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G Pap

Publications and source records attributed to G Pap.

At least 19 recordsLinked to original sources
PubMed2006

Cross-cultural adaptation, reliability and validity of the German Shoulder Pain and Disability Index (SPADI).

OBJECTIVE: To cross-culturally adapt the Shoulder Pain and Disability Index (SPADI) from English into German, and to test the reliability and validity of the German version. METHODS: Cross-cultural adaptation of the SPADI was performed according to international guidelines. One hundred and eighteen patients who had undergone shoulder arthroplasty, on average 4 yr previously, completed a questionnaire booklet containing the German SPADI, the Short Form 36 (SF-36), the Disability of the Arm, Shoulder and Hand (DASH) questionnaire, and the American Shoulder and Elbow Surgeons (ASES) questionnaire for the shoulder to assess SPADI's construct validity. One week later, they completed the SPADI again to assess test-retest reliability. RESULTS: The six-step cross-cultural adaptation procedure revealed no major problems with the content or language. The intraclass correlation coefficients for the individual items of the SPADI were between 0.68 and 0.89, and that for the SPADI total score was 0.94. The SPADI total score showed a correlation of 0.61-0.69 with the SF-36 physical scales, of 0.88 with the DASH and of 0.92 with the ASES. CONCLUSIONS: The German SPADI is a practicable, reliable and valid instrument, and can be recommended for the self-assessment of shoulder pain and function.

Activities of Daily Living↗
PubMed2006

[The femoral neck prosthesis CUT. Three- to six-year results].

BACKGROUND: As the number of younger patients undergoing total hip arthroplasty is growing steadily, bone-saving implantation techniques are increasingly gaining in importance. METHODS: Fifty-six femoral neck prostheses (type CUT, ESKA Implants, Lübeck, Germany) were implanted in 50 patients between 1999 and 2002 (average age 49 years). After a mean follow-up of 4.9 years (min.: 3.2, max.: 6.5), we determined the state of all the prostheses. Forty-four patients with 50 prostheses were examined clinically with the Harris hip score and were assessed radiologically. RESULTS: The average Harris hip score improved from 48 points preoperatively to 93 points at the most recent follow-up examination. Of the 56 CUT prostheses, 6 (10.7%) had been revised. Four of these six cases (7.1%) required revision because of aseptic loosening. The radiological evaluation of these four cases revealed in three cases progressive horizontal migration with varization of the prosthesis, although the stem had been correctly positioned in primary surgery, with the femoral neck resected too widely or completely. After 4.9 years, the survival rate of the CUT prostheses is 88.4% according to Kaplan-Meier for a necessary exchange of the CUT prostheses as an endpoint. CONCLUSION: The use of the CUT prosthesis can lead to good clinical and radiological results, but shows a higher loosening rate as compared with cementless standard stems. Further studies are necessary to determine if the CUT prosthesis is a real alternative to cementless standard stems.

Adult↗
PubMed2004

Protease expression in interface tissues around loose arthroplasties.

To determine whether cathepsins and matrix metalloproteinase-1 are involved in accelerating tissue destruction, we examined, immunohistochemically, the expression of matrix metalloproteinase-1 and cathepsins B, D, L, and X in periprosthetic synovial-like interface tissues from 14 patients with failed prosthetic hips and in the synovial membranes of hips from 18 patients with rheumatoid arthritis and 25 patients with primary osteoarthritis. The expression levels of all these proteases in the interface tissue were higher than in the synovial membrane of osteoarthritis. The expression levels of cathepsins B and X in the interface tissue were higher than in the rheumatoid synovium. The results show similarities in the expression patterns of cathepsins D and L and matrix metalloproteinase-1 between aseptic prosthetic loosening and rheumatoid arthritis. In addition, these data suggest that the impact of cathepsins B and X on tissue degradation is more pronounced in aseptic prosthetic loosening than in rheumatoid arthritis.

Aged↗
PubMed2001

Development and characteristics of a synovial-like interface membrane around cemented tibial hemiarthroplasties in a novel rat model of aseptic prosthesis loosening.

OBJECTIVE: Aseptic prosthesis loosening (APL) is related to the formation and aggressive growth of a synovial-like interface membrane (SLIM) between prosthesis and bone. However, investigation of the early phases of SLIM development in humans presents major difficulties. This study was undertaken to develop and characterize the usefulness of a novel animal model of APL that is based on an established model of defined exercise in a running wheel by Wistar rats that have been subjected to intracranial self-stimulation (ICSS). METHODS: Cemented tibial hemiarthroplasties were implanted into the left knees of 7 male Wistar rats. After 2 weeks, exercise in a running wheel was started in all rats, with a running-load of 2 hours/day for 5 days/week. Six months postoperatively, the knee joints were removed, decalcified, and embedded in paraffin. Histologic evaluation on hematoxylin and eosin-stained sections was performed to investigate the development of a SLIM and the presence of cement debris particles. To characterize the SLIM on a molecular level and investigate growth-regulating factors, the expression of transforming growth factor beta (TGFbeta) and the anti-apoptotic molecule Bcl-2 was analyzed by immunohistochemistry. RESULTS: Although the prostheses appeared mechanically stable after 6 months, the development of SLIM with areas of bone resorption was seen in all samples. Resembling human SLIM, these membranes consisted of loose fibrous tissue, with cement debris particles located particularly at sites originally attached to the prostheses. Immunohistochemistry studies revealed the expression of TGFbeta and Bcl-2 in all specimens. Interestingly, staining for TGFbeta and Bcl-2 was restricted to areas where the SLIM were attached to bone. In contrast, there was only negligible expression of both proteins at sites adjacent to the prostheses. CONCLUSION: Our findings demonstrate that the ICSS Wistar rat model constitutes a feasible tool for studying early stages of APL, and specifically the effect of defined running exercise on SLIM formation. The results further suggest that both cellular proliferation, as stimulated by TGFbeta, and altered apoptosis contribute to early stages of SLIM formation. The expression patterns of TGFbeta and Bcl-2 indicate that the growth of the SLIM is initiated and promoted from the bone rather than from the prosthesis.

Animals↗
PubMed2001

[Comparison of 2 surgical techniques in isolated supraspinatus rupture. A matched-pair study].

The comparison of results after open surgery methods in the repair of rotator cuff ruptures needs homogen patient groups. We compared 34 patients in 2 groups who were treated with open surgery for isolated ruptures of the supraspinatus muscles (lesion type III). Patients in group I were treated with transosseous suture refixation of the supraspinatus, in group II suture anchors (type: Corkscrew) were used. Both groups were age and gender paired. Preoperatively, all patients had the same clinical status. For the evaluation of the clinical results at follow-up we used the Constant-Score. In addition, strength and pain measurement and oblique X-rays of the shoulder were performed. The follow-up time was 18 months. In all patients, the mean Constant-Score improved significantly with increase in muscle strength and marked pain reduction. Significant differences between both groups could not be observed. The mean time of surgery in group II (suture anchor) was significantly lower than in group I. In conclusion, with the anchor techniques the same good results can be achieved as with bone refixation. The shortening of the surgery time should, however, be seen in relation to the higher costs with this technique.

Adult↗
PubMed2001

[History of German orthopedics 1989-2001].

The present article describes essential aspects of the development of German orthopedics from 1989 to 2001. Special attention is given to the unification of the two German orthopedic groups after the political turnaround in the German Democratic Republic and the resultant changes in the landscape of German orthopedics. In addition, further milestones in the development of German orthopedics during the last 10 years are presented, e.g., the formation of the Alliance of German Orthopedists, the establishment of various sections of the DGOT (German Association of Orthopedics and Traumatology) as well as the main focus of scientific activity in the past few years.

Congresses as Topic↗
PubMed2001

[Calcifications after operations of the subacromial space].

OBJECTIVE: Although there are several studies on the development of periarticular calcifications after different operation procedures of the joints, such calcifications have only seldomly been described in connection with operations in the subacromial space. Therefore, the present study was aimed at investigating the incidence of periarticular calcifications after operations in the subacromial space and to assess their clinical relevance. PATIENTS AND METHODS: In a retrospective study we examined 152 patients (51 female, 101 male) who had been operated on for primary shoulder impingement by open or arthroscopic procedures. The average follow-up time was 32.5 months. The assessment of the outcome of the treatment was performed using the criteria of the Constant score, different shoulder tests, a visual-analog scale for the evaluation of pain, and by evaluation of radiographs. RESULTS: Our study revealed good clinical results in the operative treatment of different stages of primary shoulder impingement and thus confirmed the results of similar studies before. However, in 25.6% of all patients we found periarticular calcifications. Hereby, calcifications occurred significantly more often after open procedures (56.8%) than after arthroscopic procedures (12.9%). There was non correlation between the occurrence of such calcifications and the stage of the disease. Moreover, comparison of the clinical results and the Constant scores at follow-up did not reveal any differences between patients with and without periarticular calcifications. CONCLUSION: Our study shows that the presence of periarticular calcifications after operations in the subacromial space is not necessarily associated with clinical symptoms. Therefore, routine prophylactic measurements against such calcifications are not justified.

Acromioclavicular Joint↗
PubMed2001

[Recurrent luxations after arthroscopic refixation of the labrum using suture anchors in traumatic ventral shoulder luxation].

OBJECTIVE: Recurrence rates after arthroscopic labral reconstruction for anterior shoulder instability are still higher than after open procedures. Therefore, proper selection of patients becomes increasingly important. The aim of this study was to investigate factors influencing recurrence rates after arthroscopic labral repair with suture anchors. PATIENTS AND METHODS: We examined 53 patients (43 male, 10 female) with traumatic anterior shoulder dislocations, who were treated with arthroscopic labral repair using Fastak-Suture anchors between 1995 and 1996. The average follow-up time was 18 (12-30) months. The mean age of the patients at the time of operation was 27 (15-44) years. RESULTS: Postoperatively, 11 patients (20.7%) reported on redislocations. Recurrence rates increased significantly in patients with more than 4 preoperative dislocations and in patients with bony Bankart lesions. In patients without redislocations, the mean Rowe score improved from 65.9 (SD +/- 12.3) preoperatively to 88.6 (SD +/- 12.5) at follow-up. Thus, there were 24 excellent, 9 good and 6 fair results, while in 3 patients with persisting signs of shoulder instability results had to be estimated as poor. Deficits in the range of motion of more than 15 degrees were seen in 7 patients with predominant affection of the external rotation. CONCLUSION: Frequent preoperative dislocations and bony Bankart lesions contribute substantially to high recurrence rates after arthroscopic labral repair. Therefore, in these cases open procedures should be preferred.

Adolescent↗
PubMed2001

Have the new drugs relieved the burden of the orthopedic surgeon?

Rheumatoid arthritis (RA) represents a chronic joint inflammation that leads to destructive lesions of joint cartilage and periarticular bone. Increased understanding of the molecular and cellular mechanisms of RA and recent advantages in molecular technology have resulted in new antirheumatic drugs such as tumor necrosis factor-alpha blockers, inhibitors of interleukin-1, and novel disease-modifying antirheumatic drugs such as leflunomide. This review summarizes the important effects of the novel antirheumatic drugs and their potential impact on the work of orthopedic surgeons. The ability of these agents not only to improve the clinical signs and symptoms of RA but also to prevent progressive joint damage promises support to the work of orthopedic surgeons and to the interdisciplinary treatment of RA patients. The challenge, however, will be to conduct studies that show the concrete way in which the single drugs may best relieve the burden of the orthopedic surgeon.

Animals↗
PubMed2000

[Functional changes in the quadriceps femoris muscle in patients with varus gonarthrosis].

In osteoarthritis (OA) of the knee, arthrogenous muscle inhibition (AMI) is considered to be one of the reasons of quadricep muscle weakness. Its influence on functional impairment such as gait alterations, however, still remains unclear. Fourty-seven patients with knee OA (mean age 64 +/- 5.2 years, 36 women, 11 men) and 47 age- and gender-matched healthy controls were investigated for voluntary activation (VA) and maximum voluntary contraction (MVC) of the quadricep muscle. In addition, these two parameters of AMI have been correlated with the extent of gait alterations. Measurement of VA and MVC were performed by a twitch interpolation technique; for gait analysis an optoelectronic motion analysis system (ELITE, Italy) was used. Quadricep MVC and VA were significantly lower in OA than in control knees. Moreover, in addition to reduced walking velocity and step cadence, gait analysis revealed significantly lower stance phase re-extension angles in OA patients (mean 2.7 degrees +/- 2.6) than in control knees (mean 10.7 degrees +/- 4.9). Hereby, in OA knees there was a significant correlation between MVC and VA deficits and the reduction of re-extension angles. The work shows that knee OA is characterized by severe alterations of the quadricep motor function due to arthrogenous muscle inhibition. Hereby, quadricep AMI represents one major reason for functional impairment in knee OA.

Aged↗
PubMed2000

Radiographic findings in osteoarthritis of the knee joint are not correlated with cartilage histomorphology or immunohistochemistry.

The purpose of this study was to investigate whether radiographic joint space narrowing (JSN) of the lateral knee compartment predicts the histomorphological or immunhistochemical grading in cases of osteoarthritis of the knee joint. The lateral joint space was measured on weight-bearing radiographs. Femoral osteochondral plugs of 29 patients undergoing total knee replacement were obtained from lateral condyles. All these patients had severe osteoarthritis of the medial compartment, with the lateral compartment showing different stages of osteoarthritis. The specimens were histomorphologically evaluated with the Mankin score, and the expression of the cartilage-degrading enzymes MMP1 and MMP3 was measured. There was no correlation between the joint space and histomorphological or immunohistochemical data, whereas the enzyme expression was correlated with histomorphological grading. We conclude that radiographic assessment alone is not sufficient to evaluate the cartilage damage of the lateral condyle.

Arthroplasty, Replacement, Knee↗
PubMed2000

Expression of stromelysin and urokinase type plasminogen activator protein in resection specimens and biopsies at different stages of osteoarthritis of the knee.

This study aimed at assessing the possible diagnostic value of cartilage biopsies as a convenient marker for cartilage matrix degradation. We therefore examined cartilage specimens from 56 patients with primary osteoarthritis (OA) of the knee. Resection and biopsy cartilage specimens obtained during joint replacement surgery were used for this study. In addition to histomorphology, immunohistochemistry (ICH) was performed to determine the expression levels and distribution patterns of stromelysin and u-PA protein. The latter data were compared with the degree of histomorphological changes in osteoarthritic cartilage samples, based on a modified version of Mankin's grading score. Compared to the cartilage resection specimens, the biopsies showed comparable expression patterns for both proteinases: the strongest signals were noted in the superficial zone and, as matrix destruction increased, also in the chondrocytes of the transition and deep zones. The strongest signals were ascertained in cell clusters beneath deep matrix fissures. At the immunohistochemical level, we found a direct correlation in the expression of MMP-3 and u-PA between resection specimens and biopsies. Furthermore, in both types of cartilage samples, we noticed a positive relationship between the expression of both proteins and the Mankin score. Analysis of the expression levels revealed significant differences between deep, transition and superficial zones. Histomorphological and immunohistochemical examinations of MMP-3 and u-PA in biopsies of osteoarthritic cartilage turned out to be useful for estimating the pathological changes within osteoarthritic knee joints. Therefore, in future, cartilage biopsies from osteoarthritic knee joints might serve as a diagnostic tool and thus have an influence on further therapeutic strategies.

Biopsy↗
PubMed2000

Proprioception after total knee arthroplasty: a comparison with clinical outcome.

We determined proprioception in replaced and unreplaced arthrotic knees by measuring threshold levels for the perception of passive knee motion. In addition, results of these proprioception measurements were compared with the clinical outcomes in patients with a total knee arthroplasty. Threshold detection levels were significantly higher in the replaced than in the unreplaced knees. Moreover, detection-failure rates were significantly higher in the replaced knees as well. In contrast to this diminished movement sense in the replaced knees, clinical examination of these knees showed good or excellent outcome in all cases. A correlation between the clinical outcome and the ability to perceive passive motion in either patient group could not be found. We hypothesize that our findings may be due to the operative removal of intraarticular receptor-rich tissue that is affected by arthrosis. This would not only contribute to marked clinical improvements but also to a significant decrease in proprioception.

Activities of Daily Living↗
PubMed2000

The role of joint afferents in sensory processing in osteoarthritic knees.

OBJECTIVE: To test the role of joint receptors for proprioception in patients with bilateral knee osteoarthritis (OA) and patients who had undergone unilateral total knee arthroplasty (TKA). METHODS: Nine patients were tested bilaterally with a conventional movement detection paradigm that evaluated conscious detection perception and a newly developed hunting paradigm that measured maximal sensory performance (hunting perception). RESULTS: For detection perception, patients exhibited a slightly lower threshold on the arthritic side than on their TKA side. For hunting perception, the patients showed threshold values that were an order of magnitude smaller than for the conventional paradigm in both knees. Performance was much better on prosthetic knees than on OA knees. CONCLUSION: The joint receptors of OA knees might have an adverse effect on the maximal proprioceptive performance, being important for the normal reflexive knee joint functions. These deficits may be overcome by joint receptor removal during knee replacement.

Knee Joint↗
PubMed2000

[Joint loading as a possible etiology for arthrosis development. Results of animal experiment studies of the rat model].

We review our results with an animal model for investigations on the development of osteoarthritis (OA). This model is based on running exercises of wistar rats performed in a running wheel using intracranial self-stimulation to motivate rats to excessive running. In our studies a total of 49 rats was divided into groups with running exercises of 15 km, 20 km, and 30 km respectively. In order to investigate the influence of altered sensible joint innervation on the development of OA, in addition to a total running load of 20 km in another group of 8 rats we performed Capsaicin (8 Methyl-N-vanillyl-6-noneamide) mediated partial sensible knee joint denervation. Complete knee joint sections of all rats were evaluated histologically using Mankins grading system. In addition, we performed semiquantitative assessment of the immunoreactivity of the chondrocytes to MMP-3 by immunostaining with monoclonal MMP-3 IgG antibodies. Histological assessment and immunostaining for MMP-3 of the knee joint sections revealed a significant increase in osteoarthritic changes with higher running load. Moreover, osteoarthritic changes in the knee joints of the rats with sensible joint denervation and running exercises were significantly greater as compared to those with sole running load. In conclusion, our studies revealed a significant relationship between the development of knee osteoarthritis and the extent of joint load. Hereby, an alteration of the sensible joint innervation seems to have a promoting effect on the development of osteoarthritic changes. This model offers a wide range of further approaches to studying different processes of the development of OA.

Animals↗
PubMed1999

[Deterioration of sensory joint innervation as an enabling factor for development of arthrosis. An animal experiment study of the rat model].

In the present study we investigated the influence of an altered sensible joint innervation on the development of knee osteoarthritis in a wistar rat model of osteoarthritis. Capsaicin (8-methyl-N-vanillyl-6-noneamide) mediated partial sensible knee joint denervation was performed in a group of 16 male wistar rats. Twelve rats without alterations of the sensible knee joint innervation served as controls. In both groups, half of the rats underwent strenuous running exercises (total running load of 20 km) in a running wheel by intracranial self-stimulation, while the other half did not have any running load. In rats without running, there were no histological sings of knee osteoarthritis according to the Mankin score. In contrast, in rats running a total of 20 km significant osteoarthritis changes were observed. Hereby, in rats without altered sensible knee joint innervation, osteoarthritis was mostly classified as mild or moderate, while severe osteoarthritis was the predominant finding in the knee joints of the rats with partial sensible knee joint denervation. In conclusion, our study gives strong evidence for the hypothesis that an altered sensible joint innervation works as a contributing factor in the development of osteoarthritis.

Animals↗