Background: This study aims to present a new therapeutic option for the treatment of thumb carpometacarpal joint osteoarthritis. Knowing that autologous fat may be beneficial for osteoarthritis through antiinflammatory and chondroprotective effects, the authors transplanted autologous adipose fat into the thumb carpometacarpal joint with the objective of postponing definite resection arthroplasty surgery. Methods: In this pilot study, the authors performed surgery on 99 joints. The study population consisted of patients with symptomatic and radiologically confirmed osteoarthritis of the thumb carpometacarpal joint. After harvesting abdominal adipose tissue, 1 to 2 ml of fat without physical or enzymatic manipulation were transplanted into the thumb carpometacarpal joint. Surgical outcome was quantified by use of the Michigan Hand Outcomes Questionnaire in addition to strength and pain measurements during a 12-month follow-up consultation. We conducted Friedman’s analysis of variance to gauge the differences over time regarding Michigan Hand Outcomes Questionnaire and pain under stress. Results: From 2 weeks on, there was pain relief, both under stress and at rest. Friedman’s analysis of variance revealed a significant change in pain under stress [chi-square (5) = 68.52; p < 0.001]. Postoperative Michigan Hand Outcomes Questionnaire Scores improved significantly over 12 months [chi-square (5) = 90.56; p < 0.001]. Conclusion: The authors’ preliminary findings suggest that intraarticular autologous fat transplantation is a promising alternative treatment of carpometacarpal joint osteoarthritis of the thumb. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Preliminary data suggest that an intraarticular autologous fat transplant may be useful in osteoarthritis (OA) of the CMC-1 joint. This prospective, non-randomised pilot study investigates this new method with a view to clinical outcomes compared with intraarticular corticosteroid injection. 17 women and 7 men with an average age of 63.3 (47-75) years with symptomatic OA were included in the study. In 12 patients, a radiologically guided injection of 1-1.5 ml of adipose tissue was carried out after transumbilical liposuction of 10 ml of abdominal fat. Prior to that, the fat was homogenised using two Luer-Lock Syringes, but not centrifuged. Postoperatively, the thumb was immobilised for one week. The patients from the cortisone control group received an intraarticular injection of 10 mg (1 ml) of Triamcinolon® under sterile conditions without subsequent immobilisation. Preoperatively as well as 2, 6 and 12 weeks postoperatively, the QuickDASH and the Michigan-Hand-Questionnaire (MHQ) were analysed, the pain was measured by means of the visual analogue scale (VAS), and strength and grip force were measured. Both the cortisone group and the autologous fat group showed a significant reduction in stress pain after two weeks. Both methods had no significant effect on force. The evaluation of quality of life by means of QuickDASH and MHQ after cortisone treatment initially demonstrated an improvement in quality of life, which, however, fell below the previous level after 6 weeks. After autologous fat transplantation, quality of life increased continuously. In contrast to cortisone injection treatment, a persistent pain reduction was achieved in the fat injection group in the 3-month follow-up period, whereas cortisone injection only resulted in a short-term reduction of pain lasting about 6 weeks. Long-term follow-up is required now to show how long the effect of autologous fat transplantation in OA can be sustained.
Zusammenfassung Einleitung: Trotz der Anerkennung als eigenst?ndiges Fachgebiet ist die Plastische Chirurgie in der deutschen Universit?tsmedizin noch unzureichend im Sinne unabh?ngiger Kliniken mit entsprechendem Forschungsfokus verankert. Ziel dieser Arbeit war es, die Publikationsleistung der deutschen akademischen Plastischen Chirurgie zu untersuchen und einen Vergleich zwischen eigenst?ndigen Kliniken und untergeordneten Organisationsstrukturen zu ziehen. Material und Methodik: Mittels Webseiten-Analyse wurden Organisationsstrukturen und personelle Ausstattung an Universit?tsklinika errmittelt. Via Pubmed-Analyse wurde die Publikationsleistung (Publikationsanzahl, kumulativer Impactfaktor, Impactfaktor/Publikation, Publikationen/Arzt, Publikationen/Klinik) im Zeitraum von 2009 bis 2013 eruiert. Die Verteilung von kumulativem Impactfaktor und Publikationsanzahl auf die verschiedenen Fachzeitschriften sowie die Entwicklung des Impactfaktors wurde in einer Journal-Analyse untersucht. Ergebnisse: An den 35 Universit?tsklinika existierten 12 eigenst?ndige Kliniken und 8 untergeordnete Organisationsstrukturen. An 15 Universit?tsklinika gab es keine plastisch-chirurgischen Organisationsstrukturen. Der Personalschl?ssel unterschied sich deutlich zwischen Kliniken (3,6 Ober?rztInnen/Einheit) und untergeordneten Organisationsstrukturen (1,1 Ober?rztInnen/Einheit). Der Gro?teil der Publikationen (89,0%) und kumulativen Impactfaktorpunkte (91,2%) sowie die meisten Publikationen/Arzt (54 Publikationen/Jahr) und pro Klinik (61 Publikationen/Jahr) waren an den eigenst?ndigen Kliniken zu finden. Nur hier gab es Top-Publikationen mit einem Impactfaktor>5. Es zeichnete sich ein allgemeiner Negativtrend bzgl. Publikationszahl (??13,4%) und kumulativen Impactfaktorpunkten (??28,9%) ab. 58,4% aller Publikationen verteilten sich auf die Top-10 Zeitschriften, wovon ein Gro?teil (60% der Publikationen, 79,7% des kumulativen Impactfaktors) auf englischsprachige Fachzeitschriften entfiel. Der Impactfaktor der Top-10 Fachzeitschriften entwickelte sich im Untersuchungszeitraum positiv (+?13,5%). Schlussfolgerung: Eigenst?ndige Kliniken f?r Plastische Chirurgie sind im Gegensatz zu untergeordneten Organisationsstrukturen die zentralen Leistungstr?ger innerhalb der akademischen Plastischen Chirurgie, welche im Allgemeinen bzgl. der Publikationsleistung r?ckl?ufige Tendenzen zeigt. Die Art der Organisationsstruktur hat somit entscheidenden Einfluss auf die wissenschaftliche Leistungsf?higkeit.
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