Metal-on-metal metaphyseal and ceramic-on-ceramic femoral neck arthroplasty: the impact on clinical results, oxidative stress and concentration of metal ions in serum and blood.

PURPOSE: Growing number of hip arthroplasty in Poland performed with the use of metaphyseal stems results from the decreasing age of patients qualified for procedures and is consistent with the corresponding trends in European countries. To this day, a significant population functions after undergoing hip replacement using metal-on-metal implant. This study was aimed at the assessment of the variability of the oxidative system, as well as the concentrations of chromium and cobalt ions in serum and blood and their potential impact on postoperative clinical status. MATERIAL AND METHODS: The analysis included 58 men. The first group-operated using J&J DePuy ASR metal-on-metal implant with metaphyseal stem ProximaTm. Second group-operated using K-Implant SPIRON® femoral neck prosthesis in full ceramic articulation. Selected parameters of oxidative stress and the antioxidant system as well as the concentration of metal ions in blood were determined twice. Each patient underwent two clinical evaluations using acclaimed physical examination scale systems. RESULTS: In the first group, significantly higher concentrations of Cr (p = 0.028) and Co (p = 0.002) were demonstrated compared to the group of femoral neck arthroplasty. The mean concentrations of Cr and Co, 10.45 and 9.26 µg/l, respectively, were higher in patients operated bilaterally. In the ASR group, greater pain intensity in the operated hip and higher indicators of oxidative stress were found. CONCLUSIONS: Metal-on-metal articulation of the hip significantly increases the concentration of Cr and Co in blood, induces oxidative stress and modifies function of the antioxidant system and generates greater pain in the operated hip.

Antioxidant System and Ions Concentrations After Femoral Neck and Resurfacing Hip Arthroplasty.

BACKGROUND Oxidative stress is a disruption of the pro-oxidative-antioxidant balance, caused by excessive production or ineffective removal of reactive oxygen species. MATERIAL AND METHODS The study included 42 male patients aged 38 to 69 years. The first group consisted of 21 men with osteoarthritis after primary hip arthroplasty using the Smith & Nephew Birmingham Hip Resurfacing implant. The second group included 21 men after hip arthroplasty using the femoral neck SPIRON K-implant. In both groups, concentrations of ions, the antioxidant system in the blood, and parameters of oxidative stress were evaluated twice. Clinical assessment using the Western Ontario and McMaster Universities Osteoarthritis Index, Harris Hip Score, and Short Form (12) Health Survey (SF-12) scales was performed. RESULTS Concentrations of metal ions in the blood and the level of oxidative stress were significantly higher in the resurfacing group than in the femoral neck arthroplasty group. The response of the antioxidant system was significantly greater in the femoral neck arthroplasty group. During clinical evaluation, groups did not show significant differences, with the exception of greater shortening of the operated limb and a lower score in the mental-sphere of the SF-12 scale in the resurfacing arthroplasty group. CONCLUSIONS Resurfacing hip arthroplasty increased oxidative stress, increased the concentration of metal ions, and did not affect alignment of the abbreviation of the operated limb. A significant improvement in the quality of life of patients in the mental sphere according to the SF-12 occurred after the application of resurfacing arthroplasty, in the first month after the procedure.

Cementless femoral neck endoprosthesis SPIRON in men in aspects of clinical status and quality of life in an average 7-year follow-up.

BACKGROUND: We report the clinical evaluation, quality of life and pain assessment in patients who had a femoral neck SPIRON endoprosthesis. METHODS: The study group consisted of 27 men in whom 35 femoral neck endoprosthesis were implanted (8 on the left side, 12 on the right side and 7 bilateral) due to idiopathic osteoarthritis of the hip (20 patients) or avascular femoral osteonecrosis (7 patients) in a mean 7-year follow-up. RESULTS: The median pre-operative Harris Hip score (HHS) was 35.5 and post-operative 98.5 (p < 0.001). The median WOMAC HIP score was pre-operatively 57 and post-operatively 0 (p < 0.001). The median SF-12 score was pre-operatively 4 and post-operatively 33 (p < 0.001). The median pain assessment in VAS scale was 7 pre-operatively and 0 post-operatively (p < 0.001). CONCLUSIONS: The results of all examined patients have changed significantly in every category showing that SPIRON endoprosthesis improved their quality of life and statistically reduced pain ailments. Moreover we have proved that higher BMI (> 30) is associated with worse operation outcomes.

Tibiotalocalcaneal Arthrodesis in Osteoarthritis Deformation of Ankle and Subtalar Joint: Evaluation of Treatment Results.

Tibiotalocalcaneal arthrodesis (TTCA) is an increasingly used method of stiffening the ankle and subtalar joints in advanced degenerative deformities. The study group consisted of 19 men who were subjected to intramedullary and intraosseous arthrodesis using an intramedullary nail. The average age of patients was 46 (range 19-68) years. The main indication for surgical treatment was post-traumatic arthrosis 11 (58%). In the studied group, clinical condition was assessed using the American Orthopedic Foot and Ankle Score (AOFAS) classification, quality of life using the SF-12 scale, and assessment of pain intensity using the visual-analog scale (VAS) scale. The above parameters were evaluated before surgery (under 2 years), intermediate (from 2 to 5 years), and late (over 5 years) postoperative period. The clinical condition on the AOFAS scale improved from an average of 20.6 points before tibiotalocalcaneal arthrodesis to 63.5 after the procedure. The result was statistically significant (p < .0001). Analyzing the results using the SF-12 scale, a statistically significant increase was found. In the physical sphere of Physical Health Component Score-12 (p = .0004) and in the mental sphere of Mental Health Component Score-12 (p = .030). The intensity of pain assessed in the VAS scale, decreased in all three periods-p < .05. The strongest analgesic effect was observed in the early postoperative follow-up period. Tibiotalocalcaneal arthrodesis using an intramedullary nail causes a significant improvement in the clinical condition according to the AOFAS classification, enabling most patients to move independently, a significant improvement quality of life assessed in the SF-12 scale and a significant reduction of pain ailments assessed in the VAS scale, especially in the early postoperative period.

THE INFLUENCE OF HIP ARTHROPLASTY ON HEALTH RELATED QUALITY OF LIFE IN MALE POPULATION WITH OSTEOARTHRITIS HIP DISEASE.

OBJECTIVE: Introduction: Hip osteoarthritis is a disabling disease which become substantial health-related, social, and economic issue. The aim: To assess short term quality of life in male population with hip ostheoarthritis, after total hip arthroplasty. PATIENTS AND METHODS: Material and methods: 118 male patients were included in the study, age range from 31 to 79 year-old, who underwent total hip arthroplasty. Patients quality of life was assessed using questioners: abbreviated version of WHOQoL-BREF, as well as EQ-5D-5L, and SF-36 scale. Patients condition was investigated before surgery, 6 weeks and 6 months after the surgery. RESULTS: Results: The results from WHOQoL-BREF questionnaire demonstrated a statistically significant improvement of quality of life after the surgery - 6 weeks after the procedure by 4% and 21% (p<0.001), after 6 months by 13% and 42% (p<0.001), respectively. The most significant improvement was found in the somatic domain - by 5% after 6 weeks, and by 6% after 6 months (p<0.001). The quality of life according to the EQ-5D-5L questionnaire revealed statistically significant improvement after 6 weeks, by 18-24% (p<0.001), after 6 months by 41-48% (p<0.001). Substantial improvement was achieved in reducing pain and improving mobility. SF-36 questionnaire showed statistically significant improvement after 6 months from the surgery in both physical (by 44%), and mental condition (by 54%) (p<0.001). CONCLUSION: Conclusions: Improvement of the quality of life - mainly less severe pain and better mobility after total hip arthroplasty in the investigated group of men was proven in 6 weeks after the procedure, while the further progress was more noticeable 6 months after the procedure.

Effect of Total Ankle Arthroplasty and Ankle Arthrodesis for Ankle Osteoarthritis: A Comparative Study.

BACKGROUND Surgical methods in treatment of joint osteoarthritis (OA) aim at meeting the increasing expectations of people with active lifestyles. Ankle joint arthroplasty has been performed increasingly more often as an alternative to arthrodesis. The aim of this study was to compare arthrodesis and arthroplasty in the treatment of ankle osteoarthritis. MATERIAL AND METHODS The study involved 56 patients (45 males and 11 females) aged 21-72 years (mean 51) presenting with end-stage ankle OA: 29 patients (52%) underwent arthroplasty (Group A) and 27 patients (48%) underwent arthrodesis (Group B). Patients underwent surgery between 2004 and 2016 at a single clinical center. The observation period ranged from 6 to 150 months (mean 55 months). To assess the results of surgical treatment, quality of life (Health Assessment Questionnaire-HAQ, 12-Item Short-Form Survey-SF-12) and functional (American Orthopedic Foot & Ankle-AOFAS, Kofoed, Takakura) scores were used. For pain assessment, Visual Analog Scale was used (VAS). RESULTS After the surgery, group A and B had a statistically significant improvement in the joint function and pain relief according to AOFAS (A: 32.6 to 68.2; B: 27.4 to 61.3), Kofoed (A: 31.8 to 68; B: 25.9 to 60.3), Takakura (A: 30.6 to 62.9; B: 25.4 to 49.3), and VAS scores (A: 7.28 to 4.14; B: 7.33 to 3.78) compared with preoperative scores. After the surgery, quality of life scores improved in both groups, for HAQ (A: 0.91 to 0.53; B: 1.34 to 0.56) and for SF-12 (A: 26.6 to 36.8; B: 25.6 to 38.0). CONCLUSIONS The comparison of total ankle arthroplasty and ankle arthrodesis in treatment of end-stage ankle osteoarthritis did not reveal any significant differences.

The 13-year observation of hip fracture in Poland-worrying trend and prognosis for the future.

INTRODUCTION: Hip fractures are often considered to be one of the most common osteoporotic fractures. In our previous study, we noted the increasing trend in the total number of hip fractures as well as crude and standardized rates, for both women and men. This observation enabled us to delve deeper into the study of osteoporotic fractures. METHODS: Hospital records between 1.01.2002 and 31.12.2014 with ICD-10 codes S72.0. S72.1 and S72.2 (femoral neck. intertrochanteric, subtrochanteric, and inter and subtrochanteric fracture) were analysed. All fractures occurred in citizens who lived in the district Tarnowskie Góry and the city of Piekary Slaskie aged 50 years and more. RESULTS: 1507 fragility hip fractures (400 in men, and 1107 in women) were registered. The rates increase in both sexes was still observed. The tendency to sustain fractures was lower in female (29.3%) than in the male population (63.6%). We observed a lower increase in urban (35.8%) population when compared to rural (40.8%) population. Incidence rate ratios for female gender were 1.89 (95% CI 1.65-2.18). The rates in 2014 were as follows: crude rate of 216.2 (men 140.9; women 276.5) and standardized 183.9 (131.6 and 219.4, respectively). This observation allowed as to project a total crude rate of 467.2 (men 329.6; women 584.7) for the year 2050. CONCLUSIONS: The number of osteoporotic hip fractures in Polish men and women is still relatively low, but the epidemiological situation is getting worse. The over 13 years of follow-up demonstrated that the trend to increase in total number of hip fractures for men and women is still observed. This prognosis is of a major concern.

Male gender and age range 20-29 years are the most important non-modifiable risk factors for recurrence after primary post-traumatic shoulder dislocation.

PURPOSE: The aim of the study was to identify and analyze non-modifiable risk factors for recurrence after a first-time post-traumatic dislocation of the shoulder in the entire Polish population. METHODS: The entire Polish population was included in a cohort study. Patients diagnosed with primary post-traumatic dislocation of the shoulder between January 1st, 2010 and December 31st, 2011 were identified and followed up from January 1st, 2010 to December 31st, 2014. Incidence and recurrence rates and odds ratios (OR) were calculated. Demographic data were obtained from Poland's Central Statistical Office. Data on the number of patients with primary post-traumatic shoulder dislocation were drawn from the National Health Fund database. RESULTS: A total of 21,739 patients (14,466 males and 7273 females) with a primary shoulder dislocation in Poland were identified in 2010 and 2011. There were 3341 (15.4%) recurrences. Increased risk of recurrence was associated with male gender (OR = 1.92, 95% CI 1.76-2.09, p < 10-10) in the age range of 20-29 years (OR = 2.59, 95% CI 2.38-2.83, p < 10-10). The highest risk of first-time shoulder dislocation was revealed among females in the age group ≥ 80 years (OR = 24.1, 95% CI 22.6-25.7, p < 10-10). The risk of recurrence in the same group was significantly decreased (OR = 0.41, 95% CI 0.32-0.51, p < 10-10). CONCLUSION: Male gender and age range 20-29 years are highest population risk factors for recurrence after primary shoulder dislocation. Female gender and age ≥ 80 years are highest risk factors for the first-time post-traumatic dislocation of the shoulder joint and protective factors for recurrences after the first-time shoulder dislocation. LEVEL OF EVIDENCE: III.

Five-year prevalence of recurrent shoulder dislocation in the entire Polish population.

PURPOSE: The aim of this study was to evaluate five-year prevalence of recurrent shoulder dislocation in the entire Polish population. METHODS: The study involved the entire Polish population between 01 January 2010 and 31 December 2014. Demographic data were retrieved from the Central Statistical Office of Poland. Data on the number of shoulder joint dislocations were retrieved from the database of the National Health Fund. RESULTS: We identified 32,253 Polish residents with shoulder instability. About 0.1% of Polish residents suffered from recurrent shoulder dislocation. Males suffered almost two times more often than females (66% and 34%, respectively), and male gender was recognized as a risk factor of instability (OR = 2.07, p <10-10). Females in their eighth decade of life had the highest risk of recurrent shoulder dislocation (OR = 3.33, p <10-10). In males the highest risk of recurrences was noted for the third decade of life (OR = 1.78, p <10-10). CONCLUSION: The period prevalence rate of recurrent shoulder dislocation in Poland is 83.7 per 100,000 persons per five years. The rate of recurrent shoulder dislocation for the general Polish population is 0.1%. Males suffered from recurrent shoulder dislocation almost twice as frequently as females (OR = 2.07).

Do we need orthogeriatrics in Poland? Changes in the age structure and location of hip fractures.

BACKGROUND: Patients with hip fractures present a great challenge for surgeons due to multimorbidity, polypharmacy as well as difficulty in communicating. These could be attributed to a recent trend in the aging patient population (80 years and older) as compared to the past. The aim of this study is to analyze age structure and location in male and female patients' population with hip fracture over 50. MATERIALS AND METHODS: Hospital records between 2005 and 2014 with ICD-10 codes S72,0, S72,1 and S72,2 were included in the analysis. All fractures occurred in citizen aged 50 years and over living in the district of Tarnowskie Góry and the city of Piekary Slaskie in Poland. RESULTS: Within the study period, 1258 hip fractures were registered. The mean age of the patients was higher every year, starting from 77.27 ± 9.52 in 2005 to 80.80 ± 9.65 years in 2014 (p < 0.01). The average age also increased in both gender groups from 73.85 ± 8.30 to 77.89 ± 9.52 years in male and from 78.14 ± 9.66 to 81.98 ± 9.49 years in female, respectively. The median age value was changed from 78.00 to 83.00 years in the total population. We noted a significant increase in female with trochanteric fracture; however, the level of neck fracture was almost the same. In men, crude rates for both trochanteric and cervical fractures slightly increased. CONCLUSIONS: As the age of patients increases, fractures were shown to be more complicated. Given the scale of the phenomenon and its determinants, we emphatically conclude orthogeriatrics is needed in Poland.

Incidence of Posttraumatic Shoulder Dislocation in Poland.

BACKGROUND The incidence of shoulder joint dislocation has been estimated at 11-26 per 100 000 population per year. In our opinion, basic epidemiological data need to be continually updated in studies of large populations. To study the incidence of posttraumatic dislocation of the shoulder joint in the Polish population. MATERIAL AND METHODS We retrospectively investigated the entire Polish population between 1 January 2010 and 1 January 2015. To identify the study group, data collected in the electronic database of the National Health Fund were used. The study group was divided into subgroups to detect possible differences in the incidence of shoulder dislocation with regard to age, sex, and season of the year (month) when the dislocation occurred. RESULTS The cumulative size of the study sample was 192.72 million over the 5 years of the study. We identified 51 409 patients with first posttraumatic shoulder dislocation, at a mean age of 50.83 years (SD 21.12), from 0 to 104 years. The incidence of traumatic shoulder dislocations for the entire study group ranged from 24.75/100 000/year (number of posttraumatic shoulder dislocations per 100 000 persons per year) to 29.09/100 000/year, for a mean of 26.69/100 000/year. CONCLUSIONS In this study, the overall incidence of first-time posttraumatic shoulder dislocations in the Polish general population was 26.69 per 100 000 persons per year. These results are higher than estimates presented by other authors. It is necessary to study, regularly update, and monitor this problem in the general population.

Results of Arthroscopic Bankart Lesion Repair in Patients with Post-Traumatic Anterior Instability of the Shoulder and a Non-Engaging Hill-Sachs Lesion with a Suture Anchor after a Minimum of 6-Year Follow-Up.

BACKGROUND: Shoulder instability is an important clinical problem. Arthroscopic surgery is an established treatment modality in shoulder instability, but it continues to be associated with a high rate of recurrences and complications. The purpose of the study was to analyze late outcomes of arthroscopic repair of Bankart lesions in patients with post-traumatic anterior shoulder instability and non-engaging Hill-Sachs lesion, with special focus on the incidence and causes of recurrences and complications. MATERIAL AND METHODS: We investigated 92 patients (92 shoulders) who underwent surgery on account of post-traumatic anterior shoulder instability. The duration of follow-up ranged from 6 to 12.5 years (mean: 8.2 years). All patients were operated on in the lateral decubitus position using FASTak 2.8-mm suture anchors (FASTak, Arthrex, Naples, Florida). Treatment outcomes were evaluated using the Rowe and University of California at Los Angeles rating system (UCLA). RESULTS: According to Rowe scores, there were 71 (81.5%) excellent, 12 (12.6%) good, 5 (5.3%) satisfactory, and 2 (2.1%) poor results. Rowe scores improved in a statistically significant manner (p=0.00) post-surgery, to a mean of 90 (range: 25-100). Treatment outcomes measured as UCLA scores improved in a statistically significant manner (p=0.00), reaching post-operative levels of 12-35 (mean: 33.5). There were 9 recurrences, 1 case of axillary nerve praxia, and 1 case of anchor loosening. CONCLUSIONS: With rigorous criteria for qualifying patients for surgery, arthroscopic treatment of post-traumatic anterior shoulder instability produces good outcomes and low recurrence and complication rates irrespective of the number of previous dislocations, age, or sex.

Hip resurfacing arthroplasty in treatment of avascular necrosis of the femoral head.

BACKGROUND: Hip resurfacing is a conservative type of total hip arthroplasty but its use is controversial, especially in patients with osteonecrosis. The aim of this study was analysis of the clinical and radiographic outcomes of hip resurfacing in patients with osteonecrosis. MATERIAL/METHODS: Between 2007 and 2008, 30 hip resurfacing arthroplasties were performed due to osteoarthritis secondary to avascular necrosis of femoral head staged as Ficat III and IV. Patients were qualified to resurfacing arthroplasty when the extent of avascular necrosis using Kerboul's method was <200° and the angle between avascular necrosis and head-neck junction was >20°. All patients were evaluated clinically and radiologically before and 60 months after the operation. RESULTS: The mean Harris Hip Score (HHS) score increased from 47.8 to 94.25 (p<0.05). Physical activity level (University of California, Los Angeles activity score--UCLA activity score) improved from 3.7 to 7.55 (p<0.05). No implant migration was observed. CONCLUSIONS: Management of osteonecrosis of the hip with resurfacing arthroplasty seems to be effective in strictly-selected patients.

Comparison of short- to medium-term results of Coonrad-Morrey elbow replacement in patients with rheumatoid arthritis versus patients after elbow injuries.

BACKGROUND: The aim of this study was to assess the utility of the Coonrad-Morrey elbow prosthesis in patients with severe elbow dysfunction secondary to rheumatoid arthritis (RA) or post-traumatic elbow dysfunction. MATERIAL/METHODS: The study involved 35 patients followed up for a mean of 36 months. The patients were divided into those with RA (Group I) and those with post-traumatic elbow dysfunction (Group II). Treatment outcomes were evaluated according to the Mayo Elbow Performance Score (MEPS) and the Disabilities of the Arm, Shoulder and Hand Score (Quick DASH). RESULTS: According to the MEPS, there were 20 (57.15%) excellent, 12 (34.3%) good, 1 (2.85%) fair, and 2 (5.7%) poor outcomes. The mean post-operative Quick-DASH score for the entire study group was 37.73 points. In subgroup analysis, the MEPS-based evaluation revealed: 14 (70%) excellent, 5 (25%) good, and 1 (5%) satisfactory outcome in Group I, versus 6 (40%) excellent, 7 (46.7%) good, and 2 (13.3%) poor outcomes in Group II. The mean Quick Dash scores were 78.64 points in Group I and 76.36 points in Group II. The final MEPS scores in Group I (p=0.000018) and Group II (p=0.00065) were most markedly influenced by reduction in elbow pain and improvement in the ability to perform activities of daily living (ADL): p=0.000018 in Group I and p=0.000713 in Group II. CONCLUSIONS: The treatment outcomes confirm the utility of arthroplasty for severe elbow dysfunctions; they were most strongly influenced by pain reduction and improved ability to perform activities of daily living.

Mortality as an indicator of treatment quality after pertrochanteric fractures in the elderly.

BACKGROUND: Fractures in people over the age of 65, especially pertrochanteric fractures of the femur, present a growing medical problem. Surgical treatment of such fractures should be performed in the shortest possible time after the accident. Efforts were made to answer the question what contributes to the reduction in mortality after pertrochanteric fractures. MATERIAL/METHODS: This work presents a comparative analysis of two populations treated surgically due to pertrochanteric fractures at the District Hospital of Orthopedic and Trauma Surgery in Piekary Slaskie during years 1988-1992 and 2005-2008. Patient mortality was used as an indicator of treatment quality. In the first group of 118 patients hospitalized in years 1988-1992, there were 48 deaths reported during 12 months after the surgery. In the second studied population of 244 patients (operated in years 2005-2008), 54 deaths were noted in the 12-month period after the surgery. There was a reduction in mortality from 40.6% to 22.3% over those 15 years. CONCLUSIONS: Introducing mortality as an indicator in the comprehensive assessment of treatment quality will intensify its monitoring in both the hospital as well as the out-of-hospital period of care. It will also reveal the individuality and social importance of geriatric fractures.

Femoral press-fit fixation in ACL reconstruction using bone-patellar tendon-bone autograft: results at 15 years follow-up.

BACKGROUND: If anterior cruciate ligament (ACL) reconstruction is to be performed, decision regarding graft choice and its fixation remains one of the most controversial. Multiple techniques for ACL reconstruction are available. To avoid disadvantages related to fixation devices, a hardware-free, press-fit ACL reconstruction technique was developed. The aim of this study was to evaluate clinical outcome and osteoarthritis progression in long term after ACL reconstruction with central third patellar-tendon autograft fixed to femur by press-fit technique. METHODS: Fifty two patients met inclusion/excusion criteria for this study. The patients were assessed preoperatively and at 15 years after surgery with International Knee Documentation Committee Knee Ligament Evaluation Form, Lysholm knee score, Tegner activity scale and radiographs. RESULTS: Good overall clinical outcomes and self-reported assessments were documented, and remained good at 15 years. The mean Lysholm and Tegner scores improved from 59.7 ± 18.5 and 4.2 ± 1.0 preoperatively to 86.4 ± 5.6 (p = 0.004) and 6.9 ± 1.4 (p = 0.005) respectively at follow-up. The IKDC subjective score improved from 60.1 ± 9.2 to 80.2 ± 8.1 (p = 0.003). According to IKDC objective score, 75% of patients had normal or nearly normal knee joints at follow-up. Grade 0 or 1 results were seen in 85% of patients on laxity testing. Degenerative changes were found in 67% of patients. There was no correlation between arthritic changes and stability of knee and subjective evaluation (p > 0.05). CONCLUSIONS: ACL reconstruction with patellar tendon autograft fixed to femur with press-fit technique allows to achieve good self-reported assessments and clinical ligament evaluation up to 15 years. Advantages of the bone-patellar-tendon-bone (BPTB) press-fit fixation include unlimited bone-to-bone healing, cost effectiveness, avoidance of disadvantages associated with hardware, and ease for revision surgery. BPTB femoral press-fit fixation technique can be safely applied in clinical practice and enables patients to return to preinjury activities including high-risk sports.

Protein metabolism in the synovial membrane in the hip osteoarthritis.

BACKGROUND: Osteoarthritis (OA), and particularly osteoarthritis of the hip (coxarthrosis), together with hypertension and diabetes, belong to the most common lifestyle diseases. Usually the determination of a clear reason for the degenerative changes is impossible. However, the role of reactive oxygen species (ROS) that can affect the protein metabolism and thus cause the degradation of the joint connective tissue structures has been recently frequently pointed out. The aim of this study was to compare the activity of selected enzymes and albumin and protein level in the synovial membrane obtained during hip replacement surgery due to coxarthrosis. MATERIAL/METHODS: The reference group consisted of patients after traumatic femoral neck fracture, without osteoarthritis in the medical record. Collected sections of the synovial membrane were prepared for biochemical tests according to the authors' methodology. RESULTS: In the synovial membrane of patients with hip osteoarthritis significantly higher activity of superoxide dismutase (SOD) and glutamate dehydrogenase (GLDH) was observed, as well as increased activity of prolidase and lower activity of acid phosphatase activity compared with the reference group. The concentration of total protein and albumin in the synovial membrane was similar in both groups. CONCLUSIONS: Increased SOD activity indirectly indicates ROS participation in OA pathogenesis. Coexisting protein metabolism disorders of the synovial membrane may contribute to the degradation of the articular cartilage.

Metabolism and protein transformations in synovial membrane of a knee joint in the course of rheumatoid arthritis and degenerative arthritis.

BACKGROUND: In the course of musculoskeletal system diseases, such as rheumatoid arthritis and degenerative arthritis a chronic inflammatory process develops, which deteriorates all the joint elements and leads to the movement insufficiency of a patient. In case of both of theses diseases, etiology is multi-factor and still not known thoroughly. It is suggested that in the process of degradation of a joint cartilage, active form of oxygen take part. Their excessive production contributes to oxidation imbalances in cells and an oxidative stress. Under the activity of fee radicals, among others, activation of proteolytic enzymes participating the collagen degradation starts. The aim of this work is to compare parameters characteristic a cell metabolism and protein transformations taking place in the course of the aforementioned musculoskeletal system diseases. MATERIAL/METHODS: The material tested consisted of fragments of synovial membrane of a knee joint taken from 36 women suffering from rheumatoid arthritis and 24 women suffering from osteoarthritis during the procedure of knee-joint endoprothesoplastic surgery. Then the material was subject to the author's methodology of preparations of synovial membrane for biochemical markings. RESULTS: In the group of patients suffering from rheumatoid arthritis significantly higher protein and sulfhydryl groups concentrations were achieved. Moreover, an increase of activity of manganese isoenzyme of superoxide dismutase, glutamate dehydrogenase and enzymes participating in the process of collagen degradation--prolidase and acid phosphatase was observed. CONCLUSIONS: In the course of rheumatoid arthritis a speed of cell metabolism increase, which leads to a higher intensity of protein turnover in cells.

One year of the COVID-19 pandemic in Poland-the incidence of osteoporotic forearm, arm, and hip fractures.

The study attempts to analyse whether the COVID-19 pandemic affected the incidence of forearm, arm, and hip fractures during a 1-year observation period. Additionally, changes in the overall treatment costs of those fractures were estimated. During the COVID-19 pandemic, the incidence of forearm, arm, and hip fractures remained statistically unchanged, neither were any significant changes observed in the expenditure, incurred for the treatment of the fracture cases. PURPOSE: The purpose of the study was to find out and evaluate if the consequences of COVID-19 pandemic (including lockdown and the fear of infection) influenced the incidence of osteoporotic forearm, arm, and hip fractures and to estimate the changes in the costs of their management during one-year observation period. METHODS: The incidence of forearm, arm, and hip fractures was collected for the population, aged ≥ 50, residing at the district of Tarnowskie Góry and the Town of Piekary Slaskie, Poland, during 1 year of COVID-19 pandemic (from March 16th 2020 to March 15th 2021). The obtained results were compared with the number of corresponding limb fractures, recorded before the pandemic during five consecutive yearly periods, each starting from 16th March and ending on the 15th March of a subsequent year, the entire period covering the years 2015-2020. The rates of the analysed fractures were calculated per 100,000 inhabitants together with their economic impact. RESULTS: The mean numbers and the incidence rates of upper extremity fractures were slightly lower during the COVID-19 pandemic than in the previous 5 years, whereas hip fracture figures remained almost stable. The observed changes were not statistically significant. That annual observation revealed a slight decrease in expenditure volumes, when compared to the analysed period before the pandemic (-0.33%). CONCLUSION: The decreased incidence rate of forearm, arm, and hip fractures, observed during the first months of the COVID-19 pandemic, was not statistically significant in the 1-year observation. After several weeks/months under the shock, caused by government limitations and the fear of infection, the number of patients remained unchanged during the one-year observation.

Are there really specific risk factors for heterotopic ossifications? A case report of 'non-risk factor' after total hip replacement.

Femoral neck fractures are one of the most common fractures in the elderly population. Due to frequent complications of the fixation of these fractures, patients are more and more often eligible for hip replacement surgery. One of the most frequently mentioned postoperative complication is the formation of heterotopic ossification. This case report describes as a 70-year-old male patient that presented with an old hip fracture accompanied by a mild craniocerebral trauma. The patient underwent total cementless hip arthroplasty followed by rehabilitation. At 8 months after surgery, the patient was diagnosed with Brooker IV° heterotopic ossification in the area of the operated hip joint. Due to the persistent pain and complete loss of mobility in the operated joint, computed tomography imaging was performed and the patient was recommended for a revision surgery. The procedure was performed 14 months after the original surgical treatment, resulting in a significant improvement in the range of motion and reduction of pain.