Outcomes of Total Knee Arthroplasty in Patients with Bleeding Disorders.

BACKGROUND: Advanced haemophilic arthropathy is a possible complication in patients with congenital bleeding disor-ders. This study aimed to assess treatment outcomes after primary total knee arthroplasty in this group of patients. MATERIAL AND METHODS: A total of 60 primary total knee arthroplasties were performed in the period 2011-2014. The study ultimately included 40 knee replacements in 35 patients. The average follow-up period was 19.4 months (max. 32, min. 12), with patients followed up for a period shorter than 12 months excluded from the study. The average age of the patients was 36.7 years (min. 27, max. 72). Types of inherited bleeding disor-ders among the study population were as fol-lows: 82% with haemophilia A, 15% with haemophilia B and 1% with Von Willebrand disease. Pain intensity was assessed before the surgery and at a 12-month follow-up visit using VAS. The patients completed the OKS and WOMAC question-naires before the surgery and at the 12-month follow-up visit. Functional evaluation of the patients was performed using KSS before the TKA and 12 months after the knee replacement surgery. RESULTS: The pain intensity was considerably reduced 12 months after the surgery. VAS scores averaged 7.4 pts (SD 1.6) before TKA and 1.6 pts (SD 1.7) after the surgery. A significant improvement in patients' functioning was recorded. The average WOMAC score was 33 pts (SD 26) before the operation and 72.7 pts (SD 23.4) after TKA. Similar results were obtained for OKS: 20.9 pts (SD 7.3) before knee replacement and 41.2 pts (SD 2.4) after the surgery. The average KSS score before TKA was 29.2 pts (SD 22.8) and 71.5 pts (SD 9.5) after 12 months. CONCLUSIONS: 1. Total knee arthroplasty is a very good therapy for patients with advanced haemophilic arthropathy. 2. TKA considerably reduces pain intensity in patients. 3. TKA considerably improves patients' functioning in daily life. 4. Patients are very satisfied with the outcomes of this procedure.

A Comparison of Outcomes of Treatment with Resection Prosthesis of the Hip in Revision and Oncological Surgery.

INTRODUCTION: The introduction of resection prostheses paved the way for the development of limb-sparing surgery in patients with primary or metastatic bone tumours. After some time, the developing possibilities of treatment of extensive bone defects allowed for the use of resection prostheses as an emergency procedure in patients undergoing revision surgery due to hip implant loosening. The aim of this paper is to compare treatment outcomes in patients receiving the Modular Universal Tumour and Revision System (MUTARS) resection prosthesis during arthroplasty performed for different indications: treatment of a tumour metastasis and revision surgery in cases of implant loosening. MATERIAL AND METHODS: A total of 34 MUTARS femoral resection prostheses were implanted in 34 patients at the Cracow Centre of Rehabilitation and Orthopaedics between December 2008 and January 2016. The procedure was indicated due to the presence of a tumour metastasis (in 13 cases) or due to implant loosening that required revision arthroplasty with a resection prosthesis (in 21 cases). Femoral bone defects were classified according to Paprosky and Katthagen in all operated patients. Clinical assessment was conducted with the modified Harris Hip Score before the surgery and at one year after the procedure. In addition, pain intensity was assessed with a Visual Analogue Scale (VAS). RESULTS: No statistically significant differences were observed between the groups with respect to the length of the femoral bone resected, perioperative blood loss and the number of packed red blood cell (PRBC) units required. A statistically significant difference was found in duration of the surgery and hospital stay, which were longer in the revision arthroplasty group. No statistically significant differences were observed between the groups in the post-operative HHS scores and pain assessment in the VAS scale. The revision arthroplasty group showed significantly more dislocations (8 vs. 2) and cases of surgical site infection. CONCLUSIONS: 1.The use of the MUTARS modular resection prosthesis allows for fast clinical improvement that meets the patient's expectations both in oncological treatment and in revision arthroplasty. 2. The extent of bone resection, procedure duration and perioperative blood loss associated with the surgical placement of a resection prosthesis are similar in oncological treatment and in revision arthroplasty. 3. The use of a resection prosthesis in revision arthroplasty is associated with a high risk of implant dislocation.

Hydrogen Sulfide and Carbon Monoxide Protect Gastric Mucosa Compromised by Mild Stress Against Alendronate Injury.

BACKGROUND: Alendronate is an inhibitor of osteoclast-mediated bone resorption, but its clinical utility is limited due to gastrointestinal complications including bleeding erosions. AIMS: We studied whether potent vasodilators hydrogen sulfide (H2S) and carbon monoxide (CO) can protect against alendronate-induced gastric lesions in rats exposed to mild stress. METHODS: Three series (A, B, and C) of Wistar rats received alendronate (150-700 mg/kg i.g., series A) with or without NaHS (5 mg/kg), H2S donor or CORM-2 (5 mg/kg) releasing CO administered i.g. 30 min before alendronate administration (series B) in rats exposed for 3 days before alendronate administration to mild stress (series C). The area of gastric lesions was assessed by planimetry, the gastric blood flow (GBF) was determined by H2-gas clearance technique, and H2S production via CSE/CBS/3-MST activity and the gastric expression of HO-1, HO-2, HIF-1α, NF-κB, iNOS, COX-2, IL-1ß, TNF-α, GPx-1 and SOD-2 were analyzed by qPCR or Western blot. RESULTS: Alendronate dose-dependently produced gastric mucosal lesions and significantly decreased GBF, and these effects were exacerbated by mild stress. NaHS and CORM-2 significantly reduced the alendronate-induced gastric lesions in non-stressed and stressed animals, but only NaHS but not CORM-2 raised H2S production. NaHS and CORM-2 inhibited gastric expression of HIF-1α protein and HO-1, HIF-1α, NF-κB, COX-2, iNOS, IL-1ß, TNF-α mRNAs but failed to affect those of HO-2, GPx-1, and SOD-2. CONCLUSION: Both H2S and CO released from their donors, NaHS and CORM-2, protect gastric mucosa compromised by stress against alendronate-induced gastric damage via mechanism involving downregulation of HIF-1α, NF-κB and proinflammatory factors COX-2, iNOS, IL-1ß, and TNF-α.

Use of Trabecular Titanium Implants for Primary Hip Arthroplasty.

BACKGROUND: Total hip arthroplasty is an increasingly common procedure. The large number of cases inevitably includes patients who require filling of their acetabular defect even in their primary surgery. The use of a utogenous grafts and allografts as well as resistance rings requires patients to avoid loading the limb for a long time to enable implant integration. This disadvantage may be partially eliminated by using trabecular titanium implants. The aim of this paper is to present the outcomes of the use of trabecular titanium implants in primary hip arthroplasty. MATERIAL AND METHODS: The study embraced 23 patients (18 women and 5 men) whose primary hip arthroplasty was performed in the Cracow Centre of Rehabilitation and Orthopaedics in the period 2010-2015 and involved placement of a trabecular titanium implant. RESULTS: Medium-term follow-up revealed improvement according to the modified and traditional Harris Hip Score and reduction in pain according to VAS. Loosening of the implant or infection were not recorded. The use of trabecular titanium allowed for reducing the amount of bone grafts used. CONCLUSIONS: 1. Reconstruction of acetabular defects with trabecular titanium implants may be used in primary hip arthroplasty to produce good clinical and radiographic outcomes. 2. The use of trabecular titanium implants allows for reducing the amount of bone grafts necessary to fill the acetabular defect and enables immediate partial loading of the limb.

Postoperative migration of short stem prosthesis of the hip joint.

BACKGROUND: Hip replacement surgery is a popular procedure that provides predictable, long-lasting and good effects. The use of short stem prostheses helps preserve an intact medullary cavity and proximal diaphysis. It has been demonstrated that the use of short stem prostheses leads to better clinical results compared to standard stem prostheses. The study aimed to assess the migration of the stem of the Proxima hip prosthesis. Migration was defined as a change in the angle of stem position towards a varus deformity. MATERIAL AND METHODS: The study involved 164 patients (83 women, 81 men) who underwent hip replacement surgery with a total of 185 Proxima prostheses in the Cracow Rehabilitation Centre between 2007 and 2012. RESULTS: Radiographic analysis included a series of three radiographs obtained for each patient on Day 0 and after 6 and 12 months. Stem migration towards a varus deformity was reported during the follow-up period. There was a correlation between the change in the angle of varus prosthesis alignment and the length of follow-up. The mean change of the varus angle was 8.21° after 12 months. There was a statistically significant difference in the angle of the varus prosthesis alignment between the sexes. After 12 months the total change was 6.82° in women and 9.65° in men. There was no significant correlation between a patient's BMI, age, the total length of the neck of the implant and the progression of the angle of varus prosthesis alignment. CONCLUSIONS: 1. The greatest displacement of the Proxima short stem implant towards a varus deformity is seen within the first 6 months following implantation. 2. The change of the angle of varus prosthesis alignment depends on the initial positioning of the prosthesis and the sex of the patient. 3. The change of the angle of varus prosthesis alignment is independent from the patient's age and BMI.

Probiotics in the mechanism of protection against gut inflammation and therapy of gastrointestinal disorders.

A growing body of experimental and clinical evidence supports the hypothesis that the intestinal microbiota markedly influences function and the structure of the mucosal lining. Intestinal microbiota can potentially cause damage to the mucosa either directly by releasing toxins or indirectly by causing a detrimental immune response. Probiotic bacteria have been defined as live microorganisms, which when consumed in adequate amounts, confer a health benefit for the host. In recent years, the therapeutic and preventive application of probiotics for several gastrointestinal and liver disorders has received increasing attention. Probiotics appear to be beneficial for premature infants who suffer necrotizing enterocolitis. The effectiveness of certain probiotics as treatment for infectious and antibioticassociated diarrhea in adults and for allergic disorders in children has been supported by clinical studies; however, the potential mechanism( s) remains to be studied. Experimental studies and clinical trials for probiotic treatment of inflammatory bowel diseases (IBD) have yielded conflicting results. Daily intake of selected probiotics was effective in the prevention of ulcerative colitis and the attenuation of the active onset of Crohn's disease or ulcerative colitis but others failed to show a beneficial effect. The combination of Lactobacillus, Bifidobacterium, Saccharomyces boulardi and the treatment with Escherichia coli Nissle were found beneficial in inducing and maintaining remission of disease activity of gut inflammation and moderately severe ulcerative colitis. Probiotic bacteria were considered in some studies as a safe adjuvant when added to triple eradication therapy against the symptoms induced by the major gastric pathogen, Helicobacter pylori. This review attempted to overview these new exciting advances in the role of these microbes in the pathogenesis, management and treatment of gastrointestinal disorders.