Total knee arthroplasty (TKA) is a common surgical procedure for the treatment of patients with pain and immobility as a result of osteoarthritis or rheumatoid arthritis. Pain-related interference, pain and nausea are recovery-limiting in these patients in the immediate postoperative period. Preoperative educational interventions that include pain communication and management information have been shown to decrease pain in joint replacement patients (McDonald & Molony, 2004). This randomized controlled trial compared usual preoperative education to an individually delivered preoperative education program. Participants (N=143) were randomized to intervention or usual care groups during routine preadmission testing. The usual care group received the usual preoperative teaching. The treatment group received the usual care teaching, a booklet containing content specific to symptom management after TKA, an individual teaching session during the preadmission testing visit and a telephone follow-up support call during the week before surgery. The primary outcome for this study was pain-related interference with activity and was measured using the Brief Pain Inventory Interference subscale (BPI-I) (Cleeland et al., 1994) on postoperative day three. Secondary outcomes were pain, nausea and expected postoperative activity and were measured on postoperative days one, two and three. There were no differences between groups in any of the outcomes for this study. BPI-I total scores were 24.4±14.4 in the intervention group and 22.4±15.1 in the usual care group (P=0.5) on the third postoperative day. Overall results demonstrated that although TKA patients had severe postoperative pain and severe nausea, they received inadequate doses of analgesia and anti-emetics. Available evidenced based protocols and practices in the health care environment were not followed Individualizing education content was not sufficient to produce a change in postoperative symptoms for these patients. Further research involving the modification of environmental and system factors affecting the provision of symptom management interventions is warranted.

Total knee arthroplasty (TKA) is a common surgical procedure for the treatment of patients with pain and immobility as a result of osteoarthritis or rheumatoid arthritis. Pain-related interference, pain and nausea are recovery-limiting in these patients in the immediate postoperative period. Preoperative educational interventions that include pain communication and management information have been shown to decrease pain in joint replacement patients (McDonald & Molony, 2004). This randomized controlled trial compared usual preoperative education to an individually delivered preoperative education program. Participants (N=143) were randomized to intervention or usual care groups during routine preadmission testing. The usual care group received the usual preoperative teaching. The treatment group received the usual care teaching, a booklet containing content specific to symptom management after TKA, an individual teaching session during the preadmission testing visit and a telephone follow-up support call during the week before surgery. The primary outcome for this study was pain-related interference with activity and was measured using the Brief Pain Inventory Interference subscale (BPI-I) (Cleeland et al., 1994) on postoperative day three. Secondary outcomes were pain, nausea and expected postoperative activity and were measured on postoperative days one, two and three. There were no differences between groups in any of the outcomes for this study. BPI-I total scores were 24.4±14.4 in the intervention group and 22.4±15.1 in the usual care group (P=0.5) on the third postoperative day. Overall results demonstrated that although TKA patients had severe postoperative pain and severe nausea, they received inadequate doses of analgesia and anti-emetics. Available evidenced based protocols and practices in the health care environment were not followed Individualizing education content was not sufficient to produce a change in postoperative symptoms for these patients. Further research involving the modification of environmental and system factors affecting the provision of symptom management interventions is warranted.

Anksčiau naudotiems čiurnos sąnario operacinio gydymo metodams (koreguojanti blauzdikaulio osteotomija, čiurnos sąnario artrodezė, artroplastika) atsirado alternatyva – čiurnos sąnario pakeitimas endoprotezu. Tačiau ir po pooperacinės reabilitacijos išlieka dalinis čiurnos sąnario funkcijos nepakankamumas, skausmo problema. Apie tai rašoma tiek užsienio tiek ir Lietuvos moksliniuose straipsniuose. Šio darbo tikslas nustatyti kineziterapijos programų efektyvumą po čiurnos sąnario pakeitimo operacijos Tyrimas buvo atliktas Palangos reabilitacijos ligoninėje. Tyrime dalyvavo pacientai po čiurnos sąnario pakeitimo. Visi pacientai buvo operuoti Klaipėdos ligoninėje sąnarių implantacijos centre (SIC), operacijas atliko tas pats ortopedas-traumatologas, visiems buvo implantuotas STAR tipo protezas. Pirmą grupę tiriamųjų sudarė 12 pacientų, visiems buvo taikyta pratimų terapija. Antrą grupę sudarė taip pat 12 pacientų, kuriems buvo atlikta pratimų terapija kartu su minkštųjų audinių atpalaidavimo metodika ir krioterapija. Matavimai buvo atliekami 2 kartus: atvykus į reabilitacijos ligoninę ir išvykstant. Buvo analizuojami bendri visų tiriamųjų rezultatai ir palyginti pirmosios ir antrosios grupių rezultatai. Nustatyta, kad po reabilitacinio gydymo statistiškai reikšmingai pagerėjo visi funkcinės būklės vertinimo rodikliai abiejose grupėse. Po gydymo čiurnos sąnario tiesimo ir lenkimo amplitudės padidėjo antrosios grupės tiriamiesiems. Antrosios grupės tiriamiesiems, taikant pratimų... [toliau žr. visą tekstą] / The surgical treatment methods of ankle joints (adjusting tibial osteotomy, arthrodesis of intertarsal joint, arthroplasty) were used before there appears an endoprosthesis for replacement of ankle joint. Even so, after the surgical rehabilitation there are still a partial insufficiency of ankle joint function and ache problems. Foreign and Lithuanian scientific press write about it equally. The purpose of this research work is to evaluate the physiotherapy influence on the rehabilitation efficiency. The second objective is to compare how the physiotherapy governed by relaxation techniques on soft issues and cryotherapy have had influence on the results. The research was done in Palanga rehabilitation hospital. The patients who have had the implanted ankle joint replacements were engaged in this research work. All patients had surgeries in Center for Joint Replacement (CJR) in Klaipeda hospital. It was done by the same orthopaedist-traumatologist. A STAR prosthesis were implanted into every patient. In first group there are 12 patients who have been applied physiotherapy. The second group consists of 12 patients as well who were treated by physiotherapy governed by relaxation techniques on soft tissues and cryotherapy. The measurements were done twice; arriving at rehabilitation hospital and leaving the hospital. The results of both groups have been studied and also they have been carefully compared. Conclusion. It is certain that after the rehab treatment the functional... [to full text]

Model-based radiostereometric analysis (MBRSA) of a total ankle arthroplasty (TAA) prosthesis was studied for the first time. The TAA MBRSA system precision was determined from the double exams of 20 patients implanted with the Mobility(TM). The MTE for any direction was 0.07mm for the tibial component. The MTE was 0.09mm and the MRE was 0.51° for the talar component. The MTPM detection limits were 0.22mm and 0.85mm for the tibial and talar components. Both components followed the typical subsidence-stabilization pattern. There was little detectable continuous migration at one to two years. The median(range) MTPM at two years was 0.96mm(0.17-2.28mm) and 1.23mm(0.39-1.9 mm) for the tibial and talar components. There was no detectable inducible displacement observed for any components at two years, except one talar component. The median(range) MTPM induced by the loading at two years was 0.08mm(0.03-0.18mm) and 0.39mm(0.27-1.06mm) for the tibial and talar components.

Knee osteoarthritis is a debilitating disease causing pain and disability in adults. Biomechanical factors including obesity, abnormal magnitude and load distribution have been cited to play a role in its initiation and progression with its definite cause being multi-factorial. Total knee arthroplasty has become the treatment of choice for knee osteoarthritis and although the procedure is mostly successful, there are some patients who experience implant failures which necessitates revision surgery. Revision surgery is more complicated and thus there is the need to monitor patients who have undergone TKA so as ensure better outcomes and also address problems much earlier. Objective methods like Radiostereometric Analysis (RSA) has proven to be a good tool at diagnosing these implant failures. Inducible displacement with RSA has the potential to serve as a one-time measure to diagnose implant failures. Previous studies have applied loads to induce motion to the knee in various ways- squatting, exercising and weight-bearing on the affected limb. This was not standardized and caused wide variations in the data. This work looked at refining a device used to apply standardized loads to the knee resulting in a more portable and faster way of applying load to the joint. Gait analysis is used to assess implant function pre and post surgery. Some gait patterns have also been related to implant failure. Previous works have focussed primarily on associations between well-working implants (non-revised patients) and these gait patterns (adduction moments and flexion angles). This work focussed on any differences in the gait patterns between patients who did not undergo revision surgery and those that did. Although most parameter differences did not reach statistical differences, they point to important trends that may explain the causative factors (adduction moments) whiles others may point to the effects of disease progression (external rotation).

Wear particle-induced inflammation leading to periprosthetic osteolysis remains a major cause of hip implant failure. As polyethylene particles from conventional metal-on-polyethylene implants have been associated with these failures, an interest in lower wear metal-on-metal (MM) bearings has emerged. However, the biological effects of nanometer-size chromium oxide particles, predominant type of wear particles produced by MM implants, remain mostly unknown. Therefore, this study aimed to determine the cytotoxicity of nanometer-size Cr2O3 particles on macrophages in vitro, by analyzing their effects on cell mortality and cytokine release and comparing them with those of similarly-sized alumina (Al2O3) particles (known to be relatively bioinert). Results showed that at high concentrations, nanometer-size Cr2O3 particles can be cytotoxic to macrophages, inducing significant decreases in total cell numbers and increases in necrosis. Results also showed that, at high concentrations, the cytotoxicity of Cr2O3 particles was overall higher than that of Al2O3 particles, even though Cr2O3 and Al2O3 are both stable forms of ceramic materials. However, it appeared to be lower than that of previously reported conventional polyethylene and CoCrMo particles. Therefore, chromium oxide particles may not be the main culprit in initiating the inflammatory reaction in MM periprosthetic tissues.

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Aquesta tesi està dedicada a l’estudi de la utilitat del nombre de leucòcitspolimorfonuclears en els teixits periprotètics pel diagnòstic de la infecció, a determinarquin es el punt de tall per definir infecció i a estudiar quina relació hi ha entre el númerode leucòcits polimorfonuclears trobats en les membranes periprotètiques i elmicroorganisme aïllat en els cultius convencionals.El primer objectiu avalua la utilitat de la histologia segons el criteri de Mirra iadaptat per Feldman (≥5 leucòcits polimorfonuclears per camp de gran augment) en tressituacions; recanvi protètic per sospita d’afluixament asèptic, per sospita d’afluixamentsèptic o reimplantació d’una pròtesi després d’un primer temps sèptic. En el cas delrecanvi per afluixament asèptic i en el moment de la reimplantació d’una pròtesi desprésd’un primer temps sèptic, la histologia presenta una sensibilitat baixa per tald’identificar una infecció. En canvi en el cas d’un recanvi amb la sospita d’afluixamentsèptic, la histologia es mostra com un test vàlid, ja que en la majoria de les situacionsconfirma aquesta sospita preoperatòria.El segon objectiu estudia si un punt de tall més baix (≥1 leucòcitspolimorfonuclears per camp de gran augment) és més eficaç en el diagnòstic de lainfecció. El resultat demostra que aquesta modificació fa que la histologia sigui méssensible però comporta un descens de l’especificitat.El tercer objectiu analitza la relació entre el número de leucòcitspolimorfonuclears i el tipus de microorganisme aïllat. L’aïllament d’estafilococscoagulasa-negativa es va associar a una menor infiltració de leucòcits polimorfonuclearsen els teixits periprotètics que amb altres microorganismes com Staphylococcus aureuso Bacils Gram-negatius com Escherichia coli o Pseudomonas spp.

Bibliography: leaves 193-206. / xiii, 206 leaves : ill. (chiefly col.) ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / This thesis investigates the effect of femoral stem surface roughness and a collar on the fixation of cemented hip hemi-arthroplasty femoral stems in an in vivo sheep model up to nine months following implantation. Plain radiography, micromotion between prosthesis and bone during mechanical testing and histology are used. / Thesis (Ph.D.)--University of Adelaide, Dept. of Orthopaedics and Trauma, 1997?

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.