The aim of this research is to present the initial results of patellofemoral (PF) knee joint prosthesis implantation, as well as a review of recent literature. In the ten-year time period from 2012 ...to 2021, we implanted 8 PF prostheses, which account for 0.7% of all implanted knee prostheses. Out of the eight patients, two were male and six were female. The average age of the patients was 55.3 (47–70) years, with the average BMI being 26.4 (22.9– 31.9) kg/m2. Four patients had the procedure done on their right leg, and the other four on their left leg. The indication for surgery was secondary osteoarthritis following dysplasia or patellar instability in 5 patients, post-traumatic osteoarthritis in one patient, grade II chondromalacia with chronic anterior knee pain in one patient, and patella baja following surgical treatment in one patient FU was 5.87 (1–10) years. The patients underwent functional testing, Womac, KSS, Tegner and VAS. We analysed 7 patients, one of whom underwent conversion to TEP after 5.5 years. Range of motion was 0/128 (120–135) deg. Through clinical and radiological follow-ups, we found that the prostheses were stable throughout the follow-up period, with a normal patellar tracking. Preoperative WOMAC score was 38.4 , postoperative score was 95.5 points (p < 0.0001); preoperative KKS 1 (pain) score was 34.25, postoperative score was 94 (p < 0.0057); KKS 2 (function) score was 53.75, postoperative score was 95 (p < 0.0485), preoperative Tegner activity level was 1.86, postoperative level was 3 (p < 0.0002); preoperative VAS score was 7.14, postoperative score was 1.86 (p < -0.0001). PF arthroplasty has proven to be a successful option for treating isolated patellofemoral osteoarthritis, In recent years, the design of the prosthesis have been improving, which leaves open the possibility of this method of treatment being used more frequently and the indications being expanded.
In Croatia, hospitals where patients with diseases of the locomotor system were cared for date from more than 100 years ago. However, we consider the beginning of orthopaedics in Croatia to be the ...year 1908 when Božidar Špišić (1879 - 1957) founded the first Orthopaedic Institute in Zagreb. In 1917, the School of Medicine, University of Zagreb was founded, and when the first students were in their fifth year of studies, the Department of Orthopaedic Surgery was established on December 15, 1922, and Božidar Špišić became an Assistant Professor. From that date until today, Orthopaedics has been an independent department within the School of Medicine. The Department of Orthopaedic Surgery was primarily established for the education of medical students. Another important activity of the Department was the training of orthopaedic surgeons and specialists in overlapping fields with orthopaedics. In 1973, the department made a program of postgraduate studies in orthopaedics. The department also participated in postgraduate studies of other professions overlapping with orthopaedics and held numerous post-graduate courses and continuous medical education for doctors. Also, the department organised both domestic and international meetings, symposia, and congresses. Within the scientific post-graduate and doctoral studies, the Department of Orthopaedic Surgery members are lecturers in many courses. This article presents the work and development of the Department of Orthopaedic Surgery in the first 100 years of orthopaedics education at the School of Medicine, University of Zagreb and clinical work as a part of the University Hospital Centre Zagreb. It is a presentation of time periods under nine heads of the department, starting from Professor Božidar Špišić all to the current head Professor Domagoj Delimar.
Background
Postoperatively shed blood salvage is commonly used to reduce allogenic blood transfusion in patients undergoing total hip (THA) and knee arthroplasty (TKA). Autologous blood retransfusion ...is not devoid of risk. We hypothesized that adding tranexamic acid (TXA) to a restrictive blood transfusion protocol would reduce the need for postoperative autologous blood retransfusion in primary knee and hip arthroplasty.
Study Design and Methods
Ninety‐eight adult patients undergoing primary THA or TKA were randomly assigned to receive an intraoperative intravenous loading dose of 1.0 g of TXA followed by another 1.0‐g dose 3 hours later (TXA group) or a matching volume 0.9% saline placebo (control group). A postoperatively shed autologous blood recovery system was used in all patients and the minimum reinfusion volume set at 250 mL. Red blood cells were transfused if hemoglobin level was less than 8 or if 8 to 10 g/dL with symptoms of anemia.
Results
The proportion of patients receiving autologous blood reinfusion was significantly lower in the TXA group (5/49) compared to placebo (42/49) with an absolute difference of −75.5% (adjusted relative risk, 0.005), and none of the patients in the TXA group received more than 400 mL retransfused. Median total external blood loss during the first 24 hours was lower in the TXA group, 320 mL (range, 80‐930 mL), compared to 970 mL (range, 100‐2600 mL) in the placebo group (p < 0.001). There were no significant differences in homologous blood transfusions and hematologic variables between groups. Treatment differences were consistent by size and significance when the analysis was repeated separately in patients undergoing TKA or THA.
Conclusion
Addition of TXA to a restrictive transfusion protocol makes the use of a postoperative blood salvage system in patients undergoing primary hip and knee arthroplasty unnecessary.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Snapping hip or coxa saltans is a condition characterized by an audible and/or palpable snapping during hip movement and can be associated with pain around the hip. There are various causes of this ...condition and can be divided into two types: extra-articular and intra-articular. The most common type is the external extra-articular, where the snapping is due to thickened posterior part of the iliotibial band or anterior part of the gluteus maximus muscle sliding over the greater trochanter during hip movement. Two patients with external snapping hip are presented, who were treated with our original endoscopic iliotibial band release and greater trochanteric bursectomy. There were no surgical complications and the patients did not experience snapping or pain in the hip during 24-month follow-up period. Results of various open techniques and one endoscopic technique in the treatment of external snapping hip are also reported.
Purpose
Pro-inflammatory cytokines play a pivotal role in osteoarthritis, as well as in bone tunnel widening after ACL reconstructive surgery. A new treatment option is to administer autologous ...conditioned serum (ACS) containing endogenous anti-inflammatory cytokines including IL-1Ra and growth factors (IGF-1, PDGF, and TGF-β1, among others) in the liquid blood phase. The purpose of this trial was to establish whether the postoperative outcome could be affected by intraarticular application of ACS.
Methods
In a prospective, randomized, double-blinded, placebo-controlled trial with two parallel groups, 62 patients were treated. Bone tunnel width was measured by CT scans, while clinical efficacy was assessed by patient-administered outcome instruments (WOMAC, IKDC 2000) up to 1 year following the ACL reconstruction in patients receiving either ACS (Group A) or placebo (Group B). We compared the levels and dynamics of IL-1β concentrations in the synovial liquid and examined the correlation between the levels of IL-1β at three different postoperative points.
Results
Bone tunnel enlargement was significantly less (6 months: 8%, 12 months: 13%) in Group A than in Group B (6 months: 31%, 12 months: 38%). Clinical outcomes (WOMAC, IKDC 2000) were consistently better in patients treated with ACS at all data points and for all outcome parameters, and there were statistically significant differences in the WOMAC stiffness subscale after 1 year. The decrease in IL-1β synovial fluid concentration was more pronounced in the ACS group, and values were lower, to a statistically significant degree, in the ACS group at day 10.
Conclusion
The intraarticular administration/injection of ACS results in decreased bone tunnel widening after ACL reconstructive surgery.
Level of evidence
Therapeutic study, Randomized controlled trial (significant differences and narrow confidence intervals), Level I.
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EMUNI, FSPLJ, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, SBNM, UL, UM, UPUK
Background: As the natural healing capacity of damaged articular cartilage is poor, joint surface injuries are a prime target for regenerative
medicine. Characterized chondrocyte implantation uses an ...autologous cartilage cell therapy product that has been optimized
for its biological potency to form stable cartilage tissue in vivo.
Purpose: To determine whether, in symptomatic cartilage defects of the femoral condyle, structural regeneration with characterized
chondrocyte implantation is superior to repair with microfracture.
Study Design: Randomized controlled trial; Level of evidence, 1.
Methods: Characterized chondrocyte implantation was compared with microfracture in patients with single grade III to IV symptomatic
cartilage defects of the femoral condyles in a multicenter trial. Patients aged 18 to 50 years were randomized to characterized
chondrocyte implantation (n = 57) or microfracture (n = 61). Structural repair was blindly assessed in biopsy specimens taken
at 1 year using (1) computerized histomorphometry and (2) evaluation of overall histological components of structural repair.
Clinical outcome was measured using the self administered Knee injury and Osteoarthritis Outcome Score. Adverse events were
recorded throughout the study.
Results: Characterized chondrocyte implantation resulted in better structural repair, as assessed by histomorphometry ( P = .003) and overall histologic evaluation ( P = .012). Aspects of structural repair relating to chondrocyte phenotype and tissue structure were superior with characterized
chondrocyte implantation. Clinical outcome as measured by the Knee injury and Osteoarthritis Outcome Score at 12 to 18 months
after characterized chondrocyte implantation was comparable with microfracture at this stage. Both treatment groups had a
similar mean baseline overall Knee injury and Osteoarthritis Outcome Score (56.30 ± 13.61 and 59.53 ± 14.95 for microfracture
and characterized chondrocyte implantation, respectively), which increased in both groups to 70.56 ± 12.39 and 72.63 ± 15.55
at 6 months, 73.26 ± 14.66 and 73.10 ± 16.01 at 12 months, and 74.73 ± 17.01 and 75.04 ± 14.50 at 18 months, respectively.
Both techniques were generally well tolerated; the incidence of adverse events after characterized chondrocyte implantation
was not markedly increased compared with that for microfracture.
Conclusion: One year after treatment, characterized chondrocyte implantation was associated with a tissue regenerate that was superior
to that after microfracture. Short-term clinical outcome was similar for both treatments. The superior structural outcome
may result in improved long-term clinical benefit with characterized chondrocyte implantation. Long-term follow-up is needed
to confirm these findings.
Keywords:
chondrocyte
chondral
regenerative medicine
autologous chondrocyte implantation (ACI)
characterized chondrocyte implantation (CCI)
cell therapy product
microfracture
cartilage repair
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
The aim of this research was to determine if the age of healthy subjects older than 40 years of age has an influence on the concentration of β2‐microglobulin in the serum of subjects of different ...populations. We examined the values of β2‐microglobulin in the serum of 51 healthy subjects aged 40–86 years using the microparticle enzyme immunoassay AxSYM β2‐microglobulin test. The reference values of β2‐microglobulin according to the nonparametric statistical method is 0.95–2.73 mg/L. A correlation was found between β2‐microglobulin and age: 40–50 years (0.94–1.54 mg/L), 51–65 years (0.96–2.62 mg/L), and >65 years (1.13–2.84 mg/L). There was no significant statistical difference of β2‐microglobulin between genders (P > 0.05); however, there was a statistically significant difference between the concentration of β2‐microglobulin and the subjects' age. (Spearman's rank correlation coefficient ρ = 0.66; P < 0.01). A direct correlation between age and the concentration of β2‐microglobulin was observed. This research is a contribution to determining reference values of β2‐microglobulin in subjects of different populations.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Purpose
Prevention of the knee osteoarthritis following meniscectomy is implantation of an allotransplant or an artificial meniscus. We present retrospective study of our early results of the ...treatment using polyurethane meniscal scaffold.
Methods
From 2016 to 2020, we implanted nine polyurethane scaffolds (Actifit) after partial meniscectomy, five males and four females, age 36 (16–47), BMI 26.7 (17.2–35.9) kg/m
2
. Functional status, activity, pain, and MRI were assessed.
Results
FU 20.8 (6–48.5) months, 35.2 (0–68) months from the meniscectomy to the implantation. The average implant length was 46.1 (35–60) mm, average number of sutures was 7.6 (5–10). Lysholm score before surgery was 61.7 (49–85), after the surgery 86.4 (62–95) with
p
0.0045, Tegner activity score before meniscectomy was 5.8 (4–7), after 3.8 (2–5), and after the scaffold implantation 4.6 (3–7) with
p
0.0488. Before surgery, VAS score was 3.1 (2–4), and after 7.7 (5–9) with
p
0.0042.
Pursuant to the Genovese classification, the last follow-up MRI showed a type 2 meniscal morphology in four cases and a type 3 in five cases. Seven patients had type 1 and two had type 2 signal intensity. On average, the absolute extrusion of a transplanted meniscus was 3.67 mm, and the relative extrusion was 0.58 mm. Extrusion progress was not detected.
Conclusion
Significantly improved knee functionality, increased level of physical activity, and reduced pain. MRI analysis revealed the meniscal transplant morphology and volume loss, as well as its extrusion without progression.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background: Characterized chondrocyte implantation (CCI) results in significantly better early structural tissue regeneration than microfracture (MF), and CCI has a midterm clinical benefit over ...microfracture.
Purpose: This study was undertaken to evaluate the 5-year clinical outcome of CCI in a randomized comparison with MF for the treatment of symptomatic cartilage defects of the femoral condyles of the knee.
Study Design: Randomized controlled trial; Level of evidence, 1.
Methods: Participants aged 18 to 50 years with a symptomatic isolated International Cartilage Repair Society (ICRS) grade III or IV cartilage lesion of the femoral condyles between 1 and 5 cm2 were randomized to either CCI or MF. Clinical outcomes were measured up to 60 months after surgery using the Knee Injury and Osteoarthritis Outcome Score (KOOS). The main outcome parameter was change from baseline in overall KOOS (oKOOS). Adverse events were monitored.
Results: Fifty-one participants were treated with CCI and 61 with MF. On average, clinical benefit was maintained through the 60-month follow-up period. The average change from baseline in oKOOS was not different between both groups (least squares LS mean ± standard error SE 18.84 ± 3.58 for CCI vs 13.21 ± 5.63 for MF; P = .116). Treatment failures were comparable (n = 7 in CCI vs n = 10 in MF), although MF failures tended to occur earlier. Subgroup analysis revealed that CCI resulted in better outcome in participants with time since symptom onset of less than 3 years, which was statistically significant and clinically relevant (change in oKOOS <3 years mean ± SE 25.96 ± 3.45 for CCI vs 15.28 ± 3.17 for MF; P = .026 vs oKOOS >3 years mean ± SE 13.09 ± 4.78 for CCI vs 17.02 ± 4.50 for MF, P = .554). Other subgroup analyses such as age (cutoff 35 years) did not show a difference. Female patients showed more failures irrespective of treatment.
Conclusion: At 5 years after treatment, clinical outcomes for CCI and MF were comparable. In the early treatment group, CCI obtained statistically significant and clinically relevant better results than MF. Delayed treatment resulted in less predictable outcomes for CCI. These results provide strong evidence that time since onset of symptoms is an essential variable that should be taken into account in future treatment algorithms for cartilage repair of the knee.
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FSPLJ, NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
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