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1.
J Arthroplasty ; 39(8S1): S237-S243, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38401612

RESUMO

BACKGROUND: Chronic extensor mechanism disruption after total knee arthroplasty (TKA) is a rare but challenging condition. There are several surgical approaches for quadriceps tendon repairs. In this report, we present a modified surgical technique for quadriceps tendon repair in chronic extensor mechanism disruption without the use of allografts or mesh augmentation. METHODS: We retrospectively reviewed 12 consecutive cases of chronic extensor mechanism with complete quadriceps tendon ruptures after TKA that underwent the advancement and imbrication technique. Patient outcomes were evaluated using the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, the range of motion and extensor lag measurements, and standardized lateral radiographs were reviewed for Insall-Salvati-Ratio preoperatively and at their most recent follow-up visit. RESULTS: There were 12 knees from patients who had a mean age of 72 years (range, 62 to 81) and were evaluated with a mean follow-up of 15.9 months (range, 11.4 to 50.9). The extensor lag significantly improved from 40.8 ± 31.9° (range, 10 to 90°) to 2.9 ± 6.9° (P = .014), the Insall-Salvati-Ratio significantly changed from 0.87 to 1.07 (P = .010), and the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement showed a significant difference: a raw score of 13.0 ± 5.8 versus 8.7 ± 5.6 (P = .002) and an interval score of 54.1 ± 14.0 versus 66.2 ± 15.6 (P = .001). CONCLUSIONS: Reconstruction of extensor mechanism in chronic quadriceps tendon ruptures after TKA with the advancement and imbrication technique showed excellent functional outcomes with no extensor lag and excellent restoration of motion. This technique can be combined with TKA revision surgery or used on its own. To ensure successful outcomes, the authors favor rigid immobilization for 12 weeks before starting mobilization.


Assuntos
Artroplastia do Joelho , Músculo Quadríceps , Amplitude de Movimento Articular , Traumatismos dos Tendões , Humanos , Idoso , Masculino , Feminino , Artroplastia do Joelho/métodos , Estudos Retrospectivos , Traumatismos dos Tendões/cirurgia , Músculo Quadríceps/cirurgia , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Ruptura/cirurgia , Resultado do Tratamento , Procedimentos de Cirurgia Plástica/métodos , Articulação do Joelho/cirurgia , Articulação do Joelho/fisiopatologia
2.
Knee Surg Sports Traumatol Arthrosc ; 32(2): 323-333, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38294107

RESUMO

PURPOSE: The primary purpose of the study was to use pre-revision total knee arthroplasty (TKA) computer-tomography (CT)-images to analyse typical tibial bone defects and create a new schematic three-dimensional (3D)-classification system. The secondary purpose was to investigate the association between defect size and implant selection at the time of revision surgery. METHODS: Eighty-four patients with preoperative CT-scans underwent revision of a primary TKA. CT-image segmentation with the 3D-Slicer Software was performed retrospectively, and a new three-dimensional classification system was used to grade tibial bone defects. The location of tibial bone defects was recorded for all cases. Volumetric 3D bone defect measurements were used to investigate the association between the bone defect volume, the indication for rTKA, and the use of modular revision components. The t-test, the Mann-Whitney-U test, and the Fisher's exact-test were used for group comparisons, and the Kruskal-Wallis test was used for multiple group comparisons. RESULTS: The most common anatomic regions for both contained and uncontained tibial bone defects were the anteromedial epiphysis (N = 50; mean epiphyseal-defect: 5.9 cm³) and metaphysis (N = 15; mean metaphyseal-defect: 9.6 cm³). A significant association was found between patients with preoperative metaphyseal defects (N = 22) and the use of tibial augments (N = 7) (p = 0.04). The use of cones/sleeves was associated with a significantly increased 3D-CT volume of the preoperative metaphyseal bone defects (p = 0.04). Patients with osteoporosis had significantly larger volumetric defects in the metaphysis (p = 0.01). CONCLUSION: Our results emphasise the importance of considering the three-dimensional nature of tibial defects in rTKA. The findings suggest that an understanding of the volume of the defect size through CT imaging can predict the need for augments and cones/sleeves and, especially in patients with osteoporosis can help the surgeon identify larger metaphyseal defects and ensure optimal metaphyseal fixation through appropriate implant selection. LEVEL OF EVIDENCE: Level III, retrospective cohort study.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoporose , Humanos , Artroplastia do Joelho/métodos , Estudos Retrospectivos , Desenho de Prótese , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Reoperação/métodos , Osteoporose/etiologia , Osteoporose/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia
3.
Spine (Phila Pa 1976) ; 49(7): 478-485, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-37796191

RESUMO

STUDY DESIGN: A retrospective analysis of prospectively collected data. OBJECTIVE: To assess the association between intervertebral disk degeneration and hip and knee osteoarthritis (OA) in patients with degenerative lumbar spondylolisthesis. BACKGROUND: The co-occurrence of hip OA and degenerative spinal pathologies was first described as the "hip-spine syndrome" and has also been observed in knee OA. It remains unclear whether both pathologies share an underlying connection beyond demographic factors. MATERIALS AND METHODS: Intervertebral disk degeneration was classified by the Pfirrmann Classification and intervertebral vacuum phenomenon. Intervertebral vacuum phenomenon was classified into mild (1 point), moderate (2 points), and severe (3 points) at each level and combined into a lumbar vacuum score (0-15 points). Similarly, a lumbar Pfirrmann grade was calculated (5-25 points). Patients with previous hip or knee replacement surgery were classified as having an OA burden. We used multivariable regression to assess the association between OA and disk degeneration, adjusted for age, body mass index, and sex. RESULTS: A total of 246 patients (58.9% female) were included in the final analysis. Of these, 22.3% had OA burden. The multivariable linear regression showed an independent association between OA burden and lumbar vacuum (ß = 2.1, P <0.001) and Pfirrmann grade (ß = 2.6, P <0.001). Representing a 2.1 points higher lumbar vacuum and 2.6 points higher lumbar Pfirrmann grade after accounting for demographic differences. CONCLUSIONS: Our study showed that OA burden was independently associated with the severity of the intervertebral disk degeneration of the lumbar spine. These findings give further weight to a shared pathology of OA of large joints and degenerative processes of the lumbar spine. LEVEL OF EVIDENCE: 3.


Assuntos
Degeneração do Disco Intervertebral , Osteoartrite do Quadril , Osteoartrite do Joelho , Espondilolistese , Humanos , Feminino , Masculino , Degeneração do Disco Intervertebral/epidemiologia , Degeneração do Disco Intervertebral/cirurgia , Degeneração do Disco Intervertebral/patologia , Espondilolistese/cirurgia , Espondilolistese/patologia , Osteoartrite do Quadril/patologia , Estudos Retrospectivos , Osteoartrite do Joelho/patologia , Vértebras Lombares/cirurgia , Vértebras Lombares/patologia
4.
J Clin Med ; 12(20)2023 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-37892620

RESUMO

BACKGROUND: Younger and physically active patients demand a return to sport after total hip arthroplasty (THA). However, because of the risk of implant wear and loosening, high-impact activities are often not recommended. The current study evaluates predictive factors and revision rates in patients with higher activity levels. METHODS: This retrospective study included 4152 hips in 3828 patients aged 45-75 that underwent primary THA for primary osteoarthritis between 2009 and 2019 with a minimum follow-up of 2 years. Pain and Lower Extremity Activity Scale (LEAS) were assessed before and 2 years after surgery. Activity was classified as low (LEAS 1-6), moderate (LEAS 7-13), or high (LEAS 14-18). RESULTS: Pain and LEAS improved from preoperative to 2-years postoperative (p < 0.001). The activity level was low in 6.2%, moderate in 52.9%, and high in 40.9% of the patients. Younger age, lower BMI, ASA, and CCI, male sex, and higher preoperative LEAS correlated with higher activity at 2 years (p < 0.001). The predicted revision-free survival rates between the activity groups were better for more highly active patients (p < 0.001). CONCLUSIONS: High physical activity 2 years following THA, with participating in sports like jogging several times a week, did not increase the risk of revision surgery. THA patients should not be prevented from a highly active lifestyle.

5.
BMC Musculoskelet Disord ; 24(1): 665, 2023 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-37608323

RESUMO

BACKGROUND: Intra-articular corticosteroid injections (ICSI) are an effective symptomatic treatment for osteoarthritis of the hip. However, the safety of ICSI has been questioned and a relatively high risk for septic arthritis, rapidly progressive osteoarthritis (RPIO) and periprosthetic joint infections (PJI) in patients undergoing subsequent total hip arthroplasty (THA) have been suggested. METHODS: This is a retrospective evaluation of 682 hips that underwent ICSI with 40 mg of Triamcinolone for primary osteoarthritis of the hip. All ICSI were performed using sterile techniques, the number of ICSI in each hip and the cumulative corticosteroid dosage were assessed. Pre- and post-injection radiographs were compared to identify cases with RPIO. Native joint septic arthritis, surgical site infections and PJI were identified by chart review. RESULTS: 4 hips (0.6%) developed RPIO 2-4 months following ICSI. The cumulative Triamcinolone dose was not associated with the development of RPIO (p = 0.281). 1 case was diagnosed with septic arthritis and treated with staged THA, there were no signs of infection at a 5 years follow-up. 483 hips (75.7%) underwent THA, including 199 hips with THA less than 3 months following ICSI and 181 hips with > 1 ICSI prior to THA. There were 3 superficial surgical site infections/wound dehiscence and no PJI. CONCLUSION: The rate of RPIO was 0.6%. The current findings suggest that if ICSI is performed under sterile conditions, the risk for septic arthritis or PJI following THA, even in patients with multiple ICSI or ICSI within 3 months prior to surgery, is minimal.


Assuntos
Artrite Infecciosa , Osteoartrite do Quadril , Humanos , Infecção da Ferida Cirúrgica , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/tratamento farmacológico , Osteoartrite do Quadril/cirurgia , Estudos Retrospectivos , Corticosteroides/efeitos adversos , Triancinolona , Artrite Infecciosa/tratamento farmacológico
6.
Knee Surg Sports Traumatol Arthrosc ; 31(11): 4842-4850, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37558747

RESUMO

PURPOSE: The purpose of this study was to evaluate the accuracy of preoperative CT-based Anderson Orthopaedic Research Institute (AORI)-grading and to correlate Computed tomography (CT)-based volumetric defect measurements with intraoperative AORI findings. METHODS: 99 patients undergoing revision total knee arthroplasty (rTKA) with preoperative CT-images were identified in an institutional revision registry. CT-image segmentation with 3D-Slicer Software was used to create 3D tibial bone defects which were then graded according to the AORI-classification. The AORI classification categorizes tibial defects into three types: Type I has healthy cortical and cancellous bone near the joint line, Type II involves metaphyseal bone loss affecting one or both condyles, and Type III indicates deficient metaphyseal bone with distal defects and potential damage to the patellar tendon and collateral ligament attachments. These 3D-CT gradings were compared to preoperative X-ray and intraoperative AORI grading. The Friedman test was used to investigate differences between AORI values of each measurement method. Volumetric 3D-bone defect measurements were used to investigate the relationship between AORI classification and volumetric defect size in the three anatomic zones of the tibia. RESULTS: Substantial agreements between preoperative 3D-CT AORI and intraoperative AORI (kappa = 0.663; P < 0.01) and fair agreements between preoperative X-ray AORI and intraoperative AORI grading (kappa = 0.304; P < 0.01) were found. Moderate correlations between volume of remaining bone and intraoperative AORI grading were found in epiphysis (rS = - 0.529; P < 0.001), metaphysis (rS = - 0.557; P < 0.001) and diaphysis (rS = - 0.421; P < 0.001). Small volumetric differences between AORI I vs. AORI II defects and relatively large differences between AORI II and AORI III defects in each zone were detected. CONCLUSION: Tibial bone defect prediction based on preoperative 3D-CT segmentation showed a substantial agreement with intraoperative findings and is superior to standard radiograph assessment. The relatively small difference in defect volume between AORI I, IIa and IIb suggests that updated CT-based classifications might hold benefits for the planning of rTKA. LEVEL OF EVIDENCE: Retrospective Cohort Study; III.


Assuntos
Prótese do Joelho , Tíbia , Humanos , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Estudos Retrospectivos , Artefatos , Reoperação/métodos , Tomografia Computadorizada por Raios X , Epífises , Desenho de Prótese , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia
7.
Orthopadie (Heidelb) ; 52(8): 677-690, 2023 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-37428228

RESUMO

Spondylodiscitis is a severe infectious disease of the spine that affects the intervertebral discs and adjacent vertebrae. It can lead to nonspecific pain, limited mobility, and destruction of spinal structures. Various pathogens, such as bacteria, fungi, or parasites, can trigger the disease. An early diagnosis and targeted treatment are crucial to reduce the risk of serious complications. Magnetic resonance imaging (MRI) with contrast agent and blood tests are essential for the diagnosis and assessing the course of the disease. The treatment includes conservative and surgical approaches. Conservative treatment consists of a minimum 6­week antibiotic course and immobilization of the affected area. Surgical interventions, along with several weeks of antibiotic therapy, are indicated for instabilities or complications in order to eliminate the infection focus and to restore spinal stability.


Assuntos
Discite , Disco Intervertebral , Humanos , Discite/diagnóstico , Disco Intervertebral/diagnóstico por imagem , Imageamento por Ressonância Magnética , Antibacterianos/uso terapêutico , Bactérias
8.
Molecules ; 28(11)2023 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-37299023

RESUMO

Targeting inflammatory mediators and related signaling pathways may offer a rational strategy for the treatment of cancer. The incorporation of metabolically stable, sterically demanding, and hydrophobic carboranes in dual cycloxygenase-2 (COX-2)/5-lipoxygenase (5-LO) inhibitors that are key enzymes in the biosynthesis of eicosanoids is a promising approach. The di-tert-butylphenol derivatives R-830, S-2474, KME-4, and E-5110 represent potent dual COX-2/5-LO inhibitors. The incorporation of p-carborane and further substitution of the p-position resulted in four carborane-based di-tert-butylphenol analogs that showed no or weak COX inhibition but high 5-LO inhibitory activities in vitro. Cell viability studies on five human cancer cell lines revealed that the p-carborane analogs R-830-Cb, S-2474-Cb, KME-4-Cb, and E-5110-Cb exhibited lower anticancer activity compared to the related di-tert-butylphenols. Interestingly, R-830-Cb did not affect the viability of primary cells and suppressed HCT116 cell proliferation more potently than its carbon-based R-830 counterpart. Considering all the advantages of boron cluster incorporation for enhancement of drug biostability, selectivity, and availability of drugs, R-830-Cb can be tested in further mechanistic and in vivo studies.


Assuntos
Boranos , Inibidores de Lipoxigenase , Humanos , Ciclo-Oxigenase 2 , Inibidores de Lipoxigenase/farmacologia
9.
Life (Basel) ; 13(6)2023 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-37374148

RESUMO

In this case report, we present a rare case of a female patient who developed pain and swelling after a total knee arthroplasty. An extensive diagnostic workup including serum and synovial testing to rule out infection was performed in addition to advanced imaging including an MRI of the knee, but it was only after an arthroscopic synovectomy that the diagnosis of secondary synovial chondromatosis was confirmed. The purpose of this case report is to highlight the occurrence of secondary synovial chondromatosis as a rare cause of pain and swelling after total knee arthroplasty, thereby assisting clinicians in providing prompt diagnosis, surgical treatment, and efficient recovery in the setting of secondary synovial chondromatosis after total knee arthroplasty.

10.
Children (Basel) ; 10(4)2023 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-37189935

RESUMO

The correction of valgus leg malalignment in children using implant-mediated growth guidance is widely used and effective. Despite the minimal invasive character of the procedure, a relevant number of patients sustain prolonged pain and limited mobility after temporary hemiepiphysiodesis. Our aim was to investigate implant-associated risk factors (such as implant position and screw angulation), surgical- or anesthesia-related risk factors (such as type of anesthesia, use, and duration), and pressure of tourniquet or duration of surgery for these complications. Thirty-four skeletally immature patients with idiopathic valgus deformities undergoing hemiepiphysiodesis plating from October 2018-July 2022 were enrolled in this retrospective study. Participants were divided into groups with and without prolonged complications (persistent pain, limited mobility of the operated knee between five weeks and six months) after surgery. Twenty-two patients (65%) had no notable complications, while twelve patients (35%) had prolonged complications. Both groups differed significantly in plate position relative to physis (p = 0.049). In addition, both groups showed significant differences in the distribution of implant location (p = 0.016). Group 1 had a shorter duration of surgery than group 2 (32 min vs. 38 min, p = 0.032) and a lower tourniquet pressure (250 mmHg vs. 270 mmHg, p = 0.019). In conclusion, simultaneous plate implantation at the femur and tibia and metaphyseal plate positioning resulted in prolonged pain and a delay of function. In addition, the amplitude of tourniquet pressure or duration of surgery could play a factor.

11.
ChemMedChem ; 18(14): e202300206, 2023 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-37160667

RESUMO

The presence of inflammatory mediators in the tumor microenvironment, such as cytokines, growth factors or eicosanoids, indicate cancer-related inflammatory processes. Targeting these inflammatory mediators and related signal pathways may offer a rational strategy for the treatment of cancer. This study focuses on the incorporation of metabolically stable, sterically demanding, and hydrophobic dicarba-closo-dodecaboranes (carboranes) into dual cyclooxygenase-2 (COX-2)/5-lipoxygenase (5-LO) inhibitors that are key enzymes in the biosynthesis of eicosanoids. The di-tert-butylphenol derivative tebufelone represents a selective dual COX-2/5-LO inhibitor. The incorporation of meta- or para-carborane into the tebufelone scaffold resulted in eight carborane-based tebufelone analogs that show no COX inhibition but 5-LO inhibitory activity in vitro. Cell viability studies on HT29 colon adenocarcinoma cells revealed that the observed antiproliferative effect of the para-carborane analogs of tebufelone is enhanced by structural modifications that include chain elongation in combination with introduction of a methylene spacer resulting in higher anticancer activity compared to tebufelone. Hence, this strategy proved to be a promising approach to design potent 5-LO inhibitors with potential application as cytostatic agents.


Assuntos
Adenocarcinoma , Boranos , Neoplasias do Colo , Humanos , Ciclo-Oxigenase 2/metabolismo , Anti-Inflamatórios não Esteroides/farmacologia , Inibidores de Ciclo-Oxigenase/química , Microambiente Tumoral
12.
J Orthop Surg Res ; 18(1): 69, 2023 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-36707864

RESUMO

BACKGROUND: Malalignments of the lower extremity are common reasons for orthopedic consultation because it may lead to osteoarthritis in adulthood. An accurate and reliable radiological assessment of lower limb alignment in children and adolescents is essential for clinical decision-making on treatment of limb deformities and for regular control after a surgical intervention. OBJECTIVE: First, does the analysis of full-length standing anteroposterior radiographs show a good intra- and interobserver reliability? Second, which parameter is most susceptible to observer-dependent errors? Third, what is the Standard Error of Measurement (SEM95%) of the absolute femoral and tibial length? METHODS: Two observers evaluated digital radiographs of 144 legs from 36 children and adolescents with pathological valgus alignment before a temporary hemiepiphysiodesis and before implant removal. Parameters included Mechanical Femorotibial Angle (MFA), Mechanical Axis Deviation (MAD), mechanical Lateral Distal Femoral Angle (mLDFA), mechanical Medial Proximal Tibial Angle (mMPTA), mechanical Lateral Proximal Femoral Angle (mLPFA), mechanical Lateral Distal Tibial Angle (mLDTA), Joint Line Convergence Angle (JLCA), femur length, tibial length. Intra- and interobserver reliability (ICC2,1), SEM95% and proportional errors were calculated. RESULTS: The intra- and interobserver reliability for almost all measurements was found to be good to excellent (Intra-ICC2,1: 0.849-0.999; Inter-ICC2,1: 0.864-0.996). The SEM95% of both observers was found to be ± 1.39° (MFA), ± 3.31 mm (MAD), ± 1.06° (mLDFA) and ± 1.29° (mMPTA). The proportional error of MAD and MFA is comparable (47.29% vs. 46.33%). The relevant knee joint surface angles show a lower proportional error for mLDFA (42.40%) than for mMPTA (51.60%). JLCA has a proportional error of 138%. Furthermore, the SEM95% for the absolute values of the femoral and tibial length was 4.53 mm for the femur and 3.12 mm for the tibia. CONCLUSIONS: In conclusion, a precise malalignment measurement and the knowledge about SEM95% of the respective parameters are crucial for correct surgical or nonsurgical treatment. The susceptibility to error must be considered when interpreting malalignment analysis and must be considered when planning a surgical intervention. The results of the present study elucidate that MAD and MFA are equally susceptible to observer-dependent errors. This study shows good to excellent intra- and interobserver ICCs for all leg alignment parameters and joint surface angles, except for JLCA. TRIAL REGISTRATION: This study was registered with DRKS (German Clinical Trials Register) under the number DRKS00015053. LEVEL OF EVIDENCE: I, Diagnostic Study.


Assuntos
Perna (Membro) , Osteoartrite do Joelho , Adolescente , Humanos , Criança , Perna (Membro)/anormalidades , Reprodutibilidade dos Testes , Extremidade Inferior , Tíbia/patologia , Fêmur/cirurgia , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Estudos Retrospectivos
13.
Int J Mol Sci ; 23(23)2022 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-36499685

RESUMO

Despite advanced knowledge of the cellular and biomechanical processes of intervertebral disc degeneration (IVDD), the trigger and underlying mechanisms remain unclear. Since the sympathetic nervous system (SNS) has been shown to exhibit catabolic effects in osteoarthritis pathogenesis, it is attractive to speculate that it also influences IVDD. Therefore, we explored the adrenoceptor (AR) expression profile in human IVDs and correlated it with clinical parameters of patients. IVD samples were collected from n = 43 patients undergoing lumbar spinal fusion surgery. AR gene expression was analyzed by semi-quantitative polymerase chain reaction. Clinical parameters as well as radiological Pfirrmann and Modic classification were collected and correlated with AR expression levels. In total human IVD homogenates α1A-, α1B-, α2A-, α2B-, α2C-, ß1- and ß2-AR genes were expressed. Expression of α1A- (r = 0.439), α2A- (r = 0.346) and ß2-AR (r = 0.409) showed a positive and significant correlation with Pfirrmann grade. α1A-AR expression was significantly decreased in IVD tissue of patients with adjacent segment disease (p = 0.041). The results of this study indicate that a relationship between IVDD and AR expression exists. Thus, the SNS and its neurotransmitters might play a role in IVDD pathogenesis. The knowledge of differential AR expression in different etiologies could contribute to the development of new therapeutic approaches for IVDD.


Assuntos
Degeneração do Disco Intervertebral , Disco Intervertebral , Fusão Vertebral , Humanos , Disco Intervertebral/metabolismo , Degeneração do Disco Intervertebral/metabolismo , Região Lombossacral , Receptores Adrenérgicos/metabolismo , Vértebras Lombares/metabolismo , Imageamento por Ressonância Magnética
14.
Orthopade ; 50(7): 520-527, 2021 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-34156496

RESUMO

Radiographic measurement of the lower limb alignment in the frontal plane is used to assess limb deformity, to plan corrective surgery and for follow-up. It is essential that age-related normal lower limb alignment and joint orientation angles are known before planning surgical treatment. EOS (EOS™ Imaging, Paris, France) can lead to supplemental information, especially in cases of severe multidimensional joint malalignment. It allows 3D reconstruction of a bone model of the limb to assess multi-dimensional deformity.


Assuntos
Mau Alinhamento Ósseo , Extremidade Inferior , Mau Alinhamento Ósseo/diagnóstico por imagem , Mau Alinhamento Ósseo/cirurgia , Osso e Ossos , França , Humanos , Articulação do Joelho
15.
J Arthroplasty ; 36(3): 1149-1155, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33160804

RESUMO

BACKGROUND: Accurate preoperative planning is a key component of successful total hip arthroplasty (THA). The purpose of the present study was to compare the accuracy and reliability of three-dimensional (hipEOS) and common digital two-dimensional (TraumaCad) templating with special focus on stem morphology. METHODS: 51 patients undergoing THA were randomized to two groups. Preoperative planning was performed on 23 patients with hipEOS (3D) and on 28 patients with TraumaCad (2D) planning software. Planning results were compared with the implanted component size. Inter- and intraobserver reliability as well as planning accuracy of both planning methods with special focus on straight and short stem design were recorded. RESULTS: Intraobserver reliability of both planning methods was good for component planning (ICC2,1: 0.835-0.967). Interobserver ICC2,1 for stem and cup planning were higher for 3D templating (3D ICC2,1: 0.906-0.918 vs. 2D ICC2,1: 0.835-0.843). Total stem and cup size predictions were within 2 sizes for 3D and within 3 sizes for 2D planning. Comparing short stem planning accuracy of both planning methods, absolute difference between implanted and planned component size was significantly lower in 3D planning (P = .029). There was no significant difference in straight stem (P = .935) and cup (P = .954) planning accuracy. CONCLUSION: Our findings suggest that 3D templating with hipEOS software has a good overall reliability and may have a better planning accuracy of short stem prostheses than digital templating with TraumaCad software. Assuming that the number of implanted short stem prostheses will further increase in coming years, a more precise planning with 3D technique can contribute to improve surgery outcome.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Humanos , Cuidados Pré-Operatórios , Radiografia , Reprodutibilidade dos Testes
16.
Gait Posture ; 79: 26-32, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32334347

RESUMO

BACKGROUND: Multiple full-length standing anteroposterior radiographs are common practice to quantify the mechanical axis angle (MAA) in young patients with lower limb malalignment in the frontal plane treated with a temporary hemiepiphysiodesis. RESEARCH QUESTION: Is it possible to predict the MAA measured with gold-standard radiographs from a non-invasive method using the marker-based motion capture technique in a standing position and has an increased body mass index (BMI) a negative effect on this prediction? METHODS: Forty-six children and adolescents with valgus or varus malalignment of the knee were measured several times during the treatment period. In total 175 data sets were evaluated in this prospective study. BMI was included into the linear mixed effect regression to detect the influence of this variable on the prediction model. Bland and Altman plots were obtained to examine methods' agreement. RESULTS: The X-ray-based MAA highly correlated (r = 0.808, p <  0.001) with the marker-based MAA. The association between measurements was stronger in patients with a BMI < 25 (r = 0.881, p <  0.001) than in patients with a BMI ≥ 25 (r = 0.747, p <  0.001). The Bland and Altman plots illustrated a better agreement between both methods for patients with a BMI < 25 (bias of 0.7°) than for patients with a BMI ≥ 25 (bias of 3.7°). SIGNIFICANCE: Determination of frontal plane lower limb alignment using motion capture technique is an alternative method to assess the MAA non-invasively. The approach is therefore relevant for clinical and scientific use when cumulative radiation dosage becomes a problem or when radiation may be prohibited (e.g. healthy control group). A higher BMI overestimates the valgus malalignment in the motion capture method which may result from excess body tissue and the difficulty in palpating bony landmarks on the skin.


Assuntos
Mau Alinhamento Ósseo/diagnóstico por imagem , Mau Alinhamento Ósseo/cirurgia , Extremidade Inferior , Movimento , Procedimentos Ortopédicos , Gravação em Vídeo , Adolescente , Índice de Massa Corporal , Criança , Feminino , Humanos , Articulação do Joelho , Modelos Lineares , Masculino , Estudos Prospectivos , Radiografia
17.
BMC Infect Dis ; 20(1): 297, 2020 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-32321435

RESUMO

BACKGROUND: Most individuals are infected with human papillomavirus (HPV) at least once in their lifetime. Infections with low-risk types can cause genital warts, whereas high-risk types can cause malignant tumors. The aim of this study was to determine the burden of anogenital diseases potentially related to HPV in young women based on German statutory health insurance claims data. METHODS: We conducted a retrospective claims data analysis using the "Institute for Applied Health Research Berlin" (InGef) Research Database, containing claims data from approximately 4 million individuals. In the period from 2012 to 2017 all women born in1989-1992, who were continuously insured between the age of 23-25 years were identified. Using ICD-10-GM codes (verified diagnosis in the outpatient sector or primary or secondary diagnosis in the inpatient sector) the administrative prevalence (95% confidence interval) of genital warts (A63.0), anogenital diseases grade I (K62.8, N87.0, N89.0, N90.0), grade II (N87.1, N89.1, N90.1) and grade III (D01.3, D06.-, D06.0, D07.1, D07.2, N87.2, N89.2, N90.2) was calculated (women with diagnosis divided by all women). RESULTS: From 2012 to 2017, a total of 15,358 (birth cohort 1989), 16,027 (birth cohort 1990), 14,748 (birth cohort 1991) and 14,862 (birth cohort 1992) women at the age of 23-25 were identified. A decrease of the administrative prevalence was observed in genital warts (1.30% (1.12-1.49) birth cohort 1989 vs. 0.94% (0.79-1.10) birth cohort 1992) and anogenital diseases grade III (1.09% (0.93-1.26) birth cohort 1989 vs. 0.71% (0.58-0.86) birth cohort 1992). In anogenital diseases grade III, this trend was especially observed for severe cervical dysplasia (N87.2) (0.91% (0.76-1.07) birth cohort 1989 vs. 0.60% (0.48-0.74) birth cohort 1992). In contrast, anogenital diseases grade I (1.41% (1.23-1.61) birth cohort 1989 vs. 1.31% (1.14-1.51) birth cohort 1992) and grade II (0.61% (0.49-0.75) birth cohort 1989 vs. 0.52% (0.42-0.65) birth cohort 1992) remained stable. CONCLUSIONS: A decrease of the burden of anogenital disease potentially related to HPV was observed in the younger birth cohorts. This was observed especially for genital warts and anogenital diseases grade III. Further research to investigate this trend for the upcoming years in light of varying HPV vaccination coverage for newer birth cohorts is necessary.


Assuntos
Doenças do Ânus/epidemiologia , Doenças dos Genitais Femininos/epidemiologia , Papillomaviridae/fisiologia , Infecções por Papillomavirus/epidemiologia , Demandas Administrativas em Assistência à Saúde/estatística & dados numéricos , Adulto , Doenças do Ânus/virologia , Estudos de Coortes , Condiloma Acuminado/epidemiologia , Condiloma Acuminado/virologia , Feminino , Doenças dos Genitais Femininos/virologia , Alemanha/epidemiologia , Humanos , Infecções por Papillomavirus/complicações , Prevalência , Estudos Retrospectivos , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , Adulto Jovem , Displasia do Colo do Útero/epidemiologia , Displasia do Colo do Útero/virologia
18.
ESC Heart Fail ; 6(4): 840-855, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286685

RESUMO

AIMS: The aim of this study was to assess the burden of heart failure (HF) patients with/without iron deficiency/iron deficiency anaemia (ID/A) from the health insurance perspective. METHODS AND RESULTS: We conducted a retrospective claims database analysis using the Institut für angewandte Gesundheitsforschung Berlin research database. The study period spanned from 1 January 2012 to 31 December 2014. HF patients were identified by International Statistical Classification of Diseases and Related Health Problems, 10th revision, German Modification codes (I50.-, I50.0-, I50.00, I50.01, I50.1-, I50.11, I50.12, I50.13, I50.14, I50.19, and I50.9). HF patients were stratified into HF patients without ID/A and HF patients with ID/A (D50.-, D50.0, D50.8, D50.9, and E61.1). HF patients with ID/A were stratified into three subgroups: no iron treatment, oral iron treatment, and intravenous iron treatment. A matching approach was applied to compare outcomes for HF patients without ID/A vs. HF patient with untreated incident ID/A without iron treatment and for HF patients receiving no iron treatment vs. oral iron treatment vs. intravenous iron treatment. Matching parameters included exact age, sex, and New York Heart Association functional class. An optimization algorithm was used to balance total health care costs in the baseline period for the potential matched pairs without sample size reduction. In total, 172 394 (4537.4 per 100 000) HF patients were identified in the Institut für angewandte Gesundheitsforschung Berlin research database in 2013. Of these, 11.1% (19 070; 501.9 per 100 000) were diagnosed with ID/A and/or had a prescription for iron medication in 2013. The mean age of HF patients was 77.0 years (±12.0 years). Women were more frequently diagnosed with HF (54.6%). HF patients with untreated incident ID/A (1.77%) had a significantly higher all-cause mortality than HF patients without ID/A (33.1% vs. 24.1%, P < 0.01). The analysis of health care utilization revealed significant differences in the rate of all-cause hospitalization (72.9% vs. 50.5%, P < 0.01). The annual health care costs for HF patients with untreated incident ID/A amounted to €17 347 with incremental costs of €849 (P < 0.01) attributed to ID/A. CONCLUSIONS: Heart failure is associated with a major burden for patients and the health care system in terms of health care resource utilization, costs, and mortality. Our findings suggest that there is an unmet need for treating more HF patients with ID/A with iron medication.


Assuntos
Anemia Ferropriva/complicações , Insuficiência Cardíaca/complicações , Deficiências de Ferro , Distúrbios do Metabolismo do Ferro/complicações , Idoso , Idoso de 80 Anos ou mais , Anemia Ferropriva/tratamento farmacológico , Efeitos Psicossociais da Doença , Feminino , Humanos , Ferro/uso terapêutico , Distúrbios do Metabolismo do Ferro/tratamento farmacológico , Masculino , Estudos Retrospectivos
19.
Clinicoecon Outcomes Res ; 10: 93-103, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29440920

RESUMO

BACKGROUND: Iron-deficiency anemia and iron deficiency are common comorbidities associated with inflammatory bowel disease (IBD) resulting in impaired quality of life and high health care costs. Intravenous iron has shown clinical benefit compared to oral iron therapy. AIM: This study aimed to compare health care outcomes and costs after oral vs intravenous iron treatment for IBD patients with iron deficiency or iron deficiency anemia (ID/A) in Germany. METHODS: IBD patients with ID/A were identified by ICD-10-GM codes and newly commenced iron treatment via ATC codes in 2013 within the InGef (formerly Health Risk Institute) research claims database. Propensity score matching was performed to balance both treatment groups. Non-observable covariates were adjusted by applying the difference-in-differences (DID) approach. RESULTS: In 2013, 589 IBD patients with ID/A began oral and 442 intravenous iron treatment. After matching, 380 patients in each treatment group were analyzed. The intravenous group had fewer all-cause hospitalizations (37% vs 48%) and ID/A-related hospitalizations (5% vs 14%) than the oral iron group. The 1-year preobservation period comparison revealed significant health care cost differences between both groups. After adjusting for cost differences by DID method, total health care cost savings in the intravenous iron group were calculated to be €367. While higher expenditure for medication (€1,876) was observed in the intravenous iron group, the inpatient setting achieved most cost savings (€1,887). CONCLUSION: IBD patients receiving intravenous iron were less frequently hospitalized and incurred lower total health care costs compared to patients receiving oral iron. Higher expenditures for pharmaceuticals were compensated by cost savings in other domains.

20.
Oncotarget ; 7(36): 58203-58217, 2016 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-27533460

RESUMO

Bmi1 was originally identified as a gene that contributes to the development of mouse lymphoma by inhibiting MYC-induced apoptosis through repression of Ink4a and Arf. It codes for the Polycomb group protein BMI-1 and acts primarily as a transcriptional repressor via chromatin modifications. Although it binds to a large number of genomic regions, the direct BMI-1 target genes described so far do not explain the full spectrum of BMI-1-mediated effects. Here we identify the putative tumor suppressor gene EphA7 as a novel direct BMI-1 target in neural cells and lymphocytes. EphA7 silencing has been reported in several different human tumor types including lymphomas, and our data suggest BMI1 overexpression as a novel mechanism leading to EphA7 inactivation via H3K27 trimethylation and DNA methylation.


Assuntos
Regulação da Expressão Gênica , Genes Supressores de Tumor , Complexo Repressor Polycomb 1/metabolismo , Proteínas Proto-Oncogênicas/metabolismo , Receptor EphA7/genética , Animais , Linfócitos B , Técnicas de Cultura de Células/métodos , Núcleo Celular/metabolismo , Proliferação de Células/fisiologia , Células Cultivadas , Cerebelo/anatomia & histologia , Cerebelo/metabolismo , Metilação de DNA/fisiologia , Regulação para Baixo , Histonas/metabolismo , Imuno-Histoquímica , Antígeno Ki-67/metabolismo , Ventrículos Laterais/anatomia & histologia , Ventrículos Laterais/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Análise em Microsséries , Células-Tronco Neurais , Complexo Repressor Polycomb 1/genética , Proteínas Proto-Oncogênicas/genética , Receptor EphA7/metabolismo , Baço/citologia , Transdução Genética , Regulação para Cima
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