Georg Matziolis

Cytokine Expression in Human Osteoblasts After Antiseptic Treatment: A Comparative Study Between Polyhexanide and Chlorhexidine

ABSTRACT Purpose/Aim of the study: Chlorhexidine and polyhexanide are frequently used antiseptics in clinical practice and have a broad antimicrobial range. Both antiseptics are helpful medical agents for septic wound treatment with a high potential for defeating joint infections. Their effect on human osteoblasts has, so far, not been sufficiently evaluated. The aim of this study was to investigate the activating potential of polyhexanide and chlorhexidine on inflammatory cytokines/chemokines in human osteoblasts in vitro. Materials and Methods: Human osteoblasts were isolated and cultivated in vitro and then treated separately with 0.1% and 2% chlorhexidine and 0.04% polyhexanide as commonly applied concentrations in clinical practice. Detection of cell structure and cell morphology was performed by light microscopic inspection. Cytokine and chemokine secretion was determined by using a multiplex suspension array. Results: Cell shrinking, defective cell membrane, and the loss of cell adhesion indicated cell damage of human osteoblasts after treatment with both antiseptics was evaluated by using light microscopy. Polyhexanide, but not chlorhexidine, caused human osteoblasts to secrete various interleukins (1β, 6, and 7), interferon γ, tumor necrosis factor α, vascular endothelial growth factor, eotaxin, fibroblast growth factor basic, and granulocyte macrophage colony-stimulating factor as quantified by multiplex suspension array. Conclusions: Both antiseptics induced morphological cell damage at an optimum exposure between 1 and 10 min. But only polyhexanide mediated a pronounced secretion of inflammatory cytokines and chemokines in human osteoblasts. Therefore, we recommend a preferred usage of chlorhexidine in septic surgery to avoid the induction of an inflammatory reaction.

[Patella height after total knee replacement: influence of the radiological setting].

BACKGROUND Acquired patella baja is a possible cause of painful total knee arthroplasty (TKA) and a poor functional outcome. Standardized lateral radiographs - often missing in the daily routine - are required for evaluating the patella height. It is unknown which patella index is insensitive to the radiological setting so that it can be used efficiently in the clinical routine. PATIENTS AND METHODS This prospective study included 25 patients after TKA. Their average age was 69.5+/-8.8 (51-80) years. In two cases (8%), resurfacing of the patella was performed. The modified Insall-Salvati index (mIS) and the Caton-Deschamps index (CD) were determined and compared on lateral radiographs with the patients knee extended while lying down, extended while standing, and 30 degrees flexed while lying down. RESULTS The average mIS in extension was 1.63+/-0.31 with the patient lying and 1.68+/-0.31 with the patient standing. In 30 degrees flexion and lying, it was 1.7+/-0.3. The mIS on the recommended radiographs (30 degrees flexion) correlated well with the mIS in extension while lying (R=0.48, p<0.001) and standing (R=0.99, p<0.001). The CD in extension was 0.78+/-0.21 while lying and 0.49+/-0.12 while standing; it was 0.48+/-0.15 in 30 degrees flexion. The CD on the recommended radiographs (30 degrees flexion) correlated satisfactorily with the CD in extension while standing (R=0.93, p<0.001) but not in extension while lying (not significant). CONCLUSION The mIS is less dependent on the radiological setting than the CD is. The mIS can be used efficiently for evaluating an acquired patella baja in radiographs performed in different, not standardized, conditions.

Increase of cortical cerebral blood flow and further cerebral microcirculatory effects of Serelaxin in a sheep model

Serelaxin, recombinant human relaxin-2, modulates endothelial vasodilatory functionality and is under evaluation for treatment of acute heart failure. Little is known about acute effects on cerebral perfusion. We tested the hypothesis that Serelaxin might also have effects on the cerebral microcirculation in a sheep model, which resembles human brain structure quite well. We used laser Doppler flowmetry and sidestream dark-field (SDF) imaging techniques, which are reliable tools to continuously assess dynamic changes in cerebral perfusion. Laser Doppler flowmetry shows that bolus injection of 30 μg Serelaxin/kg body wt induces an increase (P = 0.006) to roughly 150% of cortical cerebral blood flow (CBF), whereas subcortical CBF remains unchanged (P = 0.688). The effects on area-dependent CBF were significantly different after the bolus injection (P = 0.042). Effects on cortical CBF were further confirmed by SDF imaging. The bolus injection of Serelaxin increased total vessel density to 127% (P = 0.00046), perfused vessel density to 145% (P = 0.024), and perfused capillary density to 153% (P = 0.024). Western blotting confirmed the expression of relaxin receptors RXFP1 and truncated RXFP2-variants in the respective brain regions, suggesting a possible contribution of RXFP1 on the effects of Serelaxin. In conclusion, the injection of a high dose of Serelaxin exerts quick effects on the cerebral microcirculation. Therefore, Serelaxin might be suitable to improve cortical microcirculation and exert neuroprotective effects in clinically relevant scenarios that involve cortical hypoperfusion. These findings need to be confirmed in relevant experimental settings involving cerebral cortical hypoperfusion and can possibly be translated into clinical practice.

Renal glucose release during hypoglycemia is partly controlled by sympathetic nerves – a study in pigs with unilateral surgically denervated kidneys

Catecholamines are known to increase renal glucose release during hypoglycemia. The specific extent of the contribution of different sources of catecholamines, endocrine delivery via circulation or release from autonomous sympathetic renal nerves, though, is unknown. We tested the hypothesis that sympathetic renal innervation plays a major role in the regulation of renal gluconeogenesis. For this purpose, instrumented adolescent pigs had one kidney surgically denervated while the other kidney served as a control. A hypoglycemic clamp with arterial blood glucose below 2 mmol/L was maintained for 75 min. Arteriovenous blood glucose difference, inulin clearance, p‐aminohippurate clearance, and sodium excretion were measured in intervals of 15 min separately for both kidneys. Blood glucose was lowered to 0.84 ± 0.33 mmol/L for 75 min. The side‐dependent renal net glucose release (SGN) decreased significantly after the unilateral ablation of renal nerves. In the linear mixed model, renal denervation had a significant inhibitory effect on renal net glucose release (P = 0.036). The SGN of the ablated kidney decreased by 0.02 mmol/min and was equivalent to 43.3 ± 23.2% of the control (nonablated) kidney in the pigs. This allows the conclusion that renal glucose release is partly controlled by sympathetic nerves. This may be relevant in humans as well, and could explain the increased risk of severe hypoglycemia of patients with diabetes mellitus and autonomous neuropathy. The effects of denervation on renal glucose metabolism should be critically taken into account when considering renal denervation as a therapy in diabetic patients.

Effects of Kinesio taping compared to arterio-venous Impulse System™ on limb swelling and skin temperature after total knee arthroplasty

PurposeIt is an established fact that post-operative (p.o.) soft-tissue swelling and lymphoedema after total knee arthroplasty (TKA) have a major influence on the p.o. early functional outcome. Kinesio taping has a proven clinical effect in increasing lymph drainage. Despite the decades of experience gained and the assumed positive effects, hardly any investigations have been conducted to date on the influence of Kinesio taping on the p.o. healing process after TKA. The objective of the present study was to test the hypothesis that Kinesio taping used as a lymph application leads to a reduction of p.o. soft-tissue swelling. As a secondary objective, it was to be tested whether there is an effect on skin temperature as a surrogate parameter for dermal micro-circulation.MethodsIn this prospective study with a historical control (A-V Impulse System™ group), 42 subjects were included and treated with Kinesio taping after implantation of a TKA. The patients of the study group were treated immediately p.o. with Kinesio® Tex Gold™ fan cut tape as a lymph application with a common base. A thermographic temperature determination of the knee joint operated on was performed on each patient in the supine position every day from the first to the seventh p.o. day. The leg circumference was documented daily at eight specified measuring points on both lower limbs. As a statistical analytical approach, the so-called principal component analysis was used. An analysis of variance was performed. The significance level was set at p < 0.001.ResultsThe course of soft-tissue swelling of the study group did not differ from that of the control group at any point in time. For the temperature course of the medial wound aspect, no difference was seen between the Kinesio taping study group and the A-V Impulse System™ group. In contrast, the temperature course of the lateral wound aspect showed a reproducibly higher temperature in the Kinesio tape group than in the control group (0.6 °C (0.5–0.8), p < 0.001).ConclusionThe hypothesis of the study that Kinesio taping as a lymph application induces a reduction of soft-tissue swelling after TKA must be rejected on the basis of the present data. Solely the temperature of the lateral wound aspect was higher in the Kinesio taping group than in the control group, so that an increased blood circulation can be assumed here. Considering that the actively working A-V Impulse System™ used in the control group also increases local blood circulation, the effect of the passive Kinesio tape is surprising. However, this was not reflected in a quicker wound healing, as the day of last wound secretion was the same in both groups. Kinesio taping as a lymph application represents an equivalent alternative to the A-V Impulse System™ for therapy after total knee arthroplasty with regard to soft-tissue swelling and wound healing.

Course of pelvic lift during total hip arthroplasty

IntroductionThe position of the cup makes a major contribution to the success of total hip arthroplasty (THA). In conventional implantation of the prosthesis without navigation, the surgeon relies on the spatial position of the pelvis. However, iatrogenic manipulation of the pelvis during different surgical steps constantly changes the position of the pelvis during the operation. The position of the pelvis is substantial for the correct placement of the cup. The objective of this study was to investigate and visualize the course of this pelvic lift and correlate it to certain surgical steps.Materials and methodsPelvic lift was measured in 67 patients during implantation of a THA. This was done by measuring acceleration using the SensorLog app on a smartphone. It was placed on the patient’s contralateral anterior superior iliac spine and recorded the movement of the pelvis throughout the whole surgical procedure. The position of the pelvis was allocated to each of eight relevant surgical steps during the operation. These surgical steps were normed over the time axis and transferred to a diagram.ResultsWe found an average pelvic lift displacement of up to 14.9° upon placement in the figure-of-four position. This lift is particularly critical when exposing the acetabulum, as the true cup position can be unconsciously influenced. Average values of between 5.6° and 6.9° were found here.ConclusionsWhen implanting a THA in supine position, the pelvis is not fixed on the operating table. Rather, the side to be operated on is lifted to a greater or lesser degree, depending on the surgical step to be performed. The retractor traction immediately before cup implantation should be minimized. Nevertheless, it should be taken into account that anteversion of the cup implant in relation to the table plane is systematically higher than in relation to the pelvic entry plane.

Erratum zu: Komplikationen und Kosten in der primären Knieendoprothetik in einem Endoprothetikzentrum – Einfluss des Weiterbildungsstandes

timierungeineswesentlichenFunktionsbereiches imKrankenhaus.ErfahrungenundAnsätzevonRoland Berger Strategy Consultants – 2014. https:// www.rolandberger.de/media/pdf/ Roland Berger Baustelle OP 20140501.pdf. Zugegriffen: 02. Mai 2016 14. Tan SC, Chan YH, Chong HC, Chin PL, Yew A, Chia SL, Tay D, Lo NN, Yeo SJ (2014) Association of surgeon factors with outcome scores after total kneearthroplasty. JOrthopSurg22:378–382 15. Thienpont E, Grosu I, Jonckheere S, Yombi JC (2013) C-reactive protein (CRP) in different types ofminimally invasive kneearthroplasty. KneeSurg SportsTraumatolArthrosc21:2603–2610 16. Vogt JC, Saarbach C (2009) LCS mobile-bearing total knee replacement. A 10-year’s follow-up study.OrthopTraumatolSurgRes95(3):177–182 17. von Lewinski G, Floerkemeier T, Budde S, Fuhrmann U, Schwarze M, Windhagen H, Radtke K (2015) Experience in establishing a certified endoprosthesis center.Orthopäde44:193–202 18. White J, Kelly M, Dunsmuir R (1998) C-reactive protein level after total hip and total knee replacement. JBoneJointSurgBr80:909–911 Orthopäde 2017 · 46:358 DOI 10.1007/s00132-017-3404-8 Online publiziert: 27. Februar 2017

Komplikationen und Kosten in der primären Knieendoprothetik in einem Endoprothetikzentrum

BACKGROUND This work examines the hypothesis that in endoprosthesis implantation there are differences between experienced primary and senior caregivers (S-Op) and less experienced follow-up assistants (T-Op) with respect to process-relevant parameters. The main hypothesis is that compared to S‑Op, T‑Op cause significantly longer surgery times and thus additional operating theatre costs. As sub-hypotheses, differences in various perioperative (p-o) parameters between T‑Op and S‑Op were examined. MATERIALS AND METHODS The status of the operator (senior and/or senior main operator [S-Op]) and/or postoperative CRP, perioperative blood loss, the amount of transfused erythrocyte concentrates, patient age, gender, ASA risk classification (American Society of Anesthesiologists), duration of surgery and blood transfusion, duration of inpatient stay, as well as the rates of early revision surgery and complications were recorded. A comparison of patients who had been operated by an S‑Op and those who had been operated by a T‑Op was made for all parameters. RESULTS Significant differences were found with respect to the duration of surgery, the duration of the hospital stay, and CRP on the third p‑o day. The T‑Op required an average of 11 min more than the S‑Op. CRP was significantly higher in the T‑Op group only on the third p‑o day, by 18 mg/l. In contrast, in the T‑Op group, a blood loss of 181 ml was lower than in the S‑Op group. This corresponded to a reduction of 0.26 transfused erythrocyte concentrates. There were no significant differences in complication rates between S‑Op and T‑Op. DISCUSSION In the setting of a certified endoprosthetics centre, the comparison of T‑Op with S‑Op showed that the use of the former with at a non-increased complication rate led to a significant extension of the operating time. This leads to additional training costs in the amount of an estimated 3% of the current DRG remuneration. These additional costs are not represented adequately in the current remuneration system.

Multifragmentary dislocated humeral head fracture—A case report of a successful head preserving treatment strategy despite delayed presentation

Highlights • Case report of multifragmentary and luxated humeral head fracture treated headpreserving despite delayed surgery (120 h).• “Avoiding arthroplasty inspite of extrmely high risk of avascular necrosis due to compromised blood supply in luxation oft he humeral head.• The headpreserving treatment showed excellent functional and radiologic results keeping a high “quality of life level”.• Divergent from the recommended standard−treatment (trauma arthroplasty) of luxated humeral headsplit fractures in a “delayed situation” a head preserving option should be taken into consideration.

Open Ankle Fracture in Geriatric Patient - A Treatment Strategy

The alteration of the age pyramid also leads to changes in the orthopaedic routine. Hence, increasingly more old and very old people (>75.YOA and 91.-100.YOA according to WHO Definition) are being treated with injury patterns that were very rare in this form until now. This could be explained on one hand both by the decreasing osseous stability and the alteration of the soft-tissue condition, and on the other hand by the maintenance of everyday activities even in old age. Thus, low-energy traumas can partly lead to serious injuries. Treatment strategies need to be adapted to the individual cases. The medical care of bones and soft-tissue injuries results to be demanding.