Christoph Schulze

Comparative Study of Clinical and Radiological Outcomes of Unconstrained Bicondylar Total Knee Endoprostheses with Anti-allergic Coating.

Background: Hypersensitivity reactions to implant materials have become more important in total knee replacement (TKR). The purpose of this retrospective comparative study was to evaluate the clinical and radiological outcomes of unconstrained bicondylar total knee prostheses with and without anti-allergic titanium(niobium)nitrite (Ti(Nb)N) coating. Methods: Twenty-four patients (25 TKRs) underwent a preoperative clinical evaluation and then a postoperative evaluation after 26.2 months in the allergy group treated with coated implants (n=13 implants) and after 24.5 months in the control group treated with uncoated implants but identical geometry (n=12) using HSS, WOMAC and SF-36 scores. Radiological evaluations were performed using standard anterior-posterior (a.p.) and lateral X-rays. Results: During follow-up two patients of the allergy group had to undergo revision surgery due to non-implant-related reasons. A comparative analysis of both study groups showed a significant difference in the HSS scores at both evaluation time points (MW test p≤0.050); these findings are remarkable since the control group had a significantly lower score preoperatively (54.0 vs 65.0 points) and a significantly higher score (82.5 vs 75.0 points) postoperatively. The preoperative and postoperative WOMAC and SF-36 scores were comparable in both groups (MW test p≥0.052), although the postoperative increase in the score for the allergy group was lower. The radiological results were comparable in both groups and were unlikely to influence the results. Conclusions: This clinical study demonstrates the restricted outcome in postoperative function and quality of life in the allergy group compared to the control group.

Comparative Analysis of the Oxygen Supply and Viability of Human Osteoblasts in Three-Dimensional Titanium Scaffolds Produced by Laser-Beam or Electron-Beam Melting

Synthetic materials for bone replacement must ensure a sufficient mechanical stability and an adequate cell proliferation within the structures. Hereby, titanium materials are suitable for producing patient-individual porous bone scaffolds by using generative techniques. In this in vitro study, the viability of human osteoblasts was investigated in porous 3D Ti6Al4V scaffolds, which were produced by electron-beam (EBM) or laser-beam melting (LBM). For each examination, two cylindrical scaffolds (30 mm × 10 mm in size, 700 µm × 700 µm macropores) were placed on each other and seeded with cells. The oxygen consumption and the acidification in the center of the structures were investigated by means of microsensors. Additionally, the synthesis of pro-collagen type 1 was analyzed. On the LBM titanium scaffolds, vital bone cells were detected in the center and in the periphery after 8 days of cultivation. In the EBM titanium constructs, however, vital cells were only visible in the center. During the cultivation period, the cells increasingly produced procollagen type 1 in both scaffolds. In comparison to the periphery, the oxygen content in the center of the scaffolds slightly decreased. Furthermore, a slight acidification of the medium was detectable. Compared to LBM, the EBM titanium scaffolds showed a less favorable behavior with regard to cell seeding.

The Influence in Airforce Soldiers Through Wearing Certain Types of Army-Issue Footwear on Muscle Activity in the Lower Extremities

The objective of the study was to analyse the influence of the shape and material of the military footwear worn by soldiers on muscle activity in the lower extremities, and whether such footwear could explain specific strain complaints and traumatic lesions in the region of the lower extremities. 37 soldiers (one woman, 36 men) aged between 20 and 53 years underwent a dynamic electromyography (EMG) analysis. Wearing – one pair at a time - five different types of shoes, the subjects were asked to walk on a treadmill, where an EMG of the following muscles was taken: M. tibialis anterior, M. gastrocnemius mediales, M. gastrocnemius laterales, M. peroneus longus and M. rectus femoris. When the subjects wore old-fashioned outdoor jogging shoes increased muscle activity was observed in the region of the M. peroneus longus. This can be interpreted as a sign of the upper ankle joint requiring increased support and thus explain the higher susceptibility to sprains experienced in connection with these shoes. When the subjects wore combat boots, increased activity was observed in the region of the Mm. tibialis anterior and rectus femoris. The specific activity differences that were observed in particular muscles may have influence in the occurrence of certain disorders, especially in untrained recruits. This can be linked to various strain-related disorders such as shin splints and patellofemoral pain. The data obtained using EMG can provide information about the likelihood of a clustering of the complaints experienced by soldiers during training or active service.

Influence of footwear and equipment on stride length and range of motion of ankle, knee and hip joint.

PURPOSE Footwear and equipment worn by military personnel is of importance for them to be able to meet the physical demands specific to their profession daily activities. The aim of the present study was to investigate by means of gait analysis how army-provided footwear and equipment influence the range of motion of hip, knee and ankle joints as well as stride length. METHODS Thirty-two soldiers were subjected to gait analysis on a treadmill by way of video recordings and goniometric measurements. RESULTS The stride length increased when military shoes are worn. We found no influence on stride length in connection to increased loading. The weight of the shoes represents the decisive factor. Neither shoes nor equipment changed the range of motion of the knee joint. Weight of equipment affected range of motion of the hip joint. The range of motion of the upper and lower ankle joints was mainly influenced by the properties of the shoes. CONCLUSIONS Military footwear and weight of equipment influence stride length and range of motion of joints of the lower extremities in a specific way. Shape of material is the decisive factor.

Treatment of medial tibial stress syndrome according to the fascial distortion model: a prospective case control study.

Medial tibial stress syndrome (MTSS) is a common problem among athletes and soldiers. There is no proven theory that could explain the pathophysiology of shin splints. The therapies described so far are time-consuming and involve a high risk of relapse. The method according to the fascial distortion model (FDM) addresses local changes in the area of the lower leg fascia. It is suited to reduce pain and functional impairments associated with this symptom complex by applying targeted manual techniques. 32 patients (male: 30; female: 2) participated in this study. Visual analogue scale (VAS) was used for the quantification of pain. Scores were also given to rate the maximum painless exercise tolerance of the patients. Subsequently treatment of the crural fascia was performed. Patients retested ability of running and jumping. Therapy was continued until full exercise tolerance or painlessness was reached. A significant reduction of the VAS pain score from 5.2 to 1.1 could be achieved (P < 0.001). The impairment of exercise tolerance could be reduced from 7 to 2 points (P < 0.001). The duration of treatment was 6.3 (SD: 4.3) days on average. The FDM therapy is a potential effective method for acute treatment of MTSS.

Cell viability, collagen synthesis and cytokine expression in human osteoblasts following incubation with generated wear particles using different bone cements

In total hip arthroplasty, wear particles generated at articulating surfaces and interfaces between bone, cement and implants have a negative impact on osteoblasts, leading to osteolysis and implant loosening. The aim of this experimental study was to determine the effects of particulate wear debris generated at the interface between straight stainless steel hip stems (Exeter(®)) and three different bone cements (Palacos(®) R, Simplex™ P and Cemex(®) Genta) on cell viability, collagen synthesis and cytokine expression in human osteoblasts. Primary osteoblasts were treated with various concentrations of wear particles. The synthesis of procollagen type I and different cytokines was analysed, and markers for apoptosis and necrosis were also detected. The cytokine synthesis rates in the osteoblasts were initially increased and varied, depending on incubation time and particle concentration. Specific differences in the synthesis rates of interleukin (IL)‑6, IL-8, vascular endothelial growth factor (VEGF) and monocyte chemotactic protein-1 (MCP-1) were observed with the different bone cements examined. The negative effect of the particles on the synthesis of procollagen type I and increased rates of cell apoptosis and necrosis were observed with all three cements analysed. Our present data suggest that wear particles from the interface between the total hip stem and bone cement have a significant effect on viability, cytokine expression and collagen synthesis in human osteoblasts, depending on the bone cement used.

Contribution of human osteoblasts and macrophages to bone matrix degradation and proinflammatory cytokine release after exposure to abrasive endoprosthetic wear particles

One of the major reasons for failure after total joint arthroplasty is aseptic loosening of the implant. At articulating surfaces, defined as the interface between implant and surrounding bone cement, wear particles can be generated and released into the periprosthetic tissue, resulting in inflammation and osteolysis. The aim of the present study was to evaluate the extent to which osteoblasts and macrophages are responsible for the osteolytic and inflammatory reactions following contact with generated wear particles from Ti-6Al-7Nb and Co-28Cr-6Mo hip stems. To this end, human osteoblasts and THP-1 monocytic cells were incubated with the experimentally generated wear particles as well as reference particles (0.01 and 0.1 mg/ml) for 48 h under standard culture conditions. To evaluate the impact of these particles on the two cell types, the release of different bone matrix degrading matrix metalloproteinases (MMPs), tissue inhibitors of MMPs (TIMPs), and relevant cytokines were determined by multiplex enzyme-linked immunosorbent assays. Following incubation with wear particles, human osteoblasts showed a significant upregulation of MMP1 and MMP8, whereas macrophages reacted with enhanced MMP3, MMP8 and MMP10 production. Moreover, the synthesis of TIMPs 1 and 2 was inhibited. The osteoblasts and macrophages also responded with modified expression of the inflammatory mediators interleukin (IL)-6, IL-8, monocyte chemoattractant protein-1 and vascular endothelial growth factor. These results demonstrate that the release of wear particles affects the release of proinflammatory cytokines and has a negative impact on bone matrix formation during the first 48 h of particle exposure. Human osteoblasts are directly involved in the proinflammatory cascade of bone matrix degradation. The simultaneous activation and recruitment of monocytes/macrophages boosted osteolytic processes in the periprosthetic tissue. By the downregulation of TIMP production and the concomitant upregulation of MMPs as a response to particle exposure, bone formation around implants may be suppressed, resulting in implant failure.

Erythropoietin receptor-mediated Egr-1 activation: Structural requirements and functional implications

The transcription factor Egr-1 is encoded by an immediate early response gene and has been shown to be a key regulator in the induction of apoptosis, mitogenesis and differentiation. It is rapidly induced by different stimuli including the glycoprotein hormone erythropoietin. In this report, we analyse the role of different erythropoietin receptor substructures for the activation of Egr-1 and the functional consequences of Egr-1 overexpression in the erythroleukemic cell line ELM-I-1. The investigation of receptor variants revealed that the activity of JAK2 and the phosphorylation of receptor tyrosine residues are essential preconditions for the ability to target Egr-1. Furthermore, we observed a close correlation of the abilities of receptors to activate the Ras-MAPK pathway and Egr-1. Using mass spectrometry we identified the Ras-GTPase-activating protein-SH3-domain-binding protein 1 (G3BP-1), a component of the Ras network of proteins, as an Egr-1 interacting protein in EPO stimulated ELM-I-1 cells. The overexpression of Egr-1 in these cells resulted in an enhanced rate of spontaneous erythroid differentiation.

Evaluation of the Physical Activity of German Soldiers Depending on Rank, Term of Enlistment, and Task Area

Physical fitness of soldiers plays an important role during combat operations and training for deployment. The aim of this study was to collect data on the physical activity of soldiers of all rank categories and to identify task areas in which inactivity and the resulting health problems such as obesity, cardiovascular disease, and musculoskeletal problems pose a special risk. For this purpose, the physical activity of 169 German soldiers of different ranks and task areas was measured. These soldiers wore accelerometer-based physical activity monitors for a period of 7 days. Their activities were also documented in standardized forms. The results showed that officers (541 steps/h) had the lowest level of physical activity during their duties (compared to noncommissioned officers): 600 steps/h, and junior enlisted personnel: 724 steps/h). With respect to term of enlistment, conscripts and temporary-career volunteers showed a higher level of physical activity than regulars (751 and 640 vs. 539 steps/h). With respect to different task areas, drivers showed the highest activity level, whereas staff personnel showed the lowest. High-ranking personnel and soldiers in staff positions were shown to have the lowest physical activity level. In these groups, possible health problems caused by physical inactivity could be alleviated.

The Effect of the Weight of Equipment on Muscle Activity of the Lower Extremity in Soldiers

Due to their profession and the tasks it entails, soldiers are exposed to high levels of physical activity and strain. This can result in overexertion and pain in the locomotor system, partly caused by carrying items of equipment. The aim of this study was to analyse the extent of muscle activity in the lower extremities caused by carrying specific items of equipment. For this purpose, the activity of selected groups of muscles caused by different items of equipment (helmet, carrying strap, backpack, and rifle) in the upper and lower leg was measured by recording dynamic surface electromyograms. Electrogoniometers were also used to measure the angle of the knee over the entire gait cycle. In addition to measuring muscle activity, the study also aimed to determine out what influence increasing weight load has on the range of motion (ROM) of the knee joint during walking. The activity of recorded muscles of the lower extremity, that is, the tibialis anterior, peroneus longus, gastrocnemius lateralis, gastrocnemius medialis, rectus femoris, and biceps femoris, was found to depend on the weight of the items of equipment. There was no evidence, however, that items of equipment weighing a maximum of 34% of their carriers body weight had an effect on the ROM of the knee joint.