Minimal-invasive periazetabuläre Osteotomie zur Therapie der Hüftdysplasie des Erwachsenen

Wassilew, Georgi I.; Hofer, André; Rakow, Anastasia; Gebhardt, Sebastian; Hoffmann, Manuela Andrea; Janz, Viktor; Zimmerer, Alexander

doi:10.1007/s00064-022-00771-w

Cited by 5 publications

(2 citation statements)

References 21 publications

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“…A modified, minimally invasive Bernese periacetabular osteotomy (PAO) technique was performed in all patients. This involved the use of a bikini incision and either a rectus-sparing (RS) approach with bony detachment of the sartorius from its origin or a rectus- and sartorius-sparing (RASS) approach, as previously described by our group [ 22 ]. All procedures were performed by the senior author (G.I.W).…”

Section: Methodsmentioning

confidence: 99%

Psychological Factors as Risk Contributors for Poor Hip Function after Periacetabular Osteotomy

Fischer

Nonnenmacher

Möller

et al. 2023

JCM

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Psychologic comorbidities have been identified as risk factors for poor outcomes in orthopedic procedures, but their influence on the outcome of hip-preserving periacetabular osteotomy (PAO) remains uncertain. This retrospective cohort study aimed to assess the impact of patients’ psychological health on the outcome of PAO in patients with hip dysplasia (HD) and acetabular retroversion (AR). The study included 110 patients undergoing PAO for HD or AR between 2019 and 2021. Standardized questionnaires were administered to assess psychological factors, postoperative hip function, and activity level (mean follow-up: 25 months). Linear regression analyses were used to examine the associations between psychological factors and postoperative hip function and activity level. Both HD and AR patients showed improved postoperative hip function and activity levels. Linear regression analyses revealed that depression significantly impaired postoperative outcomes in both groups, whereas somatization negatively influenced the outcome in AR patients. General health perceptions significantly contributed to an improved postoperative outcome. These findings highlight the importance of concomitantly addressing psychologically relevant factors in order to improve patient outcomes after PAO procedures. Future prospective studies should continue to investigate the impact of various psychological factors and explore possibilities of incorporating psychological support into routine postoperative care for these patient cohorts.

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Section: Methodsmentioning

confidence: 99%

Psychological Factors as Risk Contributors for Poor Hip Function after Periacetabular Osteotomy

Fischer

Nonnenmacher

Möller

et al. 2023

JCM

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“…Since PAO is applied to treat hip dysplasia in adolescents and young adults, patients are respectively young [ 25 ]. During the procedure, three osteotomies are performed to enable reorientation of the acetabulum and to thereby achieve an improved coverage of the femoral head [ 26 ]. Bone marrow-containing bone wedges are sometimes resected from the anterior Os ilium or superior Os pubis and discarded as surgical waste in the course of PAO [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Bone marrow from periacetabular osteotomies as a novel source for human mesenchymal stromal cells

Handke,

Rakow,

Singer

et al. 2023

Stem Cell Res Ther

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Background Bone marrow-derived mesenchymal stromal cells (BM-MSCs) are used in regenerative medicine and related research involving immunomodulatory, anti-inflammatory, anti-fibrotic and regenerative functions. Isolation of BM-MSCs from samples obtained during total hip arthroplasty (THA) is routinely possible. Advanced age and comorbidities of the majority of patients undergoing THA limit their applicability. Our study aimed to evaluate the potential of bone marrow obtained during periacetabular osteotomy (PAO) as a novel source of BM-MSCs from young donors by analyzing cell yield and cell characteristics. Methods Bone samples were obtained from the anterior Os ilium or superior Os pubis during PAO and from the femoral cavity during primary THA. Isolation of bone marrow-derived mononuclear cells (BM-MNCs) was performed by density gradient centrifugation. The samples from PAO and THA patients were compared in terms of BM-MSC yield, colony formation and the proportion of BM-MSCs within the BM-MNC population using flow cytometry analysis. The cells were characterized based on the expression of BM-MSC-specific surface markers. The functionality of the cells was compared by quantifying post-thaw viability, metabolic activity, proliferation capacity, senescence-associated beta galactosidase (SA-β-gal) expression, trilineage differentiation potential and major secretome proteins. Results Isolation of BM-MNCs was possible in a reliable and reproducible manner when using bone from PAO containing more than 0.24 g bone marrow. PAO patients were younger than patients of the THA group. Bone obtained during PAO contained less bone marrow and led to a lower BM-MSC number after the first cell culture passage compared to BM-MSCs obtained during THA. BM-MSCs from PAO samples are characterized by a higher proliferation capacity. This results in a higher yield in cell culture passage two, when normalized to the sample weight. BM-MSCs from PAO patients showed increased secretion of TGF-β1, TIMP2, and VEGF upon osteogenic differentiation. BM-MSCs from PAO and THA patients revealed similar results regarding the onset of SA-β-gal expression and trilineage differentiation capacity. Conclusions We suggest that bone obtained during PAO is a promising novel source for BM-MSCs from young donors. Limited absolute cell yield due to low sample weight must be considered in early cell culture passages and might be critical for the range of clinical applications possible for BM-MSCs from this source. The higher proliferation capacity and increased growth factor secretion of BM-MSCs from young donors may be beneficial for future regenerative cell therapies, in vitro models, and tissue engineering.

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Komplikationen und deren Behandlung nach PAO

et al. 2023

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Zusammenfassung Hintergrund Die Hüftdysplasie stellt die häufigste Ursache der sekundären Koxarthrose dar. Die periazetabuläre Osteotomie (PAO) nach Ganz ist ein etabliertes Therapieverfahren, welches eine reproduzierbare Korrektur der dreidimensionalen Pathologie erlaubt. Den mittel- und langfristigen guten Behandlungsergebnissen stehen potenzielle Komplikationsrisiken eines invasiven Beckeneingriffes gegenüber. In Anbetracht des vornehmlich jungen Alters der Patient*innen ist eine Kenntnis der möglichen Komplikationen und der daraus resultierenden adäquaten Therapie wichtig. Therapieentwicklung Die kontinuierliche Weiterentwicklung der Operationstechnik und die zunehmende Erfahrung der Operateur*innen – mit dem sich hieraus ergebenden wachsenden Verständnis bezüglich kritischer Operationsschritte – haben zu einer wesentlichen Reduktion schwerwiegender Komplikationen geführt. Um darüber hinaus das Outcome für die Patient*innen zu verbessern, sind neben der Reduktion der Komplikationsrate auch ein besseres Verständnis bezüglich der hüftdysplasieassoziierten Begleitpathologien essenziell.

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Minimal-invasive periazetabuläre Osteotomie zur Therapie der Hüftdysplasie des Erwachsenen

Cited by 5 publications

References 21 publications

Psychological Factors as Risk Contributors for Poor Hip Function after Periacetabular Osteotomy

Psychological Factors as Risk Contributors for Poor Hip Function after Periacetabular Osteotomy

Bone marrow from periacetabular osteotomies as a novel source for human mesenchymal stromal cells

Komplikationen und deren Behandlung nach PAO

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