[Is aseptic loosening of joint prostheses aseptic?] / Czy aseptyczne obluzowanie protez stawów jest aseptyczne?

The observed changes in the periarticular space may be caused by both mechanical action and biological reactions. Periprosthetic infections are the most common cause of loosening and destructive changes in the joints, however, the diagnosis of an aseptic reaction is not always fully obvious. Micromovements between the implant and the surrounding bone can cause remodeling of the bone trabeculae and migration of fibroblasts into the voids between the implant surface and the bone. In addition, repetitive stresses can induce fibroblast proliferation. On the other hand, the residues arising from the wear of implanted materials in the joints may play an important role in the process of loosening of prostheses - both aseptic and septic. Direct interactions between the released molecule and the macrophage surface are sufficient to activate osteoclastogenic signaling pathways. You cannot ignore allergic reactions to metals used in prostheses in patients undergoing arthroplasty. Demonstration of hypersensitivity to the components of dentures in some cases requires the use of appropriate material in order not to cause an inflammatory allergic reaction. Emerging treatment strategies using mesenchymal stem cells (MSCs) are aimed at improving the initial implant integration and preventing periprosthetic osteolysis. It should be emphasized, however, that the diagnosis of aseptic loosening in many clinical situations raises doubts, because it is at the root of everyone.

Analysis of mortality between 2019-2020 at the Neuroorthopedic and Traumatic Orthopedic Departments.

The number of deaths from skeletal injuries is still significant, but is declining with advances in emergency medicine. The adopted principles of emergency procedures and the availability of specialist centres enable the treatment to be effective. AIM: The aim of the study was to analyse the deaths of patients with spine and limb injuries who required surgery. MATERIALS AND METHODS: The analysis covered 22 deaths in the years 2019-2020. The assessment took into account: the cause of admission, the condition of the patient and comorbidities, the medical scales which were used to assess the possible risk of complications, the diagnostic correctness and qualification for surgical treatment, the waiting time for surgery and the cause of death and prior course of action. RESULTS: It can be stated that in 2019, the mortality rate was 0.21 (10 deaths out of 4658 hospitalized), in 2020, the mortality rate was 0.31 (12 deaths out of 3852 hospitalized). The mortality rate in the Department of Traumatic Orthopedics was: 0.30 in 2019 (8 deaths out of 2625 hospitalized) and 0.39 in 2020 (8 deaths in 2020 hospitalized). 10 patients with hip fractures (trochanteric and femoral neck) underwent surgery within 2.7 days (from 1 to 4 days). The causes of death within 1-9 days (average 4.86 days) from admission in this group were complex, and associated with the presence of chronic diseases, including: circulatory failure (9), septic shock (1), heart rhythm disturbances (7), renal failure (6), pulmonary congestion (4), hyperkalemia (1), coagulation disorders (1). In patients after spinal injury with quadriplegia, decompression (1), stabilization (1) and disc removal (1) were performed on the day of admission to the hospital. The patients were hospitalized in the ICU, and deaths occurred on days 9, 15 and 187 from admission due to respiratory and circulatory failure and sudden cardiac arrest. Patients after arthroplasty of the knee (1) and hip (2) were operated on day 2 from admission, and deaths occurred on day 4, 22 and 53 due to: sepsis (1), pulmonary embolism (1), respiratory failure in the course of pneumonia (1). CONCLUSIONS: The deceased were admitted in a serious general condition, burdened with numerous concomitant chronic diseases and their age ranged from 66 to 97 years. The surgical treatment was undertaken for life saving reasons but 5 of the deceased did not undergo surgery due to the extreme general condition leading to respiratory and circulatory failure.

[Pro-health cycle lane versus environmental pollution and trauma]. / Prozdrowotne sciezki rowerowe a zanieczyszczenie srodowiska naturalnego i urazowosc.

A bicycle as a mean of transport and recreation, but is it a healthy lifestyle? The construction of numerous cycle lanes in cities and promotion of physical activity aims to encourage the public to move around by bicycle. The aim of mass cycling is to reduce car exhaust emissions and, on the other hand, to improve public health. The paper presents the potential benefits of cycling, but also its negative effects on the human body. Minimizing the danger of using a bicycle lies not only with cyclists, but also with people who are planning to build cycle lane.

Hip arthoplasty in a forester after numerous tick bites.

Arthritis is one of the most important symptoms of late-stage borreliosis, observed in approximately 60% of untreated patients with Lyme disease. In several percent of them, this manifestation is of interest to orthopedic surgeons. The authors present a case of a patient, working as a forester, who underwent left hip replacement arthroplasty having contracted a Borrelia burgdorferi infection in the past, and who was hospitalized 12 years before in the infectious ward due to suspected neuroborreliosis for which he was treated with Ceftriaxone 2 × 2.0 g intravenously for 4 weeks. At that time, a tomographic examination of the spinal cord revealed herniated nuclei at levels L4/L5 and L5/S1, which filled the left lateral recess, narrowing the intervertebral holes and compressing the nerve roots on the left side of L4 and L5. In September 2019, total hip replacement in the patient's left hip joint was performed. It is concluded that an active role of neuroborreliosis in this process of hip joint destruction may be suggested. Int J Occup Med Environ Health. 2021;34(5):693-9.

Finegoldia magna the cause of hip revision surgery - a two case report.

The cause of septic arthritis in 20% of cases is anaerobic bacteria, including infections caused by Finegoldia magna. The occurrence of this pathogen in the etiology of postoperative post-implantive septic joint inflammations is estimated at 5-12% of all anaerobic infections, and 20-40% of all gram-positive anaerobic coccus (GPAC). CASE REPORTS: The 65-year-old male patient was admitted due to symptoms of pain in the left hip after having undergone arthroplasty three years prior. It was found that the relative length of the left lower limb was shortened by 1.5 cm and there was limited mobility of the left hip joint. The radiological image of the left hip indicated the loosening of the endoprosthesis, which qualified for a revision surgery. During hip revision surgery, the material was collected from the site, for microbiological examination, in which Finegoldia magna was detected, sensitive to Amoxicillin with Clavulanic acid, Clindamycin, Chloramphenicol, Imipenem, Metronidazole and Piperacillin with Tazobactam. Based upon the antibiogram, the patient was given piperacillin with tazobactam (Tazocin, Pfizer) 4 times a day 4.5 g intravenously over 7 days, resulting in a clinical improvement. The 55-year-old female patient was admitted due to recurrent exudates in left trochlear bursa which arose 5 years after left hip arthroplasty. The patient had limited movements in the left hip. Ulrasound diagnostics showed a presence of a thick fluid reservoir located under the fascia in the lateral side of the left thigh measuring 160 x 42 x 25 mm, which had contact with the hip joint. In the radiographic image of the joint, a cyst around the bottom of the implanted acetabular component was revealed. The patient underwent hip revision surgery, and an anaerobic bacterium Finegoldia magna was isolated from a swab taken from the acetabulum. The patient was given piperacillin with tazobactam (Tazocin, Pfizer) 4 times a day 4.5 g intravenously over 7 days, with good clinical effect. CONCLUSIONS: In both cases, the post-implantation septic infection was triggered by Finegoldia magna. Arthroplasty with subsequent antibiotic therapy resulted in an improvement of the patients' condition and joint reconstruction. In orthopedic practice it should be noted that infections due to the anaerobic bacteria Finegoldia magna may be the cause of complications after the arthroplasty of the joints.

[The growing resistance of bacterial strains to antibiotics]. / Narastajaca opornosc szczepów bakteryjnych na dzialanie antybiotyków.

Understanding the mechanisms of bacterial resistance to antibiotics made it possible to divide this phenomenon into natural and acquired resistance. The natural resistance of the bacteria is related to the lack of antibiotic ability to penetrate into the interior of the bacteria and limit the ability of penetration through the cell wall, as well as the poor affinity of the drug for the receptor or the lack of such a receptor. The acquired bacterial resistance is related to the changes occurring within the resistance genes and their rapid transfer, in which plasmids participate. The single- and multistage mutations of TEM (temoneira), SHV (sulfhydryl variable) and CTX-M (cefotaximase) lead to ESBL (extended-spectrum beta-lactamase) resistance. The main mechanisms responsible for shaping bacterial resistance to antibiotics are intracellular transformations determining internal resistance, acquisition of resistance in the process of mutation or transfer of horizontal resistance genes, and adaptive resistance, which is defined as a transient increase in resistance due to gene induction by the antibiotic itself, e.g. as a result of interaction with an antibiotic. Observed increasing resistance of bacteria to antibiotics is associated with their abuse without reasonable indications and with extensive use in veterinary and food industry. In Europe, about 25,000 people die every year due to antibiotic-resistant infections, which involves costs - about 1.5 billion euros a year.

Radiological evaluation of the Stoffella metatarsal I osteotomy in the treatment of hallux valgus.

The Stoffella surgical method is a reverse Chevron distal metatarsal osteotomy, typically used in younger patients, with good bone quality. The technique is suitable for a variety of cases, from mild to severe, since the head of the first metatarsal may be moved laterally to the edge of the first metatarsal bone, thereby allowing for a significant degree of correction. AIM: The aim of the paper is to review the radiological results of patients suffering from hallux valgus who underwent Stoffella metatarsal I osteotomy. MATERIALS AND METHODS: The study has been carried out using a sample of 23 patients, evaluating their pre and post-surgery radiographs. It seeks to examine the effectiveness of the Stoffella metatarsal I osteotomy by measurements of the HVA (Hallux Valgus Angle), IMA (Intermetatarsal Angle), DMAA (Distal Metaphyseal Articular Angle) both prior to and post-surgical correction. RESULTS: The study demonstrated that the Stoffella Metatarsal I osteotomy has a high rate of success, with correction of the HVA, IMA, DMAA angles, with pre- surgery HVA being 29.7°±6.1°, IMA - 12.9°±3.6°, DMAA - 13.7°±7.1°, Post-surgery results show a mean reduction of 51.28%, 51.13%, 50.56% respectively towards a mean HVA of 14.5°±7.4° (p<0.001), mean IMA of 6.3°±3.7° (p<0.001), mean DMAA of 6.8°±4° (p<0.001). All patients who underwent the surgery had HVA, IMA, DMAA angles within the normal physiological range post-surgery. CONCLUSIONS: It was concluded that the Stoffella Metatarsal I osteotomy is effective in the correction of the hallux valgus.