295 results on '"Rolvien T"'
Search Results
52. Mutationsanalyse erbringt den Nachweis von Monogenetischen Knochenerkrankungen bei Frauen mit suspekter Schwangerschafts-assoziierter Osteoporose (SSAO)
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Butscheidt, S, additional, Delsman, A, additional, Rolvien, T, additional, Mundlos, S, additional, Kornak, U, additional, Amling, M, additional, and Oheim, R, additional
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- 2017
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53. Osteocytic vs. anosteocytic bone
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Busse, B., primary and Rolvien, T., additional
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- 2016
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54. A novel COL1A2 C-propeptide cleavage site mutation causing high bone mass osteogenesis imperfecta with a regional distribution pattern.
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Rolvien, T., Kornak, U., Stürznickel, J., Schinke, T., Amling, M., Mundlos, S., and Oheim, R.
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BIOMARKERS , *BONE resorption , *BONE growth , *COLLAGEN , *COMPUTED tomography , *BONE fractures , *GENETIC polymorphisms , *HIP joint , *OSTEOGENESIS imperfecta , *SPINAL injuries , *BONE density , *PHOTON absorptiometry , *SEQUENCE analysis - Abstract
Osteogenesis imperfecta (OI) is typically characterized by low bone mass and increased bone fragility caused by heterozygous mutations in the type I procollagen genes ( COL1A1/ COL1A2). We report two cases of a 56-year-old woman and her 80-year-old mother who suffered from multiple vertebral and non-vertebral fractures with onset in early childhood. A full osteologic assessment including dual-energy X-ray absorptiometry (DXA), high-resolution peripheral quantitative computed tomography (HR-pQCT), and serum analyses pointed to a high bone mineral density (BMD) in the hip (DXA Z-score + 3.7 and + 3.9) but low to normal bone mass in the spine and preserved bone microstructure in the distal tibia. Serum markers of bone formation and bone resorption were elevated. Using whole exome sequencing, we identified a novel mutation in the COL1A2 gene causing a p. (Asp1120Gly) substitution at the protein level and affecting the type I procollagen C-propeptide cleavage site. In line with previously reported cases, our data independently prove the existence of an unusual phenotype of high bone mass OI caused by a mutation in the procollagen C-propeptide cleavage with a clinically persistent phenotype through adulthood. [ABSTRACT FROM AUTHOR]
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- 2018
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55. Osteocytic vs. anosteocytic bone
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Rolvien, T. and Busse, B.
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- 2016
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56. Bone biology in the elderly: clinical importance for fracture treatment
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Rolvien Tim and Amling Michael
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bone remodeling ,dxa ,fragility fractures ,hr-pqct ,osteoporosis ,secondary fracture prevention ,vitamin d ,Surgery ,RD1-811 - Abstract
Age-related bone impairment often leads to fragility fractures in the elderly. Although excellent surgical care is widely provided, diagnosis and treatment of the underlying bone disorder are often not kept in mind. The interplay of the three major bone cells – osteoblasts, osteoclasts, and osteocytes – is normally well regulated via the secretion of messengers to control bone remodeling. Possible imbalances that might occur in the elderly are partly due to age, genetic risk factors, and adverse lifestyle factors but importantly also due to imbalances in calcium homeostasis (mostly due to vitamin D deficiency or hypochlorhydria), which have to be eliminated. Therefore, the cooperation between the trauma surgeon and the osteologist is of major importance to diagnose and treat the respective patients at risk. We propose that any patient suffering from fragility fractures is rigorously screened for osteoporosis and metabolic bone diseases. This includes bone density measurement by dual-energy X-ray absorptiometry, laboratory tests for calcium, phosphate, vitamin D, and bone turnover markers, as well as additional diagnostic modalities if needed. Thereby, most risk factors, including vitamin D deficiency, can be identified and treated while patients who meet the criteria for a specific therapy (i.e. antiresorptive and osteoanabolic) receive such. If local health systems succeed to manage this process of secondary fracture prevention, morbidity and mortality of fragility fractures will decline to a minimum level.
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- 2016
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57. Primär intraossäres Meningeom: Klinische, histologische und differentialdiagnostische Aspekte
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Butscheidt, S, Ernst, M, Rolvien, T, Hubert, J, Zustin, J, Amling, M, and Martens, T
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- 2019
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58. Vorläufige Ergebnisse der Gen-Panel-Diagnostik im Rahmen der Schwangerschafts-assoziierten Osteoporose (SSAO)
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Butscheidt, S, Tsourdi, E, Rolvien, T, Delsmann, A, Hofbauer, LC, Amling, M, Kornak, U, Seefried, L, and Oheim, R
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- 2019
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59. Die trabekuläre Mikroarchitektur ermöglicht die Vorhersage von Frakturen bei postmenopausalen Frauen unter Denosumab-Therapie
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Butscheidt, S, Rolvien, T, Vettorazzi, E, and Frieling, I
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- 2019
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60. Prevention and Treatment of Glucocorticoid-Induced Osteoporosis in adults: Recommendations From the European Calcified Tissue Society.
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Paccou J, Yavropoulou MP, Naciu AM, Chandran M, Messina OD, Rolvien T, Carey JJ, D'oronzo S, Anastasilakis AD, Saag KG, and Lems WF
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Introduction: This report presents the recommendations of the European Calcified Tissue Society (ECTS) for the prevention and treatment of glucocorticoid-induced osteoporosis (GIOP) in adults. Our starting point was that the recommendations be evidence based, focused on non-bone specialists who treat patients with GC and broadly supported by ECTS., Methods: The recommendations were developed by global experts. After a comprehensive review of the literature, twenty-five recommendations were formulated, based on quality evidence. For stratifying fracture risk and the most appropriate first line of treatment, we have classified patients into 3 categories: those at medium risk of fractures i.e. adults without a recent (in the last 2 years) history of fracture, those at high risk of fractures i.e. adults with recent history of fracture, and/or at least one vertebral fracture (grade ≥ 2 according to Genant classification), and those at very high risk of fractures i.e. adults aged ≥ 70 years with a recent hip fracture, pelvis fracture, and/or at least one vertebral fracture (grade ≥ 2 according to Genant classification) . The subtopics in the recommendations include Who to assess, How to assess, Who to treat, How to treat, and Follow-up and Monitoring., Results: General measures are recommended for all patients who are being prescribed glucocorticoids (GCs) for > 3 months: i.e. calcium and protein intake should be normalized, a 25(OH) vitamin D concentration of 50-125 nmol/L should be attained, and the risk of falls be minimized. 1)Who to assess? (R1-2) A preliminary assessment of fracture risk should be routinely performed in patients likely to receive oral GCs for ≥ 3 months: (i) women and men ≥ 50 years and (ii) patients at increased risk of fracture (history of fragility fracture and/or have comorbidities or are on medications that are frequently associated with osteoporosis.2)How to assess (fracture risk)? (R3-6) Clinical risk factors including history of fragility fracture, systematic vertebral imaging, and GCs dose-adjusted FRAX, measurement of BMD by DXA, fall risk, and biochemical testing.3) Who to treat? (R7-12) Anti-osteoporosis treatment is indicated for women and men ≥ 50 years with (i) the presence of a recent history of vertebral and/or non-vertebral fracture (less than 2 years) (ii)and/or a GCs dosage ≥ 7.5 mg/day, (iii)and/or age ≥ 70 years (iv)and/or a T-score ≤ -1.5, (v)and/or 10-year probability risk above the country specific GC dose-adjusted FRAX® thresholds. In premenopausal women and men < 50 years with a Z-score ≤ -2 and/or a history of fragility fracture, it is recommended to refer the patient to a bone specialist.4) How to treat? (R13-18) In women and men ≥ 50 years, (i) alendronate or risedronate is preferred as the first line of treatment in patients at medium risk of fractures, (ii) zoledronic acid or denosumab in patients at high risk of fractures, and (iii) teriparatide in patients at very high risk of fractures. It is imperative that sequential therapy be implemented in individuals receiving denosumab or teriparatide as their first-line treatment regimen.5) Follow-up and Monitoring (R19-25): In patients receiving anti-osteoporosis treatment, monitoring of clinical risk factors (e.g., history of fragility fracture), systematic vertebral imaging, fall risk, BMD measurement using DXA, and biochemical testing should be performed regularly during follow-up., Conclusions: The new, evidence-based recommendations by the ECTS for the prevention and treatment of GIOP provide clear and pragmatic advice to all health practitioners especially those who are not bone specialists., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Endocrinology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
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- 2024
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61. Sex-Specific Association of Clinical Parameters and Components of Femoral Bone Quality in Patients Undergoing Total Hip Arthroplasty.
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Alimy AR, Thiessen ML, Strahl A, Boese CK, von Kroge S, Beil FT, Rolvien T, and Ries C
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- Humans, Female, Male, Aged, Middle Aged, Femur Neck diagnostic imaging, Aged, 80 and over, Sex Characteristics, Sex Factors, Arthroplasty, Replacement, Hip adverse effects, Bone Density physiology, Absorptiometry, Photon methods, Femur diagnostic imaging
- Abstract
Poor bone quality is a critical factor associated with an increased risk of complications after total hip arthroplasty (THA). However, no consistent recommendations have yet been established for assessing indicators of bone quality preoperatively. Thus, it remains unclear which preoperatively available and readily accessible parameters are most closely associated with femoral bone quality. Here, we obtained femoral neck specimens from 50 patients undergoing THA. Preoperative Dual-energy X-ray absorptiometry (DXA) scans, pelvic radiographs, and laboratory parameters were analyzed. In the obtained specimens, bone microstructure was assessed using micro-CT and histomorphometry. Additionally, matrix mineralization and osteocyte lacunar morphology were evaluated using quantitative backscattered electron imaging. Our analysis revealed that DXA-derived T-scores correlated with trabecular microstructure. Furthermore, radiographic indices and body mass index correlated differentially with aspects of bone quality in women and men. Contrary to previous observations, no correlation was found between serum vitamin D levels and osteoid indices, nor between clinical parameters and matrix mineralization. Age was strongly associated with the number of mineralized osteocyte lacunae, a factor that appeared to be independent of sex. Taken together, our study demonstrates that no single preoperatively available parameter exhibits a strong and consistent association with femoral bone quality. However, DXA remains a reliable preoperative measure for determining the trabecular microstructure of the femoral neck. In clinical practice, surgeons should adopt an individualized approach to preoperative assessments by considering age, sex, BMI, and radiographic indices to enhance their insight into femoral bone quality, particularly when DXA is unavailable., (© 2024. The Author(s).)
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- 2024
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62. The lateral approach for total knee arthroplasty in valgus osteoarthritis provides similar clinical and radiological results compared with the medial approach.
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Alsalloum M, Alimy AR, Hubert J, Rolvien T, and Fink B
- Abstract
Purpose: In total knee arthroplasty (TKA), valgus deformities require special approaches to achieve precise mechanical axis correction and joint stability. This study aimed to determine whether the lateral approach without tibial tubercle osteotomy allows mechanical axis correction in valgus knee osteoarthritis (OA), which is at least as effective as the medial approach, while also assessing whether it provides clinically comparable results and complications., Methods: A total of 204 patients undergoing TKA for valgus knee OA were included in this retrospective comparative study, with 131 patients in the lateral approach group and 73 patients in the medial approach group. The surgical goal was to achieve stability with a neutral axis based on mechanical alignment. Detailed pre- and postoperative clinical and radiographic data were obtained, including measurements of the hip-knee-ankle angle (HKAA) and patella tilt angle. Functional status was determined based on the Oxford Knee Score (OKS). Age, body mass index, sex and preoperative HKAA were adjusted between both groups using propensity score matching (n = 45 per group)., Results: In the propensity score-matched cohort, the postoperative HKAA did not show differences when comparing the lateral and the medial approach at a mean follow-up of 19.7 months (p = 0.385). The achieved correction of the patella tilt angle was higher in the lateral approach group in the overall (p < 0.001) and matched cohort (p < 0.001). No differences were detected regarding the postoperative OKS and complications. However, wound healing disorders showed a tendency to be more prevalent in patients who underwent the lateral approach in the overall cohort (6.1%, n = 8 vs. 0.0%, n = 0, p = 0.053) but not in the propensity score-matched cohort (p = 0.494)., Conclusion: This study demonstrated that for pronounced valgus OA, the lateral approach achieves favourable results in HKAA correction, patellar tilt and complications comparable to the medial approach. However, the risk of wound healing disorders appears higher with severe valgus deformity., Level of Evidence: Level III therapeutic study., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)
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- 2024
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63. [Risk factors and prevention strategies for periprosthetic femoral fractures in hip arthroplasty].
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Alimy AR, Soltys PJ, Hubert J, Ries C, Beil FT, and Rolvien T
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Background: Periprosthetic fractures represent a major complication following joint replacement surgery, particularly total hip arthroplasty (THA). Due to demographic changes, a rising number of THAs is expected to lead to an increase in periprosthetic femoral fractures (PPF) in the coming decades. Despite the resulting high clinical relevance, there is as yet no comprehensive overview of risk factors and possible preventive approaches to PPF., Objectives: The aim of this review is to present current findings and data from various studies and to derive evidence-based recommendations for clinical practice., Methods: Narrative review., Results: Various factors, such as advanced age, female sex, and rheumatic conditions, can increase the risk of PPF. In the presence of risk factors, a comprehensive assessment of bone health, including DXA osteodensitometry, should be considered prior to surgery., Conclusions: An individualized approach is essential in the planning and execution of THAs to minimize the risk of PPF. In cases of confirmed osteoporosis or for women aged ≥ 70 years and men aged ≥ 75 years, cemented stem fixation should be chosen, as uncemented stems are associated with an increased risk of PPF. Overall, the clinical risk profile should be considered in preoperative planning and postoperative care to reduce this complication and improve patient care., (© 2024. The Author(s).)
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- 2024
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64. Conservative Treatments in the Management of Acute Painful Vertebral Compression Fractures: A Systematic Review and Network Meta-Analysis.
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Alimy AR, Anastasilakis AD, Carey JJ, D'Oronzo S, Naciu AM, Paccou J, Yavropoulou MP, Lems WF, and Rolvien T
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- Humans, Acute Pain etiology, Acute Pain therapy, Osteoporotic Fractures complications, Osteoporotic Fractures therapy, Conservative Treatment methods, Fractures, Compression complications, Fractures, Compression therapy, Network Meta-Analysis, Pain Management methods, Spinal Fractures therapy, Spinal Fractures complications
- Abstract
Importance: Osteoporotic vertebral compression fractures (VCFs) frequently cause substantial pain and reduced mobility, posing a major health problem. Despite the critical need for effective pain management to restore functionality and improve patient outcomes, the value of various conservative treatments for acute VCF has not been systematically investigated., Objective: To assess and compare different conservative treatment options in managing acute pain related to VCF., Data Sources: On May 16, 2023, 4 databases-PubMed, Embase, Scopus, and CINAHL-were searched. In addition, a gray literature search within Scopus and Embase was also conducted., Study Selection: Included studies were prospective comparative and randomized clinical trials that assessed conservative treatments for acute VCF., Data Extraction and Synthesis: Data extraction and synthesis were performed by 2 authors according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Network Meta-Analyses recommendations. A frequentist graph-theoretical model and a random-effects model were applied for the meta-analysis., Main Outcomes and Measures: Primary outcomes were short-term (4 weeks) pain during activity and long-term (latest available follow-up) nonspecified pain in patients with acute VCF., Results: The study included 20 trials, encompassing 2102 patients, and evaluated various interventions for managing VCF. Calcitonin (standardized mean difference [SMD], -4.86; 95% CI, -6.87 to -2.86) and nonsteroidal anti-inflammatory drugs (NSAIDs; SMD, -3.94; 95% CI, -7.30 to -0.58) were beneficial regarding short-term pain during activity compared with placebo. For long-term nonspecific pain management, bisphosphonates were associated with inferior pain outcomes compared with daily (SMD, 1.21; 95% CI, 0.11 to 2.31) or weekly (SMD, 1.13; 95% CI, 0.05 to 2.21) administration of teriparatide, with no treatment being superior to NSAIDs. The qualitative analysis of adverse events highlighted that typical adverse events associated with these medications were observed., Conclusions and Relevance: NSAIDs and teriparatide may be the preferred treatment options for pain management in acute osteoporotic VCF. Although calcitonin also proved to be beneficial, its safety profile and potential adverse effects restrict its widespread application. The limited evidence on braces and analgesics underscores the urgent need for future research.
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- 2024
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65. Influence of the transverse tarsal arch on radiological components of progressive collapsing foot deformity.
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Krüger L, Hedar A, Simon A, Spethmann T, Heinemann A, Viezens L, Lenz AL, Amling M, Beil FT, Hahn M, and Rolvien T
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- Humans, Male, Aged, Female, Middle Aged, Foot Deformities diagnostic imaging, Foot Deformities physiopathology, Cone-Beam Computed Tomography, Aged, 80 and over, Biomechanical Phenomena, Weight-Bearing, Tarsal Bones diagnostic imaging
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The importance of the transverse tarsal arch (TTA) has recently been extensively reevaluated and has even been considered to play a greater role in foot stability than the medial longitudinal arch (MLA). However, the relevance of this observation in the context of common clinical foot disorders, such as progressive collapsing foot deformity (PCFD), has not yet been fully clarified. In this biomechanical study, we examined ten pairs of human cadaveric feet by serial weight-bearing cone-beam computed tomography under controlled loading using a custom-designed testing machine. The MLA and TTA were transected separately, alternating the order in two study groups. A semiautomated three-dimensional evaluation of their influence on three components of PCFD, namely collapse of the longitudinal arch (sagittal Meary's angle), hindfoot alignment (sagittal talocalcaneal angle), and forefoot abduction (axial Meary's angle), was performed. Both arches had a relevant effect on collapse of the longitudinal arch, however the effect of transecting the MLA was stronger compared to the TTA (sagittal Meary's angle, 7.4° (95%CI 3.8° to 11.0°) vs. 3.2° (95%CI 0.5° to 5.9°); p = 0.021). Both arches had an equally pronounced effect on forefoot abduction (axial Meary's angle, 4.6° (95%CI 2.0° to 7.1°) vs. 3.0° (95%CI 0.6° to 5.3°); p = 0.239). Neither arch showed a consistent effect on hindfoot alignment. In conclusion, weakness of the TTA has a decisive influence on radiological components of PCFD, but not greater than that of the MLA. Our findings contribute to a deeper understanding and further development of treatment concepts for flatfoot disorders., (© 2024 The Author(s). Journal of Orthopaedic Research® published by Wiley Periodicals LLC on behalf of Orthopaedic Research Society.)
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- 2024
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66. Patients with Periprosthetic Femoral Hip Fractures are Commonly Classified as Having Osteoporosis Based on DXA Measurements.
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Ritter J, Alimy AR, Simon A, Hubert J, Ries C, Rolvien T, and Beil FT
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- Humans, Female, Male, Aged, Retrospective Studies, Middle Aged, Aged, 80 and over, Absorptiometry, Photon methods, Osteoporosis, Periprosthetic Fractures, Bone Density physiology, Hip Fractures surgery, Arthroplasty, Replacement, Hip adverse effects
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Periprosthetic femoral hip fractures are subject to an increasing incidence and are often considered to be related to osteoporosis. However, there are no available studies that have determined the frequency of osteoporosis in affected patients using gold standard dual-energy X-ray absorptiometry (DXA). In this retrospective comparative study, we analyzed the DXA results of 40 patients with periprosthetic femoral hip fractures who were treated surgically in our department. DXA measurements were performed at the total hip and the lumbar spine to determine bone mineral density T-scores. Data were compared to two age-, sex-, and BMI-matched control groups in which patients underwent DXA prior to aseptic revision surgery for other causes or primary THA (consisting of 40 patients each). The mean T-score in the periprosthetic fracture cohort was significantly lower (- 1.78 ± 1.78) than that of the aseptic revision (- 0.65 ± 1.58, mean difference - 1.13 [95% CI - 1.88 to - 0.37]; p = 0.001) and the primary THA cohort (- 0.77 ± 1.34, mean difference - 1.01 [95% CI - 1.77 to - 0.26]; p = 0.005). Accordingly, osteoporosis was detected more frequently (45%) in the fracture cohort compared to patients undergoing aseptic revision (12.5%) and primary THA (10%). In conclusion, almost half of the patients with periprosthetic femoral hip fractures have osteoporosis according to DXA measurements. A regular assessment of bone health in THA enables identification of patients with osteoporosis who likely benefit from initiation of osteoporosis medication and cemented stem fixation., (© 2024. The Author(s).)
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- 2024
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67. Biopsies from patients with sacral insufficiency fracture are characterized by low bone matrix mineralization and high turnover.
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Delsmann MM, Leonhardt LG, Alimy AR, Hoenig T, Beil FT, Püschel K, von Brackel FN, Amling M, Viezens L, Thiesen DM, and Rolvien T
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Sacral insufficiency fractures are known to occur primarily in older women without adequate trauma. While an association with low bone mineral density (ie, osteoporosis) has been reported, more detailed information on local bone quality properties in affected patients is not available. In the present study, core biopsies were obtained from the S1 sacral ala in patients with a bilateral sacral insufficiency fracture (type IV according to the fragility fractures of the pelvis classification) who required surgical stabilization. Dual energy X-ray absorptiometry (DXA) and laboratory bone metabolism analyses were performed. For comparison, control biopsies were acquired from skeletally intact age- and sex-matched donors during autopsy. A total of 31 biopsies (fracture: n = 19; control: n = 12) were evaluated by micro-computed tomography, histomorphometry on undecalcified sections, and quantitative backscattered electron imaging (qBEI). DXA measurements showed mean T-scores in the range of osteoporosis in the fracture cohort (T-score
min -2.6 ± 0.8). Biochemical analysis of bone metabolism parameters revealed high serum alkaline phosphatase and urinary deoxypyridinoline/creatinine levels. In the biopsies, a loss of trabecular microstructure along with increased osteoid values were detected in the fracture patients compared with controls (osteoid volume per bone volume 5.9 ± 3.5 vs. 0.9 ± 0.5%, p <.001). We also found evidence of microfractures with chronic healing processes (ie, microcallus) as well as pronounced hypomineralization in the biopsies of the fracture cohort compared with the controls as evidenced by lower CaMean measured by qBEI (22.5 ± 1.6 vs. 24.2 ± 0.5 wt%, p =.003). In conclusion, this high-resolution biopsy study provides evidence of local hypomineralization in patients with sacral insufficiency fractures, pointing to reduced fracture resistance but also a distinct phenotype other than the predominant loss of trabeculae as in postmenopausal osteoporosis. Our data highlight the importance of therapies that promote bone mineralization to optimally treat and prevent sacral insufficiency fractures., Competing Interests: All authors declare no conflict of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Society for Bone and Mineral Research.)- Published
- 2024
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68. Advantages of cone beam computed tomography for evaluation of subchondral insufficiency fractures of the knee compared to MRI.
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Delsmann MM, Delsmann J, Jandl NM, Maas KJ, Beil FT, Amling M, Henes FO, Rolvien T, and Spink C
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- Humans, Female, Male, Middle Aged, Aged, Fractures, Stress diagnostic imaging, Knee Joint diagnostic imaging, Knee Joint pathology, Reproducibility of Results, Cone-Beam Computed Tomography methods, Magnetic Resonance Imaging methods
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To determine the diagnostic yield of cone beam computed tomography (CBCT) compared with 3 T magnetic resonance imaging (MRI) for the evaluation of subchondral insufficiency fractures of the knee. Consecutive patients with subchondral insufficiency fractures of the knee examined by 3 T MRI and CBCT of the femoral condyles were reviewed. Two experienced raters graded the lesion severity on 3 T MRI and CBCT images: grade 1: no signs of a subchondral bone lesion; grade 2: subchondral trabecular fracture or cystic changes, but without infraction of the subchondral bone plate; grade 3: collapse of the subchondral bone plate. Ratings were repeated after six weeks to determine reliability. In addition, the bone lesion size was measured as elliptical area (mm
2 ) and compared between CBCT and T1-weighted MRI sequences. Among 30 patients included (43.3% women; mean age: 60.9 ± 12.8 years; body mass index (BMI) 29.0 ± 12.8 kg/m2 ), the medial femoral condyle was affected in 21/30 patients (70%). The grading of subchondral lesions between MRI and CBCT did not match in 12 cases (40%). Based on MRI images, an underestimation (i.e., undergrading) compared with CBCT was observed in nine cases (30%), whereas overgrading occurred in three cases (10%). Compared to CBCT, routine T1-weighted 3 T sequences significantly overestimated osseus defect zones in sagittal (84.7 ± 68.9 mm2 vs. 35.9 ± 38.2 mm2 , p < 0.01, Cohen's d = 1.14) and coronal orientation (53.1 ± 24.0 mm2 vs. 22.0 ± 15.2 mm2 , p < 0.01, Cohen's d = 1.23). The reproducibility of the grading determined by intra- and inter-rater agreement was very high in MRI (intra-class correlation coefficient (ICC) 0.78 and 0.90, respectively) and CBCT (ICC 0.96 and 0.96, respectively). In patients with subchondral insufficiency fractures of the knee, the use of CBCT revealed discrepancies in lesion grading compared with MRI. These findings are clinically relevant, as precise determination of subchondral bone plate integrity may influence the decision about conservative or surgical treatment. CBCT represents our imaging modality of choice for grading the lesion and assessing subchondral bone plate integrity. MRI remains the gold standard modality to detect especially early stages., (© 2024. The Author(s).)- Published
- 2024
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69. Costal Cartilage Calcification: Prevalence, Amount, and Structural Pattern in the General Population and Its Association with Age: A Cadaveric Study.
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Hawellek T, Beil FT, Hischke S, Saul D, Hoffmann DB, Kleiss S, Rolvien T, Ries C, Püschel K, Frosch S, and Hubert J
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- Humans, Female, Male, Middle Aged, Aged, Adult, Prevalence, Cross-Sectional Studies, Age Factors, Aged, 80 and over, Sex Factors, Costal Cartilage transplantation, Costal Cartilage diagnostic imaging, Cadaver, Calcinosis epidemiology, Calcinosis diagnostic imaging, Calcinosis surgery
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Importance: Costal cartilage calcification (CCC) of the cartilage graft, commonly used in reconstruction of nasal/auricular deformities, can cause poor surgical outcome, but structural and quantitative analyses are lacking. Objective: To compare the prevalence, amount, and structural pattern of CCC from individuals by gender and age, as measured by digital contact radiography. Design, Setting, and Participants: This is a cross-sectional cadaveric study ( n = 92) of the seventh rib cartilage. CCC prevalence/amount/structural pattern (central [c]/peripheral [p]/diffuse [d]) was analyzed within three age groups: I (<40 years), II (40-70 years), and III (>70 years). Main Outcomes and Measures: Qualitative and quantitative CCC analyses were set in relation to gender/structural pattern/age. Results: CCC prevalence was gender independent (96.7%) and occurred in c/p/d: 12.4%/22.4%/65.2%. Structural CCC pattern differed between age groups (I: 80%; c/p/d: 26.7%/46.6%/6.7%; II: 100%; c/p/d: 18.0%/30.8%/51.2%; III: 100%; p/d: 2.6%/97.4%). The mean CCC amount (9.1%) was gender independent and showed a significant correlation with age ( p = 0.001). The mean amount showed a significant difference between the structural pattern [d/p: 3.3 times higher ( p = 0.006), d/c: 7.7 times higher ( p < 0.001)] and age groups (I/II/III: 6.4/8.5%/10.9%), whereby the amount was higher in groups II (factor: 7.4; p < 0.001) and III (factor: 16.5; p < 0.001) compared with group I. Conclusions: These data show an age-/gender-independent high CCC prevalence in the general population (96.7%). CCC already occurred in young donors (<40 years) with a not negligible amount (6.4%). CCC increased with age and structural analysis showed a gender-/age-specific pattern, whereby males were prone to peripheral/females to central CCC. Diffuse CCC was observed as an age-independent sign for high CCC levels.
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- 2024
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70. Influence of variable hinge positioning on coronal and sagittal alignment in uniplanar medial open-wedge high tibial osteotomy.
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Frings J, Korthaus A, Linke P, Rolvien T, Stürznickel J, Strahl A, Krause M, and Frosch KH
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Purpose: There is a high risk of increasing the posterior tibial slope (PTS) during medially opening-wedge high tibial osteotomy (mowHTO). Most recently, the idea of intentional simultaneous coronal and sagittal correction, using uniplanar cutting techniques has emerged. This study aims to examine the influences of variable hinge positioning and osteotomy gap height on the sagittal and coronal plane., Methods: Twenty uniplanar mowHTOs were performed in standardised (left) solid-foam proximal tibia models. In the different models, hinge position was rotated stepwise by 10°, between 90° (cutting straight medial to lateral) and 0° (cutting straight anterior to posterior) ( n = 10). Additionally, gap heights of 5 and 10 mm were produced and analysed. Logistic regression analysis was performed to calculate a predictive regression formula for the relation between gap height, hinge rotation and the changes of medial proximal tibia angle (MPTA), medial and lateral PTS., Results: Between cutting angles of 90 and 20°, the MPTA was mainly influenced by the gap height (0.95° MPTA per 1 mm gap height), but not by the cutting angle. Between 20 and 0°, the MPTA was decreased by 3.6° per 10° of rotation, but not by the gap height. Between cutting angles of 90 and 10°, the PTS was increased linearly by 0.97° per 10° of rotation and by 0.61° per 1 mm gap height., Conclusion: In mowHTO with lateral hinge positions, the MPTA is mainly influenced by gap height. Changes of PTS can be avoided by a straight lateral hinge position. In posterior hinge locations (0-20°), changes of MPTA are mainly caused by hinge rotation, but not by gap height., Level of Evidence: Level III, Case-control study., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s). Journal of Experimental Orthopaedics published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)
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- 2024
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71. A clinical risk score enables early prediction of dissatisfaction 1 year after total knee arthroplasty.
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Strahl A, Delsmann MM, Simon A, Ries C, Rolvien T, and Beil FT
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Purpose: Dissatisfaction after total knee arthroplasty (TKA) is a prevalent and clinically relevant problem that affects approximately 10%-20% of patients. The aim of this study is to identify factors associated with dissatisfaction 1 year after TKA., Methods: A total of 236 patients undergoing TKA were included in this prospective cohort study. Demographic data, preoperative clinical parameters (e.g., axial alignment, osteoarthritis severity) and patient-reported outcome measures (PROMs) were collected preoperatively, at 1 month and 1 year after TKA, encompassing the Knee Society Score (KSS) and Knee injury and Osteoarthritis Outcome Score (KOOS). The primary outcome was dissatisfaction 1 year after TKA, defined as ≤20 points on the KSS satisfaction scale. A risk score based on multiple regression and area under the curve (AUC) analyses was calculated to predict dissatisfaction., Results: One year after TKA, 16% of the patients were dissatisfied. Dissatisfied patients were significantly younger (p = 0.023) and had a higher body mass index (BMI) (p = 0.007). No differences were observed in preoperative objective (p = 0.903) and functional KSS (p = 0.346), pain (p = 0.306), osteoarthritis severity (p = 0.358), axial knee alignment (p = 0.984) or psychological distress (p = 0.138). The likelihood of dissatisfaction at 1 year was 3.0, 4.0, 7.4, 4.3 and 2.8 times higher amongst patients aged <63.5 years, with a BMI > 30.1 kg/m
2 , a KOOSPain < 50%, a KSSFunction < 42 points and a KSSExpectation < 9 points (all at 1 month), respectively. Using these variables, a risk score with a maximum of 7 points was developed, demonstrating a high predictive value for dissatisfaction (AUC: 0.792 [95% confidence interval: 0.700-0.884], p < 0.001)., Conclusion: Dissatisfaction 1 year after TKA can be predicted by a weighted risk score that includes patient age, BMI, pain, subjective functionality and unmet expectation 1 month postoperatively. Using the risk score, early detection of dissatisfaction has the potential to enable targeted interventions and improve patients' quality of life., Level of Evidence: Level II, Prognostic study., (© 2024 The Author(s). Knee Surgery, Sports Traumatology, Arthroscopy published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)- Published
- 2024
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72. Raman spectroscopy and U-Net deep neural network in antiresorptive drug-related osteonecrosis of the jaw.
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Matthies L, Gebrekidan MT, Braeuer AS, Friedrich RE, Stelzle F, Schmidt C, Smeets R, Assaf AT, Gosau M, Rolvien T, and Knipfer C
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- Humans, Aged, Female, Male, Middle Aged, Neural Networks, Computer, Aged, 80 and over, Bone Density, Bone Density Conservation Agents adverse effects, Principal Component Analysis, Discriminant Analysis, Spectrum Analysis, Raman, Bisphosphonate-Associated Osteonecrosis of the Jaw
- Abstract
Objective: Application of an optical method for the identification of antiresorptive drug-related osteonecrosis of the jaw (ARONJ)., Methods: We introduce shifted-excitation Raman difference spectroscopy followed by U-Net deep neural network refinement to determine bone tissue viability. The obtained results are validated through established histological methods., Results: Discrimination of osteonecrosis from physiological tissues was evaluated at 119 distinct measurement loci in 40 surgical specimens from 28 patients. Mean Raman spectra were refined from 11,900 raw spectra, and characteristic peaks were assigned to their respective molecular origin. Then, following principal component and linear discriminant analyses, osteonecrotic lesions were distinguished from physiological tissue entities, such as viable bone, with a sensitivity, specificity, and overall accuracy of 100%. Moreover, bone mineral content, quality, maturity, and crystallinity were quantified, revealing an increased mineral-to-matrix ratio and decreased carbonate-to-phosphate ratio in ARONJ lesions compared to physiological bone., Conclusion: The results demonstrate feasibility with high classification accuracy in this collective. The differentiation was determined by the spectral features of the organic and mineral composition of bone. This merely optical, noninvasive technique is a promising candidate to ameliorate both the diagnosis and treatment of ARONJ in the future., (© 2023 The Authors. Oral Diseases published by Wiley Periodicals LLC.)
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- 2024
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73. Pronounced cortical porosity and sex-specific patterns of increased bone and osteocyte lacunar mineralization characterize the human distal fibula with aging.
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Hering RN, von Kroge S, Delsmann J, Simon A, Ondruschka B, Püschel K, Schmidt FN, and Rolvien T
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- Male, Humans, Female, Aged, X-Ray Microtomography, Fibula diagnostic imaging, Porosity, Osteocytes, Bone Density, Aging, Fractures, Bone, Calcinosis
- Abstract
The high occurrence of distal fibula fractures among older women suggests a potential link to impaired bone health. Here we used a multiscale imaging approach to investigate the microarchitecture, mineralization, and biomechanics of the human distal fibula in relation to age and sex. Micro-computed tomography was performed to analyze the local volumetric bone mineral density and various microarchitectural parameters of the trabecular and the cortical compartment. Bone mineral density distribution and osteocyte lacunar parameters were quantified using quantitative backscattered electron imaging in periosteal, endocortical, and trabecular regions. Additionally, cortical hardness and Young's modulus were assessed by nanoindentation. While cortical porosity strongly increased with age independent of sex, trabecular microarchitecture remained stable. Notably, nearly half of the specimens showed non-bony hypermineralized tissue located at the periosteum, similar to that previously detected in the femoral neck, with no consistent association with advanced age. Independent of this finding, cortical and trabecular mineralization, i.e., mean calcium content, as well as endocortical tissue hardness increased with age in males but not females. Importantly, we also observed mineralized osteocyte lacunae that increased with age specifically in females. In conclusion, our results indicate that skeletal aging of the distal fibula is signified not only by pronounced cortical porosity but also by an increase in mineralized osteocyte lacunae in females. These findings may provide an explanation for the increased occurrence of ankle fractures in older women., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2024
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74. Alterations in compositional and cellular properties of the subchondral bone are linked to cartilage degeneration in hip osteoarthritis.
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Delsmann J, Eissele J, Simon A, Alimy AR, von Kroge S, Mushumba H, Püschel K, Busse B, Ries C, Amling M, Beil FT, and Rolvien T
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- Humans, Osteoblasts, Osteocytes, Osteoarthritis, Hip, Cartilage, Articular, Cartilage Diseases
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Objective: The subchondral bone is an emerging regulator of osteoarthritis (OA). However, knowledge of how specific subchondral alterations relate to cartilage degeneration remains incomplete., Method: Femoral heads were obtained from 44 patients with primary OA during total hip arthroplasty and from 30 non-OA controls during autopsy. A multiscale assessment of the central subchondral bone region comprising histomorphometry, quantitative backscattered electron imaging, nanoindentation, and osteocyte lacunocanalicular network characterization was employed., Results: In hip OA, thickening of the subchondral bone coincided with a higher number of osteoblasts (controls: 3.7 ± 4.5 mm
-1 , OA: 16.4 ± 10.2 mm-1 , age-adjusted mean difference 10.5 mm-1 [95% CI 4.7 to 16.4], p < 0.001) but a similar number of osteoclasts compared to controls (p = 0.150). Furthermore, higher matrix mineralization heterogeneity (CaWidth, controls: 2.8 ± 0.2 wt%, OA: 3.1 ± 0.3 wt%, age-adjusted mean difference 0.2 wt% [95% CI 0.1 to 0.4], p = 0.011) and lower tissue hardness (controls: 0.69 ± 0.06 GPa, OA: 0.67 ± 0.06 GPa, age-adjusted mean difference -0.05 GPa [95% CI -0.09 to -0.01], p = 0.032) were detected. While no evidence of altered osteocytic perilacunar/canalicular remodeling in terms of fewer osteocyte canaliculi was found in OA, specimens with advanced cartilage degeneration showed a higher number of osteocyte canaliculi and larger lacunocanalicular network area compared to those with low-grade cartilage degeneration. Multiple linear regression models indicated that several subchondral bone properties, especially osteoblast and osteocyte parameters, were closely related to cartilage degeneration (R2 adjusted = 0.561, p < 0.001)., Conclusion: Subchondral bone properties in OA are affected at the compositional, mechanical, and cellular levels. Based on their strong interaction with cartilage degeneration, targeting osteoblasts/osteocytes may be a promising therapeutic OA approach., Data and Materials Availability: All data are available in the main text or the supplementary materials., Competing Interests: Declaration of Competing Interest All authors declare that they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)- Published
- 2024
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75. Tranexamic Acid Attenuates the Progression of Posttraumatic Osteoarthritis in Mice.
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Xie W, Jiang S, Donat A, Knapstein PR, Albertsen LC, Kokot JL, Erdmann C, Rolvien T, Frosch KH, Baranowsky A, and Keller J
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- Humans, Female, Animals, Mice, X-Ray Microtomography, Tranexamic Acid pharmacology, Tranexamic Acid therapeutic use, Osteophyte, Osteoarthritis drug therapy, Osteoarthritis etiology, Synovitis
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Background: Posttraumatic osteoarthritis (OA) is a common disorder associated with a high socioeconomic burden, particularly in young, physically active, and working patients. Tranexamic acid (TXA) is commonly used in orthopaedic trauma surgery as an antifibrinolytic agent to control excessive bleeding. Previous studies have reported that TXA modulates inflammation and bone cell function, both of which are dysregulated during posttraumatic OA disease progression., Purpose: To evaluate the therapeutic effects of systemic and topical TXA treatment on the progression of posttraumatic OA in the knee of mice., Study Design: Controlled laboratory study., Methods: OA was induced via anterior cruciate ligament (ACL) transection on the right knee of female mice. Mice were treated with TXA or vehicle intraperitoneally daily or intra-articularly weekly for 4 weeks, starting on the day of surgery. Articular cartilage degeneration, synovitis, bone erosion, and osteophyte formation were scored histologically. Micro-computed tomography evaluation was conducted to measure the subchondral bone microstructure and osteophyte volume. Cartilage thickness and bone remodeling were assessed histomorphometrically., Results: Both systemic and topical TXA treatment significantly reduced cartilage degeneration, synovitis, and bone erosion scores and increased the ratio of hyaline to calcified cartilage thickness in posttraumatic OA. Systemic TXA reversed ACL transection-induced subchondral bone loss and osteophyte formation, whereas topical treatment had no effect. Systemic TXA decreased the number and surface area of osteoclasts, whereas those of osteoblasts were not affected. No effect of topical TXA on osteoblast or osteoclast parameters was observed., Conclusion: Both systemic and topical TXA exerted protective effects on the progression of posttraumatic OA. Drug repurposing of TXA may, therefore, be useful for the prevention or treatment of posttraumatic OA, particularly after ACL surgery., Clinical Relevance: TXA might be beneficial in patients with posttraumatic OA of the knee., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This work was supported in part by the German Research Foundation (KE 2179/9-1). The China Scholarship Council provided funds to W.X. and S.J. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
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- 2024
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76. Influence of health literacy on health-related quality of life after total hip arthroplasty.
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Strahl A, Bücker L, Bechler U, Krüger L, Ries C, Hubert J, Beil FT, and Rolvien T
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- Humans, Female, Infant, Male, Quality of Life psychology, Treatment Outcome, Surveys and Questionnaires, Arthroplasty, Replacement, Hip, Health Literacy, Osteoarthritis surgery
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Introduction: Personal knowledge about the own disease, a key component of health literacy (HL), may have a considerable impact on treatment outcomes. The purpose of this study was to investigate whether the patients' knowledge about the surgical procedure, risks, and aftercare, as well as the satisfaction with the preoperative level of information, has an influence on the health-related quality of life (HRQoL) after primary total hip arthroplasty (THA)., Materials and Methods: A total of 176 patients (68.3 ± 10.3 years, 60.8% female) were evaluated. HRQoL was assessed prior to surgery as well as one and twelve months after THA using the 12-item Short Form Questionnaire. Following standardized surgical informed consent, HL was assessed preoperatively using a self-constructed quiz score, while information satisfaction was measured with a single-item rating scale. Sociodemographic and clinical characteristics, including pain (VAS), functionality (WOMAC), and psychological distress (PHQ-4), were also assessed at baseline. Multiple linear regression analyses were performed to examine whether HL, satisfaction with information, age, social class, WOMAC, VAS, and PHQ-4 predict HRQoL at one and twelve months post-surgery., Results: The average HL quiz score was 23 ± 5.1 out of a possible 33 points. Social class index significantly influenced HL (p < 0.001). A weak correlation between HL and age (r = 0.23, p = 0.01) and no correlation between HL and psychological distress (p = 0.868) were observed. One month after THA, physical HRQoL was significantly predicted by the WOMAC index (p = 0.031) and subjective satisfaction with information (p = 0.022), but not by HL. After twelve months, only the WOMAC was a significant predictor (p < 0.001) of physical HRQoL., Conclusion: Although subjective satisfaction with the patient's preoperative level of information had a significant effect on the physical HRQoL at one month after THA, the influence of osteoarthritis severity outweighed this effect after twelve months. HL had no direct influence on HRQoL. These results suggest that patient satisfaction, rather than knowledge, predicts HRQoL., (© 2023. The Author(s).)
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- 2024
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77. Areal bone mineral density is not associated with femoral stem subsidence in patients younger than 70 years undergoing total hip arthroplasty.
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Rolvien T, Thiessen ML, Boese CK, Bechler U, Strahl A, Beil FT, and Ries C
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- Humans, Male, Female, Middle Aged, Aged, Bone Density, Retrospective Studies, Femur diagnostic imaging, Femur surgery, Absorptiometry, Photon methods, Lumbar Vertebrae diagnostic imaging, Lumbar Vertebrae surgery, Prosthesis Design, Arthroplasty, Replacement, Hip adverse effects, Arthroplasty, Replacement, Hip methods, Hip Prosthesis adverse effects, Obesity, Morbid, Osteoporosis diagnostic imaging, Osteoporosis epidemiology, Osteoporosis etiology
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Introduction: Femoral stem subsidence is a known complication after uncemented total hip arthroplasty (THA). The purpose of this study was to determine the frequency of osteoporosis and to investigate the relationship between areal bone mineral density (aBMD) and subsidence in a cohort of patients younger than 70 years., Methods: One hundred consecutive patients (age 60 ± 6 years; 52 female, 48 male) undergoing uncemented THA using a collarless press fit femoral stem were retrospectively reviewed. Dual-energy X-ray absorptiometry (DXA) was performed preoperatively at the proximal femur and lumbar spine, and if not feasible at these sites, at the distal radius. DXA results were compared to a cohort of 100 patients ≥ 70 years scheduled for cemented THA. Age, sex, and body mass index (BMI), canal flare index (CFI), and canal fill ratio (CFR) were assessed. Analysis of stem subsidence and migration was performed on standardized, calibrated radiographs obtained postoperatively and at follow-up., Results: The frequency of osteoporosis was considerably lower in the study cohort compared to patients ≥ 70 years (7% vs. 19%, p = 0.02). Illustrated by the high CFR (mean 96 ± 4%) in the mid-stem region, a sufficient press fit was achieved. After a mean follow-up of 7.4 months, the mean stem subsidence was 0.9 ± 0.9 mm. Only two patients had subsidence greater than 3 mm, one of whom was morbidly obese and the other diagnosed with severe osteoporosis. There were no correlations between any of the parameters (CFI, CFR, age, sex, BMI) and femoral stem subsidence. In addition, aBMD T-scores showed no correlations with subsidence., Conclusion: aBMD by DXA does not appear to be associated with stem subsidence in patients younger than 70 years and with adequate press fit., (© 2023. The Author(s).)
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- 2024
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78. Skeletal Status in Patients Scheduled for Elective Lumbar Spine Surgery: Comparison of Discectomy, Decompression, Fusion, and Revision.
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Schaefer C, Mafi A, Beil FT, Schroeder M, and Rolvien T
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Study Design: Retrospective Cohort Study., Objectives: To investigate and compare the prevalence of low bone mineral density (BMD) and abnormal laboratory bone metabolism parameters in patients undergoing elective primary discectomy, decompression, and fusion and to outline possible differences in these parameters between patients undergoing revision for skeletal vs non-skeletal complications., Methods: We retrospectively evaluated BMD measurements by dual-energy x-ray absorptiometry (DXA) in 389 consecutive patients scheduled for elective lumbar spine surgery. Next to demographic characteristics, laboratory bone metabolism parameters were assessed. Group comparisons were performed between primary discectomy, decompression, and fusion. In patients scheduled for revision surgery after fusion, potential differences in the skeletal status between those with skeletal vs non-skeletal complications were analyzed., Results: Osteoporosis by T-score was detected in 6.7%, 11.0% and 14.7% of the patients undergoing discectomy, decompression and fusion, respectively. While vitamin D deficiency (67.6%) and hyperparathyroidism (16.4%) were frequently detected, no differences in laboratory bone metabolism markers could be found between the groups. Female sex (P<.001), higher age (P=.01) and lower BMI (P<.001) were associated with lower BMD. In the cohort of patients undergoing revision surgery due to complications after fusion, those with skeletal complications did not differ in BMD or bone metabolism from those with non-skeletal complications., Conclusions: Osteoporosis represents a relevant comorbidity in patients scheduled for elective spine surgery, which is why DXA should be routinely performed in these patients. However, DXA may provide limited information in identifying patients at increased risk for skeletal complications after fusion., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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79. Are Synovial Inflammatory Markers Increased in Patients Who Have Aseptic Total Hip Arthroplasty Dislocation Indicated for Revision?
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Hubert J, Ritter J, Krüger L, Simon A, Beil FT, Jandl NM, and Rolvien T
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- Humans, Retrospective Studies, Synovial Fluid, Reoperation adverse effects, Arthroplasty, Replacement, Hip adverse effects, alpha-Defensins, Prosthesis-Related Infections etiology, Joint Dislocations, Hip Dislocation complications
- Abstract
Background: Previous studies have speculated on elevated synovial inflammatory markers in patients undergoing surgical revision for total hip arthroplasty (THA) dislocation. However, this assumption is based on small patient series and a full investigation according to International Consensus Meeting (ICM) criteria has not yet been performed., Methods: Patients who had aseptic THA dislocation indicated for revision surgery were identified retrospectively. Only patients who had available diagnostic workup according to ICM 2018 criteria, including preoperative and intraoperative parameters, were included. For comparison, we analyzed a matched cohort of patients indicated for aseptic THA revision for other conditions. The 2 cohorts each consisted of 55 patients and were not different regarding age, sex, BMI, or implant fixation., Results: There was no difference in synovial white blood cell count (2,238 ± 2,544 versus 2,533 ± 3,448 c/μL; P = .601), alpha-defensin quotient (0.14 ± 0.11 versus 0.19 ± 0.28; P = .207), or polymorphonuclear neutrophil percentage (% PMN) (36.7 ± 22.6 versus 31.3 ± 24.5%; P = .312) between the groups. In the dislocation cohort, 20% of patients had a synovial white blood cell count of 3,000 c/μL or higher, compared with 18% in the control cohort. However, all patients in the dislocation cohort were below the cutoff for alpha-defensin or % PMN., Conclusion: In patients who have aseptic THA dislocation, synovial inflammatory markers are not elevated compared with patients undergoing aseptic revision for other complications. A detailed preoperative analysis of synovial inflammatory markers using ICM criteria appears critical in patients who have a THA dislocation to exclude periprosthetic joint infection., Level of Evidence: Level III, retrospective, comparative study., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2024
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80. Piezo1 expression in chondrocytes controls endochondral ossification and osteoarthritis development.
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Brylka LJ, Alimy AR, Tschaffon-Müller MEA, Jiang S, Ballhause TM, Baranowsky A, von Kroge S, Delsmann J, Pawlus E, Eghbalian K, Püschel K, Schoppa A, Haffner-Luntzer M, Beech DJ, Beil FT, Amling M, Keller J, Ignatius A, Yorgan TA, Rolvien T, and Schinke T
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- Animals, Humans, Mice, Chondrocytes, Ion Channels genetics, Osteogenesis genetics, Cartilage, Articular pathology, Osteoarthritis genetics, Osteophyte metabolism
- Abstract
Piezo proteins are mechanically activated ion channels, which are required for mechanosensing functions in a variety of cell types. While we and others have previously demonstrated that the expression of Piezo1 in osteoblast lineage cells is essential for bone-anabolic processes, there was only suggestive evidence indicating a role of Piezo1 and/or Piezo2 in cartilage. Here we addressed the question if and how chondrocyte expression of the mechanosensitive proteins Piezo1 or Piezo2 controls physiological endochondral ossification and pathological osteoarthritis (OA) development. Mice with chondrocyte-specific inactivation of Piezo1 (Piezo1
Col2a1Cre ), but not of Piezo2, developed a near absence of trabecular bone below the chondrogenic growth plate postnatally. Moreover, all Piezo1Col2a1Cre animals displayed multiple fractures of rib bones at 7 days of age, which were located close to the growth plates. While skeletal growth was only mildly affected in these mice, OA pathologies were markedly less pronounced compared to littermate controls at 60 weeks of age. Likewise, when OA was induced by anterior cruciate ligament transection, only the chondrocyte inactivation of Piezo1, not of Piezo2, resulted in attenuated articular cartilage degeneration. Importantly, osteophyte formation and maturation were also reduced in Piezo1Col2a1Cre mice. We further observed increased Piezo1 protein abundance in cartilaginous zones of human osteophytes. Finally, we identified Ptgs2 and Ccn2 as potentially relevant Piezo1 downstream genes in chondrocytes. Collectively, our data do not only demonstrate that Piezo1 is a critical regulator of physiological and pathological endochondral ossification processes, but also suggest that Piezo1 antagonists may be established as a novel approach to limit osteophyte formation in OA., (© 2024. The Author(s).)- Published
- 2024
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81. Bisphosphonate Use and Periprosthetic Fractures.
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Alimy AR, Beil FT, Amling M, and Rolvien T
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- Humans, Diphosphonates adverse effects, Retrospective Studies, Reoperation, Periprosthetic Fractures etiology, Periprosthetic Fractures surgery, Bone Density Conservation Agents adverse effects, Femoral Fractures surgery, Arthroplasty, Replacement, Hip
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- 2024
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82. Mice heterozygous for an osteogenesis imperfecta-linked MBTPS2 variant display a compromised subchondral osteocyte lacunocanalicular network associated with abnormal articular cartilage.
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Danyukova T, Alimy AR, Velho RV, Yorgan TA, Di Lorenzo G, von Kroge S, Tidow H, Wiegert JS, Hermans-Borgmeyer I, Schinke T, Rolvien T, and Pohl S
- Subjects
- Animals, Female, Male, Mice, Bone and Bones, Osteocytes, Peptide Hydrolases, Cartilage, Articular, Osteoarthritis, Osteogenesis Imperfecta genetics, Metalloendopeptidases genetics, Metalloendopeptidases metabolism
- Abstract
Missense variants in the MBTPS2 gene, located on the X chromosome, have been associated with an X-linked recessive form of osteogenesis imperfecta (X-OI), an inherited bone dysplasia characterized by multiple and recurrent bone fractures, short stature, and various skeletal deformities in affected individuals. The role of site-2 protease, encoded by MBTPS2, and the molecular pathomechanism underlying the disease are to date elusive. This study is the first to report on the generation of two Mbtps2 mouse models, a knock-in mouse carrying one of the disease-causative MBTPS2 variants (N455S) and a Mbtps2 knock-out (ko) mouse. Because both loss-of-function variants lead to embryonic lethality in hemizygous male mutant mice, we performed a comprehensive skeletal analysis of heterozygous Mbtps2
+/N455S and Mbtps2+/ko female mice. Both models displayed osteochondral abnormalities such as thinned subchondral bone, altered subchondral osteocyte interconnectivity as well as thickened articular cartilage with chondrocyte clustering, altogether resembling an early osteoarthritis (OA) phenotype. However, distant from the joints, no alterations in the bone mass and turnover could be detected in either of the mutant mice. Based on our findings we conclude that MBTPS2 haploinsufficiency results in early OA-like alterations in the articular cartilage and underlying subchondral bone, which likely precede the development of typical OI phenotype in bone. Our study provides first evidence for a potential role of site-2 protease for maintaining homeostasis of both bone and cartilage., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)- Published
- 2023
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83. Cholesteatoma Severely Impacts the Integrity and Bone Material Quality of the Incus.
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Delsmann MM, Bonik P, Ocokoljic A, Häussler SM, Püschel K, Praetorius M, Amling M, Peichl J, and Rolvien T
- Subjects
- Humans, Incus, Hearing Loss, Conductive, X-Ray Microtomography, Chronic Disease, Cholesteatoma, Middle Ear, Otitis Media
- Abstract
Cholesteatoma can lead to progressive destruction of the auditory ossicles along with conductive hearing loss but precise data on the microstructural, cellular, and compositional aspects of affected ossicles are not available. Here, we obtained incus specimens from patients who had cholesteatoma with conductive hearing loss. Incudes were evaluated by micro-computed tomography, histomorphometry on undecalcified sections, quantitative backscattered electron imaging, and nanoindentation. Results were compared with two control groups taken from patients with chronic otitis media as well as from skeletally intact donors at autopsy. The porosity of incus specimens was higher in cholesteatoma than in chronic otitis media, along with a higher osteoclast surface per bone surface. Histomorphometric assessment revealed higher osteoid levels and osteocyte numbers in cholesteatoma incudes. Incudes affected by cholesteatoma also showed lower matrix mineralization compared with specimens from healthy controls and chronic otitis media. Furthermore, the modulus-to-hardness ratio was higher in cholesteatoma specimens compared with controls. Taken together, we demonstrated increased porosity along with increased osteoclast indices, impaired matrix mineralization, and altered biomechanical properties as distinct features of the incus in cholesteatoma. Based on our findings, a possible impact of impaired bone quality on conductive hearing loss should be further explored., (© 2023. The Author(s).)
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- 2023
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84. Increased local bone turnover in patients with chronic periprosthetic joint infection.
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Hinz N, Butscheidt S, Jandl NM, Rohde H, Keller J, Beil FT, Hubert J, and Rolvien T
- Abstract
Aims: The management of periprosthetic joint infection (PJI) remains a major challenge in orthopaedic surgery. In this study, we aimed to characterize the local bone microstructure and metabolism in a clinical cohort of patients with chronic PJI., Methods: Periprosthetic femoral trabecular bone specimens were obtained from patients suffering from chronic PJI of the hip and knee (n = 20). Microbiological analysis was performed on preoperative joint aspirates and tissue specimens obtained during revision surgery. Microstructural and cellular bone parameters were analyzed in bone specimens by histomorphometry on undecalcified sections complemented by tartrate-resistant acid phosphatase immunohistochemistry. Data were compared with control specimens obtained during primary arthroplasty (n = 20) and aseptic revision (n = 20)., Results: PJI specimens exhibited a higher bone volume, thickened trabeculae, and increased osteoid parameters compared to both control groups, suggesting an accelerated bone turnover with sclerotic microstructure. On the cellular level, osteoblast and osteoclast parameters were markedly increased in the PJI cohort. Furthermore, a positive association between serum (CRP) but not synovial (white blood cell (WBC) count) inflammatory markers and osteoclast indices could be detected. Comparison between different pathogens revealed increased osteoclastic bone resorption parameters without a concomitant increase in osteoblasts in bone specimens from patients with Staphylococcus aureus infection, compared to those with detection of Staphylococcus epidermidis and Cutibacterium spp., Conclusion: This study provides insights into the local bone metabolism in chronic PJI, demonstrating osteosclerosis with high bone turnover. The fact that Staphylococcus aureus was associated with distinctly increased osteoclast indices strongly suggests early surgical treatment to prevent periprosthetic bone alterations., Competing Interests: All authors declare no conflict of interest., (© 2023 Author(s) et al.)
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- 2023
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85. Do Clinical Parameters Reflect Local Bone Metabolism in Heterotopic Ossification After Septic or Aseptic THA?
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von Kroge S, Büyükyilmaz Z, Alimy AR, Hubert J, Citak M, Amling M, Beil FT, Ohlmeier M, and Rolvien T
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- Humans, Male, Female, Middle Aged, Aged, Aged, 80 and over, Retrospective Studies, Longitudinal Studies, Anti-Inflammatory Agents, Non-Steroidal, Reoperation, Arthroplasty, Replacement, Hip adverse effects, Osteophyte surgery, Ossification, Heterotopic etiology, Ossification, Heterotopic surgery
- Abstract
Background: Heterotopic ossification (HO) is a common complication after THA. Although current research primarily focuses on treatment and prevention, little is known about the local bone metabolism of HO and clinical contributing factors., Questions/purposes: We aimed to assess bone remodeling processes in HO using histomorphometry, focusing on the effects of inflammation and prior NSAID treatment. Specifically, we asked: (1) Are HO specimens taken from patients with periprosthetic joint infection (PJI) more likely to exhibit active bone modeling and remodeling than specimens taken at the time of revision from patients without infection? (2) Do clinical or inflammatory serum and synovial parameters reflect the microstructure of and remodeling in both HO entities? (3) Is NSAID treatment before revision surgery associated with altered local bone mineralization or remodeling properties?, Methods: Between June 2021 and May 2022, we screened 395 patients undergoing revision THA at two tertiary centers in Germany. Of those, we considered all patients with radiographic HO as potentially eligible. Based on that, 21% (83 of 395) were eligible; a further 43 were excluded because of an inability to remove the implant intraoperatively (16 patients), insufficient material (11), comorbidities with a major effect on bone metabolism (10), or bone-specific drugs (six), leaving 10% (40) for analysis in this retrospective, comparative study. HO specimens were collected during aseptic (25 patients: 18 male, seven female, mean age 70 ± 11 years, mean BMI 29 ± 4 kg/m 2 ) and septic (15 patients: 11 male, four female, mean age 69 ± 9 years, mean BMI 32 ± 9 kg/m 2 ) revision THA at a mean of 6 ± 7 years after primary implantation and a mean age of 70 ± 9 years at revision. Septic origin (PJI) was diagnosed based on the 2018 International Consensus Meeting criteria, through a preoperative assessment of serum and synovial parameters. To specify the local bone microstructure, ossification, and cellular bone turnover, we analyzed HO specimens using micro-CT and histomorphometry on undecalcified sections. Data were compared with those of controls, taken from femoral neck trabecular bone (10 patients: five female, five male, mean age 75 ± 6 years, mean BMI 28 ± 4 kg/m 2 ) and osteophytes (10 patients: five female, five male, mean age 70 ± 10 years, mean BMI 29 ± 7 kg/m 2 ). The time between primary implantation and revision (time in situ), HO severity based on the Brooker classification, and serum and synovial markers were correlated with HO microstructure and parameters of cellular bone turnover. In a subgroup of specimens of patients with NSAID treatment before revision, osteoid and bone turnover indices were evaluated and compared a matched cohort of specimens from patients without prior NSAID treatment., Results: Patients with aseptic and septic HO presented with a higher bone volume (BV/TV; aseptic: 0.41 ± 0.15, mean difference 0.20 [95% CI 0.07 to 0.32]; septic: 0.43 ± 0.15, mean difference 0.22 [95% CI 0.08 to 0.36]; femoral neck: 0.21 ± 0.04; both p < 0.001), lower bone mineral density (aseptic: 809 ± 66 mg HA/cm 3 , mean difference -91 mg HA/cm 3 [95% CI -144 to -38]; septic: 789 ± 44 mg HA/cm 3 , mean difference -111 mg HA/cm 3 [95% CI -169 to -53]; femoral neck: 899 ± 20 mg HA/cm 3 ; both p < 0.001), and ongoing bone modeling with endochondral ossification and a higher proportion of woven, immature bone (aseptic: 25% ± 17%, mean difference 25% [95% CI 9% to 41%]; septic: 37% ± 23%, mean difference 36% [95% CI 19% to 54%]; femoral neck: 0.4% ± 0.5%; both p < 0.001) compared with femoral neck specimens. Moreover, bone surfaces were characterized by increased osteoblast and osteoclast indices in both aseptic and septic HO, although a higher density of osteocytes was detected exclusively in septic HO (aseptic: 158 ± 56 1/mm 2 versus septic: 272 ± 48 1/mm 2 , mean difference 114 1/mm 2 [95% CI 65 to 162]; p < 0.001). Compared with osteophytes, microstructure and turnover indices were largely similar in HO. The Brooker class was not associated with any local bone metabolism parameters. The time in situ was negatively associated with bone turnover in aseptic HO specimens (osteoblast surface per bone surface: r = -0.46; p = 0.01; osteoclast surface per bone surface: r = -0.56; p = 0.003). Serum or synovial inflammatory markers were not correlated with local bone turnover in septic HO. Specimens of patients with NSAID treatment before revision surgery had a higher osteoid thickness (10.1 ± 2.1 µm versus 5.5 ± 2.6 µm, mean difference -4.7 µm [95% CI -7.4 to -2.0]; p = 0.001), but there was no difference in other osteoid, structural, or cellular parameters., Conclusion: Aseptic and septic HO share phenotypic characteristics in terms of the sustained increase in bone metabolism, although differences in osteocyte and adipocyte numbers suggest distinct homeostatic mechanisms. These results suggest persistent bone modeling or remodeling, with osteoblast and osteoclast indices showing a moderate decline with the time in situ in aseptic HO. Future studies should use longitudinal study designs to correlate our findings with clinical outcomes (such as HO growth or recurrence). In addition, the molecular mechanisms of bone cell involvement during HO formation and growth should be further investigated, which may allow specific therapeutic and preventive interventions., Clinical Relevance: To our knowledge, our study is the first to systematically investigate histomorphometric bone metabolism parameters in patients with HO after THA, providing a clinical reference for evaluating modeling and remodeling activity. Routine clinical, serum, and synovial markers are not useful for inferring local bone metabolism., Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2023 by the Association of Bone and Joint Surgeons.)
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- 2023
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86. Outcome of different reconstruction options using allografts in revision total hip arthroplasty for severe acetabular bone loss: a systematic review and meta-analysis.
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Strahl A, Boese CK, Ries C, Hubert J, Beil FT, and Rolvien T
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- Humans, Young Adult, Adult, Middle Aged, Aged, Aged, 80 and over, Follow-Up Studies, Allografts surgery, Retrospective Studies, Acetabulum surgery, Reoperation methods, Bone Transplantation methods, Prosthesis Failure, Arthroplasty, Replacement, Hip methods, Hip Prosthesis
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Introduction: Several studies have reported good to excellent outcomes of revision total hip arthroplasty (rTHA) using allografts for treating severe acetabular bone defects. However, precise information on the impact of allograft type and reconstruction method is not available., Material and Methods: Systematic literature search was performed in Medline and Web of Science including patients with acetabular bone loss classified according to the Paprosky classification who underwent rTHA involving the use of allografts. Studies with a minimum follow-up of 2 years published between 1990 and 2021 were included. Kendall correlation was applied to determine the relationship between Paprosky grade and allograft type use. Proportion meta-analyses with 95% confidence interval (CI) were performed to summarize the success of various reconstruction options, including allograft type, fixation method, and reconstruction system., Results: Twenty-seven studies met the inclusion criteria encompassing 1561 cases from 1491 patients with an average age of 64 years (range 22-95). The average follow-up period was 7.9 years (range 2-22). Structural bulk and morselized grafts were used in equal proportions for all Paprosky acetabular defect types. Their use increased significantly with the type of acetabular defect (r = 0.69, p = 0.049). The overall success rate ranged from 61.3 to 98.3% with a random effect pooled estimate of 90% [95% CI 87-93]. Trabecular metal augments (93% [76-98]) and shells (97% [84-99]) provided the highest success rates. However, no significant differences between reconstruction systems, allograft types and fixation methods were observed (p > 0.05 for all comparisons)., Conclusion: Our findings highlight the use of bulk or morselized allograft for massive bone loss independent of Paprosky classification type and indicate similar good mid- to long-term outcomes of the different acetabular reconstruction options using allografts., Clinical Trial Registration: PROSPERO: CRD42020223093., (© 2023. The Author(s).)
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- 2023
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87. Conservative versus operative treatment of FFP II fractures in a geriatric cohort: a prospective randomized pilot trial.
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Thiesen DM, Althoff G, Strahl A, Rolvien T, Frosch KH, Koepke LG, Arras C, Ballhause TM, Dalos D, and Hartel MJ
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- Humans, Aged, Middle Aged, Prospective Studies, Pilot Projects, Pain, Treatment Outcome, Retrospective Studies, Fracture Fixation, Internal, Quality of Life, Fractures, Bone surgery
- Abstract
A clear recommendation regarding treatment strategy of fragility fractures of the pelvic ring is missing. The most typical fracture pattern is a lateral compression type injury with non-displaced fractures of the anterior pubic rami and a unilateral os sacrum fracture (FFP II). We hypothesized that operative treatment would be superior to conservative treatment. From October 2017 to April 2020, a randomized prospective non-blinded trial with n = 39 patients was carried out. Two arms with 17 operative versus 22 conservative cases were created. Inclusion criteria were a posterior pelvic ring fracture FFP type II, age over 60 years and acute fracture (< 3 weeks). Barthel index, pain level (VAS), quality of life (EQ-5D-3L), and Tinetti-Gait Test were determined on admission, at discharge, and after 3, 6, 12 and 24 months. Median follow-up was 12.9 months. The Barthel index (= 0.325), VAS (p = 0.711), quality of life (p = 0.824), and Tinetti-Gait Test (p = 0.913) showed no significant differences between the two groups after 12 months. Two patients switched from the conservative to the operative arm due to persistent immobilization and pain. The one-year mortality rate showed no significant difference (p = 0.175). Our hypothesis that surgical treatment is superior was refuted. No significant benefit was shown in terms of quality of life, mortality and pain levels. The results suggest a more differentiated treatment approach in the future, with initial conservative treatment preferred. A larger multi-center trial is required to confirm these findings.Trial registration: The study was retrospectively registered with the German Clinical Trials Registry (DRKS00013703) on 10/12/2018., (© 2023. The Author(s).)
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- 2023
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88. Performance and Hypothetical Impact on Joint Infection Management of the BioFire Joint Infection Panel: a Retrospective Analysis.
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Berinson B, Spenke L, Krivec L, Tanida K, Both A, Keller J, Rolvien T, Christner M, Lütgehetmann M, Aepfelbacher M, Klatte TO, and Rohde H
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- Humans, Retrospective Studies, Bacteria genetics, Multiplex Polymerase Chain Reaction methods, Arthritis, Infectious diagnosis, Arthritis, Infectious drug therapy, Arthritis, Infectious microbiology
- Abstract
Pathogen identification is key in septic arthritis. Culture-based techniques are challenging, especially when patients have been pretreated with antibiotics or when difficult-to-culture bacteria are encountered. The BioFire joint infection assay (BJA) is a multiplex PCR panel which detects 31 of the most prevalent bacterial and fungal pathogens causing septic arthritis. Here, 123 cryoconserved contemporary synovial fluid samples from 120 patients underwent BJA analysis. Results were compared to those of culture-based diagnostics (standard of care [SOC]). Clinical data were collected, and the possible impact of the molecular diagnostic application on patient management was evaluated. Fifteen of 123 synovial fluid cultures grew bacterial pathogens. All on-panel pathogens (9/15) were correctly identified by the BJA. The BJA identified four additional bacterial pathogens in four SOC-negative cases. BJA sensitivity and specificity were 100% (95% confidence interval [CI], 69.2% to 100%) and 100% (95% CI, 96.8% to 100%), respectively. Compared to the SOC, the BJA would have resulted in faster provision of species identification and molecular susceptibility data by 49 h and 99 h, respectively. Clinical data analysis indicates that in BJA-positive cases, faster species ID could have led to timelier optimization of antibiotic therapy. This retrospective study demonstrates high sensitivity and specificity of the BJA to detect on-panel organisms in bacterial arthritis. The usefulness of the BJA in prosthetic-joint infections is limited, as important pathogens (i.e., coagulase negative staphylococci and Cutibacterium acnes) are not covered. Evidence from patient data analysis suggests that the assay might prove valuable for optimizing patient management in acute arthritis related to fastidious organisms or for patients who received antibiotics prior to specimen collection., Competing Interests: The authors declare a conflict of interest. H.R. served as a consultant and speaker for Biomerieux.
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- 2023
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89. Osteoid osteoma in the bones of the hand: a systematic literature review.
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Meyer J, Rolvien T, Reiter A, Priemel M, Frosch KH, Krukenberg A, and Yarar-Schlickewei S
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- Humans, Hand surgery, Pain, Osteoma, Osteoid diagnostic imaging, Osteoma, Osteoid surgery, Finger Phalanges diagnostic imaging, Finger Phalanges surgery, Bone Neoplasms diagnostic imaging, Bone Neoplasms surgery
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Introduction: Osteoid osteoma (OO) is a common benign bone tumor. OO is observed most frequently in the long bones, especially in the tibia and femur. When occurring in the bones of the hand, OO can be a diagnostic and therapeutic challenge. The aim of this study was to provide a systematic review of occurrence, symptoms, diagnosis and treatment options regarding OO in hand bones., Materials and Methods: We performed a systematic review of the literature. All studies from the online databases PubMed and SpringerLink, which reported cases of osteoid osteomas in the bones of the hand, were included. By summarizing the literature, we evaluated the localization within the hand as well as diagnostic and therapeutic options., Results: We included 133 studies reporting 401 cases. OO was mostly common in the phalanges. The diagnosis was mostly made by CT (computed tomography) scan. Most of the OO were treated surgically by open curettage or en bloc resection., Conclusions: Osteoid osteomas in the bones of the hand are rare and a delayed diagnosis is common. In cases of pain combined with particular symptoms such as nail hypertrophy and swelling OO should be considered. Of the most used imaging methods, CT scans have the highest sensitivity., (© 2023. The Author(s).)
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- 2023
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90. Epidemiology of injuries and illnesses in elite wheelchair basketball players over a whole season - a prospective cohort study.
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Weith M, Junge A, Rolvien T, Kluge S, and Hollander K
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Background: Wheelchair basketball is an adaptation of pedestrian basketball and one of the most popular Paralympic sports worldwide. The epidemiology of health problems in wheelchair basketball has been prospectively studied only during the Paralympic Games, the 2018 World Championships, the 2021 South America Wheelchair Basketball Championship, and one season of two American intercollegiate wheelchair basketball teams. The objective of the study was to prospectively monitor and analyze the prevalence, incidence, burden, and characteristics of injuries and illnesses in a wheelchair basketball league during an entire season for the first time., Methods: All players of the highest German wheelchair basketball league (Bundesliga) were invited to participate in the study. Included players completed the Oslo Sports Trauma Research Center Questionnaire once a week during the entire season 2020/21 to report health problems. Exposure was captured by self-reported training time and officially-recorded competition time., Results: Sixty of 117 players (51%, 47 male, 13 female) of the national league participated with an average response of 93%. Seventy health problems (5.5/1000 exposure hours [95% CI: 4.9-6.1]) were reported, including 54 injuries and 16 illnesses. Prevalence of health problems was 60% (95% CI: 48-72). Most injuries affected the shoulder (32% of all injuries), cervical spine/neck (17%), and hand (13%). More overuse injuries (2.9/1000 exposure hours [95% CI: 2.5-3.3]) than acute injuries (1.3/1000 exposure hours [95% CI: 1.0-1.6]) occurred. Of all health problems, 53% were associated with time-loss. The incidences of all health problems, illnesses, injuries, and overuse injuries were higher in women than in men., Conclusions: Characteristics and frequency of injuries and illnesses during wheelchair basketball season differed from those during major wheelchair basketball tournaments. The high proportion of overuse injuries and the higher injury rates in women should be regarded in the development of individualized prevention measures. Since results from previous studies during major tournaments are only partially comparable to wheelchair basketball league play, further studies should follow., (© 2023. The Author(s).)
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- 2023
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91. Classifications of posterior malleolar fractures: a systematic literature review.
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Terstegen J, Weel H, Frosch KH, Rolvien T, Schlickewei C, and Mueller E
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- Humans, Ankle Joint, Fracture Fixation, Internal, Reproducibility of Results, Retrospective Studies, Tibia, Tibial Fractures, Treatment Outcome, Ankle Fractures
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Introduction: Complex ankle fractures frequently involve the posterior malleolus. Many classifications describing posterior malleolar fractures (PMF) exist. The aim of this study was to provide a systematic literature review to outline existing PMF classifications and estimate their accuracy., Methods: The databases PubMed and Scopus were searched without time limits. Only specific PMF classifications were included; general ankle and/or pilon fracture classifications were excluded. Selection and data extraction was performed by three independent observers. The systematic literature search was performed according to the current criteria of Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). The methodological quality of the included studies was quantified using the modified Coleman score., Results: A total of 110 studies with a total of 12.614 patients were included. Four main classifications were identified: Those describing the size of the posterior malleolar fracture (n = 66), Haraguchi (n = 44), Bartoníček/Rammelt (n = 21) and Mason (n = 12). The quality of the studies was moderate to good with a median Coleman-score of 43.5 (14-79) and a weighted median Coleman-score of 42.5 points. All classifications achieved a substantial to perfect score regarding the inter- and intraobserver reliability, with Mason scoring the lowest in comparison., Conclusions: None of the reviewed PMF classifications has been able to establish itself decisively in the literature. Most of the classifications are insufficient in terms of a derivable treatment algorithm or a prognosis with regard to outcome. However, as the Bartoníček/Rammelt classification has the greatest potential due to its treatment algorithm, its reliability in combination with consistent predictive values, its usage in clinical practice and research appears advisable., (© 2022. The Author(s).)
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- 2023
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92. Does Minimally Invasive Surgery Provide Better Clinical or Radiographic Outcomes Than Open Surgery in the Treatment of Hallux Valgus Deformity? A Systematic Review and Meta-analysis.
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Alimy AR, Polzer H, Ocokoljic A, Ray R, Lewis TL, Rolvien T, and Waizy H
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- Humans, Prospective Studies, Treatment Outcome, Osteotomy adverse effects, Osteotomy methods, Minimally Invasive Surgical Procedures methods, Randomized Controlled Trials as Topic, Hallux Valgus diagnostic imaging, Hallux Valgus surgery, Metatarsal Bones
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Background: Hallux valgus is the most common foot deformity and affects 23% to 35% of the general population. More than 150 different techniques have been described for surgical correction. Recently, there has been increasing interest in the use of minimally invasive surgery to correct hallux valgus deformities. A variety of studies have been published with differing outcomes regarding minimally invasive surgery. However, most studies lack sufficient power and are small, making it difficult to draw adequate conclusions. A meta-analysis can therefore be helpful to evaluate and compare minimally invasive and open surgery., Questions/purposes: We performed a systematic review and meta-analysis of randomized controlled trials and prospective controlled studies to answer the following question: Compared with open surgery, does minimally invasive surgery for hallux valgus result in (1) improved American Orthopaedic Foot and Ankle Society (AOFAS) scores and VAS scores for pain, (2) improved radiologic outcomes, (3) fewer complications, or (4) a shorter duration of surgery?, Methods: The systematic review and meta-analysis was conducted according to the guidelines of the Cochrane Handbook for Systematic Reviews of Intervention and the Preferred Reporting Items for Systematic Reviews and Meta-analyses. A search was performed in the PubMed, Embase, Scopus, CINAHL, and CENTRAL databases on May 3, 2022. Studies were eligible if they were randomized controlled or prospective controlled studies that compared minimally invasive surgery and open surgery to treat patients with hallux valgus. We defined minimally invasive surgery as surgery performed through the smallest incision required to perform the procedure accurately, with an incision length of approximately 2 cm at maximum. Open surgery, on the other hand, involves a larger incision and direct visualization of deeper structures. Seven studies (395 feet), consisting of six randomized controlled studies and one prospective comparative study, were included in the qualitative and quantitative data synthesis. There were no differences between the minimally invasive and open surgery groups regarding age, gender, or severity of hallux valgus deformity. Each included study was assessed for the risk of bias using the second version of the Cochrane tool for assessing the risk of bias in randomized trials or by using the Newcastle-Ottawa Scale for comparative studies. Most of the included studies had intermediate quality regarding the risk of bias. We excluded one study from our analysis because of its high risk of bias to avoid serious distortions in the meta-analysis. We performed a sensitivity analysis to confirm that our meta-analysis was robust by including only studies with a low risk of bias. The analyzed endpoints included the AOFAS score (range 0 to 100), where higher scores represent less pain and better function; the minimum clinically important difference on this scale was 29 points. In addition, the VAS score was analyzed, which is based on a pain rating scale (range 0 to 10), with higher scores representing greater pain. Radiologic outcomes included the hallux valgus angle, intermetatarsal angle, and distal metatarsal articular angle. Complications were qualitatively assessed and evaluated for differences. A random-effects model was used if substantial heterogeneity (I 2 > 50%) was found; otherwise, a fixed-effects model was used., Results: We found no clinically important difference between minimally invasive and open surgery in terms of the AOFAS score (88 ± 7 versus 85 ± 8, respectively; mean difference 4 points [95% CI 1 to 6]; p < 0.01). There were no differences between the minimally invasive and open surgery groups in terms of VAS scores (0 ± 0 versus 0 ± 1, respectively; standardized mean difference 0 points [95% CI -1 to 0]; p = 0.08). There were no differences between the minimally invasive and open surgery groups in terms of the hallux valgus angle (12° ± 4° versus 12° ± 4°; mean difference 0 points [95% CI -2 to 2]; p = 0.76). Radiographic measurements of the intermetatarsal angle did not differ between the minimally invasive and open surgery groups (7° ± 2° versus 7° ± 2°; mean difference 0 points [95% CI -1 to 1]; p = 0.69). In addition, there were no differences between the minimally invasive and open surgery groups in terms of the distal metatarsal articular angle (7° ± 4° versus 8° ± 4°; mean difference -1 point [95% CI -4 to 2]; p = 0.28). The qualitative analysis revealed no difference in the frequency or severity of complications between the minimally invasive and the open surgery groups. The minimally invasive and open surgery groups did not differ in terms of the duration of surgery (28 ± 8 minutes versus 40 ± 10 minutes; mean difference -12 minutes [95% CI -25 to 1]; p = 0.06)., Conclusion: This meta-analysis found that hallux valgus treated with minimally invasive surgery did not result in improved clinical or radiologic outcomes compared with open surgery. Methodologic shortcomings of the source studies in this meta-analysis likely inflated the apparent benefits of minimally invasive surgery, such that in reality it may be inferior to the traditional approach. Given the associated learning curves-during which patients may be harmed by surgeons who are gaining familiarity with a new technique-we are unable to recommend the minimally invasive approach over traditional approaches, in light of the absence of any clinically important benefits identified in this meta-analysis. Future research should ensure studies are methodologically robust using validated clinical and radiologic parameters, as well as patient-reported outcome measures, to assess the long-term outcomes of minimally invasive surgery., Competing Interests: Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request., (Copyright © 2022 by the Association of Bone and Joint Surgeons.)
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- 2023
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93. Video analysis of Achilles tendon ruptures in professional male football (soccer) reveals underlying injury patterns and provides strategies for injury prevention.
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Hoenig T, Gronwald T, Hollander K, Klein C, Frosch KH, Ueblacker P, and Rolvien T
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- Humans, Male, Rupture prevention & control, Achilles Tendon surgery, Achilles Tendon injuries, Ankle Injuries, Soccer injuries, Tendon Injuries prevention & control, Tendon Injuries surgery
- Abstract
Purpose: In professional football (soccer), Achilles tendon ruptures are severe injuries. Video analysis promotes a better understanding of the underlying situational and biomechanical patterns, and provides a roadmap for future research to improve the management and prevention of Achilles tendon ruptures. The purpose of this study was to identify injury patterns contributing to acute Achilles tendon ruptures in professional male football players., Methods: Professional male football players with an acute Achilles tendon rupture were identified using an online database. For every in-competition injury, the corresponding football match was detected. Video footage of the injury was accessed using Wyscout.com or publicly available video databases. Situational patterns and injury biomechanics of the injury frame were independently analysed by two reviewers using a standardised checklist and a motion analysis software. Finally, consensus was reached to describe the main injury patterns of Achilles tendon ruptures in professional male football players., Results: The search identified video footage of 80 Achilles tendon ruptures in 78 players. Most injuries (94%) occurred through indirect or non-contact mechanisms. The kinematic analysis revealed characteristic joint positions at the time of injury consisting of hip extension, knee extension, ankle dorsiflexion, foot abduction, and foot pronation in most cases. The underlying direction of movement was from flexion to extension (knee) and from plantarflexion to dorsiflexion (ankle). Player actions identified as main injury patterns were stepping back (26%), landing (20%), running/sprinting (18%), jumping (13%), and starting (10%)., Conclusion: Most Achilles tendon ruptures in professional male football players are closed-chain indirect or non-contact injuries. Sudden loading to the plantarflexor musculotendinous unit remains to be the main component for most cases. By achieving a better understanding of underlying injury mechanisms, this study provides new strategies for the prevention of Achilles tendon ruptures., Level of Evidence: Level IV., (© 2023. The Author(s).)
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- 2023
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94. Bone mineral density and microarchitecture change during skeletal growth in harbor seals (Phoca vitulina) from the German coast.
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Delsmann J, Schmidt B, Oheim R, Amling M, Rolvien T, and Siebert U
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- Adult, Animals, Infant, Newborn, Humans, Ecosystem, Absorptiometry, Photon methods, Lumbar Vertebrae, Bone Density, Phoca
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Across species, the skeletal system shares mutual functions, including the protection of inner organs, structural basis for locomotion, and acting as an endocrine organ, thus being of pivotal importance for survival. However, insights into skeletal characteristics of marine mammals are limited, especially in the growing skeleton. Harbor seals (Phoca vitulina) are common marine mammals in the North and Baltic Seas and are suitable indicators of the condition of their ecosystem. Here, we analyzed whole-body areal bone mineral density (aBMD) by dual-energy X-ray absorptiometry (DXA) and lumbar vertebrae by high-resolution peripheral quantitative computed tomography (HR-pQCT) in neonate, juvenile, and adult harbor seals. Along skeletal growth, an increase in two-dimensional aBMD by DXA was paralleled by three-dimensional volumetric BMD by HR-pQCT, which could be attributed to an increasing trabecular thickness while trabecular number remained constant. Strong associations were observed between body dimensions (weight and length) and aBMD and trabecular microarchitecture (R
2 = 0.71-0.92, all p < 0.001). To validate the results of the DXA measurement (i.e., the standard method used worldwide to diagnose osteoporosis in humans), we performed linear regression analyses with the three-dimensional measurements from the HR-pQCT method, which revealed strong associations between the two imaging techniques (e.g., aBMD and Tb.Th: R2 = 0.96, p < 0.0001). Taken together, our findings highlight the importance of systematic skeletal investigations in marine mammals during growth, illustrating the high accuracy of DXA in this context. Regardless of the limited sample size, the observed trabecular thickening is likely to represent a distinct pattern of vertebral bone maturation. As differences in nutritional status, among other factors, are likely to affect skeletal health, it appears essential to routinely perform skeletal assessments in marine mammals. Placing the results in the context of environmental exposures may allow effective measures to protect their populations., (© 2023. The Author(s).)- Published
- 2023
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95. Errata.
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Jandl NM, Kleiss S, Mussawy H, Beil FT, Hubert J, and Rolvien T
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Competing Interests: None declared
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- 2023
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96. Analysis of Three-Dimensional Bone Microarchitecture of the Axis Exposes Pronounced Regional Heterogeneity Associated with Clinical Fracture Patterns.
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Koepke LG, von Kroge S, Heuer A, Kammal AL, Ondruschka B, Rolvien T, and Viezens L
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- Humans, Female, Bone and Bones, Tomography, X-Ray Computed methods, Autopsy, Bone Density, Radius, Fractures, Bone diagnostic imaging, Odontoid Process surgery
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The odontoid process (dens) of the second cervical vertebra (axis) is prone to fracture. While the importance of its skeletal integrity has been previously noted, representative three-dimensional microarchitecture analyses in humans are not available. This study aimed to determine the bone microarchitecture of the axis using high-resolution quantitative computed tomography (HR-pQCT) and to derive clinical implications for the occurrence and treatment of axis fractures. For initial clinical reference, the apparent density of the axis was determined based on clinical computed tomography (CT) images in patients without and with fractures of the axis. Subsequently, 28 human axes (female 50%) obtained at autopsy were analyzed by HR-pQCT. Analyses were performed in three different regions corresponding to zones I (tip of dens), II (base of dens), and III (corpus axis) of the Anderson and D'Alonzo classification. Lower apparent densities based on clinical CT data were detected in zone II and III compared to zone I in both the group without and with fracture. In the autopsy specimens, cortical thickness and bone volume fraction decreased continuously from zone I to zone III. Trabecular and cortical tissue mineral density was lowest in zone III, with no differences between zones I and II. In conclusion, our clinical and high-resolution ex vivo imaging data highlight a marked regional heterogeneity of bone microarchitecture, with poor cortical and trabecular properties near the dens base. These results may partly explain why zones II and III are at high risk of fracture and osteosynthesis failure., (© 2023. The Author(s).)
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- 2023
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97. Radiolucent zones of biodegradable magnesium-based screws in children and adolescents-a radiographic analysis.
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Delsmann MM, Stürznickel J, Kertai M, Stücker R, Rolvien T, and Rupprecht M
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- Female, Humans, Adolescent, Child, Retrospective Studies, Osteotomy methods, Radiography, Absorbable Implants, Magnesium adverse effects, Bone Screws adverse effects
- Abstract
Introduction: Albeit the implantation of magnesium-based biodegradable implants can avoid a second surgery for implant removal, the postoperative occurrence of radiolucent zones around these implants based on corrosion processes has not been previously investigated in children and adolescents. We sought to characterize the distinct temporal and spatial dynamics for magnesium-based implants based on standard clinical routine radiographs., Materials and Methods: We retrospectively analyzed 29 patients, treated with magnesium-based compression screws (MAGNEZIX
® CS 2.7 mm, CS 3.2 mm, CSC 4.8 mm; Syntellix AG) for fracture fixation, osteotomy, or osteochondral refixation. During a follow-up examination, the clinical and functional status was evaluated. Based on digital radiographs, the ratio of the area of the radiolucent zone and that of the screw was evaluated to assess implant degradation at two follow-up visits (i.e., after 6-8 weeks and 12-24 weeks)., Results: In 29 patients (16/29 females, 14.03 ± 2.13 years), a total of 57 implants were evaluated that were used for osteotomy (n = 13, screws n = 26), fracture fixation (n = 9, screws n = 18), or osteochondral refixation (n = 7, screws n = 13). All patients healed without complications and regained full function. Radiolucent zones were observed in 27/29 patients at the first follow-up, with significantly decreased ratios at the second follow-up (2.10 ± 0.55 vs 1.64 ± 0.60, p = 0.0006). Regression analyses were performed to assess the temporal dynamics of radiolucent zones and revealed significant logarithmic developments for the 2.7 mm and 3.2 mm screws, marked by a strong ratio decrease during the first weeks and an almost complete disappearance after approximately 100 days and 200 days, respectively. In contrast, the ceramic-coated 4.8 mm screws presented a significant linear and slower decrease of radiolucent zones., Conclusion: Radiolucent zones are a common phenomenon in the course of implant degradation. However, they represent a self-limiting phenomenon. Remarkably, neither implant failure nor affected implant function is noted in this context. Yet, the microstructural changes accompanying the presence of radiolucent zones remain to be analyzed by three-dimensional high-resolution imaging., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)- Published
- 2023
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98. Bi-planar calibration method for templating of hip joint arthroplasty: phantom study and proof of concept.
- Author
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Boese CK, Rolvien T, Henes FO, Beil FT, Strahl A, and Ries C
- Subjects
- Humans, Acetabulum surgery, Calibration, Hip Joint diagnostic imaging, Hip Joint surgery, Arthroplasty, Replacement, Hip adverse effects, Arthroplasty, Replacement, Hip methods, Hip Prosthesis
- Abstract
Purpose: Calibration of radiographs is a critical step in digital templating for hip arthroplasty. Calibration errors of > 1.5% lead to over- or undersizing of the templated implants and may affect logistics and patient safety. Contemporary calibration methods are known to be imprecise with average errors of 6.5% and wide variance. A novel bi-planar radiograph-based calibration method is proposed, and a phantom study was conducted as proof of concept., Methods: A spherical external calibration marker (ECM) is placed in front of the pubic symphysis of a pelvic bone model at twelve different positions. For each marker position, standard anteroposterior radiographs and four corresponding lateral radiographs with different degrees of rotation (0°-30°) are taken (overall, 60 radiographs). Calibration factors are calculated for an internal calibration marker (ICM) at the centre of the right hip (reference) and the ECM using a novel algorithm. Rotation and marker positions simulate foreseeable use errors and misplacements and aim to test robustness of the method against these errors., Results: ECM calibration factor was 125.9% (range 124.7-127.2), and the mean ICM calibration factor was 126.6% (range 126.2-127.1) ([Formula: see text]). Four images (8.3%) were beyond the 1% error threshold (all with 30° rotation). The mean difference was 0.79% (SD 0.49)., Conclusion: The bi-planar method precisely predicts the true calibration factor of the hip joint plane under various conditions. In lateral radiographs, rotation of up to 20° did not adversely affect the precision and all images had calibration errors below the threshold for clinical significance., (© 2023. The Author(s).)
- Published
- 2023
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- View/download PDF
99. Morphologic analysis of the 1st and 2nd tarsometatarsal joint articular surfaces.
- Author
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Requist MR, Rolvien T, Barg A, and Lenz AL
- Subjects
- Joints, Metatarsus, Foot Joints diagnostic imaging, Foot Joints surgery, Foot Joints anatomy & histology, Metatarsal Bones diagnostic imaging, Metatarsal Bones surgery
- Abstract
Tarsometatarsal joint arthrodesis is used to treat a variety of injuries and deformities in the midfoot. However, the surgical technique has not been optimized, in part due to limited knowledge of morphologic features and variation in the related joints. Previous research has relied primarily on dissection-based anatomical analysis, but quantitative imaging may allow for a more sophisticated description of this complex. Here, we used quantitative micro-CT imaging to examine dimensions, distance maps, and curvature of the four articular surfaces in the first and second tarsometatarsal joints. Image segmentation, articular surface identification, and anatomic coordinate systems were all done with semi or fully automatic methods, and distance and size measurements were all taken utilizing these anatomic planes. Surface curvature was studied using Gaussian curvature and a newly defined measure of curvature similarity on the whole joint and on four subregions of each surface. These data show larger articular surfaces on the cuneiforms, rather than metatarsals, and define the generally tall and narrow articular surfaces seen in these joints. Curvature analysis shows minimally curved opposing convex surfaces. Our results are valuable for furthering knowledge of surgical anatomy in this poorly understood region of the foot., (© 2023. The Author(s).)
- Published
- 2023
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100. Return to sport following low-risk and high-risk bone stress injuries: a systematic review and meta-analysis.
- Author
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Hoenig T, Eissele J, Strahl A, Popp KL, Stürznickel J, Ackerman KE, Hollander K, Warden SJ, Frosch KH, Tenforde AS, and Rolvien T
- Subjects
- Humans, Athletes, Prognosis, Return to Sport, Sports
- Abstract
Objective: Bone stress injuries (BSIs) are classified in clinical practice as being at low- or high-risk for complication based on the injury location. However, this dichotomous approach has not been sufficiently validated. The purpose of this systematic review was to examine the prognostic role of injury location on return-to-sport (RTS) and treatment complications after BSI of the lower extremity and pelvis., Design: Systematic review and meta-analysis., Data Sources: PubMed, Web of Science, Cochrane CENTRAL and Google Scholar databases were searched from database inception to December 2021., Eligibility Criteria for Selecting Studies: Peer-reviewed studies that reported site-specific RTS of BSIs in athletes., Results: Seventy-six studies reporting on 2974 BSIs were included. Sixteen studies compared multiple injury sites, and most of these studies (n=11) described the anatomical site of injury as being prognostic for RTS or the rate of treatment complication. Pooled data revealed the longest time to RTS for BSIs of the tarsal navicular (127 days; 95% CI 102 to 151 days) and femoral neck (107 days; 95% CI 79 to 135 days) and shortest duration of time for BSIs of the posteromedial tibial shaft (44 days, 95% CI 27 to 61 days) and fibula (56 days; 95% CI 13 to 100 days). Overall, more than 90% of athletes successfully returned to sport. Treatment complication rate was highest in BSIs of the femoral neck, tarsal navicular, anterior tibial shaft and fifth metatarsal; and lowest in the fibula, pubic bone and posteromedial tibial shaft., Conclusion: This systematic review supports that the anatomical site of BSIs influences RTS timelines and the risk of complication. BSIs of the femoral neck, anterior tibial shaft and tarsal navicular are associated with increased rates of complications and more challenging RTS., Prospero Registration Number: CRD42021232351., Competing Interests: Competing interests: KEA: KEA is a deputy editor of BJSM., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2023
- Full Text
- View/download PDF
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