An evaluation of the posterior cruciate ligament function in total knee arthroplasty with regard to its morphology and clinical properties.

The aim of the study was to determine the degree of posterior cruciate ligament (PCL) degeneration and the reduction in the number of its mechanoreceptors, in patients with advanced degenerative joint disease. PCLs taken from study group of 50 patients in the mean age of 70.7 (53-84) years with a diagnosis of advanced idiopathic osteoarthritis undergoing condylar total knee arthroplasty were compared to those taken form the control group of 10 knee joints of cadavers. Groups were matched with regard to sex and age. Histological examination of PCLs of the study group showed changes of an inflammatory process and no significant signs of osteoarthritis in the control group. A close correlation was found between the severity of degenerative changes on the X-ray images according to the Ahlbäck scale, and the increased mucoid degeneration (p < 0.0001), the severity of the degeneration of the collagen structure (p < 0.0001) and the presence of proprioceptors of PCLs (p < 0.0001). Conserving the PCL by the use of type cruciate retaining knee arthroplasty does not guarantee the preservation of correct proprioceptive sensation.

Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet.

BACKGROUND: The contemporary American diet figures centrally in the pathogenesis of numerous chronic diseases-'diseases of civilization'. We investigated in humans whether a diet similar to that consumed by our preagricultural hunter-gatherer ancestors (that is, a paleolithic type diet) confers health benefits. METHODS: We performed an outpatient, metabolically controlled study, in nine nonobese sedentary healthy volunteers, ensuring no weight loss by daily weight. We compared the findings when the participants consumed their usual diet with those when they consumed a paleolithic type diet. The participants consumed their usual diet for 3 days, three ramp-up diets of increasing potassium and fiber for 7 days, then a paleolithic type diet comprising lean meat, fruits, vegetables and nuts, and excluding nonpaleolithic type foods, such as cereal grains, dairy or legumes, for 10 days. Outcomes included arterial blood pressure (BP); 24-h urine sodium and potassium excretion; plasma glucose and insulin areas under the curve (AUC) during a 2 h oral glucose tolerance test (OGTT); insulin sensitivity; plasma lipid concentrations; and brachial artery reactivity in response to ischemia. RESULTS: Compared with the baseline (usual) diet, we observed (a) significant reductions in BP associated with improved arterial distensibility (-3.1+/-2.9, P=0.01 and +0.19+/-0.23, P=0.05);(b) significant reduction in plasma insulin vs time AUC, during the OGTT (P=0.006); and (c) large significant reductions in total cholesterol, low-density lipoproteins (LDL) and triglycerides (-0.8+/-0.6 (P=0.007), -0.7+/-0.5 (P=0.003) and -0.3+/-0.3 (P=0.01) mmol/l respectively). In all these measured variables, either eight or all nine participants had identical directional responses when switched to paleolithic type diet, that is, near consistently improved status of circulatory, carbohydrate and lipid metabolism/physiology. CONCLUSIONS: Even short-term consumption of a paleolithic type diet improves BP and glucose tolerance, decreases insulin secretion, increases insulin sensitivity and improves lipid profiles without weight loss in healthy sedentary humans.

Increased responsiveness to toll-like receptor 4 stimulation in peripheral blood mononuclear cells from patients with recent onset rheumatoid arthritis.

BACKGROUND: Cell signaling via Toll-like receptors (TLRs) leads to synovial inflammation in rheumatoid arthritis (RA). We aimed to assess effects of TLR2 and TLR4 stimulation on proinflammatory cytokine production by peripheral blood mononuclear cells (PBMCs) from patients with recent-onset RA, osteoarthrosis (OA), and healthy control (HC). METHODS: PBMCs were stimulated with LPS, biglycan and cytokine mix. Cytokines were analyzed in supernatants with ELISA. Expression of toll-like receptors mRNA in leukocytes was analyzed using real-time qPCR. RESULTS: PBMCs from RA patients spontaneously produced less IL-6 and TNFalpha than cells from OA and HC subjects. LPS increased cytokines' production in all groups. In RA patients increase was dramatic (30 to 48-fold and 17 to 31-fold, for respective cytokines) compared to moderate (2 to 8-fold) in other groups. LPS induced 15-HETE generation in PBMCs from RA (mean 251%) and OA patients (mean 43%), although only in OA group, the increase was significant. TLR2 and TLR4 gene expressions decreased in response to cytokine mix, while LPS enhanced TLR2 expression in HC and depressed TLR4 expression in OA patients. CONCLUSION: PBMCs from recent-onset RA patients are overresponsive to stimulation with bacterial lipopolysaccharide. TLR expression is differentially regulated in healthy and arthritic subjects.

[Short stature treatment by lower limb lengthening--multicenter study from five centers]. / Leczenie niskiego wzrostu metoda Ilizarowa--zbiorcza analiza wyników z pieciu osrodków w Polsce.

MATERIAL: 26 patients (17 female, 9 male) from 5 centers were evaluated. The age at the beginning of treatment ranged from 6 to 29 years (mean 13.8). The cause of short stature in 19 patients was achondroplasia or pseudoachondroplasia, in next 2--other bone dysplasias. The other 5 patients had not bone pathology and were treated because of cosmetic indications. Preoperative body height ranged from 90 to 149 cm (mean 120). Axial deviations of the lower extremities were noted in 11 patients. Mean follow-up was 3.7 years. METHOD OF TREATMENT: Most of patients were treated with Ilizarov device using cross lengthening strategy (2 stages--opposite femur and tibia lengthening). Mean duration of treatment including interval between two stages (mean 12 months) was 29 months. Planned increase of body height ranged from 10 to 26 cm (mean 16.4). RESULTS: Planned or greater lengthening (mean 14.8 cm) was achieved in 14 patients. Partial planned lengthening (mean 65% of planned lengthening) was achieved in 8 patients (mean 11.8 cm) including two patients who resigned the second stage of treatment. In two patients lengthening was stopped during first month of treatment because of great complications. In 2 patients treatment was not completed (interval between first and second stage). Mean increase of body height of patients with complete treatment was 13.1 cm (from 2 to 28). Problems, obstacles and complications were analyzed according to Paley classification. PROBLEMS: There were 24 problems in 15 patient (inflammation process around K wires--15 patients, bone healing disturbances--3, regenerate fracture--2, transient foot equinus--2 and axial deviation of the lower extremity--1). OBSTACLES: There were 31 obstacles in 19 patients (regenerate's defect--7 patients, premature bone consolidation--6, foot equinus--4 and other--14). COMPLICATIONS: There were 26 complications in 18 patients (axial deviation of the lengthened segment--8, foot equinus--6, paresis of the peroneal nerve--3, fractures--2 and other--5). The most serious complication was hemiparesis after cerebral embolism (1 patient) and damaging of the femoral artery (1 patient) both disrupting bone lengthening. CONCLUSION: The risk of complication in surgical treatment of short stature patients is high. Qualification for short stature treatment because of cosmetic indication should be made very careful and after precise psychological and/or psychiatric investigation.

[Corrective surgical procedures as repeated treatment of residual clubfoot]. / Zabiegi poprawcze jako uzupelnienie leczenia operacyjnego wrodzonej stopy konsko-szpotawej.

The authors present an analysis of failed surgery in 139 patients with congenital clubfeet. There were 72 feet, which required repeated surgical procedures after primary treatment. Twelve feet were treated by posterior release, and 65 by postero-medial release. The repeated reconstruction was performed at a mean age of 3.6 years. No very good results were found in either group at final follow-up, done according to the Magone et al. classification. In the first group treated by posterior release god results were noted in 53.3% of the cases, sufficient in 43.1% and poor in 38.5%. The authors underline that the final results depend on early consequent conservative treatment, use of adequate operating techniques and cooperation between child, parents, physician and orthotic specialist.

Revision hip arthroplasty in aseptic loosening of total hip replacement.

Background. Problems encountered during revision hip arthroplasty are presented, based on 30 years of experience at the Orthopedic Clinic of the Medical University of Lodz.
Material and methods. During this period of time 96 cases (5,13%) with aseptic hip loosening were diagnosed. All patients were evaluated clinically based o the Merle d'Aubigne-Postel criteria, and radiologically by means of De Lee and Gruen migration zones.
Results. In our material hip loosening was most frequently observed in cases where a McKee-Farrar hip prosthesis had been used, and in cases with a PM uncemented acetabulum or uncemented Mittelmeier pin.
Conclusions. The study showed that surgical technique plays the most significant role in aseptic loosening of hip replacement. The aseptic loosening of hip prostheses should be diagnosed early, and revision hip arthroplasty should be performed as soon as possible. This surgery must be preformed in specialized centers with adequate equipment and a team of experienced surgeons.

Experimental epiphysiodesis: magnetic resonance imaging evaluation with histopathologic correlation.

We performed an experimental epiphysiodesis on the tibia in 16 immature New Zealand white rabbits. The purpose was to study the process of trauma-induced growth plate closure. The animals were killed at weekly intervals over 8 weeks. We correlated the histological findings with serial magnetic resonance images. The undamaged, central part of the growth plate became histologically abnormal within 1 week. Mature bone bridge formation in the area of the epiphysiodesis was seen after 3 to 4 weeks. The study suggests that growth arrest starts before the bone bridge formation. Factors regulating cartilage growth may also play a role.

[The use of Bicontact hip prosthesis in treatment of coxarthrosis]. / Zastosowanie endoprotezy Bicontact w leczeniu zmian zwyrodnieniowych stawu biodrowego.

The issue of a stabile, long lasting bone-implant interface is still very valid. One of the new models of uncemented hip prosthesis is the Bicontact prosthesis made by Aesculap. This four-part endoprosthesis offers two types of cups: threaded München type and spherical Plasmacup type. The prosthesis stem is a wedged type stem, porous in the proximal type. The aim of this paper was to evaluate the value of Bicontact prosthesis in treatment of coxarthrosis. Our material consisted of 69 patients (38 female and 31 male) with 72 operated hips. Average age of the patients was 50.8 years. The mean follow-up was 24.5 months. Clinical and radiological evaluation according to Merle d'Aubine-Postel classification with Charnley's modification yielded 88% very good and good results. In 11 hips a similar complication was noted--fracture of the femur during final hammering of the prosthesis stem into the medullary canal. This was immediately repaired by circular wire fixation without any influence on the final result. This complication was observed during the first procedures. The learning curve of surgical technique allowed us to avoid this complication during subsequent procedures. We concluded that type of hip prosthesis was is very useful in in treatment of coxarthrosis.

[Heterotopic ossification as a complication of total hip replacement]. / Kostnienie pozaszkieletowe jako powiklanie calkowitej alloplastyki stawu biodrowego.

Heterotopic ossification is the most common complication after THR. The authors present the distribution of frequency of ectopic ossification after cementless THR using Mittelmeier and Parhofer-Mönch prosthesis and it's influence on THR outcome. 151 hip joints were evaluated with a follow-up period of more than 2 years. All procedures were performed by a lateral approach. The ectopic ossification was verified according to the Brooker classification. Clinical evaluation was performed according to the d'Aubigne-Postel method in Charnley's modification. The 3rd degree ectopic ossification was found in 14 hip joint and 4th degree ectopic ossification in 2 hip joints (together 10.6%). The positive correlation between the degree of ossification (3rd and 4th) and the decrease of range of motion of the hip joint along with an increase in pain after THR was found.

[An analysis of selected risk factors of aseptic loosening of hip endoprosthesis]. / Analiza wybranych czynników ryzyka aseptycznego obluzowania calkowitej endoprotezy stawu biodrowego.

An analysis of selected risk factors of aseptic loosening of hip endoprosthesis has been attempted on the ground of retrospective evaluation of 57 hips in 54 patients (41 females, 13 males) who underwent revision of the hip replacement. Age of the patients at primary surgery ranged from 18 to 73 years (mean 55.6 years). Follow-up ranged from 8 to 212 months (mean 83 months). Originally, in 45 cases cemented hip replacement was done and in 12 cementless endoprosthesis was implanted. In 34 cases both components were replaced, in 14 cases acetabular component, in 9 cases stem only and in 1 case the endoprosthesis was removed. Clinical evaluation was done according to Merle-d'Aubignea criteria, radiologic assessment was done according to DeLee and Charnley classification and the one of Gruen. Within 10 years after primary surgery all cementless hips were revised (all Parhofer-Mönch type within 5 years). Among Weller cemented replacements both components were replaced in 18 cases, acetabulum in 8, the stem in 5 and 1 endoprosthesis was removed. McKee-Farrar implants were replaced completely in all but 2 cases. Most of revisions among cemented hip replacements took place 10 years after primary operation. Angular migration of the acetabular component was found in 40 cases; in 8 cases no migration was observed. Forty-three hips with loosened stem have been analyzed: to small size of the stem was found in 6 cases, varus deviation was found in 14 cases and valgus deviation in 6. Special attention has been paid to the technical errors that are essential for long-term result of hip replacement.

[Clinical evaluation of the hip joint after implantation of cementless Mittelmeier type and Parhofer-Mönch type hip prosthesis]. / Ocena kliniczna stawu biodrowego po implantacji endoprotezy bezcementowej typu Mittelmeiera i Parhofera-Möncha.

Total hip replacement is the most common procedure in the treatment of severe degenerative changes in the hip joint. The authors present clinical evaluation of 129 patients (151 hips) who underwent total hip replacement using either the Mittelmeier type or the Parhofer-Mönch type hip prothesis. The age of the patients ranged at the time of the operation between 17 and 74 years (average 44.9). The follow-up ranged from 24 to 143 months (average 61.2 months). The P-M prothesis was implanted in 53 hips, the P-M "Plasmapore" prothesis in 42 patients, Mittelmeier Autophor 900 prothesis in 49 patients and the Mittelmeier Autophor 900S prothesis in 7 patients. Clinical evaluation was performed according to the d'Aubigne-Postel method with the Charnley modification. The results were graded as very good in 17 cases, good in 64 cases, satisfactory in 53 cases and poor in 17 cases. Very good and good results were mainly observed after implantation of the P-M type prothesis and P-M "Plasmapore" type prothesis. Worse results were observed in patients, who at the time of the operation were aged 45 years or less and who had congenital hip dysplasia. P-M type prothesis gives better clinical results in the treatment of degenerative changes of the hip joint.

[The value of selected imaging techniques in evaluation of bone regeneration during limb lengthening]. / Wartosc wybranych metod obrazowych w ocenie regeneratu kostnego w procesie wydluzania konczyn dolnych.

The paper presents the value of different imaging techniques, including X-rays, ultrasonography, computed tomography and densitometry in the evaluation of bone regenerates during limb lengthening. Material consisted of 60 children, age ranging from 4 to 18 years who underwent surgery using the Ilizarov technique because of limb inequality. During of limb lengthening different imaging techniques were employed for monitoring regenerate growth and remodeling. The study showed that all the employed imaging techniques play an important role in monitoring bone regenerate remodeling at different stages of limb lengthening.

[Long term results of the treatment of clubfoot with postero-medial fibular graft]. / Odlegle wyniki leczenia wrodzonej stopy konsko-szpotawej metoda uwolnienia okoloskokowego.

The authors present long term results of treatment of congenital clubfoot by postero-medial release. Our material consisted of 82 patients, with 103 clubfeet, 5 months to 9 years old (mean age 22 months) at the time of surgery. The age at the time of the final follow-up ranged from 6.3 to 27 years. Final results were evaluated according to the Magone classification. Basing on this classification we achieved very good results in 9 feet, good results in 20, sufficient results in 28 and poor results in 46 feet. In the analyzed group most of the results were either sufficient or poor--71.84% of the cases. These feet required further surgical procedures. The authors stress that incorrect classification for this type of surgery and inadequate surgical technique caused a high percentage of poor and sufficient results.

The treatment of pseudarthrosis using the Ilizarov method.

This paper presents a method for treating pseudarthrosis in the lower limbs using the Illizarov method. 20 patients were treated, including 3 cases with infected false joints. Bone union was attained in cases with infected false joints. Bone union was attained in cases of pseudarthrosis without infection within an average time of 8 months. In cases of infected false joints the time required to achieve bone union was 12 months. On the basis of the authors' observations the method described here proved to be suitable for the treatment of disturbed bone union. The value of this method is further increased by the slow, steady correction of axial disorders in the limb accompanied by simultaneous equalization. Bone union was achieved in 94,2% of the cases studied.

The application of shock waves in the treatment of delayed bone union and pseudoarthrosis in long bones.

Lithotripsis using shock waves generated extracorporeally was administered to 46 patients with pseudarthrosis or delayed union of long bone fractures. From 1500 to 3000 high energy shock waves were administered one time only on an outpatient basis. Anesthesia was not required. No complications were observed. Complete recovery was obtained in all 25 patients with delayed union, and in 12 of the 21 patients with pseudoarthrosis (57%). The initiation of callus formation was observed 6-12 weeks after treatment. These results confirm that bone union can be stimulated by shock waves. The treatment procedure, advantages, contraindications and reasons for failures are discussed. This method appears to be a valuable supplement to the treatment of bone union disturbances.

[Long-term results of surgical treatment for clubfoot with the posterior release method]. / Odlegle wyniki leczenia operacyjnego wrodzonej stopy konsko-szpotawej metoda uwolnienia tylnego.

The authors present long term results of congenital clubfoot by posterior release. Our material consisted of 57 patients, with 57 clubfeet, 5 to 27 months old (mean age 9.5 months) at the time surgery. The age at the time of the final follow-up ranged from 8 to 20 years (mean age 14.7 years). The time of the observation ranged from 7 to 20 years (mean 13.9 years). Final results were evaluated according to the Magone classification. Basing on this classification we achieved very good results in 21.3%, good results in 29.3%, sufficient results in 26.7% and poor results in 22.6%. In the authors opinion posterior release and Achilles tendon elongation give the best possibility of correction of residual deformation. Varus deformity, abduction and equinal position should not be treated by posterior release.

[Surgical treatment of congenital clubfoot with constriction band syndrome]. / Leczenie operacyjne wrodzonej stopy konsko-szpotawej ze wspólistniejacymi przewezeniami amniotycznymi goleni.

Twelve feet in 11 patients with constriction band syndrome age ranging from 3 to 18 months (mean age 11 months) were evaluated in this study. The constriction band was located at the in the calf, at distal, media and proximal third levels. All these patients were treated surgically by a wide peritalar release using the Cincinnati incision, followed by a two-stage Z-skin plasty. Both clinical and radiological results were evaluated. In our material an excellent result was achieved in 1 case, good results in 3 cases, satisfactory in 4 cases and poor in the remaining four cases. Very good and good results were achieved in feet with shallow bands type II and III, while poor results were found in feet with deep constriction band type I. Early surgical treatment followed by serial casting leads to better functional results.

[Analysis of intraoperative complications during surgery for clubfoot]. / Analiza powiklan wystepujacych podczas operacyjnego leczenia wrodzonych stóp konsko-szpotawych.

The paper presents an analysis of the complications accompanying surgical treatment of congenital club feet. In the year 1966-1993 178 feet in 149 patients aged ranging from 5 to 140 months (mean age 17.5 months. In 57 cases a posterior capsulotomy with lengthening of the Achilles tendon was performed, in 121 cases a total sub-talar release was performed. Complications wee classified as intra-operative and early and late post-operative. A total of 85 complications in 44 patients were observed, which amount to 44.7% of the cases. In 16 cases intra-operative complications were a result of technical mistakes during the procedure (severing of a tendon, blood vessel or joint). Post-op complications were due to wound healing disturbances in 28 cases and necrotic changes in 12 cases. Sub-talar release gives a larger number of complications (55.4%) compared to posterior capsulotomy with Achilles tendon lengthening (31.6%).

[Application of the Ilizarov apparatus in the treatment of knee osteoarthritis]. / Zastosowanie aparatu Ilizarowa w nadwiezadlowej osteotomii kosci piszczelowej w leczeniu zmian zwyrodnieniowych stawu kolanowego.

Illizarov apparatus has been applied to stabilize "dome" high tibial osteotomy in 14 cases (11 females and 3 males). The age of patients ranged from 22 to 77 years (mean 60.3 years). Varus deformity was present in 12 cases (mean 18 deg) and valgus in 2 (mean 20 deg). The Dihlman's classification of knee osteoarthritis was used. The patients started full weight bearing on the second postoperative day. Primary bone union was achieved in all cases within 6 weeks and at this point the fixator was removed. The range of knee motion was good, no neurovascular complications occurred. Superficial infection around K-wire was found in 4 cases but did not require any replacement. Temporary limitation of the ankle motion occurred in 2 cases. Good clinical results and high patients satisfaction proved Illizarov apparatus effectiveness in treatment of knec osteoarthritis.