Publications by authors named "R M Hoogendoorn"

22 Publications

Optimization of Best Practice Wound Care in the Netherlands.

Int J Low Extrem Wounds 2020 Oct 21:1534734620965815. Epub 2020 Oct 21.

Alrijne Ziekenhuis, Leiderdorp, The Netherlands.

Estimates regarding the prevalence of chronic wounds in the Netherlands vary from 350 000 to 500 000. The cross-sectional multicenter study presented here provides evidence for the incidence and prevalence of wounds and chronic wounds. The primary aim of the present study was to provide evidence for incidence and prevalence of (chronic) wounds outside the hospital. The secondary aim was to optimize the organization for chronic wounds care within our region. From January 2017 until January 2018, information was prospectively collected of patients with new onset of wounds in 2 general practitioner practices to which 19 100 patients are enrolled. For the patients with new onset of wounds the "fast track protocol" was used and outcomes including etiology and wound healing were measured. This protocol included a structured treatment protocol and predetermined triage moments. The Alrijne Wound Centre database 2014 was used as a control group (469 records). The incidence of new onset of wounds was 364/19 100 (1.9%). The prevalence of wounds was 405/19 100 (2.1%). The prevalence of wounds, that is, wounds that did not show a sufficient healing rate after 4 to 6 weeks, was 78/19 100 (0.4%). Time to referral to a wound physician (the triage moment) was 5 weeks versus 19 weeks in 2014 ( < .001). Unnecessary referrals to the hospital was reduced by 17.4% ( = .007). In conclusion, the prevalence of the chronic wounds was 4 per 1000 patients. The use of the "fast track" protocol optimizes wound care, wounds heal faster, and unnecessary referrals decrease significantly.
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October 2020

Treating infections with ionizing radiation: a historical perspective and emerging techniques.

Antimicrob Resist Infect Control 2020 07 31;9(1):121. Epub 2020 Jul 31.

Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands.

Background: Widespread use and misuse of antibiotics have led to a dramatic increase in the emergence of antibiotic resistant bacteria, while the discovery and development of new antibiotics is declining. This has made certain implant-associated infections such as periprosthetic joint infections, where a biofilm is formed, very difficult to treat. Alternative treatment modalities are needed to treat these types of infections in the future. One candidate that has been used extensively in the past, is the use of ionizing radiation. This review aims to provide a historical overview and future perspective of radiation therapy in infectious diseases with a focus on orthopedic infections.

Methods: A systematic search strategy was designed to select studies that used radiation as treatment for bacterial or fungal infections. A total of 216 potentially relevant full-text publications were independently reviewed, of which 182 focused on external radiation and 34 on internal radiation. Due to the large number of studies, several topics were chosen. The main advantages, disadvantages, limitations, and implications of radiation treatment for infections were discussed.

Results: In the pre-antibiotic era, high mortality rates were seen in different infections such as pneumonia, gas gangrene and otitis media. In some cases, external radiation therapy decreased the mortality significantly but long-term follow-up of the patients was often not performed so long term radiation effects, as well as potential increased risk of malignancies could not be investigated. Internal radiation using alpha and beta emitting radionuclides show great promise in treating fungal and bacterial infections when combined with selective targeting through antibodies, thus minimizing possible collateral damage to healthy tissue.

Conclusion: The novel prospects of radiation treatment strategies against planktonic and biofilm-related microbial infections seem feasible and are worth investigating further. However, potential risks involving radiation treatment must be considered in each individual patient.
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July 2020

Poor Radiological and Good Functional Long-term Outcome of Surgically Treated Scheuermann Patients.

Spine (Phila Pa 1976) 2016 Jul;41(14):E869-E878

Department of orthopaedic surgery, Sint Maartenskliniek, Ubbergen, the Netherlands.

Study Design: Cohort study.

Objective: To analyze long-term clinical and radiological outcomes of surgically treated Scheuermann patients.

Summary Of Background Data: Long-term clinical and radiological outcomes of surgery for Scheuermann kyphosis are unknown. A single-center cohort of 33 consecutive, surgically treated (between 1991 and 1998) Scheuermann patients was studied.

Methods: Clinical and radiological data of 29 surgically treated Scheuermann patients were collected (posterior approach n = 13; combined anterior-posterior procedure n = 16), after a mean follow-up of 18 years. Oswestry Disability Index (ODI) scores were measured preoperatively (PRE) and twice postoperatively: 2 to 8 years postoperative (FU 1) and 14 to 21 years postoperative (FU 2). Visual Analog Score pain, Short Form-36 (SF-36), and EQ-5d scores were recorded at FU 2 only. Radiographs were analyzed for correction, distal and proximal junctional kyphosis, and implant failures.

Results: Mean preoperative kyphosis of the corrected levels was 76° (range 60°-105°) and decreased to a Cobb of 58°(range 30°-105°) at FU 2. Median Visual Analog Score was 2.5 points (range 0-8) and median ODI score was 12 (range 0-62) at FU 2. The ODI score at FU 1 was significantly better as compared to PRE (P < 0.001) and FU 2 (P < 0.001). Also, anterior-posterior treated group had a significantly better ODI score as compared to the posterior-only group (P = 0.023). EQ-5d scores on mobility, usual activities, and pain/discomfort were worse compared to an age-matched population control group; however, SF-36 outcome scores were comparable.Proximal junctional kyphosis was present in 53% of patients, distal junctional kyphosis did not occur, and implant failure/removal had occurred in 69% of patients. Radiological complications do not relate with the ODI, EQ-5d, and SF-36 and 72% of the patients were satisfied.

Conclusion: Radiological results of this cohort were disappointing but did not relate to clinical outcome scores. Even lumbar pain could not prevent a high patient satisfaction and quality of life. Patients treated with a combined anterior-posterior approach tended to perform better.

Level Of Evidence: 3.
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July 2016

Mechanics and biology in intervertebral disc degeneration: a vicious circle.

Osteoarthritis Cartilage 2015 Jul 27;23(7):1057-70. Epub 2015 Mar 27.

Department of Orthopedic Surgery, VU University Medical Center, Amsterdam, The Netherlands; MOVE Research Institute Amsterdam, Amsterdam, The Netherlands. Electronic address:

Intervertebral disc degeneration is a major cause of low back pain. Despite its long history and large socio-economical impact in western societies, the initiation and progress of disc degeneration is not well understood and a generic disease model is lacking. In literature, mechanics and biology have both been implicated as the predominant inductive cause; here we argue that they are interconnected and amplify each other. This view is supported by the growing awareness that cellular physiology is strongly affected by mechanical loading. We propose a vicious circle of mechanical overloading, catabolic cell response, and degeneration of the water-binding extracellular matrix. Rather than simplifying the disease, the model illustrates the complexity of disc degeneration, because all factors are interrelated. It may however solve some of the controversy in the field, because the vicious circle can be entered at any point, eventually leading to the same pathology. The proposed disease model explains the comparable efficacy of very different animal models of disc degeneration, but also helps to consider the consequences of therapeutic interventions, either at the cellular, material or mechanical level.
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July 2015

Adverse effects of stromal vascular fraction during regenerative treatment of the intervertebral disc: observations in a goat model.

Eur Spine J 2015 Sep 15;24(9):1992-2000. Epub 2015 Feb 15.

Department of Orthopaedic Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands,

Stromal vascular fraction (SVF), an adipose tissue-derived heterogeneous cell mixture containing, among others, multipotent adipose stromal cells (ASCs) and erythrocytes, has proved beneficial for a wide range of applications in regenerative medicine. We sought to establish intervertebral disc (IVD) regeneration by injecting SVF intradiscally during a one-step surgical procedure in an enzymatically (Chondroitinase ABC; cABC) induced goat model of disc degeneration. Unexpectedly, we observed a severe inflammatory response that has not been described before, including massive lymphocyte infiltration, neovascularisation and endplate destruction. A second study investigated two main suspects for these adverse effects: cABC and erythrocytes within SVF. The same destructive response was observed in healthy goat discs injected with SVF, thereby eliminating cABC as a cause. Density gradient removal of erythrocytes and ASCs purified by culturing did not lead to adverse effects. Following these observations, we incorporated an extra washing step in the SVF harvesting protocol. In a third study, we applied this protocol in a one-step procedure to a goat herniation model, in which no adverse responses were observed either. However, upon intradiscal injection of an identically processed SVF mixture into our goat IVD degeneration model during a fourth study, the adverse effects surprisingly occurred again. Despite our quest for the responsible agent, we eventually could not identify the mechanism through which the observed destructive responses occurred. Although we cannot exclude that the adverse effects are species-dependent or model-specific, we advertise caution with the clinical application of autologous SVF injections into the IVD until the responsible agent(s) are identified.
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September 2015