. Standardized and calibrated radiographs were screened i.a. for stress shielding and loosening. Einzel-Bild-Roentgen-Analyse - femoral component analysis (EBRA-FCA) was used to detect longitudinal subsidence. Results: At 7 year follow-up, n = 139/224 cases were available for analysis. All clinical parameters improved significantly (p < 0.001) and improvement persisted. There were no radiographic changes indicating stress shielding. EBRA-FCA revealed a mean subsidence of -1.44 mm followed by a stabilization. Weight >80 kg (p = 0.115), BMI <30 kg/m2 (p = 0.282), male gender (p = 0.246), and age <65 years (p = 0.304) seemed to be associated with a higher risk for migration. The cumulative revision rate was 2.23%. Revisions due to stem migration (0.89%) occurred early (mean time between index surgery and revision: 3.3 months). Conclusions: If at all, there appears to be a pronounced initial subsidence, which stabilizes thereafter. Stem migration was rarely a compelling reason for failure or revision. Demographics do not seem to have a significant effect on migration pattern. The absence of radioluce lines, resorption or hypertrophy of the proximal femora support the hypothesis of a reduced stress shielding for metaphyseal anchoring short stems.

2.
Foot Ankle Spec ; : 19386400221136757, 2022 Nov 23.
Article in English | MEDLINE | ID: mdl-36418935

ABSTRACT

INTRODUCTION: Biomechanical studies have proved that locking plates have better primary stability besides versatility regarding fracture pattern while reducing bone contact and bridging the gap, whereas conventional nonlocking plates (plus lag screw) depend on bone-plate compression. The clinical benefit of locking plates over nonlocking plates remains unanswered, however. Therefore, this retrospective cohort study was set up to test the hypothesis that the use of locking plates for unstable ankle fractures will result in fewer re-displacements, superior bony healing, and functional and clinical outcomes better than observed in the nonlocking cohort. METHODS: Bimalleolar ankle fractures (AO 44-B2) without syndesmotic injury treated with either a locking or a nonlocking plate were included. Groups were compared for complications, bone healing, secondary dislocation, progressions of osteoarthritis, and clinical outcome using patient-reported outcome measures. RESULTS: Data revealed no clinical outcome differences (Olerud-Molander Ankle Score: nonlocking 88.2 ± 14.4, locking 88.8 ± 12.3, P = .69, robust two 1-sided test for equality (RTOST): P = .03; American Orthopaedic Foot and Ankle Score: nonlocking 91.2 ± 12.9, locking 91.8 ± 11.3, P = .96, RTOST: P = .04). Nevertheless, a significant postoperative progression of osteoarthritis was detected in both groups (P = .04). This was independent of implant (P = .16). Although difference was not significant, locking plates were preferred in older (P = .78) and sicker patients (P = .63) and in cases with severer osteoarthritis (P = .16), and were associated with a higher complication rate (P = .42) and secondary dislocation (nonlocking 9.4%, locking 18.2%; P = .42). Re-displacement, however, was not a compelling reason for revision. CONCLUSIONS: The present study shows statistically significant equality of both types of implants. Contrary to our expectation, locking plates seemed to be associated with a higher risk for re-displacement. Overall, the use of either locking or nonlocking plates for unstable AO 44-B2 fractures is safe and successful despite significant progression of osteoarthritis. LEVEL OF EVIDENCE: III, Retrospective observational cohort study.

3.
Cartilage ; 7(4): 346-60, 2016 Oct.
Article in English | MEDLINE | ID: mdl-27688843

ABSTRACT

OBJECTIVE: To compare the regenerative capacity of 2 distinct bilayer implants for the restoration of osteochondral defects in a preliminary sheep model. METHODS: Critical sized osteochondral defects were treated with a novel biomimetic poly-ε-caprolactone (PCL) implant (Treatment No. 2; n = 6) or a combination of Chondro-Gide and Orthoss (Treatment No. 1; n = 6). At 19 months postoperation, repair tissue (n = 5 each) was analyzed for histology and biochemistry. Electromechanical mappings (Arthro-BST) were performed ex vivo. RESULTS: Histological scores, electromechanical quantitative parameter values, dsDNA and sGAG contents measured at the repair sites were statistically lower than those obtained from the contralateral surfaces. Electromechanical mappings and higher dsDNA and sGAG/weight levels indicated better regeneration for Treatment No. 1. However, these differences were not significant. For both treatments, Arthro-BST revealed early signs of degeneration of the cartilage surrounding the repair site. The International Cartilage Repair Society II histological scores of the repair tissue were significantly higher for Treatment No. 1 (10.3 ± 0.38 SE) compared to Treatment No. 2 (8.7 ± 0.45 SE). The parameters cell morphology and vascularization scored highest whereas tidemark formation scored the lowest. CONCLUSION: There was cell infiltration and regeneration of bone and cartilage. However, repair was incomplete and fibrocartilaginous. There were no significant differences in the quality of regeneration between the treatments except in some histological scoring categories. The results from Arthro-BST measurements were comparable to traditional invasive/destructive methods of measuring quality of cartilage repair.

5.
Ann Anat ; 193(1): 30-2, 2011 Feb 20.
Article in English | MEDLINE | ID: mdl-20851584

ABSTRACT

Wagner hip arthroplasty has been used as a resurfacing and thereby bone-preserving method for the treatment of disabling osteoarthritis particularly in younger individuals. The underlying rationale was to replace exclusively diseased tissue, to restore anatomy and function and to optimize range of motion and stress transfer to the proximal femur. Wagner's approach was designed to reduce the risk of infection and to make later revisions easier. The technique was however associated with a high revision rate due to early aseptic wear induced component loosening and neck fractures. Nevertheless, we report a case of a 30 years follow-up of a Wagner resurfacing hip arthroplasty.


Subject(s)
Arthroplasty, Replacement, Hip , Osteoarthritis, Hip/diagnostic imaging , Osteoarthritis, Hip/surgery , Female , Follow-Up Studies , Humans , Middle Aged , Radiography , Treatment Outcome
6.
Biomaterials ; 31(10): 2798-805, 2010 Apr.
Article in English | MEDLINE | ID: mdl-20053441

ABSTRACT

Previously we demonstrated that chondrocyte ECM synthesis and mitotic activity was dependent on scaffold composition when cultured on uncoated PCL scaffolds (pPCL) or PCL composites containing hyaluronan (PCL/HA), chitosan (PCL/CS), fibrin (PCL/F), or collagen type I (PCL/COL1). We hypothesized that initial cell contact with these biomaterials results in ultrastructural changes and alters CD44 and integrin beta1 expression. The current study was designed to investigate the early ultrastructural responses of chondrocytes on these scaffolds and expression of CD44 and integrin beta1. A common observation 1 h after seeding was the abundance of cell processes. Different types of cell processes occurred in different areas of the same cell and on different cells within the same composite. Chondrocytes seeded onto PCL/CS had the greatest cell surface enhancement. PCL/HA promoted CD44 expression and almost spherical cells with a low degree of surface enhancement. PCL/COL1 enabled continuing expression of integrin beta1 and CD44. In contrast, cells in PCL/CS, PCL/F and pPCL promoted elliptic cells with a higher degree of surface enhancement and no prolonged CD44 and integrin beta1 expression. A strong variability of cell surface processes indicated either reparative or degenerative adaptation to the artificial environment. Interestingly, we found initial integrin beta1 expression in all composite scaffolds, but not in pPCL although this promoted strong adhesiveness as indicated by the formation of stress fibers. In conclusion, chondrocytes respond to biomaterials early after implantation by altering ultrastructural characteristics and expression of CD44 and integrin beta1.


Subject(s)
Cell Adhesion Molecules/metabolism , Chondrocytes/cytology , Chondrocytes/metabolism , Tissue Scaffolds/chemistry , Actins/metabolism , Animals , Cell Adhesion/drug effects , Cell Shape/drug effects , Chondrocytes/drug effects , Chondrocytes/ultrastructure , Cytoskeleton/drug effects , Cytoskeleton/metabolism , Fluorescent Antibody Technique , Hyaluronan Receptors/metabolism , Integrin beta1/metabolism , Microscopy, Electron, Scanning , Microscopy, Electron, Transmission , Phenotype , Polyesters/pharmacology , Rabbits , Surface Properties/drug effects
7.
Arch Orthop Trauma Surg ; 130(8): 957-64, 2010 Aug.
Article in English | MEDLINE | ID: mdl-19711090

ABSTRACT

BACKGROUND: In autologous chondrocyte implantation (ACI), the periosteum patch which is sutured over the cartilage defect has been identified as a major source of complications such as periosteal hypertrophy. In the present retrospective study, we compared midterm results of first-generation ACI with a periosteal patch to second generation ACI using a biodegradable collagen fleece (BioSeed-C) in 82 patients suffering from chronic posttraumatic and degenerative cartilage lesions of the knee. METHODS: Clinical outcome was assessed in 42 patients of group 1 and in 40 patients of group 2 before implantation of the autologous chondrocytes and at a minimum follow-up of 2 years using the ICRS score, the modified Cincinnati score and the Lysholm score. RESULTS: Although patients treated with BioSeed-C had more previous surgical procedures on their respective knees, highly significant improvements (P < 0.001) were assessed in both groups at comparable outcome levels: the ICRS score improved from grade D (poor) preoperatively to grade C (fair); the modified Cincinnati knee score from 3.26 to 6.4 (group 1) and 3.3 and 6.88 (group 2). Lysholm score improved from 33 to 70 points (group 1) and from 47 to 78 points (group 2), respectively. Revision surgery was due to symptomatic periosteal hypertrophy (n = 4), graft failure (n = 3), plica syndrome (n = 2) synovectomy (n = 1) (group 1); and graft failure (n = 2), debridement (n = 1), synovectomy (n = 2) (group 2). CONCLUSION: These results suggest that BioSeed-C is an equally effective treatment option for focal degenerative chondral lesions of the knee in this challenging and complex patient profile.


Subject(s)
Cartilage, Articular/pathology , Chondrocytes/transplantation , Osteoarthritis, Knee/surgery , Adolescent , Adult , Cartilage, Articular/injuries , Cell Transplantation/methods , Female , Humans , Hypertrophy , Knee Injuries/surgery , Male , Middle Aged , Periosteum/pathology , Retrospective Studies , Tissue Engineering/methods , Transplantation, Autologous , Treatment Outcome , Young Adult
8.
J Orthop Res ; 28(2): 141-8, 2010 Feb.
Article in English | MEDLINE | ID: mdl-19743507

ABSTRACT

Currently, various techniques are in use for the repair of osteochondral defects, none of them being truly satisfactory and they are often two step procedures. Comorbidity due to cancellous bone harvest from the iliac crest further complicates the procedure. Our previous in vitro studies suggest that porous tantalum (TM) or poly-epsilon-caprolactone scaffolds (PCL) in combination with periosteal grafts could be used for osteochondral defect repair. In this in vivo study, cylindrical osteochondral defects were created on the medial and lateral condyles of 10 rabbits and filled with TM/periosteum or PCL/periosteum biosynthetic composites (n = 8 each). The regenerated osteochondral tissue was then analyzed histologically, and evaluated in an independent and blinded manner by five different observers using a 30-point histological score. The overall histological score for PCL/periosteum was significantly better than for TM/periosteum. However, most of the regenerates were well integrated with the surrounding bone (PCL/periosteum, n = 6.4; TM/periosteum, n = 7) along with partial restoration of the tidemark (PCL/periosteum, n = 4.4; TM/periosteum, n = 5.6). A cover of hyaline-like morphology was found after PCL/periosteum treatment (n = 4.8), yet the cartilage yields were inconsistent. In conclusion, the applied TM and PCL scaffolds promoted excellent subchondral bone regeneration. Neo-cartilage formation from periosteum supported by a scaffold was inconsistent. This is the first study to show in vivo results of both PCL and TM scaffolds for a novel approach to osteochondral defect repair.


Subject(s)
Biocompatible Materials/therapeutic use , Caproates/therapeutic use , Cartilage, Articular/injuries , Cartilage, Articular/surgery , Lactones/therapeutic use , Periosteum/transplantation , Tantalum/therapeutic use , Animals , Bone Regeneration , Cartilage, Articular/pathology , Chondrogenesis , Femur/pathology , Femur/surgery , Knee Injuries/pathology , Knee Injuries/surgery , Porosity , Prosthesis Design , Prosthesis Implantation/instrumentation , Prosthesis Implantation/methods , Rabbits , Tibia/pathology , Tibia/surgery , Tissue Scaffolds , Treatment Outcome , Wound Healing
9.
Tissue Eng Part A ; 15(1): 75-82, 2009 Jan.
Article in English | MEDLINE | ID: mdl-18783325

ABSTRACT

The objective of the current study was to determine the suitability of cell-laden and cell-free alginate-gelatin biopolymer hydrogel for osteochondral restoration in a sheep model (n = 12). Four femoral defects per animal were filled with hydrogel (cHG) plus autologous chondrocytes (cHG + C) or periosteal cells (cHG + P) or gel only (cHG) or were left untreated (E). In situ solidification enabled instantaneous implant fixation. Sixteen weeks postoperatively, defect sites were processed for light microscopy and immunofluorescence. A modified Mankin and a semi-quantitative immunoreactivity score were used to evaluate histology and immunofluorescence, respectively. Defects after cHG + C were restored with smooth, hyaline-like neo-cartilage and trabecular subchondral bone. cHG + P and cHG treatments revealed slightly inferior regenerate morphology. Undifferentiated tissue was found in E. The histological score showed significant (p < 0.05) differences between all treatment groups. In conclusion, cHG induces satisfactory defect regeneration. Complete filling of the cavity in one step and subsequent rapid in situ solidification was feasible and facilitated graft fixation. Cell implantation might be beneficial, because cells seem to play a key role in histological outcome. Still, their contribution to the repair process remains unresolved because host cell influx takes place. The combination of alginate and gelatin, however, creates an environment capable of serving implanted and host cells for osteo-chondrogenic tissue regeneration.


Subject(s)
Biopolymers/chemistry , Hydrogel, Polyethylene Glycol Dimethacrylate/chemistry , Alginates/chemistry , Animals , Biocompatible Materials/chemistry , Buffers , Cartilage, Articular/cytology , Cartilage, Articular/injuries , Cartilage, Articular/transplantation , Cells, Cultured , Chondrocytes/transplantation , Collagen Type I/chemistry , Feasibility Studies , Fluorescent Antibody Technique, Direct , Glucuronic Acid/chemistry , Hexuronic Acids/chemistry , Hydrogen-Ion Concentration , Knee Joint/surgery , Materials Testing , Models, Animal , Periosteum/cytology , Regeneration , Sheep, Domestic/surgery , Time Factors , Transplantation, Autologous/methods , Treatment Outcome
10.
Cells Tissues Organs ; 182(2): 89-97, 2006.
Article in English | MEDLINE | ID: mdl-16804299

ABSTRACT

Different cell- and biomaterial-based tissue engineering techniques are under investigation to restore damaged tissue. Strategies that use chondrogenic cells or tissues in combination with bioresorbable delivery materials are considered to be suitable to regenerate bio-artificial cartilage. Three-dimensional (3-D) cell embedding techniques can provide anchorage-independent cell growth and homogenous spatial cell arrangement, which play a key role in the maintenance of the characteristic phenotype and thus the formation of differentiated tissue. We developed a new injectable high water content (90%) hydrogel formulation with 5% sodium alginic acid and 5% gelatin as a temporary supportive intercellular matrix for 3-D cell culture. The objective was to determine whether the in vitro hydrogel culture of chondrocytes could preserve hyaline characteristics and thus could provide cartilage regeneration in vitro. Chondrocytes harvested from knee joints of skeletally mature sheep were cultured 3-D in hydrogel (7 x 10(6) cells/ml, 2.8-mul beads) for up to 10 weeks. Cell morphology and viability were evaluated with light microscopy, and proliferative activity was assessed with antibromodeoxyuridine immunofluorescence. Expression of collagens type I (COL1) and II (COL2), cartilage proteoglycans (PG) and hyaluronan synthases (HAS) were studied immunohistochemically. We observed that up to 36% of chondrocytes proliferated, while almost 100% presented a differentiated spheroidal phenotype. After an initial decrease at 2 weeks, cell density recovered to 85% of the initial absolute value at 10 weeks. Expression of hyaline matrix molecules resembled the in vivo pattern with increasing spatial deposition of PG and COL2. The proportion of PG-positive cells increased from initially 13 to 53% after 10 weeks, in contrast to consistently 100% COL2-positive cells. We conclude that 3-D hydrogel culture, even without mechanical stimulation or growth factor application, can keep chondrocytes in a differentiated state and provides a chondrogenic cell environment for in vitro cartilage regeneration for at least 10 weeks. Moreover, this hydrogel appears to be a suitable cell delivery material for subsequent in vivo implantation.


Subject(s)
Cartilage, Articular/cytology , Cartilage, Articular/metabolism , Cell Culture Techniques/methods , Chondrocytes/cytology , Chondrocytes/metabolism , Hydrogels/chemistry , Animals , Biocompatible Materials/chemistry , Cells, Cultured , Collagen Type I/biosynthesis , Collagen Type II/biosynthesis , Hyaluronic Acid/biosynthesis , Proteoglycans/biosynthesis , Sheep , Tissue Engineering/methods
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