Long-term effects of intravenous iloprost therapy in patients with bone marrow oedema of the hip.

Bone marrow oedema (BMO) is a multifactorial condition. Various conservative treatment options include analgesic therapy, immobilisation of the affected joint and/or systemic intravenous iloprost or bisphosphonate therapy. Many studies confirm the positive effect of iloprost therapy in larger joints, e.

Outcome of short versus long interval in two-stage exchange for periprosthetic joint infection: a prospective cohort study.

Introduction: A two-stage exchange is the standard treatment approach for chronic periprosthetic joint infection (PJI). While a 6-8 week interval is commonly used before reimplantation, the optimal length of the prosthesis-free interval has not yet been determined. We evaluated the influence of a short (< 4 weeks) and long (≥ 4 weeks) interval on reinfection rate and functional outcome of hip and knee PJI.

Immunomodulatory placental-expanded, mesenchymal stromal cells improve muscle function following hip arthroplasty.

Background: No regenerative approach has thus far been shown to be effective in skeletal muscle injuries, despite their high frequency and associated functional deficits. We sought to address surgical trauma-related muscle injuries using local intraoperative application of allogeneic placenta-derived, mesenchymal-like adherent cells (PLX-PAD), using hip arthroplasty as a standardized injury model, because of the high regenerative and immunomodulatory potency of this cell type.

Methods: Our pilot phase I/IIa study was prospective, randomized, double blind, and placebo-controlled.

Relationship between muscular and bony anatomy in native hips: a theoretical background for approach-specific implant positioning.

Introduction:: The aim of this study was to analyse the relationship between bony joint orientation and the distribution of hip musculature.

Methods:: The bone anatomy of the hip (femoral antetorsion (AT), acetabular anteversion (AV), and combined anteversion (AV/AT)) and the muscle volume of the gluteal muscles and the tensor fasciae latae were analysed bilaterally using computed tomography data of 49 patients. Muscle force direction (MFD) was determined for each muscle.

Femoral head necrosis: A finite element analysis of common and novel surgical techniques.

Background: Femoral head necrosis is a common cause of secondary osteoarthritis. At the early stages, treatment strategies are normally based on core decompression techniques, where the number, location and diameter of the drilling holes varies depending on the selected approach. The purpose of this study was to investigate the risk of femoral head, neck and subtrochanteric fracture following six different core decompression techniques.

Inadequacy of Joint Aspiration for Detection of Persistent Periprosthetic Infection During Two-Stage Septic Revision Knee Surgery.

Despite the lack of validation, synovial aspiration remains a common practice during 2-stage septic revision total knee arthroplasty (TKA). The goal of this study was to investigate the diagnostic validity of synovial polymethylmethacrylate (PMMA) spacer aspiration of temporary knee arthrodesis to detect persistent periprosthetic joint infection before TKA reimplantation. This retrospective cohort study included 73 consecutive patients who underwent 2-stage septic revision TKA according to a standard protocol.

CD31+ Cells From Peripheral Blood Facilitate Bone Regeneration in Biologically Impaired Conditions Through Combined Effects on Immunomodulation and Angiogenesis.

Controlled revascularization and inflammation are key elements regulating endogenous regeneration after (bone) tissue trauma. Peripheral blood-derived cell subsets, such as regulatory T-helper cells and circulating (endothelial) progenitor cells, respectively, can support endogenous tissue healing, whereas effector T cells that are associated with an aged immune system can hinder bone regeneration. CD31 is expressed by diverse leukocytes and is well recognized as a marker of circulating endothelial (precursor) cells; however, CD31 is absent from the surface of differentiated effector T cells.

Temporary arthrodesis using fixator rods in two-stage revision of septic knee prothesis with severe bone and tissue defects.

Purpose: The present study describes a new temporary arthrodesis procedure, which aims for septic knee prosthesis replacement, in particular for larger bone and soft tissue defects. Our technique offers high stability and full weight-bearing capacity of the knee joint.

Methods: The study included 16 patients with major bone defects (AORI type IIb or greater) after receiving a radical debridement and a septic two-stage revision total knee arthroplasty.

Reproducibility of femoral offset following short stem and straight stem total hip arthroplasty.

Bone stock-preserving short stem prostheses have gained importance in total hip arthroplasty (THA) with the use of minimally invasive surgical procedures. Because of their metaphyseal fixation and their dependency on the calcar radius, it is unknown whether the femoral offset can be reproduced with the same accuracy following short stem vs standard stem THA. This study clarifies whether it is possible to restore the femoral offset using a short stem prosthesis (Fitmore; Zimmer, Warsaw, Indiana) compared with a conventional straight stem prosthesis (CLS; Zimmer) following minimally invasive implantation using an anterolateral approach.

The early phases of bone healing can be differentiated in a rat osteotomy model by focused transverse-transmission ultrasound.

Here we describe the use of a 5-MHz focused transmission system to image the bone repair region and to distinguish the early healing phases in a rat osteotomy (OT) model. Twelve-month-old female rats underwent a 2-mm OT. After 6 wk of consolidation, 2-D projection images of time-of-flight, speed of sound, and ultrasound attenuation were measured in vitro.

CD133: enhancement of bone healing by local transplantation of peripheral blood cells in a biologically delayed rat osteotomy model.

Sufficient angiogenesis is crucial during tissue regeneration and therefore also pivotal in bone defect healing. Recently, peripheral blood derived progenitor cells have been identified to have in addition to their angiogenic potential also osteogenic characteristics, leading to the hypothesis that bone regeneration could be stimulated by local administration of these cells. The aim of this study was to evaluate the angiogenic potential of locally administered progenitor cells to improve bone defect healing.

Effects of indigo carmine on human chondrocytes in vitro.

Joint infections following or accompanying superficious soft tissue infections are severe complication in orthopedic surgery. The use of intra-articular blue staining is a helpful method to visualize a fistula and to differentiate between superficial and intra-articular infections. Regarding this clinical implication data about the effects of indigo carmine, a frequently used blue staining substance, on cartilage is missing.

Femoral Offset (3D) in Patients without Osteoarthritis - Index Values from 200 Hip Joints.

Introduction: Femoral offset (FO) is a crucial parameter for hip joint biomechanics. Reference values for FO are particularly important when joint geometry has to be reconstructed during surgical interventions. Such reference values are scarce in literature and have mainly been obtained from osteoarthritis (OA) patients.

Use of Redon drains in primary total hip arthroplasty has no clinically relevant benefits.

Although no proven evidence exists for the use of drainage in primary total hip arthroplasty, such drainage is routinely used. This prospective, randomized study comprised 80 patients who underwent a non-cemented total hip arthroplasty using a minimally invasive anterolateral approach. Patients were divided into 2 groups of 40: group 1 underwent drainage treatment and group 2 underwent no drainage treatment.

Femur positioning in navigated total knee arthroplasty.

Navigated total knee arthroplasty (TKA) results in better restoration of neutral mechanical axis than does the conventional technique. Nevertheless, coronal malalignment has not been eliminated. It is yet unknown whether errors in implant positioning occur more on the femoral side, more on the tibial side, or equally on both sides.

In situ tele-thermographic measurements during PMMA spacer augmentation in temporary arthrodesis after periprosthetic knee joint infection.

Poly-Methylmethacrylate (PMMA) is widely-used in orthopaedic surgery in revision arthroplasty or as a spacer in temporary arthrodesis of periprostehtic knee joint infection during a two stage procedure. The intra-operative temperature behaviour, however, has not yet been quantified. It is known that high temperature induce thermally necrosis of surrounding bone tissue during polymerisation process.

Intra-Arterial MSC Transplantation Restores Functional Capacity After Skeletal Muscle Trauma.

Introduction: Skeletal muscle trauma leads to severe functional deficits, which cannot be addressed by current treatment options. Our group could show the efficacy of local transplantation of mesenchymal stroma cells (MSCs) for the treatment of injured muscles. While local application of MSCs has proven to be effective, we hypothesized that a selective intra-arterial transplantation would lead to a better distribution of the cells and so improved physiological recovery of muscle function.

Histogram feature-based classification improves differentiability of early bone healing stages from micro-computed tomographic data.

Objective: Contrast between not fully mineralized tissues is weak and limits conventional computed tomography (CT). An automated grayscale histogram-based analysis features could improve the sensitivity to tissue alterations during early bone healing.

Materials And Methods: Tissue formation in a rat osteotomy model was analyzed using in vivo micro-CT and classified histologically (mineralized, cartilage, and connective tissues).

Immediate and delayed transplantation of mesenchymal stem cells improve muscle force after skeletal muscle injury in rats.

Mesenchymal stem cell (MSC) therapy is a promising approach for regaining muscle function after trauma. Prior to clinical application, the ideal time of transplantation has to be determined. We investigated the effects of immediate and delayed transplantation.

Mesenchymal stem cell therapy following muscle trauma leads to improved muscular regeneration in both male and female rats.

Background: Mesenchymal stem cell (MSC) therapy has the potential to enhance muscular regeneration. In previous publications, our group was able to show a dose-response relationship in female animals between the amount of transplanted cells and muscle force. The impact of sex on the regeneration of musculoskeletal injuries following MSC transplantation remains unclear.

BMI and gender do not influence surgical accuracy during minimally invasive total hip arthroplasty.

We investigated the accuracy of implant positioning during total hip arthroplasty (THA) through a minimally invasive approach in relation to body mass index (BMI) and gender by assessing 48 patients. Functional and radiological parameters were evaluated. BMI positively correlated with operation time (p=0.

The sex specificity of hip-joint muscles offers an explanation for better results in men after total hip arthroplasty.

Purpose: Choosing a surgical approach for total hip arthroplasty (THA) has a patient-specific impact on peri-operative muscle damage as well as postoperative functional outcome. Women and aged patients increasingly benefit from minimally invasive surgical procedures. For this reason, and due to the distinctly different bony anatomy of men and women, the hypothesis of this study is that muscle distribution around the hip joint is dependent on sex and age.

Preferred use of polyhexanide in orthopedic surgery.

In orthopedic and trauma surgery, the most frequently used antiseptic is polyhexanide. Its favored application is based on prepossessing tissue compatibility in contrast to various antiseptics and a high antimicrobiological effect. Recent studies showed toxic effects of this antiseptic on human chondrocytes.

A formula to predict patients' gluteus medius muscle volume from hip joint geometry.

The volume of the gluteus medius muscle (GMV) has been shown to be closely related to hip joint function. A defined relation between joint geometry and GMV would allow a calculation of the patient-specific GMV providing reference values to individually determine the goals for rehabilitation programs after total hip arthroplasty (THA). The aim of this study was to investigate correlations between hip geometry and GMV.

Spatial-temporal mapping of bone structural and elastic properties in a sheep model following osteotomy.

The course of bone healing in animal models is conventionally monitored by morphologic approaches, which do not allow the determination of the material properties of the tissues involved. Mechanical characterization techniques are either dedicated to the macroscopic evaluation of the entire organ or to the microscopic evaluation of the tissue matrix. The latter provides insight to regionally specific alterations at the tissue level in the course of healing.