Bone graft incorporation failure with inappropriate limb load transfer can lead to aseptic acetabular loosening of metal-on-metal prosthesis: A case report.

BACKGROUND: Aseptic acetabular loosening can result from various factors that can be categorized into groups: patient-related, surgeon-related and implant-related. We present a case of a 63-year-old patient who at first underwent a total hip arthroplasty (THA) using a metal-on-metal bearing due to hip arthrosis. Follow-up visits revealed no complications after the procedure. Two years after the THA, acetabular component loosening occurred due to subsequent trauma of the opposite hip, necessitating a revision THA using a ceramic-on-ceramic bearing. CASE SUMMARY: We aim to illustrate a rare case where the primary reason for undergoing THA revision was not only incomplete bone graft incorporation but also improper limb load distribution. Following the revision arthroplasty, a 9-year follow-up visit revealed improvements in all evaluation measures on questionnaire compared to the state before surgery: Harris Hip Score (before surgery: 15; after surgery: 95), Western Ontario and McMaster Universities Arthritis Index (before surgery: 96; after surgery: 0), and Visual Analogue Scale (before surgery: 10; after surgery: 1). CONCLUSION: Opposite-hip trauma caused a weight transfer to the limb after a THA procedure. This process led to a stress shielding effect, resulting in acetabular component loosening.

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.

A new aspect of in vitro antimicrobial leukocyte- and platelet-rich plasma activity based on flow cytometry assessment.

The current literature suggests that the antibacterial effect of leukocyte- and platelet-rich plasma (L-PRP) is directly related to platelet and leukocyte concentrations. The aim of this study was twofold: first, to evaluate the antimicrobial effect of L-PRP against selected bacterial strains in vitro, and second, to correlate this effect with leukocyte and platelet content in the final concentration. Blood was collected from 20 healthy males, and L-PRP, acellular plasma (AP), and autologous thrombin were consecutively prepared. Flow cytometry analysis of the blood, L-PRP, and AP was performed. The L-PRP gel, liquid L-PRP, and thrombin samples were tested in vitro for their antibacterial properties against seven selected bacterial strains using the Kirby-Bauer disk-diffusion method. There was notable antimicrobial activity against selected bacterial strains. No statistically significant correlations between antimicrobial activities and the platelet concentration in L-PRP were observed. Statistically significant positive correlations between selected leukocyte subtypes and antimicrobial activity were noted. A negative correlation was found between elevated monocyte count and antimicrobial activity of L-PRP against one bacterial strain studied. L-PRP possesses antimicrobial activity and can be potentially useful in the fight against certain postoperative infections. The bactericidal effect of L-PRP is caused by leukocytes, and there exists a relationship among selected leukocyte subtypes and L-PRP antimicrobial activity.

A 23-year follow-up of a male with Hajdu-Cheney syndrome due to NOTCH2 mutation.

We present a natural history of a 32-year-old man with Hajdu-Cheney syndrome (HJCYS), because of the de novo truncating mutation in the exon 34 of NOTCH2 (c.6424-6427delTCTG, p.Ser2142ArgfsX4), who has been followed up for a period of 23 years (between 9 and 32 years). During follow-up, we observed abnormalities of vision, hearing, voice, and progression of craniofacial features in the form of skeletal dysplasia with affected skull, dentition, spine, limbs, fingers, and toes. Low bone mineral density and history of fragility fractures also suggested primary osteoporosis being a clinical manifestation. According to Stengel-Rutkowski, Schimanek, and Wernheimer (1984; Human Genetics, 6, 272-295), systematic data acquisition has been used for quantitative analysis of anthropological, radiographic, and clinical features at childhood, adolescence, and young adulthood separately. A detailed phenotype description together with the results of reanalysis of 14 reports so far published on patients with HJCYS and NOTCH2 mutation showed similar phenotype evolution with age. The spectrum of observed features may improve diagnostic tools for HJCYS at different periods of the lifespan.

The application of L-PRP in AIDS patients with crural chronic ulcers: A pilot study.

PURPOSE: Nonhealing wounds or skin ulcerations are the result of insufficient repair and destruction of a local healing potential. Opportunistic infections which cause a lot of ulcer complications influence the worsening general condition of patients with AIDS, ultimately leading to death. The chronicity of the condition and poor results of conventional therapy have prompted the search for new methods of treatment. MATERIALS AND METHODS: We have examined venous or arteriovenous insufficiency-related extensive crural ulcers in AIDS patients. Crural ulcer healing processes were evaluated with clinical observations and histopathological, immunohistochemical and molecular examinations of tissue samples harvested from the wound edges before and on day 10 after L-PRP cover dressing. RESULTS: Clinical observations showed positive effects of L-PRP in all patients. However, complete wound closure was noted in 60% of cases. Statistical analysis of histological examination showed increased epidermal processes between samples, but the difference was nonsignificant. However, immunohistochemical investigations showed an increased healing process with strong statistical significance. The mean VEGF level before L-PRP usage was 114.3 vessels/mm2 and on day 10 118.9 (p=0.001523). The mean FLK level was 103.2 and 109.9 respectively (p=0.008241). The biggest differences were observed for CD34, with values of 68.2 on day 0 and 100.8 on day 10 (p=0.006982). Molecular analysis generally showed decreased gene expression and confirmed vascular formation and reepithelialization processes. CONCLUSIONS: In our opinion, L-PRP may be used to eradicate microorganisms from wounds, to induce neovascularization, and in unhealed cases prepare the base and edge of the ulcer for skin grafting and tissue expansion procedures.

Benefit of Leukocyte- and Platelet-Rich Plasma in Operative Wound Closure in Oral and Maxillofacial Surgery.

This article reports the influence of an autologous leukocyte- and platelet-rich plasma (L-PRP) injection as a minimally invasive method on supporting wound healing processes after a mandibular odontogenic cystectomy and double mandibular fracture fixation. 113 patients were enrolled into a control group (received no L-PRP injection) and 102 patients were enrolled into an L-PRP group with an oral mucosa incision. 18 patients after a double mandibular fracture were operated on using 2 external submandibular approaches receiving no fluids in the right site (a control group) and an L-PRP injection in the left incision (L-PRP group). Clinical observations showed that the oral mucosa healed faster in patients treated with L-PRP, in comparison to cases where inductive biomaterial was not added. Pain at the L-PRP injection site was relieved within few hours after an operation in patients with double mandibular fractures. However, there were no differences observed in the progression of the healing process. L-PRP possesses inductive properties that could stimulate healing processes and it seems to be one of the most promising methods in the future for the treatment of soft tissue defects.

Large cartilage lesions of the knee treated with bone marrow concentrate and collagen membrane--results.

BACKGROUND: The study presents to assess the clinical results of cartilage lesion treatment with bone marrow concentrate and collagen membrane. MATERIAL AND METHODS: The study group comprised 54 patients with ICRS grade III or IV lesions. Lesion sizes ranged from 4 to 12 cm(2). The assessment was carried out at one and five years following the surgery with the use of KOOS and Lysholm functional scales and VAS and KOOS Pain scales. RESULTS: A significant improvement was obtained in 52 out of 54 patients across all scales. No complicating infections were noted. The average improvement at one year was 25 points in the KOOS scale and 35 points in the Lysholm scale. After 5 years an insignificant deterioration was noted in three patients. CONCLUSIONS: 1. One-stage reconstruction of large cartilage lesions with bone marrow concentrate is an effective treatment modality. 2. Due to its lower cost it is a valuable alternative to autologous chondrocyte transplantation. 3. The study group requires 2-3 years of further monitoring to clinically verify this treatment modality.

Cartilage lesions of the knee treated with blood mesenchymal stem cells - results.

BACKGROUND: The study aimed to assess long-term clinical outcomes of cartilage lesion treatment with blood stem cells. The analysis of complications of this method was an additional aim. MATERIAL AND METHODS: The study group comprised 52 patients with ICRS grade III or IV lesions of 4 to 12 cm2. The assessment was carried out at one and six years following the surgery with the use of KOOS and Lysholm scales and VAS and KOOS Pain scales. RESULTS: No postoperative infections were reported. Poor outcomes were noted in 2 patients at 12 months following the surgery. Scores improved in across all scales with an average improvement of 23 points in the KOOS scale and 35 points in the Lysholm scale at one year. At 6 years, minor deterioration was reported in 2 more patients. CONCLUSIONS: 1. The reconstruction of large cartilage lesions with peripheral blood stem cells is an effective treatment modality. 2. This method is a valuable alternative to autologous chondrocyte transplantation.

[Sacral pressure sores and their treatment]. / Odlezyny okolicy krzyzowej i ich leczenie.

INTRODUCTION: Sacral bed sores still present a serious problem in most surgery departments. They occur mainly in elderly patients of limited mobility. The treatment of such sores extends over long periods of time and therefore involves considerable costs. MATERIAL AND METHODS: The material consisted of 11 sacral pressure ulcers treated surgically. The sores occurred in 4 severely disabled patients suffering from proximal third femur fractures, 4 patients with traumatic brain injury (treated in the Intensive Care Unit), and 3 patients suffering from bed sores after spinal cord injury. In 6 patients a fasciocutaneous flap was applied to the sores and in 5 cases a pedicled musculocutaneous gluteus maximus flap. The end results were assessed using Seiler's criteria. RESULTS: Complications of the "seroma" type were observed in 3 patients, and in 2 marginal necrosis. In all our patients complete healing was achieved within 2-4 weeks. CONCLUSIONS: On analysing our experience to date in surgical treatment of bed sores we are of the opinion that even extensive sacral sores can be covered with unilateral pedicled flaps provided that they are appropriately planned. Deep sores of the 4th degree sometimes with concomitant osteomyelitis require pedicled muscle flaps or in some cases musculocutaneous flaps to improve local circulation. The preparation of the patient for reconstruction surgery is just as important as the operation itself and therefore such preparation should never be neglected.

Distally based sural artery flap in soft tissue defects of the heel region.

Background. The coverage of tissue defects caused by decubitus ulcers in the remains a challenge for reconstructive surgery. In this article we describe our own experience with the use of the distally-based superficial sural artery flap. Material and methods. Between 1997 and 2004 we used distally-based superficial sural artery island flaps in 8 patients. In all cases the tissue was prepared as a fasciocutaneous flap. Results. All the flaps have survived. The advantages offered by this flap include constant and reliable blood supply, easy dissection, minimal morbidity of donor site, and preservation of the major arteries in the leg. We observed venous congestion and edema in three flaps, and marginal necrosis in one flap. Conclusions. The distally based sural artery flap is a good method for the treatment of soft tissue defects in the heel region. The procedure is short and can be performed in a single stage without microsurgery. This flap has the potential for reinnervation in demanding patients.

The radiological outcomes of total knee arthroplasty using computer assisted navigation ORTHOPILOT.

Comprehensive radiographic analysis of total knee arthroplasty performed traditionally and with the use of Computer Assisted Navigation (CAN) is presented. The aim of this study was to compare the precision of implant alignment considering two operating techniques. The analyzed material consisted of 100 radiograms of patients operated on traditional way and 100 knee joint radiograms of patients operated on with a use of CAN. Assessment of postoperative radiograms was carried out in order to analyze coronal mechanical axis and sagittal orientation of both femoral and tibial components. Measurements were taken precisely up to 1 degrees and therefore results were classified as good (0-2 degrees deviation due to mechanical axis), satisfactory (2-4 degrees) and poor (over 4 degrees). The radiological outcome allows to present the following conclusions: CAN allows to minimize the risk of incorrect prosthesis alignment and therefore significantly improves the radiological outcome of total knee arthroplasty. This improvement can lead to better long time "survival" of implant components. The only price one pays for this improvement is 15-20 minute surgery delay, however it needs further studies to determine other possible disadvantages.

The Oxford II medial unicompartmental knee replacement. A minimum 10-year follow-up study.

Background. The first clinical results from unicondylar knee arthroplasty (UKA), which was introduced in the early seventies, were non-conclusive. The development and modernization of unicompartmental implants (mobile bearing models, such as Oxford II), and also stricter qualification criteria for UKA brought about significant improvement in long term outcome. The aim of our study was to assess the long-term outcome of UKA using Oxford II implants, and also to verify the inclusion criteria. Material and methods. The authors present an analysis of long-term outcome in unicompartmental knee arthroplasty in 42 patients, qualified for treatment according to the criteria of Kozin and Scott, and also the designers of the implant. The follow-up assessment was performed a minimum of 10 years after surgery (11.2 years average). Results. The results were assessed using the 100-point HSS scale. Excellent results were achieved in 10 cases, good results in 22 cases, fair results in 6 cases, and poor results in 4 cases. The implant survival rate was 86%. There were some complications related to surgical error or lack of strict compliance with the qualification criteria. Conclusion. UKA late results are comparable to those achieved in TKA, given proper qualification. Also, this procedure can be considered as a definitive solution in older patients.