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Gahr P, Mittlmeier T, Grau A, Herlyn PKE, Rahn A, Fischer DC. Functional assessment and outcome following surgical treatment of displaced tibial plateau fractures: a retrospective analysis. Eur J Trauma Emerg Surg 2023; 49:2373-2379. [PMID: 37978059 PMCID: PMC10728243 DOI: 10.1007/s00068-023-02401-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Patients with tibial plateau fractures (TPF) are at risk of long-term hampered bipedal locomotion. A retrospective single-center study using patient-related outcome measures and a sophisticated assessment of walking abilities was conducted. METHODS Adults receiving surgical treatment of an isolated TPF between January 2012 and December 2016 received the KOOS questionnaire together with the invitation for an extensive follow-up examination on the clinical outcome including standardized assessment of the walking abilities (loadsol® system). Outcome was assessed relative to the severity of the injury or time to follow-up. Fractures were classified according to AO/OTA and Luo, respectively. RESULTS 58 out of 132 eligible patients filled in the questionnaire and participated at a median follow-up of 3.05 years after injury. For the categories "pain", "mobility", and "daily life activities", all patients were rather satisfied and this was virtually not related to the time between fracture and assessment. Relevant limitations were reported for "sports and recreational activities" and "quality of life". Loading of the previously fractured leg was most evidently changed on stairs and outdoor walking. Outcome was not related to either fracture type severity or time from injury. CONCLUSION Outcome after an isolated TPF is neither related to fracture type, severity of the fracture nor time from injury. Simple gait analysis techniques relying on different tasks appear to yield a more sophisticated image on functional deficits after TPF than classical exam of ground-level walking and correlate quite well with validated patient-related outcome measures as the KOOS.
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Affiliation(s)
- Patrick Gahr
- Department of Traumatology, Hand- and Reconstructive Surgery, University Medical Center, Rostock, Germany
| | - Thomas Mittlmeier
- Department of Traumatology, Hand- and Reconstructive Surgery, University Medical Center, Rostock, Germany.
| | - Anja Grau
- Department of Traumatology, Hand- and Reconstructive Surgery, University Medical Center, Rostock, Germany
- Department of Internal Medicine II, Klinikum Südstadt Rostock, Rostock, Germany
| | - Philipp K E Herlyn
- Department of Traumatology, Hand- and Reconstructive Surgery, University Medical Center, Rostock, Germany
- Department of Traumatology, Hand- and Reconstructive Surgery, Städtisches Klinikum Dresden-Friedrichstadt, Dresden, Germany
| | - Anja Rahn
- Department of Pediatrics, University Medical Center, Rostock, Germany
| | - Dagmar-C Fischer
- Department of Pediatrics, University Medical Center, Rostock, Germany
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Polan C, Brenner C, Herten M, Hilken G, Grabellus F, Meyer HL, Burggraf M, Dudda M, Jahnen-Dechent W, Wedemeyer C, Kauther MD. Increased UHMWPE Particle-Induced Osteolysis in Fetuin-A-Deficient Mice. J Funct Biomater 2023; 14:jfb14010030. [PMID: 36662077 PMCID: PMC9865936 DOI: 10.3390/jfb14010030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/30/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023] Open
Abstract
Particle-induced osteolysis is a major cause of aseptic prosthetic loosening. Implant wear particles stimulate tissue macrophages inducing an aseptic inflammatory reaction, which ultimately results in bone loss. Fetuin-A is a key regulator of calcified matrix metabolism and an acute phase protein. We studied the influence of fetuin-A on particle-induced osteolysis in an established mouse model using fetuin-A-deficient mice. Ten fetuin-A-deficient (Ahsg−/−) mice and ten wild-type animals (Ahsg+/+) were assigned to test group receiving ultra-high molecular weight polyethylene (UHMWPE) particle implantation or to control group (sham surgery). After 14 days, bone metabolism parameters RANKL, osteoprotegerin (OPG), osteocalcin (OC), alkaline phosphatase (ALP), calcium, phosphate, and desoxypyridinoline (DPD) were examined. Bone volume was determined by microcomputed tomography (μCT); osteolytic regions and osteoclasts were histomorphometrically analyzed. After particle treatment, bone resorption was significantly increased in Ahsg−/− mice compared with corresponding Ahsg+/+ wild-type mice (p = 0.007). Eroded surface areas in Ahsg−/− mice were significantly increased (p = 0.002) compared with Ahsg+/+ mice, as well as the number of osteoclasts compared with control (p = 0.039). Fetuin-A deficiency revealed increased OPG (p = 0.002), and decreased levels of DPD (p = 0.038), OC (p = 0.036), ALP (p < 0.001), and Ca (p = 0.001) compared with wild-type animals. Under osteolytic conditions in Ahsg−/− mice, OPG was increased (p = 0.013), ALP (p = 0.015) and DPD (p = 0.012) were decreased compared with the Ahsg+/+ group. Osteolytic conditions lead to greater bone loss in fetuin-A-deficient mice compared with wild-type mice. Reduced fetuin-A serum levels may be a risk factor for particle-induced osteolysis while the protective effect of fetuin-A might be a future pathway for prophylaxis and treatment.
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Affiliation(s)
- Christina Polan
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
- Correspondence: ; Tel.: +49-201-723-1301
| | - Christina Brenner
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Monika Herten
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Gero Hilken
- Central Animal Laboratory, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Florian Grabellus
- Institute of Pathology and Neuropathology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Heinz-Lothar Meyer
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Manuel Burggraf
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Marcel Dudda
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Willi Jahnen-Dechent
- Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Christian Wedemeyer
- Department of Orthopaedic Surgery, St. Barbara Hospital Gladbeck, 45964 Gladbeck, Germany
| | - Max Daniel Kauther
- Department of Trauma Surgery and Orthopedics, Pediatric Orthopedics, Agaplesion Diakonieklinikum Rotenburg (Wümme), 27356 Rotenburg, Germany
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