Blood Pressure Trends, Demographic Data, Workload, and Lifestyle Factors Among Nurses in the Subcarpathian Region of Poland: A Cross-Sectional Observational Study.

BACKGROUND Hypertension is one of the main modifiable risk factors linked to cardiovascular disease and its prevalence is currently increasing in various age groups. This study aimed to evaluate blood pressure, demographic data, workload, and lifestyle factors in nurses employed in hospitals in the Subcarpathian region of southeastern Poland. MATERIAL AND METHODS This cross-sectional observational study was conducted among 627 professionally active nurses. Certified devices were used for measurements: body mass analyzer (Tanita MC-980 PLUS MA), automated sphygmomanometer (Welch Allyn 4200B), stadiometer (Seca 213), and tape measure (Seca 201). The frequency of consumption of specific product groups was assessed using a survey method. Analysis using R software (version 4.3.1) employed logistic regression to examine variables affecting hypertension occurrence. RESULTS The study found that elevated blood pressure is more prevalent among nurses than they self-report. Logistic regression analysis identified significant predictors for hypertension, including age (odds ratio; OR=1.061; OR=1.045), working more than 1 job (OR=1.579; OR=1.864), and body mass index (OR=1.152; OR=1.113). CONCLUSIONS Regular monitoring of blood pressure is necessary for early detection and timely intervention of hypertension. Enhancing nurses' awareness of their own health will encourage proactive preventive measures. Implementing comprehensive education programs focused on the latest advances in cardiovascular disease prevention is essential.

Prevalence of dyslipidaemia within Polish nurses. Cross-sectional study - single and multiple linear regression models and ROC analysis.

BACKGROUND: Maintaining good health is vital not only for own well-being, but also to ensure high-quality patient care. The aim of this study was to evaluate the prevalence of dyslipidaemia and to determine the factors responsible for the development of this disorder among Polish nurses. Lipid profile disorders are the most prevalent and challenging risk factors for the development of cardiovascular disease. Nurses have significant potential and play a crucial role in providing care and treatment services. METHODS: This cross-sectional study involved nurses and included measurements of body weight composition (Tanita MC-980), body mass index, waist circumference, blood pressure (Welch Allyn 4200B), lipid profile, and fasting blood glucose (CardioChek PA). RESULTS: The results revealed that more than half of the nurses (60.09%) were overweight or obese, with 57.28% exhibiting elevated blood pressure, 32.25% having fasting glucose levels, and 69.14% experiencing dyslipidaemia. Multiple model evaluation using ROC curves demonstrated that multiple models accurately predicted hypercholesterolemia (AUC = 0.715), elevated LDL (AUC = 0.727), and elevated TC (AUC = 0.723) among Polish nurses. CONCLUSION: Comprehensive education programmes should be implemented that include the latest advances in cardiovascular disease prevention. Regular check-ups, as well as the promotion and availability of healthy food in hospital canteens, are essential.

Is There Safety Outside the "Safe Zone" in Total Hip Replacement? A Retrospective Observational Study.

Background and Objectives: The safe zone in total hip replacement was introduced many years ago. Its aim was to provide guidelines for orthopedic surgeons in order to avoid complications such as instability. With the growing interest in spinopelvic alignment, some new insights suggest that the safe zone is an obsolete concept. This study aims to show that, even outside the safe zone, the effect of total hip replacement can be satisfactory. This could be used as preliminary study for an analysis of a larger group. Materials and Methods: Fifty-nine consecutive patients with end-stage osteoarthritis treated by total hip replacement were enrolled into the study and divided into two groups: inside the safe zone and outside the safe zone. A physical examination during postoperative visits was performed; the range of movement was measured using a goniometer; and the HHS and VAS were taken to measure functional outcomes and pain, respectively. An analysis of the radiological outcomes was performed. Results: There was no significant difference in regard to changes in total offset, pain, HHS and other complications. There were no signs of instability among patients during the follow-up. Conclusions: The results of this study show that the "safe zone" is a more complicated term that was previously thought. A proper soft tissue balance and spinopelvic alignment could be factors that change the "safe zone" for each patient and make it more individual.

Bone turnover markers and muscle decay indicator in patients with proximal femur fracture - a case-control study.

Introduction: Fracture of the proximal femur is common in elderly patients, in fact threatening their lives. Age-related sarcopenia may be involved in the imbalance resulting in the injury. Handy and readily accessible biochemical tests would be useful to assess the musculoskeletal system condition in daily practice. The aim of the study was to determine whether there is any relation between muscle decay and fracture of the proximal femur and to assess bone quality in elderly patients. Material and methods: In the study 22 patients who represented the treatment group were hospitalized due to proximal femur fracture. Eighteen patients from the control group with no fracture in their history were admitted to the Internal Medicine Department. Anyone treated for osteoporosis, immune disease affecting protein balance, neoplasm, mental illness, heart failure, or myocardial infarction was excluded from the study. In every case a blood sample from an elbow vein was drawn, collected in EDTA-K2 tubes, and then centrifuged to separate plasma from the whole blood. Subsequently, the concentrations of C-terminal cross-linked telopeptide of type I collagen (CTX-I), sex hormone binding globulin (SHBG) and creatine kinase (CK) in plasma were determined using commercial enzyme-linked immunosorbent assays. Results: The CK plasma concentration differed between the patient groups (p = 0.011). The SHBG plasma concentration was significantly higher in the treatment group (p = 0.006), whereas a slight difference in CTX-I plasma concentration between the groups was found (p = 0.038). No significant correlations between plasma CK, SHBG or CTX-I were found (p > 0.05). Conclusions: Creatine kinase is actually not an appropriate marker for the clinical assessment of muscle tissue quality in patients with or at risk of proximal femur fracture. Analyzing the quality of bone tissue, we can conclude it was poorer in patients with proximal femur fracture than in the control group.

Impact of acetabular roof's angle on precision of cup center of rotation reproduction and placement in total hip arthroplasty.

Introduction: Total hip arthroplasty (THA) is nowadays considered as the most effective treatment option for end-stage hip osteoarthritis (OA) and one of the most successful orthopedic procedures. Precise reproduction of the center of rotation (COR) is among the most important aspects of recreating native hip biomechanics after THA as it is strictly related to muscle tension and force distribution within the hip joint. Both vertical and horizontal shift in cup positioning and COR restoration are commonly observed radiological signs corresponding with lesser functional outcome. The aim of this study was to assess whether the superior border of the native acetabulum morphology has an impact on cup positioning and COR restoration in patients undergoing THA as treatment of primary OA of the hip. Material and methods: A cohort of 150 consecutive patients with diagnosis of end-stage primary hip OA who underwent THA via an anterolateral approach with the same implant in 2021 was analyzed retrospectively. Standard standing pelvic X-rays were performed pre- and postoperatively and appropriate measurements were taken. Several radiological parameters on obtained X-rays were assessed. Statistical analysis of all the measurements was performed. Results: There was a statistically significant positive weak correlation between cup offset and acetabular roof angle (rs = 0.25, p = 0.002). There were statistically insignificant positive correlations between acetabular roof angle and COR restoration (rs = 0.14, p = 0.097), acetabular roof angle and total offset (rs = 0.087, p = 0.29) and a negative correlation between acetabular roof angle and femoral offset (rs = 0.071, p = 0.39). Conclusions: The present study revealed that preoperative acetabular roof angle influences the positioning of the prosthetic cup in the transverse axis. There also seems to be a correlation between the acetabular roof angle and COR restoration, but its significance needs further evaluation. Surgeons could use this knowledge to preoperatively assess the risk of cup malposition and adjust their technique during the THA procedure with probable improvement of hip function.

Differences in joint line level and posterior condylar offset during total knee replacement with use of gap-balancing and measured resection techniques-matched cohort study.

BACKGROUND: Total knee replacement (TKR) is considered one of the most common elective orthopaedic procedures. The main focus of TKR is to offer patient's symptomatic relief from persistent knee pain. To achieve this it is crucial to restore joint biomechanics by performing proper bone cuts. Some surgeons favor the measured resection technique, others prefer gap balancing technique. The researchers of the presented study performed TKR using these two techniques. The aim of this study was to compare the postoperative change in joint line and posterior condylar offset after TKR with use of anatomic knee design implants between gap balancing and measured resection techniques. METHODS: Two hundred twenty-five X-rays of patients who underwent TKR performed by a single surgeon between 2020 and 2021 were analyzed. The first group of patients (101) was operated with the use of gap balancing technique and the second group (124) was operated with the use of measured resection technique. Patients included in the study were > 50 years of age, had confirmed primary knee osteoarthritis, underwent primary TKR with a PS (posterior stabilized) knee implants without patella resurfacing and had at least 15 degree flexion contracture. T-student test and U Mann-Whitney test were used in statistical analysis of results, according to the normality of distribution examined with the Shapiro-Wilk test. Post-hoc analysis was performed using the Dwass-Steel-Crichtlow-Fligner test (DSCF). RESULTS: The postoperative analysis showed a significantly elevated joint line level in the gap balancing group (-2.6 ± 4.1 vs -0.7 ± 4.8, p < 0.0005). In the gap balancing group significantly more patients had joint lines elevated > 2 mm comparing to measured resection technique. The difference between pre- and postoperative PCO (posterior condylar offset) and PCOR (posterior condylar offset ratio) results had no significant differences (100.8 ± 11.8 vs 101 ± 12.5, p > 0.05) between the groups. CONCLUSIONS: The results of the study suggest that when it comes to restoring joint line level measured resection technique seems to be superior in comparison to the gap balancing technique. What is more, results indicate measured resection is equal in terms of restoring posterior condylar offset to the gap balancing technique. TRIAL REGISTRATION: NCT04164147, date of registration: November 14, 2019.

The Influence of Single Whole-Body Cryostimulation on Cytokine Status and Oxidative Stress Biomarkers during Exhaustive Physical Effort: A Crossover Study.

The purpose of the study was to assess the impact of single whole-body cryostimulation (WBC) preceding submaximal exercise on oxidative stress and inflammatory biomarkers in professional, male athletes. The subjects (n = 32, age 25.2 ± 37) were exposed to low temperatures (-130 °C) in a cryochamber and then participated in 40 min of exercise (85% HRmax). Two weeks afterwards, the control exercise (without WBC) was performed. Blood samples were taken before the start of the study, immediately after the WBC procedure, after exercise preceded by WBC (WBC exercise) and after exercise without WBC. It has been shown that catalase activity after WBC exercise is lower in comparison with activity after control exercise. The interleukin 1ß (IL-1-1ß) level was higher after control exercise than after WBC exercise, after the WBC procedure and before the start of the study (p < 0.01). The WBC procedure interleukin 6 (IL-6) level was compared with the baseline level (p < 0.01). The level of Il-6 was higher both after WBC exercise and after control exercise compared with the level recorded after the WBC procedure (p < 0.05). Several significant correlations between the studied parameters were shown. In conclusion, the changes in the cytokine concentration in the athletes' blood confirm that body exposition to extremely low temperatures before exercise could regulate the inflammatory reaction course and secretion of cytokines during exercise. A single session of WBC in the case of well-trained, male athletes does not significantly affect the level of oxidative stress indicators.

Curve-on-curve technique does not improve tibial coverage in total knee arthroplasty in comparison to tibial tuberosity technique with use of anatomical implants: randomized controlled trial.

INTRODUCTION: During the last years, main attention while performing total knee replacement was paid to femoral component alignment; however, there is still lack of studies concerning tibial baseplate rotational alignment, especially in terms of anatomical designs of knee prosthesis. Some recent studies proved that tibial baseplate malrotation might be a cause of knee pain and patients' dissatisfaction. The aim of this study was to compare tibial component rotation and its coverage on the tibial plateau achieved with curve-on-curve and tibial tuberosity techniques (t-t technique) with use of anatomic knee designs with asymmetric tibial baseplate. MATERIALS AND METHODS: A total of 88 patients were randomly assigned in a 1:1 ratio to undergo total knee arthroplasty with use of the PERSONA PS (Zimmer Biomet) knee design with an asymmetric baseplate. The rotation of the tibial component was assessed and performed with two different techniques: curve-on-curve technique and tibial tuberosity technique. Tibial component rotation was measured on computed tomography (CT) scans using the method suggested by Benazzo et al. and designed for asymmetrical implants. For the measurement of the tibial bone coverage, the component surface area was outlined and measured on a proper CT section, then the tibial cut surface area was outlined and measured on a section just below the cement level. Pre- and post-operative range of motion was measured by another independent researcher 12 months post-operatively during follow-up visit. RESULTS: There was a statistically significant difference between both groups in median value of tibial rotation angle: 7° (interquartile range (IQR) = 0-12) in curve-on-curve technique group vs 2° (IQR-1-7) in tibial tuberosity technique group, probability value (p) = 0.0041, with values above 0 meaning external rotation of the component. There was no statistically significant difference between both groups in terms of range of motion (ROM) with average values of 124.3° ± 13.0° for curve-on-curve technique and 125.6° ± 12.8° for t-t technique with p = 0.45. There was a statistically insignificant difference between both groups in terms of coverage percentage in slight favor for curve-on-curve technique (85.9 ± 4.2 vs 84.5 ± 4.8, p = 0.17). CONCLUSION: In this study, no difference between the groups in terms of tibial bone coverage and range of motion was proved, even though both techniques differed significantly with values of tibial rotation. Future studies should be focused on influence of specific values of tibial rotation on patient-reported outcomes and survivorship of anatomic knee implants.

Comparison of Femoral Component Rotation between Robotic-Assisted vs. Soft-Tissue Tensor Total Knee Arthroplasty with Anatomic Implants.

Background and Objectives: Total knee arthroplasty (TKA) is the most effective treatment method for end-stage osteoarthritis. One of the most important aspects of this surgery is adequate implant positioning, as it guarantees the desired outcome of restoring limb biomechanics. Surgical technique is being continuously improved along with hardware development. There are two novel devices designed to help establish proper femoral component rotation: soft-tissue tensor and robotic-assisted TKA (RATKA). This study compared the femoral component rotation achieved with the use of three methods: RATKA, soft tissue tensioner and the conventional measured-resection technique, all of them utilizing anatomical design prosthesis components. Materials and Methods: A total of 139 patients diagnosed with end-stage osteoarthritis underwent total knee arthroplasty between December 2020 and June 2021. After the surgery, they were divided into three groups depending on procedure technique and implant type: Persona (Zimmer Biomet) + Fuzion Balancer, RATKA + Journey II BCS or conventional TKA + Persona/Journey. Postoperatively, a computed tomography examination was performed in order to measure femoral component rotation. All three groups were compared independently during statistical analysis. Fisher's exact, Kruskal-Wallis and Dwass-Steel-Crichtlow-Fligner tests were used for particular calculations. Results: Statistically significant differences in femoral component rotation between groups were noticed. However, in terms of values other than 0° in external rotation, no significant variance was revealed. Conclusions: Additional total knee arthroplasty instruments seem to improve the outcomes of the surgery, providing better component positioning than in the conventional measured-resection technique based only on bone landmarks.

Analysis of biomechanical gait parameters in patients after total hip replacement operated via anterolateral approach depending on size of the femoral head implant: retrospective matched-cohort study.

INTRODUCTION: Total hip replacement (THR) is considered one of the most effective medical procedures in treatment of osteoarthritis. Since its introduction, there has been a worldwide debate over proper implant selection in terms of size, bearing type and shape. Following study was designed to assess the importance of femoral head size in long-term follow-up. MATERIALS AND METHODS: A cohort of 30 patients with primary end stage osteoarthritis who underwent total hip replacement was analysed retrospectively. A homogenous group was chosen with no major differences in BMI. Patients' gait parameters were measured in a biomechanics laboratory using the 3D BTS Smart system. WOMAC and VAS questionnaires were used to assess patient reported outcome. RESULTS: The subgroup with larger implant head size had several outcomes significantly superior to the subgroup with standard head size and non-inferior to healthy hips. Following variables were measured during this study: time of support phase, time of swing phase, double support time, walking hip extension angle. CONCLUSIONS: Use of larger sized femoral heads during THR gives better results in terms of gait pattern. Since restoring the gait pattern is one of the aspects of rehabilitation and returning to daily activities it seems to be an important observation.

Hip hemiprosthesis due to femoral neck fracture in the elderly population - are we doing it right?

Introduction: Femoral neck fracture is one of the most common orthopaedic traumas affecting the elderly population. The standard treatment method is hip hemiarthroplasty and total hip arthroplasty. In hip hemiprostheses surgeons mainly have to reconstruct the femoral offset and limbs' length to obtain the correct gait biomechanics and a satisfactory surgical outcome.The aim of this study is to examine the radiological results of patients after hip hemiarthroplasty for femoral neck fracture and to evaluate the reconstruction of the femoral offset using standard neck angle stems. Material and methods: A consecutive series of 97 patients diagnosed with femoral neck fracture treated with a hip hemiprosthesis between 2017 and 2021 was identified and met the inclusion criteria. On preoperative images, the neck-shaft angle and the femoral offset on the healthy limb were measured. The femoral offset of the operated limb was measured on the postoperative X-rays. Results: There was a significant positive moderate correlation between neck-shaft angle and femoral offset change (r = 0.568, p < 0.0001). There was a statistically significant difference between femoral offset change and neck-shaft angle (24:52 vs. 14:7, p = 0.005). This means that in patients with coxa vara the change in femoral offset was more often < -5 mm. Less than half of operated patients had the femoral offset restored within a safe range (between -5 and 5 mm). Conclusions: Our study proved that it is sometimes hard to achieve femoral offset within a safe range while performing hip hemiarthroplasty in patients with coxa vara. The topic of using high offset stems in partial hip arthroplasty has not been thoroughly researched worldwide. However, taking into account the results of our study, during a hip hemiarthroplasty the usage of high offset stems for varus hips should be considered in order to improve the clinical outcome and improve patients' quality of life and functioning.

Balance and motion coordination parameters can be improved in patients with type 2 diabetes with physical balance training: non-randomized controlled trial.

BACKGROUND: Type 2 diabetes (T2D) is a cause of multiple complications, including retinopathy and peripheral neuropathy. These complications are well understood and believed to contribute to gait instability. Poor balance control and increased falling risk have also been reported in people with diabetic peripheral neuropathy (DPN). Patients with DPN have increased risk of falling due to decreased proprioceptive feedback. Effective balance training should improve postural control in patients with DPN. For this purpose further evaluation was conducted and balance training was designed. METHODS: The goal of our study was to determine values of proprioception, balance, muscle coordination and strength in patients with T2D and analyze whether biofeedback balance training with use of the Biodex Balance System could improve these parameters. To assess the fall risk the general stability index (GSI), the index of frontal-posterior (FPI) and medial-lateral (MLI) stability were evaluated. 37 patients with diagnosed type 2 diabetes mellitus were recruited to this study. Their results were compared with control group consisting of 41 healthy participants who were homogenic to the study group in terms of age and body mass index (BMI). RESULTS: There were statistically significant differences between patients with diabetes compared to healthy subjects in GSI (2.79 vs 1.1), FPI (1.66 vs 0.7), MLI (0.88 vs 0.52) and risk of falling (5.18 vs 2.72) p < 0.05. There were also statistically significant changes before and after training in all stability indices (GSI: 2.79 vs 1.26, FPI: 1.66 vs 0.77, MLI: 0.88 vs 0.54 accordingly) p < 0.05 and risk of falling (5.18 vs 3.87) p < 0.05 in the study group who had undergone training with biofeedback. CONCLUSIONS: This study found that there is a decreased balance and motor coordination and an increased risk of falling in patients with type 2 diabetes. These parameters improved in patients who have undergone training programme with biofeedback. Furthermore, an age-dependent deprivation of static balance was observed along with an increased risk of falling as a result of increasing BMI.

Genetic Predisposition for Osteoporosis and Fractures in Postmenopausal Women.

Osteoporosis is a disease with complex etiology where the genetic factors may account for as much as 50-85% of the risk of its development in postmenopausal women. The polymorphism of estrogen receptor genes (ESR1, ESR2) seems essential among the genetic factors. The goal of this study was to analyze polymorphisms of selected genes in a population of postmenopausal women treated for osteoporosis and to evaluate the influence of genetic and nongenetic factors on the estimated 10-year risk of fracture. The study group consisted of 214 women hospitalized for treatment of postmenopausal osteoporosis. We investigated the presence of ESR1, ESR2, LRP5, and WNT16 genetic polymorphisms and the risk of fracture in each woman. The main finding was that of significant differences in the polymorphisms of the WNT16 rs2908004 genetic variant, notably, the less frequent presence of TC allele in women with a greater risk of osteoporotic fractures. We conclude that the polymorphism of the WNT16 gene seems highly relevant in the pathogenesis of osteoporosis, which makes it a promising object for further research on the genetic background of fracture risk.

Autologous Platelet-Rich Plasma Reduces Healing Time of Chronic Venous Leg Ulcers: A Prospective Observational Study.

The study investigated whether the application of dressings with autologous platelet-rich plasma (PRP) would reduce the healing time in patients with chronic venous leg ulcers. This is a prospective observational study that included 100 patients diagnosed with lower extremity venous insufficiency complicated by ulceration of a leg or foot, who had been after angioplasty of stenotic artery. Patients were divided into two groups of 50 each: treated with PRP (study group) and treated with conventional hydrocolloid dressings (control group). We followed the wound changes at Day 10, Day 20, and Day 30 of treatment and compared them with the baseline appearance at Day 0. We evaluated the appearance, area, and depths of wounds with ultrasound. The granulation process was examined histologically to document skin formation and wound tissue neovascularization. The findings were that treatment with PRP dressings resulted in a significant progressive reduction in ulcer size, irrespective of the ulcer's initial size, compared to treatment with conventional dressings. Further, the best effect of PRP was noticed in the category of largest wounds. After a month of treatment with PRP dressings, more than 50% of all ulcers were completely healed. The young epidermis appeared together with the granulation tissue, and the formation of dermis took shape after 20 days of treatment. We conclude that the use of PRP dressings is a safe, nonsurgical adjunctive procedure for treating chronic venous leg ulcers. The potential benefit of PRP dressings over conventional ulcer treatment requires further in-depth exploration.

Influence of diabetes on tissue healing in orthopaedic injuries.

Diabetes is a group of metabolic diseases characterized by hyperglycaemia resulting from the defective action or secretion of insulin. Chronic hyperglycaemia can lead to the damage, dysfunction and failure of various organs. In the context of complications of healing and orthopaedic rehabilitation, vascular (microangiopathy) and nerve (neuropathy) disorders deserve particular attention. About 12% of the patients admitted to orthopaedic departments have diabetes. Studies indicate that there is an indisputable link between diabetes and: an increased risk of fractures, the difficult healing of injuries of bones, ligaments and musculotendinous. It appears that one of the main reasons for this is non-enzymatic glycosylation (glycation) of collagen molecules, a phenomenon observed in the elderly and diabetic populations, as it leads to the formation of advanced glycation end products (AGEs). Collagen is one of the major connective tissue components, and is therefore part of ligaments, tendons and bones. AGEs affect the weakening of its structure and biomechanical properties, and thus also affects the weakening of the structure and properties of the above-mentioned tissues. The aim of the study is to undertake an overview of the current knowledge of the impact of diabetes on the risk of some injuries and subsequent healing and rehabilitation of patients following orthopaedic injuries.

Improvement in Gait Pattern After Knee Arthroplasty Followed by Proprioceptive Neuromuscular Facilitation Physiotherapy.

The aim of the study was to assess the influence of a physiotherapy program based on proprioceptive neuromuscular facilitation (PNF) on kinematic gait pattern after total knee arthroplasty. This comparative study included two groups of patients qualified for total surgical knee joint replacement due to osteoarthritis: a study group and a control group, either consisting of 28 patients of a matched age range of 55-90 years. Following surgery, 4 days after standard postoperative rehabilitation, the study patients were subjected to a 3-week-long therapist-assisted rehabilitation based on PNF principles (10 sessions of 75 min each), whereas control patients were discharged with instructions on how to exercise in the home setting. The outcome consisted of spatial-temporal gait parameters that were assessed at three time points: a day before surgery and then 1 month and 6 months after. The findings were that PNF caused substantial, sustained improvements in gait kinematics, shortening the stance phases, gait cycle duration, and double support phase and prolonging swing phase velocity, gait velocity, cadence, step length, and gait cycle length. Also, postsurgical pain was evidently less. We conclude that the individually tailored PNF rehabilitation program is superior compared to a standard recommendation of home-based physiotherapy in terms of improving gait kinematic pattern as well as psychological aspects related to pain perception in patients after knee arthroplasty.

Does Patient-Specific Instrumentation Improve Femoral and Tibial Component Alignment in Total Knee Arthroplasty? A Prospective Randomized Study.

Alignment of the prosthesis is one of the most significant factors that affect the long-term clinical outcome following total knee arthroplasty (TKA). There is conflicting evidence whether patient-specific instrumentation (PSI) for TKA improves the component position compared to standard instrumentation. This study aimed to compare the rotational alignment of the femoral and tibial components in TKA patients when performed with either conventional or PSI. Sixty patients with primary knee osteoarthritis were randomly divided into two groups treated surgically with TKA: one with conventional instrumentation and the other with the Visionaire PSI system (Smith and Nephew, Memphis, TN). Computerized tomography (CT) and X-ray imaging were performed preoperatively and 12 weeks after surgery. The rotational alignment of the femoral and tibial component in all patients was assessed postsurgically using CT imaging according to the Berger protocol. Both groups were clinically assessed in a blinded fashion using the Knee Society Score (KSS) and a visual analog scale (VAS). Fifty-eight patients were prospectively assessed. The mean postsurgical follow-up was 3.0 ± 0.4 months. CT images did not reveal any significant improvement in the rotational alignment of the implant components between the groups. X-rays revealed a significant improvement in the deviation from the optimal alignment range of the femoral component in the coronal plane in both groups. Patients operated with Visionaire PSI assistance had poorer functional outcomes. We conclude that there were no improvements in clinical outcomes or knee component alignment in patients treated with PSI compared with those treated with standard instruments. In addition, clinical and functional assessment showed inferior results in terms of KSS and VAS scores at the midterm follow-up in patients treated with PSI.

Use of cervical collar after whiplash injuries.

Whiplash injuries, also known as neck sprains and strains, are currently some of the most common injuries of the cervical spine. Mechanism of injury is still controversial and current treatment methods do not provide satisfactory results. In this article we present QTF classification of related disorders, epidemiological data and treatment methods. We described basic principles of using a soft collar, goals and effects of collar use and potential complications ensuing from immobilization. Authors reviewed publications comparing the effects of collar use with other methods of treatment and physiotherapy following whiplash injury.

High prevalence of vitamin D insufficiency in community-dwelling postmenopausal Polish women.

INTRODUCTION: Inadequate vitamin D level is associated with altered bone turnover and bone loss, which increases the fracture risk. AIM: To assess the seasonal prevalence of inadequate (insufficient or deficient) serum vitamin D levels in community-dwelling postmenopausal Polish women screened for osteoporosis. MATERIAL AND METHODS: A cross-sectional observational study based on the regional urban non-institutionalized sample (n = 107) of postmenopausal Caucasian women in the age range of 51-83 years, not taking any medication and free from any condition likely to affect vitamin D status or calcium/bone metabolism. The outcome measures were the mean 25-OH vitamin D level across all the seasons and the percentage of vitamin D deficiency and insufficiency and defined as < 20 ng/dl (50 nmol/l) and 20-30 ng/dl (50-75 nmol/l), respectively. RESULTS: No statistically significant difference has been found in the mean vitamin D level, regardless of the season (p = 0.4). The prevalence of vitamin D deficiency and insufficiency were in spring 54% and 32%, in summer 46% and 46%, in autumn 67% and 27%, and in winter 61% and 22%, respectively. CONCLUSIONS: Vitamin D inadequacy is common in a sample of Polish community-dwelling postmenopausal women regardless of the season.