Functional recovery after muscle sparing total hip arthroplasty in comparison to classic lateral approach - A three years follow-up study.

BACKGROUND: The muscle sparing total hip arthroplasty had generated a distinguishable interest, in both the patients and the surgeons, but its benefits are still often questioned. The main idea of this study was to compare the functional clinical outcome of the patients operated by the anterolateral approach with a muscle-sparing technique (modified Watson-Jones approach), and the patients operated by modified direct lateral approach without the muscle-sparing technique (Bauer/Hardinge approach). METHODS: The patients (N = 130) were divided into two groups: 68 in a standard method group (STAND) and 62 patients in a muscle sparing surgery group (MSS). The hip flexibility, mobility, the strength of the hip abduction, the pain scale, Harris hip scores, the duration of the hospital stay and the overall satisfaction were measured seven days, three months, one year and three years (in 80 patients) after the surgery. There were no differences in any of the parameters between the groups prior to the procedure. RESULTS: The statistically significant differences in first three follow-ups (up to one year) were determined between the groups in passive and active hip flexion ability but the hip abduction strength, which is a crucial parameter for functional recovery, and 50 m walk test remained better in MSS group even after three years. Patients, who underwent MSS suffered also less pain, stayed in hospital shorter and were more satisfied with the operation outcome. CONCLUSIONS: The functional recovery in patients treated with muscle sparing method was faster than in patients operated with conventional lateral approach. Based on the results, we could recommend anterolateral muscle sparing approach for a total hip replacement for its faster and fuller functional recovery.

Measuring improvement following total hip and knee arthroplasty using the SF-36 Health Survey.

The aim of this study was to evaluate the impact of total hip or knee arthroplasty upon quality of life in elderly patients. The study was carried out at the Clinic for Orthopaedic Surgery Lovran on 74 total hip arthroplasty and 70 total knee arthroplasty patients. All patients had completed the Medical Outcomes Study 36-Item Short Form in the week having preceded their surgery and then again postoperatively, 2 years after. The data obtained were statistically processed at the level of physical function, role limitations due to physical problems, role limitations due to emotional problems, social function, mental health, energy or vitality, pain and general health perception, and change in health. The primary total hip arthroplasty patients showed significant improvement at all levels measured. Similarly, the primary total knee arthroplasty patients expressed significant improvement according to all the parameters but the mental health assessment. Comparison of outcomes between the two assessment groups of patients resulted in slightly superior quality of life outcomes in total hip arthroplasty patients. It can be concluded that total hip or knee arthroplasty significantly enhances the health related quality of life in elderly patients.

Granulysin expression and granulysin-mediated apoptosis in the peripheral blood of osteoarthritis patients.

Osteoarthritis (OA) is a chronic joint disease caused by mechanical damage and metabolic factors that support the development of low-grade inflammation. Increased levels of T helper 1 pro-inflammatory cytokines in the serum of OA patients may support granulysin (GNLY) mediated cytotoxicity, which in-turn may contribute to the pathogenesis of OA. In the present study, GNLY expression and cytotoxic/apoptotic mechanisms mediated by GNLY in the peripheral blood of OA patients were assessed. A total of 40 non-obese women (median age of 64 years old) with knee OA, and 40 controls (median age 62 years old) were enrolled in the study. GNLY, IFN-γ and IL-4 expression levels were investigated in peripheral blood lymphocytes (PBLs) using flow cytometry, immunocytochemistry and/or confocal microscopy. Natural killer (NK) GNLY-mediated apoptosis through NK effectors against K-562 targets was analyzed using the PKH-26 18-h cytotoxicity assay. Serum GNLY levels were assessed using ELISA. The percentage of GNLY+PBLs was higher in the OA patients than that in the controls due to the increase in the proportions of GNLY+ cells in the natural killer (NK), T and natural killer T (NKT) subsets. GNLY localization inside exocytotic lysosomal-associated membrane protein-1+ granules was ~40% in both groups. However, the intensity of GNLY labeling in PBLs was higher in OA patients than in the controls, and it was supported by the increased expression of IFN-γ relative to IL-4 in NK and T cells from OA patients. The serum GNLY concentration was <0.3 ng/ml in both groups. RC8 anti-GNLY mAb by itself was unable to significantly alter early apoptosis, whereas RC8 anti-GNLY mAb combined with anti-perforin mAb significantly reduced NK-mediated early apoptosis of K-562 targets in the OA patients, whilst not exerting a notable effect in the controls. Anti-perforin mAb by itself did not affect apoptosis significantly. These results suggest that in women with knee OA, GNLY expression in the PBL subsets and GNLY-mediated early apoptosis of K-562 targets are increased compared with the controls and accompanied by intracellular dominance of IFN-γ over IL-4 in NK cells.

Bone allograft provides bone healing in the medial opening high tibial osteotomy.

Various materials are used to fill osteotomy defects created in the medial opening wedge high tibial osteotomy (MOWHTO). Our hypothesis was that a bone allograft would provide the osteotomy site bone healing within the expected time. We performed the MOWHTO using a cancellous bone allograft in 310 knees in 284 patients between 2000 and 2005. Internal fixation was achieved with a T-profile AO plate. Preoperative and postoperative radiographic measurements were taken and statistically processed. All patients were followed up for a period ranging from three to eight years, or 5.9 years on average. Implanted cancellous bone allografts

The influence of test repetition on bipodal visually controlled static and dynamic balance.

This study explores the influence of test repetition on bipodal visually controlled balance, both static and dynamic. Our goal was to get an insight into the pattern of changes in posture maintenance results during repeated balance tests. Fifteen young, healthy male recreational athletes were tested for static and for dynamic balance using KAT 2000 balance platform. The subjects first performed three trial tests of static and dynamic balance to get used to the platform followed by seven repetitions of static as well as dynamic test which were recorded. During the repeated tests we could not determine any significant improvements of static balance test resulting from number of test repetitions neither in static nor in dynamic balance (Friedman ANOVA: Static balance p = 0.497, Dynamic balance p = 0.393). Correlating static and dynamic balance results we found that only one third of the dynamic balance was related to static balance abilities (r2 = 0.36). Possible patterns in front-back and left-right directions were analyzed as well, however, none of these balance scores were found to be related to the number of repetitions. In conclusion, this study found no significant influence of limited number of repetitions (seven) on test results in static and dynamic posture. However, as large number of repetitions might still influence test results we discourage the use of KAT 2000 as a training tool in patients in which it will be used as an instrument to validate postoperative rehabilitation or investigation results.

Limb salvage surgery in Enneking's stage III a--a case of leiomyosarcoma.

Limb saving surgery is today's tendency in treating the musculoskeletal tumours. Preserving the limb should not only pursue a good oncological and functional result but also aim at good psychological outcome. Our aim was to treat a very rare case of proximal femoral leiomyosarcoma with present solitary lung metastasis by conservative operative procedures.

Arthroscopic removal of metal foreign bodies from the knee joint after explosive war injuries.

The results of arthroscopic removal of metallic fragments from knee joint due to explosive war injuries are presented. In period from 1991-1995 during war in Croatia we have operated 25 knee joints. Indications for arthroscopy were based on radiographic and clinical findings. The foreign bodies in the joint were found in 19 patients while additional 6 had foreign bodies in the periarticular soft tissues. Arthroscopies were performed on average one month after wounding. The foreign bodies were placed in different parts of the joint with no prediction sites. In 8 knees foreign bodies were freely mobile, and in 11 were anchored to different intraarticular structures. There were no complications during early postoperative period as well as in follow up period.

Keller's arthroplasty with proximal metatarsal opening wedge osteotomy in treating severe Hallux valgus deformity--surgical techniques and case report.

The paper presents an operative technique proposed for treating severe Hallux Valgus deformity with arthrosis of the first metatarsal joint in elderly people. The procedure consists of the Keller's arthroplasty in combination with basal osteotomy of the first metatarsal bone, whereby the head of the metatarsal is displaced laterally and plantarward. The osteotomy is fixed with a reconstructive plate. The results show a significant improvement in the hallux valgus angle, the first metatarsal angle, as well as in the plantar pressure distribution.

Microfracture technique in combination with intraarticular hyaluronic acid injection in articular cartilage defect regeneration in rabbit model.

Although articular hyaline cartilage typically has low potential for regeneration, numerous methods and techniques have been proposed to induce the reparation process. In our work, we used microfracture techniques in combination with intraarticular application of hyaluronic acid in rabbit knee articular cartilage defect. In comparison with the control group, after 6 and 10 weeks we observed a higher potential of healing in the experimental group, with thicker and more organized repair tissue filling the defect. In conclusion, a combination of the microfracture technique and application of hyaluronic acid might be potentially beneficial in inducing articular cartilage defect reparation.

[Bone bank at University Department of Orthopedic Surgery in Lovran, Croatia]. / Kostana banka Klinike za ortopediju Lovran.

AIM: At University Department of Orthopedic Surgery in Lovran, bone bank was established in 1985 for preserving and storage of musculoskeletal tissue. At first, storage was only done for femoral heads as surgical residues of hip replacement. Since 1993, storage is also done for transplants obtained by retrieving bone allografts from cadavers during multiorgan explantations. METHODS: Transplant donors are chosen on the basis of medical history, physical examination and laboratory analysis of blood samples. Transplants are kept at the bone bank, by deep freeze method, at temperature of -80 degrees C. RESULTS: During the 2002-2006 period, bone bank delivered a total of 729 bone allografts, which were succesfully used in surgical treatment. CONCLUSION: Good results of the surgeries using bone allografts stimulated us for further development of bone banking.

Bone morphogenetic protein-7 (osteogenic protein-1) promotes tendon graft integration in anterior cruciate ligament reconstruction in sheep.

BACKGROUND: Bone morphogenetic proteins induce new bone both in patients with bone defects and at extraskeletal sites in animals. After anterior cruciate ligament rupture, tendon graft fixation into a bone tunnel is a widely used method for anterior cruciate ligament reconstruction. HYPOTHESIS: Bone morphogenetic protein-7 applied to the bone-tendon interface enables better integration of a free tendon graft into the surrounding bone. STUDY DESIGN: Controlled laboratory study. METHODS: The anterior cruciate ligament was reconstructed using a free tendon graft in the right rear knees of 30 one-year-old male sheep. Recombinant human bone morphogenetic protein-7 (25 microg) was applied randomly to the bone-tendon interface in 15 animals, and a vehicle was applied in 15 control animals. At 3 weeks, 10 animals from each group were sacrificed, and the remaining sheep were sacrificed at 6 weeks after surgery. Subsequently, histologic analysis and mechanical testing were performed. In another group of 20 sheep, the same procedure was used and mechanical testing was performed after 3 weeks. RESULTS: More new bone was formed at the bone-tendon interface in the knees treated with bone morphogenetic protein-7 as compared histologically with similar areas in control animals, creating areas of dense trabecular network with significantly greater invasion of the tendon fibrous tissue into the bone marrow space. Mechanical testing showed greater strain resistance to force (368 N) in the knees treated with bone morphogenetic protein-7 than in control specimens (214 N). There was no difference between mechanical testing of samples from 3 and 6 weeks after surgery. CONCLUSION: Bone morphogenetic protein-7 promotes complete tendon graft integration into the newly formed surrounding trabecular bone in the reconstruction of the anterior cruciate ligament. CLINICAL RELEVANCE: Bone morphogenetic protein-7 in tendon graft integration might be successfully used in reconstructive surgery of ligaments.