Lukas A. Holzer

The 50 Highest Cited Papers in Hip and Knee Arthroplasty

The 50 highest cited articles related to hip and knee arthroplasty were searched in Thomson ISI Web of Science®. The 50 highest cited articles had up to 2495 citations. The top 10 papers according to absolute number were cited 580 times at least. Most papers were published in the Journal of Bone and Joint Surgery American Volume (n = 22). Eight countries contributed to the list with most contributions from the United States (n = 30). The majority of papers were published since 1990 (n = 27). Studies focusing on the clinical outcome of hip arthroplasty dominate the literature in orthopedic arthroplasty in respect to absolute citations numbers. In the last decade however, papers on perioperative management have been published that show a high citation frequency.

Expression of VEGF, its receptors, and HIF-1α in Dupuytren’s disease

Background and purpose — Dupuytren’s disease (DD) is a benign fibroproliferative process that affects the palmar fascia. The pathology of DD shows similarities with wound healing and tumor growth; hypoxia and angiogenesis play important roles in both. We investigated the role of angiogenic proteins in DD. Patients and methods — The expression of vascular endothelial growth factor (VEGF), its receptors vascular endothelial growth factor receptor 1 (VEGFR1) and vascular endothelial growth factor receptor 2 (VEGFR2), hypoxia-inducible factor alfa (HIF-1α), and alfa-smooth muscle actin (α-SMA) were analyzed immunohistochemically in fragments of excised Dupuytren’s tissue from 32 patients. We compared these values to values for expression in a control group. Results — 15 of 32 samples could be attributed to the involutional phase (α-SMA positive), whereas 17 samples were considered to be cords at the residual phase (α-SMA negative). In the involutional phase, the HIF-1α and VEGFR2 expression was statistically significantly higher than in the residual phase and in the controls. Interpretation — Both the VEGFR2 receptor and HIF-1α were expressed in α-SMA positive myofibroblast-rich nodules with characteristics of DD in the active involutional phase. Thus, hypoxia and (subsequently) angiogenesis may have a role in the pathophysiology of DD.

The Most Cited Papers in Osteoporosis and Related Research

Osteoporosis is a systemic disease of the bone that affects millions of people and causes burden for both the affected individual and health systems and societies worldwide. Since the 1970s much research has been done in the field of osteoporosis. The number of citations of a paper reflects its influence and importance to the field. Thomson ISI Web of Science database was searched to retrieve a list of the fifty most cited articles related to osteoporosis and its research. The fifty most cited articles in absolute numbers in the field of osteoporosis were cited from 877 to 3056 times (mean 1141 ± 537). Most papers were published in the basic science category (n = 23). 395 authors contributed; a single paper had between one and 62 authors (mean: 10.02 ± 9.9 authors). 12 authors (3.04%) contributed between 7 and 4 papers; 340 authors (86.1%) were at least named once. Corresponding authors were from eight countries with most contributions from the United States (n = 34, 68%). The majority of papers were published in the 1990s (n = 29). The list of 50 most cited papers presents citation classics in the field of osteoporosis and related research.

Quality of life after volar locked plating: a 10-year follow-up study of patients with intra-articular distal radius fractures.

BackgroundThis study aimed to present functional results and patient’s health related quality of life (HRQOL) data ten years after volar locked plate fixation (VPF) of unstable intra-articular distal radial fractures (DRF).MethodsThirty-nine patients with a mean age of sixty-one years were operatively treated with VPF after intra-articular distal radial fractures. They were evaluated two, six, and ten years postoperatively according to the Gartland and Werley score. For subjective evaluation the Short Form 36 (SF-36) and the Disability of Arm, Shoulder and Hand (DASH) questionnaires were adopted.ResultsOverall, wrist function did not differ significantly two, six and ten years after the operation. Over 90% patients achieved “good” or “excellent” results ten years after surgery according to the Gartland and Werley score. Ten years postoperatively the results of the SF 36 did not differ significantly from the two- and six-year follow-up. Overall findings from the SF-36 did not differ significantly from the data of Austrian and American norm populations. Only in the subscale of mental health (MH) the ten-year follow-up did show significantly poorer results (p = 0.045) compared to the Austrian norm population. The median DASH scores did not show significant differences during the ten-year follow-up period.ConclusionThe ten-year results of this single-center study suggest that operative treatment of intra-articular DRF with volar locked plates is a useful and satisfactory therapy option, both in terms of function and HRQOL.

An Unusual Cause of Low Back Pain

Cotton gauzes are commonly used during surgical procedures. Retained surgical gauzes can result in tumors called textiloma. A 63-year-old female patient presented with chronic low back pain that had lasted about 20 years. She had surgery in the lumbar spine for discus herniation 19 years ago, as well as surgery for an intramuscular lipoma in the right lumbosacral paravertebral muscles 16 years ago. Clinically, she had pain in the …

Noise measurement in total knee arthroplasty.

Few studies have been performed to analyze noise levels produced by various surgical instruments in the operating room (OR). The highest levels of noise that have been described were due to instruments used for total knee arthroplasty (TKA). These high levels of noise might be a potential health hazard for patients and medical staff. Therefore, we aimed to measure noise levels of current instruments that are widely used worldwide. During a conventional primary TKA the levels of noise in the OR were measured using a Class 1 integrating-averaging sound level meter. The highest A-weighted equivalent level was produced when using a hammer during the implantation of the femoral and tibial components with 90.2 dBA. In total surgical instruments were used for about 10% of the total time of surgery. Noise exposure due to instrument use during TKA does not seem to be a potential health hazard for medical staff or patients.

Analysis of scientific articles published in two general orthopaedic journals

OBJECTIVE: To give an overview of the behaviour and scientific contributions of the Journal of Bone and Joint Surgery American (JBJS-A) and British Volume (JBJS-B). METHODS: 480 original articles published in 2009 were identified through a combined comprehensive computer and manual library search. Articles were assigned to 11 orthopaedic categories and by country, type and specialty of the institution. Possible grants and citations were analysed. USA led all countries in published articles (36,87%), followed by UK (20,62%) and South Korea (5,83%). Most studies published were performed at academic institutions (65,83 %), only 4,16% at private practices. RESULTS: Almost half of the articles (46,24%) were published in three categories: hip (19.16%), knee (13.75%) and trauma (13.33%). In both journals 47.15% articles had at least one funding source. A review of articles published in major journals allows to show how research in orthopaedics is distributed worldwide. CONCLUSION: This study shows that a variety of different journals is neccessary to reflect the broad spectrum of orthopaedics in depth. Level of Evidence III, Retrospective Comparative Study.

Clinical experience with the artificial bone graft substitute Calcibon used following curettage of benign and low-grade malignant bone tumors

Artificial bone graft substitutes, such as Calcibon, are becoming increasingly interesting as they do not cause donor site morbidity which is an advantage compared to autologous bone grafts. The aim of this study was to evaluate the efficacy and potential complications associated with the use of Calcibon. Twenty-seven patients with benign and low-grade malignant bone tumors were treated with curettage and refilling of the bony cavity. Based on the radiological classification system of Neer, these lesions only comprised Grade I lesions, describing cysts that only require curettage and filling, but no additional treatment. At a mean follow up of six months we observed radiological consolidation without resorption of the bone graft substitute. These observations were also made at a mean follow-up of 13 and 32 months, respectively. According to the classification system of Goslings and Gouma we observed six surgical complications. Summing up, Calcibon seems to be a reliable bone graft substitute with low complication rates. However, delayed resorption should be expected. Calcibon seems to be an alternative to autologous bone grafts or allografts in adequate indications.

A novel mutation in ATRX associated with intellectual disability, syndromic features, and osteosarcoma

Osteosarcomas are the most frequently diagnosed primary malignancies of bone.1 They occur sporadically, although some distinct syndromes increase the risk of development, such as Li–Fraumeni, retinoblastoma, RAPADILINO (RECQL4), Bloom, and Werner syndromes.2,3 X-linked intellectual disability syndromes have a higher incidence in males.4 Examples include Lesch–Nyhan syndrome, Coffin–Lowry syndrome, and alpha-thalassemia X-linked intellectual disability (ATRX) syndrome caused by amutation in the ATRX (XNP) gene.5 A 22-year-old Caucasian man was referred to our outpatient clinic with severe knee pain, eventually diagnosed as localized osteosarcoma. He was treated according to the European and American Osteosarcoma Study Group 1 protocol with preand postoperative chemotherapy, as well as above-knee amputation. Three years after surgery, there was no evidence of local or systemic recurrence. Born with microcephaly, the patient was intellectually disabled and in need of full-time care. His younger half-brother (8a) presented with microcephaly, growth delay, and intellectual disability. While in themother’s family a relatively high incidence ofmalignancies was evident (brother [35a; pharyngeal cancer], mother [35a], and grandmother [50a, endometrial cancer]), the family histories of both fathers were inconspicuous. After collecting blood from the brothers, all genes on the X-chromosome were enriched using the Agilient SureSelect Target Enrichment System. Illumina MiSeq sequencing and variant prioristion revealed a hemizygous sequence variant within the ATRX gene (NM_000489: c.6130C>T, p.Leu2044Phe) in both brothers. This variant, which themotherwas heterozygous for, has not been reported yet in any population frequency (ExAc, ESP, 1,000 g) ormutation database. In silico predictions (SIFT, PolyPhen, LRT, Mutation taster) consistently indicated a deleterious effect of the mutation on protein function. Therefore, according to the ACMG guidelines, the variant is classified as likely pathogenic.6 Unambiguously heterogenetic mutations are causative for ATRX syndrome, characterized by distinctive craniofacial features, genital anomalies, severe developmental delays, intellectual disability, and mild-to-moderate anemia secondary to alpha-thalassemia.7 In line with the literature,8 intellectual disability and typical skeletal deformities (Fig. 1) were present in both brothers, while the mother had unspecific symptoms compatible with this trait (i.e., major depression). Overall, the genotype–phenotype correlation is rather nonspecific in patients with ATRX syndrome8 and overlaps with syndromes caused bymutations at other gene loci.9

Clinical Results and Serum Metal Ion Concentrations following Ceramic-on-Metal Total Hip Arthroplasty at a Mean Follow-Up of 60 Months

Background. Increased metal ion levels following total hip arthroplasty (THA) with metal-on-metal bearings are a highly debated topic. Local soft tissue reactions with chronic pain and systemic side effects such as neuropathy are described. The aim of the current study was to determine the serum metal ion concentrations of Cobalt (Co) and Chrome (Cr) after THA with a ceramic-on-metal (CoM) bearing. Patients and Methods. Between 2008 and 2010, 20 patients underwent THA using a CoM bearing. Clinical function was evaluated by standardized scores systems (Harris Hip Score and WOMAC Score) and radiological examination included X-rays. Patients blood samples were obtained for metal ion analysis and correlation analysis was done between these results and implant position. Results. Overall, 13 patients with 14 CoM devices were available for the current series. The mean age at time of surgery was 61 years (range, 41 to 85). The postoperative follow-up ranged from 49 to 68 months (mean, 58). Metal ion determination showed mean concentrations of 3,1 µg/L (range, 0,3–15,2 µg/L) for Co and 1,6 µg/L (range, 0,1–5,5 µg/L) for Cr, respectively. A correlation between cup anteversion and Co and Cr concentrations was shown. Conclusion. The current series showed increments for Co and Cr following CoM THA. However, these levels are lower compared to metal ion concentrations in patients with metal-on-metal bearings and the international accepted threshold for revision of MoM devices. We recommend routine follow-up including at least one obligatory evaluation of serum metal ion concentrations and an MRI once to exclude local soft tissue reactions.