Non-bacterial Thrombotic Endocarditis (NBTE) in the Absence of Malignancy or Lupus Anticoagulant/Antiphospholipid Antibodies: A Case Report.

Non-bacterial thrombotic endocarditis (NBTE) is a very rare condition characterized by sterile thrombi formation on cardiac valves and is often associated with hypercoagulation states, such as malignancy and autoimmune disorders. We present the case of a 74-year-old patient admitted to the intensive care unit with acute respiratory failure, who had a history of COVID-19 infection five months prior to admission, despite having received certified vaccination. The patient developed NBTE involving the mitral valve, alongside acute respiratory distress syndrome (ARDS). In spite of the exclusion of cancer and systemic connective tissue disorders, the patient's condition rapidly deteriorated, leading to treatment-resistant multi-organ failure and demise, despite aggressive management, including anticoagulation therapy, mechanical ventilation, and renal replacement therapy. This case underscores the need for further research into the mechanisms underlying NBTE in the absence of traditional risk factors. Additionally, it highlights the importance of long-term anticoagulant therapy in NBTE management to mitigate the risk of embolic complications. Our case contributes to the growing body of literature identifying a subset of NBTE cancer-free patients with distinct characteristics, including those associated with current or past COVID-19 infection.

Hip-specific quality of life survey for patients with hip osteoarthritis - development and preliminary validity assessment.

BACKGROUND: Many various surveys are used to assess quality of life of patients with hip osteoarthritis, but none of them evaluates quality of life dependent on a single joint in bilateral disease. Aim. Development and preliminary validation of hip-specific quality of life survey (HSS) of patients with hip osteoarthritis. MATERIAL AND METHODS: A group of experts developed the final version of HSS questionnaire in 4 stages. Statistical analysis was conducted on 181 preoperative and postoperative HSS questionnaires completed by patients undergoing hip replacement surgery due to hip osteoarthritis. Discrimination index for each item, questionnaire internal consistency, proportion and dispersion of unanswered items, questionnaire filling time, ceiling effect and floor effect values as well as correlation between each item and subscale score were subject to statistical analysis. RESULTS: Final version of the questionnaire is characterized by good discriminant power (CR >3 for each item except for one). Cronbach alpha coefficient for each subscale of preoperative as well as postoperative questionnaire reached a value over 0.8 and point value for each item correlated significantly with the sum of points in each HSS subscale. CONCLUSIONS: No floor effect was observed in any of the cases, while ceiling effect was demonstrated in 1.1% of preoperative HSS questionnaires.

Patient-related outcome questionnaires in the assessment of the results of total hip replacement.

A variety of patient-related outcome questionnaires have been used for the assessment of results of total hip replacement. Generic core scales (SF-12, SF-36) and disease-specific scales like: Harris Hip Score, Western Ontario and McMaster University Osteoarthritis Index, Hip dysfunction and Osteoarthritis Outcome Score, Oxford Hip Score, American Academy of Orthopedic Surgeons hip and knee Questionnaire, Lower Extremity Functional Scale are used most frequently. Even though all of them were assessed in terms of construct and content validity, reproducibility and sensitivity, there are still some problems related to bias when total hip replacement evaluation is performed in the presence of comorbidities, contralateral hip disease and ceiling effect influencing the final score. As a result, there is a need for development of a new PRO questionnaire in order to improve total hip replacement assessment, enable early detection of postoperative complications or to evaluate the results of surgery in both hips separately. It is crucial that such measuring device has to be deprived of the influence of irrelevant factors on the final score.

Influence of age on the outcome of rehabilitation after total hip replacement.

BACKGROUND: This publication compares the results of physiotherapy after total hip replacement in two groups, each consisting of 50 subjects, differing in age by 10 years. MATERIAL AND METHODS: A group of 100 patients after total hip replacement was divided into two subgroups consisting of 50 subjects each, with mean age difference of 10 years. The first group included patients aged 47-60 years, the other 61-69 years. Patients were assessed at 6 weeks and reevaluated at 10 weeks after surgery during a 4-week in-hospital rehabilitation program. The study was based on a questionnaire, physical examination, 6-minute walking test and a test on stabilometric platform. RESULTS: In the younger group we observed easier and faster resolution of pain in the operated joint. In group II, which included patients aged 61 to 69 years, improvement in hip joint mobility was less pronounced than in the younger group. Six-minute walking test showed less improvement in walking distance in group II than group I. Among group II patients we noted less pronounced increase in weight bearing on the operated limb (by 2%, while 4% improvement was noted in group I), while final degree of weight-bearing was greater in group II than in group I and amounted to 48%. CONCLUSIONS: Younger patients recover faster, hip pain subsides easier, hip function returns more readily and to a greater extent. During a 4-week course of in-hospital rehabilitation older patients may regain hip function in a manner that brings them closer to the younger group.

[Possibilities of leg length equalization in total hip replacement]. / Mozliwosci egalizacji konczyn dolnych w endoprotezoplastyce stawu biodrowego.

Leg length discrepancy is a common and not appreciated complication after THR. Unequal leg length may cause earlier implant wear, patient's dissatisfaction, impair patient's function or even some legal consequences for the surgeon. To achieve the final equal leg length after surgery one must comply with some rules: proper patient's examination, informing patient about possible leg length discrepancy, proper length measurement- both clinical and radiological after antero-posterior pelvis x-ray; proper radiological length measurements especially when some hip contractures are observed, appropriate implant selection, proper prosthesis templating. The intraoperative leg length measurement with some surgical or radiological devices is essential for leg equalization. Special operative techniques are necessary for leg lengthening or shortening without hip instability. Final leg length measurement after surgery is necessary to determine a rehabilitation program.

Radiographic evaluation of the results of total hip arthroplasty with the cementless Zweymüller endoprosthesis.

BACKGROUND: Cementless endoprostheses include the Zweymüller endoprosthesis. Extensive clinical and radiological investigations were carried out in the Department of Orthopaedics and Traumatology of the University of Medical Sciences in Poznan in 180 patients who had received this endoprosthesis between 1995 and 2004. MATERIAL AND METHODS: The study group was composed of 180 patients (252 hips), out of whom 138 patients (193 hips) had been operated on due to primary (idiopathic) degenerative changes and 42 patients (59 hips) had needed treatment on account of degenerative changes secondary to developmental hip dysplasia and hip joint dislocation. The mean duration of post-operative follow-up was 6 years in patients with primary degenerative changes and 7 years in patients with secondary degenerative changes. The patients were also divided into two groups according to the length of post-operative follow-up. The first group, evaluated after a follow-up of more than 10 years, was composed of 31 hips, whereas the second group, with a follow-up of up to 10 years after the surgery, comprised of 221 hips. We evaluated anteroposterior hip joint radiographs taken before the surgery, during the follow-up and at the final examination and, additionally, axial hip radiographs taken on the first post-operative day and lateral radiographs of the femur and the hip joint taken at the final examination. The radiographic evaluation was carried out according to the recommendations of the Hip Society. RESULTS: There was no radiographic evidence of implant loosening among the 180 patients. In the group of post-dysplastic hips, the inclination angle of the acetabular component was 29-52 ° (mean: 40.2 °) and the acetabular opening angle was 0-21 ° (mean: 7.9 °). The stem was valgus-oriented in 9 hips, varus-oriented in 11 hips and neutral-oriented in 39 hips. In the group of patients with primary degenerative changes the inclination angle of the acetabular component was 29-65 ° (mean: 42.5 °) and the opening angle was 0-32 ° (mean: 8.9 °). The stem was valgus-oriented in 12 cases (6.3 %), varus-oriented in 43 cases (22.6%) and neutral-oriented in 138 cases (71%).There were no statistically significant differences between the group of patients treated due to idiopathic degenerative changes and those treated on account of post-dysplastic patients as well as between the groups divided according to the length of the follow-up as regards the position, the inclination and opening angle of the acetabular component, and the position of the stem. CONCLUSIONS: The Zweymüller Alloclassic endoprosthesis provides good stability of the acetabular component and the stem in the treatment of both primary and post-dysplastic degenerative changes. The Zweymüller stem provides good conditions for the integration of bone surface with the endoprosthesis, while the acetabular component facilitates the remodelling of the bone surrounding the implant.

[Long follow-up radiological assessment of the cemented hip prosthesis]. / Odlegla ocena radiologiczna endoprotezoplastyki cementowej stawu biodrowego.

MATERIALS AND METHODS: The postoperative and last follow-up radiograms: 7 to 25 years after surgery (mean: 10.4 +/- 3.9) were evaluated in 123 patients (167 hips). The radiological evaluation was performed according to Hip Society recommendations. The position of the cup and the stem, polyethylene wear, the migration of the cup or stem, radiolucent lines and ectopic ossification were evaluated. RESULTS: At last follow-up in 17 hips a prior revision was performed and further radiological assessment revealed 16 cases of prosthesis loosening. The retrospective analysis of the postoperative radiograms of 33 hips with loosening revealed radiolucent lines around the cup in de-Lee zones I, II, III respectively in 5, 2, 5 hips where in patients without loosening radiolucent lines were found in respectively 11, 4, 17 hips. The correlation between the cup or stem positioning and the rate of loosening was not significant. Fracture of the cup cement was found in 5 hips and radiolucent line around the cup cement in I, II and III zone of deLee was found respectively in 70, 26, 52 hips at last follow-up. No polyethylene wear was found in 77 hips when mean wear of 2.9 mm was found in the rest. The radiolucent line was most often detected in Gruen zones 3, 9 and 10. The ectopic ossification was found in 67% hips at last follow-up. CONCLUSIONS: The radiolucent line around the cup is more often detected on postoperative radiograms in patients with early cup loosening but this correlation is not so clear in stem loosning. The increased osteolysis around the implant as well as ectopic ossifications are found in long follow-up of the cemented hip prosthesis.

[Total hip replacement for acetabular protrusion in patients with osteoarthritis]. / Totalna endoprotezoplastyka stawu biodrowego w chorobie zwyrodnieniowej z panewka protruzyjna.

BACKGROUND: Total hip replacement (THR) is at present an accepted treatment in patients with severe deformity of the hip and acetabular protrusion. The aim of this paper is to evaluate the results of THR in patients suffering from acetabular protrusion, operated from 1991 to 2006 in the Orthopaedic and Traumatologic Department of Poznan University of Medical Sciences. MATERIAL: Material included 36 patients, 34 females and 2 males, on whom 51 THR were performed, lateral approach was used in all cases. At the time of operation, the age of patients ranged from 41 to 78 years (mean 63). Follow-up ranged from 4 to 19 years (mean 9.9 years). The operative treatment was a multistage process (during one operation only one joint was replaced). Cemented total hip arthroplasty was used during 28 of the THR, 22 of them were cementless and 1 as a hybrid. METHOD: The patients were clinically and radiologically evaluated preoperatively, postoperatively, and at final examination. The clinical state was evaluated with Harris hip score and WOMAC scale. We based our radiological examination on Hip Society system. RESULTS: The average preoperative Harris score for the group of patients was 29, WOMAC score 77. After an average of 9 years follow-up all hips were considered excellent, with average Harris score of 90, WOMAC Score of 6. All patients had increased function and decreased pain. The radiograms of all patients revealed that the acetabular and femoral components were correctly positioned with no radiographic evidence of loosening in the last examination. The inclination angle of the acetabular component was 30-55 degrees (mean: 40 degrees) and the acetabular opening angle was 2-15 (mean: 4 degrees). The stem was valgus-oriented in 8 hips, varus-oriented in 13 hips and neutral-oriented in 30 hips. No ectopic ossification concentrations were found. CONCLUSION: Clinical and radiological evaluation of our material showed that total hip replacement in the treatment of severe deformity of the hip caused by osteoarthritis with acetabular protrusion allows regaining good lower limb function, which helps the patients staying less dependant on the surrounding environment. The results of THR are good regardless of the type of prosthesis and the type of fixation. Ectopic ossification is not the clinical problem during THR in patients who suffer from acetabular protrusion. We found a significant acetabular remodeling with the decreasing of the protrusion after THR.

[Survivorship of the cemented hip prosthesis]. / Ocena przezywalnosci cementowej endoprotezy stawu biodrowego.

OBJECTIVES: To asses a survival-time of the cemented hip prostheses and to find factors causing its loosening. MATERIALS AND METHODS: 211 patients (282 hip prostheses) were analyzed, of the 1693 patients (2096 hip prostheses) treated between 1970-2000. The follow-up ranged from 7 to 34 years (mean: 12.2 ++/- 5.4 years). The age of the patients at the operation procedure ranged from 25 to 74 years (mean 52 +/- 12 years). Only aseptic prosthesis loosening were considered and Kaplan-Meyer method was used for the prosthesis survivorship assessment. RESULTS: Of the 282 prostheses, implant exchange was performed in 39 cases, where in 15 cases only cup was revised, in 5 cases the stem exclusively, and in 19 patients the whole implant was exchanged. Only 1.1% of implants were exchanged during first 5 years after surgery but from the 6th year the percentage of loosening increased several percents each year. Respectively 88.6, 70 and 65% survivorship of prosthesis was found after 10, 15, 20 years of follow-up. In the group of bilateral prosthesis implantation, the first implanted prosthesis was more susceptible for loosening. Seven cases of aseptic loosening (5.4%) of the 129 prostheses implanted between 1974 and 1995, occurred within 7 years after initial surgery where only one prosthesis (0.7%) was revised of the 152 implanted between 1996-2000 in the same time of follow-up. The age, growth, weight, BMI and sex did not influence the risk of implant loosening. CONCLUSION: The mean survivorship of the hip prosthesis is 65% in 20- years follow up. When a proper initial fixation of the cemented hip prosthesis is performed, the risk of implant loosening increases gradually especially from the 6th year after surgery. The modern implants are less susceptible for loosening.

[The retrospective analysis of good and poor results of the intertrochanteric osteotomy for hip osteoarthritis]. / Retrospektywna analiza dobrych i zlych wyników leczenia zmian zwyrodnieniowych stawu biodrowego osteotomia miedzykretarzowa.

OBJECTIVES: To predict the final result of intertrochanteric osteotomy. MATERIALS AND METHODS: 56 hips in 53 patients after intertrochanteric osteotomy without any change in neck-shaft angle were enrolled into the analysis. 26 hips with a good result of intertrochanteric osteotomy were included into A group and 26 hips with a poor result were included into B group. The follow up was 5 to 11 years. Such preoperative parameters as: age and body weight of patients, severity of arthritis, sphericity of the head, joint space width, center-edge angle, pain severity, walking capacity, range of motion- were analyzed in both groups of patients. Survival of the hips was estimated with a Kaplan-Meyer survival curve. RESULTS: At last follow up 27 hips (26 patients) were converted into hip prosthesis. The mean operative age of the patients in group A was 37.8 years and in group B 43.4 years. The severity of hip arthritis was similar in both groups of patients. Regular spherical head was found in 10 hips of group A and in 12 of B group. The center-edge angle was 15 degrees in group A and 18 degrees in group B. The joint space width was 2.6 mm in group A, and 2.5 mm in B group. Walking capacity, pain severity, range of motion of the affected hip was very similar in both groups of patients. Patients of group B had hip prosthesis already implanted 2.8 years after osteotomy. CONCLUSIONS: No statistically significant difference was found between analyzed preoperative parameters in patients with good and poor results of intertrochanteric osteotomy. The final result of intertrochanteric osteotomy is not predictable.

Distal greater trochanteric transfer in the treatment of deformity of the proximal femur caused by avascular necrosis.

Background. Distal greater trochanteric transfer is one of the surgical methods used to correct proximal femoral deformity arising in the course of treatment for developmental dysplasia of the hip. Material and methods. We reviewed a series of 49 patients (55 hips) who had undergone distal greater trochanteric transfer at the mean age of 13.9 years due to deformity of the proximal femur after treatment for developmental dysplasia of the hip, in order to verify the value of the procedure. The mean follow-up was 15 years. Clinical and radiological assessment was supplemented with strain-gauging evaluation of the muscles involved. Results. Good results were achieved in those patients who had good range of movement or isolated restriction of abduction before the operation. After surgery, a 22% increase of abductor torque was found, the Trendelenburg sign disappeared in 30 individuals, and 15 patients regained normal gait. Conclusions. Distal greater trochanteric transfer improved hip joint biomechanics. Good abduction/adduction range of hip movement was essential for clinical improvement and increased muscle strength after surgery. Arthritic changes occurred primarily in those hip joints without clinical improvement. Distal transfer of the greater trochanter delayed osteoarthritis of the hip.

[Long-range outcome in idiopathic scoliosis correction with Cotrel-Dubousset instrumentation]. / Odlegle wyniki leczenia operacyjnego skolioz idiopatycznych metoda Cotrela-Dubousseta.

Background. The purpose of this study is to evaluate outcome in idiopathic scoliosis treated surgically with Cotrel-Dubousset instrumentation. Material and methods. We analyzed the results of surgical treatment of 147 patients with idiopathic scoliosis classified according to King. The mean age of the patients at surgery was 15 years (range 12-25 years), and the mean follow-up was 6.3 years (range 3-12 years). Full-length standing preoperative, postoperative and last follow-up radiographs were studied. Radiographic analysis included the Cobb angle, Risser stage, apical vertebral rotation according to Perdriolle, radiological compensation, T2-T12 kyphosis and L1-S1 lordosis. Results. The greatest scoliosis correction was found in the frontal plane (60% in King IV), much lower in the sagittal. The mean loss of correction was 6.5% thoracic and 10.4% lumbar. In lordoscoliosis, postoperative kyphosis was below the normal range. Apical vertebral derotation ranged from 1 to 5 degrees. Derotation in the thoracic curve correlated with increased rotation in the lumbar curve. Decompensation to the left occurred postoperatively in the majority of patients. At last follow-up, the number of decompensated patients and mean decompensation was smaller. No back pain was found in the majority of patients (78.5%), and they judged the final result of treatment to be excellent (77.5%) or good (20.4%). Complications occurred in 10 patients (6.8%), early infection in 2 cases and late in 3. Conclusions. The greatest correction of scoliosis was found in the frontal plane, less in the sagittal. Small correction of the apical vertebral rotation of the main curve correlated with increased rotation in the secondary curve. The final follow-up decompensation was less than postoperatively.

[Surgical treatment of advanced congenital scoliosis with the C-D method]. / Leczenie operacyjne zaawansowanych skolioz wrodzonych metoda C-D.

The paper presents the results of surgical treatment of 15 cases of congenital scolisios with CD instrumentation. Progression of the deformity was most often seen in cases with combined deformities (according to the McMaster classification). Indications for surgical treatment were progression of the curvature and trunk and thorax deformity progression, particularly during the growth spurt. The age at the time of surgery ranged from 10.3 to 16 years (average: 13.8 years). Follow-up period ranged from 2 to 8 years (average: 4 years). Intraoperative deformity correction ranged from 0 to 60% (average 32%). Loss of correction during follow up ranged from 0 to 3%. The overall silhouette improvement was a result of correction of the spine curvature, correction of thoracic hyperkiphosis and a decrease of trunk decompensation. The only complications noted were 3 cases of transient neurological symptoms from the lower extremities. Preoperative MRI allows detection of congenital deformities of the spinal canal, a contraindication for surgical correction of the deformity with spinal implants.