Bone morphogenetic protein-2 (BMP-2) is a well-known osteoinductive protein, which requires a carrier for local application. As an alternative to the previously described carriers, an in situ hardening, resorbable, and osteoconductive β-tricalcium phosphate cement (TCP) is tested. Trepanation defects in the bovine distal femoral epiphysis are filled with a composite consisting of TCP and 200 μg rhBMP-2 per cm³ TCP, autologous bone graft, pure TCP, or left empty. A radiological follow-up is performed after 7 weeks and 3 months. The sheep are euthanized and bone samples are analyzed by microradiography, histology, and histomorphometry. Microradiography and histology show similar results for pure TCP and the composite. The defects are filled with trabecular bone and newly formed bone is in close contact with the remaining TCP-particles. The majority of the cement is resorbed, in the composite group the amount of remaining cement particles is reduced. Defects treated with autologous bone graft are filled completely, while untreated defects shows only a small amount of bone originating from the rim of the defect. Histomorphometry of the defects treated with pure TCP shows a significantly increased bone content in comparison to defects treated with the composite or autologous bone graft. Analysis of the remaining cement particles shows significantly less cement in the TCP/rhBMP-2 group in comparison to pure TCP. The sum of bone and cement content in the rhBMP-2 group shows amounts comparable to the calcified structures found following autologous bone grafting. The addition of rhBMP-2 to the TCP leads to faster remodeling of the defect comparable to autologous bone graft, while defects treated with pure TCP are not completely remodeled.

This prospectively registered systematic review and meta-analysis examines whether exercise (EX) training has an additive effect to osteoanabolic and/or an

Osteoporosis is a progressive metabolic bone disease characterized by decreased bone density and microarchitectural deterioration, leading to an increased risk of fracture, particularly in postmenopausal women and the elderly. Increasing evidence suggests that inflammatory processes play a key role in the pathogenesis of osteoporosis and are strongly associated with the activation of osteoclasts, the cells responsible for bone resorption. In the present study, we investigated, for the first time, the influence of proinflammatory cytokines on the osteogenic differentiation, proliferation, and metabolic activity of primary human osteoblast-like cells (OBs) derived from the femoral heads of elderly patients. We found that all the proinflammatory cytokines, IL-1β, TNF-α, IL-6, and IL-8, enhanced the extracellular matrix mineralization of OBs under differentiation-induced cell culture conditions. In the cases of IL-1β and TNF-α, increased mineralization was correlated with increased osteoblast proliferation. Additionally, IL-1β- and TNF-α-increased osteogenesis was accompanied by a rise in energy metabolism due to improved glycolysis or mitochondrial respiration. In conclusion, we show here, for the first time, that, in contrast to findings obtained with cell lines, mesenchymal stem cells, or animal models, human OBs obtained from patients exhibited significantly enhanced osteogenesis upon exposure to proinflammatory cytokines, probably in part via a mechanism involving enhanced cellular energy metabolism. This study significantly contributes to the field of osteoimmunology by examining a clinically relevant cell model that can help to develop treatments for inflammation-related metabolic bone diseases.

Einleitung: Die Epiphyseolysis capitis femoris wird in der Regel operativ behandelt, wobei es keine einheitliche Empfehlung zu den verwendeten Verfahren gibt. Bis 30° Abrutschwinkel ist die Fixierung in situ Mittel der Wahl. Ziel der vorliegenden Studie ist ein Vergleich der mittelfristigen Ergebnisse nach In-situ Fixierung der Hüftkopfepiphyse mit Kirschner-Drähten oder kanülierten Titanschrauben (Königsee-Implantate, Königsee-Aschau, Deutschland). Methode: In die Studie wurden 46 Patienten mit einer ECF Grad I oder II mit überwiegend chronischer Verlaufsform aufgenommen. Nach der operativen Fixierung nach ggfs. vorsichtiger, geschlossener Reposition wurden die Patienten klinisch und radiologisch bis zu einem Jahr postoperativ nachuntersucht. Die klinischen Ergebnisse wurden anhand des Scores nach Heyman und Herndon dokumentiert. Außerdem wurden bei den Patienten, welche mit Titanschrauben versorgt wurden, prä- und postoperativ Kernspintomografien zur Beurteilung der Hüftkopfvitalität durchgeführt. Ergebnisse: Die klinische Nachuntersuchung ergab vergleichbare Resultate der klinischen Scores nach Versorgung mit Kirschner-Drähten und Titanschrauben (3,13 ± 1,02 vs. 3,10 ± 1,01). Nach der Versorgung mit kanülierten Titanschrauben zeigte sich häufiger ein auffälliges Gangbild (33,3 % vs. 19 %) und weniger häufig ein positives Drehmann-Zeichen (10 % vs. 38 %) als nach Versorgung mit Kirschner-Drähten. Die Revisionsrate nach Verschraubung war geringer als nach Drahtspickung (16 % vs. 50 %). In einem Fall kam es bei Materialfehllage nach Drahtspickung zu einer Chondrolyse und Präarthrose. Die Metallentfernung der Kirschner-Drähte war unproblematisch, bei Entfernung der kanülierten Titanschrauben kam es in 4 von 10 Fällen zu einem Implantatversagen. Schlussfolgerung: Die Versorgung der ECF mit Kirschner-Drähten und kanülierten Titanschrauben zeigt im klinischen Verlauf vergleichbare Ergebnisse. Die Versorgung mit kanülierten Schrauben reduziert die Zahl der notwendigen Revisionseingriffe, die Materialentfernung ist dagegen erschwert. Aufgrund der geringeren Komplikationsrate bevorzugen wir mittlerweile die Verwendung von Stahlschrauben. Aim: The treatment of slipped capital femoral epiphysis (SCFE) is usually treated operatively, but there is still no consensus about the method to be used. Up to a 30° degree of slipping, the epiphysis is normally fixed in situ. The aim of our study was to compare the intermediate results after fixation in situ by K-wires versus cannulated titanium screws (Königsee-Implantate, Königsee-Aschau, Germany). Methods: In this study 46 patients with SCFE grade I and II and mostly chronic slipping of the epiphysis were included. After fixation in situ and, if necessary, careful, closed reposition, the patients were clinically and radiologically followed-up for one year. The clinical results were documented by the score adapted from Heyman and Herndon. Furthermore, MRI scans were done to evaluate the vitality of the epiphysis pre- and postoperatively, when titanium screws were used. Results: Clinical follow-up showed comparable results in the clinical scores after fixation by K-wires or cannulated titanium screws (3.13 ± 1.02 vs. 3.10 ± 1.01). After the treatment with titanium screws we saw a higher rate of abnormal gait (33.3 % vs. 19 %), a decreased rate of the positive Drehmann sign (10 % vs. 38 %) and a lower rate of revisions (16 % vs. 50 %) in comparison to K-wire fixation. After displacement of the K-wires we saw chondrolysis and prearthrosis in one case. Removal of the K-wires was done without any complications, while the removal of the cannulated titanium screws failed in 4 of 10 cases. Conclusion: The treatment of SCFE with K-wires and cannulated titanium screws showed comparable results in the clinical follow-up. The treatment with cannulated titanium screws reduces the number of necessary revisions, but the removal of the material is hindered. Because of the lower rate of complications we prefer in the meantime the use of cannulated steel screws.