Periprosthetic Infections after Total Hip and Knee Arthroplasty – A Review

Periprosthetic joint infections (PJI) in orthopedic surgery are considered to be very serious and dangerous complications of total joint arthroplasty. PJI becomes a long-lasting medical problem and a heavy burden on patient and his family. Patients with such a complication are a signifi cant fi nancial burden for the health care system. Recognizing this issue, investing in scientifi c research and simultaneously developing technologies in medicine are efforts taken to increase successfulness in preventing and treating PJI. Each year the number of total joint arthroplasties increases which entails a rise in the number of complications among which infections are the leading ones. Sometimes, in the worst case scenarios, infections can endanger patients’ lives. New procedural algorithms and new diagnostic possibilities help us make accurate and early diagnoses of postoperative PJI with a great degree of certainty. These diagnostic methods include laboratory tests, imaging, histopathology and microbiological analyses. Treatment options depend on many factors which include the onset of symptoms, patients’ general physical condition and type of pathogen. The approach to treating PJI is complex and it requires a multidisciplinary approach in order to ensure the most successful treatment possible. For adequate and successful treatment we need to take into account antibiotic therapy, one-stage or two-stage revision, Girdlestone operation, athrodesis and amputation. In this review we will try to sum up all relevant fi ndings and suggest further steps in management of PJI

The importance of neuromuscular coordination of the knee joint after anterior cruciate ligament injuries

Cilj: Istražiti jesu li nakon ozljede prednjeg križnog ligamenta koljena aktivni mehanizmi stabilizacije zgloba, potaknuti vježbama propriocepcije i ravnoteže tijekom programa rehabilitacije, dovoljni za uspostavljanje normalne funkcije zgloba, praćenjem živčano-mišićne kontrole na nestabilnoj podlozi u ranim razdobljima od ozljede, odnosno operacije rekonstrukcije prednjeg križnog ligamenta (od 1 mjesec do 1 godine). Ispitanici i metode: U kliničko istraživanje bilo je uključeno 53 ispitanika s ozljedom prednjeg križnog ligamenta (PKL) koljena, liječenih konzervativno/operacijski. Svi su nakon ozljede/operacije proveli rehabilitacijski program s naglaskom na vježbama na nestabilnoj podlozi za poticanje živčano-mišićne koordinacije i ravnoteže. Statičku i dinamičku stabilnost pratili smo i mjerili aparatom SportKAT 2000. Usporedbu rezultata vršili smo prema usporedbenoj skupini zdravih ispitanika i/ili prema zdravom ekstremitetu istog ispitanika. Rezultati: Koristeći se Sport KAT metodom, pronašli smo disfunkciju neuromišićne kontrole u održavanju statičke i dinamičke stabilnosti zgloba i ravnoteže u promatranim skupinama pacijenata određivanjem statičkih i dinamičkih ravnotežnih indeksa. Vježbe živčano-mišićne koordinacije, kao dio rehabilitacijskog protokola nakon ozljede PKL-a koljena, vrlo brzo dovode do poboljšanja obaju ravnotežnih indeksa (p < 0,001), u obje skupine pacijenata. No, ako se navedene vježbe svakodnevno ne izvode, dinamički ravnotežni indeks pogoršava se u neoperiranoj skupini, dok se nakon operacijske stabilizacije zgloba uspostavlja „normalizacija” ravnoteže (p < 0,001). Zaključak: S ciljem rehabilitacije neurosenzoričkih i propriocepcijskih oštećenja nastalih nakon ozljede PKL-a koljena liječenih konzervativno/operacijski, potrebno je koristiti vježbe koje stimuliraju dinamičke stabilizatore zgloba, preko mehanizama neuromišićne ko-kontrakcije tijekom održavanja ravnoteže. Spomenuto predstavlja znanstveni doprinos ovog rada s naglašavanjem važnosti živčano-mišićne koordinacije u rehabilitaciji donjeg ekstremiteta pri održavanju stabilnosti zglobova.Aim: To evaluate if the restoration of neuromuscular coordination in knee ACL-injured patients could be estimated by the stimulation of neuromuscular control during the rehabilitation or if operative stabilisation should be performed previously. The study had to examine a short-term and long-term efficiency by monitoring the indicators of joint functionality in the early stages, from one month to one year after the injury/operation. Patients and methods: We analysed 53 ACL-injured patients treated operatively and non-operatively. All the patients underwent a functional rehabilitation programme with balance exercises. The measuring of static and dynamic balance on SportKAT 2000 device was performed, and the results were compared with the healthy subjects and the healthy limb of the same subject. Results: Measuring the static and dynamic balance indexes, a dysfunction of neuromuscular control was found in the maintenance of balance in the patient groups. Exercises that included stimulation of the neuromuscular coordination, as a part of the rehabilitation procedure following ACL injuries, soon lead to an improvement of both balance indexes (p<0,001) in both groups, however, no long term impact was noted in non-operatively treated group. Namely, if the above exercises are not conducted on a regular daily basis, the balance indexes will deteriorate. Contrary, after the operative joint stabilization the balance indexes tend to improve to the ‘normal’ balance (p<0,001). Conclusion: In order to restore dynamic stabilization of the joint in ACL injured patients, exercises stimulating the neuromuscular mechanisms are necessary. This suggests the importance of neuromuscular coordination in the rehabilitation of the lower extremity while maintaining joint stability, which represents the scientific contribution of this paper

MECHANISMS OF CARTILAGE AND BONE DESTRUCTION IN RHEUMATOID ARTHRITIS

Reumatoidni artritis (RA) sistemska je, progresivna, kronična, upalna i autoimuna bolest zglobova koja dovodi do ireverzibilnih oštećenja zglobnih struktura i uzrokuje tešku invalidnost. Usprkos intenzivnim istraživanjima, patogenetski mehanizam bolesti još nije sasvim razjašnjen, ali se pretpostavlja da različiti putovi nastanka bolesti vode u zajednički put destrukcije zglobova. U ovome preglednom članku opisani su važniji stanični i molekularni mehanizmi destrukcije zglobnih struktura tijekom razvoja RA. Pritom su navedene meðustanične interakcije koje dovode do neravnoteže odnosa matriks metaloproteinaza i njihovih inhibitora. Opisan je i izravan molekularni model destrukcije kosti koji uključuje neravnotežu membranskih i solubilnih liganada koji se izražavaju na stanicama koštanog i imunološkog sustava, štoo konačno dovodi do poticanja sazrijevanja osteoklasta i resorpcije kosti. Razjašnjavanje molekularnih patogenetskih mehanizama destrukcije hrskavice i kosti svakako će pridonijeti pronalasku novih i specifičnih farmakoterapijskih pristupa u liječenju RA.Rheumatoid arthritis (RA) is a systemic, progressive, chronic, inflammatory and autoimmune joint disease in which substantial irreversible joint destruction and severe functional disability occur. In spite of intensive research efforts in the field of RA, pathogenic mechanism remains incompletely understood. It is likely that disperate disease courses converge into a common route of joint destruction. In this review, some potential cellular and molecular mechanisms involved in joint destruction during the course of rheumatoid arthritis are described. Disturbed intercellular interactions which could result in overproduction of matrix metalloproteinases in comparison to their inhibitors are summarized. A direct molecular mechanism in which stimulation of osteoclastogenesis and bone resorption was explained by disbalance of distinct membrane-bound and solubile ligands, expressed simultaneously on bone and immune cells, has also been described. The continuing elucidation of pathophysiological pathways relevant in RA, offer substantional hope for the continued development of specific pharmacotherapy for the treatment of RA

HALLUX VALGUS

Hallux valgus najčešća je deformacija prednjeg dijela stopala. Bolest se javlja u svim narodima i rasama, a najzastupljenija je u urbanoj populaciji. Najznačajnijim egzogenim etiološkim čimbenikom smatra se neprikladna i uska obuća. Anamneza, klinički pregled te redgenološka obrada glavne su pretrage na osnovi kojih se provodi izbor metode liječenja i planiranje operacijskog zahvata. U ovom radu iznijete su osnove navedenih metoda pretrage, te osnovne smjernice u odabiru operacijskih načina liječenja i njihove tehničke pojedinosti.Hallux valgus is a common disorder of the forefoot. Deformities occur in all races, but the higher incidence was observed in urban population. High fashion footwear was observed as the most important extrinsic factor in developing hallux valgus. Anamnesis, clinical examination as well as plain radiography represent the most important methods in determining the final method of treatment. Here we reviewed the basic principles of plain radiography examination and technical aspects of various operative procedures

HALLUX VALGUS

Hallux valgus najčešća je deformacija prednjeg dijela stopala. Bolest se javlja u svim narodima i rasama, a najzastupljenija je u urbanoj populaciji. Najznačajnijim egzogenim etiološkim čimbenikom smatra se neprikladna i uska obuća. Anamneza, klinički pregled te redgenološka obrada glavne su pretrage na osnovi kojih se provodi izbor metode liječenja i planiranje operacijskog zahvata. U ovom radu iznijete su osnove navedenih metoda pretrage, te osnovne smjernice u odabiru operacijskih načina liječenja i njihove tehničke pojedinosti.Hallux valgus is a common disorder of the forefoot. Deformities occur in all races, but the higher incidence was observed in urban population. High fashion footwear was observed as the most important extrinsic factor in developing hallux valgus. Anamnesis, clinical examination as well as plain radiography represent the most important methods in determining the final method of treatment. Here we reviewed the basic principles of plain radiography examination and technical aspects of various operative procedures

Balance Index Score as a Predictive Factor for Lower Sports Results or Anterior Cruciate Ligament Knee Injuries in Croatian Female Athletes – Preliminary Study

Female athletes participating in high-risk sports suffer anterior cruciate ligament (ACL) knee injury at a 4- to 6-fold greater rate than do male athletes. ACL injuries result either from contact mechanisms or from certain unexplained non-contact mechanisms occurring during daily professional sports activities. The occurrence of non-contact injuries points to the existence of certain factors intrinsic to the knee that can lead to ACL rupture. When knee joint movement overcomes the static and the dynamic constraint systems, non-contact ACL injury may occur. Certain recent results suggest that balance and neuromuscular control play a central role in knee joint stability, protection and prevention of ACL injuries. The purpose of this study is to evaluate balance neuromuscular skills in healthy Croatian female athletes by measuring their balance index score, as well as to estimate a possible correlation between their balance index score and balance effectiveness. This study is conducted in an effort to reduce the risk of future injuries and thus prevent female athletes from withdrawing from sports prematurely. We analysed fifty-two female athletes in the high-risk sports of handball and volleyball, measuring for their static and dynamic balance index scores, using the Sport KAT 2000® testing system. This method may be used to monitor balance and coordination systems and may help to develop simpler measurements of neuromuscular control, which can be used to estimate risk predictors in athletes who withdraw from sports due to lower sports results or ruptured anterior cruciate ligament and to direct female athletes to more effective, targeted preventive interventions. The tested Croatian female athletes with lower sports results and ACL knee injury incurred after the testing were found to have a higher balance index score compared to healthy athletes. We therefore suggest that a higher balance index score can be used as an effective risk predictor for lower sports results and lesser sports motivation, anterior cruciate ligament injury and the ultimate decision to withdraw from active participation in sports. If the balance testing results prove to be effective in predicting the occurrence of ligament injuries during future sports activities, we suggest that prophylactic training programs be introduced during athlete training, since the prevention of an initial injury will be more effective than prevention of injury recurrence

MECHANISMS OF CARTILAGE AND BONE DESTRUCTION IN RHEUMATOID ARTHRITIS

Reumatoidni artritis (RA) sistemska je, progresivna, kronična, upalna i autoimuna bolest zglobova koja dovodi do ireverzibilnih oštećenja zglobnih struktura i uzrokuje tešku invalidnost. Usprkos intenzivnim istraživanjima, patogenetski mehanizam bolesti još nije sasvim razjašnjen, ali se pretpostavlja da različiti putovi nastanka bolesti vode u zajednički put destrukcije zglobova. U ovome preglednom članku opisani su važniji stanični i molekularni mehanizmi destrukcije zglobnih struktura tijekom razvoja RA. Pritom su navedene meðustanične interakcije koje dovode do neravnoteže odnosa matriks metaloproteinaza i njihovih inhibitora. Opisan je i izravan molekularni model destrukcije kosti koji uključuje neravnotežu membranskih i solubilnih liganada koji se izražavaju na stanicama koštanog i imunološkog sustava, štoo konačno dovodi do poticanja sazrijevanja osteoklasta i resorpcije kosti. Razjašnjavanje molekularnih patogenetskih mehanizama destrukcije hrskavice i kosti svakako će pridonijeti pronalasku novih i specifičnih farmakoterapijskih pristupa u liječenju RA.Rheumatoid arthritis (RA) is a systemic, progressive, chronic, inflammatory and autoimmune joint disease in which substantial irreversible joint destruction and severe functional disability occur. In spite of intensive research efforts in the field of RA, pathogenic mechanism remains incompletely understood. It is likely that disperate disease courses converge into a common route of joint destruction. In this review, some potential cellular and molecular mechanisms involved in joint destruction during the course of rheumatoid arthritis are described. Disturbed intercellular interactions which could result in overproduction of matrix metalloproteinases in comparison to their inhibitors are summarized. A direct molecular mechanism in which stimulation of osteoclastogenesis and bone resorption was explained by disbalance of distinct membrane-bound and solubile ligands, expressed simultaneously on bone and immune cells, has also been described. The continuing elucidation of pathophysiological pathways relevant in RA, offer substantional hope for the continued development of specific pharmacotherapy for the treatment of RA

Treatment of Infected Tibial Nonunion with Bone Defect Using Central Bone Grafting Technique

Treatment of infected tibial nonunion with bone defect represents a challenge for every orthopaedic surgeon. Various methods of treatment have been described for nonunions with infection, bone loss or both. One of them is the central bone grafting technique, which is a safe and effective treatment for nonunions of the tibia. The technique involves placement of autogenous cancellous bone from the iliac crest on the anterior surface of the interosseous membrane with the aim of creating a tibiofibular synostosis. We present the results of uncontrolled, retrospective and continuous series of ten patients treated by a central bone grafting technique for infected tibial nonunion with bone loss. Mean follow-up period was 12 (10–15) years. Most injuries were a result of war injuries. Clinically and radiologically confirmed bony healing with total consolidation of the graft was achieved in all patients within a period of 10–12 months without further bone grafting. The newly-formed bone mass was able to fulfil the mechanical and functional demands of everyday life activities. Once again, the central bone grafting technique has shown to be a safe, reliable and effective method of treatment for infected tibial nonunion with bone defect