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Development of an internally braced prosthesis for total talus replacement

World Journal of Orthopedics 2017年第3期8卷 221-228页

作者： Markus Regauer Mirjam Lange Kevin Soldan Steffen Peyerl Sebastian Baumbach Wolfgang Bocker Hans Polzer Klinik für Allgemeine Unfall und Wiederherstellungschirurgie Klinikum der Ludwig-Maximilians-Universitat München stryker gmbh

Total loss of talus due to trauma or avascular necrosis,for example,still remains to be a major challenge in foot and ankle surgery with severely limited treatment *** of a custom made total talar prosthesis has shown promising results so *** important factors for long time success are degree of congruence of articular surfaces and ligamentous stability of the ***,our aim was to develop an optimized custom made prosthesis for total talus replacement providing a high level of primary stability.A custom made hemiprosthesis was developed using computed tomography and magnetic resonance imaging data of the affected and contralateral talus considering the principles and technology for the development of the ***(stryker).Additionally,four eyelets for fixation of artificial ligaments were added at the correspondent footprints of the most important *** modifications can be provided according to the clinical requirements:A tri-articular hemiprosthesis or a bi-articular hemiprosthesis combined with the tibial component of the *** ankle replacement system.A feasibility study was performed using a fresh frozen human *** range of motion of the ankle was measured and ligamentous stability was evaluated by use of standard X-rays after application of varus,valgus or sagittal stress with 150 *** implantation of the prosthesis was technically possible via an anterior approach to the ankle and using standard *** osteotomies were not *** ankle dorsiflexion and plantarflexion were measured as 22-0-28 *** anterior displacement of the talus was 6 mm,maximum varus tilt 3 degrees and maximum valgus tilt 2 *** of an internally braced prosthesis for total talus replacement in humans is technically feasible and might be a reasonable procedure in carefully selected cases with no better alternatives left.

关键词： Ankle Avascular necrosis Total loss of talus Prosthesis Hemiprosthesis InternalBrace Talus replacement

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Impact of Biomechanical Forces on Antibiotics Release Kinetics from Hydroxyapatite Coated Surgical Fixation Pins

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Journal of Biomaterials and Nanobiotechnology 2013年第4期4卷 343-350页

作者： Mirjam Lilja Jan H.Sorensen Torben C.Sorensen Maria Astrand Philip Procter Hartwig Steckel Maria Stromme Division for Nanotechnology and Functional Materials Department of Engineering SciencesThe Angstrom LaboratoryUppsala UniversityUppsalaSweden Sandvik Coromant AB StockholmSweden Department of Pharmaceutics and Biopharmaceutics Christian Albrecht University KielKielGermany stryker trauma gmbh SchonkirchenGermany stryker trauma AG SelzachSwitzerland School of Engineering and Design Brunel UniversityUxbridgeUK

This work investigates the impact of biomechanical wear and abrasion on the antibiotic release profiles of hydroxyapatite (HA) coated fixation pins during their insertion into synthetic bone. Stainless steel fixation pins are coated with crystalline TiO2 by cathodic arc evaporation forming the bioactive layer for biomimetic deposition of Tobramycin containing HA. Tobramycin is either introduced by co-precipitation during HA formation or by adsorption-loading after HA deposition. The samples containing antibiotics are inserted into bone mimicking polyethylene foam after which the drug release is monitored using high performance liquid chromatography. This analysis shows that HA coating wear and delamination significantly decrease the amount of drug released during initial burst, but only marginally influence the sustained release period. Spalled coating fragments are found to remain within the synthetic bone material structure. The presence of HA within this structure supports the assumption that the local release of Tobramycin is not only expected to eliminate bacteria growth directly at the pin interface but as well at some distance from the implant. Furthermore, no negative effect of gamma sterilization could be observed on the drug release profile. Overall, the observed results demonstrate the feasibility of a multifunctional implant coating that is simultaneously able to locally deliver clinically relevant doses of antibiotics and an HA coating capable of promoting osteoconduction. This is a potentially promising step toward orthopaedic devices that combine good fixation with the ability to treat and prevent post-surgical infections.

关键词： Hydroxyapatite Fixation Pin Tobramycin Coating Wear Drug Release Gamma Sterilization

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Biomimetic Hydroxyapatite Coated Titanium Screws Demonstrate Rapid Implant Stabilization and Safe Removal In-Vivo

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Journal of Biomaterials and Nanobiotechnology 2015年第1期6卷 20-35页

作者： Jan Henrik Sorensen Lutz Durselen Ken Welch Torben Christian Sorensen Philip Procter Hakan Engqvist Maria Stromme Anita Ignatius Hartwig Steckel Department of Pharmaceutics and Biopharmaceutics Christian-Albrechts UniversityKielGermany Institute of Orthopaedic Research and Biomechanics Centre of Musculoskeletal ResearchUlmGermany Division for Nanotechnology and Functional Materials The Angstrom LaboratoryUppsala UniversityUppsalaSweden stryker trauma gmbh SchonkirchenGermany stryker trauma AG SelzachSwitzerland Division for Applied Materials Sciences The Angstrom LaboratoryUppsala UniversityUppsalaSweden

The early fixation of bone screws after surgical implantation still remains a challenge in the field of traumatology. Whilst hydroxyapatite (HA) coatings are known to enhance the fixation of implants;their removal at a later time-point may be problematic. An HA coating has been developed to demonstrate that both implant fixation and safe removal are feasible in the same design. Accordingly the aim of this study was to compare the In-Vivo performance of thin biomimetic HA coated titanium screws to uncoated counterparts used as control after bilateral implantation in the femoral condyle of 36 New Zealand White Rabbits. The screws were analysed macroscopically, by histology, micro-CT and biomechanically at both two and six weeks post-implantation. The HA coated screws demonstrated excellent biocompatibility. At two weeks the HA coated screws demonstrated a significant increase in removal torque values as well as a strong trend towards higher pull-out forces. In addition histology confirmed a higher degree of osseointegration and direct bone to implant contact. At six weeks no difference in pull-out force and removal torque could be detected. SEM images confirmed the absence of any residual HA coating indicating a fast coating degradation In-Vivo. The low level of removal torque after full osseointegration at 6 weeks supports the feasibility of safe and easy removal of the implant. The HA coating under study appears to offer a unique characteristic of enhanced fixation with a minimal increase in removal torque after full osseointegration. This may be of value in clinical applications where it is necessary to assure both screw fixation and later removal.

关键词： Biomimetic Hydroxyapatite In-Vivo Screw Implant Removal Pull-Out Force Removal Torque

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Long-term results of olecranon fractures treated using the XS nail? system

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中华创伤杂志(英文版) 2022年第6期25卷 336-344页

作者： H?chtl-Lee Leonard Spalteholz Matthias Raven Tim Friedrich Moghaddam Arash Friedl Wilhelm Aschaffenburg trauma and Orthopaedic Research Group Center for Orthopaedics trauma Surgery and Sports Medicine Hospital Aschaffenburg-Alzenau Ggmbh Am Hasenkopf 1 Aschaffenburg Germany Center for Orthopaedics and trauma Surgery Leipzig Division of Orthopaedics and trauma Surgery Rotkreuzklinik Wertheim Ggmbh Wertheim Am Main

Purpose: Olecranon fractures are particularly vulnerable to distraction and subsequent fracture dislocation due to the high tensile forces. Surgical treatment aims at reducing the fracture and restoring the anatomical joint surface condition, as well as neutralizing the strain inhibiting fracture healing. The XS nail? (Intercus gmbh, Bad Blankenberg, Germany), an intramedullary implant exerting compression across the entire fracture surface, unlike plates, leaves a minimal extra-cortical profile, and can be secured with threaded locking wires, thereby retaining the anatomical reduction without displacement or steps within the articular surface, which was often found in tension band wiring. After encouraging initial results, the long-term outcome was assessed. Methods: This retrospective study evaluated the long-term outcome of patients surgically treated at our trauma center between January 2002 and December 2005 using the XS nail?. Patients over the age of 18 years eligible for the study must have undergone surgery for isolated, recent (less than 14 days) traumatic olecranon fractures, without concomitant injuries to the ipsilateral elbow and forearm. Further exclusion criteria were pseudarthrosis, re-fractures and osteotomy for distal humerus surgery, as well as polytraumatized patients unable to aid in their own recovery. Data were retrospectively gathered by standardised questionnaire and patient records, as well as surgery and anesthesiology reports. Data analysis was performed using Microsoft Office Excel? 2016. Results: There were 32 patients, 13 males (mean age 49.0 years) and 19 females (mean age 68.9 years) with 11 Schatzkers type D, 7 each type A and C, 5 type B and 2 type E at an average of 55.2 months, all showing complete consolidation. Of them, 6 patients had a loss of range of motion with more than 10° in the sagittal plane, and only 1 patient exceeded 10° reduction of supina

关键词： Olecranon fracture Intramedullary nail Treatment DASH XS nail

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Periprosthetic joint infections in femoral neck fracture patients treated with hemiarthroplasty–should we use antibiotic-loaded bone cement?

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World Journal of Orthopedics 2022年第2期13卷 150-159页

作者： Diana Crego-Vita Daniel Aedo-Martín Rafael Garcia-Cañas Andrea Espigares-Correa Coral Sánchez-Pérez Christof Ernst Berberich Department of Orthopaedic and trauma Surgery Hospital Central de la Defensa Gómez UllaMadrid 28047Spain Department of Orthopaedic and trauma Surgery Hospital Universitario del HenaresUniversidad Francisco de VitoriaCoslada 28822MadridSpain Department of Orthopeadic and trauma Surgery Hospital Central de la Defensa Gómez UllaMadrid 28047Spain Department of Orthopeadic and trauma Surgery General University Hospital Gregorio MaranonMadrid 28007Spain Department of Medical Training Heraeus Medical GmbHWehrheim 612173HessenGermany

BACKGROUND Hemiarthroplasty is the most common treatment in elderly patients with displaced intra-capsular femoral neck fracture(FNF).Prosthetic joint infection(PJI)is one of the most feared and frequent complications post-surgery because of the frail health status of these patients and the need for fast track ***,priorities should lie in effective preventive strategies to mitigate this *** To determine how much the implementation of the routine use of antibioticloaded bone cement(ALBC)as a relatively easy-to-apply amendment to the surgical practice reduces the infection rate in our hemiarthroplasty *** We retrospectively assessed all demographic,health status and treatment-related data of our FNF patients undergoing cemented hemiarthroplasty in the period from 2011 to 2017;241 patients were further analyzed after exclusion of patients with cancer-related sequelae and those who died before the end of the 1-year observation *** PJI rate as diagnosed on basis of the Musculoskeletal Infection Society(MSIS)criteria 2011 was determined for each included patient and compared in function of the bone cement used for hip stem *** were split into a group receiving a plain bone cement in the period from January 2011 to June 2013(non-ALBC group)and into a group receiving an ALBC in the period July 2013 to December 2017(ALBC group).Data analysis was performed with statistical *** further calculated the cost-efficacy of the implementation of routine use of ALBC in the second group balancing the inhospital infection related treatment costs with the extra costs of use of *** In total 241 FNF patients who received cemented hemiarthroplasty in the period from January 2011 to January 2017 were eligible for inclusion in this retrospective *** were 8 PJI cases identified in the ALBC group among n=94 patients,whereas 28 PJI cases were observed in the non-ALBC group among n=147 *** statistical analysis

关键词： prosthetic joint infection Femoral neck fracture patients Hemiarthroplasty Antibiotic-loaded bone cement Prophylaxis Cost-efficacy

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First immunohistochemical evidence of human tendon repair following stem cell injection: A case report and review of literature

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World Journal of Stem Cells 2021年第7期13卷 944-970页

作者： Eckhard Alt Ralf Rothoerl Matthias Hoppert Hans-Georg Frank Tobias Wuerfel Christopher Alt Christoph Schmitz Chairman of the Board Isarklinikum MunichMunich 80331Germany Department of Spine Surgery Isarklinikum MunichMunich 80331Germany Department for Orthopedics and trauma Surgery Isarklinikum MunichMunich 80331Germany Chair of Neuroanatomy Institute of AnatomyFaculty of MedicineLMU MunichMunich 80336Germany Director of Science and Research InGeneron GmbHMunich 80331Germany

BACKGROUND Current clinical treatment options for symptomatic,partial-thickness rotator cuff tear(sPTRCT)offer only limited potential for true tissue healing and improvement of clinical *** animal models,injections of adult stem cells isolated from adipose tissue into tendon injuries evidenced histological regeneration of tendon ***,it is unclear whether such beneficial effects could also be observed in a human tendon treated with fresh,uncultured,autologous,adipose derived regenerative cells(UA-ADRCs).A specific challenge in this regard is that UA-ADRCs cannot be labeled and,thus,not unequivocally identified in the host ***,histological regeneration of injured human tendons after injection of UA-ADRCs must be assessed using comprehensive,immunohistochemical and microscopic analysis of biopsies taken from the treated tendon a few weeks after injection of *** SUMMARY A 66-year-old patient suffered from sPTRCT affecting the right supraspinatus and infraspinatus tendon,caused by a bicycle *** day 18 post injury[day 16 post magnetic resonance imaging(MRI)examination]approximately 100 g of abdominal adipose tissue was harvested by liposuction,from which approximately 75×10^(6) UA-ADRCs were isolated within 2 ***,UA-ADRCs were injected(controlled by biplanar X-ray imaging)adjacent to the injured supraspinatus tendon immediately after *** fast clinical recovery,a follow-up MRI examination 2.5 mo post treatment indicated the need for open revision of the injured infraspinatus tendon,which had not been treated with *** this operation,a biopsy was taken from the supraspinatus tendon at the position of the injury.A comprehensive,immunohistochemical and microscopic analysis of the biopsy(comprising 13 antibodies)was indicative of newly formed tendon *** Injection of UA-ADRCs can result in regeneration of injured human tendons by formation of new tendon tissue.

关键词： Stem cells Partial-thickness rotator cuff tear Tendon regeneration Adipose derived regenerative cells Cell-based therapy at point of care Case report

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Long-term results of olecranon fractures treated using the XS nail® system

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Chinese Journal of traumatology 2022年第6期25卷 336-344页

作者： Leonard Hochtl-Lee Matthias Spalteholz Tim Friedrich Raven Arash Moghaddam Wilhelm Friedl Aschaffenburg trauma and Orthopaedic Research Group Center for OrthopaedicsTrauma Surgery and Sports MedicineHospital Aschaffenburg-Alzenau GGmbHAm Hasenkopf1AschaffenburgGermany Center for Orthopaedicsand trauma Surgery LeipzigGermany Division of Orthopaedics and trauma Surgery Rotkreuzklinik Wertheim GGmbHWertheim Am MainGermany

Purpose:Olecranon fractures are particularly vulnerable to distraction and subsequent fracture dislocation due to the high tensile *** treatment aims at reducing the fracture and restoring the anatomical joint surface condition,as well as neutralizing the strain inhibiting fracture *** XS nail®(Intercus gmbh,Bad Blankenberg,Germany),an intramedullary implant exerting compression across the entire fracture surface,unlike plates,leaves a minimal extra-cortical profile,and can be secured with threaded locking wires,thereby retaining the anatomical reduction without displacement or steps within the articular surface,which was often found in tension band *** encouraging initial results,the long-term outcome was ***:This retrospective study evaluated the long-term outcome of patients surgically treated at our trauma center between January 2002 and December 2005 using the XS nail®.Patients over the age of 18 years eligible for the study must have undergone surgery for isolated,recent(less than 14 days)traumatic olecranon fractures,without concomitant injuries to the ipsilateral elbow and *** exclusion criteria were pseudarthrosis,re-fractures and osteotomy for distal humerus surgery,as well as polytraumatized patients unable to aid in their own *** were retrospectively gathered by standardised questionnaire and patient records,as well as surgery and anesthesiology *** analysis was performed using Microsoft Office Excel?***:There were 32 patients,13 males(mean age 49.0 years)and 19 females(mean age 68.9 years)with 11 Schatzkers type D,7 each type A and C,5 type B and 2 type E at an average of 55.2 months,all showing complete *** them,6 patients had a loss of range of motion with more than 10°in the sagittal plane,and only 1 patient exceeded 10°reduction of ***-five patients reported being pain-free under all circumstances,and all but 2 patients(93.75%)had returned to

关键词： Olecranon fracture Intramedullary nail Treatment DASH XS nail

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Validation of a novel animal model for sciatic nerve repair with an adipose-derived stem cell loaded fibrin conduit

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Neural Regeneration Research 2018年第5期13卷 854-861页

作者： Maximilian M.Saller Rosa-Eva Huettl Julius M.Mayer Annette Feuchtinger Christian Krug Thomas Holzbach Elias Volkmer Experimental Surgery and Regenerative Medicine (ExperiMed) Department of General Trauma and Reconstructive SurgeryLudwig-Maximilians-University (LMU) Max-Planck-Institute of Psychiatry Department of Stress Neurobiology and Neurogenetics Department of Hand- Plastic-and Aesthetic Surgery Ludwig-Maximilians-University (LMU) Research Unit Analytical Pathology Munich Helmholtz Zentrum Muenchen-German Research Center for Environmental Health (GmbH) Department of Hand and Plastic Surgery Spital Thurgau AG

Despite the regenerative capabilities of peripheral nerves, severe injuries or neuronal trauma of critical size impose immense hurdles for proper restoration of neuro-muscular circuitry. Autologous nerve grafts improve re-establishment of connectivity, but also comprise substantial donor site morbidity. We developed a rat model which allows the testing of different cell applications, i.e., mesenchymal stem cells, to improve nerve regeneration in vivo. To mimic inaccurate alignment of autologous nerve grafts with the injured nerve, a 20 mm portion of the sciatic nerve was excised, and sutured back in place in reversed direction. To validate the feasibility of our novel model, a fibrin gel conduit containing autologous undifferentiated adipose-derived stem cells was applied around the coaptation sites and compared to autologous nerve grafts. After evaluating sciatic nerve function for 16 weeks postoperatively, animals were sacrificed, and gastrocnemius muscle weight was determined along with morphological parameters（g-ratio, axon density ＆ diameter） of regenerating axons. Interestingly, the addition of undifferentiated adipose-derived stem cells resulted in a significantly improved re-myelination, axon ingrowth and functional outcome, when compared to animals without a cell seeded conduit. The presented model thus displays several intriguing features： it imitates a certain mismatch in size, distribution and orientation of axons within the nerve coaptation site. The fibrin conduit itself allows for an easy application of cells and, as a true critical-size defect model, any observed improvement relates directly to the performed intervention. Since fibrin and adipose-derived stem cells have been approved for human applications, the technique can theoretically be performed on humans. Thus, we suggest that the model is a powerful tool to investigate cell mediated assistance of peripheral nerve regeneration.

关键词： critical-size nerve defect fibrin conduit autologous nerve transplant peripheral nerve regeneration adipose-derived stem/progenitor cells sciatic function index sciatic nerve re-innervation axon guidance peripheral circuitry

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Review on cochlear implant electrode array tip fold-over and scalar deviation

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Journal of Otology 2019年第3期14卷 94-100页

作者： Anandhan Dhanasingh Claude Jolly MED-EL Medical Electronics gmbh

Objective: Determine the occurrence rate of cochlear implant (CI) electrode tip fold-over and electrode scalar deviation as reported in patient cases with different commercial electrode types. Data-sources: PubMed search for identifying peer-reviewed articles published till 2018 on CI electrode tip fold-over and scalar deviation. Key-words for searching were “Cochlear electrode tip fold-over”,“Cochlear electrode scalar position” and “Cochlear electrode scalar location”. Articles-selection: Only if electrode related issues were investigated in patient cases. 38 articles met the inclusion-criteria. Results: 13 articles on electrode tip fold-over issue covering 3177 implanted ears, out of which 50 ears were identified with electrode tip fold-over with an occurrence rate of 1.57%. Out of 50 ears, 43 were implanted with pre-curved electrodes and the remaining 7 with lateral-wall electrodes. One article reported on both tip fold-over and scalar deviation. 26 articles reported on the electrode scalar deviation covering an overall number of 2046 ears out of which, 458 were identified with electrode scalar deviation at a rate of 22.38%. After removing the studies that did not report on the number of electrodes per electrode type, it was 1324 ears implanted with pre-curved electrode and 507 ears with lateral-wall electrode. Out of 1324 pre-curved electrode implanted ears, 424 were reported with scalar deviation making an occurrence rate of 32%. Out of 507 lateral-wall electrode implanted ears, 43 were associated with scalar deviation at an occurrence rate of 6.7%. Conclusion: This literature review revealing the fact of higher rate of electrode insertion trauma associated with pre-curved electrode type irrespective of CI brand is one step closer to obsolete it from the clinical practice in the interest of patient's cochlear health.

关键词： Electrode tip fold-over Scalar deviation Pre-curved electrode Straight electrode

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Improved Osteointegration of Ti-6Al-4V-implants of Different Surface Texture by the Use of Bone Morphogenetic Protein-3 (BMP-3)

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Journal of Wuhan University of Technology(Materials Science) 2005年第B12期20卷 301-303页

作者： Esenwein S A Esenwein S Herr G Hauser J Muhr G Hartwig C-H Department of Surgery BG Trauma Center Bergmannsheil University Hospital Buerkle-de-la-Camp-Platz 1 D-44789 Bochum Germany Dental Practice Am Obstmarkt 5 D-71522 Backnang Germany Advanced Tissue Regeneration gmbh Turmstr. 16 D-35578 Wetzlar Germany Department of Orthopaedics Michaelis-Hospital Eichenstrasse 34 D-20244 Hamburg Germany

Half of altogether 60 cylindrical implant devices made of titanium-aluminum-vanadium alloy （ Ti-6Al-4V） were plusna-sprayed with a hydroxyapatite-couting and the other half had a corundum blasted porous surface. 15 implants of each group of the titanium test buplants were coated with 230 μg porcine, high-purified BMP- 3-precipitute per implant. In each case a BMP- 3-couted and an uncoated control-device were implanted into the femoral part of the putellofemoral joint of the right and left leg of 30 adult giant rabbits. Histomorphological and histomorphometrical we found in both groups with BMP- 3-coated test devices an improved osteointegrution. Stutistical evaluation using the t-test for matched samples showed 5 weeks after surgery a significant higher volume of tony formed bone of the BMP- 3-coated corundum- blasted or hydroxyapathe- coated Ti- 6Al- 4 V test devices compared to the non-couted controls of the same t）pe （p 〈 0.01, t-test for matched samples）. In both implant groups with BMP-couting a synergetic effect was verifiable although the bone ongrowth in the hydroxyaputite coated implants was more extensive than in the corundum blasted implants. Light microscopy demonstrated osteointegrution without connective tissue membrane around the surface of the implants. Our results indicate that composite metal implants,as used in endoprosthetics and implantology , are suitable carriers for BMP- 3 and im proved fixation of the implants can be achieved. The hydroxyapatite surface is superior to the corundum-blasted surface with regards to the observed parameters because of its pronounced bioactivity and its osteoconductive characteristics.

关键词： bone morphogenetic protein-3 BMP- 3 hydroxyapatite osteointegration surface coating bone ingrowth implantology

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