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Z Orthop Unfall 2013; 151(1): 25-30
DOI: 10.1055/s-0032-1328209
Osteoporose
Georg Thieme Verlag KG Stuttgart · New York

Dihydrotestosteron verbessert die knöcherne Einheilung von Kobalt-Chrom-Implantaten

Dihydrotestosterone Improves the Osseointegration of Cobalt-Chromium Implants
U. M. Maus
1   Orthopädisches Zentrum, St. Antonius-Stift, Emstek
2   Universitätsmedizin Mainz, Orthopädische Klinik
,
M. Lühmann
1   Orthopädisches Zentrum, St. Antonius-Stift, Emstek
3   Unfall-, Hand- und Wiederherstellungschirurgie, Medizinisches Zentrum StädteRegion Aachen, Würselen
,
J. A. K. Ohnsorge
1   Orthopädisches Zentrum, St. Antonius-Stift, Emstek
4   Klinik für Orthopädie und Unfallchirurgie – Schwerpunkt Orthopädie, Universitätsklinikum Aachen
,
S. Andereya
4   Klinik für Orthopädie und Unfallchirurgie – Schwerpunkt Orthopädie, Universitätsklinikum Aachen
,
H. Schmidt
3   Unfall-, Hand- und Wiederherstellungschirurgie, Medizinisches Zentrum StädteRegion Aachen, Würselen
,
G. Zombory
4   Klinik für Orthopädie und Unfallchirurgie – Schwerpunkt Orthopädie, Universitätsklinikum Aachen
,
C. Siebert
5   Abteilung für Orthopädie und Sporttraumatologie, Medizinische Hochschule Hannover – Annastift e. V.
,
C. Niedhart
4   Klinik für Orthopädie und Unfallchirurgie – Schwerpunkt Orthopädie, Universitätsklinikum Aachen
› Author Affiliations
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Publication History

Publication Date:
19 February 2013 (online)

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Zusammenfassung

Hintergrund: Die knöcherne Einheilung von mittlerweile seltener eingesetzten Kobalt-Chrom-Implantaten kann insbesondere bei älteren Patienten problematisch sein. Ziel unserer Studie war es, den Effekt einer präoperativen Testosteron-Behandlung auf das knöcherne Einwachsen zu bewerten. Material und Methoden: Kobalt-Chrom-Molybdän-(CoCrMo-)Implantate von 1,6 mm Durchmesser wurden Ratten pressfit implantiert, wobei eine Gruppe (n = 10) 2 Tage präoperativ 1 mg Dihydrotestosteron (DHT) erhielt, die andere Gruppe (n = 10) blieb ohne präoperative Behandlung. Die Proben wurden nach 14 Tagen histologisch und histomorphometrisch sowie durch einen Pull-out-Test untersucht. Ergebnisse: Die biomechanischen Tests lieferten inkonsistente Daten und führten zu keinem signifikanten Unterschied (6,45 ± 6,94 N vs. 4,66 ± 3,77 N). Histologisch zeigte sich in beiden Gruppen ein geschlossener Kontakt zwischen den Implantaten und dem umgebenden Gewebe. Die Knochen/Implantat-Kontaktfläche war nach der Behandlung mit DHT signifikant erhöht (42,23 % ± 9,25 vs. 57,57 % ± 16,71, p < 0,05), der Anteil an unverkalkter Knochensubstanz (Osteoid) unterschied sich nicht signifikant zwischen den beiden Gruppen (38,68 % ± 16,7 vs. 27,38 % ± 13,02). Schlussfolgerung: Die Vorbehandlung mit DHT fördert die Osseointegration von Kobalt-Chrom-Implantaten durch eine verstärkte Mineralisierung des periimplantären Gewebes. Die Behandlung mit DHT kann zusätzlich die postoperative Rehabilitation aufgrund seiner positiven Auswirkungen auf die Muskulatur, gerade bei hypogonadalen Patienten, verkürzen.

Abstract

Background: The osseointegration of actually rarely implanted cobalt-chromium implants can be critical in an elderly population. The aim of our study was to evaluate the effect of preoperative testosterone treatment on the osseointegration of cobalt-chromium implants. Materials and Methods: Press-fit implantation of 1.6 mm-diameter cobalt-chromium-molybdenum (CoCrMo) implants was performed in rats without pre-treatment in one group (n = 10) and after pre-treatment with 1 mg dihydrotestosterone (DHT) 2 days before surgery in the other group (n = 10). After 14 days, the specimens were examined by a pull-out test, histology and histomorphometry. Results: The biomechanical testing delivered inconsistent data leading to no significant difference (6.45 ± 6.94 N vs. 4.66 ± 3.77 N). Histology showed closed contact between surrounding tissue and the implants in both groups. The bone/implant contact area was significantly enhanced after treatment with DHT (42.23 % ± 9.25 vs. 57.57 % ± 16.71, p < 0.05), while the ratio of osteoid was reduced (38.68 % ± 16.7 vs. 27.38 % ± 13.02, not significant). Conclusions: Pre-treatment with DHT enhances osseointegration of cobalt-chromium implants through enhanced mineralisation of peri-implant tissue. The treatment might additionally shorten postoperative rehabilitation due to its positive effects on musculature.

Schlüsselwörter

Knochen - Osseointegration - Dihydrotestosteron - Kobalt-Chrom - Mineralisation

Key words

bone - osseointegration - dihydrotestosterone - cobalt-chromium - mineralisation
 

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