Restoration of leg length and offset correlates with trochanteric pain syndrome in total hip arthroplasty

Persistent pain around the greater trochanter is a common complication after total hip arthroplasty. Restoration of biomechanics such as leg length, femoral und acetabular offset is crucial in THA. The purpose of this study was to evaluate postoperative differences of these parameters after THA and to analyze their association to greater trochanteric pain syndrome. Furthermore, we aimed to evaluate the clinical relevance of trochanteric pain syndrome compared to patient reported outcome measures. 3D-CT scans of 90 patients were analyzed after minimalinvasive total hip arthroplasty and leg length, femoral and acetabular offset differences were measured. Clinical evaluation was performed three years after THA regarding the presence of trochanteric pain syndrome and using outcome measures. Furthermore, the patients' expectation were evaluated. Patients with trochanteric pain syndrome showed a higher absolute discrepancy of combined leg length, femoral and acetabular offset restoration compared to the non-operated contralateral side with 11.8 +/- 6.0mm than patients without symptoms in the trochanteric region with 7.8 +/- 5.3mm (p=0.01). Patients with an absolute deviation of the combined parameters of more than 5mm complained more frequently about trochanteric symptoms (29.2%, 19/65) than patients with a biomechanical restoration within 5mm compared to the non-affected contralateral side (8.0%, 2/25, p=0.03). Clinical outcome measured three years after THA was significantly lower in patients with trochanteric symptoms than without trochanteric pain (p<0.03). Similarly, fulfillment of patient expectations as measured by THR-Survey was lower in the patients with trochanteric pain (p<0.005). An exact combined restoration of leg length, acetabular and femoral offset reduces significantly postoperative trochanteric pain syndrome and improves the clinical outcome of the patients

Klinische und sonographische Meniskusdiagnostik (=Clinical and sonographic meniscus diagnosis)

Clinical examination still plays an important role in diagnosing meniscal tears. The types of sensitive nerves in the knee joint are responsible for nonspecific pain, which is often correlated with too little specificity in meniscal tests. Ultrasound examination of meniscal structures of the knee joint has been debated extensively in recent years. Criticism of this noninvasive technique was due to small patient groups, improper technical and inaccurate manual standards. Since 1988 ultrasound of the tibial meniscus has become a standard technique in our Department of Orthopaedic Surgery with defined criteria of the intersecting plane and evaluation of ultrasound images. A prospective follow-up study during 6/1988 and 5/1993 including 1186 ultrasound examinations before arthroscopy, was performed. The sensitivity for ultrasound of the lateral meniscus was 58% and for the medial meniscus 83%. Specificity with 98% for the lateral and 90% for the medial meniscus was good. Sonographic detection of meniscal tears depends on the shape and location of meniscal tears. This has been shown by experimental studies in cadavers. A follow-up study including 113 knee joints was performed to prove the value of clinical and ultrasound examination in relation to arthroscopy. The sensitivity of sonography for medial meniscus was 81% and 40% for the lateral meniscus. Although the sensitivity of the clinical examination was 81% (medial) and 47% (lateral), the low specificity of 70% for meniscus tears indicated that it was because of false-positive clinical evaluation of meniscal disorders. In young patients with reflectory muscle spasm and those with acute trauma of the knee joint, clinical examination of the meniscal structures showed poor results. In these cases, too, ultrasound examination showed advantages. Ultrasound of the knee joint meniscus is noninvasive, reproducible and low cost. In cases of uncertain clinical results, ultrasound offers a good opportunity to visualize meniscal disorders

The oncofetal gene survivin is re-expressed in osteoarthritis and is required for chondrocyte proliferation in vitro

Background Regulation of cell death and cell division are key processes during chondrogenesis and in cartilage homeostasis and pathology. The oncogene survivin is considered to be critical for the coordination of mitosis and maintenance of cell viability during embryonic development and in cancer, and is not detectable in most adult differentiated tissues and cells. We analyzed survivin expression in osteoarthritic cartilage and its function in primary human chondrocytes in vitro. Methods Survivin expression was analyzed by immunoblotting and quantitative real-time PCR. The localization was visualized by immunofluorescence. Survivin functions in vitro were investigated by transfection of a specific siRNA. Results Survivin was expressed in human osteoarthritic cartilage, but was not detectable in macroscopically and microscopically unaffected cartilage of osteoarthritic knee joints. In primary human chondrocyte cultures, survivin was localized to heterogeneous subcellular compartments. Suppression of survivin resulted in inhibition of cell cycle progression and sensitization toward apoptotic stimuli in vitro. Conclusions The present study indicates a role for survivin in osteoarthritic cartilage and human chondrocytes. In vitro experiments indicated its involvement in cellular division and viability. Learning more about the functions of survivin in chondrocyte biology might further help toward understanding and modulating the complex processes of cartilage pathology and regeneration

Arbeitsbezogenes sedentäres Verhalten

Hintergrund Sedentäres Verhalten ist mit einem erhöhten Risiko für chronische Krankheiten und einer höheren Gesamtmortalität assoziiert. Arbeitsbezogenes Sitzen hat einen großen Anteil am täglichen sedentären Verhalten, insbesondere bei Büroangestellten. Ziel der Arbeit In dieser Studie sollte untersucht werden, wie viel Zeit bei verschiedenen Aufgaben am Arbeitsplatz und beim Pendeln von Verwaltungsangestellten einer Universitätsklinik in Deutschland im Sitzen verbracht wird. Material und Methoden Eine fragebogengestützte Querschnittsstudie mit Verwaltungsangestellten des Universitätsklinikums Regensburg wurde durchgeführt, um arbeitsbezogenes sedentäres Verhalten zu untersuchen. Ergebnisse Die Studienpopulation bestand aus 159 Teilnehmenden (54,1 % Frauen, 51,6 % älter als 40 Jahre), was einer Antwortquote von 26 % entspricht. Die durchschnittliche tägliche Sitzzeit am Arbeitsplatz betrug im Median 7,0 h (Interquartilsbereich [IQR] 6,0–7,5 h) und fand hauptsächlich bei der Computerarbeit statt (57,3 %). Die mittlere Stehzeit bei der Arbeit betrug im Median 0,8 h (IQR 0,3–1,4 h). Verwaltungsangestellte verbrachten während des Pendelns im Median 0,7 h (IQR 0,3–1,0 h) pro Tag im Sitzen. Die Teilnehmenden waren der Ansicht, dass langes und ununterbrochenes Sitzen negative (69,6 %) oder eher negative (29,7 %) Auswirkungen auf die Gesundheit hat. Diskussion Verwaltungspersonal in Krankenhäusern verbringt einen großen Teil der täglichen Arbeitszeit mit sedentärem Verhalten. Maßnahmen, die es ermöglichen, sowohl im Sitzen als auch im Stehen zu arbeiten, können zu einer Verringerung der arbeitsbedingten Sitzzeit führen und damit die Gesundheit am Arbeitsplatz und im weiteren Sinne die öffentliche Gesundheit verbessern

Trainee Surgeons Affect Operative Time but not Outcome in Minimally Invasive Total Hip Arthroplasty

Training of young surgeons in total hip arthroplasty (THA) is crucial, but might affect operative time and outcome especially in minimally invasive (MIS) THA. We asked whether the learning curve of orthopaedic residents trained on MIS THA has an impact on (1) operative time (2) complication rates and (3) early postoperative outcome. In a retrospective analysis of over 1000 MIS THAs from our institutional joint registry, operative time, complication rates, patient reported outcome measures (Western Ontario and McMaster Universities Arthritis Index [WOMAC] and Euro-Qol 5D-5L [EQ-5D]) within the first year and responder rates for positive outcome as defined by the Outcome Measures in Rheumatology and Osteoarthritis Research Society International consensus responder (OMERACT-OARSI) criteria were compared between trainee and senior surgeons. Mean operative time was nine minutes longer for trainees compared to senior surgeons (78.1 +/- 25.4 min versus 69.3 +/- 23.8 min, p < 0.001). Dislocation (p = 0.21), intraoperative fracture (p = 0.84) and infection rates (p = 0.58) were comparably low in both groups. Both trainee and senior THAs showed excellent improvement of EQ-5D (0.34 +/- 0.26 versus 0.32 +/- 0.23, p = 0.40) and WOMAC (45.9 +/- 22.1 versus 44.9 +/- 20.0, p = 0.51) within the first year after surgery without clinical relevant differences. Similarly, responder rates for positive outcome were comparable between trainees with 92.9% and senior surgeons with 95.2% (p = 0.17). MIS THA seems to be a safe procedure during the learning curve of young orthopaedic specialists, but requires higher operative time

Sex-Dependent Differences in Symptom-Related Disability Due to Lumbar Spinal Stenosis

Study Design: Retrospective observational study. Objective: The objective of this study is to identify possible sex-dependent differences in symptom-related disability in patients with lumbar spinal stenosis. Methods: 103 consecutive outpatients (42 men and 61 women) with lumbar spinal stenosis were assessed on the basis of their medical history, the physical examination, and a series of questionnaires including the Oswestry Disability Index (ODI), the Roland Morris Disability Questionnaire (RMDQ), the Patient Health Questionnaire module 9 (PHQ-9), and the Depression Anxiety Stress Scales (DASS). Narrowing of the spinal canal was graded according to the method established by Schizas. Parameters were statistically analyzed according to the biological sex of the patients. The influence of the variables on the disability scores was analyzed by means of a multivariate regression model. Results: Symptom severity was equally distributed between men and women. Female patients showed higher RMDQ and ODI scores as well as significantly higher intermediate depression scores. The confounding variables age, pain chronicity, and psychological affection as well as the symptoms level of pain and paresis were dependent on patient sex. Conclusion: The study shows sex-depended differences in the perception of symptoms of lumbar spinal stenosis and disability of life. The findings suggest that the main mediators are pain perception and psychological influences on the quality of life

Proximal interphalangeal joint replacement with an unconstrained pyrocarbon prosthesis (Ascension(R)): a long-term follow-up

There have been limited publications that report long-term outcomes of pyrocarbon implants. This report describes both clinical and radiographic long-term results for patients who have been treated with pyrocarbon proximal interphalangeal implants. Thirteen implants in ten patients are reported for an average follow-up of 8.3 years (range 6.2–9.3). All patients were suffering from degenerative joint disease. Five of the 13 digits were free of pain, the remaining eight digits had mild to moderate pain (visual analogue scale 2–5). The average active range of motion was 58° (SD 19°) at latest examination. X-ray results were unremarkable in six digits with an acceptable position of the prosthesis. However, in seven patients significant radiolucent lines (≥ 1 mm) were observed. Three prostheses demonstrated a migration of the proximal component, and one a subsidence of the distal component. Our study does not support the use of this implant for treatment of osteoarthritis of the finger joint owing to high complication rates and limited range of motion

Measuring functional outcome after total hip replacement with subject-specific hip joint loading

Total hip replacement is an often-performed orthopedic surgical procedure; the amount of procedures undertaken will increase since our life expectancy is growing. In order to optimize function, hip biomechanics should be restored to as near normal as possible. The goal of this pilot study was to determine whether or not it is feasible to compute the vectorial hip reaction force pathways on the head of the prosthesis and the force angles relative to the cup of the prosthesis that occur during gait in total hip replacement patients, serving as an objective measurement of the functional outcome following hip replacement. A three-dimensional gait analysis, measuring ground reaction forces and kinematics, was performed. The data retrieved from the gait analysis was used as the input for the musculoskeletal model to compute vectorial joint reaction forces for data processing. To evaluate the position and orientation of the joint reaction forces, the force path, as well as the force angles for the operated and non-operated joint, has been calculated during the stance phase of the specific leg. The force path for subject 2 on the non-operated side is only located in the posterior-lateral quarter, as is the force path for subject 1. In contrast to this subject, the force path for subject 2 at the operated hip joint can be found only within the anterior quarter of the head of the implant, where it is nearly equally distributed in the medio-lateral half of the prosthesis head. The force-inclination angles on the cup of subject 1, with respect to the plane of the socket face, indicates that the force vector is mainly positioned in the same quadrant when compared with subject 2 (in a cup-fixed coordinate system). The force-anteversion angle behaves similarly to the force-inclination angle, even when the effects are not as pronounced. The proposed methods in this article are aiming to define two functional outcomes of total hip replacement that are related to wear and rim loading. It is accepted that wear is not only a function of time, but a function of use. Owing to the methods listed in this article, we are able to determine a) the applied force and b) the sliding distance (force pathway) in a subject-specific manner. The computed hip-reaction force angles and the distance to the rim cup are a measurement for cup or rim loading, and occurs in the so-called safe-zones. This method may well give us insight into the biomechanical situation during gait, after receiving total hip replacement, that we need to fully understand the mechanisms acting on a hip joint and to prove a possible increase of functional outcome after receiving total hip replacement