H.W. Neumann

Cementless CUT femoral neck prosthesis: increased rate of aseptic loosening after 5 years.

Background Bone-saving hip arthroplasty techniques, which facilitate revision, are gaining importance as the number of hip replacements in younger patients increases. Patients and methods 123 CUT femoral neck prostheses (ESKA Implants, Lübeck, Germany) were implanted in 113 patients (average age 53 years) between 1999 and 2002. After a mean follow-up of 5 (3–7) years, we determined the state of 120 prostheses; 3 patients could not be located. 97 patients with 107 prostheses, none of which had been revised, were evaluated clinically and radiographically. Results The median Harris hip score improved from 51 points to 92 points in the unrevised hips. 13 CUT prostheses (11%) had been revised, 7 because of aseptic loosening, 3 because of persisting thigh pain, 1 because of immediate vertical migration, and 2 because of septic loosening. The 5-year survival rate of the CUT prosthesis was 89%. Interpretation The medium-term survival with this type of femoral component is unsatisfactory, with a high rate of aseptic loosening. The surviving prostheses had a good clinical outcome.BACKGROUND Bone-saving hip arthroplasty techniques, which facilitate revision, are gaining importance as the number of hip replacements in younger patients increases. PATIENTS AND METHODS 123 CUT femoral neck prostheses (ESKA Implants, Lübeck, Germany) were implanted in 113 patients (average age 53 years) between 1999 and 2002. After a mean follow-up of 5 (3-7) years, we determined the state of 120 prostheses; 3 patients could not be located. 97 patients with 107 prostheses, none of which had been revised, were evaluated clinically and radiographically. RESULTS The median Harris hip score improved from 51 points to 92 points in the unrevised hips. 13 CUT prostheses (11%) had been revised, 7 because of aseptic loosening, 3 because of persisting thigh pain, 1 because of immediate vertical migration, and 2 because of septic loosening. The 5-year survival rate of the CUT prosthesis was 89%. INTERPRETATION The medium-term survival with this type of femoral component is unsatisfactory, with a high rate of aseptic loosening. The surviving prostheses had a good clinical outcome.

Genetic instability in osteoblastic tumors of the skeletal system

At the histological level, the differential diagnosis of osteoblastic bone tumors is characterized by several problems that cannot be solved by conventional histological methods including immunohistology. Differentiating aneurysmal bone cyst from telangiectatic osteosarcoma or giant cell tumor from giant cell-containing highly malignant osteosarcoma are only two examples reflecting the complexity of this field. To develop a new approach to these diagnostic problems, we analyzed the genetic instability in a large number of bone-forming tumor-like lesions as well as in benign and malignant osteoblastic tumors. Our research concentrated on genetic alterations in cell cycle regulator genes: mutations in the p53 gene and ras gene, loss of heterozygosity at the p53, p16 and Rb-locus, and amplification of the mdm2-gene and the c-myc-gene. In addition to cell cycle regulators, the telomerase activity has also been analyzed. The results show that the number of genetic alterations increases with the malignancy of the tumors. The highest number of genetic alterations could thus be found in conventional intraosseous osteosarcoma. In tumor-like lesions, genetic alterations have rarely been observed. The results of this study show that analyzing the genetic instability probably contributes to an improvement in the differential diagnosis of osteoblastic tumors.

Vergleich von 2 Operationstechniken bei isolierter Supraspinatusruptur Eine Matched-pair-Studie

ZusammenfassungDer Wert neuer Operationstechniken in der Versorgung von Rotatorenmanschettenrupturen lässt sich nur bei homogenem Patientengut in vergleichenden (Matched-pair-)Studien belegen.Wir verglichen 34 Patienten in 2 Gruppen, die mit einer isolierten Supraspinatusruptur (Typ III) operiert wurden. Gruppe I wurde mit der transossären Fixierung versorgt, Gruppe II mit Hilfe von Corcscrew®-Ankern. Beide Gruppen waren alters- und geschlechtsgepaart, die klinischen Ausgangsbefunde waren identisch. Die Beurteilung der klinischen Ergebnisse erfolgte mit dem Constant-Score, einer Kraftmessung, der Schmerzbeurteilung und Röntgenkontrolle. Die Nachuntersuchung wurde 18 Monate postoperativ durchgeführt.Insgesamt verbesserte sich in beiden Gruppen der mittlere Constant-Wert bei deutlichem Kraftzuwachs und Schmerzreduktion. Klinische Unterschiede zwischen den beiden Gruppen ließen sich nicht nachweisen. Die Operationszeit in Gruppe II (Corcscrew®-Anker) war signifikant geringer als in Gruppe I.Mit der Ankertechnik lassen sich somit bei isolierten Supraspinatusrupturen gleich gute Ergebnisse wie mit der transossären Technik erzielen. Bei kürzerer Operationszeit bleibt die Abwägung der Ankerkosten.AbstractThe comparison of results after open surgery methods in the repair of rotator cuff ruptures needs homogen patient groups.We compared 34 patients in 2 groups who were treated with open surgery for isolated ruptures of the supraspinatus muscles (lesion type III). Patients in group I were treated with transosseous suture refixation of the supraspinatus, in group II suture anchors (type: Corcsrew®) were used. Both groups were age and gender paired. Preoperatively, all patients had the same clinical status. For the evaluation of the clinical results at follow-up we used the Constant-Score. In addition, strength and pain measurement and oblique X-rays of the shoulder were performed. The follow-up time was 18 months.In all patients, the mean Constant-Score improved significantly with increase in muscle strength and marked pain reduction. Significant differences between both groups could not be observed. The mean time of surgery in group II (suture anchor) was significantly lower than in group I.In conclusion, with the anchor techniques the same good results can be achieved as with bone refixation. The shortening of the surgery time should, however, be seen in relation to the higher costs with this technique.

Expression of stromelysin and urokinase type plasminogen activator protein in resection specimens and biopsies at different stages of osteoarthritis of the knee.

This study aimed at assessing the possible diagnostic value of cartilage biopsies as a convenient marker for cartilage matrix degradation. We therefore examined cartilage specimens from 56 patients with primary osteoarthritis (OA) of the knee. Resection and biopsy cartilage specimens obtained during joint replacement surgery were used for this study. In addition to histomorphology, immunohistochemistry (ICH) was performed to determine the expression levels and distribution patterns of stromelysin and u-PA protein. The latter data were compared with the degree of histomorphological changes in osteoarthritic cartilage samples, based on a modified version of Mankins grading score. Compared to the cartilage resection specimens, the biopsies showed comparable expression patterns for both proteinases: the strongest signals were noted in the superficial zone and, as matrix destruction increased, also in the chondrocytes of the transition and deep zones. The strongest signals were ascertained in cell clusters beneath deep matrix fissures. At the immunohistochemical level, we found a direct correlation in the expression of MMP-3 and u-PA between resection specimens and biopsies. Furthermore, in both types of cartilage samples, we noticed a positive relationship between the expression of both proteins and the Mankin score. Analysis of the expression levels revealed significant differences between deep, transition and superficial zones. Histomorphological and immunohistochemical examinations of MMP-3 and u-PA in biopsies of osteoarthritic cartilage turned out to be useful for estimating the pathological changes within osteoarthritic knee joints. Therefore, in future, cartilage biopsies from osteoarthritic knee joints might serve as a diagnostic tool and thus have an influence on further therapeutic strategies.

Radiographic findings in osteoarthritis of the knee joint are not correlated with cartilage histomorphology or lmmunohistochemistry

The purpose of this study was to investigate whether radiographic joint space narrowing (JSN) of the lateral knee compartment predicts the histomorphological or immunhistochemical grading in cases of osteoarthritis of the knee joint. The lateral joint space was measured on weight-bearing radiographs. Femoral osteochondral plugs of 29 patients undergoing total knee replacement were obtained from lateral condyles. All these patients had severe osteoarthritis of the medial compartment, with the lateral compartment showing different stages of osteoarthritis. The specimens were histomorphologically evaluated with the Mankin score, and the expression of the cartilage-degrading enzymes MMP1 and MMP3 was measured. There was no correlation between the joint space and histomorphological or immunohistochemical data, whereas the enzyme expression was correlated with histomorphological grading. We conclude that radiographic assessment alone is not sufficient to evaluate the cartilage damage of the lateral condyle.

Geschichte der deutschen Orthopädie von 1989–2001

ZusammenfassungDer vorliegende Artikel beschreibt wesentliche Aspekte der Entwicklung der deutschen Orthopädie in den Jahren 1989–2001. Dabei wird insbesondere auf die Vereinigung der beiden deutschen Orthopädien nach der Wende in der DDR und die sich daraus ergebenden Veränderungen in der deutschen Orthopädielandschaft eingegangen. Darüber hinaus werden weitere Eckpunkte der Entwicklung der deutschen Orthopädie der letzten 10 Jahre wie die Gründung der Allianz Deutscher Orthopäden, die Gründung der verschiedenen Sektionen der DGOT sowie Kernpunkte der wissenschaftlichen Tätigkeit der letzten Jahre dargestellt.AbstractThe present article describes essential aspects of the development of German orthopedics from 1989 to 2001. Special attention is given to the unification of the two German orthopedic groups after the political turnaround in the German Democratic Republic and the resultant changes in the landscape of German orthopedics. In addition, further milestones in the development of German orthopedics during the last 10 years are presented, e.g., the formation of the Alliance of German Orthopedists, the establishment of various sections of the DGOT (German Association of Orthopedics and Traumatology) as well as the main focus of scientific activity in the past few years.The present article describes essential aspects of the development of German orthopedics from 1989 to 2001. Special attention is given to the unification of the two German orthopedic groups after the political turnaround in the German Democratic Republic and the resultant changes in the landscape of German orthopedics. In addition, further milestones in the development of German orthopedics during the last 10 years are presented, e.g., the formation of the Alliance of German Orthopedists, the establishment of various sections of the DGOT (German Association of Orthopedics and Traumatology) as well as the main focus of scientific activity in the past few years.