Biomedical subjects

Rüdiger Krauspe

Publications and source records attributed to Rüdiger Krauspe.

11 recordsLinked to original sources

PubMed2006

Radiological evaluation of unstable (acute) slipped capital femoral epiphysis treated by pinning with Kirschner wires.

Treatment of slipped capital femoral epiphysis is still controversial with regard to the implants used for stabilization and the need for prophylactic treatment of the contralateral, unaffected, side. The objective of this study was to ascertain whether prophylactic transfixation of the epiphysis with Kirschner wires in patients with unstable slipped capital femoral epiphysis resulted in significant disturbance of the growth plate and impairment of further growth of the femoral neck and head. Between 1990 and 1999, 29 patients with unstable slipped capital femoral epiphysis were simultaneously treated with internal fixation of the epiphysis and metaphysis with 3-4 Kirschner wires on the affected and the not (yet) affected side. After a mean follow-up of 3.5 years, we evaluated the hip joints radiologically, analysing different roentgenological parameters (CCD angle, femoral head diameter, length of the femoral neck and sphericity of the femoral head). CCD angle, femoral head diameter and length of the femoral neck showed statistically significant (P<0.001, Student's t-test) differences between the affected and unaffected, but prophylactically pinned, sides. Asphericity of the femoral head was found in six cases only on the affected side, whereas all hips, which were operated prophylactically, showed spherical femoral heads at follow-up (P<0.02, Pearson's chi test). These results indicate that the slip itself may cause impairment of the femoral growth plate in patients with unstable slipped capital femoral epiphysis and not stabilization with Kirschner wires. Compared with other series from the literature using different implants (screws, nails), prophylactic transfixation of the epiphysis and metaphysis with Kirschner wires is less compromising to the growth plate on the not (yet) affected side.

Acute Disease↗

PubMed2006

Partial hemi-resurfacing of the hip joint--a new approach to treat local osteochondral defects?

There is currently renewed interest in articular resurfacing for the treatment of damaged hip-joint cartilage. In contrast to these implants, which involve endoprosthetic replacement of both articulating surfaces, we present a new joint-preserving technique that allows treatment of local osteochondral defects of the femoral head by partial hemi-resurfacing. In this study we describe the operative and technical aspects and problems for partial hemi-resurfacing of the hip joint and critically discuss indications for this procedure in one case. To guarantee an adequate view of the situs, we recommend a surgical approach involving trochanter flip osteotomy, followed by surgical dislocation of the hip joint. Besides partial hemi-resurfacing of the osteochondral defect, this approach allows treatment of associated labral tears and cartilage defects of the hip joint at the same time. For adequate implant fixation, good bone quality is required. Furthermore, osteochondral defects of limited extent and excellent patient compliance are essential for clinical success. In particular, prominence of the implant has to be avoided, which can lead to an irregular joint surface and may induce further cartilage destruction. Long-term studies on statistical populations will show if partial articular hemi-resurfacing is a bone-preserving and useful therapeutic alternative to hemi-resurfacing caps in the treatment of osteochondral hip-joint defects, especially in young patients.

Adult↗

PubMed2005

Computerized gait analysis in Legg Calvé Perthes disease--analysis of the frontal plane.

OBJECTIVE: Current follow-up and outcome studies of Legg Calvé Perthes disease (LCPD) are based on subjective measures of function, clinical parameters and radiological changes [Herring JA, Kim HT, Browne RH. Legg-Calvé-Perthes disease. Part II: prospective multicenter study of the effect of treatment on outcome. J Bone Joint Surg 2004;86A:2121-34; Aksoy MC, Cankus MC, Alanay A, Yazici M, Caglar O, Alpaslan AM. Radiological outcome of proximal femoral varus osteotomy for the treatment of lateral pillar group-C. J Pediatr Orthop 2005;14 B:88-91; Kitakoji T, Hattori T, Kitoh H, Katho M, Ishiguro N. Which is a better method for Perthes' disease: femoral varus or Salter osteotomy? Clin Orthop 2005;430:163-170; Joseph B, Rao N, Mulpuri K, Varghese G, Nair S. How does femoral varus osteotomy alter the natural evolution of Perthes' disease. J Pediatr Orthop 2005;14B:10-5; Ishida A, Kuwajima SS, Laredo FJ, Milani C. Salter innominate osteotomy in the treatment of severe Legg-Calvé-Perthes disease: clinical and radiographic results in 32 patients (37 hips) at skeletal maturity. J Pediatr Orthop 2004;24:257-64.]. The objective of this study was to evaluate the frontal plane kinematics and the effect on hip joint loading on the affected side in children with a radiographic diagnosis of LCPD. MATERIAL AND METHOD: Computerized, three-dimensional gait analysis was performed in 33 individuals aged > or =5 years (mean 8.0+/-2 years) with unilateral LCPD and no history of previous surgery to the hip or any disorder leading to gait abnormality. Frontal plane kinematics and kinetics were compared to a group of healthy children (n=30, mean age 8.1+/-1.2 years). Hip joint loading was estimated as a function of the hip abductor moment. RESULTS: Subjects with LCPD demonstrated two distinct frontal plane gait patterns, both deviating from normal. Type 1 (n=3) was characterized by a pelvic drop of the swinging limb, a trunk lean in relation to the pelvis towards the stance limb and hip adduction during stance phase and corresponded well to the description of Trendelenburg gait caused by abductor insufficiency. Type 2 (n=12) is characterized by a trunk lean toward the affected stance limb with the pelvis stable or elevated on the swinging limb during single stance phase. The abductor moment of the involved side during single stance was significantly reduced in type 2 compared to the controls (p=0.004) indicating a hip-unloading mechanism. These results may influence the physiotherapy regimen, which may require to work towards a hip-unloading gait pattern.

Biomechanical Phenomena↗

PubMed2005

Association between botulinum toxin injection into the arm and changes in gait in adults after stroke.

Botulinum toxin (BTX) is often used to improve arm function in persons with hemiparesis after stroke. Persons injected into the arm sometimes report changes in their gait. The purpose of this open-labeled pilot study was to investigate the association between injecting BTX into the upper limb and ankle and knee range of motion (ROM) and paretic-leg stride-time, defined as the time in seconds required to move the hemiparetic leg from initial contact of the foot to initial contact of the same foot. Gait parameters were recorded before and 4 to 6 weeks after the hemiparetic arm was injected with BTX in 13 adults with hemiparesis secondary to stroke, using a three-dimensional computerized motion analysis system. BTX injection into the paretic arm was associated with a decrease in stride-time of the paretic leg in all participants. Slower striding participants improved knee and ankle ROM in the paretic leg. There was no change in ankle and knee ROM in faster striding participants. Injection of BTX into the upper extremity is associated with a change in hemiparetic leg stride-time and ankle and knee ROM. There is a variability of response, with slow striders improving to a greater extent than fast striders.

Adult↗

PubMed2005

Strain adaptive bone remodelling in total joint replacement.

Histomorphologic analyses of artificial joint components implanted into bone need special technology for processing and for documentation; published histological work systematically done therefore is rare. The histopathology, three-dimensionally analyzed in a complete sequence of sections is, however, the only precise answer in terms of biocompatibility and bone response. A complete analysis allows a type-related predictable prognosis of an implantation that is at least comparable to a finite element analysis with respect to load transfer to host bone. The histopathologic collection of the ZOW Munich is comprised of more than 5000 nondemineralized bone and joint specimens and more than 500 artificial joint components implanted in the human skeleton for up to 25 years. Fifty-nine implant-bone specimens without signs of loosening already have been processed and analyzed systematically. According to the strain-adapted bone remodelling, different types of anchorage clearly were differentiated and their morphologic substrate could be worked out. Based on that, the cemented standard anchorage could be distinguished histologically from the cemented press-fit procedure, and the noncemented press-fit from the porous ingrowths pattern. In terms of the topography of the bony integration, the proximal and distal press-fit and ingrowth pattern were analyzed; beside that, the cemented and noncemented epiphyseal resurfacings could be defined histologically. In all histologic specimens the remodelling appeared as a result of stress-related strain, reflecting stiffness of the implant and the resistance of bone to deformation. It clearly was worked out that all success of cemented components is based on preserved cancellous bone honeycombs stiffened by bone cement, representing an adaptation of bone in terms of stiffness to the stiff implants.

Adaptation, Physiological↗

PubMed2004

Femoroacetabular impingement caused by a femoral osseous head-neck bump deformity: clinical, radiological, and experimental results.

Femoroacetabular impingement is often associated with reduced femoral anteversion or an osseous bump deformity on the femoral head-neck junction. We report prospectively on 17 patients showing an osseous bump at the anterolateral head-neck junction on radiography (22 hips) and typical signs of femoroacetabular impingement on clinical examination. Following three plans of treatment, nine patients (10 hips) underwent nonoperative treatment, and eight patients (12 hips) had surgery. In eight hips with labral defects but minor cartilage damage, the bump was surgically removed via trochanter flip osteotomy. Two hips were treated surgically through an anterior surgical approach without hip dislocation. Four hips with severe signs of osteoarthritis and significantly reduced range of motion underwent total replacement. To elucidate a local osteogenic differential potential, tissue specimens of the perilesional capsule were investigated immunohistochemically. Various antigens and protein synthesis products served to identify osteoblastic and progenitor cells. There was a significant improvement in internal rotation and pain relief in patients who underwent surgical resection of the osseous bump. No avascular osteonecrosis or other significant severe side effects were observed during follow-up. In contrast, no nonoperatively treated patients improved. Furthermore, immunohistochemical studies showed perilesional recruitment of osteoprogenitor cells.

Acetabulum↗

PubMed2003

[Osteonecrosis of Behçet's disease: diagnosis, therapy, and course].

AIM: The aim of this study is to review the data of skeletal manifestations of Behçet's disease (BD, Morbus Adamantiades- Behçet, silk road disease), which is clinically diagnosed by dermatological, neurological and ophthalmological symptoms. This paper demonstrates the diagnostic and therapeutic difficulties in the management of osteonecrosis and recurrent arthritis associated with BD. Arthrogenic symptoms are a well-recognized feature of the syndrome but low in incidence. METHOD: A literature review served as the database to show the characteristics of osseous and articular manifestations in Behçet's disease. Furthermore, we present a 25-year clinical follow up of a patient with BD and multiple osteonecrosis. RESULTS/CONCLUSIONS: Chronic or intermittent joint pain should lead the physician to include BD into the differential diagnosis especially if there are findings of cutaneous ulcerations, ophthalmological inflammations or neurological symptoms. For detection of osteonecrosis at an early stage, which would allow for successful treatment, MRI scans of at least the symptomatic joints are recommended.

Adult↗

PubMed2003

Clinical outcome in monosegmental fusion of degenerative lumbar instabilities:instrumented versus non-instrumented.

BACKGROUND: Degenerative lumbar instabilities are one of the major reasons for low back pain, especially in elderly people. There is still controversy in the literature about the clinical outcome of instrumented monosegmental fusions compared to noninstrumented posterolateral fusions. MATERIAL/METHODS: In this study we described the postoperative outcome of 33 patients who underwent posterolateral monosegmental spinal fusion:instrumented (17 patients)or noninstrumented (16 patients).All patients received the same instrumentation system. Medical history (considering daily activities,sports,social contacts and quality of life),clinical examination and radiological analysis served as evaluation parameters. Data were collected by a questionnaire based on the Oswestry Disability Score for low back pain. RESULTS: 86.6%of all subjects showed an improvement of postoperative health status. Although patients with fusion without internal fixation needed a reduced dose of postoperative analgesics compared to the monosegmental non-instrumented group,there were no statistical differences in patient-reported,clinical and radiographical outcome between the two groups. CONCLUSIONS: The results do not indicate a benefit in outcome from added instrumentation in elective lumbar fusions. This should be considered in each single case when a spinal fusion in the treatment of degenerative lumbar instability is indicated.

Adult↗

PubMed2002

Classification and management of early complications in open lumbar microdiscectomy.

Complications and side effects in any kind of surgery, especially in spine surgery, should be evaluated to prevent those problems in the future. Since retrospective studies are of minor value and randomized controlled studies for complications are impossible to perform because of ethical and legal reasons, so-called "expert opinion" has to take their place in evidence-based medicine. On the basis of an analysis of the results of three spine centers together with the opinions of experienced spine surgeons, the authors have drawn up a classification of complications in open lumbar disc surgery and recommendations on how to manage common complications such as excessive bleeding, dural opening, nerve root lesions and recurrent disc herniation. The management of intraoperative complications should have the same training in microdiscectomy instructional courses as the operation itself.

Diskectomy↗

PubMedDate not supplied

In vitro osteogenic differentiation is affected in Wiedemann-Rautenstrauch-Syndrome (WRS).

BACKGROUND: Wiedemann-Rautenstrauch (neonatal progeroid) syndrome (WRS) is a rare autosomal recessive condition, with the characteristic appearance of premature aging already present at birth and other typical features (hypotrichosis, macrocephaly, mental retardation, aged face, generalized lipoatrophy, abnormal tooth status, osteopenia and other skeletal abnormalities). To date, there are no data about the differentiation capacity of WRS progenitor cells available in the literature. PATIENTS AND METHODS: To elucidate the osteoblastic and chondroblastic regeneration potential in WRS, a progenitor cell culture system was used. Bone marrow-derived stem cells of a 16-year-old WRS patient were cultivated and stimulated by dexamethasone, ascorbic acid and beta-glycerolphosphate (DAG) over 21 days. Immunocytochemical stainings of CD34, CD45, CD105, osteocalcin, osteopontin and collagen II served for a quantitative evaluation of the differentiated cells. The results were compared to bone marrow-derived stem cells of a healthy female volunteer donor. RESULTS: It was shown, for the first time, that WRS cells showed a highly significant lower in vitro response to osteoblastic differentiation stimulus. Furthermore, significantly fewer chondrocytes and hematopoietic cells were induced in WRS progenitors compared to the control group. CONCLUSION: Our data suggest a lack of cellular differentiation capacity in WRS patients, which may be responsible for the clinical appearance and symptoms of this rare disorder.

Adolescent↗

PubMedDate not supplied

Ovine cord blood accommodates multipotent mesenchymal progenitor cells.

BACKGROUND: Stem cells derived from umbilical cord blood display mesenchymal multipotency and can differentiate into osteoblasts, chondroblasts and adipoblasts in vitro under defined stimuli. Although sheep have been used as experimental models for investigations on xenoreactivity after transplantation of stem cells isolated from human umbilical cord blood, the potential of ovine cord blood stem cells to differentiate has been examined to date. MATERIALS AND METHODS: Mononuclear cells from the placentoms of 3 lambs were isolated via density gradient centrifugation and cultivated. After expansion up to 3 passages, the cells were stimulated to differentiate towards osteogenic (dexamethasone, ascorbic-acid-2-phosphate, beta-glycerolphosphate), chondrogenic (TGF-beta3, insulin, transferrin, selenium, dexamethasone, ascorbic-acid-2-phosphate) and adipogenic (indomethacine, insulin, 3-isobutyl-1-methylxanthine, dexamethasone) lines for 20 days. The cells were characterized morphologically by transmission and phase contrast light microscopy during lineage-specific stimulation. Immunocytochemistry and conventional stains were used to detect lineage-typical markers: fat vacuoles and peroxisome proliferation-acitivated receptor gamma2 (PPAR) served to detect adipoblasts, whereas osteopontin (OP) was used to characterize osteoblasts. A positive antibody reaction to collagen II and chondrogenic oligomeric protein (COMP) revealed the presence of chondroblasts. RESULTS: The osteogenic line formed bone nodules, adipogenic cells developed lipid droplets and the cells of the chondrogenic line showed typical chondroblast-like morphology. CONCLUSION: It was demonstrated that ovine mesenchymal stem cells, derived from umbilical cord blood (sheep unrestricted somatic stem cells, S-USSCs), can be isolated via gradient density centrifugation and expanded in vitro. Under lineage-specific stimulation, S-USSCs differentiated into osteo-, chondro- and adipoblasts with typical morphological characteristics. Significant quantitative differences between the stimulated and control groups in lineage-typical immunocytochemical markers verified these findings.

Adipose Tissue↗