[Treatment of osteoporosis in the outpatient field : Possibilities and challenges]. / Osteoporosebehandlung im ambulanten Bereich : Möglichkeiten und Herausforderungen.

Despite the high incidence of osteoporosis, the high risk of subsequent fractures after an initial fracture and effective treatment options, there is a substantial deficit in the diagnostics and treatment of patients suffering from osteoporosis in Germany and worldwide. The reasons for this are multifactorial and can be attributed to physicians and patients as well as mismanagement inherent to the system. This article provides an overview of the challenges in the treatment of osteoporosis patients and shows the possibilities for improvement of care in the outpatient area. With respect to the exact schedule of the diagnostics and treatment of osteoporosis, reference is made to the pocket-sized edition of the current guidelines of the Governing Body Osteology (DVO).

Factors associated with high 24-month persistence with denosumab: results of a real-world, non-interventional study of women with postmenopausal osteoporosis in Germany, Austria, Greece, and Belgium.

Persistence with osteoporosis therapy is vital for fracture prevention. This non-interventional study of postmenopausal women receiving denosumab in Germany, Austria, Greece, and Belgium found that persistence with denosumab remains consistently high after 24 months in patients at high risk of fracture. PURPOSE: Continued persistence with osteoporosis therapy is vital for fracture prevention. This non-interventional study of clinical practice evaluated medication-taking behavior of postmenopausal women receiving denosumab in Germany, Austria, Greece, and Belgium and factors influencing persistence. METHODS: Subcutaneous denosumab (60 mg every 6 months) was assigned according to prescribing information and local guidelines before and independently of enrollment; outcomes were recorded during routine practice for up to 24 months. Persistence was defined as receiving the subsequent injection within 6 months + 8 weeks of the previous injection and adherence as administration of subsequent injections within 6 months ± 4 weeks of the previous injection. Medication coverage ratio (MCR) was calculated as the proportion of time a patient was covered by denosumab. Associations between pre-specified baseline covariates and 24-month persistence were assessed using multivariable logistic regression. RESULTS: The 24-month analyses included 1479 women (mean age 66.3-72.5 years) from 140 sites; persistence with denosumab was 75.1-86.0%, adherence 62.9-70.1%, and mean MCR 87.4-92.4%. No covariate had a significant effect on persistence across all four countries. For three countries, a recent fall decreased persistence; patients were generally older with chronic medical conditions. In some countries, other covariates (e.g., older age, comorbidity, immobility, and prescribing reasons) decreased persistence. Adverse drug reactions were reported in 2.3-6.9% patients. CONCLUSIONS: Twenty-four-month persistence with denosumab is consistently high among postmenopausal women in Europe and may be influenced by patient characteristics. Further studies are needed to identify determinants of low persistence.

GRAND-4: the German retrospective analysis of long-term persistence in women with osteoporosis treated with bisphosphonates or denosumab.

UNLABELLED: This retrospective database study assessed 2-year persistence with bisphosphonates or denosumab in a large German cohort of women with a first-time prescription for osteoporosis treatment. Compared with intravenous or oral bisphosphonates, 2-year persistence was 1.5-2 times higher and risk of discontinuation was significantly lower (P < 0.0001) with denosumab. INTRODUCTION: Persistence with osteoporosis therapies is critical for fracture risk reduction. Detailed data on long-term persistence (≥2 years) with bisphosphonates and denosumab are sparse. METHODS: From the German IMS® database, we included women aged 40 years or older with a first-time prescription for bisphosphonates or denosumab between July 2010 and August 2014; patients were followed up until December 2014. The main outcome was treatment discontinuation, with a 60-day permissible gap between filled prescriptions. Two-year persistence was estimated using Kaplan-Meier survival curves, with treatment discontinuation as the failure event. Denosumab was compared with intravenous (i.v.) and oral bisphosphonates separately. Cox proportional hazard ratios (HRs) for the 2-year risk of discontinuation were calculated, with adjustment for age, physician specialty, health insurance status, and previous medication use. RESULTS: Two-year persistence with denosumab was significantly higher than with i.v. or oral bisphosphonates (39.8 % [n = 21,154] vs 20.9 % [i.v. ibandronate; n = 20,472] and 24.8 % [i.v. zoledronic acid; n = 3966] and 16.7-17.5 % [oral bisphosphonates; n = 114,401]; all P < 0.001). Patients receiving i.v. ibandronate, i.v. zoledronic acid, or oral bisphosphonates had a significantly increased risk of treatment discontinuation than did those receiving denosumab (HR = 1.65, 1.28, and 1.96-2.02, respectively; all P < 0.0001). CONCLUSIONS: Two-year persistence with denosumab was 1.5-2 times higher than with i.v. or oral bisphosphonates, and risk of discontinuation was significantly lower with denosumab than with bisphosphonates. A more detailed understanding of factors affecting medication-taking behavior may improve persistence and thereby reduce rates of fracture.

[Osteoporosis: Diagnostics and Therapy According to the German Guidelines]. / Osteoporose: leitliniengerechte Diagnostik und Therapie.

The S3 guideline on the diagnosis and therapy of osteoporosis has existed since 2003. This was last updated in 2014. The aim of the present article is to present the knowledge needed for the diagnosis and therapy in men aged 60 or more and in postmenopausal women. The contexts of the updated guideline 1 are presented, together with comments on recent literature that has appeared since the last version. Both abbreviated and long versions of the guideline are available in the Internet under "www.dv-osteologie.org".

Early changes in biochemical markers of bone formation during teriparatide therapy correlate with improvements in vertebral strength in men with glucocorticoid-induced osteoporosis.

UNLABELLED: Changes of the bone formation marker PINP correlated positively with improvements in vertebral strength in men with glucocorticoid-induced osteoporosis (GIO) who received 18-month treatment with teriparatide, but not with risedronate. These results support the use of PINP as a surrogate marker of bone strength in GIO patients treated with teriparatide. INTRODUCTION: To investigate the correlations between biochemical markers of bone turnover and vertebral strength estimated by finite element analysis (FEA) in men with GIO. METHODS: A total of 92 men with GIO were included in an 18-month, randomized, open-label trial of teriparatide (20 µg/day, n = 45) and risedronate (35 mg/week, n = 47). High-resolution quantitative computed tomography images of the 12th thoracic vertebra obtained at baseline, 6 and 18 months were converted into digital nonlinear FE models and subjected to anterior bending, axial compression and torsion. Stiffness and strength were computed for each model and loading mode. Serum biochemical markers of bone formation (amino-terminal-propeptide of type I collagen [PINP]) and bone resorption (type I collagen cross-linked C-telopeptide degradation fragments [CTx]) were measured at baseline, 3 months, 6 months and 18 months. A mixed-model of repeated measures analysed changes from baseline and between-group differences. Spearman correlations assessed the relationship between changes from baseline of bone markers with FEA variables. RESULTS: PINP and CTx levels increased in the teriparatide group and decreased in the risedronate group. FEA-derived parameters increased in both groups, but were significantly higher at 18 months in the teriparatide group. Significant positive correlations were found between changes from baseline of PINP at 3, 6 and 18 months with changes in FE strength in the teriparatide-treated group, but not in the risedronate group. CONCLUSIONS: Positive correlations between changes in a biochemical marker of bone formation and improvement of biomechanical properties support the use of PINP as a surrogate marker of bone strength in teriparatide-treated GIO patients.

[Significant reduction of osteoporosis fracture-related hospitalisation rate due to intensified, multimodal treatment - results from the Integrated Health Care Network Osteoporosis North Rhine]. / Signifikante Reduktion von Krankenhauseinweisungen aufgrund osteoporoseassoziierter Frakturen durch intensivierte multimodale Therapie - Ergebnisse der Integrierten Versorgung Osteoporose Nordrhein.

INTRODUCTION: Osteoporosis is known as being undertreated in Germany. The aim of the integrated health care model "osteoporosis" was the improvement of patient care by multimodal treatment within an integrated health care network. This paper shows the results of the accompanying evaluation. METHODS: A retrospective cross-sectional analysis was performed using routine data from the AOK Rheinland/Hamburg for the years 2007-2010. Patients were included if they were 50-89 years old and had a diagnosis of osteoporosis (ICD-10 M80 or M81) and at least three prescriptions of osteoporosis-specific medication. Data were analysed separately for integrated health care and regular health care. RESULTS: 22 040 patients were detected, thereof 3173 patients in the integrated health care group (IV). The hospitalisation rate for hip fractures was significantly lower in the IV group: 5.93/1000 patient years versus 22.96/1000 patient years (- 74 %, p < 0.05). Also the hospitalisation rate of all other osteoporosis-related fractures was reduced by 73 %: 46.92/1000 patient years versus 172.88/1000 patient years (p < 0.05). Osteoporosis-related medication costs were doubled in the IV group, while total medication costs were lower in the IV group (1438 € vs. 1702 €). DISCUSSION: This observational, cross-sectional study shows that an intensified, multimodal treatment of osteoporosis within an integrated health care network of highly qualified physicians can reduce the hospitalisation rate due to osteoporosis-associated fractures and simultaneously reduce direct costs even in the short term.

[Dihydrotestosterone improves the osseointegration of cobalt-chromium implants]. / Dihydrotestosteron verbessert die knöcherne Einheilung von Kobalt-Chrom-Implantaten.

BACKGROUND: The osseointegration of actually rarely implanted cobalt-chromium implants can be critical in an elderly population. The aim of our study was to evaluate the effect of preoperative testosterone treatment on the osseointegration of cobalt-chromium implants. MATERIALS AND METHODS: Press-fit implantation of 1.6 mm-diameter cobalt-chromium-molybdenum (CoCrMo) implants was performed in rats without pre-treatment in one group (n = 10) and after pre-treatment with 1 mg dihydrotestosterone (DHT) 2 days before surgery in the other group (n = 10). After 14 days, the specimens were examined by a pull-out test, histology and histomorphometry. RESULTS: The biomechanical testing delivered inconsistent data leading to no significant difference (6.45 ± 6.94 N vs. 4.66 ± 3.77 N). Histology showed closed contact between surrounding tissue and the implants in both groups. The bone/implant contact area was significantly enhanced after treatment with DHT (42.23 % ± 9.25 vs. 57.57 % ± 16.71, p < 0.05), while the ratio of osteoid was reduced (38.68 % ± 16.7 vs. 27.38 % ± 13.02, not significant). CONCLUSIONS: Pre-treatment with DHT enhances osseointegration of cobalt-chromium implants through enhanced mineralisation of peri-implant tissue. The treatment might additionally shorten postoperative rehabilitation due to its positive effects on musculature.

[Procalcitonin (PCT) as diagnostic tool for the monitoring of spondylodiscitis]. / Procalcitonin (PCT) als Verlaufsparameter der Spondylodiszitis.

AIM: The diagnosis of spondylodiscitis is often prolonged, but it is an important differential diagnosis of backache. The discrimination between a bacterial infection and an aseptic inflammation with laboratory examinations like ESG, CRP or leukocytes is not possible. The aim of the present study was to determine the value of procalcitonin (PCT) as a diagnostic tool and monitoring parameter for spondylodiscitis and for the discrimination between bacterial infection and aseptic inflammation of the spine. METHOD: A total of 17 patients with spondylodiscitis and 18 patients with disc herniation as control were included in this study and ESG, CRP, leukocytes, fibrinogen, PNM elastase und PCT were examined for 50 days. The median age was 65 (17-78) years and the ratio of males to females was 8 : 9 in patients with spondylodiscitis and 62 (32-87) years and 7 : 11 in patients with disc herniation. For microbiological examination, CT-guided punctures were performed in patients with spondylodiscitis. RESULTS: In 64 % of the 17 patients with spondylodiscitis a microbiological agent was detected, in 73 % of these cases staphylococcus aureus was isolated. The laboratory parameters indicating an infection were increased except for two cases in patients with spondylodiscitis, the mean value of CRP was 115 mg/dL. Influenced by the therapy these parameters decreased during the observation period. Except for one patient with an infection of a cardiac pacemaker, the PCT concentration was not elevated in both groups (< 0.5 ng/mL). In the group with disc herniation there were no elevated laboratory parameters during the entire observation period. CONCLUSION: PCT is not useful as diagnostic tool or monitoring parameter for spondylodiscitis. Furthermore, it is not useful for the discrimination between a bacterial infection and an aseptic inflammation of the spine.

[Comparison of the treatment of slipped capital femoral epiphysis with K-wires and cannulated titanium screws]. / Vergleich der Therapie der Epiphyseolysis capitis femoris mit Kirschner-Drähten und kanülierten Titanschrauben.

AIM: The treatment of slipped capital femoral epiphysis (SCFE) is usually treated operatively, but there is still no consensus about the method to be used. Up to a 30 degrees degree of slipping, the epiphysis is normally fixed in situ. The aim of our study was to compare the intermediate results after fixation in situ by K-wires versus cannulated titanium screws (Königsee-Implantate, Königsee-Aschau, Germany). METHODS: In this study 46 patients with SCFE grade I and II and mostly chronic slipping of the epiphysis were included. After fixation in situ and, if necessary, careful, closed reposition, the patients were clinically and radiologically followed-up for one year. The clinical results were documented by the score adapted from Heyman and Herndon. Furthermore, MRI scans were done to evaluate the vitality of the epiphysis pre- and postoperatively, when titanium screws were used. RESULTS: Clinical follow-up showed comparable results in the clinical scores after fixation by K-wires or cannulated titanium screws (3.13 +/- 1.02 vs. 3.10 +/- 1.01). After the treatment with titanium screws we saw a higher rate of abnormal gait (33.3 % vs. 19 %), a decreased rate of the positive Drehmann sign (10 % vs. 38 %) and a lower rate of revisions (16 % vs. 50 %) in comparison to K-wire fixation. After displacement of the K-wires we saw chondrolysis and prearthrosis in one case. Removal of the K-wires was done without any complications, while the removal of the cannulated titanium screws failed in 4 of 10 cases. CONCLUSION: The treatment of SCFE with K-wires and cannulated titanium screws showed comparable results in the clinical follow-up. The treatment with cannulated titanium screws reduces the number of necessary revisions, but the removal of the material is hindered. Because of the lower rate of complications we prefer in the meantime the use of cannulated steel screws.

[Clinical results after three years use of matrix-associated ACT for the treatment of osteochondral defects of the knee]. / Klinische Drei-Jahres-Ergebnisse der matrixgekoppelten ACT zur Behandlung osteochondraler Defekte am Kniegelenk.

AIM: The aim of this study was to examine the clinical results after the treatment of osteochondral defects of the knee with autologous bone grafting and matrix-supported autologous chondrocyte transplantation (ACT). METHOD: In this study 13 patients with osteochondral defects of the knee (12 femoral, 1 tibial) with OCD ICRS grade IV or ICRS grade IV B were included. The osteochondral defects were reconstructed simultaneously with autologous monocortical cancellous bone cylinders or chips from cancellous bone and matrix-supported autologous chondrocyte transplantation (CaReS). Data were analysed in accordance with the ICRS criteria and the Brittberg score. Patients were followed up to 36 months after the operation. RESULTS: The average age of the patients was 34.9 (16 - 47) years at the time of surgery. The size of the defect was 8.1 (3.8 - 13.5) cm(2). The subjective and objective IKDC scores, the Brittberg and the ICRS function score were statistically significantly improved during the observation time. In one patient the transplantation failed and another patient was not available for the follow-up at 36 months. The objective IKDC score and the ICRS function score increased from 0/13 (0 %) to 11/12 (91.7 %) in categories A and B, or I and II, respectively, after 3 years. At this point of time 83.4 % (10/12) of the patients voted the treatment as excellent or good. The subjective IKDC score improved from 38.4 (+/- 12.7) preoperatively to 66.1 (+/- 17.0) after 3 years. CONCLUSION: The treatment of osteochondral defects of the knee with autologous bone grafting and matrix-supported autologous chondrocyte transplantation shows promising results even for larger defects. But for a final decision about this therapy the present sample size was too small. There is a need for further long-term investigation with a larger number of patients.

[Therapy effects of testosterone on the recovery of bone defects]. / Therapieeffekte von Testosteron auf die Heilung von Knochendefekten.

AIM: Androgens have proliferative effects on osteoblasts and increase fracture healing by systemic and local stimulation of bone formation. The aim of the present study was to evaluate if the systemic stimulation by androgens leads to increased bone-defect healing. METHODS: 1.5-mm trepanation defects were created in the femoral diaphysis of 30 Sprague-Dawley rats. 10 animals were used as untreated controls and 10 animals per group were treated by intramuscular injection of 1 or 10 mg dihydrotestosterone two days prior to surgery. After 14 days the samples were explanted and examined by macroscopy, histology and histomorphometry. RESULTS: All animals were included into the study and were analysed. Clinical observation showed no complications. Macroscopic examination and histology showed no significant differences. All defects were filled with trabecular bone in direct contact to the surrounding bone. Histomorphometry showed a significantly decreased bone content in the controls in comparison to both therapy groups, while the therapy groups showed no significant differences between each other. CONCLUSION: The stimulation of healing of bone defects with androgens leads to a significantly higher bone content inside the defects. In clinical application, androgens may be a possibility to increase bone formation, especially in elderly patients. Furthermore, it may be possible to shorten postoperative rehabilitation because of the effects of androgens on muscles.

[Chronic recurrent multifocal osteomyelitis and tumoral calcinosis--is there an association?]. / Die chronisch-rezidivierende multifokale Osteomyelitis und die tumoröse Kalzinose--assoziierte Erkrankungen?

BACKGROUND: Idiopathic tumorous calcinosis is a rare benign disease of the periarticular tissue near large joints. Deposits of hydroxyapatite in single or multiple pseudocysts lead to consecutive pain or complaints by attaching the surrounding tissues. The etiology of this disease is not definitively clear. CASE REPORT: We describe the case of an 11-year-old turkish girl with a well known chronic recurrent multifocal osteomyelitis (CRMO) and hyperphosphataemia. Furthermore, she developed a tumorous calcinosis around the left hip, which recurred after surgery, and around the ankle joint. CONCLUSIONS: CRMO and tumorous calcinosis can be associated diseases. The development of tumorous calcinosis in patients with CRMO and hyperphosphataemia should be excluded.

[Bilateral fracture of the femoral neck following transient osteoporosis in pregnancy]. / Beidseitige Schenkelhalsfraktur bei transienter Osteoporose während der Schwangerschaft.

During pregnancy changes of the bone metabolism can occur. Femoral neck fractures are known as a very rare consequence of transient osteoporosis in pregnancy. In a case report we present the clinical, radiological and histological features of a bilateral fracture of the femoral neck. A 29-year-old woman presented with pain in the right hip, which occurred in the 34 (th) week of pregnancy. The symptoms were initially interpreted as a sacroiliac joint affection and consequently a conservative treatment was initiated. Five days after a Caesarean section a dislocated fracture of the femoral neck was diagnosed on the left side. On the contralateral side the fracture was not dislocated. For therapy this patient underwent a total hip replacement on the left hand side and an internal fixation on the other side. Especially during pregnancy changes of the bone are diagnosed late due to the side effects of radiation. This case report indicates that MR imaging and other non-ionising techniques should be considered if such symptoms persist in spite of therapy.

[Bacterial osteitis. Special considerations in immunocompromised patients]. / Bakterielle Osteitis. Besonderheiten beim immunkompromittierten Patienten.

With increasing life expectancy and better medical competence, the number of older patients with multimorbidity is growing. Patients with a deficient immune system need more attention during diagnosis and treatment of osteomyelitis.

Transient osteoporosis of the navicular bone in a runner.

INTRODUCTION: Transient osteoporosis or the bone marrow oedema syndrome is described as a self-limiting disorder. Transient osteoporosis usually affects only one bone, predominantly the proximal femur. Involvement of the foot is rare and often overlooked. A disorder of the navicular bone of the foot can be found twice in the literature. MATERIALS AND METHODS: We report a case of transient osteoporosis of the navicular bone of the foot in a 20-year-old, female, top-level track athlete (400 m sprinter) treated with alendronate, and a review of the literature. RESULTS: The therapeutic options are limited, frequently consisting of non-specific, symptomatic therapy. Some authors report favourable results with core decompression, while others have reported good results with a conservative regime of symptomatic treatment and avoidance of weight-bearing until the clinical and radiological changes have resolved. In the described case, the patient had a favourable result after a short course of treatment with alendronate. She experienced almost immediate pain reduction and presented a complete resolution of the abnormal signal intensity on MRI. CONCLUSION: This rapid result makes the use of alendronate seem promising in athletes with transient osteoporosis, permitting an early return to high-level activities.

[Complications after harvesting of autologous bone from the ventral and dorsal iliac crest - a prospective, controlled study]. / Komplikationen nach Entnahme autologen Knochens aus dem ventralen und dorsalen Beckenkamm - eine prospektive, kontrollierte Studie.

INTRODUCTION: In a prospective, controlled study, donor site morbidity after bone graft harvesting from the anterior and posterior iliac crest was documented. METHODS: In 113 patients, monocortical to tricortical bone grafts were taken from the anterior (n = 73) or dorsal (n = 40) iliac crest. Bone graft size (0.4 - 43 cm 3, median 9.7 cm 3), Operation time (12 - 65 minutes, median 28 minutes), and postoperative donor site were documented. RESULTS: Donor site morbidity was higher after harvesting from the ventral than from the dorsal iliac crest: total morbidity 48 vs. 32.5 %, large haematomas 9.6 vs. 7.5 %, moderate haematomas 34.3 vs. 15 %, wound dehiscence 2.7 vs. 0 %. One revision operation was necessary because of a large haematoma at the ventral crest. After harvesting from the ventral iliac crest, there was one fracture ofthe iliac wing and one avulsion fracture of the iliac crest. There were no infections, no injuries of arteries or of the lateral femoral cutaneous nerve and no hemiation. After harvesting from the dorsal iliac crest, there were no major complications. CONCLUSION: Bone graft harvesting from the posterior iliac crest should be preferred over harvesting from the anterior iliac crest beeause of the substantially reduced donor site morbidity. Harvesting from the ventral iliac crest should have a clear indication, synthetic bone substitutes should be taken into consideration.

[The value of peripheral quantitative computed tomography (pQCT) in the diagnosis of osteoporosis]. / Wert der peripheren quantitativen Computertomographie (pQCT) in der Osteoporosediagnostik.

AIM: To evaluate the accuracy of distal radial pQCT in discriminating between osteoporotic fracture and non fracture cases and its efficiency to predict fractures. METHODS: Densitometric data determined with an XCT 900 Stratec pQCT device at the distal radius of women who had suffered distal radius (57), spinal (87) or femoral neck fractures (21) before or after measurement were compared with densitometric data of age-matched healthy women (265) and were analyzed in regression tests. Women whose fractures occurred before measuring were selectively analyzed. RESULTS: More significant differences between fracture and non fracture groups were obtained by trabecular bone density (TBD) (r2radius = 0.531, r2spine = 0.528, r2femur = 0.711, p < 0.001) than by total bone density (BD) (r2radius = 0.468, r2spine = 0.495, r2femur = 0.605, p < 0.001). In the radius and spine group TBD data determined before fracture showed less significant differences than those determined afterwards, whereas in the femur group TBD data were almost equal. All femur fractures could be predicted. As TBD decreased, the relative risk of fracture increased by gradients of m radius = 0.017, m spine = 0.013, and m femur = 0.027 in the linear regions of the risk curves. CONCLUSION: Selective measuring of TBD at the distal radius enables one to detect bone loss at an early stage and to estimate the risk of future fractures not only at the point of measurement.

[Filling of osteochondral donor site defects. Experimental study with tricalcium phosphate cement and BMP-2]. / Füllung von Entnahmedefekten beim Knorpel-Knochen-Transfer. Experimenteller Ansatz mit beta-Trikalziumphosphat-Zement und BMP-2.

AIM: Osteochondral grafting procedures have developed into one of the preferred methods of treatment for focal osteochondral lesions, although the management of the donor site remains problematic. In this animal study, an attempt at sealing the donor site with a fully-resorbable tricalcium phosphate bone cement was evaluated. METHOD: Autologous osteochondral transplantation of the medial and lateral condyle was performed on the ovine knee using a standard operative protocol. The ensuing defect was filled with the original beta-TCP cement laterally, while medially the cement was augmented with 50 micro g BMP-2. Two groups, consisting of 10 sheep each, were evaluated after three and 6 months, respectively. RESULTS: The clinical evaluation of the specimens revealed an improved reconstruction of the joint surface following the application of the augmented biomaterial. Macroscopically, the superficial border of the original donor site could easily be outlined at both time periods in both groups. Solid osteointegration of the bone cement could be documented radiographically as early as three months following implantation. CONCLUSION: The beta-TCP bone cement represents a promising resorbable filler for osteochondral defects. The augmentation with BMP-2 seems to expedite the remodelling process and improve the surface reconstruction.

Efficacy of intraarticular hyaluronic acid in patients with osteoarthritis--a prospective clinical trial.

AIM: The goal of this study was to determine whether or not the intraarticular administration of hyaluronic acid can improve functional parameters, such as isokinetic muscle strength or total work and clinical test results in patients with osteoarthritis (OA) of the knee. METHOD: As part of a prospective, controlled study 43 patients with osteoarthritic changes of both knees (radiographic Kellgren stage II-III) were followed in a right/left comparison. The influence of intraarticularly injected hyaluronic acid (20mg hyaluronic acid/2ml Hyalart) on functional and clinical parameters was analysed. We used the isokinetic system Cybex 600 for measuring maximal isokinetic muscle strength and total work. A total of 20 males and 23 females fulfilled the inclusion criteria with an age between 55-78 years and underwent five injections of hyaluronic acid (one injection per week). The injected knee represented the treatment group, while the contralateral knee served as the control. RESULTS: The maximum peak torque of the knee extensors in the treatment group was measured between 57+/-26.15/32.33+/-19.63Nm prior to the injections and 77.17+/-32.54/47.83+/-21.43Nm following the hyaluronic acid therapy (P< 0.01). The analysis of the knee flexors at angular velocities of 60 degrees /s and 180 degrees /s revealed values of 40.44+/-21.58/22.89+/-16.64Nm and 53.55+/-24.26/34.05+/-17.37Nm (P< 0.01) respectively. The evaluation of the total work of the knee flexors and extensors revealed a significant difference (P< 0.01) between the treatment and control group. The Lequesne score was reduced from 13.57+/-1.88 prior to the injections to 7.94+/-2.53 after the treatment (P< 0.01). The pain score was documented with the help of a visual analog scale. The VAS values were reduced at rest from 3.83+/-1.72cm to 1.36+/-1.42cm and during weight bearing from 7.57+/-1.34cm to 3.75+/-1.32cm in the treatment group (P< 0.01). CONCLUSIONS: This controlled prospective clinical trial confirmed that 5 weekly intraarticular injections of HA (Hyalart) in patients with OA of the knee provide pain relief and functional improvements.

[Healing of osteochondral transplants--animal experiment studies using a sheep model]. / Einheilungsverhalten von osteochondralen Transplantaten--Tierexperimentelle Untersuchungen an einem Schafmodell.

AIM: Autologous grafting has developed into one of the preferred methods of treatment for focal osteochondral lesions, although basic research on this topic remains sparse. In an animal study, questions regarding the healing of such osteochondral transplants are clarified. METHOD: An autologous osteochondral transplantation was performed on the ovine knee using the standard operative protocol. Two groups, consisting of 10 sheep each, were evaluated after 3 and 6 months, respectively. RESULTS: During the clinical evaluation of the specimens, neither osteophytes nor synovial changes were observed. The consistency of the cartilaginous tissue began to reach a level equivalent to the surrounding tissue only after 6 months. Macroscopically, the superficial border of the transplanted osteochondral plug could easily be outlined at both time points. Radiographically, a solid osteointegration of the graft could already be documented at 3 months. In contrast, integration of the chondral surface of the OAT was not seen macro- or microscopically at any point in time. A firm physical interdigitation of the reconstructed joint surface could not be demonstrated. CONCLUSIONS: The lack of integration of the cartilaginous portion of the transplanted plugs into the reconstructed joint surface leads to questions regarding the long-term survival of the joint itself.