Martin Fuerst

The aim of this study was to examine the frequency of articular cartilage calcification in patients with end-stage hip OA. Further, its impact on the clinical situation and the OA severity are analyzed.

The objective of this study was to determine the clinical outcome of combined bone grafting and matrix-supported autologous chondrocyte transplantation in patients with osteochondritis dissecans of the knee. Between January 2003 and March 2005, 21 patients (mean age 29.33 years) with symptomatic osteochondritis dissecans (OCD) of the medial or lateral condyle (grade III or IV) of the knee underwent reconstruction of the joint surface by autologous bone grafts and matrix-supported autologous chondrocyte transplantation. Patients were followed up at three, six, 12 and 36 months to determine outcomes by clinical evaluation based on Lysholm score, IKDC and ICRS score. Clinical results showed a significant improvement of Lysholm-score and IKDC score. With respect to clinical assessment, 18 of 21 patients showed good or excellent results 36 months postoperatively. Our study suggests that treatment of OCD with autologous bone grafts and matrix-supported autologous chondrocytes is a possible alternative to osteochondral cylinder transfer or conventional ACT.

Basische Calciumphosphate (BCP) und Calciumpyrophosphatdihydrat (CPPD) sind die häufigsten pathologischen intraartikulären Kristalle, gefolgt von Mononatriumuratkristallen (MNU) und, in sehr seltenen Fällen, Calciumoxalatkristallen. Diese Kristalle sind die Ursache äußerst unterschiedlicher rheumatischer Gelenkpathologien. Sie sind in unterschiedlichem Maße verantwortlich für akute oder chronische Gelenkentzündungen, Knorpelschädigungen und Knochenerosionen. Obwohl die molekularen Mechanismen, die zu einer kristallinduzierten Gelenkzerstörung führen immer besser verstanden werden, ist die genaue Rolle der Kristalle (insbesondere der BCP) nicht vollständig geklärt. Die klinische und pathologische Bedeutung der BCP bei Arthrose ist unbekannt. Diese Arbeit soll einen Überblick über die unterschiedlichen klinischen und pathologischen Aspekte der unterschiedlichen Kristalle liefern. Basic calcium phosphate (BCP) and calcium pyrophosphate dihydrate crystals are the most common types of pathologic crystals, followed by monosodium urate crystals and, in rare cases, calcium oxalate crystals. These crystals have been associated with a variety of quite different rheumatic syndromes. They are responsible for acute synovial inflammation and also contribute to cartilage degradation and bone lesions within the joint. Although understanding of the molecular mechanisms involved in generating the pathologic effects of these crystals has increased, the role of BCP crystals in particular remains poorly understood. The clinical implication of articular deposits of calcium-containing crystals in osteoarthritis is unknown. This review provides an overview of the clinical and pathological changes of these four different types of crystals.

Die primäre artikuläre synoviale Chondromatose ist eine monoartikuläre, gutartige, neoplastische und selbstlimitierende Erkrankung der Synovialis mit metaplastischer Transformation subsynovialer Zellen in Knorpelzellen. Am häufigsten tritt die Erkrankung am Kniegelenk auf, gefolgt von dem Befall des Ellenbogengelenks. Männer sind häufiger betroffen als Frauen. Die transformierten synovialen Chondroblasten bilden kleine Inseln und Knoten aus Knorpel, die sich kontinuierlich vergrößern und im weiteren Verlauf in die Gelenkhöhle geboren werden. Dort können die multiplen freien Gelenkkörper, ernährt durch die Synovia, weiter wachsen, verkalken oder auch im Sinne einer enchondralen Ossifikation verknöchern. Die operative Therapie richtet sich nach dem Stadium der Erkrankung: Besteht Aktivität in der Synovialis mit persistierender Knorpelbildung ist eine Gelenkkörperentfernung mit radikaler Synovektomie erforderlich, in späten inaktiven Stadien ohne pathologische Veränderungen in der Synovialis ist die Entfernung der freien Gelenkkörper ausreichend. Die maligne sarkomatöse Transformation ist selten, bereitet aber unter Umständen Schwierigkeiten in der Abgrenzung zu einem benignen Verlauf. Primary articular synovial chondromatosis is a benign, self-limiting neoplastic process in which hyaline cartilage nodules form in the synovial tissue. The disease most frequently affects the knee in men, followed by the elbow. The basic feature of this disease is a metaplastic maturation of the mesenchymal cells in the synovial membrane of a joint into cartilage. These cells mature into chondroblasts and form small nodules of cartilage in the synovial membrane. These nodules subsequently enlarge and detach to lie within the joint space. They become free within the joint as multiple small cartilaginous loose bodies nourished by the synovial fluid. The chondrocytes in the loose bodies continue to multiply, and the loose bodies grow in diameter. Calcification appears in the central zone of the loose bodies, and in some cases, enchondral ossification takes place. The operative therapy depends on the stage of the disease: synovectomy with removal of chondral fragments if active intrasynovial disease is present, and removal of the multiple chondral bodies alone in cases of late inactive disease with no synovial abnormalities. Malignant transformation is unusual and can be difficult to distinguish from benign disease.

BACKGROUND: Rheumatoid arthritis often leads to severe destruction of the glenohumeral joint, including synovitis and inflammation-induced alterations of the rotator cuff. Cup arthroplasty, or surface replacement of the shoulder, was introduced in the 1980s. The aim of this study was to evaluate the midterm results of the DUROM cup surface replacement for patients with rheumatoid arthritis affecting the glenohumeral joint. METHODS: From 1997 to 2000, forty-two DUROM cup hemiprostheses were implanted in a cohort of thirty-five patients (forty-two shoulders), who were evaluated preoperatively and again at three, twelve, and more than sixty months postoperatively. Six patients (seven shoulders) were lost to follow-up. Thirty-five shoulders in twenty-nine patients (twenty-one women and eight men with an average age of 61.4 years) could be evaluated prospectively after an average follow-up period of 73.1 months. Patients were evaluated clinically with the use of the Constant score, and a detailed radiographic analysis was performed to determine the presence of endoprosthetic loosening, glenohumeral subluxation, and glenoid bone loss. RESULTS: The mean Constant score for the thirty-five shoulders increased from 20.8 points preoperatively to 64.3 points at a mean of 73.1 months postoperatively. There were three revisions: one to replace an implant that was too large, another to treat glenoid erosion, and a third due to loosening of the implant. No additional cases of loosening of the prosthesis or changes in cup position were observed radiographically. Over the five-year follow-up period, proximal migration of the cup increased in 63% of the shoulders, and glenoid depth increased in 31%. With the numbers studied, no differences in clinical outcome were identified between patients with a massive rotator cuff tear and those with a smaller or no tear. CONCLUSIONS: The midterm results of the cemented DUROM cup surface replacement for patients with advanced rheumatoid arthritis of the shoulder are very encouraging, even for patients with a massive tear of the rotator cuff. The advantage of this cup arthroplasty is the less complex bone-sparing surgery. In the event of failure of the implant, other reliable salvage options remain available. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. ORIGINAL ABSTRACT CITATION: “The DUROM Cup Humeral Surface Replacement in Patients with Rheumatoid Arthritis” (2007;89:1756-62).

Periarticular mineralization is a clinical disorder, which is typically found at the shoulder, knee and hip joint and only rarely diagnosed at the finger joints. Periarticular ossification is a different entity and has to be distinguished from periarticular mineralization. The typical symptoms of this disorder are pain and swelling of the joint that resolves spontaneously within 3-6 months. We report on a case of periarticular mineralization of the metacarpophalangeal (MCP) joint of a 39-year-old woman. Diagnosis was made by X-ray based on findings in the form of opaque mineralizations. There was no pain relief with conservative treatment and operative treatment was performed. Histological and electron microscope analysis of the mineralization showed hydroxyapatite crystals and chondrogenic metaplasia of the surrounding fibroblasts. The patient was symptom-free soon after treatment.Usually, the therapy of the periarticular mineralization is conservative; only exceptional cases with persistent pain and swelling need operative treatment. Acute periarticular mineralization of the hand is rare and often misdiagnosed as infectious arthritis.

Background: Rheumatoid arthritis often leads to severe destruction of the glenohumeral joint, including synovitis and inflammation-induced alterations of the rotator cuff. Cup arthroplasty, or surface replacement of the shoulder, was introduced in the 1980s. The aim of this study was to evaluate the midterm results of the DUROM cup surface replacement for patients with rheumatoid arthritis affecting the glenohumeral joint. Methods: From 1997 to 2000, forty-two DUROM cup hemiprostheses were implanted in a cohort of thirty-five patients (forty-two shoulders), who were evaluated preoperatively and again at three, twelve, and more than sixty months postoperatively. Six patients (seven shoulders) were lost to follow-up. Thirty-five shoulders in twenty-nine patients (twenty-one women and eight men with an average age of 61.4 years) could be evaluated prospectively after an average follow-up period of 73.1 months. Patients were evaluated clinically with the use of the Constant score, and a detailed radiographic analysis was performed to determine the presence of endoprosthetic loosening, glenohumeral subluxation, and glenoid bone loss. Results: The mean Constant score for the thirty-five shoulders increased from 20.8 points preoperatively to 64.3 points at a mean of 73.1 months postoperatively. There were three revisions: one to replace an implant that was too large, another to treat glenoid erosion, and a third due to loosening of the implant. No additional cases of loosening of the prosthesis or changes in cup position were observed radiographically. Over the five-year follow-up period, proximal migration of the cup increased in 63% of the shoulders, and the glenoid depth increased in 31%. With the numbers studied, no differences in clinical outcome were identified between patients with a massive rotator cuff tear and those with a smaller or no tear. Conclusions: The midterm results of the cemented DUROM cup surface replacement for patients with advanced rheumatoid arthritis of the shoulder are very encouraging, even for patients with a massive tear of the rotator cuff. The advantage of this cup arthroplasty is the less complex bone-sparing surgery. In the event of failure of the implant, other reliable salvage options remain. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Background: Rheumatoid arthritis often leads to severe destruction of the glenohumeral joint, including synovitis and inflammation-induced alterations of the rotator cuff. Cup arthroplasty, or surface replacement of the shoulder, was introduced in the 1980s. The aim of this study was to evaluate the midterm results of the DUROM cup surface replacement for patients with rheumatoid arthritis affecting the glenohumeral joint. Methods: From 1997 to 2000, forty-two DUROM cup hemiprostheses were implanted in a cohort of thirty-five patients (forty-two shoulders), who were evaluated preoperatively and again at three, twelve, and more than sixty months postoperatively. Six patients (seven shoulders) were lost to follow-up. Thirty-five shoulders in twenty-nine patients (twenty-one women and eight men with an average age of 61.4 years) could be evaluated prospectively after an average follow-up period of 73.1 months. Patients were evaluated clinically with the use of the Constant score, and a detailed radiographic analysis was performed to determine the presence of endoprosthetic loosening, glenohumeral subluxation, and glenoid bone loss. Results: The mean Constant score for the thirty-five shoulders increased from 20.8 points preoperatively to 64.3 points at a mean of 73.1 months postoperatively. There were three revisions: one to replace an implant that was too large, another to treat glenoid erosion, and a third due to loosening of the implant. No additional cases of loosening of the prosthesis or changes in cup position were observed radiographically. Over the five-year follow-up period, proximal migration of the cup increased in 63% of the shoulders, and the glenoid depth increased in 31%. With the numbers studied, no differences in clinical outcome were identified between patients with a massive rotator cuff tear and those with a smaller or no tear. Conclusions: The midterm results of the cemented DUROM cup surface replacement for patients with advanced rheumatoid arthritis of the shoulder are very encouraging, even for patients with a massive tear of the rotator cuff. The advantage of this cup arthroplasty is the less complex bone-sparing surgery. In the event of failure of the implant, other reliable salvage options remain. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.