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Liechti EF, Linke P, Gehrke T, Citak M, Lausmann C. Outcomes of rotating versus pure hinge knee arthroplasty in the setting of one-stage exchange for periprosthetic joint infection. Int Orthop 2024:10.1007/s00264-024-06139-y. [PMID: 38558190 DOI: 10.1007/s00264-024-06139-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/03/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Rotating or pure hinge knee prostheses are often used in case of periprosthetic joint infection (PJI). Five-year survival data of rotating hinge implants ranging from 52 to 90%, whereas pure hinge data are sparse. This study describes the results of both hinge knee prostheses after one-stage septic exchange. METHODS One hundred sixty-seven one-stage septic exchanges of a primary unconstrained total knee arthroplasty (TKA) to a cemented hinge prosthesis (117 rotating and 50 pure hinge TKAs) performed between 2008 and 2017 were retrospectively reviewed. Exclusion criteria were stem extensions or augments used in primary TKA, history of extensor mechanism reconstruction, and a follow-up less than two years after surgery. Rates of reinfection, mechanical failures, and all-cause revision-free survival data were documented. RESULTS At five years, the all-cause revision-free survival was 77% (95% CI 69 to 82). Thirty-one patients (19%) had further revision for aseptic reasons. In the rotating hinge group, the mechanical failure rate was more than twice as high as in the pure hinge group (13% vs 6%), significantly influenced by higher body weight. At a mean follow-up of 6.7 years, 21 (13%) patients had a reinfection and underwent a further surgery. Reinfection rates did not differ between the two groups. CONCLUSION The use of hinge TKA in the revision of PJI shows favourable five year infection-free and all-cause revision-free survival rates of 91% and 77%, respectively. Our study showed poorer results of the rotating hinge design. These results may help surgeons to choose proper implants in case of septic knee revision.
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Affiliation(s)
- Emanuel F Liechti
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstraße 2, 22767, Hamburg, Germany
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philip Linke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstraße 2, 22767, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstraße 2, 22767, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstraße 2, 22767, Hamburg, Germany
| | - Christian Lausmann
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstraße 2, 22767, Hamburg, Germany.
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Ballhause TM, Linke P, Hättich A, Klatte TO, Frosch KH, Mader K. [Infectious, pathologic humeral fracture in a patient with sickle cell disease-A rare case?]. Unfallchirurgie (Heidelb) 2024; 127:146-150. [PMID: 37270730 PMCID: PMC10834581 DOI: 10.1007/s00113-023-01334-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 06/05/2023]
Abstract
The vaso-occlusive crises of sickle cell disease are accompanied by bone necrosis, which favors endogenous bacterial colonization and thus osteomyelitis. This poses a major challenge for eradication and fracture management.A 22-year-old patient with sickle cell disease sustained a multifragmentary, humeral shaft fracture. During surgical management, pus drained from the fracture site and further diagnostic work-up revealed osteomyelitis with evidence of Klebsiella aerogenes. Septicemia due to Klebsiella aerogenes had been treated 5 months prior to the accident, which occured because of a vaso-occlusive crisis. This is associated with clustered bone necrosis and endogenous germ colonization. Eradication of the germs and fracture care become a challenge. Repeated surgical procedures with segmental transfer can be a successful treatment option.
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Affiliation(s)
- Tobias Malte Ballhause
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 22529, Hamburg, Deutschland.
| | - Philip Linke
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 22529, Hamburg, Deutschland
| | - Annika Hättich
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 22529, Hamburg, Deutschland
| | - Till Orla Klatte
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 22529, Hamburg, Deutschland
| | - Karl-Heinz Frosch
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 22529, Hamburg, Deutschland
- Unfallchirurgie, Orthopädie und Sporttraumatologie, BG Klinikum Hamburg, Hamburg, Deutschland
| | - Konrad Mader
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 22529, Hamburg, Deutschland
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Burchette DT, Dasci MF, Fernandez Maza B, Linke P, Gehrke T, Citak M. Neutrophil-Lymphocyte Ratio and Lymphocyte-Monocyte Ratio correlate with Chronic Prosthetic Joint Infection but are not useful markers for diagnosis. Arch Orthop Trauma Surg 2024; 144:297-305. [PMID: 37874358 DOI: 10.1007/s00402-023-05052-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/02/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE To investigate reported correlations between Neutrophil-to-Lymphocyte (NLR) and Lymphocyte-to-Monocyte (LMR) ratios and their value in diagnosis of chronic prosthetic joint infection (PJI) in a large cohort of patients from a single specialist hospital. METHODS Diagnostic aspirations of 362 patients under investigation for PJI were identified. Of the included patients 185 patients received a final diagnosis of PJI and 177 were classed as aseptic. Established criteria (ICM 2018) were employed to define PJI. Included in the analysis are differential white cell counts, C-Reactive Protein (CRP), Synovial Leukocyte Count, Synovial Alpha-defensin ELISA and Synovial Leukocyte esterase activity. Receiver-operator characteristic (ROC) curves were calculated for each of the available diagnostic tests together with the corresponding area under the curve values (AUC). Youden's index was utilized to identify the optimal diagnostic threshold point for the NLR and LMR. Other diagnostic tests were evaluated as per the threshold values previously defined in the literature and specified in the ICM criteria. RESULTS Using Youden's Index to identify the optimal NLR cut-off within our cohort we established a value of 2.93. This yielded a sensitivity of 0.60 and specificity of 0.64. The area under the curve (AUC) of a receiving operator characteristics (ROC) curve was 0.625. Regarding the LMR the results demonstrate similar findings; a positive correlation with a diagnosis of infection but poor sensitivity and specificity. The AUC for LMR was 0.633 and was not superior to NLR (P = 0.753). CONCLUSIONS There is a significant correlation between higher Neutrophil-Lymphocyte and Lymphocyte-Monocyte ratios, and a diagnosis of PJI. The sensitivity and specificity of this calculation is poor and the does not add value to the diagnostic algorithm for PJI. LEVEL OF EVIDENCE Level III Retrospective Cohort analysis.
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Affiliation(s)
- Daniel Timothy Burchette
- ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany.
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.
| | - Mustafa Fatih Dasci
- ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
- Department of Orthopaedics and Traumatology, Istanbul Bagcilar Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Beatriz Fernandez Maza
- ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
- Puerta de Hierro University Hospital, Calle de Joaquín Rodrigo, Madrid, Spain
| | - Philip Linke
- ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | | | - Mustafa Citak
- ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
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Fahlbusch H, Budin M, Volk A, von Rehlingen Prinz F, Linke P, Citak M, Gehrke T, Ohlmeier M. Long-term outcomes of total hip arthroplasty in patients with developmental dysplasia of the hip: a minimum 21-year follow-up. Arch Orthop Trauma Surg 2023; 143:6609-6616. [PMID: 37421515 DOI: 10.1007/s00402-023-04970-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Early osteoarthritis (OA) due to developmental dysplasia of the hip (DDH) is a known indication for total hip arthroplasty (THA). Though screening tools and joint-preserving procedures have been established successfully, there still is a relevant number of patients suffering DDH. Due to the lack of long-term outcome studies, we like to close this gap and present the results of a highly specialized center. METHODS The study included 126 patients, who were treated in our institution with primary THA for DDH between January 1997 and December 2000. At the time of final follow-up, at a mean of 23 years postoperatively, 110 patients (121 hips) were clinically evaluated using the Harris-Hip Score. In addition, complication and surgical revision rates were assessed. We collected surgery-related data like implant choice and special surgical features such as autologous acetabular reconstruction or femoral osteotomies. Additionally, the severity of preoperative DDH was measured radiographically according to Crowe classification. RESULTS There were 91 female (83%) and 19 male (17%) patients with an average age of 51 ± 9.5 years (range 21-65) included. Mean follow-up was 23 ± 1.3 years (21-25), with a minimum of 21 years being necessary for inclusion. Using revision for any indication as primary endpoint, the Kaplan-Meier survivorship was 98.3% at 10 years and 81.8% at final follow-up. The overall revision rate was 18% (22 cases), which were split up as follows: 20 (17%) implant failures (loosened or broken components), one (1%) periprosthetic infection and one (1%) periprosthetic fracture. Regarding complications, we observed nine (7%) dislocations and one case (1%) with severe heterotopic ossification that required surgical excision. The mean Harris-Hip score at latest follow-up was 78 ± 14 points (32-95). CONCLUSIONS Though implants and surgical techniques have improved over time, our results suggest THA in patients suffering DDH to be seriously challenging with relatively high overall complications in long-term observation and fair clinical outcome after 21 years postoperatively. There is evidence that prior osteotomy might be associated with a higher revision rate.
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Affiliation(s)
- Hendrik Fahlbusch
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767, Hamburg, Germany
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Maximilian Budin
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767, Hamburg, Germany
| | - Annabelle Volk
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Fidelius von Rehlingen Prinz
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767, Hamburg, Germany
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Philip Linke
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767, Hamburg, Germany
| | - Malte Ohlmeier
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767, Hamburg, Germany.
- Department of Orthopaedic and Trauma Surgery, UKM Marienhospital, Mauritiusstraße 5, 48565, Steinfurt, Germany.
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Krause M, Frosch KH, Linke P. [Anterior plate osteosynthesis for multifragmentary patella fracture with additive stabilization of the distal pole using suture cerclage]. Unfallchirurgie (Heidelb) 2023:10.1007/s00113-023-01320-1. [PMID: 37171644 DOI: 10.1007/s00113-023-01320-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 05/13/2023]
Abstract
OPERATION GOAL The aims of the surgical treatment are the anatomical reduction of the articular surface and stabilization of a multifragmentary patella fracture with a distal pole fragment using plate osteosynthesis and additive suture tape cerclage to secure the distal fragment. INDICATION Demonstration of the surgical procedure for a multifragmentary patella fracture in the knee joint of a male cadaver. SURGICAL TECHNIQUE Start with a median prepatellar skin incision and splitting of the bursa and surrounding fascia. Lateral arthrotomy with proximal and distal extension for complete eversion and articular exposure of the multifragmentary fracture. The fracture is then reduced from the articular side using temporary K‑wire fixation and reduction clamps, followed by screw osteosynthesis of the large fragments (e.g., distal and proximal poles). After selection of the plate it is fixed with locking screws. In addition, a suture cerclage according to Krakow and/or McLaughlin is applied distally and transosseously through the tibial tuberosity and proximally through the quadriceps tendon. The knotting of the McLaughlin suture cerclage should be done in 90° flexion of the knee joint. POSTOPERATIVE TREATMENT Functional postoperative treatment with hard shell orthesis with movement limitation (30°, 60° and 90° for 2 weeks each) and partial weight bearing of 15-20 kg for 6 weeks is recommended. Full weight-bearing is only allowed in full extension. EVIDENCE Plate osteosynthesis is biomechanically superior in comparison to the widely used tension band osteosynthesis. In multifragmentary fractures, additional augmentation with a suture tape cerclage seems to be appropriate. Due to the lack of study results there is currently no clinical evidence for this.
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Affiliation(s)
- Matthias Krause
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland.
| | - Karl-Heinz Frosch
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland
- Abteilung für Unfallchirurgie, Orthopädie und Sporttraumatologie, BG Klinikum Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Deutschland
| | - Philip Linke
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland
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Levent A, Kose O, Linke P, Gehrke T, Citak M. Tranexamic acid is safe and effective in patients with heterozygous factor V Leiden mutation during total joint arthroplasty. Arch Orthop Trauma Surg 2023; 143:613-620. [PMID: 34342666 DOI: 10.1007/s00402-021-04110-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 07/28/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Patients with an inherent hypercoagulable state are at a higher risk of venous thromboembolism (VTE) following total joint arthroplasty (TJA). Further administration of tranexamic acid (TXA) during TJA may increase the risk of VTE in these high-risk patients. There is no study that specifically analyzes the safety and efficacy of TXA during TJA in patients with factor V Leiden (FVL) mutation; therefore, the purpose of this study was to evaluate the safety and efficacy of TXA use on the risk of VTE and bleeding in patients carrying FVL mutation. MATERIALS AND METHODS A total of 42 patients with FVL mutation (22 hips, 20 knees) and 40 control patients (20 hips, 20 knees) who underwent TJA were retrospectively reviewed. All patients received 1 g TXA intravenously 15 min before the skin incision and 2 g of TXA was administered locally at the surgical site as a periarticular injection. Pharmacological thromboprophylaxis (low-molecular-weight heparin) was administered to all patients. Estimated blood loss and in-hospital thromboembolic complications were compared between the groups. RESULTS In both total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients, there was no significant difference in the amount of estimated blood loss among the groups (p = 0.980, and p = 0963, respectively). None of the patients in the THA group received a blood transfusion. The transfusion rate was similar in the TKA group (p = 0.756, one patient in each group). No VTE, myocardial infarction, or any other complications related to TXA use were observed in any of the patients. CONCLUSIONS The combined local and systemic administration of TXA could be safely used in patients with heterozygous FVL mutation receiving pharmacological thromboprophylaxis during TJA without increasing the risk of VTE.
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Affiliation(s)
- Ali Levent
- Department of Orthopedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany. .,Department of Orthopedics and Traumatology, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Health Sciences University, Şanlıurfa, Turkey.
| | - Ozkan Kose
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Philip Linke
- Department of Orthopedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
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Linke P, Wilhelm P, Levent A, Gehrke T, Salber J, Akkaya M, Suero EM, Citak M. Anatomical risk factors for aseptic loosening of full hinge knee prosthesis in primary and revision TKAs. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04776-3. [PMID: 36645460 DOI: 10.1007/s00402-023-04776-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 01/08/2023] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Risk factors (RF) associated with aseptic loosening (AL) in total knee arthroplasty (TKA) are poorly understood. Therefore, the aim of this study was to investigate the anatomical shape variations in relation to the inner-diameter of the femur and the tibia as prognostic RF for AL of full hinge prosthesis (FHP) in primary and revision TKA. MATERIALS AND METHODS We retrospectively examined all patients, who underwent revision surgery (2003-2018) due to AL of the FHP in primary (n = 38) and revision TKA (n = 46). Diagnosis-appropriate controls without AL at minimum follow-up of 24 months were randomly collected for each group. Besides other risk factors, we also measured the inner diameter of the femur according to the Citak classification and of the tibia on anteroposterior radiographies. RESULTS RF for AL are younger age in primary and revision as well as > 1 previous surgeries in revision TKA. The femoral index was shown to be a RF for AL in revision TKA (p = 0.001), but not in primary TKA. The novel tibial index was associated with AL in primary with AUC 0.776 (95% CI 0.67, 0.88), 65.8% sensitivity, 86.6% specificity and in revision TKA with AUC 0.817 (95% CI 0.73, 0.91), 82.6% sensitivity and 71.7% specificity. CONCLUSION This is the first study to calculate the tibial measurements and the tibial index according to Citak et al. and to identify them as prognostic RF for AL of the full hinge knee prosthesis in TKA and confirm the femoral index as a RF for AL also in revision full hinge knee prosthesis. Therefore, the preoperative radiological evaluation should include the analysis of the anatomical shape variants in order to select the appropriate prosthesis design with a possibly enhanced prognosis.
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Affiliation(s)
- Philip Linke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Peter Wilhelm
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Ali Levent
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Jochen Salber
- Department of Surgery, Ruhr-University, Bochum, Germany
| | - Mustafa Akkaya
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany.,Department of Orthopaedics and Traumatology, Ankara Yildirim Beyazit Universitesi Tip Fakultesi, Ankara, Turkey
| | - Eduardo M Suero
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany.
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Scholz T, Akkaya M, Linke P, Busch SM, Gehrke T, Salber J, Citak M. The anatomical shape of the distal femur is an independent risk factor for aseptic loosening following one-stage septic knee revision using rotating hinge knee prosthesis. Arch Orthop Trauma Surg 2023; 143:481-488. [PMID: 34978606 DOI: 10.1007/s00402-021-04327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/18/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Aseptic loosening (AL) is the second most common reason for failure after one-stage septic knee revision. In this context, the goal of the study is to identify risk factors for AL following one-stage septic knee revision using rotating hinge implants. We aimed to answer the following research question: How does the anatomical shape of the distal femur represent an independent risk factor for AL following one-stage septic knee revision arthroplasty? METHODS Patients, who had undergone re-revision surgery due to AL of the rotating hinge knee prosthesis after one-stage septic knee revision arthroplasty between January 2008 and December 2018, were included. For this purpose, 41 patients with AL after one-stage septic knee revision using rotating hinge implants and 37 controls without any revision surgery at latest follow-up were included in this study. Using standardized anteroposterior (AP) views of the knee in all patients, we measured the inner diameter of the femur 20 cm proximally from the joint line and at a point 2 cm proximally from the adductor tubercle. RESULTS Among the vast majority of AL cases, we identified an isolated loosening of the femoral component. The AL group showd a high distribution of the Type C according to the Citak classification with 75.7%. Contrary to this, with 24.3% (p < 0.001) the amount of Type C cases was relatively low in the control group. Consequently, Type C configurations of the distal femur represent an independent risk factor for AL with an approximately sevenfold higher risk for AL compareed to Type A and Type B. CONCLUSIONS The novel radiological classification system of the distal femur shows that the Type C subtype is an independent and main risk factor for AL after one-stage septic knee revision using rotating hinge knee implants.
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Affiliation(s)
- Timo Scholz
- Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Mustafa Akkaya
- Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Philip Linke
- Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Sophia-Marlene Busch
- Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Jochen Salber
- Department of Surgery, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany.
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Linke P, Lausmann C, Gehrke T, Citak M. [Arthrofibrosis of the hip joint : Diagnostic and therapeutic challenge]. Unfallchirurgie (Heidelb) 2022; 125:868-871. [PMID: 35994058 DOI: 10.1007/s00113-022-01240-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
Arthrofibrosis is a frequent complication after total knee arthroplasty (TKA). Recently, arthrofibrosis could be successfully verified histologically after primary total hip arthroplasty (THA) and the clinical presentation on the hip could be described for the first time. Possible diagnostic and therapeutic approaches have not yet been published. The diagnostic work-up differs only slightly from that for the knee joint. Other causes, such as aseptic loosening, malalignment or periprosthetic joint infection should be excluded. The gold standard is still invasive diagnostics with histological evidence of arthrofibrosis according to the synovia-like interface membrane (SLIM) criteria. Conservative treatment approaches include mobilization under anesthesia and medication according to Traut, analogous to the knee joint. Surgical treatment should be carried out under strict interpretation of the indications and after detailed clarification for the patient. In contrast to the knee joint, open arthrolysis should be preferred to arthroscopic arthrolysis of the hip joint. It must be taken into consideration that the evidence for conservative as well as surgical treatment, including possible revision arthroplasty, cannot be assessed due to the absence of clinical data. Studies under controlled conditions on the possible treatment approaches in the presence of arthrofibrosis are desirable and necessary in order to be able to assess the significance of the symptoms. In addition to treatment, great importance should also be attached to the diagnostics. Histological confirmation of the diagnosis of arthrofibrosis should only be considered to a limited extent in the case of an assumed, only moderately successful surgical intervention.
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Affiliation(s)
- Philip Linke
- Orthopädische Chirurgie, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Deutschland.
| | - Christian Lausmann
- Orthopädische Chirurgie, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Deutschland
| | - Thorsten Gehrke
- Orthopädische Chirurgie, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Deutschland
| | - Mustafa Citak
- Orthopädische Chirurgie, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Deutschland
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Linke P, Akoto R, Frosch KH, Krause M. Rolle der Umstellungsosteotomien bei chronischen peripheren Instabilitäten am Kniegelenk. Arthroskopie 2022. [DOI: 10.1007/s00142-022-00567-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Linke P, Linke C, Neumann J, Werner AW. Midterm clinical outcome of uncemented short-stem reversed shoulder arthroplasty. Arch Orthop Trauma Surg 2022; 143:3025-3036. [PMID: 35804166 DOI: 10.1007/s00402-022-04510-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION While the incidence of reverse total shoulder arthroplasty (rTSA) is increasing constantly, newer implants with designs other than the classic Grammont geometry are gaining importance. More anatomic inclination angles and lateralization are supposed to have a positive impact on clinical results and complication rates. Presentation of midterm results therefore is important to support these assumptions. The aim of this study was to report the midterm clinical outcome of primary rTSA with an uncemented humeral short-stem prosthesis (USSP) with a humeral inclination angle of 145° and the analysis of different variables on the outcome. METHODS This is a retrospective study of all patients with primary rTSA using an USSP and a combined humeral inclination angle of 145° (Ascend™ flex, Stryker) with a minimum clinical follow-up of 2 years. The implant combines a 132.5° inclination for the humeral stem with an additional 12.5° for the polyethylene inlay. Primary outcomes were patient-reported outcome measures: ASES score, simple shoulder test (SST) and subjective shoulder value (SSV). Secondary outcomes were complication and revision rates. We analyzed different variables: preoperatively gender, age, indication for surgery and status of rotator cuff. Also, the glenoid morphology was classified according to Walch and a proximal humerus cortical bone thickness measurement (CBT avg) of 6 mm was used as a threshold for osteoporosis. Postoperatively, we analyzed different radiologic parameters: filling ratio, distalization and lateralization angles according to Boutsiadis. RESULTS A total of 84 out of 99 (85%) patients with a mean FU of 46.7 months (range 24-80 months) could be included: 62 women and 22 men with a mean age of 74.7 years. Mean ASES score significantly increased from 47 preoperatively to 85.8 at the last follow-up (p = 0.001). The postoperative SST reached an average of 65.3 and the mean SSV was 83%. None of the variable parameters analyzed could be identified as a risk factor for a lower outcome defined as a SSV < 70. Three patients (3.6%) had a complication: one incomplete lower plexus lesion, one dislocation and one major hematoma. Surgical revision was needed in two cases (2.4%). CONCLUSION The midterm clinical outcome of primary reverse total shoulder arthroplasty (rTSA) with an uncemented humeral short stem and a humeral inclination angle of 145° showed good-to-excellent results with a low complication and revision rate independent from a wide range of pre- and postoperative variables. PROMs are comparable to those reported for anatomic TSA with a low complication rate, different to historical studies especially with the Grammont design. LEVEL OF EVIDENCE Treatment study, Level IV.
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Affiliation(s)
- Philip Linke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Carolin Linke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Jörg Neumann
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Andreas W Werner
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany. .,MVZ Argon, Department of Sports Medicine/Orthopaedics, ARGON Orthopädie, Große Bleichen 5, 20354, Hamburg, Germany.
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De Matteo V, Forero F, Busch SM, Linke P, Wilhelm P, Rademacher K, Gehrke T, Citak M. Enhancing the radiological classification system from the distal femur to the proximal tibia. Jt Dis Relat Surg 2022; 33:33-39. [PMID: 35361078 PMCID: PMC9057554 DOI: 10.52312/jdrs.2022.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/11/2022] [Indexed: 11/14/2022] Open
Abstract
Objectives Patients and methods Results Conclusion
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Affiliation(s)
| | | | | | | | | | | | | | - Mustafa Citak
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg Holstenstrasse 2, 22767 Hamburg, Germany.
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Akkaya M, Buday Z, Akcaalan S, Linke P, Gehrke T, Citak M. In-hospital complications following total knee and hip arthroplasty in patients with human immunodeficiency virus. Jt Dis Relat Surg 2022; 33:3-8. [PMID: 35361074 PMCID: PMC9057546 DOI: 10.52312/jdrs.2022.550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/02/2022] [Indexed: 11/14/2022] Open
Abstract
Objectives Patients and methods Results Conclusion
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Affiliation(s)
| | | | | | | | | | - Mustafa Citak
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, 22767 Hamburg, Germany.
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14
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Neufeld ME, Liechti EF, Soto F, Linke P, Busch SM, Gehrke T, Citak M. High revision rates following repeat septic revision after failed one-stage exchange for periprosthetic joint infection in total knee arthroplasty. Bone Joint J 2022; 104-B:386-393. [PMID: 35227090 DOI: 10.1302/0301-620x.104b3.bjj-2021-0481.r2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS The outcome of repeat septic revision after a failed one-stage exchange for periprosthetic joint infection (PJI) in total knee arthroplasty (TKA) remains unknown. The aim of this study was to report the infection-free and all-cause revision-free survival of repeat septic revision after a failed one-stage exchange, and to determine whether the Musculoskeletal Infection Society (MSIS) stage is associated with subsequent infection-related failure. METHODS We retrospectively reviewed all repeat septic revision TKAs which were undertaken after a failed one-stage exchange between 2004 and 2017. A total of 33 repeat septic revisions (29 one-stage and four two-stage) met the inclusion criteria. The mean follow-up from repeat septic revision was 68.2 months (8.0 months to 16.1 years). The proportion of patients who had a subsequent infection-related failure and all-cause revision was reported and Kaplan-Meier survival for these endpoints was determined. Patients were categorized according to the MSIS staging system, and the association with subsequent infection was analyzed. RESULTS At the most recent follow-up, 17 repeat septic revisions (52%) had a subsequent infection-related failure and the five-year infection-free survival was 59% (95% confidence interval (CI) 39 to 74). A total of 19 underwent a subsequent all-cause revision (58%) and the five-year all-cause revision-free survival was 47% (95% CI 28 to 64). The most common indication for the first subsequent aseptic revision was loosening. The MSIS stage of the host status (p = 0.663) and limb status (p = 1.000) were not significantly associated with subsequent infection-related failure. CONCLUSION Repeat septic revision after a failed one-stage exchange TKA for PJI is associated with a high rate of subsequent infection-related failure and all-cause revision. Patients should be counselled appropriately to manage expectations. The host and limb status according to the MSIS staging system were not associated with subsequent infection-related failure. Cite this article: Bone Joint J 2022;104-B(3):386-393.
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Affiliation(s)
- Michael E Neufeld
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany.,Department of Orthopaedics, Division of Lower Limb Reconstruction, University of British Columbia, Vancouver, Canada
| | - Emanuel F Liechti
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany.,Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fernando Soto
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany.,Department of Orthopaedic Surgery, Hospital Naval Almirante Nef, Viña del Mar, Chile
| | - Philip Linke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | | | - Thorsten Gehrke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
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Liechti EF, Neufeld ME, Soto F, Linke P, Busch SM, Gehrke T, Citak M. Favourable outcomes of repeat one-stage exchange for periprosthetic joint infection of the hip. Bone Joint J 2022; 104-B:27-33. [PMID: 34969284 DOI: 10.1302/0301-620x.104b1.bjj-2021-0970.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS One-stage exchange for periprosthetic joint infection (PJI) in total hip arthroplasty (THA) is gaining popularity. The outcome for a repeat one-stage revision THA after a failed one-stage exchange for infection remains unknown. The aim of this study was to report the infection-free and all-cause revision-free survival of repeat one-stage exchange, and to investigate the association between the Musculoskeletal Infection Society (MSIS) staging system and further infection-related failure. METHODS We retrospectively reviewed all repeat one-stage revision THAs performed after failed one-stage exchange THA for infection between January 2008 and December 2016. The final cohort included 32 patients. The mean follow-up after repeat one-stage exchange was 5.3 years (1.2 to 13.0). The patients with a further infection-related failure and/or all-cause revision were reported, and Kaplan-Meier survival for these endpoints determined. Patients were categorized according to the MSIS system, and its association with further infection was analyzed. RESULTS A total of eight repeat septic revisions (25%) developed a further infection-related failure, and the five-year infection-free survival was 81% (95% confidence interval (CI) 57 to 92). Nine (28%) underwent a further all-cause revision and the five-year all-cause revision-free survival was 74% (95% CI 52 to 88). Neither the MSIS classification of the host status (p = 0.423) nor the limb status (p = 0.366) was significantly associated with further infection-related failure. CONCLUSION Repeat one-stage exchange for PJI in THA is associated with a favourable five-year infection-free and all-cause revision-free survival. Notably, the rate of infection control is encouraging when compared with the reported rates after repeat two-stage exchange. The results can be used to counsel patients and help clinicians make informed decisions about treatment. With the available number of patients, further infection-related failure was not associated with the MSIS host or limb status. Cite this article: Bone Joint J 2022;104-B(1):27-33.
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Affiliation(s)
- Emanuel F Liechti
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany.,Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael E Neufeld
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany.,Department of Orthopaedic Surgery, Lower Limb (Adult Hip & Knee) Reconstruction, The University of British Columbia, Vancouver, Canada
| | - Fernando Soto
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany.,Department of Orthopaedic Surgery, Hospital Naval de Viña del Mar Almirante Nef, Vina del Mar, Chile
| | - Philip Linke
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany
| | - Sophia-Marlene Busch
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Hamburg, Germany
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Busch SM, Citak M, Akkaya M, Prange F, Gehrke T, Linke P. Risk factors for mortality following one-stage septic hip arthroplasty - a case-control study. Int Orthop 2021; 46:507-513. [PMID: 34591156 DOI: 10.1007/s00264-021-05230-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Despite good clinical outcomes and a high success rate, there is a comparatively high mortality after one stage septic exchange of total hip arthroplasty. The aim of this study was to identify risk factors for mortality in the hospitalization period after one-stage septic exchange of THA. METHODS We retrospectively analyzed in our database all patients who had a one-stage septic exchange for periprosthetic infection of THA and died during hospitalization (n = 33). The control group was matched semi-randomly by surgical procedure (n = 121) who did not die during hospitalization. The two groups were analyzed for risk factors such as age, Charlson Comorbidity Index (CCI), and high-/low-virulence bacteria. RESULTS In the deceased group, 16 patients were female and 17 were male with a mean age at surgery of 73.2 years. In the control group, there were 55 females and 66 males with an average age at surgery of 68.2 years. Comparing the two groups, the deceased group had a significantly higher proportion of liver disease as well as higher rate of pulmonary embolism, apoplexy, and/or myocardial infarction, an increased CCI with an average of 6.5 and advanced age. Further demographic and surgery-related parameters especially high- or low-virulent germs were not identified as risk factors for mortality during the hospitalization period. The binominal logistic regression analysis showed that the probability of an inpatient death following one-stage septic exchange of THA increases by a factor of 3.079, with each additional point of the CCI. CONCLUSION In conclusion, advanced age and high CCI are the main risk factors for mortality after single-stage septic change of THA. However, high-virulence bacteria have no influence on the mortality during the hospitalization period after one-stage septic exchange of THA.
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Affiliation(s)
- Sophia-Marlene Busch
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany.
| | - Mustafa Akkaya
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Felix Prange
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Philip Linke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
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Citak M, Luck S, Linke P, Gehrke T, Kühn KD. [Manual addition of antibiotics to industrial bone cement mixes : Investigations of the dry mix in the cement cartridge during manual admixture to polymer-active substance mixtures]. Orthopade 2021; 51:44-51. [PMID: 34032883 DOI: 10.1007/s00132-021-04115-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Periprosthetic infection (PPI) is a rare but serious complication. An elementary component of the therapy of PPI is the use of bone cement with the addition of antibiotics. For targeted therapy, manual mixing of antibiotics with industrially produced bone cement mixtures is often necessary. Possible problems resulting from manual mixing have not been described sufficiently so far. OBJECTIVES Therefore, the aim of the present study was to describe the influence of the additional homogenisation by dry mixing of a polymer-active substance mixture on the quality of manually added cement. MATERIAL AND METHODS In the laboratory-based study, four cement samples were prepared using different methods for manual addition and homogenisation of antibiotics (vancomycin). The reference control was Copal® G + V (Heraeus Medical GmbH, Wehrheim, Germany), to which the vancomycin (V) had already been industrially added. The samples were then examined for mechanical, microbiological and microscopic parameters. RESULTS In the mechanical and microbiological results, no statistically significant differences were found between the manually added mixtures and the reference. After dry mixing of the polymer powder, the inner surface of the mixing cartridges used showed signs of scratching in the microscopic examination and showed indications of abrasion during mixing. CONCLUSION The manual addition of antibiotics to industrially produced bone cement should be reserved for selected indications if the bone cement mixtures produced by industry are not sufficient.
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Affiliation(s)
- Mustafa Citak
- Abteilung für Orthopädische Chirurgie, Helios ENDO-Klinik, Holstenstr. 2, 22767, Hamburg, Deutschland
| | - Stefan Luck
- Abteilung für Orthopädische Chirurgie, Helios ENDO-Klinik, Holstenstr. 2, 22767, Hamburg, Deutschland
| | - Philip Linke
- Abteilung für Orthopädische Chirurgie, Helios ENDO-Klinik, Holstenstr. 2, 22767, Hamburg, Deutschland.
| | - Thorsten Gehrke
- Abteilung für Orthopädische Chirurgie, Helios ENDO-Klinik, Holstenstr. 2, 22767, Hamburg, Deutschland
| | - Klaus-Dieter Kühn
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, Graz, Österreich
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Levent A, Köse Ö, Linke P, Gehrke T, Çıtak M. Does tourniquet use decrease blood loss following primary total knee arthroplasty in Jehovah's Witness patients? Jt Dis Relat Surg 2020; 31:419-425. [PMID: 32962570 PMCID: PMC7607954 DOI: 10.5606/ehc.2020.76244] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/05/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES This study aims to investigate the use of multiple blood management strategies and the effect of tourniquet on the estimated blood loss (EBL) in Jehovah's Witness (JW) patients who underwent primary total knee arthroplasty (TKA). PATIENTS AND METHODS Twenty-two self-reported JW patients (9 males, 13 females; mean age 66.8±8.6 years; range, 51 to 83 years) who underwent primary TKA between January 2014 and January 2020 in our institution were retrospectively reviewed. A standard blood management protocol that consisted of hypotensive anesthesia, local and systemic administration of tranexamic acid (TXA) and intraoperative cell salvage was applied to all patients. Patients were divided into two groups: with (n=11) and without (n=11) tourniquet use. The EBL was calculated according to Meunier's formula. Hemoglobin (Hgb), hematocrit (Hct), and EBL on the first and third postoperative days were compared statistically. RESULTS There was no significant difference between groups regarding postoperative Hgb (p=0.801 and p=0.767), Hct (p=0.617 and p=0.895), Hgb decline (p=0.311 and p=0.822), and EBL (p=0.067 and p=0.284) at first and third postoperative days. None of the patients required blood transfusion. No wound complication or symptomatic deep vein thrombosis was seen during the hospital stay. CONCLUSION Combined use of hypotensive anesthesia, intravenous administration of TXA, intraoperative periarticular injection, and cell salvage seem to be sufficient in controlling the blood loss in JW patients during TKA. Additional tourniquet use may not further decrease the EBL.
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Affiliation(s)
- Ali Levent
- Department of Orthopedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767 Hamburg, Germany.
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Challiwala M, Ghouri M, Linke P, El-Halwagi M, Elbashir N. A combined thermo-kinetic analysis of various methane reforming technologies: Comparison with dry reforming. J CO2 UTIL 2017. [DOI: 10.1016/j.jcou.2016.11.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Suess E, Torres M, Bohrmann G, Collier R, Rickert D, Goldfinger C, Linke P, Heuser A, Sahling H, Heeschen K, Jung C, Nakamura K, Greinert J, Pfannkuche O, Trehu A, Klinkhammer G, Whiticar M, Eisenhauer A, Teichert B, Elver M. Sea Floor Methane Hydrates at Hydrate Ridge, Cascadia Margin. ACTA ACUST UNITED AC 2013. [DOI: 10.1029/gm124p0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
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Linke P, Münch C, Borisow N, Holm T, Maier A, Dullinger JS, Meyer T. Amyotrophe Lateralsklerose-Functional Rating Scale-online. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Maier A, Linke P, Dullinger JS, Borisow N, Münch C, Böttcher T, Meyer T. Hypakusis bei ALS. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dullinger JS, Kopp U, Maier A, Linke P, Borisow N, Meyer T. Amyotrophe Lateralsklerose mit primär progressiver Aphasie: Implikationen für das Patientenmanagement anhand eines Fallberichtes. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Meyer T, Dullinger J, Münch C, Keil J, Hempel E, Rosseau S, Borrisow N, Linke P. Elektive Termination der Beatmungstherapie bei der amyotrophen Lateralsklerose. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Meyer T, Maier A, Borisow N, Dullinger JS, Splettstößer G, Ohlraun S, Münch C, Linke P. Thalidomide causes sinus bradycardia in ALS. J Neurol 2008; 255:587-91. [DOI: 10.1007/s00415-008-0756-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Revised: 08/26/2007] [Accepted: 09/27/2007] [Indexed: 10/22/2022]
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Meyer T, Münch C, van Landeghem FKH, Borisow N, Dullinger J, Linke P. [Progressive muscle atrophy. A rarely diagnosed variant of amyotrophic lateral sclerosis]. Nervenarzt 2008; 78:1383-8. [PMID: 17516042 DOI: 10.1007/s00115-007-2288-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Progressive muscle atrophy (PMA) is a degenerative disease of the lower motor neuron. The course of the illness and the fatal prognosis correspond to those of amyotrophic lateral sclerosis (ALS). Neuropathologic and genetic findings support categorizing PMA within the spectrum of ALS, even though no clinical sign of a disorder of the upper motor neuron is demonstrable. The diagnosis of PMA is based on advanced extremity pareses and atrophies with a high progression rate. Respiratory insufficiency is determinative of the prognosis. Absent or late affection of bulbar functions is characteristic of the disease. Intraneuronal bunina bodies and ubiquitine-positive inclusions, which are established morphologic characteristics of ALS, are found post mortem. The treatment options of riluzol medication, respiratory therapy, and nutrition are analogous to those for typical ALS.
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Affiliation(s)
- T Meyer
- Neurologische Klinik und Poliklinik, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany.
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Abstract
OBJECTIVES Mutations in the p150 subunit of the axonal transport protein dynactin (DCTN1) have been reported in patients with amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). Given the common features of neurodegeneration in multiple sclerosis (MS), FTD and ALS, sequence variants of the DCTN1 gene may be a contributory factor to neurodegeneration in MS. METHODS We investigated a total of 200 MS patients and 200 controls. A total of 100 patients had a relapsing-remitting form of MS, 100 cases were primary progressive. Sequence alterations were screened for in the coding region of DCTN1 using heteroduplex and sequence analyses. RESULTS Two heterozygous missense mutations (T1249I, I196V) were found in two healthy control subjects. No mutations were identified in 200 MS patients. The frequency of a known single nucleotide polymorphism (R495Q) was not significantly different between patients and controls. CONCLUSION The results indicate that the DCTN1 gene is probably not influencing susceptibility to neurodegeneration in MS.
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Affiliation(s)
- C Münch
- Department of Neurology, Jewish Hospital, Berlin, Germany.
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Meyer T, Maier A, Borisow N, Dullinger J, Splettstoesser G, Ohlraun S, Münch C, Linke P. Thalidomide causes sinus bradycardia in ALS. Akt Neurol 2007. [DOI: 10.1055/s-2007-987546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Spuler S, Jurkat-Rott K, Huebner A, Lehmann-Horn F, Linke P, van Landeghem F, Dullinger J, Meyer T. Progressive muscle atrophy with hypokalaemic periodic paralysis and calcium channel mutation. Akt Neurol 2007. [DOI: 10.1055/s-2007-987968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Meyer T, Schwan A, Dullinger JS, Brocke J, Hoffmann KT, Nolte CH, Hopt A, Kopp U, Andersen P, Epplen JT, Linke P. Early-onset ALS with long-term survival associated with spastin gene mutation. Neurology 2006; 65:141-3. [PMID: 16009903 DOI: 10.1212/01.wnl.0000167130.31618.0a] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors report a 73-year-old patient with a natural history of early-onset ALS for 49 years presenting with limb and bulbar amyotrophy and a pyramidal syndrome. Analysis of the locus SPG4 identified a heterozygous duplication mutation (c.304_309dupGCCTCG) within exon 1 of the spastin gene. We propose that sequence alterations of spastin may comprise a genetic risk factor in a greater spectrum of motor neuron disorders including clinical variants of ALS.
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Affiliation(s)
- T Meyer
- Department of Neurology, University Hospital, Berlin, Germany.
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Munch C, Meyer R, Linke P, Meyer T, Ludolph A, Haas J, Hemmer B. The p150 subunit of dynactin gene in multiple sclerosis. Akt Neurol 2006. [DOI: 10.1055/s-2006-953203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Linke P, Schwan A, Dullinger J, Brocke J, Hoffmann K, Nolte C, Hopt A, Kopp U, Andersen P, Epplen J, Meyer T. Juvenile ALS with long-term survival associated with spastin gene mutation. Akt Neurol 2005. [DOI: 10.1055/s-2005-919644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Meyer T, Nolte C, Hopt A, Kopp U, Linke P. Parieto-occipital atrophy in chronic juvenile ALS with long-term progression of 47 years. Akt Neurol 2004. [DOI: 10.1055/s-2004-833198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Marcoulaki E, Linke P, Kokossis A. Design of Separation Trains and Reaction-Separation Networks Using Stochastic Optimization Methods. Chem Eng Res Des 2001. [DOI: 10.1205/026387601528499] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Dando P, Aliani S, Arab H, Bianchi C, Brehmer M, Cocito S, Fowlers S, Gundersen J, Hooper L, Kölbh R, Kuevere J, Linke P, Makropoulosr K, Meloni R, Miquel JC, Morri C, Müller S, Robinson C, Schlesner H, Sieverts S, Störr R, Stüben D, Thormm M, Varnavas S, Ziebiss W. Hydrothermal studies in the aegean sea. ACTA ACUST UNITED AC 2000. [DOI: 10.1016/s1464-1909(99)00112-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Oehmichen M, Linke P, Zilles K, Saternus KS. Reactive astrocytes and macrophages in the brain stem of SIDS victims? Eleven age- and sex-matched SIDS and control cases. Clin Neuropathol 1989; 8:276-83. [PMID: 2620481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The investigation was carried out on 11 sudden infant death (SIDS) cases which were compared with age- and sex-matched controls. Six brain nuclei were selected for evaluation. Using immunohistochemical methods, macrophages were selectively demonstrated by detection of lysozyme; reactive astrocytes, by detection of intracytoplasmic albumin (marker of prior impairment of blood-brain barrier function) or GFAP. No lysozyme-positive cells were demonstrable in the brain stem of any of the examined cases. Although a greater number of reactive, GFAP-expressing astrocytes were found in the SIDS cases, 3 of the 11 SIDS cases (compared to 5 controls) had no reactive astrocytes in any of examined brain nuclei. Reactive astrocytes, however, were identified in more than half the controls. Sections treated with anti-albumin serum were evaluated quantitatively. Total number of non-neuronal cells, relative proportion of astrocytes, and proportion of albumin-positive astrocytes were determined. Paired brain nuclei were counted on both sides of the brain stem. The number of non-neuronal cells, astrocytes, and albumin-positive astrocytes in the SIDS cases did not differ significantly from those in the controls. No statistically relevant difference was established between the right and left parts of the brain stem. The findings were discussed in light of the literature.
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Affiliation(s)
- M Oehmichen
- Institut für Rechtsmedizin, Universität Köln, FRG
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Weiss H, Linke P, Haiker H, Leonard K. Structure and function of the mitochondrial ubiquinol: cytochrome c reductase and NADH: ubiquinone reductase. Biochem Soc Trans 1987; 15:100-2. [PMID: 3030833 DOI: 10.1042/bst0150100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Linke P, Bechmann G, Gothe A, Weiss H. Dimeric ubiquinol:cytochrome c reductase of Neurospora mitochondria contains one cooperative ubiquinone-reduction centre. Eur J Biochem 1986; 158:615-21. [PMID: 3015618 DOI: 10.1111/j.1432-1033.1986.tb09799.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Dimeric ubiquinol:cytochrome c reductase of Neurospora mitochondria was isolated as a protein-Triton complex and free of ubiquinol (Q). The enzyme was incorporated into phosphatidylcholine membranes together with Q. The effects of varying the molar ratio of Q to enzyme on the electron transfer from duroquinol (DHQ2) to the cytochromes c, c1 and b were studied. The rate of electron flow from DQH2 to cytochrome c was 15 times increased by Q and was maximal when one molecule of Q was bound to one enzyme dimer. The apparent Km value for DQH2 of the Q-free enzyme was 5 microM and of the Q-supplemented enzyme 25 microM. The pre-steady-state rate of electron transfer from DQH2 to cytochrome c1 was also 15 times increased by Q and was maximal with one Q molecule bound to one enzyme dimer. This effect of Q was inhibited by antimycin. The pre-steady-state rate of electron transfer from DQH2 to cytochrome b was 5 times decreased when Q was bound to the enzyme and this effect of Q was insensitive to myxothiazol. The H+/2e- stoichiometry with DQH2 as substrate of the Q-supplemented enzyme was 3.6. These results are interpreted in accordance with a Q-cycle mechanism operating in a dimeric cytochrome reductase. Each enzyme monomer catalyses a single electron transfer from the QH2-oxidation centre to the Q-reduction centre and the two monomers cooperate in the reduction of Q to QH2 at one Q-reduction centre. This centre contains two different binding sites for Q. DQH2 does not properly react at the QH2-oxidation centre. DQH2, however, binds to the loose Q-binding site of the Q-reduction centre and reduces the Q bound to the tight Q-binding site of the centre. The QH2 thus formed at the Q-reduction centre serves as electron donor for the QH2-oxidation centre.
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