310 results on '"Leitner, Lukas"'
Search Results
102. Recall of the ASR XL Head and Hip Resurfacing Systems
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Maurer-Ertl, Werner, primary, Friesenbichler, Joerg, additional, Holzer, Lukas A., additional, Leitner, Lukas, additional, Ogris, Kathrin, additional, Maier, Michael, additional, and Leithner, Andreas, additional
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- 2017
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103. Peptide-based vaccination against OPN integrin binding sites does not improve cardio-metabolic disease in mice
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Grün, Nicole G., primary, Strohmeier, Karin, additional, Moreno-Viedma, Veronica, additional, Le Bras, Marie, additional, Landlinger, Christine, additional, Zeyda, Karina, additional, Wanko, Bettina, additional, Leitner, Lukas, additional, Staffler, Günther, additional, Zeyda, Maximilian, additional, and Stulnig, Thomas M., additional
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- 2016
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104. Impact of preoperative antithrombotic therapy on blood management after implantation of primary total knee arthroplasty
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Leitner, Lukas, primary, Musser, Ewald, additional, Kastner, Norbert, additional, Friesenbichler, Jörg, additional, Hirzberger, Daniela, additional, Radl, Roman, additional, Leithner, Andreas, additional, and Sadoghi, Patrick, additional
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- 2016
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105. End-of-line fault detection for combustion engines using one-class classification
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Leitner, Lukas, primary, Lagrange, Antoine, additional, and Endisch, Christian, additional
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- 2016
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106. Osteopontin affects macrophage polarization promoting endocytic but not inflammatory properties
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Schuch, Karina, primary, Wanko, Bettina, additional, Ambroz, Katharina, additional, Castelo-Rosa, Alexandra, additional, Moreno-Viedma, Verónica, additional, Grün, Nicole G., additional, Leitner, Lukas, additional, Staffler, Günther, additional, Zeyda, Maximilian, additional, and Stulnig, Thomas M., additional
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- 2016
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107. Sports Activity after Low-contact-stress Total Knee Arthroplasty – A long term follow-up study
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Vielgut, Ines, primary, Leitner, Lukas, additional, Kastner, Norbert, additional, Radl, Roman, additional, Leithner, Andreas, additional, and Sadoghi, Patrick, additional
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- 2016
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108. Fast Crank-Angle Based 0D Simulation of Combustion Engine Cold Tests including Manufacturing Faults and Production Spread
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Wiederer, Julian, primary, Leitner, Lukas, additional, Endisch, Christian, additional, and Reiss, Hans, additional
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- 2016
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109. Inhibition of Cellular Adhesion by Immunological Targeting of Osteopontin Neoepitopes Generated through Matrix Metalloproteinase and Thrombin Cleavage
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Jürets, Alexander, primary, Le Bras, Marie, additional, Staffler, Günther, additional, Stein, Gesine, additional, Leitner, Lukas, additional, Neuhofer, Angelika, additional, Tardelli, Matteo, additional, Turkof, Edvin, additional, Zeyda, Maximilian, additional, and Stulnig, Thomas M., additional
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- 2016
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110. Platelet-rich Plasma: Wirkprinzip und Behandlung von Erkrankungen des Bewegungsapparates
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Leitner, Lukas, primary, Hirzberger, Daniela, additional, Vavken, Patrick, additional, Amerstorfer, Florian, additional, Bernhardt, Gerwin, additional, Vielgut, Ines, additional, Leithner, Andreas, additional, and Sadoghi, Patrick, additional
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- 2015
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111. Die Auswirkung von Nikotin und unterschiedlichen Tabakprodukten auf die Leistungsfähigkeit
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Leitner, Lukas
- Abstract
Diese Arbeit behandelt den Einfluss von Nikotin auf die sportliche Leistungsfähigkeit. Dabei werden insbesondere die Ausdauerleistungsfähigkeit, Schnelligkeit und die kognitiven Fähigkeiten betrachtet. Nikotin kann auf unterschiedliche Arten dem Körper zugeführt werden. Im Zusammenhang mit Sport sind vor allem rauchlose Anwendungen interessant. Im ersten Teil der Arbeit wird die Wirkung von Nikotin im Körper beschrieben und es werden die unterschiedlichen Produktformen von Nikotin und Tabak vorgestellt. Im Zweiten Teil der Arbeit wird im speziellen auf die Auswirkung der oben genannten Teilbereiche der Leistungsfähigkeit eingegangen. Es gibt in allen drei Teilbereichen Anzeichen und Belege dafür, dass Nikotin eine leistungssteigernde Wirkung hat. Jedoch gibt es in den vorliegenden Studien inkonsistente und teilweise widersprüchliche Ergebnisse. Somit kann keine exakte Aussage diesbezüglich getroffen werden., The aim of this paper is to discuss the influence of nicotine on human performance in sports. Especially the performance in endurance, velocity and cognition will be considered. Nicotine can be applied by different ways. In sports the smokeless ways of supply are playing an important role. The first part of this paper describes the effect of nicotine on the human body and the different ways of consumption smokeless nicotine and tobacco products. The second part of this paper discusses the effects of nicotine on the three already known sections of performance. In all three of them there are indicators, that nicotine has an positive effect on the performance but in the available studies there are partly inconsistent results found. Therefore an exact statement can't be made at that point.
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- 2013
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112. Self-reported physical activity and performance in long-term heart transplant recipients - preliminary data
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Leitner, Lukas, Keilani, Mohammad, Bunzel, Brigitta, and Crevenna, Richard
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ddc: 610 ,610 Medical sciences ,Medicine - Abstract
Objective: Heart transplantation is state of the art treatment in severe heart failure. In the scientific medical literature, there is clear evidence that regular physical activity such as aerobic exercise may increase survival and quality of life in heart transplant recipients. Furthermore, there is[for full text, please go to the a.m. URL], 7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation
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- 2011
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113. Meldepflichten bei der feindlichen Übernahme börsennotierter Aktiengesellschaften mittels Swaps
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Leitner, Lukas
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Die vorliegende Dissertation untersucht die Zulässigkeit des Einsatzes derivativer, auf Barausgleich gerichteter Finanzinstrumente, insbesondere sogenannte Cash Settled Total Return Equity Swaps im Rahmen von feindlichen Übernahmen ohne vorherige Bekanntmachung nach den einschlägigen kapitalmarktrechtlichen Vorschriften. Zu diesem Zweck wird eingangs der Begriff der feindlichen Unternehmensübernahme sowie die verschiedenen zur Verfügung stehenden Techniken beleuchtet werden. Nach einer Vorstellung der Vorschriften über die Beteiligungstransparenz nach dem Börsegesetz und der Vorschriften betreffend das Pflichtangebot nach dem Übernahmegesetz erfolgt eine detaillierte Darstellung der eingangs erwähnten Finanzinstrumente. Neben ihrer Funktionsweise werden insbesondere auch die Motive eines Investors für den Einsatz derartiger Finanzinstrumente dargestellt. Im zweiten Teil der Arbeit werden die einschlägigen kapitalmarktrechtlichen Vorschriften, also sowohl Börsegesetz als auch Übernahmegesetz, auf Anknüpfungspunkte hinsichtlich der Erfassung derartiger Finanzinstrumente untersucht. Zu diesem Zwecke werden immer wieder Argumente der deutschen Diskussion herangezogen und auf ihre Stichhaltigkeit nach österreichischem Recht untersucht. Die Untersuchung zeigt, dass eine kapitalmarktrechtliche Erfassung derartiger Finanzinstrumente aus Gründen des Normzwecks zwar wünschenswert erscheint, eine solche mit den Vorschriften, die das geltende Kapitalmarktrecht dem Rechtsanwender derzeit zur Verfügung stellt, allerdings nur in gewissen Konstellationen und somit nicht lückenlos möglich ist. Aus diesem Grund wird im dritten Teil der Arbeit der rechtspolitische Bedarf für eine Neuregelung der Erfassung dieser Instrumente im österreichischen Kapitalmarktrecht dargestellt. Anhand der Identifizierung der mit dem Einsatz dieser Instrumente verbundenen Marktstörungen wird der Handlungsbedarf des Gesetzgebers herausgearbeitet. Berücksichtigt werden dabei auch die Erfahrungen, die in der Schweiz, wo eine Verschärfung der einschlägigen Vorschriften bereits stattgefunden hat, im Zuge dieses Prozesses gewonnen wurden. Im Anschluss daran werden verschieden Lösungsansätze zur Erfassung derartiger Finanzinstrumente vorgestellt und auf ihre Stichhaltigkeit untersucht. Dabei wird auch auf die Nachteile aufmerksam gemacht, die mit der Verschärfung der kapitalmarktrechtlichen Meldepflichten einher gehen und der Zielkonflikt dargestellt, dem der Gesetzgeber bei einer allfälligen Verschärfung der Meldepflichten ausgesetzt ist., This thesis deals with the duty to disclose the use of financial instruments, in particular contracts for difference, in the regard of hostile takeovers under the Austrian stock market regulations. The thesis starts with describing the term of hostile takeovers and illustrates the different techniques of hostile takeovers followed by an overview of the legal framework for hostile takeovers, in particular reporting obligations for major holdings and financial instruments according to the Austrian Stock Exchange Act (Börsegesetz) and the rules on mandatory bids according to the Austrian Takeover Act (Übernahmegesetz). Then the thesis takes a close look on the financial instruments mentioned above and illustrates the different reasons for their use. The application of the Austrian Stock Exchange Act and the Austrian Takeover Act on contracts for difference is subject of the second part of the thesis. In this regard the thesis also compares the Austrian laws with the respective German laws and takes into account the arguments brought forward in the context of the use of derivative financial instruments for hostile takeovers in Germany. The assessment of the application of the Austrian stock market regulations on contracts for difference shows that a duty to disclose the use of such financial instruments is desirable. However, at the present time under Austrian laws such disclosure is only compulsory in specific situations. As a result, in a third part the thesis focuses on the need for legislative actions by pointing out potential market failures that are the outcome of the use of such financial instruments without disclosure. This part of the thesis also depicts the experiences gained from the Swiss authorities when implementing more stringent reporting obligations. Finally, the thesis discusses the different methods of resolutions in order to strengthen the existing regime of disclosure and points out their pros and cons.
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- 2011
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114. Immunological blockade of adipocyte inflammation caused by increased matrix metalloproteinase‐cleaved osteopontin in obesity
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Leitner, Lukas, primary, Schuch, Karina, additional, Jürets, Alexander, additional, Itariu, Bianca K., additional, Keck, Maike, additional, Grablowitz, Viktor, additional, Aszmann, Oskar C., additional, Prager, Gerhard, additional, Staffler, Günther, additional, Zeyda, Maximilian, additional, and Stulnig, Thomas M., additional
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- 2015
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115. An efficient method to calculate optimal pulse patterns for medium voltage converters
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Fotouhi, Reza, primary, Leitner, Lukas, additional, Kennel, Ralph, additional, and du Toit Mouton, Hendrik, additional
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- 2014
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116. An accelerated mouse model for atherosclerosis and adipose tissue inflammation
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Neuhofer, Angelika, primary, Wernly, Bernhard, additional, Leitner, Lukas, additional, Sarabi, Alisina, additional, Sommer, Nicole G, additional, Staffler, Günther, additional, Zeyda, Maximilian, additional, and Stulnig, Thomas M, additional
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- 2014
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117. Impact of accelerated ventricular tachyarrhythmias on mortality in patients with implantable cardioverter-defibrillator therapy
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Schukro, Christoph, primary, Leitner, Lukas, additional, Siebermair, Johannes, additional, Pezawas, Thomas, additional, Stix, Günter, additional, Kastner, Johannes, additional, and Schmidinger, Herwig, additional
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- 2013
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118. Treatment with n-3 Polyunsaturated Fatty Acids Overcomes the Inverse Association of Vitamin D Deficiency with Inflammation in Severely Obese Patients: A Randomized Controlled Trial
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Itariu, Bianca K., primary, Zeyda, Maximilian, additional, Leitner, Lukas, additional, Marculescu, Rodrig, additional, and Stulnig, Thomas M., additional
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- 2013
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119. Was der EuGH in der Rs Donau Chemie verabsäumt hat ...
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Hummer, Christina, primary and Leitner, Lukas, additional
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- 2013
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120. Retrograde Femoral Nailing in Elderly Patients: Outcome and Functional Results
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Neubauer, Thomas, primary, Krawany, Manfred, additional, Leitner, Lukas, additional, Karlbauer, Alois, additional, Wagner, Michael, additional, and Plecko, Michael, additional
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- 2012
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121. Impact of Accelerated Ventricular Tachyarrhythmias on Mortality in Patients with Implantable Cardioverter-Defibrillator
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Schukro, Christoph, primary, Leitner, Lukas, additional, Siebermair, Johannes, additional, Pezawas, Thomas, additional, Stix, Guenter, additional, Kastner, Johannes, additional, and Schmidinger, Herwig, additional
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- 2011
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122. Antitrust Audit in the Context of Transactions: Motives and Key Practical Aspects.
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Hummer, Christina and Leitner, Lukas
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ANTITRUST investigations ,BUSINESS enterprises ,DUE diligence ,ECONOMIC sectors ,DATA protection - Abstract
Antitrust audits are increasingly essential as well as due diligence in the context of transactions, as a result of rules regarding parental liability and succession at a European level.They must be conducted in a vast array of circumstances, for example when a firm or its competitors face a change in ownership or management as well as when antitrust investigations are being planned or carried out in the same or a related economic sector.In addition to European law, national provisions (e.g. data protection) must be taken into account—particularly when planning the execution of an antitrust audit. [ABSTRACT FROM PUBLISHER]
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- 2012
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123. Individualizing Follow-Up Strategies in High-Grade Soft Tissue Sarcoma with Flexible Parametric Competing Risk Regression Models.
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Smolle, Maria Anna, van de Sande, Michiel, Callegaro, Dario, Wunder, Jay, Hayes, Andrew, Leitner, Lukas, Bergovec, Marko, Tunn, Per-Ulf, van Praag, Veroniek, Fiocco, Marta, Panotopoulos, Joannis, Willegger, Madeleine, Windhager, Reinhard, Dijkstra, Sander P. D., van Houdt, Winan J., Riedl, Jakob M., Stotz, Michael, Gerger, Armin, Pichler, Martin, and Stöger, Herbert
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RISK of metastasis ,CANCER patients ,CANCER patient medical care ,CANCER relapse ,COMBINED modality therapy ,HISTOLOGY ,PATIENT aftercare ,MEDICAL cooperation ,RADIOTHERAPY ,REGRESSION analysis ,RESEARCH ,RISK assessment ,SARCOMA ,RETROSPECTIVE studies ,STATISTICAL models ,DESCRIPTIVE statistics ,TUMOR grading ,DISEASE risk factors - Abstract
Currently, patients with extremity soft tissue sarcoma (eSTS) who have undergone curative resection are followed up by a heuristic approach, not covering individual patient risks. The aim of this study was to develop two flexible parametric competing risk regression models (FPCRRMs) for local recurrence (LR) and distant metastasis (DM), aiming at providing guidance on how to individually follow-up patients. Three thousand sixteen patients (1931 test, 1085 validation cohort) with high-grade eSTS were included in this retrospective, multicenter study. Histology (9 categories), grading (time-varying covariate), gender, age, tumor size, margins, (neo)adjuvant radiotherapy (RTX), and neoadjuvant chemotherapy (CTX) were used in the FPCRRMs and performance tested with Harrell-C-index. Median follow-up was 50 months (interquartile range: 23.3–95 months). Two hundred forty-two (12.5%) and 603 (31.2%) of test cohort patients developed LR and DM. Factors significantly associated with LR were gender, size, histology, neo- and adjuvant RTX, and margins. Parameters associated with DM were margins, grading, gender, size, histology, and neoadjuvant RTX. C-statistics was computed for internal (C-index for LR: 0.705, for DM: 0.723) and external cohort (C-index for LR: 0.683, for DM: 0.772). Depending on clinical, pathological, and patient-related parameters, LR- and DM-risks vary. With the present model, implemented in the updated Personalised Sarcoma Care (PERSARC)-app, more individualized prediction of LR/DM-risks is made possible. [ABSTRACT FROM AUTHOR]
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- 2020
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124. Intermediary Support for Social Entrepreneurs: The Influence of Institutional Logics.
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Vandor, Peter and Leitner, Lukas
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This paper aims to investigate the selection decisions support intermediaries apply towards social enterprises, according to their institutional logic. We hypothesize that intermediaries engage in a process of reflexive isomorphism and select social entrepreneurs according to the inherent prescription of their respective institutional logic. Hence, we ask whether support intermediaries - embedded in a developmental as opposed to a financial institutional logic - select social enterprises with differences in their earned income ratio and mission orientation. Hypotheses are tested with survey-data of 470 members of a global network of social entrepreneurs, using multilevel modelling. Preliminary results confirm our assumptions and show: actors adhering to a developmental logic tend to support social entrepreneurs with high mission orientation and low earned income, whereas supporters following a financial logic rather select ventures with a lower mission orientation but a higher earned income share. Our results aim to contribute both to the growing literature in the intersection of social entrepreneurship and institutional logics - by providing empirical evidence for the practice of reflexive isomorphism of intermediaries through selection - and to the definitional debate around social entrepreneurship as a whole: by supporting some organizations and not others, intermediaries might advance the manifestation of their "version" of social entrepreneurship in the field. [ABSTRACT FROM AUTHOR]
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- 2018
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125. Mission Orientation, Institutional Voids and the Support Needs of Social Entrepreneurs.
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Vandor, Peter and Leitner, Lukas
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Over the last few decades, support for nascent social entrepreneurs has increased drastically. The new support infrastructure often uses the same instruments as for commercial entrepreneurs. However, little is known about what support social entrepreneurs actually need and whether these needs vary for different types of entrepreneurs and institutional contexts. This paper explores the support needs of nascent social entrepreneurs. Reflecting the ongoing debate on the nature of social entrepreneurship, it presents hypotheses for two types of actors: "mission-first" entrepreneurs (vs. commercial entrepreneurs) and "hybrid entrepreneurs" (vs. entrepreneurs with one dominant value creation goal). The hypotheses are tested on a sample of 833 nascent entrepreneurs in 31 countries. The results indicate that the level of support needed depends on the type of social entrepreneur in question. The needs of mission-first entrepreneurs largely resemble those of commercial entrepreneurs. Hybrid entrepreneurs, on the other hand, require more direct support, access to networks and field-building support. Also, findings show that institutional voids increase support needs for all types of entrepreneurs. However, hybrid entrepreneurs require less additional support than other types of entrepreneurs when operating in countries with weak rule of law. Overall, the findings show that the support needs of social entrepreneurs are contingent on their mission orientation and their institutional context. [ABSTRACT FROM AUTHOR]
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- 2018
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126. MOESM1 of Identification of Matrix Metalloproteinase-12 as a Candidate Molecule for Prevention and Treatment of Cardiometabolic Disease
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Amor, Melina, Moreno-Viedma, Veronica, Alisina Sarabi, GrĂźn, Nicole, Itariu, Bianca, Leitner, Lukas, Steiner, Irene, Bilban, Martin, Kodama, Keiichi, Butte, Atul, Guenther Staffler, Zeyda, Maximilian, and Stulnig, Thomas
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3. Good health - Abstract
Identification of Matrix Metalloproteinase-12 as a Candidate Molecule for Prevention and Treatment of Cardiometabolic Disease
127. MOESM1 of Identification of Matrix Metalloproteinase-12 as a Candidate Molecule for Prevention and Treatment of Cardiometabolic Disease
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Amor, Melina, Moreno-Viedma, Veronica, Alisina Sarabi, GrĂźn, Nicole, Itariu, Bianca, Leitner, Lukas, Steiner, Irene, Bilban, Martin, Kodama, Keiichi, Butte, Atul, Guenther Staffler, Zeyda, Maximilian, and Stulnig, Thomas
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3. Good health - Abstract
Identification of Matrix Metalloproteinase-12 as a Candidate Molecule for Prevention and Treatment of Cardiometabolic Disease
128. Restoring tibial obliquity for kinematic alignment in total knee arthroplasty: conventional versus patient-specific instrumentation.
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Smolle, Maria Anna, Koutp, Amir, Clar, Clemens, Leitner, Lukas, Leithner, Andreas, and Sadoghi, Patrick
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TOTAL knee replacement , *INTRACLASS correlation - Abstract
Introduction: In total knee arthroplasty (TKA), tibial obliquity-restoration using kinematic alignment (KA) poses a major difference to conventional mechanical alignment. This study aimed at analysing the accuracy of conventional instrumentation (CI) versus patient-specific instrumentation (PSI) to restore anatomic tibial obliquity measured by the medial proximal tibial angle (MPTA) on conventional X-rays. Materials and Methods: One-hundred patients were randomized to receive CI (n = 50) or PSI (n = 50) for TKA. Further 100 patients received CI without randomisation, resulting in 200 patients in total (127 women, mean age: 70.7 (range: 48–90 years). Pre- and postoperative X-rays were measured twice by two observers with a 2-week break in-between. Inter- and intraclass correlations were calculated and postoperative tibial obliquity compared to preoperative anatomy. Results: In 150 patients with CI, no case with tibial obliquity-deviation greater than 2° was found, whilst 21.3% (n = 32) and 0.7% (n = 1) of cases and had a deviation of 0°–1°, and 1°–2°, respectively. In the remaining 78.0% (n = 117), tibial obliquity was restored. In 50 patients with PSI, no single case with a deviation greater than 1° was found. Sixty percent (n = 30) had a deviation of 0°–1°. In the remaining 40.0% (n = 20), no deviation from preoperative measurements was found. Consequently, CI resulted in a significantly smaller change in tibial obliquity from preoperative to postoperative than PSI (p < 0.001). Inter- and intra-class correlations showed a substantial agreement (any ICC > 0.90). Conclusion: Both conventional and patient-specific instrumentation revealed adequate results with respect to restoring tibial obliquity in kinematically aligned TKA, with conventional instrumentation achieving superior results. [ABSTRACT FROM AUTHOR]
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- 2023
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129. Smokers have increased risk of soft-tissue complications following primary elective TKA.
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Starzer, Moritz, Smolle, Maria Anna, Vielgut, Ines, Hauer, Georg, Leitner, Lukas, Radl, Roman, Ehall, Reinhard, Leithner, Andreas, and Sadoghi, Patrick
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SMOKING cessation , *NICOTINE replacement therapy , *REOPERATION , *VISUAL analog scale , *TOTAL knee replacement - Abstract
Introduction: Smoking has been associated with numerous adverse outcomes following surgical procedures. The purpose of this study was to investigate, whether smoking status at time of surgery influences the outcome of primary TKA. Materials and methods: Six hundred and eighty-one patients who underwent primary TKA between 2003 and 2006 were included in the study. Smoking status was defined as current, former, and never smoker. Complications leading to revisions were assessed until 17 years of follow-up. Functional outcome was evaluated using clinical scores: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Scale (VAS) for pain, Short Form-12 Physical and Mental Component Summaries (SF-12PCS/MCS), and Knee Society Function and Knee Score (KSFS and KSKS). Results: At a mean follow-up of 95 months (± 47 months), 124 complications led to revision surgery. Soft-tissue complications (OR, 2.35 [95% CI 1.08–5.11]; p = 0.032), hematoma formation (OR, 5.37 [95% CI 1.01–28.49]; p = 0.048), and restricted movement (OR, 3.51 [95% CI 1.25–9.84]; p = 0.017) were more likely to occur in current smokers than never smokers. Current smokers were more likely to score higher at KSFS (p < 0.001) and SF-12PCS (p = 0.0197) compared to never smokers. For overall revision, differences were noted. Conclusion: Current smoking increases risk of soft-tissue complications and revision after primary TKA, especially due to hematoma and restricted movement. Smoking cessation programs could reduce the risk of revision surgery. [ABSTRACT FROM AUTHOR]
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- 2023
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130. Patients successfully lose body weight after primary total knee arthroplasty but not more than a matched general population.
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Smolle, Maria Anna, Musser, Ewald, Hauer, Georg, Vielgut, Ines, Leitner, Lukas, Ehall, Reinhard, Leithner, Andreas, and Sadoghi, Patrick
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- *
TOTAL knee replacement , *WEIGHT loss , *BODY weight , *JOINT pain , *BODY mass index , *ANALGESIA - Abstract
Introduction: High BMI is associated with increased risk for knee osteoarthritis, ultimately necessitating total knee arthroplasty (TKA). The aim of this retrospective study was to (1) analyse the amount of postoperative long-term weight loss as reflected by BMI change in TKA patients, (2) identify factors associated with increased change in BMI, and to (3) compare changes with BMI trends of a general population. Materials and methods: Overall, 298 TKA patients [198 females; mean age: 65.1 ± 7.9 years, median follow-up 8.8 (interquartile range: 5.9–10.8 years)] were included in the final evaluation and compared with an age group-matched control group from the general population regarding weight trends between 2006 and 2014. Main variable of interest in both cohorts was body mass index (BMI). Linear regression analyses were performed to assess changes in weight and BMI over time between TKA patients and the general population. Furthermore, mixed linear-effects models were constructed to analyse the potential change in BMI independent from age and gender. Results: In TKA patients, a significant drop in BMI by 0.8 ± 3.2 points from postoperative to final follow-up was observed (p < 0.001), with reduction being significant independently from age (p = 0.382), gender (p = 0.310), or revision surgery (p = 0.195). In the general population, likewise a significant BMI-decrease by 0.7 ± 6.1 points was observed between 2006 and 2014, with younger people (p = 0.004) and females (p < 0.001) being more likely to reduce BMI. Yet, BMI-decrease between TKA patients and the general population over time was comparable (p = 0.734). Notably, patients with initially higher BMI were significantly more likely to lose weight postoperatively than normal-weight patients (p < 0.001). Conclusions: Our results point against the notion that TKA patients lose a considerable amount of weight in comparison to the general population as soon as improved joint function and pain relief have been achieved. Thus, individualized patient education programmes should be reinforced, promoting a healthy lifestyle. [ABSTRACT FROM AUTHOR]
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- 2023
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131. Mechanically aligned total knee arthroplasty with the extension-first technique does not equally restore neutral knee alignment in all preoperative knee phenotypes.
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Hörlesberger, Nina, Zinggl, Carina, Smolle, Maria Anna, Leitner, Lukas, Lohberger, Birgit, Leithner, Andreas, and Sadoghi, Patrick
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TOTAL knee replacement , *KNEE , *PHENOTYPES - Abstract
Purpose: The aim of this study was to determine the change in the long leg axis according to the preoperative knee phenotype using the mechanically aligned extension-first technique in total knee arthroplasty. The hypothesis of this study was that the knee phenotype would have an impact on the postoperative leg axis. Methods: This was a retrospective comparative study comprising 224 whole-leg radiographs of 112 patients. The leg axes of the pre- and postoperative radiographs were measured and categorized into three preoperative limb phenotypes (based on the hip-knee-ankle angle [HKA]) according to Hirschmann et al. (varus—HKA < 178.5°, neutral—HKA 178.5°–181.5°, and valgus—HKA > 181.5°). Additionally, femoral phenotypes (based on the femoral mechanical angle [FMA], i.e., the mechanical medial distal femoral angle [mMDFA], as well as the tibial phenotypes [based on the tibial mechanical angle, i.e., the medial proximal tibial angle (MPTA)] was calculated. The change in the long leg axis was analyzed and compared with the preoperative limb phenotype. Results: Significantly more patients with preoperative varus alignment shifted to neutral alignment (46.3%, n = 31) than did patients with preoperative valgus alignment (38.9%; n = 14). Moreover, 43.3% of patients (n = 29) with the varus phenotype remained in a varus alignment, compared with the 58.3% of patients with preoperative valgus phenotype (n = 21) remaining in valgus alignment. These findings were similar for both females (p < 0.001) and males (p = 0.015). Conclusion: Using an extension-first mechanically aligned surgical technique, varus phenotypes predominantly result in neutral leg axes or remain varus, neutral phenotypes remain neutral, and valgus phenotypes remain valgus or change to neutral phenotypes. This study showed that preoperative knee phenotypes in valgus knees influence this technique more strongly than estimated in previous investigations, which is in line with modern alignment philosophies for TKA. Level of evidence: Level IV, retrospective comparative study. [ABSTRACT FROM AUTHOR]
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- 2023
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132. No difference in clinical outcome, pain, and range of motion between fixed and mobile bearing Attune total knee arthroplasty: a prospective single-center trial.
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Ruckenstuhl, Paul, Revelant, Fabio, Hauer, Georg, Bernhardt, Gerwin A., Leitner, Lukas, Gruber, Gerald, Leithner, Andreas, and Sadoghi, Patrick
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TOTAL knee replacement , *KNEE pain , *RANGE of motion of joints , *KNEE joint , *ARTIFICIAL knees , *RADIOSTEREOMETRY , *VISUAL analog scale - Abstract
Background: Despite numerous scientific investigations, the tribological advantages of mobile bearing inserts have not been sustainably confirmed or refuted for modern knee prostheses in clinical studies. The purpose of this study was to compare fixed and mobile bearing inserts in order to draw conclusions regarding clinical benefits.Methods: The present prospective single center cohort study of 2 non-randomized stratified groups consisted of 67 patients. All included patients received cemented total knee arthroplasty (Attune®) due to osteoarthritis. 34 patients were treated with a mobile and 33 patients with a fixed insert. The WOMAC score and the Visual Analogue Scale was used for the subjective assessment of success, while the Knee-Society-Score was used considering the Range of Motion for the objective assessment. The subjective and the clinical scores showed improvements for both compared groups postoperatively at 2 years of minimum follow-up.Results: The overall postoperative results of the WOMAC score, the Knee-Society-Score and the Visual Analogue Scale presented no statistically difference between the compared groups (p > 0,05). The postoperative ROM showed a superior improvement of 13.2° ± 18.4° in the mobile-bearing group versus 4.9° ± 18.4° (p = 0.017) in the fixed-bearing group. The flexion of the knee joint was 114° ± 10.1° for the mobile-bearings and 109.2° ± 7.2° for fixed bearings (p = 0.012).Conclusion: According to the findings, both inserts showed overall promising postoperative results, in terms of objective as well as subjective parameters, without clinically relevant significant differences, except for ROM, which was superior in the mobile bearing group. The present clinical trial has been registered at the ISRCTN registry with the reverence number ISRCTN15117998 on 04/04/2022. [ABSTRACT FROM AUTHOR]- Published
- 2022
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133. Going green: Development of a sustainable lipid-based enteric coating formulation for low-dose aspirin multiparticulate systems.
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Schertel, Sonja, Corzo, Carolina, Leitner, Lukas, Karrer, Julia, Engel, Daniel, Teichmann, Yannik, Zimmer, Andreas, and Salar-Behzadi, Sharareh
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SUSTAINABLE development , *SURFACE coatings , *POLYMORPHIC transformations , *PALMITIC acid , *CHEMICAL decomposition , *ASPIRIN , *ENOXAPARIN - Abstract
[Display omitted] There is a rising awareness of pharmaceutical industry of both patient-centric and sustainable product development. Manufacturing of multiparticulate systems (MPS) with functional coating via solvent-free hot melt coating (HMC) can fulfill both requirements. An innovative lipid-based formulation was developed with the composition of palmitic acid and Grindsted® citrem BC-FS (BC-FS) for enteric coating of acetylsalicylic acid (ASA). The ASA crystals were directly hot melt coated to produce user-friendly low-dose ASA MPS for thromboembolism prophylaxis. Prior to HMC, rational boundaries for the process temperature were defined based on the melting and crystallization behavior of coating blend. Stability of coating in terms of resistance to heat stress and solidstate stability were screened via Fourier-transform infrared spectroscopy and x-ray diffraction. Exposure of coating blend to 100 °C for two hours did not cause any chemical degradation. Crystal growth of palmitic acid and polymorphic transformation in BC-FS were observed after storage under accelerated conditions, however did not significantly affect the ASA release from coating. The developed formulation is a unique solvent-free, lipid-based enteric composition and paves the way for sustainable green pharmaceutical manufacturing. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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134. Septic complications are on the rise and aseptic loosening has decreased in total joint arthroplasty: an updated complication based analysis using worldwide arthroplasty registers.
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Hauer, Georg, Rasic, Laura, Klim, Sebastian, Leitner, Lukas, Leithner, Andreas, and Sadoghi, Patrick
- Abstract
Introduction: A decade ago, a comprehensive study was conducted to investigate the reasons for revision surgeries and their respective frequencies in cases of total hip arthroplasty (THA) and total knee arthroplasty (TKA) based on a complication-based analysis of joint replacement registries. The aim of the present study was to determine whether the causes and risks of their occurrence have changed over the last ten years and to present an updated analysis.A systematic review of national arthroplasty registries from seven countries examined the causes and rates of revisions of THA and TKA. The study focused on a descriptive analysis that provided an updated overview without statistical significance values.The most common causes for revisions of THA were aseptic loosening (35.1%), deep infection (18.2%), dislocation/instability (15.9%), and periprosthetic fractures (11.4%). The most common causes for revisions of TKA were deep infection (21.6%), aseptic loosening (18.3%), instability (14.1%), and pain (10.9%).The findings of this study revealed significant shifts in the underlying causes of revision surgeries in the last decade. Notably, septic complications emerged as the predominant reason for revision of primary TKA, while they also gained prominence as a cause of failure of THA. Although aseptic loosening remains the primary cause for re-operation of THA, the relative risk has decreased for both THA and TKA.Materials and methods: A decade ago, a comprehensive study was conducted to investigate the reasons for revision surgeries and their respective frequencies in cases of total hip arthroplasty (THA) and total knee arthroplasty (TKA) based on a complication-based analysis of joint replacement registries. The aim of the present study was to determine whether the causes and risks of their occurrence have changed over the last ten years and to present an updated analysis.A systematic review of national arthroplasty registries from seven countries examined the causes and rates of revisions of THA and TKA. The study focused on a descriptive analysis that provided an updated overview without statistical significance values.The most common causes for revisions of THA were aseptic loosening (35.1%), deep infection (18.2%), dislocation/instability (15.9%), and periprosthetic fractures (11.4%). The most common causes for revisions of TKA were deep infection (21.6%), aseptic loosening (18.3%), instability (14.1%), and pain (10.9%).The findings of this study revealed significant shifts in the underlying causes of revision surgeries in the last decade. Notably, septic complications emerged as the predominant reason for revision of primary TKA, while they also gained prominence as a cause of failure of THA. Although aseptic loosening remains the primary cause for re-operation of THA, the relative risk has decreased for both THA and TKA.Results: A decade ago, a comprehensive study was conducted to investigate the reasons for revision surgeries and their respective frequencies in cases of total hip arthroplasty (THA) and total knee arthroplasty (TKA) based on a complication-based analysis of joint replacement registries. The aim of the present study was to determine whether the causes and risks of their occurrence have changed over the last ten years and to present an updated analysis.A systematic review of national arthroplasty registries from seven countries examined the causes and rates of revisions of THA and TKA. The study focused on a descriptive analysis that provided an updated overview without statistical significance values.The most common causes for revisions of THA were aseptic loosening (35.1%), deep infection (18.2%), dislocation/instability (15.9%), and periprosthetic fractures (11.4%). The most common causes for revisions of TKA were deep infection (21.6%), aseptic loosening (18.3%), instability (14.1%), and pain (10.9%).The findings of this study revealed significant shifts in the underlying causes of revision surgeries in the last decade. Notably, septic complications emerged as the predominant reason for revision of primary TKA, while they also gained prominence as a cause of failure of THA. Although aseptic loosening remains the primary cause for re-operation of THA, the relative risk has decreased for both THA and TKA.Conclusion: A decade ago, a comprehensive study was conducted to investigate the reasons for revision surgeries and their respective frequencies in cases of total hip arthroplasty (THA) and total knee arthroplasty (TKA) based on a complication-based analysis of joint replacement registries. The aim of the present study was to determine whether the causes and risks of their occurrence have changed over the last ten years and to present an updated analysis.A systematic review of national arthroplasty registries from seven countries examined the causes and rates of revisions of THA and TKA. The study focused on a descriptive analysis that provided an updated overview without statistical significance values.The most common causes for revisions of THA were aseptic loosening (35.1%), deep infection (18.2%), dislocation/instability (15.9%), and periprosthetic fractures (11.4%). The most common causes for revisions of TKA were deep infection (21.6%), aseptic loosening (18.3%), instability (14.1%), and pain (10.9%).The findings of this study revealed significant shifts in the underlying causes of revision surgeries in the last decade. Notably, septic complications emerged as the predominant reason for revision of primary TKA, while they also gained prominence as a cause of failure of THA. Although aseptic loosening remains the primary cause for re-operation of THA, the relative risk has decreased for both THA and TKA. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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135. Mid-term results show no significant difference in postoperative clinical outcome, pain and range of motion between a well-established total knee arthroplasty design and its successor: a prospective, randomized, controlled trial.
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Hauer, Georg, Hörlesberger, Nina, Klim, Sebastian, Bernhardt, Gerwin A., Leitner, Lukas, Glehr, Mathias, Leithner, Andreas, and Sadoghi, Patrick
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TOTAL knee replacement , *HEALTH outcome assessment , *OSTEOARTHRITIS , *RANGE of motion of joints - Abstract
Purpose: The purpose of this study was to compare the clinical and functional outcome scores following total knee arthroplasty (TKA) with two different systems. The hypothesis was that there is a difference between patients receiving the newer design than those receiving the predecessor. Methods: Two hundred patients who underwent TKA were randomized into two groups: patients received either Attune TKA or PFC Sigma (both DePuy Synthes, Warsaw, IN). Clinically, the Knee Society Knee and Function Scores (KS and FS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Range of Motion (ROM) and Visual Analogue Scale (VAS) were evaluated and compared between the groups 2 years after surgery. 158 patients (80 in the Attune group and 78 in the PFC Sigma group) were available for follow-up. Results: Through bivariate analysis using parametric and non-parametric statistical tests, no significant differences in postoperative KS, FS, WOMAC, ROM or VAS between the two groups were detected. Both groups significantly improved regarding all evaluated endpoints 2 years after surgery. Conclusions: In the current study population, no difference in clinical outcome between the two systems was found. The expected benefits of design modifications could not be observed in clinical outcome scores 2 years postoperatively. Both designs are effective options for improving pain and function in end-stage osteoarthritis. Level of evidence: I. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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136. Excellent mid-term osseointegration and implant survival using metaphyseal sleeves in revision total knee arthroplasty.
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Klim, Sebastian M., Amerstorfer, Florian, Bernhardt, Gerwin A., Sadoghi, Patrick, Hauer, Georg, Leitner, Lukas, Leithner, Andreas, and Glehr, Mathias
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- *
ARTHROPLASTY , *KNEE surgery , *ARTHROSCOPY , *EXAMINATION of joints , *OSTEOTOMY - Abstract
Purpose: Metaphyseal fixation in revision total knee arthroplasty (RTKA) is a very promising treatment option for extended bone defects. Currently published mid-term results remain limited. The purpose was to analyse the implant durability, the clinical and the radiological mid-term results in RTKA when using metaphyseal sleeves. Methods: Clinical and radiological follow-up examinations were performed in 92 patients (93 knees) with RTKA using hybrid fixation technique (cementless sleeves and stem). Radiographic measurements regarding osseointegration at the bone–sleeve interface were performed and the range of motion (ROM), a subjective satisfaction score (SSS), the American Knee Society Score (KSS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as well as the SF-36 Health survey were examined. Bone defects were analysed using the Anderson Orthopaedic Research Institute (AORI) classification. Results: No knee had to be revised due to aseptic loosening at the time of the follow-up (mean 6.3 years ± 2.3, minimum 2 years). Satisfactory radiographic osseointegration at the sleeve/bone interface was detected in 96.1% of cases. 17 knees (18.2%) had to be re-revised, 15 of them due to a recurrent infection and 2 due to aseptic reasons (mediolateral instability and a periprosthetic fracture). The median of the ROM (96°), SSS (8), KSS (87), WOMAC (9), SF-36 MCS (55) and SF-36 PCS (38) showed very satisfying results. Conclusion: No case of aseptic loosening was found in this large series of RTKA with extended bone defects using metaphyseal sleeve fixation. In this large retrospective series, it has been shown that this technique is an excellent treatment option for extended bone defects in RTKA surgery. Level of evidence: Retrospective cohort study, level III. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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137. Similar revision rates in clinical studies and arthroplasty registers and no bias for developer publications in unicompartmental knee arthroplasty.
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Hauer, Georg, Bernhardt, Gerwin A., Hohenberger, Gloria, Leitner, Lukas, Ruckenstuhl, Paul, Leithner, Andreas, Gruber, Gerald, and Sadoghi, Patrick
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- *
PUBLICATION bias , *REOPERATION , *KNEE , *ARTHROPLASTY , *TOTAL knee replacement , *SYSTEMATIC reviews , *ACQUISITION of data , *TREATMENT effectiveness - Abstract
Purpose: Our aim was to assess the outcome with respect to cumulative revision rates of unicompartmental knee arthroplasty (UKA) by comparing published literature and arthroplasty registry data. Our hypothesis was that there is a superior outcome of UKA described in dependent clinical studies compared to independent studies or arthroplasty registers.Methods: A systematic review of all clinical studies on UKA in the past decade was conducted with the main endpoint revision rate. Revision rate was calculated as "revision per 100 component years (CY)". The respective data were analysed with regard to a potential difference of the percentage of performed revision surgeries as described in dependent and independent clinical studies. Clinical data were further compared to arthroplasty registers in a systematic search algorithm.Results: In total, 48 study cohorts fulfilled our inclusion criteria and revealed 1.11 revisions per 100 CY. This corresponds to a revision rate of 11.1% after 10 years. No deviations with regard to revision rates for UKA among dependent and independent clinical literature were detected. Data from four arthroplasty registers showed lower survival rates after 10 years compared to published literature without being significant.Conclusions: The outcomes of UKA in dependent and independent clinical studies do not differ significantly and are in line with arthroplasty register datasets. We cannot confirm biased results and the authors recommend the use of UKAs in properly selected patients by experts in their field. [ABSTRACT FROM AUTHOR]- Published
- 2020
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138. Identification of Matrix Metalloproteinase-12 as a Candidate Molecule for Prevention and Treatment of Cardiometabolic Disease.
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Amor, Melina, Moreno-Viedma, Veronica, Sarabi, Alisina, Grün, Nicole G, Itariu, Bianca, Leitner, Lukas, Steiner, Irene, Bilban, Martin, Kodama, Keiichi, Butte, Atul J, Staffler, Guenther, Zeyda, Maximilian, and Stulnig, Thomas M
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METALLOPROTEINASES , *CARDIOVASCULAR diseases , *METABOLIC syndrome , *GENE expression , *ADIPOSE tissues - Abstract
Obesity is strongly associated with metabolic syndrome, a combination of risk factors that predisposes to development of the cardiometabolic diseases: atherosclerotic cardiovascular disease and type 2 diabetes mellitus. Prevention of metabolic syndrome requires novel interventions to address this health challenge. The objective of this study was to identify candidate molecules for the prevention and treatment of insulin resistance and atherosclerosis, conditions that underlie type 2 diabetes mellitus and cardiovascular disease, respectively. We used an unbiased bioinformatics approach to identify molecules that are upregulated in both conditions by combining murine and human data from a microarray experiment and meta-analyses. We obtained a pool of 8 genes that were upregulated in all the databases analyzed. This included well-known and novel molecules involved in the pathophysiology of type 2 diabetes mellitus and cardiovascular disease. Notably, matrix metalloproteinase 12 (MMP12) was highly ranked in all analyses and was therefore chosen for further investigation. Analyses of visceral and subcutaneous white adipose tissue from obese compared with lean mice and humans convincingly confirmed the upregulation of MMP12 in obesity at the mRNA, protein and activity levels. In conclusion, by using this unbiased approach, an interesting pool of candidate molecules was identified, all of which have potential as targets in the treatment and prevention of cardiometabolic diseases. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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139. Mix and Match Use of Revision Universal Head-Neck Adapters in Hip Arthroplasty: A Complications and Survival Analysis of 306 Cases.
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Valentini M, Thaller A, Ruckenstuhl P, Sadoghi P, Leithner A, and Leitner L
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- Humans, Female, Male, Aged, Middle Aged, Retrospective Studies, Aged, 80 and over, Risk Factors, Prosthesis Design, Adult, Postoperative Complications epidemiology, Postoperative Complications etiology, Arthroplasty, Replacement, Hip adverse effects, Arthroplasty, Replacement, Hip instrumentation, Reoperation statistics & numerical data, Hip Prosthesis adverse effects, Prosthesis Failure
- Abstract
Background: Outcomes and safety of "mix and match" in total hip arthroplasty (THA) using universal head-neck adapters (UHNA) are a matter of ongoing discussion and concern due to legal affairs. This study aimed at analyzing the "mix and match" use of UHNA and evaluating complication and reoperation rates, possible risk factors, and the implant's survival., Methods: A total of 306 patients treated with THA (94.1% revisions) using a UHNA at our institution between 2006 and 2022 were identified and included. Diagnoses, comorbidities, implants, and UHNA specifications were retrospectively recorded. Outcomes, complications, and survival analyses were evaluated, taking into account various possible risk factors., Results: There were 19.9% of the 306 included cases (58.5% women; median age 74 years; median follow-up 57 months) that had at least 1 complication. There were 43 patients (14.1%) who had to receive ≥1 rerevision surgery. The most common complication was postoperative recurrent dislocation (n = 27, 8.8%). There was one case of a prosthetic stem-neck fracture that was registered. Statistically significant risk factors for postoperative recurrent dislocations and postoperative aseptic loosening were, respectively, dislocation as an indication for UHNA implantation (P < .001) and oversized neck lengths (≥2XL; P = .004). The overall revision-free survival was 92% after 1 year and 82% at ten years. Statistically significant better survival rates were registered in patients ≥60 years old, who had fewer comorbidities (<2), and normal neck lengths (S to XL)., Conclusions: The results of this study underline the overall safety of UHNA use in THA through "mix and match." Only one case of a stem-neck fracture was identified. The highlighted risk factors for failure must be kept in mind during the decision-making process with patients., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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140. Evaluation of a radiological grading system for the early detection of total knee arthroplasties at risk for revision surgery.
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Hörlesberger N, Smolle MA, Leitner L, Labmayr V, Leithner A, and Sadoghi P
- Abstract
Introduction: X-rays are regularly performed after primary total knee arthroplasty (TKA). While soft tissue management and ligament tension cannot be evaluated, important information, such as inadequate component positioning and loose cement location, as well as subsequent loosening, can be detected. The aim of this study was to correlate radiological findings, referring to the radiological grading system (previously published by the same study group, henceforth abbreviated as "RGS"), with long-term outcomes and implant survival., Materials and Methods: A total of 266 patients who underwent titanium-coated TKA were included. In addition to implant survival, visual analogue scale score, Tegner activity score, knee society score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index, and short form-12 score as well as range of motion were evaluated. Clinical examination as well as anterior-posterior, lateral, full-length weight bearing, and patellar view radiographs were performed pre- and postoperatively, at the 3-, 6-, and 12-month postoperative follow-ups and at the final follow-up. The radiological grading system was evaluated and correlated with long-term outcome and survivorship., Results: The revision-free survival rate was 88.4% at a median follow-up of 9.8 years (IQR: 9.3-10.3 years; range: 0.1-11.8 years). Revision surgery was required in 31 TKAs (11.7%). The multivariate Cox regression model showed a significant association between an RGS score ≥ 3 deviation points (DP) and an increased risk for revision (hazard ratio: 2.092; 95% CI: 1.020-4.290; p = 0.044). Moreover, the KSS for pain was significantly worse in patients with a RGS score ≥ 3 DP (median, 85 [74-92] vs. 90 [80-94]; p = 0.007)., Conclusions: This is the first study indicating that deviation in component positioning, having an inadequate long leg axis, the presence of free cement or residual bony structures on postoperative X-rays significantly correlate with TKA outcome and implant survival. Therefore RGS can be of high predicable value for the survivorship of the prosthesis., Level of Evidence: Level IV - retrospective cohort study., (© 2024. The Author(s).)
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- 2024
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141. Readmissions at Thirty-Days and One-Year for Implant-Associated Complications following Primary Total Hip and Knee Arthroplasty: A Population-Based Study of 34,392 Patients Across Austria.
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Smolle MA, Fischerauer S, Vukic I, Wenzl FA, Leitner L, Leithner A, and Sadoghi P
- Abstract
Introduction: The primary aim of this study was to assess 30-day and one-year rates for unplanned readmission due to implant-associated complications following total hip (THA) or total knee arthroplasty (TKA) in Austria. Secondary endpoints were reasons for readmission and differences in revision risk depending on demographics and hospital size., Methods: Data on patients receiving THA (n = 18,508) or TKA (n = 15,884) in orthopaedic and trauma units across Austria within a one-year period (January 2021 to December 2021) was retrieved from a government-maintained database. The absolute and relative frequencies of unplanned readmissions were calculated. Risk factors for 30-day and one-year readmission following THA or TKA due to implant-associated complications were investigated., Results: The thirty-day and one-year readmission rates for any implant-associated complication were 1.0% (339 of 34,392) and 3.0% (1,024 of 34,392). Relative to the overall readmission rate for any complication at 30 days (n = 1,952) and one year (n = 12,109), respectively, readmission rates for implant-associated complications were 17.4 and 8.5%. The thirty-day readmission rates were higher in THA (1.2%) than TKA patients (0.8%; P = 0.001), while it was the opposite at one year (THA, 2.7%; TKA, 3.3%; P < 0.001). Mechanical complications (554 of 1,024) were the most common reason for one-year readmission. Prolonged length of in-hospital stay independently associated with increased one-year readmission risk in THA and TKA patients. Treatment at large-sized hospitals was associated with a higher one-year readmission risk in TKA patients., Conclusions: The thirty-day and one-year readmission rates for implant-associated complications following THA or TKA in Austria are lower than reported in other countries, with similar risk factors and reasons for readmission. Considering that almost 20% of unplanned hospital readmissions following total joint arthroplasty are attributable to implant-associated complications, optimization of in-hospital and post-discharge medical care for these patients is warranted., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
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- 2024
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142. The worldwide survival rate of total hip arthroplasties is improving: a systematic comparative analysis using worldwide hip arthroplasty registers.
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Clar C, Leitner L, Koutp A, Hauer G, Rasic L, Leithner A, and Sadoghi P
- Abstract
Purpose: The aim of this study was to evaluate the development of the worldwide survival rate of primary total hip arthroplasty (THA). The hypothesis was that survival improved over the last decade in worldwide arthroplasty registers., Methods: THA registers were screened in 2022 and compared between different countries with respect to the number of primary implantations per inhabitant, age, fixation type, and survival rate, and compared to similar data from 2009. The data from these reports were analyzed in terms of number, age distribution, and procedure type of primary THAs. Survival curves and a comparative analysis with respect to the development over time were calculated., Results: We identified nine hip arthroplasty registers that contained sufficient data to be included. A large variation was found in the annual number of primary THA implantations per inhabitant, with more than the factor 4 for all age groups across regions. The procedure type varied strongly as well, e.g. in Sweden, 50% were cemented THAs, whereas in Emilia-Romagna (Italy), 96% of THAs were implanted cementless. We found an improved survival rate of 5%, with 90% of survival after 15 years in the cohorts from 2021 compared to 85% in the cohorts from 2009., Conclusion: The present study revealed a significant improvement in the survival of THA in worldwide arthroplasty registers within different countries and regions over the period of one decade. We believe that it is safe to state that the success of THA is still rising with respect to this main outcome.
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- 2024
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143. Comparison of revision rates and epidemiological data of a single total knee arthroplasty system of different designs (cruciate retaining, posterior stabilized, mobile bearing, and fixed bearing): a meta-analysis and systematic review of clinical trials and national arthroplasty registries.
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Wagner A, Wittig U, Leitner L, Vielgut I, Hauer G, Ortmaier R, Leithner A, and Sadoghi P
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- Humans, Male, Female, Prosthesis Failure, Clinical Trials as Topic statistics & numerical data, Aged, Arthroplasty, Replacement, Knee statistics & numerical data, Arthroplasty, Replacement, Knee methods, Reoperation statistics & numerical data, Registries, Knee Prosthesis, Prosthesis Design
- Abstract
Background: This study aimed to meta-analyze epidemiological data, revision rates, and incidences of different designs of a single Total Knee Arthroplasty System and compare these factors across different countries., Methods: A systematic review was conducted on clinical studies and arthroplasty registries of ATTUNE TKA from 1999 to 2020. The main endpoints analyzed were revision rates and epidemiological data., Results: The average age of patients was 67.8 years, with a gender distribution of 60% female and 40% male. The pooled average BMI was 29.4 kg/m
2 . Eight clinical studies showed a pooled revision rate per 100 observed CY of 0.5 (n = 1343 cases). Cumulative revision rates after 1, 3, and 5 years varied among registries, with the Swiss registry having the highest revision data (after 5 years: 6.3%) and the American registry having the lowest revision data (after 5 years: 1.7%). A comparison of the revision rates of mobile bearing and fixed bearing (41,200 cases) as well as cruciate retaining and posterior stabilized (n = 123,361 cases) showed no significant advantage in the first 5 years after implantation., Conclusion: In conclusion, pooled data from 41,200 cases of TKA with a single Total Knee Arthroplasty System in two arthroplasty registries revealed that there was no significant difference in revision rates between the mobile bearing and fixed bearing design within the first 5 years after implantation. In addition, a comparison of the revision rates in n = 123,361 cases showed no significant advantage for cruciate retaining or posterior stabilized in the first 5 years after implantation., (© 2024. The Author(s).)- Published
- 2024
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144. 30-day and one-year readmission rate in 11,270 patients with surgical treatment for proximal femoral fractures across Austria.
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Smolle MA, Fischerauer SF, Vukic I, Leitner L, Puchwein P, Widhalm H, Leithner A, and Sadoghi P
- Abstract
Aims: Patients with proximal femoral fractures (PFFs) are often multimorbid, thus unplanned readmissions following surgery are common. We therefore aimed to analyze 30-day and one-year readmission rates, reasons for, and factors associated with, readmission risk in a cohort of patients with surgically treated PFFs across Austria., Methods: Data from 11,270 patients with PFFs, treated surgically (osteosyntheses, n = 6,435; endoprostheses, n = 4,835) at Austrian hospitals within a one-year period (January to December 2021) was retrieved from the Leistungsorientierte Krankenanstaltenfinanzierung (Achievement-Oriented Hospital Financing). The 30-day and one-year readmission rates were reported. Readmission risk for any complication, as well as general medicine-, internal medicine-, and surgery/injury-associated complications, and factors associated with readmissions, were investigated., Results: The 30-day and one-year readmission rates due to any complication were 15% and 47%, respectively. The 30-day readmission rate (p = 0.001) was higher in endoprosthesis than osteosynthesis patients; this was not the case for the one-year readmission rate (p = 0.138). Internal medicine- (n = 2,273 (20%)) and surgery/injury-associated complications (n = 1,612 (14%)) were the most common reason for one-year readmission. Regardless of the surgical procedure, male sex was significantly associated with higher readmission risk due to any, as well as internal medicine-associated, complication. Advanced age was significantly associated with higher readmission risk after osteosynthesis. In both cohorts, treatment at mid-sized hospitals was significantly associated with lower readmission risk due to any complication, while prolonged length of stay was associated with higher one-year readmission risks due to any complication, as well as internal-medicine associated complications., Conclusion: Future health policy decisions in Austria should focus on optimization of perioperative and post-discharge management of this vulnerable patient population., Competing Interests: A. Leithner reports institutional educational grants from Johnson & Johnson, Alphamed, Medacta, and Implantec, unrelated to this study. P. Puchwein reports consulting fees from Hofer, I.T.S, and payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events from Medacta, I.T.S, Amgen, and Annexa, all of which are unrelated to this study. P. Puchwein also holds a leadership or fiduciary role on ÖGoUT. P. Sadoghi reports royalties or licenses, consulting fees, and support for attending meetings and/or travel from Medacta and DePuy, which are unrelated to this study. P. Sadoghi is an Editorial Board Member of JOA, KSSTA, and Arthroscopy. M. A. Smolle reports travel grants from Alphamed, ImplanTec, Implantcast, and PharmarMar, unrelated to this study., (© 2024 Puchwein et al.)
- Published
- 2024
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145. Less Induction Time and Postoperative Pain Using Spinal Anesthesia Versus General Anesthesia With or Without the Use of Peripheral Nerve Blocks in Total Knee Arthroplasty.
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Koutp A, Hauer G, Leitner L, Kaltenegger L, Fischerauer S, Clar C, Reinbacher P, Schittek G, Leithner A, and Sadoghi P
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- Humans, Analgesics, Opioid therapeutic use, Peripheral Nerves, Pain, Postoperative drug therapy, Pain, Postoperative prevention & control, Pain, Postoperative etiology, Anesthesia, General methods, Anesthesia, Spinal methods, Arthroplasty, Replacement, Knee adverse effects, Anesthetics therapeutic use
- Abstract
Background: Our aim was to analyze anesthetic induction time and postoperative pain using spinal anesthesia versus general anesthesia with or without the use of peripheral nerve blocks (PNBs) in total knee arthroplasty. The hypothesis was that spinal anesthesia would be beneficial with respect to induction time and postoperative pain and that PNBs would complement this effect., Methods: Patients were stratified according to demographics, American Society of Anesthesiologists physical status classification system (ASA), and opioid intake and divided into: (A) general anesthesia without PNB; (B) general anesthesia with PNB; (C) spinal anesthesia without PNB; and (D) spinal anesthesia with PNB. Endpoints were anesthetic induction time, opioid consumption, and pain. Of 559 patients, 348 (62.3%) received general anesthesia (consisting of group A with 46 and group B with 302 patients), and 211 (37.7%) spinal anesthesia (consisting of group C with 117 and group D with 94 patients)., Results: We observed significantly lower total opioid intake 48 hours postoperative when applying spinal anesthesia by 2.08 mg (P < .05) of intravenous morphine-equivalent, and a reduction of 7.0 minutes (P < .05) until skin incision. The application of a PNB achieved a reduction of piritramide intake of 3.59 mg (P < .05) 48 hours postoperative and lengthened induction time by 8.5 minutes (P < .05)., Conclusions: Statistically shorter anesthetic induction times without clinical relevance, but lower postoperative opioid dosages with clinical relevance were observed for patients undergoing total knee arthroplasty with spinal anesthesia. The additional application of PNBs led to a lower need for opioids and lower pain levels in the early postoperative phase., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)
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- 2024
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146. Occupational injuries in orthopedic and trauma surgeons in Austria.
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Clar C, Koutp A, Leithner A, Leitner L, Puchwein P, Vielgut I, and Sadoghi P
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- Humans, United States, Austria epidemiology, Pain, Occupational Injuries epidemiology, Occupational Injuries etiology, Orthopedics, Surgeons, Orthopedic Surgeons
- Abstract
Background: The aim of this study was to investigate the frequency and type of injuries during the career of orthopedic and trauma surgeons in Austria. The hypothesis was that the percentage of occupational injuries among orthopedic and trauma surgeons aligns with the incidence reported in the United States, thus indicating the need for a workplace prevention program., Methods: A web-based survey was created to collect all necessary data and was sent to all orthopedic and trauma surgeons in Austria via e-mail. Relevant parameters included the surgeons' age, work experience, severity of pain, type of injury, and current pain. Descriptive and explorative statistical analysis was performed., Results: A web-based survey was sent to 1122 board-certified orthopedic surgeons and residents in Austria via e-mail. In total, the response rate was 135 (12%). Seventy-two surgeons (54%) had suffered from one or more occupational injuries during their career. We detected a significant raise of occupational injuries related to the work life duration in which operations were performed and the prevalence of injuries. Most injuries of surgeons were reported between 21 and 30 years of their professional life. According to the frequency at different locations, the distribution in descending order was 25% with injuries of the hand, 22% of finger(s), 12% of the foot, 10% of the spine, 2% of the neck, 3% of the head, and 2% of the abdomen. A causality of incapacity to work through injuries at the workplace was given as 4%. Four percent stated a sick leave of at least 3 weeks. In 7% of the facilities, there was no optimization of preventive measures following an occupational injury. We found no correlation of injuries and resident status., Conclusion: Orthopedic surgeons in Austria show a high incidence of occupational injuries in line with the findings of colleagues from the United States. The impact on the health system consists of absenteeism in the workplace of highly specialized health service providers as well as the incapacity to work of a high quality, highly trained workforce of at least 4%. With more preventive measures and more attention and care in the rehabilitation phase after such injuries, a positive effect could be achieved. We believe that residents should be specifically trained on how to avoid such injuries., (© 2024. The Author(s).)
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- 2024
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147. Development of application and surgical technique of total knee arthroplasties: a systematic comparative analysis using worldwide registers.
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Leitner L, Hauer G, Rasic L, Clar C, Leithner A, and Sadoghi P
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- Humans, Prosthesis Failure, Reoperation, Registries, Treatment Outcome, Arthroplasty, Replacement, Knee methods, Knee Prosthesis
- Abstract
Purpose: The aim was to compare total knee arthroplasty (TKA) between countries with regard to epidemiologic data and surgical technique by the use of worldwide registers and compare findings with a previous report after one decade., Methods: A systematic search was carried out in November 2022 and compared to previous reports from 2010. We extracted data regarding implanted TKAs, patients' age distribution, procedure types, fixation and revision rates. After identification of 28 national arthroplasty registers, 8of them, namely Australia, Canada, Denmark, England and Wales, New Zealand, Norway, Scotland and Sweden, offered sufficient data and were included in final analysis., Results: A large variation was found in the annual number of implantations per 100,000 inhabitants with a range from 77 to 210.2 (mean 132.8). The fixation type varied strongly as well, e.g. over 95% of totally cemented TKAs in Sweden versus 61.2% cemented fixation in Denmark. Another significant difference was the use of patellar resurfacing in TKA, ranging from 47.3% (Canada) using a patellar button in TKA to less than 5% (Sweden). Within the period of one decade, the mean overall number of annual implantations increased (10%), whilst relative number of revisions decreased, the use of cemented TKA decreased from 87 to 74%, and the use of patella button remained largely inhomogeneous., Conclusion: Comparison of arthroplasty registers revealed large differences regarding the annual number of primary TKAs per inhabitant as well as primary TKA procedure types with an increase of annual implantations, decrease of relative number of revisions, and a decrease of the use of cemented systems over the period of one decade., (© 2023. The Author(s).)
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- 2024
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148. Long-term clinical and radiological outcome of a cementless titanium-coated total knee arthroplasty system.
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Hörlesberger N, Smolle MA, Leitner L, Hauer G, Leithner A, and Sadoghi P
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- Humans, Male, Female, Quality of Life, Titanium, Retrospective Studies, Knee Joint surgery, Pain surgery, Treatment Outcome, Range of Motion, Articular, Arthroplasty, Replacement, Knee, Knee Prosthesis, Osteoarthritis, Knee surgery
- Abstract
Introduction: To ensure a high-quality standard, it is important to frequently evaluate different prostheses models to avoid prostheses with high failure rates. Thus, the aim of the study was to evaluate the long-term outcome of the uncemented titanium-coated total knee arthroplasty (TKA) system (Advanced Coated System (ACS) III, Implantcast, GERMANY). We hypothesized that the ACS III would have a similar performance as other cemented TKA systems., Materials and Methods: A total of 540 ACS III mobile-bearing knee joint prostheses were implanted in 495 patients. The visual analogue scale (VAS) score, Tegner activity score (TAS), knee society score (KSS), Western Ontario and McMaster (WOMAC) score, and the Short Form 12 (SF-12) score for the evaluation of quality of life (QoL) were taken after at least 9 years of follow-up. In addition, we measured range of motion (ROM) and assessed potential sex differences. In addition, the survival analysis was calculated at a median follow-up of 16.7 years., Results: At the final follow-up, 142 patients had died, and 38 had been lost to follow-up. The rate of revision-free implant survival at 16.7 years was 90.0% (95% CI 87.1-92.2%) and the rate of infection-free survival was 97.0% (IQR 95.2-98.2%). The reasons for revision surgery were aseptic loosening (32.9%), followed by infection (27.1%), inlay exchange (15.9%), and periprosthetic fractures (5.7%). At the clinical follow-up visit, the mean VAS score was 1.9 ± 1.9, the median TAS was 3 (IQR 2-4), and the mean KSS for pain and function were 83.5 ± 15.3 and 67.5 ± 25.2, respectively. The mean WOMAC score was 81.1 ± 14.9, and the median SF-12 scores for physical and mental health were 36.9 (IQR 29.8-45.1) and 55.8 (IQR 46.2-61.0), respectively. The mean knee flexion was 102.0° ± 15.4°. Male patients had better clinical outcome scores than female patients [SF-12 mental health score, p = 0.037; SF-12 physical health score, p = 0.032; KSS pain score (p < 0.001), and KSS functional score (p < 0.001)]., Conclusion: The ACS III TKA system is a suitable option for the treatment of end-stage osteoarthritis of the knee joint because of its adequate long-term survival. Our findings are in line with published data on similar TKA systems that have shown favourable clinical scores in males., Level of Evidence: Level III-Retrospective cohort study., (© 2023. The Author(s).)
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- 2024
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149. Vancomycin Elution Kinetics of Four Antibiotic Carriers Used in Orthopaedic Surgery: In Vitro Study over 42 Days.
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Smolle MA, Murtezai H, Niedrist T, Amerstorfer F, Hörlesberger N, Leitner L, Klim SM, Glehr R, Ahluwalia R, Leithner A, and Glehr M
- Abstract
This study aimed to analyse and compare the vancomycin elution kinetics of four biodegradable, osteoconductive antibiotic carriers used in clinical practice within a 42-day in vitro setting. Carriers A and D already contained vancomycin (1.1 g and 0.247 g), whereas carriers B and C were mixed with vancomycin according to the manufacturer's recommendations (B: 0.83 g and C: 0.305 g). At nine time points, 50% (4.5 mL) of the elution sample was removed and substituted with the same amount of PBS. Probes were analysed with a kinetic microparticle immunoassay. Time-dependent changes in vancomycin concentrations for each carrier and differences between carriers were analysed. Mean initial antibiotic levels were highest for carrier A (37.5 mg/mL) and lowest for carrier B (5.4 mg/mL). We observed time-dependent, strongly negative linear elution kinetics for carriers A (-0.835; p < 0.001), C (-0.793; p < 0.001), and D (-0.853; p < 0.001). Vancomycin concentrations increased from 48 h to 7 d and dropped thereafter in carriers C and D whilst constantly decreasing at any time point for carrier A. Carrier B showed a shallower decrease. Mean antibiotics levels at 42 d were 1.5 mg/mL, 2.6 mg/mL, 0.1 mg/mL, and 0.1 mg/mL for carriers A, B, C, and D. Differences in mean initial and final vancomycin concentrations for carrier A were significantly larger in comparison to C ( p = 0.040). A carrier consisting of allogenic bone chips showed the highest vancomycin-to-carrier ratio and the largest elution over the study period. Whilst vancomycin concentrations were still measurable at 42 days for all carriers, carrier A provided a higher drug-to-carrier ratio and a more consistent antibiotic-releasing profile., Competing Interests: M.A.S. has received travel grants from Alphamed, implantcast, and PharmaMar, outside of the submitted study. A.L. has received institutional educational grants from Johnson & Johnson, ImplanTec, Medacta, and Alphamed, outside of the submitted work. The remaining authors have no conflicts of interest to declare. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.
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- 2023
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150. More help than harm: surgery for metastatic spinal cord compression is associated with more favorable overall survival within a propensity score analysis.
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Leitner L, Bratschitsch G, Kostwein A, Sadoghi P, Smolle M, Leithner A, and Posch F
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- Humans, Propensity Score, Retrospective Studies, Prognosis, Spinal Cord Compression etiology, Spinal Cord Compression surgery, Spinal Neoplasms surgery, Spinal Neoplasms secondary
- Abstract
Purpose: Indication for surgical decompression in metastatic spinal cord compression (MSCC) is often based on prognostic scores such as the modified Bauer score (mBs), with favorable prognosis suggestive of surgery and poor prognosis of non-surgical management. This study aimed to clarify if (1) surgery may directly affect overall survival (OS) aside from short-term neurologic outcome, (2) explore whether selected patient subgroups with poor mBs might still benefit from surgery, and (3) gauge putative adverse effects of surgery on short-term oncologic outcomes., Methods: Single-center propensity score analyses with inverse-probability-of-treatment-weights (IPTW) of OS and short-term neurologic outcomes in MSCC patients treated with or without surgery between 2007 and 2020., Results: Among 398 patients with MSCC, 194 (49%) underwent surgery. During a median follow-up of 5.8 years, 355 patients (89%) died. MBs was the most important predictor for spine surgery (p < 0.0001) and the strongest predictor of favorable OS (p < 0.0001). Surgery was associated with improved OS after accounting for selection bias with the IPTW method (p = 0.021) and emerged as the strongest determinant of short-term neurological improvement (p < 0.0001). Exploratory analyses delineated a subgroup of patients with an mBs of 1 point who still benefited from surgery, and surgery did not result in a higher risk of short-term oncologic disease progression., Conclusion: This propensity score analysis corroborates the concept that spine surgery for MSCC associates with more favorable neurological and OS outcomes. Selected patients with poor prognosis might also benefit from surgery, suggesting that even those with low mBs may be considered for this intervention., (© 2023. The Author(s).)
- Published
- 2023
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