Lysosomal enzymes in serum and synovial fluid in patients with osteoarthritis.

OBJECTIVE: To assess the activity of arylsulfatase (AS), acid phosphatase (ACP), cathepsin D (CAT-D) and alpha-1 antitrypsin (AAT) in blood serum and synovial fluid (SF) of patients with hip or knee osteoarthritis (OA). METHODS: The study included 43 subjects with OA (35 hip OA, 8 knee OA), submitted total joint replacement. The control group consisted of 58 subjects with no past history of musculoskeletal disorders. RESULTS: The OA blood serum samples showed a significantly higher level of lysosomal enzymes activity than in the control group (AS by 17.8%, AAT by 42.4%); only the CAT-D activity decreased by 50%). AS, ACP and CAT-D activities were about two-fold higher in SF when compared with blood of OA patients. The differences between the genders were visible in the SF: Total protein concentration, activity of ACP (both higher in OA men) and activity of CAT-D (higher in OA women). Between the involved hip and knee, there were no significant differences in all estimated parameters in the blood serum of the OA group. In regard to the SF, only ACP activity was significantly higher in patients with a hip involved. CONCLUSIONS: The osteoarthritic SF enzymatic profile differs from that in normal joints. The OA in joints is not reflected in the systemic response. Our preliminary results suggest further studies on role of lysosomal enzymes (ACP and AS) as biomarkers for the detection of osteoarthritis.

The activity of cathepsin D and alpha-1 antitrypsin in hip and knee osteoarthritis.

The progress of cartilage decay during joint degeneration is not well monitored with biochemical methods. The role of cathepsin D (CAT-D) in articular cartilage deterioration remains unclear. The aim of this study is to assess the activity of CAT-D and alpha-1 antitrypsin (AAT) in blood in patients with hip or knee osteoarthritis. The activity of CAT-D and AAT in blood serum of 40 women and 21 men with hip or knee osteoarthritis was determined before total joint replacement, on the tenth day after surgery, and once in 54 healthy patients. The preoperative activity of CAT-D in patients with osteoarthritis was lower by 53.6% (11.00 ± 4.54 10(-2) nM released tyrosine/mg protein/min, P < 0.001) and after surgery by 55.0% (10.67 ± 4.64 10(-2) nM released tyrosine/mg protein/min, P < 0.001) when compared to its activity in healthy patients. There was no significant statistical difference between CAT-D activity before the surgery and its activity on the tenth day after it in the analyzed group (P< 0.496). Simultaneously, the preoperative activity of AAT in the OA (osteoarthritis) patients was by 25.5% (0.93 ± 0.32 mg inhibited trypsin/ml blood serum, P < 0.001) and postoperative was by 44.9% higher (1.26 ± 0.36 mg inhibited trypsin/ml blood serum, P < 0.001) than in healthy patients. The low CAT-D activity in osteoarthritis of big joints is associated with a decrease of cartilage cells during the degenerative process. The higher activity of acute phase protein AAT in OA patients' blood serum confirms the inflammatory component in the osteoarthritis process.

The concentration of thiobarbituric acid reactive substances (TBARS) and paraoxonase activity in blood of patients with osteoarthrosis after endoprosthesis implantation.

BACKGROUND: The aim of this study was to evaluate the concentration of malondialdehyde (MDA) in erythrocytes and in blood plasma and the activity of blood paraoxonase (PON1) of patients with osteoarthrosis (OA) submitted to endoprosthesis implantation for evaluating oxidative stress. MATERIAL/METHODS: Study was conducted on 55 patients with OA and on 54 total movement-efficient volunteers. The material for the study was venous blood plasma, serum and erythrocytes. RESULTS: Increased concentration of MDAe before surgery was observed in the group of men and in patients with a degenerative process affecting hip joints. After an implantation of endoprosthesis, MDAe decreased to the level observed in the control groups. In the study group MDA concentration in plasma was slightly lower before surgery, and after an operation it reached the value of the parameter of the reference groups. Regardless of sex or age, paraoxonase activity was almost twice as high in almost all subgroups as in the reference group. A positive correlation between PON 1 activity and MDAe concentration was demonstrated both before and after surgery in the group of men. CONCLUSIONS: The increase of PON1 activity in patients' serum in relation to the control groups indicates a probable pathogenic role of the increased formation of reactive oxygen species in the course of OA and may suggest acute inflammation of the synovial joint. The high level of PON 1 activity after endoprosthesis implantation indicates that surgical treatment may additionally stimulate ROS generation. MDAe concentration indicate more intensive process of lipid peroxidation in the elderly.

[Roentgenometric assessment of spine shape in patients with a flexion contracture of hip as a consequence of hip osteoarthrosis]. / Rentgenometryczna ocena uksztaltowania kregoslupa u pacjentów z przykurczem zgieciowym stawu biodrowego w nastepstwie zmian zwyrodnieniowych.

OBJECTIVE: Current knowledge on influence of hip arthrosis on shape of the lumbar spine is insufficient. Also universal method of roentgenometric assessment of lumbar spine is not yet accepted. The aim of this study was the evaluation of influence of the degree of hip arthrosis on the shape of the spine in a sagittal plane measured by means of selected, roentgenometric parameters. MATERIALS AND METHODS: The study group consisted of 120 patients with hip osteoarthrosis, including 64 women and 56 men. Average age was 69.5 (range from 41 to 81 years). The analysis focused on the influence of age, flexion contracture and radiological degree of arthrosis on selected roentgenometric parameters of lumbar lordosis in the upright and supine positions: Fergusson angle (F), total lordosis angle (Th12-S1), lower lordosis angle (L3-L4/L5-S1), upper lordosis angle (L1-L2/L3-L4). RESULTS: Correlation index between flexion contracture of the hip and total lordosis angle calculated in the upright and supine positions amounted to 0.627 (p < 0.0001) to 0.554 (p < 0.0001) respectively. For the Fergusson's angle correlation index ranged between 0.879 (p <0.001) to 0.758 (p <0.0001) respectively. Differences between average values of individual parameters in groups with varying degrees of arthrosis ranging at the significance level from p <0.0001 for total lordosis angle and Fergusson angle top < 0.04 for lower lordosis angle prove the interdependence between the degree of lumbar lordosis of the spine and hip joint osteoarthrosis. CONCLUSIONS: The Fergusson angle and total lordosis angle of Th12-S1 are the most sensitive roentgenometric parameters to the severity the hip arthrosis represented by it's flexion contracture.

[Evaluation of operative treatment of subcutaneous rupture of the achilles tendon--correlation between clinical presentation and ultrasound examination]. / Ocena wyników leczenia operacyjnego podskórnego zerwania sciegna Achillesa--korelacja obrazu klinicznego i USG.

OBJECTIVE: To improve of the effectiveness of surgical procedures in the repair of rupture of the Achilles tendon, some surgeons use various augmented techniques. The purpose of this study was to evaluate the value of the use of graft from the fascia lata to add strength to the Bunnell suture in the treatment of subcutaneous tear of the Achilles tendon on the base of clinical and ultrasonographic results. MATERIALS AND METHODS: 44 cases of the Achilles tendon lesion in 43 patients were included to the study. The patients were placed quasi-randomly into one of the two groups--group A of 26 tendons, repaired using the Bunnell suture with the reinforcement by a graft of the fascia lata, and group B of 18 tendons, repaired with simple end-to-end Bunnell suture. Results of the treatment were evaluated by the objective 100-point Hannover scale and subjectively by the modified Rupp scale. Results of the static and dynamic ultrasound examination were also analysed. RESULTS: There was no statistically significant difference due to Hannover and Rupp scales in results between the two repair methods. The analysis of results of ultrasound examinations demonstrated that the decreased visibility of internal structures was statistically greater in the patients whose tendon was sutured using a graft from the fascia lata. The treatment method did not, however, influence the presence of inflammatory changes or the quality of sliding ability, as seen in ultrasound. CONCLUSIONS: Open reconstruction of the subcutaneous rupture of the Achilles tendon, regardless fascia lata was used or not, gives a high percent of positive results, both in subjective and objective evaluations. Use of the fascia lata in repair of the Achilles tendon increases the probability of ultrasonographically visible structural changes in the tendon without clinical consequences.

Oxidative equilibrium in the prophylaxis of degenerative joint changes: an analysis of pre- and postoperative activity of antioxidant enzymes in patients with hip and knee osteoarthritis.

BACKGROUND: Osteoarthritis is often accompanied by disturbance of oxidative equilibrium. The aim of the study was to analyze antioxidant defense system function in patients with hip and knee osteoarthritis by assessing superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activity in erythrocytes. MATERIAL/METHODS: The study included 26 women and 18 men who underwent hip or knee arthroplasty. The pre- and postoperative activities of the antioxidant enzymes were evaluated. SOD activity was determined using the Misra/Fridovich method, CAT by the Beer/Seizer method, and the activity of GPx by the Paglia/Valentine method. The results were compared with those of a healthy control group. RESULTS: SOD activity of the patients was insignificantly lower than in the control group. However, after arthroplasty it increased in subgroups: in males by 13% (p<0.04), in females by 7% (p<0.05), in the group <69 years of age by ca. 14%) (p<0.01), and in the group with idiopathic OA by 12% (p<0.005). The activities of CAT and GPx in all the patient groups were significantly higher than in the controls. It increased even more on the 10th day after arthroplasty with the exception of the patients with rheumatoid osteoarthritis, in whom a decrease by 65.5% (p<0.008) were found, and in the patients > or =69 years old by 9.3% (NS). CONCLUSIONS: Knowledge of antioxidant enzyme activity might offer new targets for future therapeutic methods for the treatment of degenerative joint disease.

Early diagnostic procedures in primary care and hospital for children with a painful hip. A prospective study.

OBJECTIVES: To evaluate the current practice in the approach to the painful hip in children. To determine the superiority of ultrasonographic techniques over plain X-ray and to provide guidance to primary care. METHODS: We carried out a prospective cohort study of 55 patients with a painful hip. The management leading up to admission and diagnostic procedures were examined. We carried out ultrasound of all affected hips and repeated the scan every three days. Effusion on ultrasound was noted and was correlated to the symptoms. RESULTS: In total 29/55 patients had plain X-rays taken before or at the initial presentation. No abnormalities were found. Ultrasound showed effusion in 48/55 children. The reduction of the effusion correlated with the improvement in symptoms. An effusion persisting longer than 26 days correlated well to those patients who went on to be diagnosed with a chronic condition (3/4 patients). CONCLUSIONS: At present many practitioners use plain X-ray in the initial diagnosis. Ultrasound should be the initial diagnostic tool of choice. Repeat ultrasound at one month may be of use to determine if the child is likely to develop a chronic condition.

Toxin A-producing Clostridium difficile as an aetiological factor of post-traumatic wound infection.

Clostridium difficile is a well-known cause of hospital-acquired infection such as antibiotic associated diarrhoea or pseudomembranous colitis. Extraintestinal infections caused by this pathogen are described rarely. A case of post-traumatic wound infection caused by C. difficile in an immunocompetent, young and otherwise healthy trauma patient is reported. A 31-year-old female, a car accident victim, was admitted to hospital because of polytrauma. After open reduction and internal fixation of a supracondylar femoral fracture by means of the dynamic condylar screw (DCS) system, a purulent fistula occurred. Microbiological examination of the pus revealed C. difficile as the single aetiological factor of this infection. Empirical antibiotic treatment with cefazoline and metronidazole had been administered right after the surgery, but was found to be ineffective. The strain isolated from the patient was sensitive to most antimicrobials except for clindamycin, and amoxicillin/clavulanic acid was chosen for the guided therapy. Such treatment combined with the removal of the DCS system produced a desirable effect.

Impact of injury on changes in biomechanical loads in human lumbar spine.

Implementation of new spine stabilisation systems should be preceded by the analysis of the behaviour of healthy and damaged spine under laboratory conditions. Research was performed on two-part and three-part segments without damage and with disc damage in the two-part segment, and with a wedge cut in the vertebra in the three-part segment. In the two-part segment, a relative power necessary for inducing extension-compression in the damaged segment is twice as high as in the damaged three-part segment. In the damaged two-part segment, the motion in the sagittal plane needs a relative power being more than twice as high as in the damaged three-part segment. Yet absolute average values of powers examined in the two-part and three-part segment systems in the undamaged spine for all types of motion were similar, with slight advantage of the two-part segment system. Basic two-part segment of the spine motion system is its most stable functional part.

[Total hip arthroplasty in the treatment of arthrosis with coexistent high developmental hip dislocation]. / Zastosowanie endoprotezoplastyki w leczeniu zmian zwyrodnieniowych stawu biodrowego u chorych z przetrwalym rozwojowym zwichniciem.

The question if total hip arthroplasty ought to be advised for patients with high developmental hip dislocation is still actual. The subject of hip arthroplasty, as a method of surgical treatment of high developmental hip dislocation, was analyzed on the base of follow up of seven patients, who underwent this procedure. The mean age of patients was 44.5 (+/- 12.6) years. The mean time of follow up was 64.4 (21.6) months. Initial three patients were treated in two stage regime. In first stage, a surgical hip liberalization and skeletal traction through 3 weeks was performed. In 2nd stage we did total hip replacement with simultaneous shortening of the femoral shaft just below the lesser trochanter. In next four patients we performed total hip arthroplasty with simultaneous shortening of the femoral shaft in one stage. Protection of undesirable rotational instability after osteotomy was done by means of different ways of osteotomy fixation describe in paper. Applied surgical treatment allowed for implanting a cup of prosthesis in original place of acetabulum and reduction of the big anteversion of the femoral neck. The hip congruency was improved in all patients. Score in functional Harris hip scale increased from mean value of 50 points before hip arthroplasty to mean value of 85 points after surgery. The symptoms of late consolidation of osteotomy were observed in one patient with transverse osteotomy without anty-rotational fixation. Total hip replacement with simultaneous "Z" shortening osteotomy of the femoral shaft give good such clinical as radiological results in the treatment of hip osteoarthritis in accordance to high developmental hip dislocation.

Transpedicular plate fixator as effective system of spine stabilisation: biomechanical characteristics.

INTRODUCTION: Zespol fixator, which was created in Poland by Ramatowski and Granowski, has an angular stable connection of screws and plate. These properties of this plate fixator, that is effective and not an expensive system of osteosynthesis of shaft of long bone widely used in Poland, impelled us to adapt it as a transpedicular plate fixator of spine. AIM: The aim of our in vitro study was to measure loads acting on spine stabilized by transpedicular plate fixator and to determine if its stability is comparable with uninjured spine. We also hypothesized that the spine stability with examined fixator had similar properties as spine fixators constructed with screws and rods. MATERIALS AND METHODS: We tested its biomechanical properties and compared it with a CD device by using specimens of four human spines. Each spine with damage induced in laboratory conditions was stabilised by one of those stabilisers in one (L4-L5) or two (Th12-L2) motion segments and subsequently were subject to load. The spines without and with one of transpedicular stabilization were subject to an unsymmetrical shift of +3/-4 mm for extension-compression and symmetrical shift for bending, in the frontal plane (+0.14/-0.14 rad) and the sagittal plane (+0.11/-0.11 rad), respectively. RESULTS: Loads during extension-compression and bending in the sagittal plane were similar to the uninjured spine for short stabilization by using both stabilizers and amounted to 92.3 and 98.26%, respectively, of the load range sums of healthy spines. For long stabilization these loads amounted to 93.2 and 84.4%, respectively. Only following short and long stabilization for both devices in case of bending in the frontal plane the increase in loads up to 144.2 and 163.3% of the range sums of uninjured spines was achieved. CONCLUSION: It corroborates the fact that the application of the modified Zespol device for spine stabilisation provides the possibility of restoring its load transfer capacity similar to that in the healthy spine and comparable with the CD device.

Analysis of management of patients with multiple injuries of the locomotor system.

Body injuries are very serious problems in industrialised countries and they are frequent causes of fatalities in our times. The variety and multiple combinations of body injuries are a challenge for the trauma team. On the basis of clinical and radiological documentation 315 patients with multiple injuries of the locomotor system (MILS) were included in the study. The criterion for inclusion of the patients into the study group was identification of MILS. The study showed that these injuries often involve young people (53%) (predominantly men) aged between 16 and 45 years. Road accidents were the most frequent cause of injuries -80.6%. MILS affected the lower limb in 49.,4%, upper limb in 33.2% and pelvis in 14.1%; 75% of the patients studied also suffered from concomitant injuries. The head and brain were involved in 92.9%, chest in 31.5% and abdomen in 21.3%. The mortality index for the population studied was 14%. An increasing value of the Injury Severity Score (ISS) or New Injury Severity Score (NISS) caused delay in surgical management of bone injuries and correlated with prolonged hospitalisation. Analysis emphasised the usefulness of the NISS as a valuable prognostic instrument in assessment of severity of injuries in patients with multiple injuries of the locomotor system.

Bone mineral density in patients with femoral neck fractures.

BACKGROUND: [corrected] By providing essential information regarding bone mineral density (BMD), Densitometry can predict the mechanical resistance of bone tissue and the risk of fractures. However, fractures frequently occur in the femoral cervix and the spine before the loss of BMD reaches the densitometric threshold of osteoporosis. MATERIAL AND METHODS: We studied 46 patients with total hip arthroplasty subsequent to femoral cervix fracture, divided into three age groups: 80. All subjects underwent densitometry of the unaffected hip and the spine. BMD was also measured in slices of resected bone taken from various points. RESULTS: 80.4% of the patients with fractures were women. The BMD of the femoral cervix and the lumbar spine is lower in women regardless of age. Even though the men in the 70-79 age bracket had the highest BMD in both places, their T-score for the femoral cervix indicated osteoporosis; as did that of all subjects in the 80+ age group. The remaining patients should be diagnosed with osteopenia. The in vitro results were similar. CONCLUSIONS: The lower average BMD in all women points to a significantly higher risk of fracture. Reduced BMD indicates risk but is not a certain predictor of fracture. This may result from uneven distribution of bone density in the femoral cervix. The fact that lower BMD was found in slices from the anterior and inferior regions of the femoral cervix, lying on the axis of greatest distortion during a fall, may support this hypothesis.

Outcome of total hip replacement in rheumatic arthritis.

Background. Degenerative changes caused by rheumatoid arthritis (RA) typically occur in the hands and feet, but are not rare in the hip. The purpose of our research was to assess outcome in RA patients undergoing total hip arthroplasty. Material and methods. From 1992 to 2000 we performed total arthroplasty in 166 RA patients (121 women and 45 men) with degenerative changes in the hip joint. The average age of these patients was 57.4 years (range 35 to 74). Outcome was evaluated clinically in terms of pain relief, locomotion, and range of motion in the hip, evaluated according to the Harris hip function scale. Radiological analysis was also performed. Results. The greatest problem during surgery proved to be the lack of strong bone edges on the acetabulum (78%). The average results from the Harris scale went up 46 points, to 83.2+/-11.3. During the final radiological analysis there were no visible gaps or gaps only in Zone I of the acetabulum in 80% of the joints. We had to perform revision surgery in 3 hips (1.7%) due to infection, and in 8 hips (4.5%) due to aseptic loosening of the acetabulum. Conclusions. 2/3 of the hips affected by rheumatic changes show destruction of the acetabulum, which hinders proper emplacement of the acetabulum. Loosening of the hip endoprosthesis was found radiologically in 13% of the hips, which was accompanied by clinical symptoms in half the cases. The conditions for stable insertion of the shaft were better than for the acetabulum.