Ancuţa Zazgyva

The occurrence, evolution and treatment outcome of osteoarthritis are influenced by a series of factors, including obesity. Assessing how chronic inflammation present in obesity changes the values of peri-operative biological tests could facilitate a clearer interpretation of laboratory examinations for the proper management of possible complications.

Introduction : This case-control study aimed to assess two single nucleotide polymorphisms of the gene encoding the GABRG2 protein – GABRG2 (3145 G>A) and GABRG2 rs 211037 Asn196Asn (C588T) – in a cohort of pediatric patients from Romania, and evaluate their possible impact on drug-resistant...

In younger patients, ceramic-on-ceramic (CoC) bearing surfaces are usually recommended for total hip replacement (THR) because of their low wear rate and longer expected functional life. Although technical advancements have reduced the risk of ceramic bearings fracture, this complication remains a major concern. We present the case of a 56-year-old patient undergoing 3 revision hip arthroplasties of the right hip due to ceramic liner fractures. Initial THR (2008) was performed with a CoC bearing, followed by liner fracture due to trauma a year later. The acetabular component and liner were replaced, with a minor incongruence between the old head and new insert. The 2nd ceramic insert fractured 3.5 years later, following minor trauma. Upon revision, the bearing surface was changed to metal-on-polyethylene (MoP). The performed retrieval analysis demonstrated stripe and rim wear, and evidence of adhesive wear. The patient was referred to us a month later, with a fistula on the lateral side of the hip, discharging black, petroleum-like liquid. Radiology showed well-fixed implants, no dislocation and no apparent polyethylene wear. Microbiological assessment of the discharge showed no infection. Intraoperatively massive metallosis was noticed, with stable acetabular and femoral components. The metal femoral head was heavily abraded, with almost 1% volumetric wear. Hematoxylin and eosin stained frozen tissue samples showed muscular and adipose tissue necrosis, while polarized light microscopy highlighted metal, polyethylene, and ceramic particles. The present case is yet another report showing the adverse outcomes of using MoP bearings for revision after ceramic liner fracture in THR.

Obesity is currently a global epidemic, often referred to as “globesity”, impacting the life of millions worldwide. A risk factor for many diseases, obesity can also be linked to developing intra-articular lesions of the knee, affecting the menisci, ligaments and cartilage. Furthermore, obesity has been shown to influence the outcome of surgical interventions, including those of the musculoskeletal system. Although many studies addressed the relationship of obesity and joint replacement, articles relating to arthroscopy and obesity, and knee arthroscopy in particular, are a bit scarcer. The majority of data suggest that an increase in BMI leads to a similar increase in the rates of intra- and postoperative complications, and most authors agree that a higher body mass index can influence both the procedure itself and its outcomes, including the subjective results reported by the patients. Still, some studies show different results, especially in patients that are overweight or with low-grade obesity, where the outcomes are comparable to those of the non-obese population. Thus, it can be concluded that obesity is an important patient characteristic that needs to be taken into consideration when planning, performing, and assessing the results of knee arthroscopy.

Given that the clinical and radiological examinations of lateral cervical masses are not always sufficient for deciding on appropriate management, the cytological examination of the material obtained by fine-needle aspiration might be an efficient tool in the preoperative investigation of these lesions.In this prospective cross-sectional study we evaluated the efficacy and diagnostic accuracy of fine-needle aspiration cytology in the assessment of lateral cervical nonthyroid tumors, by comparing its results with those of histopathology.A total of 58 patients with lateral cervical masses were included. Preoperative cytological results were compared with the histopathologic examination of surgical specimens.Both cytology and histology indicated that malignant tumors outnumbered benign lesions (62% vs 38%), with 88.9% of malignancies presenting in patients aged >50 years, but cytology was less effective at differentiating between benign and nontumor lesions. Cytology had 76.5% specificity and 78.1% sensitivity for identifying malignant lateral cervical lesions, and there was a concordance between the two diagnostic tests (McNemar test, P = 0.17, κ = 0.50, P <0.001).Fine-needle aspiration cytology is a simple, quick, and effective procedure that can aid in the preoperative evaluation of lateral cervical masses by differentiating benign tumors and inflammatory processes from malignancies and thus help in determining a subsequent therapeutic strategy.

This retrospective study investigated midterm outcomes of uncemented total hip replacement with acetabuloplasty using impacted bone grafts in acetabular protrusion or primary hip arthritis with an inadequate thickness of the medial acetabular wall. The medial acetabular wall was augmented by impaction bone grafting, and an uncemented cup was implanted in all cases. Hip centre of rotation, medial acetabular wall thickness and cup positioning were evaluated radiologically, with the Harris Hip Score determined at each follow-up. A total of 32 patients (39 hips) were followed for a mean of 4.5 years, with significant improvement of the Harris Hip Score at the last follow-up. Hip centre of rotation was restored close to the optimal position. Medial acetabular wall thickness and cup position obtained immediately postoperatively were maintained up to the last follow-up, without statistically significant differences. Bone graft integration was observed in all cases by one or two years postoperatively, with no signs of loosening or cup migration at the last follow-up. Heterotopic ossification was identified in 15.4 % of cases, without clinical evidence of hip mobility impairment or pain. Impaction bone grafting for acetabuloplasty, associated with the implantation of an uncemented cup, yields good midterm results in patients with acetabular protrusion and with primary hip arthrosis with a thinned medial acetabular wall. The restored bone stock and medial acetabular wall thickness enable the placement of the hip centre of rotation close to the optimal location, which could offer further long-term benefits.

The role of the subchondral bone and the importance of treating both bone and cartilage in cases of chondral and osteochondral lesions of the knee have been highly emphasized. There are no current studies on the experimental use of bioactive glass S53P4 (BonAlive®) as granules in the treatment of osteochondral lesions of the knee. Our preliminary study was designed to establish an experimental model and assesses the effect of glass granules fixed with fibrin compared to fibrin alone as fillers of the osteochondral defects created in the weight-bearing and partial weight-bearing regions of the distal femur in six adult rabbits. We found that the size of the distal femur in adult domestic rabbits allows the creation of 4 mm diameter and 5 mm deep osteochondral defects on both the medial femoral condyle and the trochlea, bilaterally, without significantly affecting the activity level of the animals. Retention of the glass granules in the defects was achieved successfully using a commercially available fibrin sealant. At five weeks post-implantation, we found macroscopic and microscopic differences between the four types of defects. The use of bioactive glass S53P4 for filling condylar osteochondral defects in rabbit femora led to the initiation of an early bone repair process, observed at five weeks after implantation, while the filling of trochlear defects with fibrin glue resulted in the appearance of cartilaginous tissue characteristic of endochondral ossification.

Objectives: Single-radius femoral designs of total knee endoprostheses were introduced with the promise of better clinical and functional results by means of superior biomechanical characteristics. We aimed to compare the mid-term clinical, functional, radiologic and survivorship outcomes of two types of posterior stabilised knee replacement systems: the single-radius Scorpio (Stryker) and the multi-radius NexGen (Zimmer). Patients and methods: This retrospective observational study included 139 patients (164 knees) that underwent total knee replacement between October 2004 and December 2010: 70 knees (64 patients) with NexGen and 94 knees (75 patients) with Scorpio. The two patient groups were similar in terms on age, sex ratio, diagnosis and disease stage, and knee joint alignment. Mean follow-up times were 32 (13-75) months and 35 (12-112) months respectively. Evaluation was based on the Knee Society scores and the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System, with survival data compiled using Kaplan-Meier survival analysis. Results: Clinical and functional improvements were recorded in all cases, with no statistically significant differences between the two patient groups. The survivorship was 95.8% (95% confidence interval: 91.8-99.8%) for the multi-radius implant at 60 months and 92.7% (95% confidence interval: 87.7-97.7%) for the single radius implant at 84 months, with no significant difference (p=0.31). Conclusion: This study demonstrates that both the single-radius and the multi-radius posterior stabilised knee endoprostheses can significantly reduce pain and improve knee joint function in patients if used with a proper technique, with the added benefit of a good mid-term survivorship. DOI: 10.3944/AOTT.2015.15.0050This abstract belongs to the un-edited version of the article and is only for informative purposes. Published version may differ from the current version.