[Priority referrals to the orthopaedic outpatient clinic--what can we improve?]. / Hitno upucivanje u ortopedsku ambulantu--sto mozemo unaprijediti?

The aim was to analyse priority referrals from the general practitioner to the specialist in the orthopaedic outpatient clinic. The analysis was conducted during two weeks in 2005. Besides general data and procedures conducted by the orthopaedic surgeons, the adequacy of the priority referral was acquired. 21.9 outpatients were daily examined and they suffered mostly from low-back pain (39%), followed by knee (20%), hip (12%), and shoulder (11%) problems. The priority referral was inadequate in 57% of cases. The X-ray imaging was conducted in 33% of cases, while an intake of oral analgesics was advised in 67% and physical therapy in 73% of the visits. The number of inadequate priority outpatients at the orthopaedic clinic was very high. They could either wait for a scheduled appointment or could be further treated by the general practitioner, as most of the conducted procedures are available at the primary health-care level.

The effect of proprioceptive training on neuromuscular function in patients with patellar pain.

Eight patients with patellar pain underwent knee proprioceptive training. The maximal knee extension torque associated with the Vastus Lateralis EMG signal increased (p 0.001 and 0.039). Although muscle balance was not improved, all the patients improved their clinical scores.

The effect of proprioceptive training in patients with recurrent dislocation of the patella.

Eleven patients with recurrent dislocation of the patella were subjected to knee proprioceptive training. Patients exhibited a gain in their Lysholm and Activity scores (p 0.03 and 0.009). No patient needed operative procedure.

The influence of the biomechanical parameters of the hip on the outcome of treatment of hips subject to avascular necrosis of the femoral head.

We were interested in whether or not the biomechanical status of the hip influences the course of avascular necrosis of the femoral head. To investigate this, we used a computer aided system based on a three dimensional mathematical model for determining the stress distribution in the hip joint from standard anteroposterior rentgenographs (X-ray images) of both hips and pelvis. Based on the results of our study, we suggest that the biomechanical parameters of the hip play an important role in the outcome of treatment of hips affected by avascular necrosis of the femoral head.

Nucleus pulposus repair with cultured autologous elastic cartilage derived chondrocytes.

Low back pain is one of the most common medical conditions in the Western world. Disc degeneration, an inevitable process of ageing, is one of the major causes of low back pain. Autologous chondrocyte transplantation (ACT) is an increasingly popular method of addressing pathological disorders of cartilage. The purpose of our study was to determine whether autologous chondrocytes from elastic cartilage could survive and synthesise a cartilage specific matrix in the intervertebral disc of rabbits. Sixteen lumbar intervertebral discs (IVD) of New Zealand White rabbits were analysed. In 6 IVD, the nucleus pulposus was evacuated and replaced with tissue engineered autologous chondrocytes from auricular cartilage. In the second group, only the nucleus pulposus was evacuated from 6 IVD, with no chondrocytes implantation. Four non-operated IVD were used as a control. Six months after the operation, the animals were euthanized and the IVD were analysed histologically. Autologous cartilage implants were well tolerated by the host for up to six months in vivo. There was only hyaline-like cartilage in the place of the nucleus pulposus. We could not detect any elastic fibres in the new cartilage matrix. In IVD from which only the nucleus pulposus was evacuated and no chondrocytes were implanted, just fibrous tissue was found instead of nucleus pulposus. The overall histological analysis of new cartilage produced after implantation in our study confirmed the hypothesis that ACT from auricular cartilage can be implanted into the IVD instead of the nucleus pulposus and that a significant percentage of implanted chondrocytes survive and produce hyaline-like cartilage.