Osteoarthritis (OA) affects the whole joint and leads to chronic pain. The sympathetic nervous system (SNS) seems to be involved in OA pathogenesis, as indicated by in vitro studies as well as by our latest work demonstrating that sympathectomy in mice results in increased subchondral bone volume in the OA knee joint. We assume that chronic stress may lead to opposite effects, such as an increased bone loss in OA due to an elevated sympathetic tone. Therefore, we analyzed experimental OA progression in mice exposed to chronic stress. OA was induced in male C57BL/6J mice by surgical destabilization of the medial meniscus (DMM) and Sham as well as non-operated mice served as controls. Half of these groups were exposed to chronic unpredictable mild stress (CUMS). After 12 weeks, chronic stress efficiency was assessed using behavioral tests. In addition to measuring body weight and length, changes in subchondral bone were analyzed by μCT. Dynamic Weight Bearing system was used to monitor OA-related pain. Histological scoring will be conducted to investigate the severity cartilage degeneration and synovial inflammation. CUMS resulted in increased anxiety and significant decrease in body weight gain in all CUMS groups compared to non-CUMS groups. CUMS also increased serum corticosterone in healthy mice, with even higher levels in CUMS mice after DMM surgery. CUMS had no significant effect on subchondral bone, but subarticular bone mineral density and trabecular thickness were increased. Moreover, CUMS resulted in significant potentiation of DMM-associated pain. Our results suggest that the autonomic imbalance with increased sympathetic nervous activity induced by chronic stress exacerbates the severity of OA pain perception. We expect significantly increased cartilage degeneration as well as more severe synovial inflammation in CUMS DMM mice compared to DMM mice.

Introduction: The osteitis of the tibia still is a common problem in orthopaedic surgery. Long lasting treatment time and possible recurrent infections bring a lot of medical and social problems to the patient. We compared in this study a group being treated in the conventional way by bone grafting the defect with another group, which had an Ilizarov procedure to find out, which method brings better results for the patient.

Material and Methods: Each group consisted of 65 patients about the same age. The follow up time was averaged 7.5 years. The size of the defect was in the conventional group 2.5 cm in the Ilizarov group 6.4 cm. Patients were classified to the Cierny Mader Classifications in both groups. Each patient was examined at the time of follow up clinically and radiologically. Special topics were: Pain, job, social activity etc. Scores were evaluated using SF 36. More than this, a questionnaire was handed out to each patient which was filled out after the investigation and was mailed back from home, not to influence the patient during the investigation. These dates were scored by Nottingham Health Profile.

Results: Healing time with the Ilisarov group was longer on the total way, but related to 1 cm defect shorter. Time of hospitalization, number of operations were very similar in both groups. There were more leg length discrepancies and axis deviations in the Ilizarov group. Refering to the job 67% of the Ilizarov group, but only 48% of the conventional group returned to their original profession. Life quality (SF 36 and Nottingham Health Profile) testing was better in the Ilizarov group too. Recurrent infection was seen in the conventional group in 13.8%, in the Ilizarov group only in 9% including the pin track Osteitis. A recurrent infection in the callus distraction group was seen only in 1 case.

Conclusions: Ilizarov treated patients show better long tenn results, even if they are classified B-type hosts, according to the Cierny Mader Classification. They return earlier to work and demonstrate better life quality results. In future these results might even be better, if axis deviations and leg length discrepancies could be minimized. With host B patients the conventional treatment should not be favoured, Ilizarov procedure brings better results too.