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Glowalla C, Langer S, Lenze U, Lazic I, Hirschmann MT, Hinterwimmer F, von Eisenhart-Rothe R, Pohlig F. Postoperative full leg radiographs exhibit less residual coronal varus deformity compared to intraoperative measurements in robotic arm-assisted total knee arthroplasty with the MAKO™ system. Knee Surg Sports Traumatol Arthrosc 2023; 31:3912-3918. [PMID: 36964782 PMCID: PMC10435414 DOI: 10.1007/s00167-023-07386-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/09/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE Robotic arm-assisted total knee arthroplasty (raTKA), currently a major trend in knee arthroplasty, aims to improve the accuracy of implant positioning and limb alignment. However, it is unclear whether and to what extent manual radiographic and navigation measurements with the MAKO™ system correlate. Nonetheless, a high agreement would be crucial to reliably achieve the desired limb alignment. METHODS Thirty-six consecutive patients with osteoarthritis and a slight-to-moderate varus deformity undergoing raTKA were prospectively included in this study. Prior to surgery and at follow-up, a full leg radiograph (FLR) under weight-bearing conditions was performed. In addition, a computed tomography (CT) scan was conducted for preoperative planning. The hip-knee-ankle angle (HKA), mechanical lateral distal femur angle (mLDFA), mechanical medial proximal tibial angle (mMPTA) and joint line convergence angle (JLCA) were measured in the preoperative and follow-up FLR as well as in the CT scout (without weight-bearing) by three independent raters. Furthermore, the HKA was intraoperatively assessed with the MAKO™ system before and after raTKA. RESULTS Significantly higher HKA values were identified for intraoperative deformity assessment using the MAKO system compared to the preoperative FLR and CT scouts (p = 0.006; p = 0.05). Intraoperative assessment of the HKA with final implants showed a mean residual varus deformity of 3.2° ± 1.9°, whereas a significantly lower residual varus deformity of 1.4° ± 1.9° was identified in the postoperative FLR (p < 0.001). The mMPTA was significantly higher in the preoperative FLR than in the CT scouts (p < 0.001). Intraoperatively, the mMPTA was adjusted to a mean of 87.5° ± 0.9° with final implants, while significantly higher values were measured in postoperative FLRs (p < 0.001). Concerning the mLDFA, no significant differences could be identified. CONCLUSION The clinical importance of this study lies in the finding that there is a difference between residual varus deformity measured intraoperatively with the MAKO™ system and those measured in postoperative FLRs. This has implications for preoperative planning as well as intraoperative fine-tuning of the implant position during raTKA to avoid overcorrection of knees with slight-to-moderate varus osteoarthritis. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Claudio Glowalla
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Ismaninger-Strasse 22, 81675, Munich, Germany
- BG Unfallklinik Murnau, Professor-Kuentscher-Strasse 8, 82418, Murnau am Staffelsee, Germany
| | - Severin Langer
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Ismaninger-Strasse 22, 81675, Munich, Germany
- BG Unfallklinik Murnau, Professor-Kuentscher-Strasse 8, 82418, Murnau am Staffelsee, Germany
| | - Ulrich Lenze
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Ismaninger-Strasse 22, 81675, Munich, Germany
| | - Igor Lazic
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Ismaninger-Strasse 22, 81675, Munich, Germany
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (BruderholzLiestalLaufen), 4101, Bruderholz, Switzerland
| | - Florian Hinterwimmer
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Ismaninger-Strasse 22, 81675, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Ismaninger-Strasse 22, 81675, Munich, Germany
| | - Florian Pohlig
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Ismaninger-Strasse 22, 81675, Munich, Germany.
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Lazic I, Stephan M, Pohlig F, Langer S, VON Eisenhart-Rothe R, Suren C. Synovial Calprotectin for Diagnosing Periprosthetic Joint Infection in Loose Hip and Knee Arthroplasties: A Prospective Cohort Study. In Vivo 2023; 37:1714-1720. [PMID: 37369505 DOI: 10.21873/invivo.13258] [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] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND/AIM Synovial calprotectin has been demonstrated as a promising biomarker for periprosthetic joint infections (PJI) in painful total hip (THA) and knee arthroplasties (TKA). However, its diagnostic utility has not been evaluated explicitly in cases with marked loosening or migration of the implant. Concerns have already been raised in cases with metallosis and severe periprosthetic osteolysis because wear-induced inflammation may yield false positive results. The purpose of this study was to evaluate calprotectin for the diagnosis of PJI in cases that preoperatively demonstrate moderate to severe periprosthetic osteolysis or implant migration as signs for implant loosening in THA and TKA. PATIENTS AND METHODS Thirty-three patients were included in this prospective study between February of 2019 and November of 2021. The extent of osteolysis was classified according to Engh et al., Paprosky et al., and the modern Knee Society Radiographic Evaluation and Scoring System. Synovial white blood cell count (WBC), percentage of polymorphonuclear neutrophils (PMC), serum C-reactive protein (CRP) and synovial calprotectin using a lateral-flow-assay were tested against the European Bone and Joint Infection Society (EBJIS) definition for PJI. Statistic quality criteria were calculated and compared using a binary classification test. RESULTS Ten patients were classified as confirmed infections according to the EBJIS definition (7 THA and 5 TKA). The calprotectin assay yielded a sensitivity of 0.60, a specificity of 0.61, a positive predictive value of 0.40, and a negative predictive value of 0.78. The calprotectin assay resulted in nine false positive and four false negative cases. No correlation between the extent of osteolysis and false classification by means of the calprotectin assay was observed. CONCLUSION The diagnostic accuracy of synovial calprotectin is impaired if moderate to severe signs of implant loosening are present. If PJI is unlikely, the calprotectin LFT can be applied as a further exclusion tool as the negative predictive value remains relatively high.
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Affiliation(s)
- Igor Lazic
- Technische Universität München, School of Medicine, Klinikum Rechts der Isar, Klinik für Orthopädie und Sportorthopädie, Munich, Germany;
| | - Maximilian Stephan
- Technische Universität München, School of Medicine, Klinikum Rechts der Isar, Klinik für Orthopädie und Sportorthopädie, Munich, Germany
| | - Florian Pohlig
- Technische Universität München, School of Medicine, Klinikum Rechts der Isar, Klinik für Orthopädie und Sportorthopädie, Munich, Germany
| | - Severin Langer
- Technische Universität München, School of Medicine, Klinikum Rechts der Isar, Klinik für Orthopädie und Sportorthopädie, Munich, Germany
| | - Rüdiger VON Eisenhart-Rothe
- Technische Universität München, School of Medicine, Klinikum Rechts der Isar, Klinik für Orthopädie und Sportorthopädie, Munich, Germany
| | - Christian Suren
- München Klinik Bogenhausen, Zentrum für Orthopädie, Unfallchirurgie und Sportmedizin, Munich, Germany
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Suren C, Lazic I, Haller B, Pohlig F, von Eisenhart-Rothe R, Prodinger P. The synovial fluid calprotectin lateral flow test for the diagnosis of chronic prosthetic joint infection in failed primary and revision total hip and knee arthroplasty. Int Orthop 2023; 47:929-944. [PMID: 36656361 PMCID: PMC10014771 DOI: 10.1007/s00264-023-05691-3] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE The diagnostic criteria of prosthetic joint infection (PJI) recommended by the most commonly used diagnostic algorithms can be obscured or distorted by other inflammatory processes or aseptic pathology. Furthermore, the most reliable diagnostic criteria are garnered during revision surgery. A robust, reliable addition to the preoperative diagnostic cascade is warranted. Calprotectin has been shown to be an excellent diagnostic marker for PJI. In this study, we aimed to evaluate a lateral flow test (LFT) in the challenging patient cohort of a national referral centre for revision arthroplasty. METHODS Beginning in March 2019, we prospectively included patients scheduled for arthroplasty exchange of a total hip (THA) or knee arthroplasty (TKA). Synovial fluid samples were collected intra-operatively. We used the International Consensus Meeting of 2018 (ICM) score as the gold standard. We then compared the pre-operative ICM score with the LFT result to calculate its diagnostic accuracy as a standalone pre-operative marker and in combination with the ICM score as part of an expanded diagnostic workup. RESULTS A total of 137 patients with a mean age of 67 (± 13) years with 53 THA and 84 TKA were included. Ninety-nine patients (72.8%) were not infected, 34 (25.0) were infected, and four (2.9%) had an inconclusive final score and could not be classified after surgery. The calprotectin LFT had a sensitivity (95% confidence interval) of 0.94 (0.80-0.99) and a specificity of 0.87 (0.79-0.93). The area under the receiver operating characteristic curve (AUC) for the calprotectin LFT was 0.94 (0.89-0.99). In nine cases with an inconclusive pre-operative ICM score, the calprotectin LFT would have led to the correct diagnosis of PJI. CONCLUSIONS The synovial fluid calprotectin LFT shows excellent diagnostic metrics both as a rule-in and a rule-out test, even in a challenging patient cohort with cases of severe osteolysis, wear disease, numerous preceding surgeries, and poor soft tissue conditions, which can impair the common diagnostic criteria. As it is available pre-operatively, this test might prove to be a very useful addition to the diagnostic algorithm.
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Affiliation(s)
- Christian Suren
- Center for Orthopedics, Trauma Surgery and Sports Medicine, München Klinik Bogenhausen, Englschalkinger Str. 77, 81925, Munich, Germany.
| | - Igor Lazic
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Haller
- Artificial Intelligence and Informatics in Medicine (AIIM), Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Florian Pohlig
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Peter Prodinger
- Department of Trauma Surgery and Orthopedics, Norbert-Kerkel-Platz, Krankenhaus Agatharied, Hausham, Germany
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Pohlig F, Wittek M, VON Thaden A, Lenze U, Glowalla C, Minzlaff P, Burgkart R, Prodinger PM. Biomechanical Properties of Repair Cartilage Tissue Are Superior Following Microdrilling Compared to Microfracturing in Critical Size Cartilage Defects. In Vivo 2023; 37:565-573. [PMID: 36881065 PMCID: PMC10026649 DOI: 10.21873/invivo.13115] [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] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND/AIM Common surgical treatment options for large focal chondral defects (FCDs) in the knee include microfracturing (MFX) and microdrilling (DRL). Despite numerous studies addressing MFX and DRL of FDCs, no in vivo study has focused on biomechanical analysis of repair cartilage tissue in critical size FCDs with different amounts of holes and penetration depths. MATERIALS AND METHODS Two round FCDs (d=6 mm) were created on the medial femoral condyle in 33 adult merino sheep. All 66 defects were randomly assigned to 1 control or 4 different study groups: 1) MFX1, 3 holes, 2 mm depth; 2) MFX2, 3 holes, 4 mm depth; 3) DRL1, 3 holes, 4 mm depth; and 4) DRL2, 6 holes, 4 mm depth. Animals were followed up for 1 year. Following euthanasia, quantitative optical analysis of defect filling was performed. Biomechanical properties were analysed with microindentation and calculation of the elastic modulus. RESULTS Quantitative assessment of defect filling showed significantly better results in all treatment groups compared to untreated FCDs in the control group (p<0.001), with the best results for DRL2 (84.2% filling). The elastic modulus of repair cartilage tissue in the DRL1 and DRL2 groups was comparable to the adjacent native hyaline cartilage, while significantly inferior results were identified in both MFX groups (MFX1: p=0.002; MFX2: p<0.001). CONCLUSION More defect filling and better biomechanical properties of the repair cartilage tissue were identified for DRL compared to MFX, with the best results for 6 holes and 4 mm of penetration depth. These findings are in contrast to the current clinical practice with MFX as the gold standard and suggest a clinical return to DRL.
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Affiliation(s)
- Florian Pohlig
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich (TUM), Munich, Germany;
| | | | - Anne VON Thaden
- German Center for Neurodegenerative Diseases, Munich, Germany
| | - Ulrich Lenze
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich (TUM), Munich, Germany
| | - Claudio Glowalla
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich (TUM), Munich, Germany
- BG Unfallklinik Murnau, Murnau am Staffelsee, Germany
| | - Philipp Minzlaff
- Krankenhaus Agatharied, Department of Orthopaedic Surgery and Traumatology, Hausham, Germany
| | - Rainer Burgkart
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich (TUM), Munich, Germany
| | - Peter Michael Prodinger
- Krankenhaus Agatharied, Department of Orthopaedic Surgery and Traumatology, Hausham, Germany
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Lazic I, Burdach A, Pohlig F, von Eisenhart-Rothe R, Suren C. Utility of synovial calprotectin lateral flow test to exclude chronic prosthetic joint infection in periprosthetic fractures: a prospective cohort study. Sci Rep 2022; 12:18385. [PMID: 36319727 PMCID: PMC9626574 DOI: 10.1038/s41598-022-22892-9] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
The diagnosis of periprosthetic joint infection (PJI) requires a combination of various clinical, laboratory, microbiological and histopathological parameters. A concomitant periprosthetic fracture (PPF) further complicates the diagnosis as it causes a confounding local inflammatory response. Synovial calprotectin has been demonstrated as a promising biomarker of PJI. The purpose of the present study was to evaluate the reliability of synovial calprotectin for the pre- or intraoperative diagnosis of PJI in PFF. 30 patients with PPF and implant loosening were included in this prospective study. Synovial fluid with white blood cells and percentage of polymorphonuclear neutrophils, serum C-reactive protein, and synovial calprotectin using a lateral-flow assay were tested against the EBJIS definition with adjusted thresholds to account for the local inflammation. 14 patients were postoperatively classified as confirmed infections (ten total hip arthroplasties and fourtotal knee arthroplasties). The calprotectin assay yielded a sensitivity of 0.71 [0.48; 0.95], a specificity of 0.69 [0.46; 0.91], a positive predictive value of 0.67 [0.43; 0.91] and a negative predictive value of 0.73 [0.51; 0.96]. Calprotectin is a promising diagnostic parameter for the detection of a PJI in a PPF. The lateral flow assay offers prompt results, which may further assist the surgeon in addition to already existing parameters of PJI diagnostics to diagnose concomitant PJI in PPF during surgery.
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Affiliation(s)
- Igor Lazic
- grid.6936.a0000000123222966Department of Orthopaedic Surgery, Technische Universität München, School of Medicine, Klinikum rechts der Isar, Klinik für Orthopädie und Sportorthopädie, Ismaninger Str. 22, 81675 Munich, Germany
| | - Alexander Burdach
- grid.6936.a0000000123222966Department of Orthopaedic Surgery, Technische Universität München, School of Medicine, Klinikum rechts der Isar, Klinik für Orthopädie und Sportorthopädie, Ismaninger Str. 22, 81675 Munich, Germany
| | - Florian Pohlig
- grid.6936.a0000000123222966Department of Orthopaedic Surgery, Technische Universität München, School of Medicine, Klinikum rechts der Isar, Klinik für Orthopädie und Sportorthopädie, Ismaninger Str. 22, 81675 Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- grid.6936.a0000000123222966Department of Orthopaedic Surgery, Technische Universität München, School of Medicine, Klinikum rechts der Isar, Klinik für Orthopädie und Sportorthopädie, Ismaninger Str. 22, 81675 Munich, Germany
| | - Christian Suren
- grid.6936.a0000000123222966Department of Orthopaedic Surgery, Technische Universität München, School of Medicine, Klinikum rechts der Isar, Klinik für Orthopädie und Sportorthopädie, Ismaninger Str. 22, 81675 Munich, Germany
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Lazic I, Hinterwimmer F, Langer S, Pohlig F, Suren C, Seidl F, Rückert D, Burgkart R, von Eisenhart-Rothe R. Prediction of Complications and Surgery Duration in Primary Total Hip Arthroplasty Using Machine Learning: The Necessity of Modified Algorithms and Specific Data. J Clin Med 2022; 11:jcm11082147. [PMID: 35456239 PMCID: PMC9032696 DOI: 10.3390/jcm11082147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 01/18/2023] Open
Abstract
Background: Machine Learning (ML) in arthroplasty is becoming more popular, as it is perfectly suited for prediction models. However, results have been heterogeneous so far. We hypothesize that an accurate ML model for outcome prediction in THA must be able to compute arthroplasty-specific data. In this study, we evaluate a ML approach applying data from two German arthroplasty-specific registries to predict adverse outcomes after THA, after careful evaluations of ML algorithms, outcome and input variables by an interdisciplinary team of data scientists and surgeons. Methods: Data of 1217 cases of primary THA from a single center were derived from two German arthroplasty-specific registries between 2016 to 2019. The XGBoost algorithm was adjusted and applied. Accuracy, sensitivity, specificity and AUC were calculated. Results: For the prediction of complications, the ML algorithm achieved an accuracy of 80.3%, a sensitivity of 31.0%, a specificity of 89.4% and an AUC of 64.1%. For the prediction of surgery duration, the ML algorithm yielded an accuracy of 81.7%, a sensitivity of 58.2%, a specificity of 91.6% and an AUC of 89.1%. The feature importance indicated non-linear outcomes for age, height, weight and surgeon. No relevant linear correlations were found. Conclusion: The attunement of input and output data as well as the modifications of the ML algorithm permitted the development of a feasible ML model for the prediction of complications and surgery duration.
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Affiliation(s)
- Igor Lazic
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, 80333 Munich, Germany; (F.H.); (S.L.); (F.P.); (C.S.); (R.B.); (R.v.E.-R.)
- Correspondence:
| | - Florian Hinterwimmer
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, 80333 Munich, Germany; (F.H.); (S.L.); (F.P.); (C.S.); (R.B.); (R.v.E.-R.)
- Institute for AI and Informatics in Medicine, Technical University of Munich, 80333 Munich, Germany;
| | - Severin Langer
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, 80333 Munich, Germany; (F.H.); (S.L.); (F.P.); (C.S.); (R.B.); (R.v.E.-R.)
| | - Florian Pohlig
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, 80333 Munich, Germany; (F.H.); (S.L.); (F.P.); (C.S.); (R.B.); (R.v.E.-R.)
| | - Christian Suren
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, 80333 Munich, Germany; (F.H.); (S.L.); (F.P.); (C.S.); (R.B.); (R.v.E.-R.)
| | - Fritz Seidl
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, 80333 Munich, Germany;
| | - Daniel Rückert
- Institute for AI and Informatics in Medicine, Technical University of Munich, 80333 Munich, Germany;
| | - Rainer Burgkart
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, 80333 Munich, Germany; (F.H.); (S.L.); (F.P.); (C.S.); (R.B.); (R.v.E.-R.)
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, 80333 Munich, Germany; (F.H.); (S.L.); (F.P.); (C.S.); (R.B.); (R.v.E.-R.)
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Hinterwimmer F, Lazic I, Langer S, Suren C, Charitou F, Hirschmann MT, Matziolis G, Seidl F, Pohlig F, Rueckert D, Burgkart R, von Eisenhart-Rothe R. Prediction of complications and surgery duration in primary TKA with high accuracy using machine learning with arthroplasty-specific data. Knee Surg Sports Traumatol Arthrosc 2022; 31:1323-1333. [PMID: 35394135 PMCID: PMC10050062 DOI: 10.1007/s00167-022-06957-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 12/13/2021] [Accepted: 03/18/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The number of primary total knee arthroplasties (TKA) is expected to rise constantly. For patients and healthcare providers, the early identification of risk factors therefore becomes increasingly fundamental in the context of precision medicine. Others have already investigated the detection of risk factors by conducting literature reviews and applying conventional statistical methods. Since the prediction of events has been moderately accurate, a more comprehensive approach is needed. Machine learning (ML) algorithms have had ample success in many disciplines. However, these methods have not yet had a significant impact in orthopaedic research. The selection of a data source as well as the inclusion of relevant parameters is of utmost importance in this context. In this study, a standardized approach for ML in TKA to predict complications during surgery and an irregular surgery duration using data from two German arthroplasty-specific registries was evaluated. METHODS The dataset is based on two initiatives of the German Society for Orthopaedics and Orthopaedic Surgery. A problem statement and initial parameters were defined. After screening, cleaning and preparation of these datasets, 864 cases of primary TKA (2016-2019) were gathered. The XGBoost algorithm was chosen and applied with a hyperparameter search, a cross validation and a loss weighting to cope with class imbalance. For final evaluation, several metrics (accuracy, sensitivity, specificity, AUC) were calculated. RESULTS An accuracy of 92.0%, sensitivity of 34.8%, specificity of 95.8%, and AUC of 78.0% were achieved for predicting complications in primary TKA and 93.4%, 74.0%, 96.3%, and 91.6% for predicting irregular surgery duration, respectively. While traditional statistics (correlation coefficient) could not find any relevant correlation between any two parameters, the feature importance revealed several non-linear outcomes. CONCLUSION In this study, a feasible ML model to predict outcomes of primary TKA with very promising results was built. Complex correlations between parameters were detected, which could not be recognized by conventional statistical analysis. Arthroplasty-specific data were identified as relevant by the ML model and should be included in future clinical applications. Furthermore, an interdisciplinary interpretation as well as evaluation of the results by a data scientist and an orthopaedic surgeon are of paramount importance. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Florian Hinterwimmer
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany. .,Institute for AI and Informatics in Medicine, Technical University of Munich, Munich, Germany.
| | - Igor Lazic
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Severin Langer
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Suren
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Fiona Charitou
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology-Liestal, Kantonsspital Baselland, Bruderholz, Laufen, Switzerland.,Endoprosthetics Committee of the German Knee Society (DKG), Munich, Germany
| | - Georg Matziolis
- Orthopaedic Department Campus Eisenberg, University Hospital Jena, Eisenberg, Germany.,Endoprosthetics Committee of the German Knee Society (DKG), Munich, Germany
| | - Fritz Seidl
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Florian Pohlig
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniel Rueckert
- Institute for AI and Informatics in Medicine, Technical University of Munich, Munich, Germany
| | - Rainer Burgkart
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Endoprosthetics Committee of the German Knee Society (DKG), Munich, Germany
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8
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Glowalla C, Ertl M, Lenze U, Lazic I, Burgkart R, Lang JJ, VON Eisenhart-Rothe R, Pohlig F. Pulsatile Lavage During Cementation of Total Knee Arthroplasty - Is Fixation Impaired? A Cadaver Study. In Vivo 2022; 36:672-677. [PMID: 35241521 DOI: 10.21873/invivo.12752] [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] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Increasing economic pressure in modern healthcare necessitates an increase in efficiency in total knee arthroplasty (TKA) while maintaining high-quality outcomes. Removal of debris using pulsatile lavage (PL) during cement polymerization may considerably reduce the operative duration. However, water can penetrate the interface, resulting in impaired implant fixation. The aim of the present study was to investigate the impact of early-onset PL during bone cement polymerization on implant fixation and operative duration. MATERIALS AND METHODS Cemented implantation of tibial trays was performed in 20 fresh-frozen human tibiae from 10 donors in a matched-pair study design in two groups: 1) PL during cement polymerization; and 2) PL after completion of the polymerization process. The cement penetration depth was analysed by computed tomography (CT), and the pull-out force was measured to evaluate primary implant fixation. The duration of the procedure was recorded for both groups. RESULTS Comparable pull-out forces were observed in the experimental (2,213 N) and control groups (2,350 N; p=0.68). The mean depth of cement penetration was similar in both groups. PL during cement polymerization could decrease the operative duration by 10 min. CONCLUSION The application of PL during cement polymerization could significantly reduce operative duration and had no adverse effect on the mechanical fixation of the tibial component.
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Affiliation(s)
- Claudio Glowalla
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.,BG Unfallklinik Murnau, Murnau am Staffelsee, Germany
| | - Max Ertl
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Ulrich Lenze
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Igor Lazic
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Rainer Burgkart
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Jan J Lang
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.,Department of Mechanical Engineering, Chair of Nondestructive Testing, Technical University of Munich, Munich, Germany
| | | | - Florian Pohlig
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany;
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9
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Hinterwimmer F, Lazic I, Suren C, Hirschmann MT, Pohlig F, Rueckert D, Burgkart R, von Eisenhart-Rothe R. Machine learning in knee arthroplasty: specific data are key-a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 30:376-388. [PMID: 35006281 PMCID: PMC8866371 DOI: 10.1007/s00167-021-06848-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/16/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Artificial intelligence (AI) in healthcare is rapidly growing and offers novel options of data analysis. Machine learning (ML) represents a distinct application of AI, which is capable of generating predictions and has already been tested in different medical specialties with various approaches such as diagnostic applications, cost predictions or identification of risk factors. In orthopaedics, this technology has only recently been introduced and the literature on ML in knee arthroplasty is scarce. In this review, we aim to investigate which predictions are already feasible using ML models in knee arthroplasty to identify prerequisites for the effective use of this novel approach. For this reason, we conducted a systematic review of ML algorithms for outcome prediction in knee arthroplasty. METHODS A comprehensive search of PubMed, Medline database and the Cochrane Library was conducted to find ML applications for knee arthroplasty. All relevant articles were systematically retrieved and evaluated by an orthopaedic surgeon and a data scientist on the basis of the PRISMA statement. The search strategy yielded 225 articles of which 19 were finally assessed as eligible. A modified Coleman Methodology Score (mCMS) was applied to account for a methodological evaluation. RESULTS The studies presented in this review demonstrated fair to good results (AUC median 0.76/range 0.57-0.98), while heterogeneous prediction models were analysed: complications (6), costs (4), functional outcome (3), revision (2), postoperative satisfaction (2), surgical technique (1) and biomechanical properties (1) were investigated. The median mCMS was 65 (range 40-80) points. CONCLUSION The prediction of distinct outcomes with ML models applying specific data is already feasible; however, the prediction of more complex outcomes is still inaccurate. Registry data on knee arthroplasty have not been fully analysed yet so that specific parameters have not been sufficiently evaluated. The inclusion of specific input data as well as the collaboration of orthopaedic surgeons and data scientists are essential prerequisites to fully utilize the capacity of ML in knee arthroplasty. Future studies should investigate prospective data with specific and longitudinally recorded parameters. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Florian Hinterwimmer
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, München, Germany. .,Institute for AI and Informatics in Medicine, Technical University of Munich, Munich, Germany.
| | - Igor Lazic
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, München, Germany.
| | - Christian Suren
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 München, Germany
| | - Michael T. Hirschmann
- Department of Orthopaedic Surgery and Traumatology-Liestal, Kantonsspital Baselland, Bruderholz, Laufen, Switzerland
| | - Florian Pohlig
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 München, Germany
| | - Daniel Rueckert
- Institute for AI and Informatics in Medicine, Technical University of Munich, Munich, Germany
| | - Rainer Burgkart
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 München, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts Der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 München, Germany
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10
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Lenze F, Hinterwimmer F, Fleckenstein L, Lazic I, Dammerer D, VON Eisenhart-Rothe R, Harrasser N, Pohlig F. Minimally Invasive Total Hip Arthroplasty: A Comparison of Restoring Hip Biomechanics With and Without a Traction Table. In Vivo 2022; 36:424-429. [PMID: 34972744 PMCID: PMC8765139 DOI: 10.21873/invivo.12720] [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] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The aim of the study was to analyze operative time and restoration of hip biomechanics in total hip arthroplasty (THA) via direct anterior approach (DAA) with and without the use of a traction table. PATIENTS AND METHODS We retrospectively compared 97 cases where a traction table was used to 92 cases without a table. Ninety-seven patients received THA with a traction table (AMIS® technique) and 92 patients with conventional DAA. Postoperative standard radiographs were used to analyze offset parameters and leg length. Furthermore, time for patient positioning and cut-to-suture time were evaluated. RESULTS Cut-to-suture time was statistically significantly shorter in the traction table group (p=0.001), whereas analysis of offset parameters (acetabular, femoral and combined) was comparable between the two groups (p=0.31, p=0.95, p=0.42). Postoperative leg length was statistically significantly different with and without traction table use (p=0.02). CONCLUSION Both methods enable restoration of hip biomechanics with high accuracy. Further studies with prospective study designs and larger sample sizes may be needed to confirm these results.
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Affiliation(s)
- Florian Lenze
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany;
| | - Florian Hinterwimmer
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Lisa Fleckenstein
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Igor Lazic
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Dietmar Dammerer
- Department of Orthopedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Rüdiger VON Eisenhart-Rothe
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Norbert Harrasser
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Florian Pohlig
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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11
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Feihl S, Querbach C, Hapfelmeier A, Busch DH, von Eisenhart-Rothe R, Gebhardt F, Pohlig F, Mühlhofer HML. Effect of an Intensified Antibiotic Stewardship Program at an Orthopedic Surgery Department. Surg Infect (Larchmt) 2021; 23:105-112. [PMID: 34762545 DOI: 10.1089/sur.2021.040] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Institutional programs such as antibiotic stewardship (ABS) programs offer possibilities to monitor and modify antibiotic usage with the aim of reducing antibiotic resistance. In orthopedic units that treat peri-prosthetic joint infections (PJIs), ABS programs are still rare, however, there is extensive use of high-risk antibiotic agents and an increased risk for the occurrence of Clostridium difficile infections (CDIs). Patients and Methods: An ABS program was implemented at the Department of Orthopedic Surgery at a university hospital. Quarterly antibiotic consumption was measured in defined daily doses (DDDs) per 100 patient-days (PDs) at 10 quarters before the intervention and seven quarters after the intervention. The effect of the new antibiotic policy on drug use rates was evaluated using an interrupted time-series analysis. Estimated changes over time in the incidence of CDIs (cases per 1,000 PDs) were analyzed. Results: A remarkable percentual reduction in second-generation cephalosporin use of 83% (p < 0.001; pre-intervention level, 81.486 DDDs/100 patient-days; post-intervention level, 13.751 DDDs/100 PDs) and clindamycin administration of 78% (p < 0.001; pre-intervention level, 18.982 DDDs/100 PDs; post-intervention level, 4.216 DDDs/100 PDs) was observed after implementation of ABS interventions. Total antibiotic use declined by 25% (p < 0.001; pre-intervention level, 129.078 DDDs/100 PDs; post-intervention level, 96.826 DDDs/100 PDs). Conclusions: This research assessed the positive impact of an intensified ABS program at an orthopedic department specializing in PJIs. Antibiotic stewardship program interventions encourage the reduction of total antibiotic usage and especially high-risk antibiotic agents, associated with the development of antimicrobial resistance.
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Affiliation(s)
- Susanne Feihl
- Institute for Medical Microbiology, Immunology and Hygiene, Statistics, Epidemiology, Technical University Munich, School of Medicine, Munich, Germany
| | - Christiane Querbach
- Pharmacy Department, University Hospital Klinikum rechts der Isar, Technical University Munich, School of Medicine, Munich, Germany
| | - Alexander Hapfelmeier
- Institute of Medical Informatics, Statistics, Epidemiology, Technical University Munich, School of Medicine, Munich, Germany
| | - Dirk H Busch
- Institute for Medical Microbiology, Immunology and Hygiene, Statistics, Epidemiology, Technical University Munich, School of Medicine, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopedic Surgery, University Hospital Klinikum rechts der Isar, Technical University Munich, School of Medicine, Munich, Germany
| | - Friedemann Gebhardt
- Institute for Medical Microbiology, Immunology and Hygiene, Statistics, Epidemiology, Technical University Munich, School of Medicine, Munich, Germany
| | - Florian Pohlig
- Department of Orthopedic Surgery, University Hospital Klinikum rechts der Isar, Technical University Munich, School of Medicine, Munich, Germany
| | - Heinrich M L Mühlhofer
- Department of Orthopedic Surgery, University Hospital Klinikum rechts der Isar, Technical University Munich, School of Medicine, Munich, Germany
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12
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Suren C, Lazic I, Stephan M, Lenze FW, Pohlig F, von Eisenhart-Rothe R. Diagnostic algorithm in septic total knee arthroplasty failure - What is evidence-based? J Orthop 2021; 23:208-215. [PMID: 33603316 DOI: 10.1016/j.jor.2020.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/08/2020] [Indexed: 11/25/2022] Open
Abstract
Prosthetic joint infection (PJI) is among the most common differential diagnoses of total knee arthroplasty failure. It is a challenging complication, not least because of the difficulty of establishing the correct diagnosis. The fact that no single diagnostic parameter or test has been identified that can accurately rule in or out PJI has led to an evolution of similar but competing definitions of PJI on the grounds of an array of criteria. This development has had very positive effects on the scientific evaluation of various methods of PJI diagnostics and treatment because of an increased comparability. However, it can be challenging to stay abreast of the evidence these definitions are based on. Also, the definitions alone do not necessarily entail an algorithm to aid in evaluating the right criteria in a sound order to be able to use the definitions as a sensible tool. The aim of this overview is to state the most recent evidence on the diagnostic parameters included in the most established PJI definitions and to exhibit and compare the few algorithmic approaches published. Clinical symptoms of PJI are very rarely reported on in the literature, hence the evidence on their diagnostic value is poor. The only symptom that is part of the established PJI definitions is the presence of a fistula. Concerning serological markers, CRP and ESR are still the common denominator in the literature, most recently accompanied by D-Dimer as a potentially suitable marker that has been included in the most recent update of the International Consensus Meeting (ICM) criteria. Imaging plays a minor role in the diagnostic cascade because of inconsistent evidence, and no role whatsoever in the established definitions. The most important preoperative diagnostic measure is arthrocentesis and cultural and cytological analysis of the synovial fluid. The much acclaimed α-Defensin test has so far not been included in the established criteria due to inconsistent reports on its diagnostic accuracy, it is, however, in wide use and considered an optional diagnostic tool for inconclusive cases. The most diagnostic accuracy lies in the cultural and histological analysis of periprosthetic tissue biopsies, whether they are gathered in a small procedure or during arthroplasty revision. Published algorithmic approaches to PJI diagnosis are much rarer than the well-established definitions by various associations. With their PJI definition, the American Academy of Orthopedic Surgeons (AAOS) published a consensus based flowchart for PJI diagnosis. Another algorithm was proposed as part of the endeavor of the MSIS and the first consensus meeting, also based on a consensus among experts. There have been two more recent publications of flowcharts based on the current evidence, one introduced at our institution in 2013, one established in 2020 by the German Society for Arthroplasty (AE).
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Affiliation(s)
- Christian Suren
- Department of Orthopedics and Sports Orthopedics, Klinikum Rechts der Isar, Technical University of Munich (TUM), Ismaningerstr. 22, 81675, Munich, Germany
| | - Igor Lazic
- Department of Orthopedics and Sports Orthopedics, Klinikum Rechts der Isar, Technical University of Munich (TUM), Ismaningerstr. 22, 81675, Munich, Germany
| | - Maximilian Stephan
- Department of Orthopedics and Sports Orthopedics, Klinikum Rechts der Isar, Technical University of Munich (TUM), Ismaningerstr. 22, 81675, Munich, Germany
| | - Florian Walter Lenze
- Department of Orthopedics and Sports Orthopedics, Klinikum Rechts der Isar, Technical University of Munich (TUM), Ismaningerstr. 22, 81675, Munich, Germany
| | - Florian Pohlig
- Department of Orthopedics and Sports Orthopedics, Klinikum Rechts der Isar, Technical University of Munich (TUM), Ismaningerstr. 22, 81675, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopedics and Sports Orthopedics, Klinikum Rechts der Isar, Technical University of Munich (TUM), Ismaningerstr. 22, 81675, Munich, Germany
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13
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Lazic I, Scheele C, Pohlig F, von Eisenhart-Rothe R, Suren C. Treatment options in PJI - is two-stage still gold standard? J Orthop 2021; 23:180-184. [PMID: 33551610 PMCID: PMC7848725 DOI: 10.1016/j.jor.2020.12.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/08/2020] [Indexed: 02/07/2023] Open
Abstract
Total knee arthroplasty (TKA) is a successful treatment for osteoarthritis with good clinical outcomes 1,2. Periprosthetic joint infection (PJI) in TKA has a low incidence between 0.5 and 3% but it is nevertheless one of the most dreadful complications 3-6. Two-staged revisions are considered to be the gold standard for revision in chronic PJI with infection eradication rates of over 90% 7. Recently, similar infection eradication rates after one-staged revision arthroplasty have been reported 8-10, raising the question whether the two-staged approach can still be considered the gold standard. We therefore performed a literature review to analyse the correlation of one-staged and two-staged TKA revisions with recurrent infection rates and functional outcomes. Studies concerning PJI treated by one- or two-staged revision published between 2000 and 2020 were retrieved by searching the databases PubMed/Medline and the Cochrane Database of Systematic Reviews. 29 studies were included in this qualitative synthesis. Mean follow-up was at 4.9 ± 2.6 years. The mean infection eradication rate after one-staged revision vs. two-staged revision in TKA was 87 ± 8.8% vs. 83 ± 11.7%. The functional outcome measured by the mean Knee Society Score (KSS) of one-staged revision vs. two-staged revision in TKA was 80 ± 5.9 vs. 80 ± 3.9 points. One-staged revision arthroplasty in TKA appears to have similar infection eradication rates and functional outcomes compared to two-staged revision arthroplasty. However, these results should be interpreted with caution, since selection bias may have played a significant role. Several criteria to guide the surgeon in selecting the appropriate procedure have been described, but the current recommendations are based on poor evidence as randomized controlled trials are lacking 11,12. Two-staged revision remains a successful treatment option which is rightly the gold standard. However, there is a variety of cases in which one-staged revision is a viable alternative, where similar success rates and functional outcome can be expected 7,13.
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Affiliation(s)
- Igor Lazic
- Department of Orthopedics and Sports Orthopedics, Klinikum Rechts der Isar; Technical University of Munich (TUM), Ismaningerstr. 22, 81675, Munich, Germany
| | - Christian Scheele
- Department of Orthopedics and Sports Orthopedics, Klinikum Rechts der Isar; Technical University of Munich (TUM), Ismaningerstr. 22, 81675, Munich, Germany
| | - Florian Pohlig
- Department of Orthopedics and Sports Orthopedics, Klinikum Rechts der Isar; Technical University of Munich (TUM), Ismaningerstr. 22, 81675, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopedics and Sports Orthopedics, Klinikum Rechts der Isar; Technical University of Munich (TUM), Ismaningerstr. 22, 81675, Munich, Germany
| | - Christian Suren
- Department of Orthopedics and Sports Orthopedics, Klinikum Rechts der Isar; Technical University of Munich (TUM), Ismaningerstr. 22, 81675, Munich, Germany
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14
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Knebel C, Menzemer J, Pohlig F, Herschbach P, Burgkart R, Obermeier A, von Eisenhart-Rothe R, Mühlhofer HML. Peri-Prosthetic Joint Infection of the Knee Causes High Levels of Psychosocial Distress: A Prospective Cohort Study. Surg Infect (Larchmt) 2020; 21:877-883. [PMID: 32282286 DOI: 10.1089/sur.2019.368] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Peri-prosthetic joint infection (PJI) is a major complication of knee arthroplasty that can cause long-term disability. In addition to its physical impact, there is a clear psychological burden that has not been measured yet. We hypothesized that the psychosocial burden of PJI can be assessed quantitatively using standardized questionnaires and may be correlated with treatment stage. Methods: Thirty-one patients were enrolled in this longitudinal prospective cohort study from August 2015 to November 2016. Participants had clinically established knee PJI after primary total knee replacement in osteoarthritis according to the Musculoskeletal Infection Society criteria and underwent a standardized two-stage protocol. After explantation of the prosthesis and implantation of a polymethylmethacrylate knee spacer, patients were treated with organism-specific intravenous antibiotics for two weeks, followed by oral antibiotics for four weeks; and then reimplantation was performed in all cases. Psychometrically validated standardized questionnaires were used to measure psychosocial stress via self-assessment at four time points: (1) Before explantation of the prosthesis; (2) after explantation; (3) after the antibiotic treatment before reimplantation; and (4) three months after reimplantation (follow-up). The Patient Health Questionnaire (PHQ)-4, Short Form (SF)-12 (including PSK and KSK), Questions about Life Satisfaction (FLZM) and Fear of Progression (PA-F-KF) (titles and abbreviations in German) scores were interpreted according to cut-off values for depression, fear of progression, anxiety, and quality of life. Results: Eighteen patients (58.1%) showed a PHQ-4 score above the cut-off value for depression at least once, with the highest score before reimplantation (time point 3). On the SF-12, the mean subtest mental scale (PSK) score was 42.6 (± 14.5), and the mean subtest physical scale (KSK) score was 26.9 (± 7.5) over the four time points, which was significantly lower than that of the general German population (PSK 53.1, KSK 44.0; p < 0.05). The SF-12 scores did not change significantly over time. On the FLZ, health was least satisfactory, followed by recreational activities and work. On the PA-F-KF, patients had the greatest fear of being dependent on outside help, drastic medical interventions, and infection progression. The mean PA-F-KF value was 31.24 (± 9.60; values ≥34 are regarded as critical). Conclusion: Peri-prosthetic joint infection is a measurable, relevant psychosocial stressor for patients. Their quality of life and fear of the disease progressing are comparable to those of oncology patients. Routine screening should be conducted to identify affected patients early for appropriate treatment, improving long-term outcomes. Orthopaedic surgeons who treat patients with PJI should initiate by psychologists as well in order to maintain the patient's long-term quality of life.
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Affiliation(s)
- Carolin Knebel
- Klinikum rechts der Isar, Clinic for Orthopaedic and Sportorthopaedic, Technical University of Munich, School of Medicine, Munich, Germany
| | - Jennifer Menzemer
- Klinikum rechts der Isar, Clinic for Orthopaedic and Sportorthopaedic, Technical University of Munich, School of Medicine, Munich, Germany
| | - Florian Pohlig
- Klinikum rechts der Isar, Clinic for Orthopaedic and Sportorthopaedic, Technical University of Munich, School of Medicine, Munich, Germany
| | - Peter Herschbach
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Comprehensive Cancer Center Munich, Munich
| | - Rainer Burgkart
- Klinikum rechts der Isar, Clinic for Orthopaedic and Sportorthopaedic, Technical University of Munich, School of Medicine, Munich, Germany
| | - Andreas Obermeier
- Klinikum rechts der Isar, Clinic for Orthopaedic and Sportorthopaedic, Technical University of Munich, School of Medicine, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Klinikum rechts der Isar, Clinic for Orthopaedic and Sportorthopaedic, Technical University of Munich, School of Medicine, Munich, Germany
| | - Heinrich M L Mühlhofer
- Klinikum rechts der Isar, Clinic for Orthopaedic and Sportorthopaedic, Technical University of Munich, School of Medicine, Munich, Germany
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15
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Lenze U, Angelini A, Pohlig F, Knebel C, Trovarelli G, Berizzi A, Mavrogenis AF, Theisen J, VON Eisenhart-Rothe R, Ruggieri P. Chondrosarcoma of the Chest Wall: A Review of 53 Cases from Two Institutions. Anticancer Res 2020; 40:1519-1526. [PMID: 32132052 DOI: 10.21873/anticanres.14097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Chondrosarcomas (CS) of the chest wall are rare, but present an aggressive biological behavior compared to CS of the extremities. The aims of the present study were to determine factors associated with oncological outcomes as well as complications. PATIENTS AND METHODS We retrospectively analyzed 53 patients (42 primary, 11 recurrent tumors). In total, 39 central CS, 10 peripheral CS, 3 dedifferentiated CS and 1 mesenchymal CS were included. The ribs were most commonly affected (68%). Overall survival and disease-free survival were estimated with Kaplan-Meier analyses and compared with log-rank test. RESULTS Mean follow-up was 7 years. Negative margins were achieved in 87% of patients. Thirty patients (57%) remained continuously disease-free (NED), three (5%) NED after treatment of relapse, seven (13%) were alive with disease, twelve (23%) were dead with disease and one of other cause. The 10-year survival rate was 81% and 45% in primary and recurrent tumors, respectively. Survival was significantly affected by tumor stage (p<0.001), local recurrence (p=0.025) and metastases (p=0.002). Six complications (16%) were observed. CONCLUSION The outcome is rather poor, especially in patients with local recurrence. Presumably due to a high biological aggressiveness, a stricter definition of surgical margins should be considered for this location.
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Affiliation(s)
- Ulrich Lenze
- Department of Orthopedics, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padua, Italy
| | - Florian Pohlig
- Department of Orthopedics, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Carolin Knebel
- Department of Orthopedics, Klinikum rechts der Isar, Technical University, Munich, Germany
| | - Giulia Trovarelli
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padua, Italy
| | - Antonio Berizzi
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padua, Italy
| | - Andreas F Mavrogenis
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padua, Italy
| | - Joerg Theisen
- Department of Surgery, Klinikum rechts der Isar, Technical University, Munich, Germany
| | | | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Padua, Italy
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16
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Abstract
Joint infections are a great challenge for the treating physicians. Infection of a native joint can result in the rapid destruction of the joint if treatment is inadequate or delayed and is associated with severe life-threatening diseases, such as sepsis. This article presents a detailed overview of the treatment of joint infections of native joints with a focus on the diagnostic approach and treatment decisions. Infections in native joints are caused either endogenously by hematogenic spreading or are caused by exogenous factors. A relevant proportion of joint infections in native joints occur in connection with iatrogenic measures, such as operations, synovial punctures and joint infiltrations. Fundamentally, acute infections represent an orthopedic surgical emergency, which is associated with the necessity for immediate operative measures. The best possible success can only be achieved by an interaction between early diagnosis, an adequate surgical approach and a tailor-made anti-infectious treatment. This is also the case with periprosthetic infections, which will be dealt with in detail in a second article.
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Affiliation(s)
- Heinrich M L Mühlhofer
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - Susanne Feihl
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Ingo J Banke
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Christian Suren
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Florian Pohlig
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Rüdiger von Eisenhart-Rothe
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
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Mühlhofer HML, Feihl S, Suren C, Banke IJ, Pohlig F, von Eisenhart-Rothe R. Implantatassoziierte Gelenkinfektionen. Orthopäde 2020; 49:277-286. [DOI: 10.1007/s00132-020-03877-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Scheele C, Krauel I, Pohlig F, Muehlhofer H, Gerdesmeyer L, Lasic I, Prodinger PM, Banke I, von Eisenhart-Rothe R, Harrasser N. Guided and Unguided Biopsy in the Diagnostic of Periprosthetic Infections of the Knee - Evaluation of an Evidence-based Algorithm. Z Orthop Unfall 2019; 157:684-694. [PMID: 31658475 DOI: 10.1055/a-1034-0923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Periprosthetic joint infection (PPI) is one of the most common reasons for revision in total knee arthroplasty (TKA). Percutaneous synovial biopsy is considered as a well-established diagnostic tool in ambiguous cases of chronic pain after TKA. The exact number of undetected low-grade infections remains unclear. OBJECTIVES The aim of this prospective study was to compare the diagnostic accuracy of arthroscopically guided and unguided synovial biopsy. Additionally, the prevalence of initially undetected PPI during synovial biopsy and revision surgery was assessed. MATERIALS AND METHODS 40 patients suffering from chronic pain after TKA and the clinical suspicion of PPI were included in the study. Synovial biopsies were collected in a standardized manner first without and then with arthroscopic visual control. Using both techniques, six samples were collected each (5 for microbiology, 1 for histology). 19 patients, initially classified aseptic, underwent revision surgery later. RESULTS The diagnosis of PPI was made in 10.0% of unguided biopsies (4 cases, 2× microbiologically, 2× histologically), 7.5% of arthroscopic biopsies (3 cases, 3× histologically) and 12.5% (5 cases, 3× histologically, 2× microbiologically) of all cases. Only histologic evaluation led to concordant positive findings using both techniques in two patients. The proportion of non-representative biopsies was twice as high after unguided tissue collection than after arthroscopic biopsy (30.0 vs. 15.0%). Microbiologic evaluation of arthroscopically collected biopsies did not lead to the diagnosis of PPI, which might have been essential to the selection of the appropriate antimicrobial therapy. During revision surgery the diagnosis of PPI was made in 22.2% of cases. CONCLUSIONS In patients suffering from chronic pain after TKA, periprosthetic low-grade infection was diagnosed in a relevant proportion of cases. Therefore, synovial biopsies for histological and microbiological evaluation should be collected whenever there's clinical suspicion of PPI. For histological evaluation, samples should be collected using arthroscopic control and ideally multiple biopsies should be taken. For microbiological evaluation, excessive joint lavage should be avoided.
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Affiliation(s)
- Christian Scheele
- Department of Orthopaedics and Sports Orthopaedics, Rechts der Isar Clinic of Munich, Technical University
| | - Isabelle Krauel
- Department of Orthopaedics and Sports Orthopaedics, Rechts der Isar Clinic of Munich, Technical University
| | - Florian Pohlig
- Department of Orthopaedics and Sports Orthopaedics, Rechts der Isar Clinic of Munich, Technical University
| | - Heinrich Muehlhofer
- Department of Orthopaedics and Sports Orthopaedics, Rechts der Isar Clinic of Munich, Technical University
| | | | - Igor Lasic
- Department of Orthopaedics and Sports Orthopaedics, Rechts der Isar Clinic of Munich, Technical University
| | - Peter Michael Prodinger
- Department of Orthopaedics and Sports Orthopaedics, Rechts der Isar Clinic of Munich, Technical University
| | - Ingo Banke
- Department of Orthopaedics and Sports Orthopaedics, Rechts der Isar Clinic of Munich, Technical University
| | | | - Norbert Harrasser
- Department of Orthopaedics and Sports Orthopaedics, Rechts der Isar Clinic of Munich, Technical University
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Suren C, Feihl S, Querbach C, Rämer P, Pohlig F, Thurner J, Bernard R, Busch D, VON Eisenhart-Rothe R, Mühlhofer HML. Integrated IT Platform for Coordination of Diagnosis, Treatment, and Aftercare of Prosthetic Joint Infections. In Vivo 2019; 33:1625-1633. [PMID: 31471415 DOI: 10.21873/invivo.11647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/14/2019] [Accepted: 06/28/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIM Prosthetic joint infections (PJI) are difficult to diagnose and treat. For a correct diagnosis, an array of information has to be processed and weighted. Successful treatment depends on the diagnosis, timing, and surgical strategy paired with treatment of the infectious agent. The complexity and interdisciplinarity needed cause difficulties concerning decision-making, the communication between disciplines, and the execution of a treatment strategy. The aim of this study was to develop a software platform to enhance the collection of information for the diagnosis of PJI, the interdisciplinary decision-making process, the communication between team members, and continuous evaluation of treatment. PATIENTS AND METHODS In regular planning sessions with an information technology (IT) specialist, a concept for an IT solution was chosen and the tool was designed in an interdisciplinary approach. RESULTS The tool has been used as a trial version since June 2017. It consists of 14 user interfaces with 431 items. A total of 117 patients with 118 infections have been entered and the strategy decided upon and communicated using 298 infection board documents outlining the treatment. The tool is now being used to organize the infections board agenda, schedule patient case discussions, document the relevant data and treatment plan, as well as communicate with the other teams involved in the treatment. CONCLUSION Using the developed tool enables the infections team to work collaboratively and under division of labor on each case, rendering the work flow more efficient for each team member.
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Affiliation(s)
- Christian Suren
- Department for Orthopedics and Sports Orthopedics, Technical University Munich, Munich, Germany
| | - Susanne Feihl
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University Munich, Munich, Germany
| | - Christiane Querbach
- Apotheke, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Patrick Rämer
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University Munich, Munich, Germany
| | - Florian Pohlig
- Department for Orthopedics and Sports Orthopedics, Technical University Munich, Munich, Germany
| | - Jakob Thurner
- Department for Orthopedics and Sports Orthopedics, Technical University Munich, Munich, Germany
| | - Rudolf Bernard
- Apotheke, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Dirk Busch
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University Munich, Munich, Germany
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Lenze F, Pohlig F, Knebel C, Mühlhofer H, Rechl H, Pichler T, Herschbach P, VON Eisenhart-Rothe R, Lenze U. Psychosocial Distress in Follow-up Care - Results of a Tablet-based Routine Screening in 202 Patients With Sarcoma. Anticancer Res 2019; 39:3159-3165. [PMID: 31177162 DOI: 10.21873/anticanres.13453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients with sarcoma are particularly vulnerable to psychosocial distress. The aim of this study was to collect preliminary data on the prevalence of psychosocial distress in such patients during follow-up care and identify risk factors associated with higher psycho-oncological stress levels. PATIENTS AND METHODS The study retrospectively enrolled 202 patients with bone or soft-tissue sarcomas who underwent routine psychosocial distress screening during their follow-up care. All patients were screened using an electronic cancer-specific questionnaire. RESULTS Females and patients who underwent radiotherapy were more distressed. Psychosocial distress levels were markedly higher in the early postoperative phase, but approximately one-third of patients showed high psychosocial distress levels even more than 2 years postoperatively. CONCLUSION The results underscore the importance of routine psychosocial distress screenings in patients with sarcoma, which should be performed throughout the follow-up period.
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Affiliation(s)
- Florian Lenze
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Florian Pohlig
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Carolin Knebel
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Heinrich Mühlhofer
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Hans Rechl
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | | | - Peter Herschbach
- Roman Herzog Comprehensive Cancer Center, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Rüdiger VON Eisenhart-Rothe
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Ulrich Lenze
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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Lenze F, Scheele C, Kösters P, Gerdesmeyer L, Lasic I, Pohlig F, Mühlhofer H, Lenze U, VON Eisenhart-Rothe R, Harrasser N. A 30-Year Single-center Experience of Cementless Total Hip Arthroplasty With Spongy Metal Structured Implants: A Follow-up of a Previous Report. In Vivo 2019; 33:833-838. [PMID: 31028205 PMCID: PMC6559900 DOI: 10.21873/invivo.11547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/13/2019] [Accepted: 03/15/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The aim of this study was to analyze survivorship and functional outcome of cementless spongy metal structured total hip arthroplasty (THA) after ultra-long-term follow-up. PATIENTS AND METHODS A total of 100 THAs in patients under 65 years at initial surgery were performed between 1985 and 1989 at our Department. Twenty patients (23 hips) were available for final follow-up. Implant survivorship and functional results (Merle d'Aubigné, SF-12) were assessed. RESULTS At a mean follow-up of 30 years (range=27.7-31.7 years), the overall stem survival rate was 82.6% (19/23 stems) and the overall cup survival rate was 52.2% (12/23 cups). Revision surgeries were performed for aseptic loosening in all cases. Functional evaluation revealed good to excellent results in 16 patients (80%) Conclusion: Spongy metal structured cementless THA provides remarkable survivorship and excellent functional results even after ultra-long-term follow-up. Further research regarding modern implants, bearing surfaces etc. is required to assess survivorship and clinical outcomes of different implant designs.
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Affiliation(s)
- Florian Lenze
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Christian Scheele
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Philipp Kösters
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Ludger Gerdesmeyer
- Department of Orthopedics and Trauma Surgery, University Medical Centre Schleswig Holstein, Kiel, Germany
| | - Igor Lasic
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Florian Pohlig
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Heinrich Mühlhofer
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Ulrich Lenze
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Rüdiger VON Eisenhart-Rothe
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Norbert Harrasser
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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Lenze F, Kirchhoff C, Pohlig F, Knebel C, Rechl H, Marten-Mittag B, Herschbach P, Eisenhart-Rothe RV, Lenze U. Standardized Screening and Psycho-oncological Treatment of Orthopedic Cancer Patients. In Vivo 2018; 32:1161-1167. [PMID: 30150439 DOI: 10.21873/invivo.11359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND/AIM Psycho-oncological distress is a relevant clinical problem. The aim of this study was to administer a standardized psycho-oncological distress screening for early identification and indication-based treatment of highly distressed orthopedic cancer patients as well as the evaluation of distress patterns. PATIENTS AND METHODS In total, 35 patients with cancer were psycho-oncologically screened using a cancer-specific expert rating scale (Basic Documentation for Psycho-Oncology Short Form) at three different time points (day of admission, day before discharge, 3 months postoperatively). Psycho-oncological support was offered to all patients whose distress exceeded a defined cut-off value. RESULTS Levels of distress in approximately 51% of patients exceeded the cut-off value at the time of admission and these patients received psycho-oncological support. The high distress levels decreased significantly over time. Patients whose distress did not exceed the cut-off value at the first assessment showed low distress levels at all time points. CONCLUSION A relevant number of orthopedic tumor patients suffer from psychosocial distress. Standardized screening might help to identify and adequately treat those patients.
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Affiliation(s)
- Florian Lenze
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Chlodwig Kirchhoff
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Florian Pohlig
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Carolin Knebel
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hans Rechl
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Birgit Marten-Mittag
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Peter Herschbach
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Roman Herzog Comprehensive Cancer Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Rüdiger V Eisenhart-Rothe
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ulrich Lenze
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Pohlig F, Mühlhofer HML, Harrasser N, Lenze F, Prodinger PM, von Eisenhart-Rothe R. [Metal hypersensitivity in total knee arthroplasty]. MMW Fortschr Med 2018; 160:58-60. [PMID: 30350062 DOI: 10.1007/s15006-018-1030-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Florian Pohlig
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, München, Deutschland.
| | - Heinrich Maria Laurentius Mühlhofer
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, München, Deutschland
| | - Norbert Harrasser
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, München, Deutschland
| | - Florian Lenze
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, München, Deutschland
| | - Peter Michael Prodinger
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, München, Deutschland
| | - Rüdiger von Eisenhart-Rothe
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, München, Deutschland
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Toepfer A, Harrasser N, Recker M, Lenze U, Pohlig F, Gerdesmeyer L, von Eisenhart-Rothe R. Distribution patterns of foot and ankle tumors: a university tumor institute experience. BMC Cancer 2018; 18:735. [PMID: 30001718 PMCID: PMC6043962 DOI: 10.1186/s12885-018-4648-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 06/28/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Bone and soft tissue masses of the foot and ankle are not particularly rare but true neoplasia has to be strictly differentiated from pseudotumorous lesions. Diagnosis is often delayed as diagnostic errors are more common than in other regions. Awareness for this localization of musculoskeletal tumors is not very high and neoplasia is often not considered. The purpose of this study is to provide detailed information on the incidence and distribution patterns of foot and ankle tumors of a university tumor institute and propose a simple definition to facilitate comparison of future investigations. METHODS As part of a retrospective, single-centre study, the data of patients that were treated for foot and ankle tumors between June 1997 and December 2015 in a musculoskeletal tumor centre were analyzed regarding epidemiologic information, entity and localization. Included were all cases with a true tumor of the foot and ankle. Exclusion criteria were incomplete information on the patient or entity (e.g. histopathological diagnosis) and all pseudotumoral lesions. RESULTS Out of 7487 musculoskeletal tumors, 413 cases (5,52%) of tumors of the foot and ankle in 409 patients were included (215 male and 198 female patients). The average age of the affected patients was 36 ± 18y (min.3y, max.92y). Two hundred sixty-six tumors involved the bone (64%), among them 231 (87%) benign and 35 (13%) malignant. There were 147 soft tissue tumors (36%), 104 (71%) were benign, 43 (29%) malignant. The most common benign osseous tumor lesions included simple bone cysts, enchondroma and osteochondroma. By far the most common malignant bone tumor was chondrosarcoma. Common benign soft tissue tumors included pigmented villo-nodular synovitis, superifcial fibromatosis and schwannoma whereas the most common malignant members were synovial sarcoma and myxofibrosarcoma. Regarding anatomical localization, the hindfoot was affected most often. CONCLUSIONS Knowledge of incidence and distribution patterns of foot and ankle tumors will help to correctly assess unclear masses and initiate the right steps in further diagnostics and treatment. Unawareness can lead to delayed diagnosis and inadequate treatment with serious consequences for the affected patient.
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Affiliation(s)
- Andreas Toepfer
- Klinik für Orthopädie und Sportorthopädie Klinikum rechts der Isar der Technischen, Universität München, Ismaningerstr.22, 81675, München, Germany. .,Wilhelm Sander-Therapieeinheit für Knochen- und Weichteilsarkome am Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Germany. .,Kantonspital St. Gallen, Klinik für Orthopädische Chirurgie und Traumatologie, Rorschacher Strasse 95, CH-9007, St. Gallen, Switzerland.
| | - Norbert Harrasser
- Klinik für Orthopädie und Sportorthopädie Klinikum rechts der Isar der Technischen, Universität München, Ismaningerstr.22, 81675, München, Germany.,Wilhelm Sander-Therapieeinheit für Knochen- und Weichteilsarkome am Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Germany
| | - Maximiliane Recker
- Klinik für Orthopädie und Sportorthopädie Klinikum rechts der Isar der Technischen, Universität München, Ismaningerstr.22, 81675, München, Germany
| | - Ulrich Lenze
- Klinik für Orthopädie und Sportorthopädie Klinikum rechts der Isar der Technischen, Universität München, Ismaningerstr.22, 81675, München, Germany.,Wilhelm Sander-Therapieeinheit für Knochen- und Weichteilsarkome am Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Germany
| | - Florian Pohlig
- Klinik für Orthopädie und Sportorthopädie Klinikum rechts der Isar der Technischen, Universität München, Ismaningerstr.22, 81675, München, Germany.,Wilhelm Sander-Therapieeinheit für Knochen- und Weichteilsarkome am Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Germany
| | - Ludger Gerdesmeyer
- Universitätsklinikum Schleswig Holstein, Campus Kiel, Sektion für Onkologische und Rheumatologische Orthopädie in der Klinik für Unfallchirurgie, Arnold Heller Strasse, D-24105, Kiel, Germany
| | - Rüdiger von Eisenhart-Rothe
- Klinik für Orthopädie und Sportorthopädie Klinikum rechts der Isar der Technischen, Universität München, Ismaningerstr.22, 81675, München, Germany.,Wilhelm Sander-Therapieeinheit für Knochen- und Weichteilsarkome am Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Germany
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Pohlig F, Mühlhofer HML, Harrasser N, Suren C, Prodinger PM, von Eisenhart-Rothe R. [Minimally invasive total hip arthroplasty: an overview]. MMW Fortschr Med 2018; 160:61-64. [PMID: 30014387 DOI: 10.1007/s15006-018-0774-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Florian Pohlig
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, München, Deutschland.
| | - Heinrich Maria Laurentius Mühlhofer
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, München, Deutschland
| | - Norbert Harrasser
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, München, Deutschland
| | - Christian Suren
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, München, Deutschland
| | - Peter Michael Prodinger
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, München, Deutschland
| | - Rüdiger von Eisenhart-Rothe
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, D-81675, München, Deutschland
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Suren C, Harrasser N, Pohlig F, Banke IJ, Lenze U, Lenze F, Knebel C, VON Eisenhart-Rothe R, Schauwecker J, Mühlhofer HML. Prospective Analysis of a Sterile, Semi-automated Tissue Biopsy Homogenization Method in the Diagnosis of Prosthetic Joint Infections. ACTA ACUST UNITED AC 2018; 31:937-942. [PMID: 28882962 DOI: 10.21873/invivo.11150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 06/09/2017] [Accepted: 06/12/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Prosthetic joint infection (PJI) remains a serious complication of total joint arthroplasty. To effectively treat PJI, it is essential to identify the microorganism causing it and be able to combine correct surgical and anti-infective treatments. This cannot always be achieved with the currently employed diagnostic methods. The aim of this study was to evaluate a semi-automated tissue biopsy bead milling method (Ultra-TurrAX, Axonlab AG; Reichenbach, Germany) based on the hypothesis that the results are more sensitive for microbe detection and less prone to contamination. MATERIALS AND METHODS We included 35 consecutive patients undergoing 38 hip or knee arthroplasty revisions in this study. In addition to manually processed biopsies, we processed tissue specimens harvested intraoperatively using a semi-automated method. The sensitivity and specificity of both methods were calculated using MSIS criteria and sonication results as gold standards. RESULTS For total hip arthroplasty samples were evaluated separately based on MSIS criteria as the reference standard, Ultra-TurrAX processing yielded 81% (62-100%) sensitivity and 100% specificity. Using sonication as the gold standard, a sensitivity of 80% (60-100%) and specificity of 80% (45-100%) were calculated. In total knee arthroplasty, Ultra-TurrAX processing yielded 27% (1-54%) sensitivity and 57% (20-94%) specificity when using MSIS criteria as the gold standard. Using sonication as the gold standard, a sensitivity of 60% (17-100%) and specificity of 77% (54-100%) were calculated. CONCLUSION This is the first study to analyze bead mill processing in total hip and knee arthroplasty revisions in a consecutive patient series. The method's sensitivity was comparable to and its specificity superior to regular sample processing results reported in the literature with respect to hip arthroplasties and to both hip and knee arthroplasties collectively. With respect to total knee arthroplasties, the method fared worse in our collective, most likely due to the small number of patients in the sample. Integrating the method into the clinical workflow allowed for speedier and more efficient sample handling and processing. The theoretical advantage of a lower risk of contamination because of fewer manual processing steps is, in our opinion, valid.
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Affiliation(s)
- Christian Suren
- Department of Orthopedic Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Norbert Harrasser
- Department of Orthopedic Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Florian Pohlig
- Department of Orthopedic Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Ingo J Banke
- Department of Orthopedic Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Ulrich Lenze
- Department of Orthopedic Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Florian Lenze
- Department of Orthopedic Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Carolin Knebel
- Department of Orthopedic Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | | | - Johannes Schauwecker
- Department of Orthopedic Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Heinrich M L Mühlhofer
- Department of Orthopedic Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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Toepfer A, Harrasser N, Petzschner I, Pohlig F, Lenze U, Gerdesmeyer L, von Eisenhart-Rothe R, Mühlhofer H, Suren C. Is total femoral replacement for non-oncologic and oncologic indications a safe procedure in limb preservation surgery? A single center experience of 22 cases. Eur J Med Res 2018; 23:5. [PMID: 29338761 PMCID: PMC5771193 DOI: 10.1186/s40001-018-0302-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 01/05/2018] [Indexed: 02/01/2023] Open
Abstract
Background Several surgical options for the reconstruction of massive bone defects have been described and include biologic methods with autografts and allografts, and the use of tumor endoprostheses (total femoral replacement, TFR). Several types of modular TFR are available, but nevertheless unpredictable outcomes and high complication rates have been described from most authors. The present study aims to compare results after TFR performed with modular total femur prosthesis MML (Fa. ESKA/Orthodynamics) in patients with and without malignant disease. Methods Retrospective chart review and functional investigation (Musculoskeletal Tumor Society (MSTS) score, Harris Hip Score (HHS), Oxford Knee Score (OKS), SF-12 Health Survey, and failure classification according to Henderson) of TFR cases from 1995 to 2011. Indications for TFR were malignant tumor resection from the femur (n = 9, Group A) or failure of a revision arthroplasty without history of malignant disease (n = 13, Group B). Results Thirty-six patients were treated during the study period, of whom 22 could be investigated clinically after a mean follow-up of 63 months. Overall failure rate for TFR was 59.1%, leading to 38 surgical revisions. The most common failure mechanisms were Type I (soft tissue), followed by Type IV (infection) and Type III (mechanical failure). Mean MSTS score out of 30 was 13 (range 1–25), with significantly higher scores in Group A (mean 19, range 3–25) than Group B (mean 9, range 1–15). Conclusion TFR is an established procedure to restore femoral integrity. However, complication rates are considerably high, and depend mainly on the age at initial reconstruction.
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Affiliation(s)
- Andreas Toepfer
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547, Munich, Germany.
| | - Norbert Harrasser
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547, Munich, Germany
| | | | - Florian Pohlig
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547, Munich, Germany
| | - Ulrich Lenze
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547, Munich, Germany
| | - Ludger Gerdesmeyer
- Departmant of Orthopaedic Surgery and Traumatology, University of Schleswig-Holstein, Kiel, Germany
| | | | - Heinrich Mühlhofer
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547, Munich, Germany
| | - Christian Suren
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547, Munich, Germany
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Mühlhofer HML, Knebel C, Pohlig F, Feihl S, Harrasser N, Schauwecker J, von Eisenhart-Rothe R. Synovial aspiration and serological testing in two-stage revision arthroplasty for prosthetic joint infection: evaluation before reconstruction with a mean follow-up of twenty seven months. International Orthopaedics (SICOT) 2017; 42:265-271. [DOI: 10.1007/s00264-017-3700-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 11/21/2017] [Indexed: 12/17/2022]
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Mühlhofer HML, Deiss L, Mayer-Kuckuk P, Pohlig F, Harrasser N, Lenze U, Gollwitzer H, Suren C, Prodinger P, VON Eisenhart-Rothe R, Schauwecker J. Increased Resistance of Skin Flora to Antimicrobial Prophylaxis in Patients Undergoing Hip Revision Arthroplasty. In Vivo 2017; 31:673-676. [PMID: 28652437 PMCID: PMC5566920 DOI: 10.21873/invivo.11111] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/07/2017] [Accepted: 05/08/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND/AIM Prosthetic joint infection (PJI) remains a major complication after total joint replacement and is the primary indication for revision arthroplasty. Specifically, coagulase-negative Staphylococci (CNS) can cause low-grade infections. Despite the use of cephalosporin-based antimicrobial prophylaxis (AMP) and antiseptic treatment at the surgical site, evidence suggests that a significant number of cases of dermal CNS results in low-grade PJI. Thus, this study examined the bacterial colonization and resistance patterns at the surgical site. We hypothesized that the bacteria developed resistance to antibiotics that are frequently used in primary and revision total hip arthroplasty (THA) procedures. PATIENTS AND METHODS Ninety patients, including 63 primary and 27 revision THA patients, were enrolled in this study. For each patient, a single swab of the skin at the surgical site was subjected to clinical microbiology to assess bacterial colonization. Furthermore, resistance to a sentinel panel of antibiotics (benzylpenicillin, erythromycin, tetracycline, oxacillin, fusidic acid, clindamycin, gentamicin, levofloxacin/moxifloxacin, rifampicin, linezolid and vancomycin) was tested. RESULTS In 96.7% of the patients, at least one bacterial strain was identified at the surgical site, with CNS strains comprising 93.1% of the total. The sentinel panel showed that 30.7% of the CNS strains exhibited maximal resistance to oxacillin, a commonly used cephalosporin. Additionally, oxacillin resistance increased 1.9-fold (p=0.042) between primary and revision THA. Notably, 8.1% of the CNS stains found on patients undergoing primary THA were resistant to gentamicin, an aminoglycoside, and this rate increased 4.7-fold (p=0.001) for patients undergoing revision THA. CONCLUSION CNS strains have significant resistance to standard AMP, particularly in individuals undergoing revision THA.
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Affiliation(s)
- Heinrich M L Mühlhofer
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Lukas Deiss
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Philipp Mayer-Kuckuk
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Florian Pohlig
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Norbert Harrasser
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Ulrich Lenze
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Hans Gollwitzer
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Christian Suren
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Peter Prodinger
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | | | - Johannes Schauwecker
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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Harrasser N, von Eisenhart-Rothe R, Pohlig F, Waizy H, Toepfer A, Gerdesmeyer L, Eichelberg K. Arthrose des oberen Sprunggelenks. Orthopäde 2017; 46:625-638. [DOI: 10.1007/s00132-017-3435-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Toepfer A, Harrasser N, Schwarz PR, Pohlig F, Lenze U, Mühlhofer HML, Gerdesmeyer L, von Eisenhart-Rothe R, Suren C. Distal femoral replacement with the MML system: a single center experience with an average follow-up of 86 months. BMC Musculoskelet Disord 2017; 18:206. [PMID: 28532493 PMCID: PMC5441101 DOI: 10.1186/s12891-017-1570-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 05/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to compare the functional outcomes and complication rates after distal femoral replacement (DFR) performed with the modular Munich-Luebeck (MML) modular prosthesis (ESKA/Orthodynamics, Luebeck, Germany) in patients being treated for malignant disease or failed total knee arthroplasty. Methods A retrospective review of patient charts and a functional investigation (involving Musculoskeletal Tumor Society Score [MSTS], American Knee Society Score [AKSS], Oxford Knee Score [OKS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], Toronto Extremity Salvage Score [TESS], the 12-Item Short-Form [SF-12] Health Survey, and a failure classification system developed by Henderson et al.) of DFR cases from 2002 to 2015 were conducted. The indications for DFR were malignant tumor resection in the femur (n = 20, group A) or failure of revision total knee arthroplasty without a history of malignant disease (n = 16, group B). Results One-hundred and twenty-nine patients were treated during the study period. Of these, 82 were analyzed for complications and implant-survival. Further, 36 patients were available for functional assessment after a mean follow-up of 86 months (range: 24–154). There were 75 complications in total. The overall failure rate for DFR was 64.6% (53/82 patients). The most common failure mechanisms were type III (mechanical failure), followed by type I (soft tissue) and type II (aseptic loosening). The mean MSTS score (out of 30) was 17 for group A and 12 for group B. All the clinical outcome scores revealed an age-dependent deterioration of function. Conclusion DFR is an established procedure to restore distal femoral integrity. However, complication rates are high. Post-procedure functionality depends mainly on the patient’s age at initial reconstruction.
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Affiliation(s)
- Andreas Toepfer
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547, Munich, Germany.
| | - Norbert Harrasser
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547, Munich, Germany
| | | | - Florian Pohlig
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547, Munich, Germany
| | - Ulrich Lenze
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547, Munich, Germany
| | - Heinrich M L Mühlhofer
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547, Munich, Germany
| | - Ludger Gerdesmeyer
- Department of Orthopaedic Surgery and Traumatology, University of Schleswig Holstein, Lübeck, Germany
| | | | - Christian Suren
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547, Munich, Germany
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Schauwecker J, Bock M, Pohlig F, Mühlhofer H, Tübel J, von Eisenhart-Rothe R, Kirchhoff C. In vitro Growth Pattern of Primary Human Osteoblasts on Calcium Phosphate- and Polymethylmethacrylate-Based Bone Cement. Eur Surg Res 2017; 58:216-226. [PMID: 28494462 DOI: 10.1159/000470839] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 03/13/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND/PURPOSE Polymethylmethacrylate (PMMA) and calcium phosphate (Ca-P) cements are widely used for arthroplasty surgery and augmentation of bone defects. However, aseptic implant loosening in absence of wear-induced osteolysis indicates an unfavourable interaction between the cement surface and human osteoblasts. Our underlying hypothesis is that cement surfaces directly modify cell viability, proliferation rate, and cell differentiation. METHODS To test this hypothesis, we examined primary human osteoblasts harvested from six individuals. These cells were pooled and subsequently seeded directly on cement pellets prepared from Palacos® R, Palacos® R+G, and Norian® Drillable cements. After incubation for 24 and 72 h, cell viability, proliferation rate, apoptosis rate, and cell differentiation were analysed. RESULTS Upon cultivation of human osteoblasts on cement surfaces, we observed a significantly reduced cell viability and DNA content compared to the control. Analysis of the apoptosis rate revealed an increase for cells on Palacos R and Norian Drillable, but a significant decrease on Palacos R+G compared to the control. Regarding osteogenic differentiation, significantly lower values of alkaline phosphatase enzyme activity were identified for all cement surfaces after 24 and 72 h compared to cultivation on tissue culture plastic, serving as control. CONCLUSIONS In summary, these data suggest a limited biocompatibility of both PMMA and Ca-P cements, necessitating further research to reduce unfavourable cell-cement interactions and consequently extend implant survival.
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Affiliation(s)
- Johannes Schauwecker
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Pohlig F, Lenze U, Muhlhofer HML, Lenze FW, Schauwecker J, Knebel C, Zimmermann T, Herschbach P. IT-based Psychosocial Distress Screening in Patients with Sarcoma and Parental Caregivers via Disease-specific Online Social Media Communities. ACTA ACUST UNITED AC 2017; 31:443-450. [PMID: 28438877 DOI: 10.21873/invivo.11081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/11/2017] [Accepted: 03/14/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Psychosocial distress can be frequently observed in patients with sarcoma, depicting a relevant clinical problem. However, prospective data collection on psychosocial distress in patients with rare tumors is often time-consuming. In this context, social media such as Facebook can serve as a potential platform to expand research. The aim of this study was to assess the feasibility of psychosocial distress screening in patients with osteosarcoma and Ewing's sarcoma via social media. MATERIALS AND METHODS For this study an online questionnaire including general information and self-assessment distress measurement tools for patients and parents was created. The link to the questionnaire was then posted on the main page of the two largest disease-specific Facebook communities on osteosarcoma and Ewing's sarcoma. RESULTS Within 2 months, 28 patients and 58 parents of patients were enrolled. All patients with osteosarcoma and Ewing's sarcoma, as well as the majority of parental caregivers of such patients, showed relevant psychosocial distress levels. CONCLUSION Crowdsourcing via disease-specific patient communities on Facebook is feasible and provides great potential for acquisition of medical data of rare diseases.
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Affiliation(s)
- Florian Pohlig
- Department of Orthopedic Surgery, Rechts der Isar Hospital, Technical University Munich, Munich, Germany
| | - Ulrich Lenze
- Department of Orthopedic Surgery, Rechts der Isar Hospital, Technical University Munich, Munich, Germany
| | - Heinrich M L Muhlhofer
- Department of Orthopedic Surgery, Rechts der Isar Hospital, Technical University Munich, Munich, Germany
| | - Florian W Lenze
- Department of Orthopedic Surgery, Rechts der Isar Hospital, Technical University Munich, Munich, Germany.,Department of Traumatology, Traunstein HospitaI, Traunstein, Germany
| | - Johannes Schauwecker
- Department of Orthopedic Surgery, Rechts der Isar Hospital, Technical University Munich, Munich, Germany
| | - Carolin Knebel
- Department of Orthopedic Surgery, Rechts der Isar Hospital, Technical University Munich, Munich, Germany
| | - Tanja Zimmermann
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hannover, Hannover, Germany
| | - Peter Herschbach
- Roman-Herzog-Comprehensive Cancer Center, Department of Psychosomatic Medicine and Psychotherapy, Rechts der Isar Hospital, Technical University Munich, Munich, Germany
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Mühlhofer HML, Pohlig F, Kanz KG, Lenze U, Lenze F, Toepfer A, Kelch S, Harrasser N, von Eisenhart-Rothe R, Schauwecker J. Prosthetic joint infection development of an evidence-based diagnostic algorithm. Eur J Med Res 2017; 22:8. [PMID: 28274250 PMCID: PMC5343418 DOI: 10.1186/s40001-017-0245-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 02/24/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Increasing rates of prosthetic joint infection (PJI) have presented challenges for general practitioners, orthopedic surgeons and the health care system in the recent years. The diagnosis of PJI is complex; multiple diagnostic tools are used in the attempt to correctly diagnose PJI. Evidence-based algorithms can help to identify PJI using standardized diagnostic steps. METHODS We reviewed relevant publications between 1990 and 2015 using a systematic literature search in MEDLINE and PUBMED. The selected search results were then classified into levels of evidence. The keywords were prosthetic joint infection, biofilm, diagnosis, sonication, antibiotic treatment, implant-associated infection, Staph. aureus, rifampicin, implant retention, pcr, maldi-tof, serology, synovial fluid, c-reactive protein level, total hip arthroplasty (THA), total knee arthroplasty (TKA) and combinations of these terms. RESULTS From an initial 768 publications, 156 publications were stringently reviewed. Publications with class I-III recommendations (EAST) were considered. We developed an algorithm for the diagnostic approach to display the complex diagnosis of PJI in a clear and logically structured process according to ISO 5807. CONCLUSIONS The evidence-based standardized algorithm combines modern clinical requirements and evidence-based treatment principles. The algorithm provides a detailed transparent standard operating procedure (SOP) for diagnosing PJI. Thus, consistently high, examiner-independent process quality is assured to meet the demands of modern quality management in PJI diagnosis.
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Affiliation(s)
- Heinrich M. L. Mühlhofer
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Florian Pohlig
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Karl-Georg Kanz
- Department of Trauma Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Ulrich Lenze
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Florian Lenze
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas Toepfer
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Sarah Kelch
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Norbert Harrasser
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Johannes Schauwecker
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
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Pohlig F, Mühlhofer HML, Lenze U, Lenze FW, Suren C, Harrasser N, von Eisenhart-Rothe R, Schauwecker J. Diagnostic accuracy of arthroscopic biopsy in periprosthetic infections of the hip. Eur J Med Res 2017; 22:6. [PMID: 28259167 PMCID: PMC5336685 DOI: 10.1186/s40001-017-0246-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 02/28/2017] [Indexed: 01/26/2023] Open
Abstract
Background Diagnosis of a low-grade periprosthetic joint infection (PJI) prior to revision surgery can be challenging, despite paramount importance for further treatment. Arthroscopic biopsy of synovial and periprosthetic tissue with subsequent microbiological and histological examination can be beneficial but its specific diagnostic value has not been clearly defined. Methods 20 consecutive patients who underwent percutaneous synovial fluid aspiration as well as arthroscopic biopsy due to suspected PJI of the hip and subsequent one- or two-stage revision surgery at our institution between January 2012 and May 2015 were enrolled. Indication was based on the criteria (1) history of PJI and increased levels of erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), (2) suspicious cell count and differential but negative bacterial culture in synovial aspirate, (3) early loosening (<less than 2 years), or (4) persisting pain without loosening but history of a PJI. At least two criteria had to be fulfilled in order to perform an arthroscopic biopsy. Results Best overall diagnostic value was identified for arthroscopic biopsy and a combination of bacteriological and histological analysis with a sensitivity of 87.5%, specificity of 100% and accuracy of 95%. Bacteriological assessment of synovial aspirate revealed a sensitivity of 50.0%, specificity of 91.7%, and accuracy of 75%. ESR and CRP yielded a sensitivity of 75.0% for either hematologic test and specificities of 87.5 and 66.7%, respectively. Conclusions In conclusion, our data indicate that arthroscopic biopsy is superior to ESR and CRP as well as joint aspiration and their combinations. Concurrent microbiological and histological examination of the biopsy specimens allows for identification of the causative pathogen and its susceptibility pattern in order to preoperatively plan the surgical strategy as well as the antibiotic regimen. Moreover, intraarticular mechanical failure can be detected during hip arthroscopy emphasizing its diagnostic value. Level II diagnostic study.
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Affiliation(s)
- Florian Pohlig
- Department of Orthopedic Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Heinrich M L Mühlhofer
- Department of Orthopedic Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Ulrich Lenze
- Department of Orthopedic Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Florian W Lenze
- Department of Traumatology, Klinikum Traunstein, Cuno-Niggl-Str. 3, 83278, Traunstein, Germany
| | - Christian Suren
- Department of Orthopedic Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Norbert Harrasser
- Department of Orthopedic Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopedic Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Johannes Schauwecker
- Department of Orthopedic Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
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Prodinger PM, Schauwecker J, Mühlhofer H, Harrasser N, Pohlig F, Suren C, von Eisenhart-Rothe R. [Hip dislocation after revision arthroplasty : Risk assessment and treatment strategies]. Orthopade 2017; 46:133-141. [PMID: 28108774 DOI: 10.1007/s00132-016-3377-z] [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] [Indexed: 11/30/2022]
Abstract
With a dislocation rate of up to 35% after revision total hip arthroplasty (THA), instability is one of the major causes why this procedure fails. Independent factors for patients at risk are age, sex, and the type of revision needed. The surgical approach, implant choice, and positioning of the components are factors that the surgeon can influence to keep the dislocation rate low. Large femoral heads or double mobility (DM) cups can increase the stability of the joint. After detailed failure analysis, targeted use of different technical innovations enhances stability in revision THA and prevents further revisions.
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Affiliation(s)
- P M Prodinger
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
| | - J Schauwecker
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - H Mühlhofer
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - N Harrasser
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - F Pohlig
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - C Suren
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - R von Eisenhart-Rothe
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland
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von Matthey F, Braun KF, Hanschen M, Pohlig F, Schubert EC, Matevossian E, Hoppmann P, Kanz KG, Biberthaler P. [Cardiac post-resuscitation care. An indication for trauma whole-body CT?]. Unfallchirurg 2017; 119:69-73. [PMID: 26239298 DOI: 10.1007/s00113-015-0045-4] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We report the case of a 51-year-old male patient who sustained a liver rupture following mechanical cardiopulmonary resuscitation (CPR) with the LUCAS® system. The patient was under anticoagulation and developed an abdominal compartment syndrome. Although the use of mechanical CPR devices, such as the LUCAS® system and the load distributing band (Autopulse®), is becoming more common, there are specific complications described in the literature, which are associated with mechanical CPR. It is important to differentiate between general complications associated with CPR and those which can be attributed to the application of mechanical CPR devices. Using the example of the presented case, this article outlines and discusses these points based on the currently available literature. It should also be noted that mechanical CPR can act in a similar way to chest trauma and can necessitate an investigation with contrast enhanced computed tomography.
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Affiliation(s)
- F von Matthey
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstraße 22, 81675, München, Deutschland.
| | - K F Braun
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstraße 22, 81675, München, Deutschland
| | - M Hanschen
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstraße 22, 81675, München, Deutschland
| | - F Pohlig
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstraße 22, 81675, München, Deutschland
| | - E C Schubert
- Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - E Matevossian
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - P Hoppmann
- I. Medizinischen Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - K-G Kanz
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstraße 22, 81675, München, Deutschland
| | - P Biberthaler
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstraße 22, 81675, München, Deutschland
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Toepfer A, Harrasser N, Petzschner I, Pohlig F, Lenze U, Gerdesmeyer L, Pförringer D, Toepfer M, Beirer M, Crönlein M, von Eisenhart-Rothe R, Mühlhofer H. Short- to long-term follow-up of total femoral replacement in non-oncologic patients. BMC Musculoskelet Disord 2016; 17:498. [PMID: 27955655 PMCID: PMC5154048 DOI: 10.1186/s12891-016-1355-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/30/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Compromised bone stock and heavily impaired structural integrity after multiple endoprosthetic revision surgeries can lead to a comparable condition as encountered in musculoskeletal tumor surgery. Total femoral replacement (TFR) can restore femoral integrity and allow patients to resume ambulation. Even though several authors reported their results of TFR, so far many questions are still on debate: Which patients are at risk to experience low functional outcome? Do complications and clinical outcome after TFR depend on the indication for the surgery (e.g. periprosthetic fractures or aseptic loosening) or the age of the patients? The purpose of the present study was to compare complication rates after TFR performed with modular total femur prosthesis MML (Fa. ESKA/Orthodynamics) in patients without malignant disease. METHODS We conducted a retrospective chart review and functional investigation of patients treated with a TFR for non-oncologic conditions from 1995 to 2015 and a minimum follow-up of 2 years. Complications were recorded according to the Henderson-Classification; outcome was evaluated with established clinical scores. The indication for TFR was periprosthetic fracture (Group A, n = 11) or aseptic loosening (Group B, n = 7) with massive bone defect of the femur deemed unsuitable for conventional arthroplastic or biologic reconstruction. RESULTS Eighteen patients matched the inclusion criteria and could be investigated clinically after a mean follow-up of 80 months (range: 28-132). Before TFA, all patients had previously undergone multiple operations (range: 1-8). The overall failure rate for any reason was 72% (n = 13/18), leading to a total of 37 surgical revisions with total exchange of TFR in 22% (n = 4/18). Most common failure mechanism was Type I (soft tissue), followed by Type IV (infection) and Type III (mechanical failure). According to Enneking's functional evaluation method (MSTS-Score), the function ranged from 1 to 15 with a mean of 10 ± 4 out of 30. CONCLUSION TFR is a salvage procedure to restore mechanical integrity and regain functional ability after extensive femoral bone loss. Outcome of the patients in the present study did mainly depend on the age at reconstruction and not on the indication for TFR.
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Affiliation(s)
- Andreas Toepfer
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547 Munich, Germany
| | - Norbert Harrasser
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547 Munich, Germany
| | | | - Florian Pohlig
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547 Munich, Germany
| | - Ulrich Lenze
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547 Munich, Germany
| | - Ludger Gerdesmeyer
- Department of Orthopaedic Surgery and Traumatology, University of Schleswig, Holstein, Germany
| | - Dominik Pförringer
- Department of Trauma Surgery, Technical University of Munich, Munich, Germany
| | - Marcel Toepfer
- Department of Nephrology and Dialysis, Klinikum Weilheim, Weilheim, Germany
| | - Marc Beirer
- Department of Trauma Surgery, Technical University of Munich, Munich, Germany
| | - Moritz Crönlein
- Department of Trauma Surgery, Technical University of Munich, Munich, Germany
| | | | - Heinz Mühlhofer
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, 81547 Munich, Germany
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Mühlhofer HML, Kanz KG, Pohlig F, Lenze U, Lenze F, Toepfer A, von Eisenhart-Rothe R, Schauwecker J. Implementation of an Algorithm for Prosthetic Joint Infection: Deviations and Problems. Surg Infect (Larchmt) 2016; 18:164-169. [PMID: 27925502 DOI: 10.1089/sur.2015.208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The outcome of revision surgery in arthroplasty is based on a precise diagnosis. In addition, the treatment varies based on whether the prosthetic failure is caused by aseptic or septic loosening. Algorithms can help to identify periprosthetic joint infections (PJI) and standardize diagnostic steps, however, algorithms tend to oversimplify the treatment of complex cases. We conducted a process analysis during the implementation of a PJI algorithm to determine problems and deviations associated with the implementation of this algorithm. PATIENTS AND METHODS Fifty patients who were treated after implementing a standardized algorithm were monitored retrospectively. Their treatment plans and diagnostic cascades were analyzed for deviations from the implemented algorithm. Each diagnostic procedure was recorded, compared with the algorithm, and evaluated statistically. RESULTS We detected 52 deviations while treating 50 patients. In 25 cases, no discrepancy was observed. Synovial fluid aspiration was not performed in 31.8% of patients (95% confidence interval [CI], 18.1%-45.6%), while white blood cell counts (WBCs) and neutrophil differentiation were assessed in 54.5% of patients (95% CI, 39.8%-69.3%). We also observed that the prolonged incubation of cultures was not requested in 13.6% of patients (95% CI, 3.5%-23.8%). In seven of 13 cases (63.6%; 95% CI, 35.2%-92.1%), arthroscopic biopsy was performed; 6 arthroscopies were performed in discordance with the algorithm (12%; 95% CI, 3%-21%). CONCLUSION Self-critical analysis of diagnostic processes and monitoring of deviations using algorithms are important and could increase the quality of treatment by revealing recurring faults.
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Affiliation(s)
- Heinrich M L Mühlhofer
- 1 Department of Orthopedic Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Karl-Georg Kanz
- 2 Department of Trauma Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Florian Pohlig
- 1 Department of Orthopedic Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ulrich Lenze
- 1 Department of Orthopedic Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Florian Lenze
- 1 Department of Orthopedic Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Andreas Toepfer
- 1 Department of Orthopedic Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Johannes Schauwecker
- 1 Department of Orthopedic Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Abstract
Because of their frequency, ankle sprains are of major clinical and economic importance. The simple sprain with uneventful healing has to be distinguished from the potentially complicated sprain which is at risk of transition to chronic ankle instability. Conservative treatment is indicated for the acute, simple ankle sprain without accompanying injuries and also in cases of chronic instability. If conservative treatment fails, good results can be achieved by anatomic ligament reconstruction of the lateral ankle ligaments. Arthroscopic techniques offer the advantage of joint inspection and addressing intra-articular pathologies in combination with ligament repair. Accompanying pathologies must be adequately addressed during ligament repair to avoid persistent ankle discomfort. If syndesmotic insufficiency and tibiofibular instability are suspected, the objective should be early diagnosis with MRI and surgical repair.
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Affiliation(s)
- N Harrasser
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaningerstr. 22, 81675, München, Deutschland.
| | - K Eichelberg
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaningerstr. 22, 81675, München, Deutschland
| | - F Pohlig
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaningerstr. 22, 81675, München, Deutschland
| | - H Waizy
- Klinik für Fuß- und Sprunggelenkchirurgie, Orthopädische Fachkliniken der Hessing-Stiftung, Hessingstr. 17, 86199, Augsburg, Deutschland
| | - A Toepfer
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Str. 51, 81547, München, Deutschland
| | - R von Eisenhart-Rothe
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaningerstr. 22, 81675, München, Deutschland
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Pohlig F, Ulrich J, Lenze U, Mühlhofer HML, Harrasser N, Suren C, Schauwecker J, Mayer-Kuckuk P, von Eisenhart-Rothe R. Glucosamine sulfate suppresses the expression of matrix metalloproteinase-3 in osteosarcoma cells in vitro. BMC Complement Altern Med 2016; 16:313. [PMID: 27562075 PMCID: PMC5000453 DOI: 10.1186/s12906-016-1315-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/23/2016] [Indexed: 01/02/2023]
Abstract
Background Glucosamine, a common dietary supplement, has a possible anti-sarcoma effect. However, an understanding of the underlying mechanism of such an effect is limited. For this study we hypothesized that glucosamine suppresses the basal level of matrix metalloproteinase expression in human osteosarcoma cell lines. Methods We examined the osteosarcoma cell lines, MG-63 and SaOS-2. Cells were exposed to 0, 10, 50 and 100 μg/ml glucosamine sulfate for 48 h and treatment toxicity was determined through measurement of cell viability and proliferation. Relative gene expression of matrix metalloproteinase (MMP)-2, -3 and -9 was quantified by real-time polymerase chain reaction. Protein levels of MMP-2 and -9 were assessed by ELISA. Results Administration of 10, 50 or 100 μg/ml glucosamine sulfate had no effect on the cell viability of MG-63 and SaOS-2 cells. A significant reduction of MMP expression in both cell lines was observed only for MMP-3, while a decrease in MMP-9 was seen in SaOS-2 cells. The expression of MMP-2 was not significantly affected in either cell line. Protein level of MMP-3 was reduced in both cell lines upon stimulation with 10 μg/ml glucosamine sulfate whereas for MMP-9 a decrease could only be observed in SaOS-2 cells. Conclusion In this study, we found a pronounced suppressive effect of glucosamine sulfate particularly on MMP-3 and also MMP-9 mRNA and protein levels in osteosarcoma cell lines in vitro. The data warrants further investigations into the potential anti-tumor efficacy of glucosamine sulfate in osteosarcoma. Electronic supplementary material The online version of this article (doi:10.1186/s12906-016-1315-6) contains supplementary material, which is available to authorized users.
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Toepfer A, Lenze U, Pohlig F, Eisenhart-Rothe R, Gerdesmeyer L, Kirchhoff C, Harrasser N. Pathologische Frakturen des Humerus: Erfahrungen an 76 Fällen eines muskuloskeletalen Tumorzentrums. Z Orthop Unfall 2016; 154:364-9. [DOI: 10.1055/s-0042-105160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - U. Lenze
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München
| | - F. Pohlig
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München
| | - R. Eisenhart-Rothe
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München
| | - L. Gerdesmeyer
- Orthopädie, Universitätsklinikum Schleswig-Holstein Campus Kiel
| | - C. Kirchhoff
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München
| | - N. Harrasser
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München
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Prodinger PM, Harrasser N, Suren C, Pohlig F, Mühlhofer H, Schauwecker J, von Eisenhart-Rothe R. [Importance of revision- and tumor-endoprosthetics in the treatment of periprosthetic fractures of the lower extremity]. Unfallchirurg 2016; 119:295-306. [PMID: 27008214 DOI: 10.1007/s00113-016-0155-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Periprosthetic fractures of hip and knee prostheses are gaining clinical significance due to the increasing numbers of of primary arthroplasties. Additionally, these fractures are often associated with poor bone quality or present in patients after multiple revision procedures and concomitant excessive bone defects precluding those patients to be adequately treated by conventional osteosynthesis. Revision implants provide a wide range of options for the treatment of these fractures in order to achieve good clinical results. In the acetabular region cavitary defects associated with periprosthetic fractures can be treated by the use of megacups. Extensive segmental defects and pelvic discontinuity necessitate the use of cups with additional iliac support or even customized implants. Proximal femoral fractures can usually be fixed with modular stems and diaphyseal anchorage. Periprosthetic knee joint fractures can be treated with revision implants with modular sleeves or augment-combinations allowing sufficient bridging of bony defects. Functional reconstruction or refixation of the extensor mechanism is of crucial importance.
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Affiliation(s)
- P M Prodinger
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - N Harrasser
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - C Suren
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - F Pohlig
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - H Mühlhofer
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - J Schauwecker
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - R von Eisenhart-Rothe
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland.
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Mühlhofer HML, Gollwitzer H, Lenze F, Feihl S, Pohlig F, von Eisenhart-Rothe R, Schauwecker J. [Periprosthetic infections of the hip joint : Clinical approach]. Orthopade 2016; 44:357-65. [PMID: 25800463 DOI: 10.1007/s00132-015-3084-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increasing rates of periprosthetic joint infections (PJI) will present orthopedic surgeons and the health care system with challenges in the next few years. New concepts in diagnostic and surgical pathways allow specialized centers to offer differentiated therapy of PJI. AIM This article presents an overview of recent treatment concepts for PJI of the hip emphasizing diagnosis and the clinical approach. METHOD A selective literature search was performed focusing on evidence-based concepts including diagnostics, surgical treatment, and biofilm active antibiotics. RESULTS PJI of the hip are classified as mature biofilm or immature biofilm infections. The most important step in the diagnostic procedure is to identify the pathogen and its antimicrobial susceptibility. Preoperative joint aspiration and leukocyte count, differentiation, and microbiological culture should be standard. Arthroscopic biopsy may be necessary to identify the pathogen. Depending on the biofilm maturity and the antimicrobial susceptibility, implant retention or two-stage revisions should be performed. Combination of surgical therapy and biofilm-active antibiotics are of utmost importance for successful treatment. DISCUSSION PJI represents a significant challenge for the orthopedic surgeon. Evidence-based and standardized clinical pathways are necessary for accurate and rapid diagnosis as well as patient-specific treatment concepts.
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Affiliation(s)
- H M L Mühlhofer
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland,
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von Matthey F, Braun KF, Hanschen M, Pohlig F, Schubert EC, Matevossian E, Hoppmann P, Kanz KG, Biberthaler P. [Erratum to: Cardiac post-resuscitation care : An indication for trauma whole-body CT?]. Unfallchirurg 2015; 119:68. [PMID: 26597193 DOI: 10.1007/s00113-015-0103-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- F von Matthey
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstraße 22, 81675, München, Deutschland.
| | - K F Braun
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstraße 22, 81675, München, Deutschland
| | - M Hanschen
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstraße 22, 81675, München, Deutschland
| | - F Pohlig
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstraße 22, 81675, München, Deutschland
| | - E C Schubert
- Institut für diagnostische und interventionelle Radiologie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - E Matevossian
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - P Hoppmann
- I. Medizinischen Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - K-G Kanz
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstraße 22, 81675, München, Deutschland
| | - P Biberthaler
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstraße 22, 81675, München, Deutschland
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Gradl G, Postl LK, Lenze U, Stolberg-Stolberg J, Pohlig F, Rechl H, Schmitt-Sody M, von Eisenhart-Rothe R, Kirchhoff C. Long-term functional outcome and quality of life following rotationplasty for treatment of malignant tumors. BMC Musculoskelet Disord 2015; 16:262. [PMID: 26403306 PMCID: PMC4582635 DOI: 10.1186/s12891-015-0721-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 09/16/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Malignant bone tumors of the lower extremity are more frequently found in children and adolescents than in adults. Modern treatment regimens led to high limb salvage rates and offer the choice between endoprosthetic replacement and rotationplasty in many cases. Rotationplasty has proven to be an effective, highly functional option in short- and mid-term studies. Aim of this study was to assess long-term results regarding quality of life and functionality after rotationplasty and to compare the obtained results to a representative healthy German sample cohort. METHODS In total 12 patients who underwent rotationplasty between 1991 and 2001 were enrolled in this study. After physical examination, they were evaluated regarding health related quality of life, functional outcome and psychosocial status. While quality of life was mainly assessed using the SF-36 (The Short Form (36) Health Survey v2), functional outcome was measured using the musculoskeletal tumor society score (MSTS) as well as the Tegner activity level scale. RESULTS Average age at the time of surgery was 19 ± 10 year. and 32 ± 11 year. at the time of follow up. Mean follow-up was 14 ± 9 years. The SF-36 scores accounted for 80.4 ± 15.7 regarding physical functioning, for 78.1 ± 24.1 regarding the physical role functioning, for 74.1 ± 17.6 regarding bodily pain and for 71.8 ± 26.1 regarding general health. SF-36 score for vitality was 75.0 ± 12.8, for social functioning 98.9 ± 3.6, 88.2 ± 23.9 for emotional role functioning and 89.6 ± 10.1 for the mental health. Comparison to a representative German sample cohort revealed significantly higher patient's scores for vitality, social functioning and mental health (p < 0.05). The overall MSTS resulted in an average of 64 ± 12 % and the Tegner activity level scale accounted for 4.1 ± 0.6 pts. CONCLUSIONS The presented long-term results indicate that rotationplasty provides a high quality of life. Patients are satisfied with a good functional outcome regarding activities of daily life and even sports.
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Affiliation(s)
- Guntmar Gradl
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Lukas K Postl
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaningerstrasse 22, 81675, Munich, Germany. .,Department of Trauma Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
| | - Ulrich Lenze
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Josef Stolberg-Stolberg
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Florian Pohlig
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Hans Rechl
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Markus Schmitt-Sody
- Department of Orthopedics, Klinikum der Universitaet Muenchen, Ludwig-Maximilians-Universitaet, Munich, Germany.
| | - Ruediger von Eisenhart-Rothe
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - Chlodwig Kirchhoff
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaningerstrasse 22, 81675, Munich, Germany. .,Department of Trauma Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
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Braun KF, Pohlig F, Lenze U, Netter C, Hadjamu M, Rechl H, von Eisenhart-Rothe R. [Insufficiency fractures after irradiation therapy - case series]. MMW Fortschr Med 2015; 157 Suppl 5:1-4. [PMID: 26168741 DOI: 10.1007/s15006-015-3305-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 12/27/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Radiation therapy plays an essential part in modern treatment regimes of musculoskeletal tumors. Nevertheless damage to the surrounding tissue does occur inevitably. Postradiogenic changes of bone are associated with decreased stability and an increased fracture rate. The orthopedic surgeon therefore faces a challenging situation with altered bone metabolism, changes in perfusion and soft tissue problems. PATIENTS/MATERIAL AND METHODS We present 3 cases of radiation induced fractures during the treatment of soft tissue tumors, all of which received radiation doses of > 58 Gy. All fractures occurred over 1 year after the exposure to radiation in otherwise uneventful follow ups. RESULTS Postoperative follow up showed fracture healing or in the case of the arthroplasty, osseous integration without further complications. CONCLUSIONS Radiation doses of ≥ 58 Gy are a major risk factor for pathological fractures in long bones. Regardless of their low incidence, fracture rates between 1,2 and 6,4 % prove their importance. Local tumor control has therefore to be weighed against the resulting decrease in bone quality and stability. Treatment options should always take into consideration the increased risk for complications such as infection, pseudarthroses and wound healing disorders. Our results show that substitution of vitamin D and calcium as well as the the use of reamed intramedullary implants benefits the outcome.
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Affiliation(s)
- Karl F Braun
- Klinik und Poliklinik für Unfallchirurgie, Klinikum Rechts der Isar, Technische Universität München, München, Deutschland
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Toepfer A, Harrasser N, Lenze F, Pohlig F, von Eisenhart-Rothe R. [Current concepts in diagnostics and treatment of hallux valgus deformity]. MMW Fortschr Med 2015; 157:37-40. [PMID: 26049347 DOI: 10.1007/s15006-015-3215-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Andreas Toepfer
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstraße 22, D-81675, München, Deutschland,
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Harrasser N, Toepfer A, Lenze F, Pohlig F, von Eisenhart-Rothe R. [Lesser toe deformities: What the general practitioner should know]. MMW Fortschr Med 2015; 157:43-4. [PMID: 26049349 DOI: 10.1007/s15006-015-3217-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Norbert Harrasser
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, D-81675, München, Deutschland
| | - Andreas Toepfer
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, D-81675, München, Deutschland,
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Postl LK, Gradl G, von Eisenhart-Rothe R, Toepfer A, Pohlig F, Burgkart R, Rechl H, Kirchhoff C. Management of musculoskeletal tumors during pregnancy: a retrospective study. BMC Womens Health 2015; 15:48. [PMID: 26059904 PMCID: PMC4462116 DOI: 10.1186/s12905-015-0204-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 05/26/2015] [Indexed: 12/03/2022]
Abstract
Background In recent years, scientific research has increasingly focused on malignancies during pregnancy. However, the development of musculoskeletal tumors during pregnancy has only been the subject of a few studies so far. The primary aim of this study was to identify the incidence of sarcomas during pregnancy at our musculoskeletal tumor center (MSTC). Secondarily we intended to analyze these cases and discuss possible recommendations regarding diagnostic work-up as well as therapy on the basis of the literature. Methods All female patients who had been treated for soft tissue or bone sarcoma at our academic MSTC in the period between the years 2002 and 2010 were screened retrospectively for anamnestic annotations of pregnancy or records of pregnancy in the obstetrical database of our university hospital. The patients who met the criteria for inclusion (diagnosed sarcoma and pregnancy) were enrolled. For every pregnant patient two age-matched female control patients that suffered from tumors with the same histologic type were included. Results In the period between 2002 and 2010, 240 female patients between the age of 16 and 45 were treated for sarcoma. In eight out of the 240 cases the tumor disease developed or progressed during pregnancy. The delay in diagnosis was approximately eight months and turned out to be significantly higher for pregnant patients compared to non- pregnant controls. Each woman’s tumor was misdiagnosed at least once. Conclusions Diagnostic follow-up of pregnant women presenting with a growing or painful mass, which is suspected to be a musculoskeletal tumor, should be performed at a specialized tumor center. We recommend a multidisciplinary approach and discussing all possible consequences for mother and child intensively in accordance with the available literature.
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Affiliation(s)
- Lukas K Postl
- Department of Trauma Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Str. 22, 81675, Munich, Germany. .,Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
| | - Guntmar Gradl
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
| | - Andreas Toepfer
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
| | - Florian Pohlig
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
| | - Rainer Burgkart
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
| | - Hans Rechl
- Department of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
| | - Chlodwig Kirchhoff
- Department of Trauma Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Str. 22, 81675, Munich, Germany.
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