Comparative study of Vancouver type B2 periprosthetic fractures treated by internal fixation versus stem revision.

PURPOSE: Currently, accepted treatment for periprosthetic femoral fractures with loose femoral stem indicates its revision; however, recent studies have proposed treating Vancouver type B2 fractures via internal fixation without stem revision, particularly in the elderly or multi-morbid patients. Despite indications for stem revision, some surgeons tend to perform internal fixation. The main goal of this study was therefore to identify the parameters that were significantly different comparing internal fixation to stem revision for Vancouver type B2 fractures. METHODS: Eighty-one Vancouver B2 periprosthetic femoral fractures, treated between 2010 and 2019, were analysed. The internal fixation (ORIF) and the revision groups were compared. Patients' age, BMI, American Society of Anaesthesiologists (ASA) score, anaesthesia type, operating time, blood loss, surgeons' experience, post-operative weight-bearing, length of hospital stay, and radiological outcome using AGORA roentgenographic assessment were analysed. RESULTS: Patients chosen for ORIF were significantly older than those treated by stem revision (85.4 vs 75.1 years; p = 0.002). Blood loss was 390.7 and 1141.6 ml in the ORIF and revision groups, respectively (p < 0.0001). The surgical times were 134.5 and 225 min in the ORIF and revision groups, respectively (p < 0.0001). Our analysis of BMI, ASA score, anaesthesia type, length of hospital stay, surgeons' experience and radiological outcome, were not significantly different between the two groups. CONCLUSION: Revision did not exhibit better radiological results; moreover, internal fixation resulted in significantly less perioperative blood loss and a shorter operating time, concluding that ORIF is a viable alternative to revision arthroplasty, particularly in older patients.

A prospective study of 93 unicompartmental knee prosthesis emphasises the appearance of radiolucencies under the tibial component.

Background and study aims: Here, we report the presence of radiolucent lines in a consecutive group of 93 partial knee replacements (UKA). Materials and methods: The prospective study was conducted from 2011 to 2019 with a minimum follow-up of two years. Clinical data and radiographs were recorded. Of the 93 UKA, 65 were cemented. The Oxford Knee Score was recorded before and two years after surgery. In 75 cases, the follow-up was conducted at > 2 years. A lateral knee replacement was performed in 12 cases. In one case, a medial UKA with patellofemoral prosthesis was performed. Results: In eight patients (8.6%), a radiolucent line (RLL) underneath the tibia component was observed. In four of these eight patients, RLLs were non-progressive, without clinical implications. In two cemented UKAs, RLLs were progressive and were revised with total knee arthroplasty. Early severe osteopenia of the tibia (zone 1 to 7) in the frontal view was observed in two cementless medial UKA cases. The demineralisation occurred spontaneously five months after surgery. We diagnosed two early deep infections, one of which was treated locally. Conclusions: RLLs were present in 8.6% of the patients. Even in severe cases of osteopenia, spontaneous recovery of RLLs is possible with cementless UKAs.

Axial plane characteristics of thoracic scoliosis and their usefulness for determining the fusion levels and the correction technique.

PURPOSE: There is insufficient information regarding axial plane characteristics of scoliosis despite its 3D nature. The posterior-anterior vertebral vector (VV) has been proposed to characterize the axial plane appearances of the thoracic scoliosis. This study aimed to highlight the importance of knowledge of axial plane features when determining fusion levels and correction techniques of thoracic curves. METHODS: Altogether, 233 thoracic curves were analyzed using the VV after proving its usability instead of 3D angles to determine axial plane parameters such as apical vertebral (APV) axial rotations, APV lateral displacement, and intervertebral rotations (IVR). K-means clustering and regression analysis were used to identify axial plane curve patterns and determine the relationship between the coronal angles and axial plane characteristics, respectively. RESULTS: A close correlation was found between 3D angles and VV projected angles. Eight axial plane clusters were distinct, exhibiting different lateral APV displacement toward the interacetabular axis with relatively small axial rotations and a simultaneous decrease in sagittal curves. The regression analysis showed that the correlation of coronal curve magnitude was significantly stronger (r = 0.78) with APV lateral translation than with APV axial rotation (r = 0.65). CONCLUSION: Based on these findings, the primary goal of scoliosis correction should focus on minimizing lateral translation rather than eliminating axial rotation. Knowing the IVR in the axial plane helps accurately determine the limits of the structural curves. VV-based axial views can facilitate the accurate determination of the end vertebrae and selection of the appropriate correction technique of the curve. These slides can be retrieved under Electronic Supplementary Material.

Axial plane dissimilarities of two identical Lenke-type 6C scoliosis cases visualized and analyzed by vertebral vectors.

PURPOSE: The global appearance of scoliosis in the horizontal plane is not really known. Therefore, the aims of this study were to analyze scoliosis in the horizontal plane using vertebral vectors in two patients classified with the same Lenke group, and to highlight the importance of the information obtained from these vertebral vector-based top-view images in clinical practice. METHODS: Two identical cases of scoliosis were selected, based on preoperative full-body standing anteroposterior and lateral radiographs obtained by the EOS™ 2D/3D system. Three-dimensional (3D) surface reconstructions of the spinal curves were performed by using sterEOS™ 3D software before and after surgery. In both patients, we also determined the vertebral vectors and horizontal plane coordinates for analyzing the curves mathematically before and after surgery. RESULTS: Despite the identical appearance of spinal curves in the frontal and sagittal planes, the horizontal views seemed to be significantly different. The vertebral vectors in the horizontal plane provided different types of parameters regarding scoliosis and the impact of surgical treatment: reducing lateral deviations, achieving harmony of the curves in the sagittal plane, and reducing rotations in the horizontal plane. CONCLUSIONS: Vertebral vectors allow the evolution of scoliosis curve projections in the horizontal plane before and after surgical treatment, along with representation of the entire spine. The top view in the horizontal plane is essential to completely evaluate the scoliosis curves, because, despite the similar representations in the frontal and sagittal planes, the occurrence of scoliosis in the horizontal plane can be completely different. These slides can be retrieved under Electronic Supplementary Material.

The horizontal plane appearances of scoliosis: what information can be obtained from top-view images?

PURPOSE: A posterior-anterior vertebral vector is proposed to facilitate visualization and understanding of scoliosis. The aim of this study was to highlight the interest of using vertebral vectors, especially in the horizontal plane, in clinical practice. METHODS: We used an EOS two-/three-dimensional (2D/3D) system and its sterEOS 3D software for 3D reconstruction of 139 normal and 814 scoliotic spines-of which 95 cases were analyzed pre-operatively and post-operatively, as well. Vertebral vectors were generated for each case. Vertebral vectors have starting points in the middle of the interpedicular segment, while they are parallel to the upper plate, ending in the middle of the segment joining the anterior end plates points, thus defining the posterior-anterior axis of vertebrae. To illustrate what information could be obtained from vertebral vector-based top-view images, representative cases of a normal spine and a thoracic scoliosis are presented. RESULTS: For a normal spine, vector projections in the transverse plane are aligned with the posterior-anterior anatomical axis. For a scoliotic spine, vector projections in the horizontal plane provide information on the lateral decompensation of the spine and the lateral displacement of vertebrae. In the horizontal plane view, vertebral rotation and projections of the sagittal curves can also be analyzed simultaneously. CONCLUSIONS: The use of posterior-anterior vertebral vector facilitates the understanding of the 3D nature of scoliosis. The approach used is simple. These results are sufficient for a first visual analysis furnishing significant clinical information in all three anatomical planes. This visualization represents a reasonable compromise between mathematical purity and practical use.

Comparison of scoliosis measurements based on three-dimensional vertebra vectors and conventional two-dimensional measurements: advantages in evaluation of prognosis and surgical results.

PURPOSE: A new concept of vertebra vectors based on spinal three-dimensional (3D) reconstructions of images from the EOS system, a new low-dose X-ray imaging device, was recently proposed to facilitate interpretation of EOS 3D data, especially with regard to horizontal plane images. This retrospective study was aimed at the evaluation of the spinal layout visualized by EOS 3D and vertebra vectors before and after surgical correction, the comparison of scoliotic spine measurement values based on 3D vertebra vectors with measurements using conventional two-dimensional (2D) methods, and an evaluation of horizontal plane vector parameters for their relationship with the magnitude of scoliotic deformity. METHODS: 95 patients with adolescent idiopathic scoliosis operated according to the Cotrel-Dubousset principle were subjected to EOS X-ray examinations pre- and postoperatively, followed by 3D reconstructions and generation of vertebra vectors in a calibrated coordinate system to calculate vector coordinates and parameters, as published earlier. Differences in values of conventional 2D Cobb methods and methods based on vertebra vectors were evaluated by means comparison T test and relationship of corresponding parameters was analysed by bivariate correlation. Relationship of horizontal plane vector parameters with the magnitude of scoliotic deformities and results of surgical correction were analysed by Pearson correlation and linear regression. RESULTS: In comparison to manual 2D methods, a very close relationship was detectable in vertebra vector-based curvature data for coronal curves (preop r 0.950, postop r 0.935) and thoracic kyphosis (preop r 0.893, postop r 0.896), while the found small difference in L1-L5 lordosis values (preop r 0.763, postop r 0.809) was shown to be strongly related to the magnitude of corresponding L5 wedge. The correlation analysis results revealed strong correlation between the magnitude of scoliosis and the lateral translation of apical vertebra in horizontal plane. The horizontal plane coordinates of the terminal and initial points of apical vertebra vectors represent this (r 0.701; r 0.667). Less strong correlation was detected in the axial rotation of apical vertebras and the magnitudes of the frontal curves (r 0.459). CONCLUSIONS: Vertebra vectors provide a key opportunity to visualize spinal deformities in all three planes simultaneously. Measurement methods based on vertebral vectors proved to be just as accurate and reliable as conventional measurement methods for coronal and sagittal plane parameters. In addition, the horizontal plane display of the curves can be studied using the same vertebra vectors. Based on the vertebra vectors data, during the surgical treatment of spinal deformities, the diminution of the lateral translation of the vertebras seems to be more important in the results of the surgical correction than the correction of the axial rotation.

The EOS™ imaging system and its uses in daily orthopaedic practice.

BACKGROUND: The EOS™ X-ray machine, based on a Nobel prize-winning invention in physics in the field of particle detection, is capable of a simultaneous capture of biplanar X-ray images by slot scanning of the whole body in an upright, physiological load-bearing position, using ultra-low radiation doses. The simultaneous capture of spatially calibrated anterioposterior and lateral images provides a three-dimensional (3D) surface reconstruction of the skeletal system using a special software. Parts of the skeletal system in X-ray images and 3D-reconstructed models appear in true 1:1 scale for size and volume, thus spinal and vertebral parameters, lower limb axis lengths and angles, as well as any relevant clinical parameters in orthopaedic practice can be very precisely measured and calculated. Visualisation of 3D reconstructed models in various views by sterEOS 3D software enables presentation of top view images to help analyse rotational conditions of lower limbs, joints and spine deformities in the horizontal plane, providing revolutionary novel possibilities in orthopaedic surgery, especially in spine surgery. APPROACH AND CONCLUSIONS: Our department has been extensively using the very first commercially available EOS™ imaging system worldwide for routine orthopaedic diagnostics since June 2007. During this period of about 4.5 years, more than 5,700 standard examinations have been carried out, about a third of them in spine deformity cases and the rest in lower limb orthopaedic cases. In this mini-review, general principles and uses of this groundbreaking integrated orthopaedic solution is reviewed with a few highlighted examples from our own clinical practice.

Geometrical values of the normal and arthritic hip and knee detected with the EOS imaging system.

PURPOSE: EOS 2D/3D is an integrated, low-dose orthopedic digital radioimaging solution, which, due to its groundbreaking properties, has recently shown an increasing application in scoliosis surgery. Its integrated sterEOS 3D software allows creation of patient-specific three-dimensional (3D) lower limb models, and can produce geometrical parameters in 3D. Currently there are a limited number of reports on EOS for lower limb applications. METHODS: Three-dimensional reconstructions of 256 hip and knee joints of 128 healthy subjects, as well as 53 hips and 46 knees of 69 patients with hip or knee arthritis, were evaluated based on orthogonal EOS two-dimensional (2D) images. Measurements for hips included femur and tibia length, total length of the extremity, femoral antetorsion and offset, femoral neck length, neck-shaft and hip-knee-shaft (HKS) angles. Lower limb alignment in both frontal and sagittal planes were determined in normal and arthritic knees. Values were compared with those obtained by standard methods published by others. RESULTS: Normal hip and knee geometrical parameters were found in our healthy subjects. In osteoarthritic cases, values for neck-shaft angle, femoral antetorsion, femur length and total length of the extremity were shown to decrease non-significantly. Evaluation of lower limb alignment in healthy and arthritic knees showed normal values in healthy subjects apart from three cases with an average six degrees varus. Arthritic knees were most frequently found to have a varus angulation, with the exception of 11 cases with normal or valgus alignment. CONCLUSION: EOS 2D/3D with its sterEOS 3D reconstruction is useful for a comprehensive 3D examination of the lower limb. In the near future it may be suitable for daily routine diagnostics of orthopedic lower limb deformities as a primary examination method.

[Principles of the EOS™ X-ray machine and its use in daily orthopedic practice]. / Az EOS™ röntgengép elve és gyakorlati használata a mindennapi ortopédiai gyakorlatban.

The EOS™ X-ray machine, based on a Nobel prize-winning invention in Physics in the field of particle detection, is capable of simultaneously capturing biplanar X-ray images by slot scanning of the whole body in an upright, physiological load-bearing position, using ultra low radiation doses. The simultaneous capture of spatially calibrated anterioposterior and lateral images allows the performance of a three-dimensional (3D) surface reconstruction of the skeletal system by a special software. Parts of the skeletal system in X-ray images and 3D-reconstructed models appear in true 1:1 scale for size and volume, thus spinal and vertebral parameters, lower limb axis lengths and angles, as well as any relevant clinical parameters in orthopedic practice could be very precisely measured and calculated. Visualization of 3D reconstructed models in various views by the sterEOS 3D software enables the presentation of top view images, through which one can analyze the rotational conditions of lower limbs, joints and spine deformities in horizontal plane and this provides revolutionary novel possibilities in orthopedic surgery, especially in spine surgery.

Avascular necrosis of the talus causing meniscoid lesions in the ankle joint: a case report.

BACKGROUND: Meniscoid lesions have been reported in patients with chronic ankle injuries, especially in soccer athletes, and such lesions cause soft-tissue impingement and pain. To our knowledge, we are the first to report a meniscoid lesion in the ankle joint presenting as a long-term sequela of avascular necrosis of the talus that developed in childhood. CASE PRESENTATION: In this paper, we describe a 55-year-old Caucasian male patient who presented with a 1-year history of intermittent locking, "giving way," weight-bearing pain, and swelling over the anterior aspect of the ankle joint. Imaging showed a rare case of avascular necrosis of the talus associated with an unstable plica-like lesion that was removed arthroscopically after unsuccessful conservative treatment. CONCLUSION: We demonstrate that unstable meniscoid lesions of the ankle joint can be treated successfully with arthroscopic debridement. We obtained satisfactory short-term clinical results at the 2-year follow-up, even though advanced osteoarthritis was present.

Breakthrough in three-dimensional scoliosis diagnosis: significance of horizontal plane view and vertebra vectors.

Scoliosis is a multifactorial three-dimensional (3D) spinal deformity with integral and directly related vertebral deviations in the coronal, sagittal and horizontal planes. Current classification and diagnostic methods rely on two-dimensional (2D) frontal and lateral X-ray images; no routine methods are available for the visualization and quantitative evaluation of deviations in the horizontal plane. The EOS 2D/3D system presented here is a new, low-dose, orthopedic radiodiagnostic device based on Nobel prize-winning X-ray detection technology with special software for 3D surface reconstruction capabilities that finally led to a breakthrough in scoliosis diagnosis with high-quality, realistic 3D visualization and accurate quantitative parametric analysis. A new concept introducing vertebra vectors and vertebra vector parametric calculations is introduced that furnishes simplified visual and intelligible mathematical information facilitating interpretation of EOS 2D/3D data, especially with regard to the horizontal plane top view images. The concept is demonstrated by a reported scoliotic case that was readily characterized through information derived from vertebra vectors alone, supplemented with the current angulation measurement methods in the coronal and sagittal planes and axial vertebral rotation measurements in the horizontal plane, with a calibrated 3D coordinate system suitable for inter-individual comparisons. The new concept of vertebra vectors may serve as a basis for a truly 3D classification of scoliosis.

Prevalence of radiographic primary hip and knee osteoarthritis in a representative Central European population.

The aim of our study was to determine the radiographic prevalence of hip and knee osteoarthritis and compare our results with prevalence data reported by other studies, as no similar study had been performed in Hungary previously. Our aim was also to investigate the usefulness of the different radiological scoring methods for the definition of osteoarthritis. Patients who earlier reported complaints and gave written consent were asked to participate in a clinical follow-up. In the 682 participants Harris hip score, visual analogue pain scale values for both joints, Knee Society score and knee functional score were calculated. Weight-bearing radiographs were taken of both joints. Kellgren-Lawrence radiological evaluation was performed and osteoarthritis prevalence was defined. Hip osteoarthritis was found in 109 cases (16.49%), and knee osteoarthritis was found in 111 cases (16.54%). Harris hip score, Knee Society score, functional score and visual analogue scale values were significantly worse in people with radiographically proven osteoarthritis compared to the control group (p < 0.05). Significantly higher osteoarthritis prevalence of both joints was found in those with increased body mass index values. Age also plays a significant role in the development of both hip and knee osteoarthritis. No significant difference was observed between male and female participants regarding osteoarthritis prevalence. The Kellgren-Lawrence score with a cut-off value of 2 or more is a useful evaluation method for the detection of osteoarthritis prevalence in epidemiological studies; according to our observations, in clinical practice a cut-off value of three or more is more relevant.

[Comparison of classical 2D measurement of scoliosis and 3D measurement using vertebral vectors; advantages for prognosis and treatment evaluation]. / Comparaison entre la mesure classique bidimen- sionnelle de la scoliose et sa mesure tridimensionnelle par les vecteurs vertébraux. Avantages dans le pronostic et l'appréciation des resultats.

The EOS system is a new medical imaging device based on low-dose X-rays, gaseous detectors and dedicated software for 3D reconstruction. It was developed by Nobel prizewinner Georges Charpak. A new concept--the vertebral vector--is used to facilitate the interpretation of EOS data, especially in the horizontal plane. We studied 95 cases of idiopathic scoliosis before and after surgery by means of classical methods and using vertebral vectors, in order to compare the accuracy of the two approaches. The vertebral vector permits simultaneous analysis of the scoliotic curvature in the frontal, sagittal and horizontal planes, as precisely as classical methods. The use of the vertebral vector simplifies and facilitates the interpretation of the mass of information provided by EOS. After analyzing the horizontal data, the first goal of corrective intervention would be to reduce the lateral vertebral deviation. The reduction in vertebral rotation seems less important. This is a new element in the therapeutic management of spinal deformations.

[Molecular genetic diagnosis of neurofibromatosis type I]. / Az 1-es típusú neurofibromatosis molekuláris genetikai diagnosztikája.

UNLABELLED: Type 1 neurofibromatosis is an autosomal dominant hamartosis, caused by mutations of the gene neurofibromin-1. The variable clinical phenotype is characterized by café-au-lait spots, benign neurofibromas, axillary, inguinal hyperpigmentations, iris hamartomas, skeletal deformities and risk of neurofibroma-development. Pathogenic variations of neurofibromin-1 arise as de novo mutations in approx. 50% of the cases. AIMS: Molecular genetic testing of neurofibromin-1 gene has been performed in our department since 2008; the following report summarizes our experiences. METHODS: 40 patients, presenting symptoms of type 1 neurofibromatosis, were screened by sequencing or multiplex ligation-dependent probe amplification. RESULTS: Pathogenic alterations were identified in 31 cases, 8 patients presented novel mutations. In 8 affected, no mutations were detected by sequencing; one of these patients had a deletion affecting the entire gene. CONCLUSIONS: Sequencing of the neurofibromin-1 gene and screening for rearrangements are useful in identifying pathogenic alterations in most of the cases.

[Unusual clinical manifestations of type 1 neurofibromatosis]. / Az 1-es típusú neurofibromatosis ritka megjelenésu, tanulságos esetei.

UNLABELLED: Type 1 neurofibromatosis is an autosomal dominant hamartosis caused by mutations of the neurofibromin-1 gene. The classic features of the clinical phenotype include the presence of café-au-lait spots, neurofibromas, axillary and inguinal freckling, Lisch-nodules and deformities of the skeletal system, as well as the risk of developing multiple tumors, especially in the central nervous system. However, it is known from the literature that the phenotypic variability can pose a huge diagnostic difficulty. AIMS: Our institute performs molecular genetic testing of the neurofibromin-1 gene since 2008; during this period several unusual phenotypic variants were found. RESULTS, CONCLUSION: The reported four cases represent interesting phenotypic variants or diagnostic challenges in which the final diagnosis was established by molecular genetic analysis.

Increased chondrocyte death after steroid and local anesthetic combination.

BACKGROUND: Hyaline articular cartilage has limited repair and regeneration capacity. Intraarticular administration of glucocorticoid and local anesthetic injections play an important role in the therapy of osteoarthritis. Glucocorticoids and anesthetics reportedly enhance apoptosis in chondrocytes, but effects of the combined use of glucocorticoids and local anesthetics are unknown. QUESTIONS/PURPOSES: We asked whether glucocorticoid and local anesthetic agents combined had any synergistic effects on chondrocyte apoptosis. METHODS: Cell viability and apoptosis/necrosis assessment of human articular chondrocytes were performed in vitro (chondrocyte cell cultures) and ex vivo (osteochondral specimens) using flow cytometry and TUNEL analysis, respectively. RESULTS: Glucocorticoids and local anesthetics induce apoptosis in chondrocytes at various rates. When used in combination, the percentage of dead chondrocytes was increased in in vitro chondrocyte cell cultures and osteochondral ex vivo specimens. CONCLUSIONS: We observed a time-dependent decrease in chondrocyte viability after concurrent steroid and local anesthetic exposure. CLINICAL RELEVANCE: The combination of glucocorticoids and local anesthetics has an adverse effect on articular chondrocytes, and it raises a question regarding whether concomitant administration should be used in treating osteoarthritis.

Prevalence of low back pain and lumbar spine degenerative disorders. Questionnaire survey and clinical-radiological analysis of a representative Hungarian population.

A cross-sectional epidemiological study via personal interviews was performed regarding low back pain and its related clinical aspects in a Hungarian sample of 10,000 people. Joining the international campaign of the "Bone and Joint Decade", our aim was to give data on low back pain prevalence and to explore the underlying possible clinical conditions in a Central European adult and adolescent population. Ten thousand people aged 14-65, selected randomly by the Hungarian central office of statistics from three counties of the south-western Hungarian region, were surveyed using a special questionnaire focusing on low back pain and other degenerative spinal symptoms. People with low back pain complaints and written consent were asked to participate in a further clinical investigation, where radiological and clinical assessment was performed. A total of 4,389 persons (44.1%) reported low back pain in the last month at the time of the survey. Work absenteeism due to low back pain affected 2,140 persons (21.5%). A total of 292 people (2.9%) had already undergone spinal surgery. Upon request 682 people came for a clinical follow-up, where thorough physical examination and radiological analysis was performed and results were statistically interpreted. The Oswestry disability index (ODI) in the examined group of patients averaged 35.1%; radiological degenerative signs were observed in 392/682 (57.5%). Individuals with signs of radiological degeneration had a statistically significant higher ODI value, age, and a higher, yet not significantly increased BMI value than radiographically negative patients (p < 0.05). Co-existence of hip and knee osteoarthritis was also investigated. Higher osteoarthritis prevalence was found in individuals with radiographic signs of spinal degeneration. Details of the survey and clinical investigations are discussed.

[Prevalence of knee osteoarthritis in Hungary. Study conducted in a representative Hungarian population]. / Térdízületi arthrosis hazai elofordulása a dél-dunántúli betegpopuláción történt felmérés alapján.

UNLABELLED: In an earlier publication, authors have already reported the result of a survey conducted in a representative Hungarian population, where joint complaint prevalence data were presented, including those of the knee joint. AIMS: Following the above mentioned publication, in the current study authors aimed to determine the clinical and radiological prevalence of knee osteoarthritis using internationally accepted scoring methods for evaluation. METHODS: 2422 patients with complaints and consent were invited for a clinical follow up. 682 people (244 male; 438 female) came to participate in the study. After recording case history, and anthropometric parameters, a thorough musculoskeletal examination was carried out. Using these data Knee Society Score, Functional score and visual analogue pain scale values were calculated. On the AP and lateral view X-rays joint space width was measured, Kellgren-Lawrence radiological evaluation was performed and osteoarthritis prevalence was defined. RESULTS: radiological evaluation was possible in 676 cases. Knee osteoarthritis was found in 91 people (13.3%), severe osteoarthritis in 20 people (2.9%). Functional parameters of radiologically negative and positive cases were compared. Knee Society Score, functional score and visual analogue scale values were significantly worse in people with defined osteoarthritis (p<0.05). Regarding Body Mass Index, significantly higher values were found in those with osteoarthritis as well. CONCLUSIONS: Authors presented radiographic knee osteoarthritis prevalence data for the first time in the Hungarian literature. According to their observations, age and higher BMI values play a significant role in the development of knee osteoarthritis. After discussing the details of the survey, an overview and comparison with data of international literature is given.

The third dimension of scoliosis: The forgotten axial plane.

Idiopathic scoliosis is a three-dimensional (3D) deformity of the spine. In clinical practice, however, the diagnosis and treatment of scoliosis consider only two dimensions (2D) as they rely solely on postero-anterior (PA) and lateral radiographs. Thus, the projections of the deformity are evaluated in only the coronal and sagittal planes, whereas those in the axial plane are disregarded, precluding an accurate assessment of the 3D deformity. A universal dogma in engineering is that designing a 3D object requires drawing projections of the object in all three planes. Similarly, when dealing with a 3D deformity, knowledge of the abnormalities in all three planes is crucial, as each plane is as important as the other two planes. This article reviews the chronological development of axial plane imaging and spinal deformity measurement.

[Legal regulation in the field of tissue engineering]. / A sejt- és szövettenyésztés jogi vonatkozásai. Hazai és külföldi tapasztalatok.

In the past few years, biotechnology and tissue engineering have developed a great deal. Legislation, however, has not been able to keep pace with the rapid changes in the research and treatment using tissue-engineered products. The authors tried to explore and compare all the regulatory factors concerning cell and tissue engineering in the Hungarian and foreign law. The thorough study elucidated that the Hungarian regulation in this area is fairly deficient when compared with the regulations of other European countries, where quite extensive directives are applied. A currently accepted regulation fills this void efficiently in the European Union providing strong base for tissue engineering-related research and therapy for the future.