D. Krocker

[C-reactive protein. An independent risk factor for the development of infection after primary arthroplasty].

BACKGROUND Infection is a severe complication after primary arthroplasty of the hip (THA) or knee joint (TKA). Based on its high sensitivity, the C-reactive protein (CRP) concentration has become a valuable tool in the diagnosis of infection, although it has only moderate specificity. Because of this, it remains unclear whether a preoperative increased CRP without clinical symptoms is a risk factor for infection after primary arthroplasty. MATERIAL AND METHODS In a retrospective analysis, we investigated individuals with infection after primary THA or TKA and matched them with patients without infection after similar operations. Matching criteria were age, gender, and present diseases. The average age of the 50 included individuals was 67.4 (range 48-81) years, with eight men and 17 women in each group. In addition to preoperative CRP, specific patient and surgery data and microbiological and histopathologic findings were obtained. RESULTS The average preoperative CRP concentration in the infected patient group was 1.3+/-2.5 mg/dl, in contrast to 0.4+/-0.7 mg/dl in the noninfected group. A threshold of 0.5 mg/dl was appropriate for discriminating between the two groups [13/25 (52%) in the infection group vs. 3/25 (12%) in the control group, p=0.003]. Independent from the patient group, CRP concentrations were significantly increased in individuals with diabetes mellitus (1.2+/-1.5 vs. 0.7+/-2.0 mg/dl, p=0.03). CONCLUSION An increased preoperative CRP concentration without clinical findings of infection is a risk factor for prosthetic infection after primary THA or TKA with a threshold concentration of 0.5 mg/dl. Latent local or systemic infections or aseptic inflammation with subsequent local immune suppression seem to be responsible. We recommend evaluating CRP before every THA and TKA. For values beyond 0.5 mg/dl, an exploration for infection should be done. Otherwise, the patient should be informed about the increased risk of infection.

Effects of tacrolimus, cyclosporin A and sirolimus on MG63 cells

The reduction in bone mineral density after organ transplantation results in increased morbidity (post‐transplantation bone disease) and remains an unsolved problem. A connection with the long‐term application of nonglucocorticoidal immunosuppressants is the subject of controversial discussion. We hypothesized that such substances have an influence on the skeletal system on the cellular level by modulating osteoblast differentiation. Therefore, we investigated the effects of tacrolimus, cyclosporin A and sirolimus as representative substances of nonglucocorticoidal immunosuppressants on cell proliferation and expression of bone tissue‐specific genes of human osteoblasts (MG63). None of the examined substances affected cell proliferation, but all influenced the gene expression pattern towards change in cell differentiation. In detail, collagen III and XII, matrix metalloproteinase 2, SMAD2, epithelial growth factor receptor, annexin V and osteonectin expression were increased by all of the examined substances. Tacrolimus, cyclosporin A and sirolimus influence intracellular signalling pathways, transmembranous receptors and bone‐specific matrix synthesis. They do not have antiproliferative or toxic effects. We postulate that the shown changes of osteoblast differentiation cause post‐transplantation disease.

Das C-reaktive Protein

BACKGROUND Infection is a severe complication after primary arthroplasty of the hip (THA) or knee joint (TKA). Based on its high sensitivity, the C-reactive protein (CRP) concentration has become a valuable tool in the diagnosis of infection, although it has only moderate specificity. Because of this, it remains unclear whether a preoperative increased CRP without clinical symptoms is a risk factor for infection after primary arthroplasty. MATERIAL AND METHODS In a retrospective analysis, we investigated individuals with infection after primary THA or TKA and matched them with patients without infection after similar operations. Matching criteria were age, gender, and present diseases. The average age of the 50 included individuals was 67.4 (range 48-81) years, with eight men and 17 women in each group. In addition to preoperative CRP, specific patient and surgery data and microbiological and histopathologic findings were obtained. RESULTS The average preoperative CRP concentration in the infected patient group was 1.3+/-2.5 mg/dl, in contrast to 0.4+/-0.7 mg/dl in the noninfected group. A threshold of 0.5 mg/dl was appropriate for discriminating between the two groups [13/25 (52%) in the infection group vs. 3/25 (12%) in the control group, p=0.003]. Independent from the patient group, CRP concentrations were significantly increased in individuals with diabetes mellitus (1.2+/-1.5 vs. 0.7+/-2.0 mg/dl, p=0.03). CONCLUSION An increased preoperative CRP concentration without clinical findings of infection is a risk factor for prosthetic infection after primary THA or TKA with a threshold concentration of 0.5 mg/dl. Latent local or systemic infections or aseptic inflammation with subsequent local immune suppression seem to be responsible. We recommend evaluating CRP before every THA and TKA. For values beyond 0.5 mg/dl, an exploration for infection should be done. Otherwise, the patient should be informed about the increased risk of infection.

Influence of adjuvant pain medication on quality of life in the treatment of postmenopausal osteoporosis

AIM OF THE STUDY Chronic pain is the main symptom of postmenopausal osteoporosis. This can decrease mobility and quality of life of the patients. The hypothesis of this study was that administration of an adjuvant pain medication is essential additionally to the basic therapy. The second question was if a recommendation can be formulated whether a peripheral or a central acting pain medication is more effective to prevent osteoporosis induced chronic pain. METHODS Three pseudorandomised patient groups were prospectively compared. Group 1 was treated with alendronate, vitamin D, and calcium. Group 2 also received ibuprofen, and group 3 also received tramadol. In 117 women suffering from postmenopausal osteoporosis, quality of life was measured before and 26 weeks after therapy using the International Osteoporosis Foundation Qualeffo-41 score, and pain intensity was measured using a visual analogue scale. RESULTS No therapy-associated complications were observed during the study. After 26 weeks, quality of life significantly increased in groups 2 and 3 compared with group 1 (p<0.001). Pain intensity decreased in group 1 by only 6 points, whereas it decreased in group 2 by 31 points and in group 3 by 24 points. Pain relief was significantly different between the treatment groups and the control group and between the treatment groups themselves (p<0.001 and p<0.01). CONCLUSION We conclude that pain therapy with an almost peripherally acting drug such as ibuprofen can reduce osteoporosis-associated chronic pain better than a centrally acting pain medication such as tramadol. It therefore can be recommended to prescribe ibuprofen rather than tramadol for treating osteoporosis-associated chronic pain in postmenopausal women if the specific risk for gastrointestinal side effects is considered.

[Reconstruction of the extensor mechanism using a free, allogenic, freeze-dried patellar graft].

ZusammenfassungEin defizitärer Streckapparat lässt sich mit einem Peressigsäure-sterilisierten, freien, allogenen, gefriergetrockneten Patellatransplantat suffizient rekonstruieren. Vorteil gegenüber Fresh-frozen-Transplantaten ist das reduzierte Infektionsrisiko.AbstractAllograft reconstruction of a deficient extensor mechanism is sufficient using an allogenic, freeze-dried patellar graft sterilized with peracetic acid. The reduced risk of infection is an advantage over fresh-frozen grafts.

Rekonstruktion des Streckapparats mittels freiem, allogenem, gefriergetrocknetem Patellatransplantat

ZusammenfassungEin defizitärer Streckapparat lässt sich mit einem Peressigsäure-sterilisierten, freien, allogenen, gefriergetrockneten Patellatransplantat suffizient rekonstruieren. Vorteil gegenüber Fresh-frozen-Transplantaten ist das reduzierte Infektionsrisiko.AbstractAllograft reconstruction of a deficient extensor mechanism is sufficient using an allogenic, freeze-dried patellar graft sterilized with peracetic acid. The reduced risk of infection is an advantage over fresh-frozen grafts.

Einfluss der adjuvanten Schmerztherapie in der Behandlung der postmenopausalen Osteoporose auf die Lebensqualität

AIM OF THE STUDY Chronic pain is the main symptom of postmenopausal osteoporosis. This can decrease mobility and quality of life of the patients. The hypothesis of this study was that administration of an adjuvant pain medication is essential additionally to the basic therapy. The second question was if a recommendation can be formulated whether a peripheral or a central acting pain medication is more effective to prevent osteoporosis induced chronic pain. METHODS Three pseudorandomised patient groups were prospectively compared. Group 1 was treated with alendronate, vitamin D, and calcium. Group 2 also received ibuprofen, and group 3 also received tramadol. In 117 women suffering from postmenopausal osteoporosis, quality of life was measured before and 26 weeks after therapy using the International Osteoporosis Foundation Qualeffo-41 score, and pain intensity was measured using a visual analogue scale. RESULTS No therapy-associated complications were observed during the study. After 26 weeks, quality of life significantly increased in groups 2 and 3 compared with group 1 (p<0.001). Pain intensity decreased in group 1 by only 6 points, whereas it decreased in group 2 by 31 points and in group 3 by 24 points. Pain relief was significantly different between the treatment groups and the control group and between the treatment groups themselves (p<0.001 and p<0.01). CONCLUSION We conclude that pain therapy with an almost peripherally acting drug such as ibuprofen can reduce osteoporosis-associated chronic pain better than a centrally acting pain medication such as tramadol. It therefore can be recommended to prescribe ibuprofen rather than tramadol for treating osteoporosis-associated chronic pain in postmenopausal women if the specific risk for gastrointestinal side effects is considered.

Das C-reaktive Protein@@@C-reactive protein: Ein unabhängiger Risikofaktor für die Entwicklung eines Infekts nach Primärendoprothetik@@@An independent risk factor for the development of infection after primary arthroplasty

BACKGROUND Infection is a severe complication after primary arthroplasty of the hip (THA) or knee joint (TKA). Based on its high sensitivity, the C-reactive protein (CRP) concentration has become a valuable tool in the diagnosis of infection, although it has only moderate specificity. Because of this, it remains unclear whether a preoperative increased CRP without clinical symptoms is a risk factor for infection after primary arthroplasty. MATERIAL AND METHODS In a retrospective analysis, we investigated individuals with infection after primary THA or TKA and matched them with patients without infection after similar operations. Matching criteria were age, gender, and present diseases. The average age of the 50 included individuals was 67.4 (range 48-81) years, with eight men and 17 women in each group. In addition to preoperative CRP, specific patient and surgery data and microbiological and histopathologic findings were obtained. RESULTS The average preoperative CRP concentration in the infected patient group was 1.3+/-2.5 mg/dl, in contrast to 0.4+/-0.7 mg/dl in the noninfected group. A threshold of 0.5 mg/dl was appropriate for discriminating between the two groups [13/25 (52%) in the infection group vs. 3/25 (12%) in the control group, p=0.003]. Independent from the patient group, CRP concentrations were significantly increased in individuals with diabetes mellitus (1.2+/-1.5 vs. 0.7+/-2.0 mg/dl, p=0.03). CONCLUSION An increased preoperative CRP concentration without clinical findings of infection is a risk factor for prosthetic infection after primary THA or TKA with a threshold concentration of 0.5 mg/dl. Latent local or systemic infections or aseptic inflammation with subsequent local immune suppression seem to be responsible. We recommend evaluating CRP before every THA and TKA. For values beyond 0.5 mg/dl, an exploration for infection should be done. Otherwise, the patient should be informed about the increased risk of infection.

Einfluss der adjuvanten Schmerztherapie in der Behandlung der postmenopausalen Osteoporose auf die Lebensqualität@@@Influence of adjuvant pain medication on quality of life in the treatment of postmenopausal osteoporosis

AIM OF THE STUDY Chronic pain is the main symptom of postmenopausal osteoporosis. This can decrease mobility and quality of life of the patients. The hypothesis of this study was that administration of an adjuvant pain medication is essential additionally to the basic therapy. The second question was if a recommendation can be formulated whether a peripheral or a central acting pain medication is more effective to prevent osteoporosis induced chronic pain. METHODS Three pseudorandomised patient groups were prospectively compared. Group 1 was treated with alendronate, vitamin D, and calcium. Group 2 also received ibuprofen, and group 3 also received tramadol. In 117 women suffering from postmenopausal osteoporosis, quality of life was measured before and 26 weeks after therapy using the International Osteoporosis Foundation Qualeffo-41 score, and pain intensity was measured using a visual analogue scale. RESULTS No therapy-associated complications were observed during the study. After 26 weeks, quality of life significantly increased in groups 2 and 3 compared with group 1 (p<0.001). Pain intensity decreased in group 1 by only 6 points, whereas it decreased in group 2 by 31 points and in group 3 by 24 points. Pain relief was significantly different between the treatment groups and the control group and between the treatment groups themselves (p<0.001 and p<0.01). CONCLUSION We conclude that pain therapy with an almost peripherally acting drug such as ibuprofen can reduce osteoporosis-associated chronic pain better than a centrally acting pain medication such as tramadol. It therefore can be recommended to prescribe ibuprofen rather than tramadol for treating osteoporosis-associated chronic pain in postmenopausal women if the specific risk for gastrointestinal side effects is considered.