Publications by authors named "Catharina Chiari"

45 Publications

[Epiphysiodesis and hemiepiphysiodesis : Physeal arrest and guided growth for the lower extremity].

Orthopade 2022 May 31;51(5):415-432. Epub 2022 Mar 31.

Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.

The principals of growth arrest by epiphysiodesis and growth guidance by hemiepiphysiodesis are effective and powerful surgical techniques in pediatric orthopedics. These procedures can be used to correct leg length discrepancies as well as sagittal, coronal and oblique deformities. A differentiation is made between temporary and permanent techniques. The most significant advantage is that these techniques are minimally invasive and have low complication rates compared to acute osteotomy and gradual deformity correction. For optimal outcome an exact preoperative planning is needed to ensure accurate timing of the procedure, especially when permanent epiphysiodesis techniques are used. Although epiphysiodesis and hemiepiphysiodesis around the pediatric knee are most frequently used and can be considered the gold standard treatment of coronal plane deformities and leg length discrepancies, novel techniques for the hip and ankle are increasingly being performed. The successful clinical results with low complications support the broad use of hemiepiphysiodesis and epiphysiodesis for a variety of indications in the growing skeleton with deformities and leg length differences.
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http://dx.doi.org/10.1007/s00132-022-04219-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9050799PMC
May 2022

[Femoroacetabular impingement syndrome in adolescents-How to adivse? How to treat?]

Orthopade 2022 Mar 15;51(3):211-218. Epub 2022 Feb 15.

Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.

Background: Femoroacetabular impingement syndrome (FAIS) is a relevant cause of groin pain in adolescents. Athletes are particularly affected.

Objectives: The article shall provide an evidence-based background for FAIS counseling and therapy in adolescents.

Material And Methods: On the basis of the current literature, an overview of the prevalence and pathogenesis, evaluation and diagnostics, as well as the therapeutic recommendations for FAIS in adolescents was compiled.

Results And Discussion: FAIS in adolescents primarily affects physically active patients. Certain sports favor the development of FAIS. Cam impingement, pincer impingement, and combined FAIS are the most common entities in this age group. Cam morphology occurs shortly before closure of the proximal femoral growth plate. In cam impingement, the slipped capital femoral epiphysis (SCFE) must be distinguished from the primary cam morphology. SCFE requires rapid surgical treatment with stabilization of the epiphysis, while primary cam impingement can be analyzed electively, and conservative treatment is first recommended. Damage to the labrum and cartilage is regularly observed. A systematic radiological evaluation using X‑rays and MRI is mandatory in order to develop an adequate treatment plan. In adolescent patients with FAIS, a conservative attempt at therapy should always be made; if this is unsuccessful, surgical repair with hip arthroscopy is indicated. The postoperative results are very good in adolescents, with a rapid improvement in symptoms, few complications, and a high return-to-sport rate.
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http://dx.doi.org/10.1007/s00132-022-04214-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8894180PMC
March 2022

Galectin network in osteoarthritis: galectin-4 programs a pathogenic signature of gene and effector expression in human chondrocytes in vitro.

Histochem Cell Biol 2022 Feb 30;157(2):139-151. Epub 2021 Nov 30.

Karl Chiari Lab for Orthopaedic Biology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.

Galectin-4 (Gal-4) is a member of the galectin family, which have been identified as galactose-binding proteins. Gal-4 possesses two tandem repeat carbohydrate recognition domains and acts as a cross-linking bridge in sulfatide-dependent glycoprotein routing. We herein document its upregulation in osteoarthritis (OA) in correlation with the extent of cartilage degradation in vivo. Primary human OA chondrocytes in vitro respond to carbohydrate-inhibitable Gal-4 binding with the upregulation of pro-degradative/-inflammatory proteins such as interleukin-1β (IL-1β) and matrix metalloproteinase-13 (MMP-13), as documented by RT-qPCR-based mRNA profiling and transcriptome data processing. Activation of p65 by phosphorylation of Ser536 within the NF-κB pathway and the effect of three p65 inhibitors on Gal-4 activity support downstream involvement of such signaling. In 3D (pellet) cultures, Gal-4 presence causes morphological and biochemical signs of degradation. Taken together, our findings strongly support the concept of galectins acting as a network in OA pathogenesis and suggest that blocking their activity in disease progression may become clinically relevant in the future.
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http://dx.doi.org/10.1007/s00418-021-02053-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8847242PMC
February 2022

Results in the surgical treatment of aneurysmal bone cysts - A retrospective data analysis.

Orthop Traumatol Surg Res 2022 06 1;108(4):103095. Epub 2021 Oct 1.

Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.

Background: Aneurysmal bone cysts (ABC) are benign tumors mostly occurring in children and young adults. Different open and minimal invasive surgical approaches have been proposed for the treatment of ABCs and yet no consensus is defined to date. The aim of this study was to retrospectively review data of a large single center series of ABCs with patients treated by open curettage with or without filling of the cavity or en-bloc resection. Questions/purposes We asked: (1) What was the local recurrence rate of ABC after surgical treatment at our institution? (2) What were positive or negative predictors for local recurrence? (3) Was there a benefit from adjuvant burring, phenolization or filling, respectively? (4) Where there changes in recurrence free survival in different time periods of primary surgery?

Methods: By retrospective data analysis of the Vienna Bone and Soft Tissue Tumor Registry, 123 patients surgically treated for primary aneurysmal bone cysts were identified. After exclusion of 33 patients (27%) due to a postoperative follow up below one year, 90 patients who were treated for primary ABCs between 1986 and 2009 were evaluated. These included 50 males and 40 females with a mean age of 16 years (SD 10 years; range: 2 to 51 years). The mean follow-up was 99 months. (SD 72 months, range: 13 to 329 months) RESULTS: Curettage was performed in 84 patients, while 45 patients received adjuvant phenolization. Local recurrence occurred in 28 patients after a mean time of 16 months, with a corresponding local recurrence free survival (RFS) of 83% after one year, 77% after 2 years and 66% after 5 years. ABCs located in hands and feet (p=0.044) showed a superior RFS, while younger patients (p=0.001) displayed an inferior RFS. Regarding adjuvant surgical techniques, mechanical cavity burring (p=0.004) and filling with autologous cancellous bone graft (p=0.024) showed protective effects on RFS. Patients treated between 1986 and 1999 (n=47) had a higher RFS than patients treated between 2000 and 2009 (n=43, p=0.011), as surgeons and surgical indications changed over time.

Conclusion: Although curettage, burring, phenolization and reconstruction with bone grafts came with a relatively high risk of local recurrence, open surgery is still justified in aggressively growing ABCs of critical localizations.

Level Of Evidence: IV; therapeutic study.
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http://dx.doi.org/10.1016/j.otsr.2021.103095DOI Listing
June 2022

Diagnosis and staging of malignant bone tumours in children: what is due and what is new?

J Child Orthop 2021 Aug;15(4):312-321

Department of Pediatric Orthopedics, Hospital Universitari Son Espases, Palma de Mallorca, Spain.

Purpose: Although malignant bone tumours in children are infrequent, it is important to know how to properly diagnose and stage them, in order to establish an adequate treatment.

Methods: We present a review of the diagnostic workflow of malignant bone tumours in children, including history and clinical examination, imaging, laboratory tests and biopsy techniques. Moreover, the two most commonly used staging systems are reviewed.

Results: History, clinical examination and laboratory tests are nonspecific for diagnosing malignant bone tumours in children. Radiographs remain the mainstay for initial diagnosis, with MRI the modality of choice for local assessment and staging. Fluorine-18 labelled fluoro-deoxy-glucose-positron emission tomography scans provide a noninvasive method to assess the aggressiveness of the tumour and to rule out metastasis and is replacing the use of the bone scintigraphy. Biopsy must be always performed under the direction of the surgeon who is to perform the surgical treatment and after all diagnostic evaluation has been done. Staging systems are useful to study the extent of the tumour and its prognosis. They are expected to evolve as we better understand new molecular and genetic findings.

Conclusion: When a malignant bone tumour is suspected in a child, it is essential to make a correct diagnosis and referral to an experienced centre. Following an appropriate workflow for diagnosis and staging facilitates, prompt access to treatment improves outcomes.

Level Of Evidence: Level V Expert opinion.
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http://dx.doi.org/10.1302/1863-2548.15.210107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8381400PMC
August 2021

Can Adding BMP2 Improve Outcomes in Patients Undergoing the SUPERhip Procedure?

Children (Basel) 2021 Jun 10;8(6). Epub 2021 Jun 10.

Joint Preservation and Limb Reconstruction Center, Jupiter, FL 33477, USA.

Congenital femoral deficiency (CFD) Paley type 1b is characterized by severe bony deformity of the upper femur, extra-articular contractures of the hip, and delayed ossification of the femoral neck and/or subtrochanteric region. The Systematic Utilitarian Procedure for Extremity Reconstruction of the hip (SUPERhip) procedure for the correction of CFD deformities was developed in 1997. Initially, a non-fixed angle device (rush rod) was used for fixation. Late complications of persistent delayed ossification and recurrent varus deformity occurred. In order to reduce and treat such complications, fixation with a fixed angle device and the off-label use of BMP2 to induce ossification of the un-ossified femoral neck were employed. The purpose of this study is to determine if the use of a fixed angle device, and, BMP2 inserted into a drill hole in the cartilage of the femoral neck, decreases the incidence of these late complications. We retrospectively reviewed 72 SUPERhip procedures performed for Paley type 1b CFD between 1997 and 2012. Due to recurrent varus or persistent delayed ossification of the femoral neck, 34 revision SUPERhip procedures were performed. In total, 106 SUPERhip procedures were studied. Sixty-eight SUPERhips were performed using internal fixation without BMP2, while 38 SUPERhips were performed with both internal fixation and the addition of BMP2. Forty-one were performed using non-fixed angle internal fixation while 65 had fixed angle internal fixation. Fixed angle devices significantly reduced the incidence of recurrent varus compared with non-fixed angle devices. Inserting BMP2 in the femoral neck significantly reduced the incidence of persistent delayed ossification. Using only a fixed angle device but no BMP2 did not reduce the incidence of delayed ossification. The combination of both a fixed angle device and BMP2 reduced the incidence of recurrent coxa vara and persistent delayed ossification of the femoral neck. The SUPERhip procedure corrects the pathoanatomy of the proximal femur in CFD Paley type 1b but is associated with a very high risk of recurrence of coxa vara and persistence of femoral neck delayed ossification, unless, a fixed angle internal fixation device is used to prevent recurrent coxa vara and BMP2 is used to induce ossification of the femoral neck.
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http://dx.doi.org/10.3390/children8060495DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8228032PMC
June 2021

[Peroneal tendon pathologies : From the diagnosis to treatment].

Orthopade 2021 Jul 23;50(7):589-604. Epub 2021 Jun 23.

Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.

Peroneal tendon pathologies are rare but often underdiagnosed. There may be an association with chronic lateral ankle instability as well as with varus hindfoot alignment. Pathologies of the tendons fall into three categories: tendinitis and tenosynovitis, tendon ruptures and tears, and tendon subluxation and dislocation. Magnetic resonance imaging is the standard method for radiological assessment; however, the diagnosis and treatment are based primarily on patient history and clinical examination. A primary conservative treatment can be attempted, except for peroneal tendon dislocations in professional athletes. Surgical treatment should be targeted to the underlying pathology and can accordingly vary from tendoscopic synovectomy to anatomic repair of the superior peroneal retinaculum with deepening of the retromalleolar groove. Postoperative results show high patient satisfaction and low reluxation rates.
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http://dx.doi.org/10.1007/s00132-021-04116-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8241798PMC
July 2021

Behandlung der Patellainstabilität.

Z Orthop Unfall 2022 Aug 13;160(4):463-475. Epub 2021 Apr 13.

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http://dx.doi.org/10.1055/a-1295-0533DOI Listing
August 2022

Epiphysiodesis for the treatment of tall stature and leg length discrepancy.

Wien Med Wochenschr 2021 Apr 18;171(5-6):133-141. Epub 2021 Mar 18.

Department of Orthopedics and Trauma Surgery-Division for Orthopedics, Comprehensive Center for Pediatrics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.

Painful orthopedic conditions associated with extreme tall stature and leg length discrepancy (LLD) include back pain and adopting bad posture. After failure of conservative treatment options, blocking of the growth plates (epiphysiodesis) around the knee emerged as gold standard in patients with tall stature and LLD in the growing skeleton. Surgical planning includes growth prediction and evaluation of bone age. Since growth prediction is associated with a certain potential error, adequate planning and timing of epiphysiodesis are the key for success of the treatment. LLD corrections up to 5 cm can be achieved, and predicted extreme tall stature can be limited. Percutaneous epiphysiodesis techniques are minimally invasive, safe and efficient methods with low complication rates. In general, a multidisciplinary approach should be pursued when treating children and adolescents with tall stature.
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http://dx.doi.org/10.1007/s10354-021-00828-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016792PMC
April 2021

Reliability of the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) 2.0 knee score for different cartilage repair techniques-a retrospective observational study.

Eur Radiol 2021 Aug 29;31(8):5734-5745. Epub 2021 Jan 29.

High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.

Objectives: To evaluate the reliability of the MOCART 2.0 knee score in the radiological assessment of repair tissue after different cartilage repair procedures.

Methods: A total of 114 patients (34 females) who underwent cartilage repair of a femoral cartilage lesion with at least one postoperative MRI examination were selected, and one random postoperative MRI examination was retrospectively included. Mean age was 32.5 ± 9.6 years at time of surgery. Overall, 66 chondral and 48 osteochondral lesions were included in the study. Forty-eight patients were treated with autologous chondrocyte implantation (ACI), 27 via osteochondral autologous transplantation, five using an osteochondral scaffold, and 34 underwent microfracture (MFX). The original MOCART and MOCART 2.0 knee scores were assessed by two independent readers. After a minimum 4-week interval, both readers performed a second reading of both scores. Inter- and intrarater reliabilities were assessed using intraclass correlation coefficients (ICCs).

Results: The MOCART 2.0 knee score showed higher interrater reliability than the original MOCART score with an ICC of 0.875 versus 0.759, ranging from 0.863 in the MFX group to 0.878 in the ACI group. Intrarater reliability was good with an overall ICC of 0.860 and 0.866, respectively. Overall, interrater reliability was higher for osteochondral lesions than for chondral lesions, with ICCs of 0.906 versus 0.786.

Conclusions: The MOCART 2.0 knee score enables the assessment of cartilage repair tissue after different cartilage repair techniques (ACI, osteochondral repair techniques, MFX), as well as for different lesion types with good intra- and interrater reliability.

Key Points: • The MOCART 2.0 knee score provides improved intra- and interrater reliability when compared to the original MOCART score. • The MOCART 2.0 knee score enables the assessment of cartilage repair tissue after different cartilage repair techniques (ACI, osteochondral repair techniques, MFX) with similarly good intra- and interrater reliability. • The assessment of osteochondral lesions demonstrated better intra- and interrater reliability than the assessment of chondral lesions in this study.
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http://dx.doi.org/10.1007/s00330-021-07688-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270819PMC
August 2021

Development of an electronic navigation system for elimination of examiner-dependent factors in the ultrasound screening for developmental dysplasia of the hip in newborns.

Sci Rep 2020 10 2;10(1):16407. Epub 2020 Oct 2.

Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria.

To develop an electronic navigation system to increase reliability and comparability in the ultrasound screening of developmental dysplasia of the hip (DDH). The impact of the navigation system on transducer positioning and on sonographic measurements according to Graf was analyzed. Twenty hips in newborns were examined sonographically using a new navigation system capable of detecting the transducer and pelvis position in order to calculate the relative tilt in the frontal, axial, and sagittal-plane. In each newborn an ultrasound image was obtained conventionally according to Graf and a second image using the sonographic navigation system. Relative roll and pitch angles and sonographic measurements were analyzed using paired T-tests and Levene-tests. Relative tilt angles in the conventional group ranged from - 8.9° to 14.3° (frontal-plane) and - 23.8° to 14.2° (axial-plane). In the navigation-assisted group ranges from - 3.0° to 3.5° and - 2.8° to 4.5° were observed. Variances were significantly lower in the navigation-assisted group (p < 0.001 and p = 0.004 respectively). The navigation system allowed for a significant reduction of relative tilt angles between the transducer and the newborn pelvis, thus supporting an optimal transducer positioning. This is a promising approach to improve reproducibility and reliability in the ultrasound screening for DDH.
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http://dx.doi.org/10.1038/s41598-020-73536-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532432PMC
October 2020

Total Hip Arthroplasty after Previous Chiari Pelvic Osteotomy-A Retrospective Study of 301 Dysplastic Hips.

J Arthroplasty 2020 12 20;35(12):3638-3643. Epub 2020 Jun 20.

Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.

Background: Controversy exists whether previous pelvic osteotomies have negative effects on total hip arthroplasty (THA). This study evaluates the implant survival and patient-reported outcomes of THA after previous Chiari pelvic osteotomy (CPO).

Methods: Data on 301 THAs after CPO were collected through clinical and radiological follow-up examinations and telephone interviews. The Kaplan-Meier survivorship analysis depicts implant survival.

Results: Of this consecutive series of 1536 CPOs, follow-up was completed in 405 patients with 504 CPOs after a mean time of 36 years (±8; range, 22-54 years). At follow-up, 301 hips (60%) had already undergone THA. The overall survival of THA with revision as an end point after 10, 20, and 25 years was 93%, 76%, and 68%, respectively. The revision rate was 12%. The average period between THA and revision surgery was 9.6 years (±6.1; 4 months-25.4 years). The patient's age at revision was 57.9 years (±10; 33.2-78.5 years). Aseptic loosening was the most common of the known reasons for revision surgery.

Conclusion: This retrospective study supports the hypothesis that prior CPO does not compromise the prerequisites for successful THA at a later stage. Survival rates of the implanted prosthesis are comparable to primary implanted hips, as overall survival was 93% after 10 years.
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http://dx.doi.org/10.1016/j.arth.2020.06.047DOI Listing
December 2020

Recombinant Human BMP6 Applied Within Autologous Blood Coagulum Accelerates Bone Healing: Randomized Controlled Trial in High Tibial Osteotomy Patients.

J Bone Miner Res 2020 10 2;35(10):1893-1903. Epub 2020 Jul 2.

Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.

Bone morphogenetic proteins (BMPs) are potent osteogenic proteins that induce new bone formation in vivo. However, their effect on bone healing in the trabecular bone surfaces remains challenging. We evaluated the safety and efficacy of recombinant human BMP6 (rhBMP6) applied within an autologous blood coagulum (ABC) in a surgically created wedge defect of the proximal tibia in patients undergoing high tibial osteotomy (HTO) for varus deformity and medial osteoarthritis of the knee. We enrolled 20 HTO patients in a randomized, placebo-controlled, double-blinded phase I/II clinical trial. RhBMP6/ABC (1.0 mg/10 mL ABC prepared from peripheral blood) or placebo (10 mL ABC containing excipients) was administered into the tibial wedge defects. Patients were followed for 0 to 24 months by clinical examination (safety) and computed tomography (CT) and serial radiographic analyses (efficacy). The results show that there were no detectable anti-rhBMP6 antibodies in the blood of any of the 20 patients at 14 weeks after implantation. During the 24 months of follow-up, there were no serious adverse reactions recorded. The CT scans from defects of patients treated with rhBMP6/ABC showed an accelerated bone healing compared with placebo at 9 weeks (47.8 ± 24.1 versus 22.2 ± 12.3 mg/cm ; p = 0.008) and at 14 weeks (89.7 ± 29.1 versus 53.6 ± 21.9 mg/cm ; p = 0.006) follow-up. Radiographic analyses at weeks 6 and 24 and months 12 and 24 suggested the advanced bone formation and remodeling in rhBMP6/ABC-treated patients. In conclusion, we show that rhBMP6/ABC at a dose of 100 μg/mL accelerated bone healing in patients undergoing HTO without serious adverse events and with a good tolerability compared with placebo alone. Overall, for the first time, a BMP-based osteogenic implant was examined against a placebo for bone healing efficacy in the trabecular bone surface, using an objective bone mineral density measurement system. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
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http://dx.doi.org/10.1002/jbmr.4107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689741PMC
October 2020

2019 EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older.

Ann Rheum Dis 2021 01 24;80(1):57-64. Epub 2020 Apr 24.

Section for Outcomes Research, Centre for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria

Objective: To establish European League Against Rheumatism (EULAR) points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older.

Methods: Points to consider were developed in accordance with EULAR standard operating procedures for EULAR-endorsed recommendations, led by an international multidisciplinary task force, including patient research partners and different health professionals from 10 European countries. Level of evidence and strength of recommendation were determined for each point to consider, and the mean level of agreement among the task force members was calculated.

Results: Two overarching principles and seven points to consider were formulated based on scientific evidence and the expert opinion of the task force. The two overarching principles focus on shared decisions between patients and non-physician health professionals and involvement of different non-physician health professionals in prevention and management of fragility fractures. Four points to consider relate to prevention: identification of patients at risk of fracture, fall risk evaluation, multicomponent interventions to prevent primary fracture and discouragement of smoking and overuse of alcohol. The remaining three focus on management of fragility fractures: exercise and nutritional interventions, the organisation and coordination of multidisciplinary services for post-fracture models of care and adherence to anti-osteoporosis medicines. The mean level of agreement among the task force for the overarching principles and the points to consider ranged between 8.4 and 9.6.

Conclusion: These first EULAR points to consider for non-physician health professionals to prevent and manage fragility fractures in adults 50 years or older serve to guide healthcare practice and education.
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http://dx.doi.org/10.1136/annrheumdis-2020-216931DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7788058PMC
January 2021

Biological Regeneration of Articular Cartilage in an Early Stage of Compartmentalized Osteoarthritis: 12-Month Results.

Am J Sports Med 2020 05 9;48(6):1338-1346. Epub 2020 Mar 9.

Division of Orthopedics, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.

Background: Biological regeneration in an early stage of osteoarthritis (OA) is an important clinical challenge. An early-stage compartmentalized OA model was used to evaluate different biological regeneration techniques.

Hypothesis: Biological regeneration in an early stage of compartmentalized OA is possible.

Study Design: Controlled laboratory study.

Methods: A 7-mm cartilage defect was surgically created in 24 sheep. After 3 months, by which time early OA had set in, the sheep were randomized into 4 different treatment groups and operated for the second time. One group (CONTROL) served as a long-term follow-up group for the further development of OA. The other 3 groups (regeneration groups) each underwent a different regeneration procedure after abrasion of the subchondral bone (defect size: 20 × 10 mm with a depth of 2.5 mm): spongialization alone (SPONGIO), spongialization followed by implantation of an unseeded hyaluronan matrix (MATRIX), or spongialization followed by implantation of a hyaluronan matrix seeded with autologous chondrocytes (MACT). Then, 12 months after the second operative procedure, the animals were euthanized and the defects subjected to macroscopic and histological grading. Historical 4-month data were compared with the 12-month results.

Results: After 12 months of follow-up, advanced cartilage degeneration was observed in the CONTROL group. On the other hand, all regeneration groups improved significantly compared with the 4-month results using the Mankin score. Cartilage quality in the MACT group was significantly better than in the MATRIX group, as determined by the Mankin and the O'Driscoll scores.

Conclusion: There are no existing clinical options for preventing early OA from progressing to a severe disease. This study provides important information on how a surgical intervention can forestall the development of OA.

Clinical Relevance: OA of the knee is very common. Total joint replacement is not an acceptable option for active patients. Biological regeneration in OA is successful for focal cartilage defects; however, a long-term follow-up for biological regeneration in OA is missing. It is essential to have long-term results for a regenerative procedure involving cartilage, which is a tissue with a very slow turnover.
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http://dx.doi.org/10.1177/0363546520906411DOI Listing
May 2020

Prevention and management of osteoporotic fractures by non-physician health professionals: a systematic literature review to inform EULAR points to consider.

RMD Open 2020 01;6(1)

Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria

Objective: To perform a systematic literature review (SLR) about the effect of non-pharmacological interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures.

Methods: Eight clinical questions based on two criteria guided the SLR: (1) adults≥50 years at high risk of osteoporotic fracture and (2) interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures. Interventions focused on diagnostic procedures to identify risk of falling, therapeutic approaches and implementation strategies. Outcomes included fractures, falls, risk of falling and change in bone mineral density. Systematic reviews and randomised controlled trials were preferentially selected. Data were synthesised using a qualitative descriptive approach.

Results: Of 15 917 records, 43 articles were included. Studies were clinically and methodologically diverse. We identified sufficient evidence that structured exercise, incorporating progressive resistance training delivered to people who had undergone hip fracture surgery, and multicomponent exercise, delivered to people at risk of primary fracture, reduced risk of falling. The effectiveness of multidisciplinary fracture liaison services in reducing refracture rate was confirmed. There was insufficient evidence found to support the effectiveness of nutrients and falls prevention programmes in this patient population.

Conclusion: Despite study heterogeneity, our SLR showed beneficial effects of some interventions delivered by non-physician health professionals and the positive impact of multidisciplinary team working and patient educational approaches to prevent and manage osteoporotic fractures. These results informed a EULAR taskforce that developed points to consider for non-physician health professionals to prevent and manage osteoporotic fractures.
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http://dx.doi.org/10.1136/rmdopen-2019-001143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7059534PMC
January 2020

Analysis and quantification of bone healing after open wedge high tibial osteotomy.

Wien Klin Wochenschr 2019 Dec 9;131(23-24):587-598. Epub 2019 Sep 9.

Department for Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.

Background: The aim of this study was to analyze radiographic imaging techniques and to quantify bone ossification in the osteotomy gap after high tibial osteotomy.

Material And Methods: Study phase 1: high tibial osteotomy was performed on six lower extremities of human body donors and experimental X‑rays and computed tomography (CT) scans were applied. Different techniques were evaluated by three specialists for best representation of the osteotomy gap. Study phase 2: optimized radiological techniques were used for follow-up on 12 patients. The radiographs were examined by 3 specialists measuring 10 different parameters. The CT scans were analyzed with semiautomatic computer software for quantification of bone ossification.

Results: The osteotomy gap was best represented in 30° of flexion in the knee and 20° internal rotation of the leg. There were significant changes of the medial width over time (p < 0.019) as well as of the length of fused osteotomy, the Schröter score, sclerosis, trabecular structure and zone area measurements. Sclerosis, medial width of the osteotomy and area measurements were detected as reproducible parameters. Bone mineral density was calculated using CT scans, showing a significantly higher value 12 weeks postoperatively (112.5 mg/cm) than at baseline (54.6 mg/cm). The ossification of the gap was visualized by color coding.

Conclusion: Sclerosis and medial width of the osteotomy gap as well as area measurements were determined as reproducible parameters for evaluation of bone healing. Quantification of bone ossification can be calculated with CT scans using a semiautomatic computer program and should be used for research in bone healing.
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http://dx.doi.org/10.1007/s00508-019-01541-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6908562PMC
December 2019

A 3-Dimensional Model of Zonally Organized Extracellular Matrix.

Cartilage 2021 12 2;13(2_suppl):336S-345S. Epub 2019 Aug 2.

Karl Chiari Lab for Orthopaedic Biology, Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.

Objective: Functional cartilage repair requires the new formation of organized hyaline cartilaginous matrix to avoid the generation of fibrous repair tissue. The potential of mesenchymal progenitors was used to assemble a 3-dimensional structure in vitro, reflecting the zonation of collagen matrix in hyaline articular cartilage.

Design: The 3-dimensional architecture of collagen alignment in pellet cultures of chondroprogenitors (CPs) was assessed with Picrosirius red staining analyzed under polarized light. In parallel assays, the trilineage capability was confirmed by calcium deposition during osteogenesis by alizarin S staining and alkaline phosphatase staining. Using reverse transcription-quantitative polymerase chain reaction (RT-qPCR), mRNA levels of ALP, RUNX2, and BGLAP were assessed after 21 days of osteoinduction. Lipid droplets were stained with oil red O and adipogenic differentiation was confirmed by RT-qPCR analysis of PPARG and LPL gene expression.

Results: Under conditions promoting the chondrogenic signature in self-assembling constructs, CPs formed an aligned extracellular matrix, positive for glycosaminoglycans and collagen type II, showing developing zonation of birefringent collagen fibers along the cross section of pellets, which reflect the distribution of collagen fibers in hyaline cartilage. Induced osteogenic and adipogenic differentiation confirmed the trilineage potential of CPs.

Conclusion: This model promotes the differentiation and self-organization of postnatal chondroprogenitors, resulting in the formation of zonally organized engineered hyaline cartilage comparable to the 3 zones of native cartilage.
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http://dx.doi.org/10.1177/1947603519865320DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8804753PMC
December 2021

Distal femoral varus osteotomy: results of the lateral open-wedge technique without bone grafting.

Int Orthop 2019 10 13;43(10):2315-2322. Epub 2018 Nov 13.

Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.

Background: The lateral opening wedge distal femoral osteotomy (LOWDFO) to reconstruct knee alignment in patients with genu valgum originating in the distal femur has gained importance within the last years.

Purpose: To analyze clinical and radiographic outcome of patients treated with LOWDFO with respect to bone healing without grafting and patient age.

Material And Methods: Twenty-two consecutive patients with genu valgum corrected with 23 LOWDFOs using a Tomofix-locking plate were retrospectively analyzed (mean age 23.7 years). Clinical evaluation was based on pre- and post-operative KOOS scores. A pre- and post-operative radiographic assessment, including MAD, mLDFA, LLD, bone healing, and patella parameters, was performed. Differences between subgroups (age, bone grafting) were analyzed.

Results: The restoration of MAD and mLDFA resulted in significantly improved post-operative KOOS scores in younger and older patients (p = 0.001). Bone healing without bone grafting was reliable in all patients. The leg length was significantly increased post-operatively (p = 0.001). The Blackburne-Peel ratio was significantly reduced to more normal values post-operatively (p < 0.001).

Conclusion: LOWDFO without bone grafting is a reliable procedure representing a promising treatment option particularly in young patients with genu valgum. Besides correction of the MAD, a significant leg length increase and additional patella stability can be expected.
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http://dx.doi.org/10.1007/s00264-018-4216-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6787112PMC
October 2019

Vessel architecture in human knee cartilage in children: an in vivo susceptibility-weighted imaging study at 7 T.

Eur Radiol 2018 Aug 26;28(8):3384-3392. Epub 2018 Feb 26.

High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria.

Objectives: To evaluate the clinical feasibility of ultrahigh field 7-T SWI to visualize vessels and assess their density in the immature epiphyseal cartilage of human knee joints.

Methods: 7-T SWI of 12 knees (six healthy volunteers, six patients with osteochondral abnormalities; mean age 10.7 years; 3 female, 9 male) were analysed by two readers, classifying intracartilaginous vessel densities (IVD) in three grades (no vessels, low IVD and high IVD) in defined femoral, tibial and patellar zones. Differences between patients and volunteers, IVDs in different anatomic locations, differences between cartilage overlying osteochondral abnormalities and corresponding normal zones, and differences in age groups were analysed.

Results: Interrater reliability showed moderate agreement between the two readers (κ = 0.58, p < 0.001). The comparison of IVDs between patients and volunteers revealed no significant difference (p = 0.706). The difference between zones in the cartilage overlying osteochondral abnormalities to corresponding normal zones showed no significant difference (p = 0.564). IVDs were related to anatomic location, with decreased IVDs in loading areas (p = 0.003). IVD was age dependent, with more vessels present in the younger participants (p = 0.001).

Conclusions: The use of SWI in conjunction with ultrahigh field MRI makes the in vivo visualization of vessels in the growing cartilage of humans feasible, providing insights into the role of the vessel network in acquired disturbances.

Key Points: • SWI facilitates in vivo visualization of vessels in the growing human cartilage. • Interrater reliability of the intracartilaginous vessel grading was moderate. • Intracartilaginous vessel densities are dependent on anatomical location and age.
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http://dx.doi.org/10.1007/s00330-017-5290-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6028839PMC
August 2018

Detecting cam-type deformities on plain radiographs: what is the optimal lateral view?

Arch Orthop Trauma Surg 2017 Dec 16;137(12):1699-1705. Epub 2017 Sep 16.

Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.

Purpose: Radial magnetic resonance imaging (MRI) is the most accurate diagnostic tool in assessing cam-type femoroacetabular impingement. Plain radiographs, however, are useful for the initial diagnosis in the daily practice and there is still debate regarding the optimal lateral view. The purpose of this study was to investigate the reliability of detecting cam deformities using the frog-leg view or the 45° Dunn view by comparison with radial MRI.

Material: 66 consecutive hips with plain radiographs (36 with AP and frog-leg views, 30 with AP and 45° Dunn views) and radial MRI were assessed. Alpha angle measurements were obtained both for radiographs and for radial MRI reformats by two investigators. Statistics included frequency analysis, bivariate linear correlation analyses, and cross-table analyses testing the sensitivity and specificity of the radiographic projections for detecting an alpha angle larger than 55°.

Results: The intra-class correlation revealed excellent agreement between the two raters [ICC = 0.959, CI (0.943; 0.972)]. 50% (33/66) had the maximum alpha angle in the superior-anterior aspect of the femoral head-neck junction. Cam deformity was found in 40/66 cases (61%) in radial MRI. Pearson correlation demonstrated that the 45° Dunn view was most accurate for the superior-anterior aspect (0.730, p < 0.05). The frog-leg view was best suited for the anterior aspect (0.703, p < 0.05). The sensitivity for detecting cam deformities in the 45° Dunn view was 84 vs 62% in the frog-leg view.

Conclusion: The frog-leg lateral radiograph does not provide reliable measurements of the alpha angle. This study highlights the importance of the 45° Dunn view for early detection of femoroacetabular cam-type impingement.
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http://dx.doi.org/10.1007/s00402-017-2793-9DOI Listing
December 2017

[Deformity Correction in Skeletally Immature Patients - Therapy].

Z Orthop Unfall 2017 04 25;155(2):232-248. Epub 2017 Apr 25.

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http://dx.doi.org/10.1055/s-0042-121623DOI Listing
April 2017

Measurement considerations on examiner-dependent factors in the ultrasound assessment of developmental dysplasia of the hip.

Int Orthop 2017 06 12;41(6):1245-1250. Epub 2017 Apr 12.

Department of Orthopaedics and Orthopaedic Surgery, Medical University of Vienna, Waehringer Gürtel 18-20, 1090, Vienna, Austria.

Purpose: The standardized sonographic hip screening according to Graf has increased reliability and comparability of measurements in the screening of developmental dysplasia of the hip (DDH). However, examiner dependent factors have been discussed to influence sonographic measurements. The objectives of this study were to examine the tolerance of the transducer positioning and to analyse the impact of transducer inclinations on Graf's hip grading system.

Materials And Methods: Twenty-four hips in consecutive newborns were screened sonographically in combination with an optoelectronic motion capture system to trace transducer positions in space. Subsequently five defined inclinations of the transducer relative to Graf's neutral transducer position were analysed, giving a total of 144 sonographic images.

Results: We found a permissible transducer inclination in the axial plane of 8.8° to anterior and 8.1° to posterior. In the frontal plane we found a permissible inclination of 15.4° to caudal and 7.2° to cranial. The impact on the α-angle was significant for posterior-cranial (p < 0.001), cranial (p = 0.009), and caudal (p < 0.001) inclined transducer positions. The effect on the results according to Graf's grading system was significant for the caudal inclination of the transducer position (p < 0.001).

Conclusion: Our findings show that the standardized plane defined by Graf's criteria allows notable inclinations of the transducer positions. Transducer inclinations show an impact on measurement results, which are clinically relevant. Those effects cannot be ruled out using Graf's ultrasound criteria alone. The examiner should pay attention to avoid transducer inclinations in the frontal plane and a combination of posterior and cranial inclination.
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http://dx.doi.org/10.1007/s00264-017-3455-9DOI Listing
June 2017

[Deformity in Skeletally Immature Patients - Diagnostic Procedures].

Z Orthop Unfall 2017 02 1;155(1):105-119. Epub 2017 Mar 1.

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http://dx.doi.org/10.1055/s-0042-110840DOI Listing
February 2017

The impact of different types of talus deformation after treatment of clubfeet.

Int Orthop 2017 Jan 11;41(1):93-99. Epub 2016 Oct 11.

Department of Orthopaedics, Medical University of Vienna, Waehringer Gürtel 18-20, 1090, Vienna, Austria.

Purpose: Deformation of the talus in idiopathic congenital clubfeet is a known problem after treatment. However evidence on types of talus deformation and clinical relevance is rare. The aims of this study were first to define different types of talus deformation, and second, to evaluate the impact of these types on long-term results.

Methods: At a minimum follow-up of ten years 40 idiopathic clubfeet treated by a modified dorsomedial release were analyzed. Based on morphological appearance and the widened range of radius to length ratios (R/L-ratio) in treated clubfeet deformed tali were divided into two groups: tali with decreased R/L-ratios were classified as small-dome talus deformation (SD), tali with increased R/L-ratios were classified as flat-top talus deformation (FT). The impact on degree of arthrosis in the ankle joint, clinical outcome, and ankle range of motion was analyzed.

Results: Small-dome talus deformation (SD) was found in nine feet. This group showed decreased R/L-ratios and increased talus opening angles, which were linked to an increased range of motion of the ankle joint (p = 0.033). The impact on onset of arthrosis was not significant for this group (p = 0.056). The group of flat top talus deformation (nine feet) showed increased R/L-ratios and decreased talus opening angles, decreased range of motion (p = 0.019), and a significant impact on onset of arthrosis (p = 0.010).

Conclusion: Our study defines a new subgroup of talus deformation: the small dome talus deformation tends to show a better ankle joint range of motion and a lower risk of arthrosis compared to the classical flat dome talus deformation.
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http://dx.doi.org/10.1007/s00264-016-3301-5DOI Listing
January 2017

Rare Variants in MME, Encoding Metalloprotease Neprilysin, Are Linked to Late-Onset Autosomal-Dominant Axonal Polyneuropathies.

Am J Hum Genet 2016 09;99(3):607-623

Department of Human Genetics and Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL 33136, USA.

Axonal polyneuropathies are a frequent cause of progressive disability in the elderly. Common etiologies comprise diabetes mellitus, paraproteinaemia, and inflammatory disorders, but often the underlying causes remain elusive. Late-onset axonal Charcot-Marie-Tooth neuropathy (CMT2) is an autosomal-dominantly inherited condition that manifests in the second half of life and is genetically largely unexplained. We assumed age-dependent penetrance of mutations in a so far unknown gene causing late-onset CMT2. We screened 51 index case subjects with late-onset CMT2 for mutations by whole-exome (WES) and Sanger sequencing and subsequently queried WES repositories for further case subjects carrying mutations in the identified candidate gene. We studied nerve pathology and tissue levels and function of the abnormal protein in order to explore consequences of the mutations. Altogether, we observed heterozygous rare loss-of-function and missense mutations in MME encoding the metalloprotease neprilysin in 19 index case subjects diagnosed with axonal polyneuropathies or neurodegenerative conditions involving the peripheral nervous system. MME mutations segregated in an autosomal-dominant fashion with age-related incomplete penetrance and some affected individuals were isolated case subjects. We also found that MME mutations resulted in strongly decreased tissue availability of neprilysin and impaired enzymatic activity. Although neprilysin is known to degrade β-amyloid, we observed no increased amyloid deposition or increased incidence of dementia in individuals with MME mutations. Detection of MME mutations is expected to increase the diagnostic yield in late-onset polyneuropathies, and it will be tempting to explore whether substances that can elevate neprilysin activity could be a rational option for treatment.
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http://dx.doi.org/10.1016/j.ajhg.2016.07.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011077PMC
September 2016

Galectin-1 Couples Glycobiology to Inflammation in Osteoarthritis through the Activation of an NF-κB-Regulated Gene Network.

J Immunol 2016 Feb 20;196(4):1910-21. Epub 2016 Jan 20.

Institute of Physiological Chemistry, Faculty of Veterinary Medicine, Ludwig-Maximilians-University Munich, 80539 Munich, Germany;

Osteoarthritis is a degenerative joint disease that ranks among the leading causes of adult disability. Mechanisms underlying osteoarthritis pathogenesis are not yet fully elucidated, putting limits to current disease management and treatment. Based on the phenomenological evidence for dysregulation within the glycome of chondrocytes and the network of a family of adhesion/growth-regulatory lectins, that is, galectins, we tested the hypothesis that Galectin-1 is relevant for causing degeneration. Immunohistochemical analysis substantiated that Galectin-1 upregulation is associated with osteoarthritic cartilage and subchondral bone histopathology and severity of degeneration (p < 0.0001, n = 29 patients). In vitro, the lectin was secreted and it bound to osteoarthritic chondrocytes inhibitable by cognate sugar. Glycan-dependent Galectin-1 binding induced a set of disease markers, including matrix metalloproteinases and activated NF-κB, hereby switching on an inflammatory gene signature (p < 10(-16)). Inhibition of distinct components of the NF-κB pathway using dedicated inhibitors led to dose-dependent impairment of Galectin-1-mediated transcriptional activation. Enhanced secretion of effectors of degeneration such as three matrix metalloproteinases underscores the data's pathophysiological relevance. This study thus identifies Galectin-1 as a master regulator of clinically relevant inflammatory-response genes, working via NF-κB. Because inflammation is critical to cartilage degeneration in osteoarthritis, this report reveals an intimate relation of glycobiology to osteoarthritic cartilage degeneration.
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http://dx.doi.org/10.4049/jimmunol.1501165DOI Listing
February 2016

Low incidence of early developmental dysplasia of the hip in universal ultrasonographic screening of newborns: analysis and evaluation of risk factors.

Int Orthop 2016 Jan 5;40(1):123-7. Epub 2015 May 5.

Department of Orthopaedics and Orthopaedic Surgery, Medical University of Vienna, Waehringer Gürtel 18-20, 1090, Vienna, Austria.

Purpose: Different timing and approaches to screening for developmental dysplasia of the hip (DDH) are used in the orthopaedic community. Thus ultrasonographic screening programs and reports based on clinical examinations produced differing incidence rates of DDH. Furthermore different risk factors and a change of incidence of DDH in the last decades were discussed. The purpose of this study was the evaluation of incidence and risk factors of the very early DDH in a modern cohort based on a universal ultrasound screening program.

Methods: We analysed the results of the screening program performed at our institution: 5,356 consecutive hips of newborns were screened ultrasonographically and clinically according to the system published by R. Graf within the first two postnatal weeks [1]. A set of risk factors was analysed by univariate and multiple linear regression models.

Results: Sonographic signs of developmental dysplasia of the hip were found in 0.24 % of the newborns. A significant negative influence of the risk factors birth weight, family history of DDH and female gender on the α-angle was found. Early or pre-term delivery showed a protective potential for DDH.

Conclusions: Our data show a very low incidence of DDH in the first two postnatal weeks. Despite the significance of the risk factors analysed, it has to be considered that these factors only showed low impact on the risk of early DDH. In conclusion we favour universal ultrasound screening for DDH at the age of six to eight weeks.
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http://dx.doi.org/10.1007/s00264-015-2799-2DOI Listing
January 2016

Treatment of Full-Thickness Chondral Defects With Hyalograft C in the Knee: Long-term Results.

Am J Sports Med 2014 Jun 24;42(6):1426-32. Epub 2014 Mar 24.

Department of Orthopaedics, Medical University of Vienna, Vienna, Austria Orthopaedic Rehabilitation Center SKA Zicksee, St Andrä am Zicksee, Austria.

Background: Matrix-associated autologous chondrocyte transplantation (MACT) has become an established articular cartilage repair technique. It provides good short-term and midterm results; however, long-term results are lacking.

Purpose: To prospectively assess the clinical outcome after MACT in the knee to report long-term results.

Study Design: Case series; Level of evidence, 4.

Methods: Fifty-three subjects (females/males, 22/31; mean age, 32 ± 12 years) were treated between 2000 and 2006 with a hyaluronan-based MACT product and were followed prospectively. The mean body mass index (BMI) was 24.5 ± 3.8 kg/m(2) and the mean defect size was 4.4 ± 1.9 cm(2). Fifty patients had single defects and 3 had multiple defects (41 medial femoral condyle, 6 lateral femoral condyle, 2 patella, 1 tibia). Two patients had 2 defects (medial femoral condyle [MFC]/lateral femoral condyle and tibial/MFC), and in 1 case, multiple defects on the MFC were treated. The patients were stratified into 23 "simple," 22 "complex," and 8 "salvage" cases. Instability or malalignment was treated before or at the time of graft implantation. For 6 patients with small defects (<2 cm(2)), microfracturing was used as first-line treatment before MACT. Clinical assessment was performed once a year with the subjective and objective International Knee Documentation Committee (IKDC) scores, Lysholm score, and a modified Cincinnati Knee Rating System.

Results: The mean follow-up time was 9.07 ± 2.9 years (range, 5-12 years). Treatment failure occurred in 12 of 53 cases (22.6%) an average of 2.99 ± 1.40 years after surgery. There was 1 failure (4.3%) among the simple cases, 4 failures (18.2%) in complex cases, and 7 failures (87.5%) in salvage cases. Statistically significant increases were observed in all scores at all time points compared with presurgery levels (P < .05). The subjective IKDC score improved from median 40.4 preoperatively to 74.7 at 10-year follow-up (n = 13 patients; P < .05).

Conclusion: MACT is an excellent surgical therapy for full-thickness cartilage defects of the knee, with good long-term results for simple defects. However, it should not be used in salvage cases.
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http://dx.doi.org/10.1177/0363546514526695DOI Listing
June 2014

Cementless total hip arthroplasty with the rectangular titanium Zweymüller stem: a concise follow-up, at a minimum of twenty years, of previous reports.

J Bone Joint Surg Am 2012 Sep;94(18):1681-4

Department of Orthopaedics, Medical University of Vienna, Waehringer Gürtel 18-20, 1090 Vienna, Austria.

In 2002 and 2006, we reported the long-term results of 208 total hip replacements performed with the Zweymüller stem and a threaded cup in 200 patients. The present study gives an update on this patient cohort. At a minimum of twenty years postoperatively, seventy-three patients (seventy-five hips) were available for follow-up; twelve patients were lost to follow-up. The key findings of our previous reports were the absence of aseptic femoral stem loosening and a poor rate of survival of the threaded cup. Since then, two revisions have been performed because of aseptic stem loosening. We observed osteolytic lesions around the proximal part of the femoral component on twenty-four (47%) of fifty-one radiographs, but no stem was deemed at risk for loosening. The probability of survival of the stem at twenty years was 0.96 (95% confidence interval, 0.91 to 0.99), and the probability of survival of the cup at twenty years was 0.67 (95% confidence interval, 0.57 to 0.75). The Zweymüller femoral stem, a tapered, rectangular implant, continues to give excellent long-term results.
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http://dx.doi.org/10.2106/JBJS.K.01574DOI Listing
September 2012
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