OBJETIVO: Avaliar o padrão de degeneração histológica do ligamento cruzado posterior (LCP) em pacientes com artrose submetidos à artroplastia total de joelho com prótese com substituição do ligamento cruzado posterior (LCP). A degeneração histológica foi classificada em leve, moderada e grave. Os achados histológicos foram correlacionados com dados clínicos, radiográficos e do transoperatório (presença ou ausência do ligamento cruzado anterior) com a finalidade de aferir se estes parâmetros seriam capazes de predizer o grau de degeneração histológica do LCP em pacientes com gonartrose. MÉTODOS: foram avaliados 89 ligamentos cruzados posterior de 85 pacientes com idade média de 69,79 anos, sendo 69 do sexo feminino, 16 do masculino. O LCP foi corado em hematoxilina-eosina e Tricrômio de Gomori e classificado quanto ao comprometimento histológico em leve, moderado e grave. A degeneração histológica foi correlacionada aos parâmetros idade, artrose radiográfica classificada por Ahlbäck (grau I ao V), eixo radiográfico tíbio-femoral (varo, neutro e valgo), e estado do ligamento cruzado anterior (LCA), presença ou ausência.Os achados histológicos de hipercelularidade, infiltração linfocitária crônica, proliferação vascular; presença de cistos; clones de condrócitos; degenerações colágena, fibrinóide, cartilaginosa ,gordurosa e mucoide foram correlacionados com o grau de degeneração do LCP e ao estado de conservação do LCA. RESULTADO: Não foram identificadas relações entre o grau de degeneração histológica do LCP e faixa etária (abaixo ou acima de 70 anos), sexo, classificação radiográfica de Ahlbäck e presença ou ausência do LCA. Os achados histológicos de degeneração fibrinóide, proliferação vascular e presença de cistos estiveram estatisticamente relacionados à degeneração histológica grave do LCP. CONCLUSÃO: Os parâmetros clínicos e radiográficos não foram capazes de predizer o grau de degeneração histológica do LCP .Os achados histológicos de degeneração fibrinóide, proliferação vascular e presença de cistos caracterizaram a degeneração histológica grave do LCP / OBJECTIVE: Evaluate the histologic degeneration pattern of the posterior cruciate ligament (PCL) in osteoarthrosis patients submitted to total knee replacement with a cruciate substituting prosthesis. The histologic degeneration was classified in mild, moderate and severe. The histologic pattern was related to clinical, per-operatory (presence or absence of anterior cruciate ligament) and radiographic parameters with the aim to settle if these parameters would be reliable to predict the PCL degeneration grade. METHODS: 89 PCLs from 85 patients, 16 men, 69 women, mean age 69, 79 years old. PCL was stained with hematoxylin and eosin and trichromium of Gomori. The PCL histologic degeneration was graded from normal-minimum to severe. The histologic PCL degeneration pattern was related to age, radiographic arthrosis classification (Ahlbäck - grades I to V), knee radiographic axis (varus, neutral, valgus) and to the ACL status (presence or absence).The histologic findings of hipercellularity, chronic lymphocit infiltration, neoangiogenesis, cysts, collagen degeneration (deg), fibrinoid deg, mucoid deg., cartilaginous, deg., fat deg. and condrocyte clones were related to the grade of PCL degeneration and to ACL status. RESULTS: There was no correlation of histologic degeneration to sex or age (above or below 70 years), arthrosis radiographic classification (Ahlbäck) and presence or absence of ACL. The histological findings of fibrinoid degeneration, vascular proliferation and cysts were statistically related to severe histologic LCP degeneration. CONCLUSION: The parameters studied were not capable of predicting the grade of LCP degeneration. The histological findings of fibrinoid degeneration, vascular proliferation and cysts were characteristic of severe PCL histologic degeneration

Abstract Knee osteoarthritis (OA) is one of the main causes of chronic disability in elderly people. In end-stage knee OA, patients experience both short- and long-term benefits from total knee arthroplasty (TKA). All the significant deficiencies in functional capacity and health-related quality of life (HRQOL) are not spontaneously resolved after surgery. Therefore, it is essential that patients receive effective rehabilitation. So far, there are no gold standards in terms of outcome measurements of TKA and rehabilitation in connection with surgery. The present series of studies was designed for the purpose of examining the effectiveness and cost-effectiveness of a multidisciplinary rehabilitation program compared with conventional orthopedic care, the attributes of disability in elderly knee OA patients waiting for primary TKA, and the impact of patient-relevant factors on the outcome of TKA one year after surgery. Special emphasis was placed on self-reported functional capacity, HRQOL, and objectively measured functional capacity. Objective and subjective physical function and HRQOL were investigated with a battery of physical function tests and questionnaires (WOMAC, 15D, and RAND-36) during a one-year follow-up. Pain, body mass index (BMI), and antero-posterior laxity of the affected knee were the main attributes of self-reported disability in the patients waiting for primary TKA. The multidisciplinary rehabilitation program did not yield faster attainment of recovery than did conventional orthopedic care. Equal, significant improvement in HRQOL and functional capacity was found in both groups, but conventional care was clearly cost-saving. A preoperative score below the general population level on the 15D, the presence of pain, higher age, and the presence of pulmonary disease preoperatively decreased the possibility of reaching the HRQOL level of the general population. More severe pain preoperatively was associated with a higher degree of functional recovery. The presence of osteoporosis, male gender, impaired function of the opposite knee, and higher age were associated with a lower degree of improvement in self-reported function. The results highlight the multifactorial nature of health status in TKA. Further intervention studies are needed to identify patients who would benefit most from intensive rehabilitation interventions after TKA and to create standards for outcome tools after joint replacement surgery and rehabilitation interventions. / Tiivistelmä Polvinivelrikko on merkittävimpiä niistä sairauksista, jotka rajoittavat ikääntyneiden toimintakykyä. Vaikka tekonivelleikkauksella voidaan sekä välittömästi että pidemmän ajan kuluessa kohentaa merkittävästi polvinivelrikosta kärsivien elämänlaatua ja toimintakykyä, osa potilaista ei leikkauksen jälkeenkään selviydy hyvin arjestaan. Siksi on tärkeää, että potilasta kuntoutetaan tekonivelleikkauksen jälkeen asianmukaisesti ja tehokkaasti. Leikkauksen ja kuntoutuksen tuloksellisuutta arvioivien mittareiden käytöstä ei ole olemassa standardoituja suosituksia. Tämän väitöskirjan päätavoitteena oli selvittää 2–4 kuukautta leikkauksen jälkeen toteutetun, moniammatillisen, polikliinisen kuntoutuksen kustannustehokkuutta sekä sen vaikuttavuutta elämänlaatuun ja toimintakykyyn verrattuna perinteiseen ortopediseen hoitokäytäntöön. Lisäksi selvitettiin tekijöitä, jotka heikentävät potilaan toimintakykyä pitkälle edenneessä polvinivelrikossa, sekä potilaslähtöisiä tekijöitä, jotka vaikuttavat leikkaustulokseen vuosi leikkauksen jälkeen. Itsearvioitua toimintakykyä sekä elämänlaatua arvioitiin kyselykaavakkeiden (WOMAC, 15D ja RAND-36) avulla ja fyysistä toimintakykyä mitattiin testipatteristolla. Tutkimuksen seuranta-aika oli yksi vuosi. Painoindeksi, kipu ja leikattavan polven etu-takasuuntainen väljyys selittivät eniten tekonivelleikkausta odottavien potilaiden toimintakyvyn rajoitteita. Potilaiden elämänlaatu ja toimintakyky kohenivat merkittävästi tekonivelleikkauksen jälkeen. Moniammatillisesti toteutettu kuntoutus ei tehostanut leikkauksesta toipumista verrattaessa sitä perinteiseen ortopediseen hoitokäytäntöön, joka vertailussa myös säästi selkeästi kustannuksia. Väestökeskiarvoa huonommaksi koettu elämänlaatu jo ennen leikkausta, kivuliaisuus, korkea ikä ja keuhkosairaudet heikensivät mahdollisuutta saavuttaa väestökeskiarvon tasoinen koettu elämänlaatu vuosi leikkauksen jälkeen. Leikkausta edeltävä vaikea-asteinen kivuliaisuus assosioitui merkittävään toimintakyvyn parantumiseen. Osteoporoosi, miessukupuoli, vastakkaisen polvinivelen epänormaali toiminta ja korkea ikä taas liittyivät vaatimattomampana koettuun toimintakyvyn parantumiseen. Tekonivelleikattujen potilaiden terveydentilan monitekijäisyys heijastuu tutkimustuloksiin. Jatkossa tarvitaan interventiotutkimuksia, jotta voitaisiin paremmin tunnistaa ne potilaat, jotka hyötyisivät eniten tehostetusta leikkauksen jälkeisestä kuntoutuksesta. Lisäksi olisi tärkeää tutkia, miten kuntoutuksen tuloksellisuutta arvioivia mittareita voitaisiin yhtenäistää.

No description available.

The thesis describes the anatomical study, which has been taken place at Orthopedic Clinic of the 1st Faculty of Medicine, Motol University Hospital and at Institute of Anatomy 1st Faculty of Medicine, Charles University in Prague from 2002 till 2009. The study was focused on the area of the upper part of the humerus in order to measure spatial relationships among anatomical structures, especially attachments of rotator cuff muscles to optimize implantation arthroplasty of shoulder joint. Clinico-anatomical study, which results were published in 2010, was also based at measuring angular relations of structures proximal humerus. The proximal humerus was marked by 29 points on the cortical bone, which defined the position of the medial margin of the greater tubercle, the lateral margin of the lesser tubercle, bicipital groove, the crest of greater tubercle and to define position of the proximal humeral metaphyseal axis and anatomical neck. Measurements were carried out in the transversal planes and the measurement method was developed on the reconstruction and the spatial definition of basic axes (axis of humeral head and axis of proximal humeral shaft) with the optimized number of reference points of anatomical neck and cortical bone of proximal humeral shaft. Angles between the axis of the head...

Bakgrund: Antalet personer som genomgår knäartroplastik ökar markant i västvärlden samtidigt som den genomsnittliga vårdtiden efter genomgången knäartroplastik minskar. Tidigare forskning visar att ingreppet är väl lämpat för dagkirurgi. Det är trots detta svårt att hitta kvalitativ forskning som beskriver patientens upplevelse av att ha genomgått en knäartroplastik i dagkirurgi. Syfte: Syftet med denna studie var att beskriva patientens upplevelse av att genomgå en unikompartmentell knäartroplastik (UKA) i dagkirurgi. Metod: Denna kvalitativa intervjustudie inkluderade åtta personer som genomgått en UKA i dagkirurgi mellan 2017 och 2020. Semistrukturerade intervjuer genomfördes i mars 2020 med stöd av en intervjuguide. Deltagarna fick berätta om upplevelsen av att ha genomgått en UKA i dagkirurgi. Resultat: Resultatet visar att de flesta deltagarna var nöjda med att ha genomgått operationen i dagkirurgi. Upplevelsen av trygghet i samband med den tidiga hemgången hade ett nära samband med uppföljning samt informationen inför operationen som gav deltagarna verktyg för att hantera såväl smärta som aktiviteter i det dagliga livet (ADL) och rehabilitering i hemmet. Konklusion: För att känna trygghet i samband med att genomgå UKA i dagkirurgi har utförlig information samt tidig uppföljning en central roll i resultatet av patientens upplevelse.

Patient-specific instrumentation (PSI) in total knee arthroplasty (TKA) has been introduced to reduce instruments and surgical time and to improve implant alignment. The aim of this study was to compare TKA with patient-specific and conventional instrumentation with regard to the use of resources in the operating room (OR), alignment and patient-reported outcome. A total of 139 TKA with PSI or conventional instrumentation were included in three centers. Economic variables of the surgery (number of instrument trays, setup and cut-sewtime), radiological alignment and patient reported outcomes (VAS Pain Scale, Oxford Knee Score, EQ-5D) were assessed after 6 weeks, 6 and 12 months. There was a significant reduction of instrument trays and of time in the OR in the PSI group. The reduction varied between the centers. With strict reorganization, more than 50% of the instrument trays could be reduced while using PSI. There were no significant differences in cut-sew-time, implant position, leg axis, pain and function. The use of PSI was associated with significantly less OR resources. However, the savings did not compensate the costs for this technology.

Purpose Allergy against implant materials is discussed controversially and still not fully understood. Despite these controversies, a relevant number of patients receive hypoallergenic knee implants. The aim of this study was to compare a new coating system with the standard implant in total knee arthroplasty (TKA). Additionally, the influence of proinflammatory cytokines on patient-reported outcome measures (PROMs) was investigated. Methods 120 patients without known metal allergy and without previous metal implants were included. The patients were randomized to receive a coated or standard TKA of the same knee system. 105 patients completed the 5 year follow-up. Patient-reported outcome measures (PROMs) including knee function (Oxford Knee Score, OKS), quality of life (SF36) and UCLA activity scale were assessed. Additionally, several cytokines with a possible role in implant allergy were measured in patient`s serum (IL-1beta, IL-5, IL-6, IL-8, IL-10, IP-10, IFN γ, TNF α). Group comparison was performed using Mann–Whitney U test for continuous values and chi-square test for categorical values. Results There were no differences in PROMs between both groups at any follow-up. The majority of patients demonstrated no elevation of the measured blood cytokines. The blood cytokine pattern after 5 years demonstrated no differences between study groups. There was a significant association between elevated IL-8 values and worse results in the overall OKS (p = 0.041), the OKS function component (p = 0.004), the UCLA activity scale (p = 0.007) and the physical component of SF36 (p = 0.001). Conclusion There were no problems with the new coating during mid-term follow-up and no differences in PROMs between coated and standard TKA. Patients with an increased inflammatory response demonstrated worse functional results, regardless of the implant. Level of evidence I. Clinical trial registration The study protocol was registered in the US National Institutes of Health’s database (http:// www.clini caltr ials. gov) registry under NCT00862511.

Introduction Le remplacement prothétique est le traitement ultime pour la dégénérescence avancée de la hanche. Cependant, l’usure prématurée des surfaces de frottement métal contre polyéthylène conventionnel (MoPc) réduit de façon importante sa longévité chez les patients jeunes et actifs. Pour surmonter ce problème, des surfaces de frottement alternatives ont été proposées, notamment les couples métal-métal (MoM) et céramique-céramique (CoC). Le but de cette étude est d'évaluer la survie à long terme de ces surfaces d'appui lors du remplacement total de la hanche (PTH) avec une articulation de petit diamètre MoM ou CoC et du resurfaçage de la hanche (RH) MoM. Méthodes La survie des implants a été évaluée à long terme dans deux études où les sujets ont été randomisées pour une PTH MoM 28 mm (99 hanches) ou un RH (104 hanches) dans l’étude 1 ou une PTH CoC (71 hanches) ou MoPc (69 hanches) dans l’étude 2. Les mesures d’efficacité principales comparés, au dernier recul, était le taux de révision, les taux de complications, score fonctionnels validés, et les signes radiographiques anormaux. Résultats Étude 1, après un suivi moyen de 15 ans, la survie avec révision pour toutes causes était de (89,2 % pour le RH versus 94,2 % pour la PTH MoM, p=0,292). Toutefois avec une révision aseptique comme critère d'évaluation, la survie était significativement plus élevée dans les PTH (97,4 % contre 89,2 % ; p=0,033). Les deux groupes ont obtenu des scores fonctionnels similaires. Étude 2, après un suivi moyen de 21 ans, la survie était significativement plus élevée (96,9% vs 73,6%, p<0,001) pour les PTH CoC versus MoPc. À l'évaluation radiographique, 13 % des MoPc étaient considérés descellées versus aucune CoC et 61 % des MoPc versus 6 % des CoC présentaient des signes d’ostéolyse (p<0,001). Les PTHs CoC avaient des scores moyens de WOMAC significativement plus élevés que le groupe MoPc (11.0 vs 19.4; p = 0.048). Conclusion L’utilisation de couples dur-dur MoM ou CoC en PTH ou RH ont offert une excellente survie et fonction à long terme chez une clientèle de sujets jeunes et actifs. En comparaison, le taux d’échec élevé du couple MoPc confirme qu’il doit être abandonné. Les résultats de cette étude doivent être mis en perspective avec les résultats futurs des nouveaux couples métal contre polyéthylènes réticulés. / Introduction Prosthetic replacement is the ultimate treatment for advanced hip degeneration. However, premature wear of the metal-on-conventional polyethylene (MoPc) bearing surfaces significantly reduces its longevity in young and active patients. To overcome this problem, alternative bearing surfaces have been proposed including metal-on-metal (MoM) and ceramic-on-ceramic (CoC) bearings. The aim of this study is to evaluate the long-term survival of these bearing surfaces during total hip replacement (THA) with a small diameter MoM or CoC bearings and hip resurfacing (HR) MoM. Methods Long-term implant survival was assessed in two studies where subjects were randomized to 28mm MoM THA (99 hips) or HR (104 hips) in Study 1, or CoC THA (71 hips) or MoPc (69 hips) in Study 2. The main outcome measures compared, at final follow-up, were revision rate, complications’ rate, validated functional scores, and abnormal radiographic signs. Results Study I: after a mean of 15 years, survivorship with endpoint all-cause revision was 89.2% for HR versus 94.2% for MoM THA MoM (p = 0.292). However, with aseptic revision as an endpoint, survivorship was significantly higher in MoM THA (97.4%) compared to (89.2%) in HR (p = 0.033). Both groups achieved similar functional scores. Study II: after a mean follow-up of 21 years, survivorship was significantly higher in CoC (96.9%) versus (73.6%) in MoPc THAs (p<0.001). On radiographic evaluation, 13% MoPc were considered loose versus non in CoC, and 61% MoPc versus 6% CoC showed osteolytic signs (p<0.001). CoC had better mean WOMAC scores than MoPc (11.0 vs 19.4; p = 0.048). Conclusion Good long-term survival and function for HR and MoM 28-mm THA implants with similar overall rates of complications and revisions. CoC provided excellent results compared to MoPc at more than 20-year follow-up.

No description available.

Em um estudo prospectivo sobre o tratamento das artroplastias de quadril infectadas, com perdas ósseas e fístulas ativas, 25 pacientes foram tratados em dois tempos e 36 pacientes foram tratados em dois tempos com espaçador de cimento impregnado com vancomicina. O acompanhamento médio foi de dois anos e onze meses. A taxa de recidiva infecciosa foi de 29,2% nos tratados em dois tempos e de 8,8% nos tratados com espaçador. O Escore de Harris para Quadril médio passou de 19,3 para 69,0 pontos nos casos tratados em dois tempos e de 19,7 para 72,2 pontos nos pacientes tratados com espaçador. Ao final do estudo, 86,1% dos tratados com espaçador e em 33,3% dos tratados em dois tempos tinham próteses em bom funcionamento e sem infecção. O espaçador de cimento com antibiótico é o tratamento de escolha nas próteses infectadas de quadril / We report a prospective study of 61 patients with chronically deep infected hip replacements with actively discharging sinuses, treated with a two-stage revision protocol, with and without a cement spacer impregnated with vancomycin. The average follow-up was two years and eleven months. Twenty-five patients were treated without a spacer and seven had recurrence of infection. Thirty-three patients were treated with a spacer and three had recurrence of infection. The average Harris Hip score increased from 19,3 to 69,0 on the non-spacer patients and from 19,7 to 75,2 on the spacer group. At the end of the study, the success rate was 86,1% for the spacer group and 33,3% for the non-spacer group. The use of the spacer increased the results of the two-stage chronic infected hip replacements