The prognostic impact of insulin resistance surrogates in patients with acute myocardial infarction with and without type 2 diabetes.

BACKGROUND: Cardiovascular disease is the major cause of morbidity and mortality, particularly in type 2 diabetes mellitus (T2DM). Novel markers of insulin resistance and progression of atherosclerosis include the triglycerides and glucose index (TyG index), the triglycerides and body mass index (Tyg-BMI) and the metabolic score for insulin resistance (METS-IR). Establishing independent risk factors for in-hospital death and major adverse cardiac and cerebrovascular events (MACCE) in patients with myocardial infarction (MI) remains critical. The aim of the study was to assess the risk of in-hospital death and MACCE within 12 months after ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) in patients with and without T2DM based on TyG index, Tyg-BMI and METS-IR. METHODS: Retrospective analysis included 1706 patients with STEMI and NSTEMI hospitalized between 2013 and 2021. We analyzed prognostic value of TyG index, Tyg-BMI and METS-IR for in-hospital death and MACCE as its components (death from any cause, MI, stroke, revascularization) within 12 months after STEMI or NSTEMI in patients with and without T2DM. RESULTS: Of 1706 patients, 58 in-hospital deaths were reported (29 patients [4.3%] in the group with T2DM and 29 patients [2.8%] in the group without T2DM; p = 0.1). MACCE occurred in 18.9% of the total study population (25.8% in the group with T2DM and 14.4% in the group without T2DM; p < 0.001). TyG index, Tyg-BMI and METS-IR were significantly higher in the group of patients with T2DM compared to those without T2DM (p < 0.001). Long-term MACCE were more prevalent in patients with T2DM (p < 0.001). The area under the ROC curve (AUC-ROC) for the prediction of in-hospital death and the TyG index was 0.69 (p < 0.001). The ROC curve for predicting in-hospital death based on METS-IR was 0.682 (p < 0.001). The AUC-ROC values for MACCE prediction based on the TyG index and METS-IR were 0.582 (p < 0.001) and 0.57 (p < 0.001), respectively. CONCLUSIONS: TyG index was an independent risk factor for in-hospital death in patients with STEMI or NSTEMI. TyG index, TyG-BMI and METS-IR were not independent risk factors for MACCE at 12 month follow-up. TyG index and METS-IR have low predictive value in predicting MACCE within 12 months after STEMI and NSTEMI.

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.

The concentration of chromium and cobalt ions and parameters of oxidative stress in serum and their impact on clinical outcomes after metaphyseal hip arthroplasty with modular metal heads.

PURPOSE: Current epidemiological data forecast an almost 40% increase in the number of hip arthroplasty performed in the population of patients with osteoarthritis in 2060, compared to year 2018. On the basis of 10 years of observation, the failure rate after a metal-on-metal hip replacement is between 56.7 and 88.9%, depending on the used implant. METHODS: Seventy-six men operated using metaphyseal hip prostheses, with modular metal heads: the J&J DePuy ASR and Biomet Recap-Magnum systems, after a period of about 5-7 years after the procedure, were assessed twice (an interval of 6 months) in terms of the parameters of oxidative stress and the concentration of chromium, cobalt and ions nickel, as well as their impact on the current clinical status and quality of life. RESULTS: The mean values of the Co and Cr ion concentrations increased in a statistically significant manner at the individual stages of the study (13.20 Co and 18.16 Cr) for J&J DePuy ASR. Using the WOMAC-hip, HHS and SF-12 rating scales, the functional status of operated patients in both study groups did not change in a statistically significant manner during subsequent visits. There was a statistically significant increase in perceived pain in patients operated bilaterally with the J&J DePuy ASR system. The severity of pain could be related to the increase in the concentration of Co and Cr ions; however, it concerned a small group of bilaterally operated patients (n = 3 + n = 4). CONCLUSIONS: Metal-on-metal configuration in hip arthroplasty significantly influences with the increase in the concentration of chromium and cobalt ions in a double assessment. A statistically significant increase in the concentration of the tested Co and Cr ions in the blood correlates with an increase in the intensity of pain, especially in patients undergoing bilateral surgery. The limitation of this study is the relatively small number of bilaterally operated patients. Elevated levels of Co and Cr ions in the blood of patients operated on with the J&J DePuy ASR system increased steadily during both follow-up visits.

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.

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.

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.

The influence of resistance training on muscle strength, irisin concentration, and metabolic parameters in type 1 diabetic patients.

INTRODUCTION: Resistance effort has a beneficial effect on muscle mass, body composition, bone density, and cardiac parameters. It is also a modulator of the inflammatory reaction. The aim of the study was to assess the impact of 3 months of resistance training on muscle strength, irisin levels, and metabolic parameters in patients with long-term type 1 diabetes. MATERIAL AND METHODS: Eleven type 1 male diabetic patients with low levels of physical activity were recruited, with mean age 38 ± 6 years, body mass index (BMI) 28.4 ± 2.6 kg/m², and diabetes duration 23 ± 7 years. All subjects participated in 60-minute resistance training sessions twice a week, for three months. At baseline and after 3 months in all patients, maximal muscle strength level, serum irisin concentration, metabolic control parameters, and anthropometric measures were assessed. RESULTS: After 3 months there was a statistically significant increase of maximal muscle strength in comparison to baseline. There was no significant change in serum irisin concentration, HbA1c, or other assessed parameters. CONCLUSION: A 3-month resistance training programme in patients with long-term type 1 diabetes and low level of physical activity significantly affects their maximum strength level. This indicates that people with diabetes are more adaptive to additional loads, which allows them to increase their load faster.

Identification of Silent Myocardial Ischemia in Patients with Long-Term Type 1 and Type 2 Diabetes.

(1) Background: This study aimed to analyze epidemiological data to identify risk factors for silent myocardial ischemia in patients with long-term type 1 and type 2 diabetes. (2) Methods: An analysis was performed on 104 patients with long-term type 1 and type 2 diabetes who had not previously been diagnosed with cardiovascular disease. During hospitalization, patients were subjected to a standard ECG exercise test on a treadmill. If the test could not be performed or the result was uncertain, a pharmacological exercise test with dobutamine was performed. In the case of a positive exercise ECG test or a positive dobutamine test, the patient underwent coronary angiography. (3) Results: Atherosclerotic lesions were found in 24 patients. Patients with silent ischemia were significantly older and had a lower mean left ventricular ejection fraction and a higher incidence of carotid atherosclerosis. The presence of microvascular complications did not increase the risk of silent ischemia. (4) Conclusions: Silent heart ischemia is more common in type 2 than type 1 diabetes. Predisposing factors include older age, coexistence of carotid atherosclerosis, lower left ventricular ejection fraction, and smoking in patients with type 1 diabetes. Concomitant microvascular complications are not a risk factor.

Revision arthroplasty using a custom-made implant in the course of acetabular loosening of the J&J DePuy ASR replacement system - case report.

RATIONALE: Resurfacing arthroplasty using the J&J DePuy ASR system was withdrawn from surgical treatment due to the necessity of frequent revision procedures after its application. There have been many studies concerning treatment of acetabular bone loss using different operating techniques. However, we felt that data of custom - made implant usage in such cases is highly insufficient, and there is lack of evidence on its application in treatment of loosening of the previous implant. The aim of the study was to evaluate the effectiveness of surgical treatment with a custom-made implant in a patient with extensive acetabular bone loss after aseptic loosening of the acetabular component of the J&J DePuy ASR surface prosthesis in the early period of observation. PATIENT CONCERNS: A 74-year-old patient was taken to the Orthopaedic Trauma Emergency Room due to increasing pain in the right hip for about 3 months. Nine years earlier he underwent resurfacing arthroplasty of the right hip using the J&J DePuy ASR method. DIAGNOSES: The imaging diagnostics (X-ray, computed tomography, ultrasound) revealed the presence of a pseudotumor and lysis around the acetabular implant, which caused a fracture in the acetabulum. INTERVENTIONS: Revision arthroplasty of the right hip joint was performed with the removal of the ASR implant. During the procedure extensive bone defects were visualized, preventing the insertion of the revision acetabulum. After extensive plasticization of the defects with the use of allogeneic cancellous chips the "hanging hip" was left with the intention of making another attempt to insert the implant after the reconstitution of the acetabular bone. A computed tomography examination 2.5 years after the ASR removal revealed the lack of an adequate degree of bone remodeling for the planned implant. Arthroplasty using custom - made aMace Acetabular Revision System by Materialize was performed 3 years after the removal of ASR. OUTCOMES: Optimal implant adherence to the bone base and full osseointegration with the pelvic bone bearing has been achieved. Significant improvement in clinical parameters has been noted, with no complications in the postoperative period. LESSONS: The use of an individual custom-made implant in extensive acetabular bone loss after aseptic loosening of the acetabular component of the J&J DePuy ASR surface prosthesis in patients is an effective method of surgical treatment.

Effects of environmental and occupational lead toxicity and its association with iron metabolism.

BACKGROUND: Discrepancies are present in the findings from clinical trials evaluating a physiological role of iron status in the lead-exposed population. OBJECTIVE: The purpose of this article was to summarize the current understanding of cellular mechanisms of lead toxicity and present a comprehensive review of existing clinical trials related to associations of lead poisoning and iron status. Although an association of iron metabolism pathways that are affected by lead intoxication has been studied, there are still aspects that remain to be elucidated. The existence of additional Pb uptake pathways besides DMT1 transporter-mediated is postulated to non-specifically regulate lead absorption. METHODS: Authors performed a systematic search of PubMed, EMBASE® and Web of Science databases to identify studies that reported an association between health risks of non-organic lead that are associated with iron status markers as possible effect modifier. RESULTS: There were 58 studies that met the pre-defined inclusion criteria for the systematic review. There is a strong body of evidence supporting the hypothesis that alleviated blood lead level can be correlated with a reduced body iron store and increasing the risk of anemia. This association is of a high significance in cases of a young adolescent, weaker in groups of older children and often without a statistical significance in adults. DISCUSSION: Discrepancies in the observations may result from different specificities of lead absorption pathways in children and adults, as well as the power of the statistical tests in varying population sizes. It may be assumed that the extent of iron deficits coupled together with source, timing, and severity of lead exposure, significantly influence the correlation between these factors. Some of the intervention programs of counteracting lead poisoning by iron supplementation proved to be effective and may be a promising prevention strategy for the exposed population.

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.

Combined Aerobic and Resistance Training Performed under Conditions of Normobaric Hypoxia and Normoxia Has the Same Impact on Metabolic Control in Men with Type 1 Diabetes.

(1) Background: The aim was to assess whether combined aerobic and resistance training performed under hypoxic and normoxic conditions had an impact on diabetes control, VO2max (maximum oxygen consumption), and echocardiological and anthropometric parameters in men with long-term type 1 diabetes. (2) Methods: Sixteen male participants (mean age: 37 years, mean HbA1c (glycated hemoglobin): 7.0%) were randomly assigned to two groups: training in normoxic conditions or training in conditions of altitude hypoxia. All subjects participated in 60 min combined aerobic and resistance training sessions twice a week for 6 weeks. At baseline and in the 6th week, echocardiography, incremental exercise test, and anthropometric and diabetes control parameters were assessed. (3) Results: After 6 weeks, there was no significant change in HbA1c value in any group. We noted a more stable glycemia profile during training in the hypoxia group (p > 0.05). Patients in the hypoxia group required less carbohydrates during training than in the normoxia group. A comparable increase in VO2max was observed in both groups (p > 0.05). There were no significant differences in cardiological and anthropometric parameters. (4) Conclusions: Combined aerobic and resistance training improved VO2max after 6 weeks regardless of the conditions of the experiments. This exercise is safe in terms of glycemic control in patients with well-controlled diabetes.

Relationship between lead absorption and iron status and its association with oxidative stress markers in lead-exposed workers.

BACKGROUND: The emission of lead (Pb) occurring during the extraction, processing and industrial applications of this element remains a significant environmental risk factor. The absorbability of lead in humans is strongly associated with the general health status of exposed individuals. Existing mineral deficiencies are considered being a predisposition to an increased Pb uptake. Both, iron deficiency and lead poisoning are the major causative factors responsible for the prevalence of anemia within the vulnerable population, especially in children. Although some of the intervention programs of counteracting lead poisoning by iron supplementation proved to be effective in the Pb-exposed population, the exact mechanisms of this interaction still require further studies. The objective of the presented study was to examine the association of iron level on oxidative stress measures and its effects on the severity of lead toxicity in the exposed population. METHODS: The analyzed population consisted of 270 male workers from the lead-zinc smelter. The studied population was divided into two sub-groups based on the serum iron concentration: low iron level group (L-Fe; Fe < median value) and high iron level group (H-Fe; Fe > median value). Measured traits comprised of blood lead (PbB), serum Fe and zinc protoporphyrin (ZPP) levels as well as a blood count and oxidative stress markers. RESULTS: No significant correlation between serum iron concentration and PbB in the tested cohort was found. On the contrary, the analysis of ZPP levels (long-term marker related to a hematologic toxic effect of Pb) within the subgroups differing in serum Fe level shown that ZPP was 12.3 % lower (p = 0.043) in subjects classified within the H-Fe group. A positive correlation of serum Fe and total antioxidant capacity (TAC) was found (R = 0.1999). The conducted 3-D PCA analysis showed that individuals classified within the H-Fe group were characterized by the co-occurrence of higher Fe levels, lower ZPP, and higher TAC value. CONCLUSION: These results support the existing evidence providing that maintaining the optimal status of Fe may play a significant role in preventing the lead poisoning and alleviating harmful effects of Pb on the oxidative balance in humans.

Influence of Radiographic Bone Quality on the Type of Proximal Humerus Fracture.

BACKGROUND: The risk of proximal humerus fractures increases with age and deterioration of bone quality over time, and the treatment of these injuries may be clinically challenging.The aim of this study was to analyse the relationship between local bone quality and the morphology of proximal humerus fractures. MATERIAL AND METHODS: We conducted a retrospective study of 187 patients diagnosed with proximal humerus fractures. X-ray images of all patients were analysed, and on this basis, bone quality was assessed, using the Deltoid Tuberosity Index (DTI), average cortical bone thickness (CBTavg) and the Tingart measurement. The type of fracture was classified according to Neer's and Association for Osteosynthesis (AO) classifications. Moreover, the caput-collum-diaphyseal (CCD) angle was measured and the relationships between valgus or varus fractures and the DTI, CBTAVG and Tingart parameters were investigated in all patients. RESULTS: Using the Neer classification, the most common fracture type was type 3, found in 90 patients (48.1%). A total of 51 patients (27.3%) sustained an AO B1 fracture. Significantly lower mean DTI values were noted in patients with a Neer 4 fracture compared to those with Neer 3 (p = 0.02) and Neer 2 fractures (p = 0.03). Moreover, significantly higher mean DTI (p <0.00) and CBTAVG (p <0.025) values were noted in the group of patients with valgus fractures (CCD> 140º). CONCLUSIONS: 1. In the group of patients diagnosed with a four-part fracture according to Neer, bone quality assessed using the Deltoid Tuberosity Index was significantly worse than in two- and three-part fractures. 2. Significantly higher bone quality, assessed on the basis of the DTI and CBTAVG indices, was observed among patients with valgus fractures compared to those with varus fractures.

Quality of Life of Men after Cementless Hip Replacement - a Pilot Study.

BACKGROUND: Hip osteoarthritis is a significant health, social and economic problem. The associated pain and pathological and pathological proliferative joint lesions significantly reduce patients' quality of life. MATERIAL AND METHODS: The study involved 61 male patients aged 30 to 75 years qualified for hip arthroplasty due to osteoarthritis. A short version of the WHOQoL-BREF and EQ-5D-5L questionnaires were used to assess the quality of life. The questionnaires were administered before surgery, during the first outpatient visit (6 weeks after the surgery) and 6 months after the surgery. RESULTS: The WHOQoL-BREF questionnaire showed that the quality of life had improved significantly after just 6 weeks by 5% and 19% (p <0.01). After 6 months, there was also an improvement, of 13% and 42% (p <0.001). The most marked statistical improvement was found in the somatic domain after 6 weeks (8%) and after 6 months (11%) (p <0.001). The quality of life according to the EQ-5D-5L questionnaire showed statistically significant improvement of 13-23% after 6 weeks and of 32-42% after 6 months (p <0.001). The most marked improvement was achieved in terms of pain relief (p <0.001). CONCLUSIONS: 1. The quality of life improved significantly after just six weeks following hip arthroplasty. 2. The results were significantly higher also after 6 months. 3. The functional status of the patients improved significantly at both 6 weeks and 6 months after hip arthroplasty, especially in terms of pain reduction.

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.

Evaluation of ß-endorphin concentration, mood, and pain intensity in men with idiopathic hip osteoarthritis treated with variable magnetic field.

Osteoarthritis is the most frequently diagnosed disease of the musculoskeletal system. Growing number of patients waiting for surgical treatment and the possible negative consequences resulting from long-term pharmacological therapy lead to the search for non-pharmacological methods aimed at alleviating pain and reducing doses of analgesics, among them physical therapy with use of magnetic fields.The study involved 30 men aged 49 to 76 (mean age, 61.7 years) treated for idiopathic osteoarthritis of the hip joint. The subjects were divided into 2 groups (15 patients each) and underwent a cycle of magnetostimulation and magnetoledtherapy procedures, respectively. During the exposure cycle concentrations of ß-endorphin were assessed 3 times and the mood was assessed 2 times. In addition, the assessment of pain intensity and the dose of analgesic drugs was performed before and after the end of therapy.Statistically significant increase in plasma ß-endorphins concentration was observed in both groups of patients (magnetostimulation-P < .01 vs magnetoledtherapy-P < .001). In the assessment of mood of respondents, no statistically significant differences were found. Significant reduction in intensity of perceived pain was observed in both groups of patients (P < .05). In the group of patients who underwent magnetoledtherapy cycle, the analgesic drug use was significantly lower by 13% (P < .05) as compared with initial values, which was not noted in group of patients who underwent magnetostimulation procedures.The use of magnetic field therapy in the treatment of men with idiopathic osteoarthritis of hip joints causes a statistically significant increase in the concentration of plasma ß-endorphins resulting in statistically significant analgesic effect in both magnetostimulation and magnetoledtherapy treated groups of patients, with accompanying decrease of need for analgetic drugs in magnetoledtherapy group, but without any significant changes regarding the patient's mood.

Importance of Computed Tomography (CT) in Talar Neck Fractures. Case Studies.

Computed tomography is a modern technique producing high quality image of scanned organs. It plays a significant role in diagnostic work-up on orthopedics wards. This paper presents an analysis of management of two cases of Hawkins type I talar neck fracture with ankle joint rotation. In both patients, the diagnosis was based on conventional radiographs of the ankle joint in two projections and was subsequently verified with CT scans. The findings of a CT scan of the talus had a significant impact on further treatment and physiotherapy. Non-surgical treatment consisting in immobilization with a short leg cast combined with medication and magnetic field therapy produced a positive therapeutic outcome. A follow-up CT scan of the talus revealed bone union with remodelling in both patients. The functional outcome according to the AOFAS scale should be regarded good. Computed tomography is the radiological modality for detecting talar neck fractures and determining the presence of displacement. Follow-up CT scans evaluate the natural process of bone healing, which is crucial for treatment decisions regarding weight-bearing status. A correct diagnosis based on CT helps to prevent the development of necrosis and posttraumatic (secondary) degenerative changes as well as advanced physical disability, especially among youn-ger patients, in whom the injury is most common, consequently helping to avoid a long and costly treatment.

Ankle Osteoarthritis - Arthroplasty or Arthrodesis?

Osteoarthritis of the talocrural joint accounts for only 4% of cases of degenerative disease of the musculo-skeletal system. Unlike other joints, idiopathic OA of the ankle joint is identified in only 7% of patients. Until the end of the 1960's, arthrodesis was the treatment of choice in advanced OA of ankle joint. Absolute indi-ca-tions for arthrodesis include irreversible loss of joint anatomy, neurological conditions, advanced osteoporosis and chronic inflammation. Currently, the surgical treatment of ankle joint OA relies on third-generation endo-prostheses of the ankle. Arthroplasty is indicated in patients under 60 years of age with no history of non-ortho-paedic co-morbidities, engaging in little physical activity, with an intact joint axis and satisfactory mobility and non-smoking. This article analyzes the available literature on the results of surgical treatment in patients with osteoarthritis of the talocrural joint treated with arthrodesis or arthroplasty, taking into consideration the strict indications for each of these surgical methods.