Publications by authors named "Sebastian Klingebiel"

16 Publications

  • Page 1 of 1

Prevalence of Musculoskeletal Diseases of the Upper Extremity Among Dental Professionals in Germany.

Risk Manag Healthc Policy 2021 11;14:3755-3766. Epub 2021 Sep 11.

Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany.

Objective: Although many findings on occupational musculoskeletal complaints are available from American and European dentists, the corresponding data from Germany are still scarce. Therefore, the aim of this study was to provide additional information on the prevalence of and risk factors for musculoskeletal disorders of the upper extremity, particularly the shoulder in this specific population.

Methods: A written survey was carried out among 600 dentists in the state of North Rhine-Westphalia, Germany. Questionnaire items included physical and psychosocial workload, general health, and the occurrence of musculoskeletal symptoms during the previous 12 months that led to sick leave and medical care according to a modified version of the Nordic Musculoskeletal Questionnaire (NMQ). Regression analysis was used to evaluate relevant risk factors for severe musculoskeletal disorders.

Results: A total of 229 dentists were participated in the study (response rate 38%). Overall, 92.6% of the participants had already suffered from musculoskeletal symptoms in at least one body region. Symptoms were mostly reported in the neck (65.1%) and in the shoulder (58.1%). Limitations in daily activities were experienced by 15.9% due to neck pain and by 15.4% due to shoulder pain. Medical care was sought by 23.7% because of neck pain and by 21.1% due to shoulder pain. Risk factors for symptoms in the upper extremity regions were gender (female), increased physical load, and numerous comorbidities.

Conclusion: There is a high prevalence of musculoskeletal disorders among dentists. Suitable interventions are therefore needed to prevent musculoskeletal diseases and pain among dental professionals, with particular attention to female dentists.
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http://dx.doi.org/10.2147/RMHP.S316795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8443801PMC
September 2021

The Bateman-Type Soft Tissue Reconstruction around Proximal or Total Humeral Megaprostheses in Patients with Primary Malignant Bone Tumors-Functional Outcome and Endoprosthetic Complications.

Cancers (Basel) 2021 Aug 5;13(16). Epub 2021 Aug 5.

Department of Orthopaedics and Tumor Orthopaedics, Albert-Schweitzer Campus 1, University Hospital of Münster, 48149 Münster, Germany.

We aimed to evaluate the functional outcome and endoprosthetic complications following the Bateman-type soft tissue reconstruction around proximal or total humeral replacements in patients undergoing resection of a primary malignant bone tumor. Between September 2001 and December 2018, a total of 102 patients underwent resection of a primary malignant bone tumor and subsequent reconstruction with a modular humeral megaprosthesis in our department. Fifteen (15%) of these patients underwent a Bateman-type soft tissue reconstruction and were included in this retrospective study. The median Musculoskeletal Tumor Society (MSTS) score was 21, the median Toronto Extremity Salvage Score (TESS) was 70, and the median American Shoulder and Elbow Surgeons (ASES) score was 72. Fifty-three percent (8/15) of all patients required a revision surgery after a median time of 6 months. There were 2 soft tissue failures, 3 infections and 3 tumor recurrences. The revision-free implant survivorship amounted to 53% (95% confidence interval (CI) 28-81) after 1 year and 47% (95% CI 22-73) at last follow-up. The Bateman-type reconstruction is a feasible option for soft tissue reconstruction but functional outcome is overall limited and the risk for revision surgery within the first postoperative year is high.
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http://dx.doi.org/10.3390/cancers13163971DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8392651PMC
August 2021

Periprosthetic Stress Shielding of the Humerus after Reconstruction with Modular Shoulder Megaprostheses in Patients with Sarcoma.

J Clin Med 2021 Jul 31;10(15). Epub 2021 Jul 31.

Department of Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Münster, Germany.

(1) Background: Modular megaprosthetic reconstruction using a proximal humerus replacement has emerged as a commonly chosen approach after bone tumor resection. However, the long-term risk for revision surgery is relatively high. One factor that might be associated with mechanical failures is periprosthetic osteolysis around the stem, also known as stress shielding. The frequency, potential risk factors, and the effect on implant survival are unknown. (2) Methods: A retrospective single-center study of 65 patients with sarcoma who underwent resection of the proximal humerus and subsequent reconstruction with a modular endoprosthesis. Stress shielding was defined as the development of bone resorption around the prosthesis stem beginning at the bone/prosthesis interface. The extent of stress shielding was measured with a new method quantifying bone resorption in relation to the intramedullary stem length. All patients had a minimum follow-up of 12 months with conventional radiographs available and the median follow-up amounted to 36 months. (3) Results: Stress shielding was observed in 92% of patients (60/65). The median longitudinal extent of stress shielding amounted to 14% at last follow-up. Fifteen percent (10/65) showed bone resorption of greater than 50%. The median time to the first radiographic signs of stress shielding was 6 months (IQR 3-9). Patients who underwent chemotherapy (43/65) showed a greater extent of stress shielding compared to those without chemotherapy. Three percent (2/65) of patients were revised for aseptic loosening, and one patient had a periprosthetic fracture (1/65, 1.5%). All these cases had >20% extent of stress shielding (23-57%). (4) Conclusions: Stress shielding of the proximal humerus after shoulder reconstruction with modular megaprosthesis is common. It occurs within the first year of follow-up and might be self-limiting in many patients; however, about one third of patients shows progression beyond the first year. Still, mechanical complications were rare, but stress shielding might be clinically relevant in individual cases. The extent of stress shielding was increased in patients who underwent perioperative chemotherapy. Stress shielding can be quantified with an easy method using the stem length as a reference.
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http://dx.doi.org/10.3390/jcm10153424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8347309PMC
July 2021

Poor performance of open incisional biopsy for the microbiological diagnosis of periprosthetic knee joint infection.

Sci Rep 2021 05 26;11(1):10989. Epub 2021 May 26.

Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.

The accurate preoperative diagnosis of periprosthetic joint infection (PJI) of total knee arthroplasty (TKA) can be difficult despite the use of a combination of serum and synovial markers. In such inconclusive cases, incisional open biopsy might be considered. This study investigates the usefulness of biopsies in patients with inconclusive diagnostic findings. We retrospectively identified 63 patients who underwent incisional biopsy for chronic PJI in the operation theatre following TKA revision between 2010 and 2018 after inconclusive preoperative diagnostics for PJI. In all cases, 5 independent biopsies were taken. Results from open biopsy for PJI were analyzed for diagnostic accuracy using the intraoperative results from following revision surgery as gold standard. 27 patients (43%) had a positive culture taken during biopsy. 15 cases (24%) met the diagnostic criteria for a chronic PJI. Most common organisms were Coagulase-negative staphylococci (67%) and Cutibacterium acnes (30%). Compared to the findings during revision surgery, biopsies showed a sensitivity of 47% and a specificity of 77% for PJI. Open incisional biopsy following inconclusive serum- and synovial diagnostics for low grade PJI may be considered for identification of microorganisms. Due to its low sensitivity and moderate specificity found in the present cohort, microbiological analysis should be combined with additional diagnostic markers and histological investigation.Level of Evidence. Retrospective cohort study (Level III).
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http://dx.doi.org/10.1038/s41598-021-90475-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8155057PMC
May 2021

The change in plasma D-dimer does not help to guide the timing of reimplantation in two stage exchange for periprosthetic joint infection.

Sci Rep 2021 04 1;11(1):7323. Epub 2021 Apr 1.

Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.

D-dimer has been included in the criteria by the Musculoskeletal Infection Society in 2018 as a novel parameter to diagnose prosthetic joint infection (PJI). However, it is unclear how D-dimer levels change in between stages of a two-stage exchange. We prospectively investigated 30 patients who underwent a two-stage exchange using a spacer for PJI. D-Dimer, CRP and IL-6 were collected before first and second stage surgery and the difference (Δ) in between stages was calculated. The levels of plasma D-Dimer did not change from first to second stage surgery (2770 ng/ml (IQR, 1600-3770 ng/ml) versus 2340 ng/ml (IQR, 1270-4100 ng/ml); p = 0.8) while CRP (4.0 mg/dl (IQR, 1.7-5.5 mg/dl) versus 0.6 mg/dl (IQR, 0.5-0.8 mg/dl); p < 0.001) and IL-6 (21 pg/ml (IQR, 10-29 pg/ml) versus 6 pg/ml (4-9 pg/ml); p < 0.001) decreased. The ΔD-dimer between both stages was 300 ng/ml (range: - 2820 to 4280 ng/ml), the median ΔCRP was - 3.4 mg/dl (IQR, - 1.2 to - 4.8 mg/dl) and ΔIL-6 was - 13 pg/ml (IQR, - 4 to - 20 pg/ml). In 15 of 30 cases (50%) the D-dimer level increased between both stages, whereas the level of CRP (93%; 28/30) and IL-6 (96%; 28/29) decreased in most patients. As the level of serum D-dimers varies greatly, lacks a uniform decrease and does not identify persisting infection, surgeons should be cautious when using it at the timing of reimplantation.
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http://dx.doi.org/10.1038/s41598-021-86890-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016946PMC
April 2021

Revision TKA with a distal femoral replacement is at high risk of reinfection after two-stage exchange for periprosthetic knee joint infection.

Knee Surg Sports Traumatol Arthrosc 2021 Feb 10. Epub 2021 Feb 10.

Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.

Purpose: Megaprosthetic distal femoral reconstruction (DFR) is a limb-salvage procedure to address bone loss following two-stage revision for periprosthetic knee joint infection (PJI). The purpose of this study was to analyze the survival of DFR compared to hinged total knee arthroplasty (TKA). It was hypothesized that DFR was associated with a poorer survival.

Methods: In this retrospective single-center study, 97 subjects who underwent two-stage revision of chronic knee PJI were included. Among these, 41 were DFR. The diagnosis of PJI was established using the Musculoskeletal Infection Society (MSIS) criteria. Implant survival was calculated using Kaplan-Meier method and compared with the log-rank test as well as multivariate Cox regression at a minimum follow-up period of 24 months.

Results: The median follow-up period was 59 (interquartile range (IQR) 45-78) months. Overall, 24% (23/97) of patients required revision surgery for infection. The infection-free survival of rotating hinge revision TKA was 93% (95% Confidence Interval (CI) 86-100%) at five years compared to 50% (95% CI 34-66%) for DFR. In multivariate analysis, the risk factors for reinfection were DFR reconstruction (HR 4.7 (95% CI 1-22), p = 0.048), length of megaprosthesis (HR 1.006 (95% CI 1.001-1.012), p = 0.032) and higher BMI (HR 1.066, 95% CI 1.018-1.116), p = 0.007). 10% (4/41) of patients undergoing DFR underwent amputation to treat recurrent infection.

Conclusion: Megaprosthetic DFR as part of a two-stage exchange for PJI is a salvage treatment that has a high risk for reinfection compared to non-megaprosthetic TKA. Patients must therefore be counseled accordingly.

Level Of Evidence: Retrospective observational study, Level IV.
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http://dx.doi.org/10.1007/s00167-021-06474-2DOI Listing
February 2021

Clinical Outcome of Two-Stage Revision after Periprosthetic Shoulder Infection.

J Clin Med 2021 Jan 9;10(2). Epub 2021 Jan 9.

Department of Orthopaedics and Tumororthopaedics, University Hospital Muenster, 48149 Münster, Germany.

Background: Periprosthetic shoulder infections are devastating complications after shoulder arthroplasty. A potential treatment concept is a two-stage prosthesis exchange. Data are sparse in terms of clinical outcome, including infection-free survival and patient satisfaction after this procedure. In the present study, we investigated recurrence of infection, revision-free survivorship and clinical outcome following two-stage revision due to periprosthetic shoulder infection. Furthermore, reasons for poor outcome were analyzed.

Methods: Sixteen patients undergoing two-stage revision after shoulder joint infection were retrospectively identified. Recurrence of infection was analyzed by Kaplan-Meier survival curve. Clinical outcome was quantified with subjective shoulder value (SSV), "quick" Disabilities of the Arm, Shoulder and Hand (qDASH) and Rowe score. Range of motion (ROM) was measured pre- and postoperatively. Postoperative scores and ROM were compared in a subgroup analysis according to different reimplanted prosthesis types.

Results: The reinfection-free implant survival was 81% after one year and at final follow-up (FU; mean of 33.2 months). The overall revision-free survival amounted to 56% after one year and at final FU. Patients who received reverse shoulder arthroplasty (RSA) as part of reimplantation had less disability and long-term complications. This group demonstrated better subjective stability and function compared to patients revised to megaprostheses or large-head hemiarthroplasties.

Conclusions: Two-stage revision following periprosthetic joint infection of the shoulder allows appropriate infection control in the majority of patients. However, the overall complications and revision rates due to mechanical failure or reinfection are high. Reimplantation of RSA seem superior to alternative prosthesis models in terms of function and patient satisfaction. Therefore, bone-saving surgery and reconstruction of the glenoid may increase the likelihood of reimplantation of RSA and potentially improve outcome in the case of infection-related two-stage revision of the shoulder.
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http://dx.doi.org/10.3390/jcm10020218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7826686PMC
January 2021

Differentiation of Traumatic Osteoporotic and Non-Osteoporotic Vertebral AO A3 Fractures by Analyzing the Posterior Edge Morphology-A Retrospective Feasibility Study.

J Clin Med 2020 Dec 2;9(12). Epub 2020 Dec 2.

Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Muenster, Germany.

Background: Differentiation between traumatic osteoporotic and non-osteoporotic vertebral fractures is crucial for optimal therapy planning. We postulated that the morphology of the posterior edge of the cranial fragment of A3 vertebral fractures is different in these entities. Therefore, the purpose of this study is to develop and validate a simple method to differentiate between osteoporotic and non-osteoporotic A3 vertebral fractures by morphological analysis.

Methods: A total of 86 computer tomography scans of AO Type A3 (cranial burst) vertebral body fractures (52 non-osteoporotic, 34 osteoporotic) were included in this retrospective study. Posterior edge morphology was analyzed using the sagittal paramedian slice with the most prominent shaped bulging. Later, the degree of bulging of the posterior edge fragment was quantified using a geometric approach. Additionally, the Hounsfield units of the broken vertebral body, the vertebra above, and the vertebra below the fracture were measured.

Results: We found significant differences in the extent of bulging comparing osteoporotic and non-osteoporotic fractures in our cohort. Using the presented method, sensitivity was 100%, specificity was 96%. The positive predictive value (PPV) was 94%. In contrast, by evaluating the Hounsfield units, sensitivity was 94%, specificity 94% and the PPV was 91%.

Conclusions: Our method of analysis of the bulging of the dorsal edge fragment in traumatic cranial burst fractures cases allows, in our cases, a simple and valid differentiation between osteoporotic and non-osteoporotic fractures. Further validation in a larger sample, including dual-energy X-ray absorptiometry (DXA) measurements, is necessary.
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http://dx.doi.org/10.3390/jcm9123910DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7760871PMC
December 2020

Postoperative Trends of Serum C-Reactive Protein Levels after Primary Shoulder Arthroplasty-Normal Trajectory and Influencing Factors.

J Clin Med 2020 Nov 30;9(12). Epub 2020 Nov 30.

Department of Orthopedics and Tumororthopedics, University Hospital Muenster, 48149 Münster, Germany.

Background-Postoperative serum C-reactive protein (CRP) is an important diagnostic parameter for systemic inflammation and reflects surgical trauma. While trends and normal trajectories after total knee (TKA) or hip arthroplasty (THA) are established, there is no reference standard for shoulder arthroplasty (SA). Therefore, the aim of this study was to research CRP trends and influencing factors following SA. Methods-This retrospective study analyzed postoperative serum CRP levels and trajectories in 280 patients following SA. Influence of prosthesis design, sex, operating time, BMI, and humeral augmentation with bone cement were analyzed using descriptive statistics and (non-) parametric testing. Results-There is a CRP trend with a peak on day two or three, with a subsequent decrease until day seven. Reverse and stemmed prostheses show a statistically higher CRP peak than stemless prostheses or hemiarthroplasties (HA). There was no influence of gender, body mass index (BMI), operating time, or bone cement. Conclusion-The presented findings may contribute to a better understanding of the postoperative CRP course after SA. The results of this retrospective study should be validated by a prospective study design in the future.
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http://dx.doi.org/10.3390/jcm9123893DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7760886PMC
November 2020

Reconstruction of Total Bone Defects following Resection of Malignant Tumors of the Upper Extremity with 3D Printed Prostheses: Presentation of Two Patients with a Follow-Up of Three Years.

Case Rep Orthop 2020 2;2020:8822466. Epub 2020 Oct 2.

Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany.

Wide tumor resection is the local treatment of choice for patients with primary malignant bone tumors and a prerequisite for long-term survival. We present two patients that underwent total bone resection in the upper limb because of primary malignant bone tumors. The defects were then reconstructed by a 3D printed prosthesis, a procedure that, to our knowledge, has not been reported for bone defects of the upper extremity so far. Complete resection of the affected bone was required in a five-year-old girl with a high-grade osteoblastic osteosarcoma of the humerus and a 53-year-old man with a dedifferentiated leiomyosarcoma of the radius, due to the tumor's extent. Following neoadjuvant chemotherapy, resection of the entire affected humerus including the axillary nerve took place in the first case and the entire affected radius including parts of the radial nerve in the second case. Approximately three years after surgery, both patients are alive and pain-free. Despite a postoperative drop hand that affected the now 56-year-old man, he is able to carry out everyday activities such as brushing his teeth, writing, and eating. The now eight-year-old girl is also able to engage in normal activities with her left arm such as eating and carrying lightweight objects. Both patients are tumor-free to date.
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http://dx.doi.org/10.1155/2020/8822466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7559838PMC
October 2020

[Imminent fracture of the tibia due to an osteolytic lesion caused by an intraosseous tenosynovial giant cell tumor : An unusual clinico-histopathological constellation].

Orthopade 2021 Mar;50(3):237-243

Klinik für Allgemeine Orthopädie und Tumororthopädie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, 48149, Münster, Deutschland.

The tenosynovial giant cell tumor is a rare disease of the joint mucosa, tendon sheaths and bursa. We report on the rare constellation of an intraosseous manifestation of the proximal tibia of a lower leg stump after Burgess amputation as a result of a locally uncontrollable tenosynovial giant cell tumor of the upper ankle. The curettage of the local findings and operative stabilization through an intramedullary composite osteosynthesis led to an early rehabilitation of the exoprosthesis care with regaining patient autonomy.
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http://dx.doi.org/10.1007/s00132-020-03936-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925330PMC
March 2021

[Postinfectious reactive arthritis after chlamydia infection in competitive sports : Clinical management and current literature review].

Orthopade 2021 Mar;50(3):179-187

Klinik für Allgemeine Orthopädie und Tumororthopädie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, 48149, Münster, Deutschland.

Background: Reactive arthritis following infection with chlamydia is a rare but important differential diagnosis in atraumatic joint swelling. A delayed diagnosis often leads to prolonged periods of absence from physical activity. This can have serious consequences, especially for the career of competitive athletes.

Objectives: Recommendation for the clinical management of postinfectious reactive arthritis for rapid diagnosis and targeted treatment in the symptomatic clinical course.

Materials And Methods: Review of the literature on the topics "chlamydia", "reactive arthritis", "postinfectious arthritis" and "sexually acquired reactive arthritis", including presentation of two clinical cases of postinfectious reactive arthritis after chlamydia infection from competitive sports.

Results And Conclusion: Reactive arthritis following chlamydia infection in competitive athletes is a rare entity. However, it can be accompanied by far-reaching individual consequences, especially with regard to possible downtime in sports. Long-term consequences such as chronic joint damage in maintained synovitis must also be considered. In order to make a diagnosis, a specific anamnesis and the direct detection of the pathogen in the specimen of synovial fluid by polymerase chain reaction is essential. This allows a reliable diagnosis to be made with immediate initiation of therapy. However, a prolonged course of the disease cannot be excluded even if therapy is started in due time.
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http://dx.doi.org/10.1007/s00132-020-03935-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925465PMC
March 2021

How shoulder immobilization influences daily physical activity - an accelerometer based preliminary study.

BMC Musculoskelet Disord 2020 Feb 24;21(1):126. Epub 2020 Feb 24.

Sportopaedicum Berlin, Berlin, Germany.

Background: To investigate the influence of shoulder immobilization on daily physical activity.

Introduction: The harmful effect of sedentary behavior does not receive much attention in orthopedic surgery even though immobilization, especially of the lower extremity, has been associated with reduced physical activity. Immobilization of the shoulder is common after reconstructive shoulder surgery and could also potentially lead to reduced physical activity and have a negative effect on a patient's general health.

Method: Twenty-one healthy volunteers were immobilized in an orthosis (DJO Ultrasling III) for 10 h on two consecutive days. In the following week, activity was measured on the same days without the orthosis. Activity including gait cycles per minute and total gait cycles per day was measured by accelerometer based step count StepWatchTMActivity Monitor. Average age was 26 +/- 3 years. A questionnaire was administered to evaluate subjective activity.

Results: Participants wearing the shoulder orthosis were significantly less active than without immobilization by 2227.5 gait cycles/day (5501.2 with SO, 7728.7 without SO). Also, significantly more time in sedentary behavior occurred (< 400 steps/h) when the shoulder was immobilized. Patients were significantly more active without shoulder orthosis in medium level activities (800-999 steps/h). Differences for low (400-799 steps/h) and high activity levels (> 1000 steps/h) were not statistically significant. Subjective limitations while wearing the orthosis were graded at 2.343 on a scale of 0-4.

Conclusion: Results of this study show that even in young, healthy volunteers immobilization of the shoulder in an orthosis for 2 days leads to significantly reduced activity levels. A negative influence on general health, especially in older patients who are immobilized for up to 6 weeks, can potentially occur. Promoting physical activity during the immobilization period should be part of rehabilitation after injuries/surgery of the shoulder.

Trial Registration: Retrospectively registered in DRKS (DRKS00017636).
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http://dx.doi.org/10.1186/s12891-020-3133-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7041289PMC
February 2020

Gorham-Stout disease: good results of bisphosphonate treatment in 6 of 7 patients.

Acta Orthop 2020 04 13;91(2):209-214. Epub 2020 Jan 13.

Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Germany.

Background and purpose - Gorham-Stout disease (GSD) is a rare mono- or polyostotic condition characterized by idiopathic intraosseous proliferation of angiomatous structures resulting in progressive destruction and resorption of bone. Little is known about the course of disease and no previous study has evaluated patients' quality of life (QoL).Patients and methods - This is a retrospective analysis of 7 consecutive patients (5 males) with a median age at diagnosis of 14 years and a median follow-up of 7 years who were diagnosed with GSD in our department between 1995 and 2018. Data regarding clinical, radiographic, and histopathological features, and treatment, as well as sequelae and their subsequent therapy, were obtained. QoL was assessed by Musculoskeletal Tumor Society Score (MSTS), Toronto Extremity Salvage Score (TESS), and Reintegration to Normal Living (RNL) Index.Results - 3 patients had a monoostotic and 4 patients a polyostotic disease. Besides a diagnostic biopsy, 4 of the 7 patients had to undergo 8 surgeries to treat evolving sequelae. Using an off-label therapy with bisphosphonates in 6 patients, a stable disease state was achieved in 5 patients after a median of 20 months. The median MSTS, TESS, and RNL Index at last follow-up was between 87% and 79%.Interpretation - Due to its rare occurrence, diagnosis and treatment of GSD remain challenging. Off-label treatment with bisphosphonates appears to lead to a stable disease state in the majority of patients. QoL varies depending on the individual manifestations but good to excellent results can be achieved even in complex polyostotic cases with a history of possibly life-threatening sequelae.
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http://dx.doi.org/10.1080/17453674.2019.1709716DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144312PMC
April 2020

Risk factors for acute injuries and overuse syndromes of the shoulder in amateur triathletes - A retrospective analysis.

PLoS One 2018 1;13(6):e0198168. Epub 2018 Jun 1.

Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany.

Objectives: To investigate the prevalence of shoulder-related acute and overuse injuries in triathletes and examine the role of possible risk factors, in order to identify potential preventive measures.

Methods: We performed a retrospective epidemiologic study of 193 amateur triathletes between June and August 2013 and evaluated their competition and training habits, as well as the presence of acute and overuse injuries of the shoulder sustained during the past 12 months. Contingency tables were analyzed using Pearson's chi-squared test. Normally distributed data were compared with the independent samples t-test, while non-parametric analyses were performed with the Mann-Whitney U test. Binary logistic regression was used to identify important predictors of injuries.

Results: 12 participants (6%) sustained acute injuries and 36 athletes experienced an overuse injury. The acute injury rate amounted to 0.11 per 1000 hours of training and the overuse injury rate to 0.33 per 1000 hours of training. There was no association between athletes' age, height, weight, BMI, a history of shoulder complaints or triathlon experience in years and acute or overuse injuries. Male athletes had a trend for sustaining more acute injuries then female athletes (8% vs. 2%, p = 0.079). Athletes with acute injuries spent a significantly higher amount of time per week doing weight training (p = 0.007) and had a trend for a higher weekly duration of cycling training (p = 0.088). Athletes with overuse injuries participated in a significantly higher number of races compared to athletes without overuse injuries (p = 0.005). The regular use of paddles was associated with a significantly higher rate of overuse injuries (24% vs. 10%, p = 0.014).

Conclusion: The regular use of paddles during swimming training appears to be a risk factor for the development of overuse injuries, while an increased duration of weight and cycling training seems to be associated with a higher rate of acute injuries.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198168PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5983428PMC
December 2018

Long-term outcomes after combined arthroscopic medial reefing and lateral release in patients with recurrent patellar instability - a retrospective analysis.

BMC Musculoskelet Disord 2017 Jun 24;18(1):277. Epub 2017 Jun 24.

Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.

Background: There is currently no consensus regarding the optimal surgical treatment method for patients with recurrent patella instability. Our goal was to evaluate the long-term results of combined arthroscopic medial reefing and lateral release, to identify possible risk factors for recurrent dislocations and residual complaints after surgical treatment and to assess functional outcome.

Methods: We performed a retrospective study of 38 patients (43 knees) treated with all-inside technique between 2001 and 2010. The functional outcome was evaluated with the Kujala score, while pain intensity was scored on a visual analogue scale (VAS). Contingency tables were analysed with Fisher's exact test. Non-parametric analyses were carried out with the Mann-Whitney U and the Wilcoxon signed-rank test. Survival curves were calculated with the Kaplan-Meier method and compared with the log-rank test.

Results: The median age at surgery was 16 years (range, 9-44 years) and the median follow-up amounted to 9.7 years (range, 4.7-14.7 years). Residual complaints were present in 34 cases (79%). Patients with residual complaints had a trend for a higher body mass index (BMI) at surgery (25.7 vs. 21.6, P = .086). Twenty-two cases had recurrent dislocation after a median interval of 30 months. The probability of recurrent dislocations amounted to 16% after 1 year and 52% after 10 years. There were no significant differences in the presence of residual complaints (P = .721) and median VAS score (P = .313) between patients with or without recurrent dislocation. Patients with recurrent dislocations had a trend towards younger age at surgery (15 vs. 18 years, P = .076). The median Kujala score of the affected knee was 81. Patients with recurrent dislocations had a significantly lower score compared to patients without recurrent dislocations (67 vs. 91, P < .001).

Conclusions: The combined arthroscopic lateral release with medial reefing does not appear to be an adequate treatment for patients with chronic patellar instability in long-term follow-up. Younger patients might be at a higher risk for recurrent dislocations, while a higher BMI at surgery might be associated with residual complaints.
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http://dx.doi.org/10.1186/s12891-017-1636-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483275PMC
June 2017
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