Placement of the acetabular cup during total hip arthroplasty is of great importance because usually every deviation from the ideal centre of rotation negatively influences endoprosthesis survival, ...polyethylene wear and hip load. Here we present hip load change in respect to various acetabular cup positions in female patients who underwent total hip replacement surgery due to hip dysplasia. The calculation suggests that, in the majority of cases, for every millimeter of lateral displacement of the acetabular cup (relative to the ideal centre of rotation) an increase of 0.7% in hip load should be expected and for every millimeter of proximal displacement an increase of 0.1% in hip load should be expected (or decreased if displacement is medial or distal). Also, for every millimeter of neck length increase, 1% decrease is expected and for every millimeter of lateral offset, 0.8% decrease is expected. Altogether, hip load decreases when the cup is placed more medially or distally and when the femoral neck is longer or lateral offset is used.
Primary hip osteoarthritis (pOA) develops without an apparent underlying reason, whereas secondary osteoarthritis arises due to a known cause, such as developmental dysplasia of the hips (DDH-OA). ...DDH-OA patients undergo total hip arthroplasty at a much younger age than pOA patients (50.58 vs. 65 years in this study). Recently, mesenchymal stem and progenitor cells (MSPCs) have been investigated for the treatment of osteoarthritis due to their immunomodulatory and regenerative potential. This study identified cells in subchondral bone expressing common MSPC markers (CD10, CD73, CD140b, CD146, CD164, CD271, GD2, PDPN) in vivo and compared the proportions of these populations in pOA vs. DDH-OA, further correlating them with clinical, demographic, and morphological characteristics. The differences in subchondral morphology and proportions of non-hematopoietic cells expressing MSPC markers were noted depending on OA type and skeletal location. Bone sclerosis was more prominent in the pOA acetabulum (Ac) in comparison to the DDH-OA Ac and in the pOA Ac compared to the pOA femoral head (Fh). Immunophenotyping indicated diagnosis-specific differences, such as a higher proportion of CD164+ cells and their subsets in DDH-OA, while pOA contained a significantly higher proportion of CD10+ and GD2+ cells and subsets, with CD271+ being marginally higher. Location-specific differences showed that CD271+ cells were more abundant in the Fh compared to the Ac in DDH-OA patients. Furthermore, immunohistochemical characterization of stromal bone-adjacent cells expressing MSPC markers (CD10, CD164, CD271, GD2) in the Ac and Fh compartments was performed. This research proved that immunophenotype profiles and morphological changes are both location- and disease-specific. Furthermore, it provided potentially effective targets for therapeutic strategies. Future research should analyze the differentiation potential of subsets identified in this study. After proper characterization, they can be selectively targeted, thus enhancing personalized medicine approaches in joint disease management.
Percutaneous vertebroplasty is a minimally invasive treatment technique for vertebral body compression fractures. The complications associated with this technique can be categorized into mild, ...moderate, and severe. Among these, the most prevalent complication is cement leakage, which may insert into the epidural, intradiscal, foraminal, and paravertebral regions, and even the venous system. The occurrence of a postprocedural infection carries a notable risk which is inherent to any percutaneous procedure. While the majority of these complications manifest without symptoms, they can potentially lead to severe outcomes. This review aims to consolidate the various complications linked to vertebroplasty, drawing from the experiences of a single medical center.
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 Junior rowers have competed internationally for over 4 decades, and there are no epidemiological data available on traumatic
and overuse injury in this population.
Objective To define the ...types of musculoskeletal problems present in international elite-level junior rowers and to determine whether
gender, physical stature, rowing discipline, and training programs affect the incidence of reported injuries.
Study Design Descriptive epidemiology study.
Methods Injury data were obtained from a total of 398 rowers (42% female, 58% male) who completed a 4-page questionnaire on injury
incidence while participating at the Junior World Rowing Championships in Beijing, Peopleâs Republic of China, in August 2007.
Results Overall, 290 (73.8%) reported injuries involved overuse, and 103 (26.2%) were related to a single traumatic event. Female
rowers were injured more frequently than male rowers (110.2 vs 90.5 injuries per 100 rowers). In both genders, the most common
injury site was the low back followed by the knee and the forearm/wrist. The severity of reported injuries was incidental
in 65.1%, minor in 21.4%, moderate in 10.4%, and major in 3.1% of cases. The rowers with traumatic injuries had less rowing
experience than the uninjured rowers (median C ± interquartile range Q = 3 ± 3 years vs 4 ± 3 years; P = .043, Mann-Whitney test). Sweep rowers who changed rowing side during the current season had significantly more acute-onset
low back injuries ( P = .012, Ï 2 test) than those who did not change rowing side during the same period. The incidence of traumatic injuries was significantly
lower in rowers who regularly performed more than 10 minutes of posttraining stretching ( P = .030, Ï 2 test). Athletes who ran more than once a week had more overuse knee injuries than those who ran once or less per week ( P = .033, Ï 2 test).
Conclusion Elite junior rowers attending the World Rowing Championships reported predominantly overuse injuries of low severity during
the current rowing season. Low back injuries were the most frequent complaint of elite-level junior rowers.
Developmental dysplasia of the hip (DDH) presents varying degrees of femoral head dislocation, with severe cases leading to the formation of a new articular surface on the external side of the iliac ...bone-the neoacetabulum. Despite conventional understanding suggesting otherwise, a tissue resembling hyaline cartilage is found in the neoacetabulum and acetabulum of Crowe III and IV patients, indicating a potential for hyaline cartilage development without mechanical pressure. To test this theory, acetabular and femoral head cartilage obtained from patients with DDH was stained with hematoxylin-eosin and toluidine blue. The immunohistochemical analysis for collagen types II and VI and aggrecan was performed, as well as delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) analysis on a 7.0 T micro-MRI machine. The results obtained from DDH patients were compared to those of the control groups. Hyaline cartilage was found in the neoacetabulum and the acetabulum of patients with DDH. The nature of the tissue was confirmed with both the histological and the MRI analyses. The results of this study proved the presence of hyaline cartilage in patients with DDH at anatomical regions genetically predisposed to be bone tissue and at regions that are not subjected to mechanical stress. This is the first time that the neoacetabular cartilage of patients with advanced stages of DDH has been characterized in detail.
Hip arthroscopy is a minimally invasive, effective and innovative orthopedic procedure with a relatively low rate of complications. In our patient, residual cam deformity and a bone fragment that ...remained in the front hip capsule after hip arthroscopy performed three years before caused thigh numbness, muscle fasciculations, and paresthesia. It was assumed that the loose bony fragment remained following burring on prior procedure. During hip flexion, neural structures were compressed and caused the mentioned symptoms. Revision hip arthroscopy was performed and the loose fragment in addition to residual cam deformity was removed. Resolution of pain and anterior thigh numbness was reported after the revision surgery.
Debonding of the porous coating from the acetabular component of a total hip endoprosthesis is a rare complication. Revision total hip arthroplasty for an unstable acetabular component with a ...debonded porous coating strongly fixed to the bone can be challenging, especially in elderly patients of poor overall health. In such patients, revision procedures should be as simple and safe as possible. We present our technique of solving that problem in a case of an 82-year-old female with bad general condition and unstable acetabular component of hip endoprosthesis. Because of extremely deficient bone stock, a well-fixed porous coating was left in acetabulum to serve as a “cage“, allowing cemented acetabular component placement. This procedure can reduce the risk of intraoperative bone fracture, blood loss, and duration of surgery, which is important in elderly patients with poor overall health.
Fondaparinux has been shown to be as effective as low molecular weight heparin
in orthopedic surgery, with no cases of heparin induced thrombocytopenia proven until today. The
main goal of this ...prospective randomized controlled trial was to define whether thromboprophylaxis
in patients with primary osteoarthritis of the knee undergoing total knee arthroplasty (TKA) influences
clinical parameters in the same manner in patients receiving fondaparinux as in those receiving
nadroparin during the first 7 postoperative days. Sixty patients with primary knee osteoarthritis underwent
unilateral TKA performed by the same surgeon and were randomized into two groups of 30
patients receiving either fondaparinux or nadroparin thromboprophylaxis. Patients were compared
according to the duration of operation, perioperative blood loss, laboratory results and clinical evaluation
of the edema during the early postoperative period. No differences were found between the
groups in the mean duration of surgery, perioperative blood loss, and most of laboratory results. The
level of urea was significantly lower in the nadroparin group on the first and second postoperative day.
No cases of heparin induced thrombocytopenia, deep vein thrombosis or pulmonary embolism were
noted during the study. Study results showed both fondaparinux and nadroparin to have the same
influence on clinical parameters during the first 7 postoperative days in patients undergoing TKA.
BackgroundModified anatomy of dysplastic hips, bone defects and previous operations make THA (total hip arthroplasty) in patients with hip dysplasia a technically challenging procedure. MethodsOne ...hundred and ten patients (mean 49.2 years of age, range 19-76, female:103, male:7) underwent 122 subsequent hip arthroplasties from 2012 to 2019. These patients were reviewed at least two years after THA. Plain radiography was used to determine Crowe classification of the affected hips. Fifty-three patients had an operation in childhood before THA was done (mean 47.0 years of age, standard deviation 8.3, range 19-62) and formed the "operated group". Among these patients, there were Chiari pelvic osteotomies, periacetabular osteotomies, femoral osteotomies, greater trochanter distalizations and soft tissue operations. Fifty-seven were not operated in childhood (mean 52.3 years of age, standard deviation 10.9, range 19-76) and formed the "non operated group". The functional status of the patients was assessed with the Oxford Hip Score (OHS). Results122 total hip arthroplasties were performed using uncemented femoral and acetabular components. There were 13 major complications identified. Ten were in the "operated group", of which 5 needed revision surgery. Only 3 were in the "non operated group", with no need for revision. Aseptic loosenings of the femoral component were seen in the patients that had femoral osteotomy done in childhood. Acetabular component migration and intrapelvic migration occurred due to the initial malposition and lack of osteointegration, thus requiring early revision after just 6 months. Other major complications were peroneal palsy, deep periprosthetic infection, severe trochanteritis and intraoperative femoral fracture. OHS was significantly higher in the "non operated group" 42.3 (10-48), opposed to 39.1 (10-48) in the "operated group" (p 0.017). ConclusionCorrective osteotomies in childhood are a risk factor for complications and lower medium-term survivorship of the THA in hip dysplasia patients.
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