Hip osteoarthritis (HOA) is characterized by degradation of the cartilage and synovitis. However, the pathohistological effects of synovial tissue inflammation on HOA are not clear. The aim of this ...study was to evaluate the expression of iNOS, BCL-2 and MMP-9 markers in different synovial cell populations. A total of 32 patients were evaluated retrospectively. Age, sex, height, weight, body mass index were recorded and lymphocyte, fibrocytes and macrophages were analysed in tissue sections. Osteoarthritis cartilage histopathology assessment system (OARSI), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Krenn score, Harris Hip Score (HHS) and Kellgren-Lawrence (K-L) grading of the hip joints were performed. Total hip arthroplasty was performed on 32 patients and controls. Patients were divided into two groups according to their disease severity. The tissues were immunohistochemically analysed. K-L grade and Krenn score differ between all three groups, but also between moderate and severe OA. Synovial lining cell layer, resident cells in stroma and especially inflammatory infiltration were increasing with severity of OA. iNOS expression in both intima and subintima was positively correlated with Krenn score in moderate and severe osteoarthritis (OA) groups. Expression of BCL-2 in intima of severe OA patients was positively correlated with Krenn score. In conclusion, iNOS, BCL-2 and MMP-9 are involved in the regulation of HOA. Our study indicates a relationship between the pathohistological features, the synovial inflammation and the cartilage condition at the time of hip replacement due to OA or femoral neck fracture.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
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).
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.
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.
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.
Abstract The “cello technique” is a new calcaneoplasty technique for the treatment of Haglund disease. It is an ultrasound-assisted technique for resection of the posterosuperior part of the ...calcaneus. It is possible to resect the posterosuperior part of the calcaneus under direct ultrasound control with the patient in the prone position, with a dorsally positioned ultrasound probe, in line with the Achilles tendon fibers (sagittal line), and with the abrader in the posteromedial working portal. We describe in detail the technique for this new procedure in foot and ankle surgery. This innovative technique offers the possibility of expanding the indications for ultrasound-guided surgery in other fields of orthopaedic surgery.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Cilj: Totalna endoproteza (TEP) gležnja ugrađuje se kod uznapredovalog stadija osteoartritisa gležnja s ciljem održavanja bezbolnog, stabilnog i pokretljivog zgloba. Cilj je ovog istraživanja bio ...analizirati rane funkcionalne rezultate nakon ugradnje TEP-a gležnja. Ispitanici i metode: Ispitana je skupina od 18 pacijenata s ugrađenim TEP-om gležnja. Prosječna dob pacijenata bila je 62 godine. Kod 12 pacijenata radilo se o sekundarnom obliku osteoartritisa gležnja na osnovi prethodne ozljede, a kod 6 o primarnom osteoartritisu gležnja. Svi su pacijenti kirurški liječeni u Klinici za ortopediju Lovran u razdoblju od 2013. do 2016. godine, a ispitivanje je provedeno uz pomoć anketnog lista institucije American Academy of Orthopedic Surgeons (AAOS), vizualne analogne ljestvice (VAS) bola i goniometra. Rezultati: Dobiveni rezultati pokazali su značajno poboljšanje u funkcionalnom stanju gležnja, kao i u njegovoj pokretljivosti. Prijeoperacijski rezultati AAOS-ova anketnog lista iznosili su 30,34, dok su poslijeoperacijski iznosili 70,01 bodova. Prosječni je opseg pokreta gležnja prije operacije bio 16,11°, a poslijeoperacijski 30,26°. Također se pokazalo da je intenzitet bola nakon ugradnje endoproteze gležnja značajno manji. Prijeoperacijski je prosječna razina VAS-a bola bila 7,83, a poslijeoperacijski 3,5. Zaključak: Rezultati ove studije potvrđuju uspješnost ugradnje TEP-a gležnja u pacijenata s uznapredovalim osteoartritisom gležnja.
Aim: Total ankle replacement (TAR) is performed in advanced stages of degenerative ankle osteoarthritis in order to maintain pain-free, stable and movable ankle joint. The main goal of this study was to analyse the early functional results following TAR. Patients and methods: We analysed a group of 18 patients with total ankle replacement. The average age was 62. 12 patients were diagnosed with secondary post-traumatic ankle osteoarthritis, while 6 had primary ankle osteoarthritis. All patients were surgically treated at the Clinic for Orthopaedics Surgery Lovran from 2013 until 2016. The research was carried out by AAOS (American Academy of Orthopaedic Surgeons) questionnaire, VAS (visual analogue scale ) of pain and a goniometer. Results: The results showed a significant improvement in the functionality of the ankle and range of motion. Preoperative results of the AAOS questionnaire were 30.34, while the postoperative were 70.01. Range of motion before surgery was 11.16° and 29.72° postoperatively. It was also shown that the intensity of pain after total ankle replacement was significantly reduced. Preoperative VAS pain was 7.83 and 3.5 postoperatively. Conclusion: The results of this study demonstrate success of the TAR in treating patients with ankle osteoarthritis.
Cilj: Totalna endoproteza (TEP) gležnja ugrađuje se kod uznapredovalog stadija osteoartritisa gležnja s ciljem održavanja bezbolnog, stabilnog i pokretljivog zgloba. Cilj je ovog istraživanja bio ...analizirati rane funkcionalne rezultate nakon ugradnje TEP-a gležnja. Ispitanici i metode: Ispitana je skupina od 18 pacijenata s ugrađenim TEP-om gležnja. Prosječna dob pacijenata bila je 62 godine. Kod 12 pacijenata radilo se o sekundarnom obliku osteoartritisa gležnja na osnovi prethodne ozljede, a kod 6 o primarnom osteoartritisu gležnja. Svi su pacijenti kirurški liječeni u Klinici za ortopediju Lovran u razdoblju od 2013. do 2016. godine, a ispitivanje je provedeno uz pomoć anketnog lista institucije American Academy of Orthopedic Surgeons (AAOS), vizualne analogne ljestvice (VAS) bola i goniometra. Rezultati: Dobiveni rezultati pokazali su značajno poboljšanje u funkcionalnom stanju gležnja, kao i u njegovoj pokretljivosti. Prijeoperacijski rezultati AAOS-ova anketnog lista iznosili su 30,34, dok su poslijeoperacijski iznosili 70,01 bodova. Prosječni je opseg pokreta gležnja prije operacije bio 16,11°, a poslijeoperacijski 30,26°. Također se pokazalo da je intenzitet bola nakon ugradnje endoproteze gležnja značajno manji. Prijeoperacijski je prosječna razina VAS-a bola bila 7,83, a poslijeoperacijski 3,5. Zaključak: Rezultati ove studije potvrđuju uspješnost ugradnje TEP-a gležnja u pacijenata s uznapredovalim osteoartritisom gležnja.
Highlights • The physiological load influences balance. • The static balance and dynamic balance are both affected. • Already at the intensity 60–65% of HRmax the significant decrease of balance ...abilities happens. • Above the anaerobic threshold the additional decrease in balance occurs.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Abstract Background The purpose of this retrospective study was to evaluate the complications associated with leg lengthening in children treated with the Ilizarov external fixator (IEF) and compare ...them between two groups of patients: one group was treated using an IEF alone and the other group was treated using an IEF in association with intramedullary alignment (IA). Patients and methods The study was performed at the University Children's Hospital in Belgrade, Serbia during a fourteen-year period (from 2000 to 2014). Complications occurred in 73 paediatric patients who underwent the leg lengthening procedure. Complications were classified according to the Caton classification and compared between two groups. Group I comprised 39 patients who underwent the limb lengthening procedure using IEF alone. Group II consisted of 34 patients who were treated with the combination of IEF and IA using two Kirschner wires (K-wires) or Titanium Elastic Nails (TEN). The duration of hospital treatment was also compared between the two groups and the impact of the type of IA on the occurrence of complications was assessed. Results There was a high rate of complications in patients treated using an IEF compared with those treated using the combination of IEF and IA, but there was no statistically significant difference between the two groups. There was a statistically significant difference in the duration of initial hospitalisation between the two groups, particularly when comparing TEN usage in IA. A comparison of the group of patients treated using an IEF in association with K-wires and patients treated using IEF and TEN showed there was no statistically significant difference in complication rate and duration of initial hospitalisation. Conclusion IA has multiple advantages as a method of treatment of leg length inequality. The major effect of applying IA in association with a circular IEF is significantly reduced complication rate and duration of initial hospitalisation, particularly when using TEN as a method of IA. This method of treatment also decreases hospital costs.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
9.
THE MOST FREQUENT INJURIES IN GOLF Rakovac, Suncica Hasagic; Rakovac, Ivan; Canaki, Martina
Hrvatski športskomedicinski vjesnik,
12/2014, Volume:
29, Issue:
2
Journal Article
BACKGROUND Pain and surgical stress cause a pro-inflammatory response followed by downregulation of the immune response, which can increase the incidence of postoperative complications, such as ...infections or prolonged wound healing. T lymphocytes and natural killer (NK) cells have cytotoxic potential and are crucial components of cellular immunity, which is important for maintenance of immune balance. The aim of this study was to analyze the effects of 3 types of postoperative analgesia on the preservation and cytotoxic potential of T lymphocytes, NK cells, and their subpopulations, as well as NKT cells, in patients after total knee replacement (TKR) to find the most effective analgesic technique for mitigating immune suppression. MATERIAL AND METHODS Forty-eight patients scheduled for TKR were randomly allocated to Group 1 (patients received epidural analgesia), Group 2 (patients received sciatic and femoral nerve block), or Group 3 (patients received multimodal systemic analgesia). Pain intensity was assessed at rest and on movement before, immediately after, and at 24 and 72 h after surgery. Blood samples were collected at the same time points and peripheral blood mononuclear cells were isolated. The frequencies of T lymphocytes, NK cells, and NKT cells, as well as their perforin expression, were simultaneously detected and analyzed by flow cytometry. RESULTS Patients in Group 1 and Group 2 experienced less severe pain than those in Group 3. The frequencies and perforin levels of T lymphocytes, their subsets, and NKT cells were significantly lower in Group 3 than in Group 1 and Group 2. CONCLUSIONS The present study confirmed that regional analgesia is more effective in maintaining cell-mediated immunity and perforin expression in peripheral blood lymphocytes in patients after TKR.
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