The assessment of post-operative rehabilitation methods in patients after total knee replacement in terms of the lower limb functions with its proprioception

In advanced stages of osteoarthritis of the knee joints arthoplasty is the only effective treatment for joint replacement. However, in the postoperative phase, due to its wide area, it influences patient’s health and their lower limb. It requires skilfull rehabilitation. The objective was to determine the relationship between the function of the lower limb proprioception in patients after implantation of knee replacement for osteoarthritis and type of rehabilitation treatment, used in this patients. The material included 45 patients who underwent knee replacement in Department of Orthopedics and Traumatology Collegium Medicum in Bydgoszcz (from October 2005 year - to March 2006 year) and then patients were randomly assigned to one of three groups of 15 people with a different way of rehabilitation: I - traditional, II - aggressive and III - proprioceptive. Improvement of lower limb function was achieved after 3 months in group 2 and 3, in group 1 only after 6 months. Improvement of proprioception already noted in the early postoperative period in group 3, and in the other groups - outright deterioration. In subsequent periods the improvement was significant only in group 3, and only after 6 months in group 2. Studies have allowed drawing following conclusions: 1. Proprioceptive rehabilitation has advantages over the traditional model and aggressive rehabilitation in terms of improving lower limb function and deep sensory. 2. The worst results of rehabilitation treatment in the assessment of lower limb function are given by a traditional model of rehabilitation.W zaawansowanych stadiach choroby zwyrodnieniowej stawów kolanowych jedynym skutecznym leczeniem jest endoprotezoplastyka, która jednak, z uwagi na swoją rozległość obciąża w fazie pooperacyjnej ogólny stan zdrowia, jak i stan operowanej kończyny dolnej. Wymaga to więc prowadzenia umiejętnej i racjonalnej rehabilitacji. Celem badań było ustalenie związku między funkcją kończyny dolnej, w tym propriocepcji u chorych po implantacji endoprotezy stawu kolanowego z powodu choroby zwyrodnieniowej, a rodzajem leczenia usprawniającego, zastosowanego u tych chorych. Materiał obejmował 45 chorych poddanych endoprotezoplastyce stawu kolanowego w okresie od października 2005 do marca 2006 w Klinice Ortopedii i Traumatologii Narządu Ruchu CM w Bydgoszczy UMK, a następnie przydzielonych losowo do jednej z trzech 15-osobowych grup o odmiennym sposobie rehabilitacji: I-tradycyjnym, II-agresywnym i IIIproprioceptywnym. Poprawę funkcji kończyny dolnej uzyskano po 3 miesiącach w grupie II i III, w I dopiero po 6 miesiącach. Poprawę propriocepcji odnotowano już we wczesnym okresie pooperacyjnym w grupie III, zaś w pozostałych grupach wręcz pogorszenie. W kolejnych okresach obserwacji poprawa ta była istotna tylko w grupie III i dopiero po 6 miesiącach w grupie II. Przeprowadzone badania pozwoliły na wyciągnięcienastępujących wniosków: 1. Rehabilitacja proprioceptywna ma przewagę nad tradycyjnym i agresywnym modelem usprawniania chorych po endoprotezoplastyce stawu kolanowego pod względem poprawy funkcji kończyny dolnej i czucia głębokiego. 2. Najgorsze wyniki leczenia usprawniającego, w zakresie oceny funkcji kończyny dolnej i propriocepcji, daje tradycyjny model rehabilitacj

The current state of knowledge on the prevention of venous thromboembolism in orthopaedic and trauma surgery — selected topics

Profilaktyka żylnej choroby zakrzepowo-zatorowej w ortopedii i traumatologii narządu ruchu należy do zagadnień najlepiej zbadanych i opracowanych w formie szczegółowych zaleceń i protokołów postępowania oraz do najszybciej rozwijających się w całym zakresie problematyki zakrzepowej. Najnowsze doniesienia naukowe dotyczące tego zagadnienia zmuszają do nieustannej modyfikacji podglądów oraz aktualizacji zasad jej stosowania. Zmiany te mogą być publikowane jako opracowania indywidualne lub prace zespołów badawczych powoływanych w tym celu przez stowarzyszenia naukowe. Takim przedsięwzięciem było wyodrębnienie interdyscyplinarnej grupy specjalistów, której celem było określenie aktualnego stanu wiedzy i opracowanie propozycji zaleceń dotyczących wybranych zagadnień z zakresu profilaktyki żylnej choroby zakrzepowo-zatorowej. Grupa ta działała pod auspicjami Prezesa Polskiego Towarzystwa Ortopedycznego i Traumatologicznego oraz Prezesa Polskiej Fundacji do Walki z Zakrzepicą THROMBOSIS. Wyniki prac zespołu zawarto w poniższym opracowaniu. Acta Angiol 2011; 17, 1: 1–36Prevention of venous thromboembolism in orthopaedic and trauma surgery is one of the best-studied topics, with respect to which the most detailed recommendations and management protocols have been drawn up. It is also the fastest-developing area of the study of thrombotic conditions. The most recent reports make us continually modify our views and update the principles of its use. These changes may be published by individual authors or by research teams appointed for this particular purpose by scientific societies. An example of such efforts was the appointment of a multidisciplinary group of specialists whose aim was to determine the current state of knowledge on the prevention of VTE and to propose recommendations on selected aspects of this topic. The group carried out its activities under the auspices of the Chair of the Polish Society of Orthopaedic and Trauma Surgeons and the Chair of the Polish Foundation Against Thrombosis. This paper presents the results of this team’s efforts. Acta Angiol 2011; 17, 1: 1–3

Preoperative Risk Factors of Persistent Pain following Total Knee Arthroplasty

Background. Despite good results of total knee arthroplasty (TKA) as a treatment of idiopathic osteoarthritis (OA) of the knee, significant number of patients (16-33%) complain of persistent pain of unknown origin. This phenomenon is the major cause of patient’s dissatisfaction. It has been theorized that certain preoperative factors may increase the risk of persistent pain; hence, their identification should enable proper preoperative education and development of realistic expectations regarding results of TKA. This study is aimed at identifying the preoperative chronic pain predictors in patients undergoing TKA. Methods. In this prospective cohort study, patients scheduled for TKA were examined one day prior to surgery. Demographics, comorbidities, pressure pain thresholds, pain intensity and duration, radiographic OA grade, and range of motion were recorded. Questionnaires such as Beck Depression Inventory (BDI) and Knee Injury and Osteoarthritis Outcome Score (KOOS) were collected. Study cohort was evaluated approximately 6 months following surgery. Patients were assigned to group A if they had no pain and to group B if they complained of any pain. Collected data was analyzed by biostatistician. Results. 64 patients were included in final analysis, 49 (76,6%) females and 15 (23,4%) males. Mean age was 67,6 yrs (48-84, ±7,42). Group A consisted of 21 patients (33%) while group B consisted of 43 patients (67%). There were no statistically significant differences regarding preoperative factors except for duration of preoperative pain, which was shorter in group A (36 (12-180) vs. 72 (24-180), p=0,011). Every 12 months of preoperative pain were found to increase risk of persistent pain by 1,27 (p=0,009). Conclusions. Preoperative duration of pain is a risk factor for chronic pain following TKA. Therefore, patients should be operated on as soon as indications arise. Should the surgical treatment of knee arthritis be postponed, intensive and individualized pain management is highly recommended

Ultrasound-guided arthroscopic management of hallux rigidus

Introduction : The use of metatarso-phalangeal joint arthroscopy in the treatment of osteochondritis dissecans was first described in 1988. The technique produces good results. However, it can be difficult to enter a joint when it is deformed by degenerative disease. Sonography is a modern visualisation modality which can be used in orthopaedic surgery. Aim: To describe a method of intraoperative sonographic navigation during first metatarso-phalangeal joint arthroscopy. Material and methods: The modality was used in 3 patients. The joint was visualised in the ultrasound scanner. After confirming the intra-articular position of the guide needle, a medial portal was established. The procedure started with the removal and vaporisation of the hypertrophic synovium. Gradual resection of the osteophytes was then carried out. The procedure was terminated after the ultrasound image showed that a smooth upper surface of the metatarsal head had been achieved. Results : All 3 patients were satisfied with the procedure and function of the treated feet. Average surgery time was 81 min. No complications were found. Conclusions : Mini-invasive treatment of hallux rigidus with sonography-guided arthroscopic cheilectomy appears to be a reproducible procedure leading to good clinical results. We encourage surgeons familiar with ultrasound visualisation of the joints to use the technique described in this paper in the arthroscopic treatment of hallux rigidus

Determining the route for the purpose light vehicles testing in Real Driving Emissions (RDE) test

In the regulations concerning approval of light vehicles starting from September 2019 it will be necessary to conduct exhaust emissions tests both on a chassis dynamometer and for real driving emissions. It is a legislative requirement set forth in EU regulations for the purpose of the RDE (Real Driving Emissions) procedure. To decide on the RDE route for the purpose of the LV exhaust emissions tests many requirements must be fulfilled, regarding for example external temperature and the topographic height of the tests, driving style (driving dynamic parameters), trip duration, length of respective test sections (urban, rural, motorway, etc.). The works on outlining RDE routes are continued across the country in various research centres. Specifying the RDE route for test purposes, i.e. works in which the authors of this article are actively involved, has become a major challenge for future approval surveys concerning the assessment of hazardous emissions from light vehicles and for development studies focusing on - for example - the consumption of energy in electric and hybrid vehicles. The test route has been chosen to ensure that the test is performed on a continual basis. Data were recorded on a constant basis with the minimum duration of the test achieved. The test involved light vehicles and PEMS device for measuring the exhaust emissions, vehicle’s speed, completed route, etc. The device was installed in such manner as to ensure that its impact on the exhaust emissions from the tested vehicle and on the device’s operation is the least. The vehicle load was consistent with the requirements of the standard and included the aforesaid measurement device, the driver and the operator of PEMS. The tests were carried out on working days. The streets and roads used for the tests were hard-surfaced. Measurements were performed in accordance with the requirements of RDE packages (Package 1-4), i.e. taking into account - among others - the engine cold start. The article discusses the method of outlining the test route fulfilling the specific requirements for RDE testing. Chosen results of exhaust emissions from a passenger car with a spark-ignition engine along the defined RDE test route have been provided. The tests discussed in the article are introductory in the area of RDE tests and provide an introduction into further studies of exhaust emissions and energy consumption in real driving conditions in conventional vehicles and vehicles with alternative engines, e.g. hybrid and electric vehicles

Wczesne i odległe wyniki endoprotezoplastyki stawu biodrowego z dostępu bezpośredniego górnego oraz bezpośredniego bocznego. Badania prospektywne z jednego ośrodka

Introduction. Total hip arthroplasty (THA) is an established treatment for severe hip osteoarthritis (OA). Traditionally, surgical approaches involved extensive soft tissue damage. New, less invasive approaches were introduced, facilitating fast recovery, reducing postoperative pain and incision length. Aim. Comparative analysis of postoperative pain and long-term results in patients undergoing total hip arthroplasty (THA) utilizing direct superior approach (DSA) and direct lateral approach (DLA). Materials and methods. Sixty-one patients scheduled for primary THA were included in the study. THA was performed utilizing the approach chosen by experienced orthopedic surgeons. After the procedure, pain intensity and use of analgesics were recorded daily. Patients were contacted 18 months following surgery to collect data on SF-36 score, pain intensity and complications (dislocations, infections, periprosthetic fractures, and revision surgeries). Fifty-two patients were included in the final analysis. Group A (DSA) consisted of 27 patients, whereas group B (DLA) consisted of 25 patients. Results. There were no significant differences between groups in terms of demographic parameters, preoperative pain intensity, Harris Hip Score, and SF-36 score. Significant differences were observed in pain intensity during the first three days post-operation. The use of non-opioid analgesics did not differ; however, the use of tramadol was lower in group A on the 1st and 2nd day post-operation. No significant differences were found in SF-36 score and pain intensity after 18 months post-surgery. Conclusions. DSA approach in THA is superior in comparison with the direct lateral approach in terms of early postoperative pain intensity and use of analgesic drugs. Late results of both approaches are comparable.Wstęp. Endoprotezoplastyka stawu biodrowego jest uznaną metodą leczenia zaawansowanej koksartrozy. Tradycyjne dostępy operacyjne wiązały się z istotną traumatyzacją tkanek miękkich, co było powodem wprowadzenia nowych, mało inwazyjnych dostępów operacyjnych. Umożliwiają one szybki powrót do sprawności, zmniejszają ból pooperacyjny oraz niejednokrotnie wiążą się z mniejszym cięciem. Cel. Porównawcza analiza bólu pooperacyjnego i wyników odległych u pacjentów zakwalifikowanych do endoprotezoplastyki stawu biodrowego z wykorzystaniem dostępu bezpośredniego górnego (DSA) i bezpośredniego bocznego (DLA). Materiał i metody. Do badania rekrutowano kolejnych chorych zakwalifikowanych do endoprotezoplastyki stawu biodrowego. Operacje wykonywane były przez doświadczonych ortopedów. Po operacji mierzono nasilenie bólu pooperacyjnego i zużycie leków przeciwbólowych. Po 18 miesiącach kontaktowano się z pacjentami w celu oceny jakości życia za pomocą kwestionariusza SF-36, nasilenia bólu (w skali NRS), satysfakcji oraz ewentualnych powikłań (zwichnięć, infekcji, złamań okołoprotezowych i operacji rewizyjnych). Do ostatecznej analizy włączono 52 chorych. Grupę A (27 osób) stanowili chorzy operowanie z dostępu DSA, natomiast grupę B chorzy operowani z dostępu DLA (25 osób). Wyniki. Nie zaobserwowano różnic w zakresie parametrów demograficznych, bólu przedoperacyjnego, wyników kwestionariusza Harris Hip Score czy SF-36. Wykazano istotne różnice w zakresie wczesnego bólu pooperacyjnego w pierwszych trzech dobach. Zapotrzebowanie na nieopioidowe leki przeciwbólowe nie różniło się między grupami, natomiast zużycie tramadolu było istotnie niższe w grupie A w I i II dobie. Po 18 miesiącach nie wykazano różnic między grupami w zakresie SF-36, satysfakcji oraz nasilenia bólu. Wnioski. Dostęp DSA wykazuje przewagę nad dostępem DLA w zakresie wczesnego bólu pooperacyjnego i zapotrzebowania na leki przeciwbólowe. Zastosowanie obu dostępów daje porównywalne, znakomite wyniki odległe

Peripheral snap-fit locking mechanisms and smooth surface finish of tibial trays reduce backside wear in fixed-bearing total knee arthroplasty: A retrieval analysis of 102 inlays

Background and purpose — Severe backside wear, observed in older generations of total knee replacements (TKRs), led to redesign of locking mechanisms to reduce micromotions between tibial tray and inlay. Since little is known about whether this effectively reduces backside wear in modern designs, we examined backside damage in retrievals of various contemporary fixed-bearing TKRs. Patients and methods — A consecutive series of 102 inlays with a peripheral (Stryker Triathlon, Stryker Scorpio, DePuy PFC Sigma, Aesculap Search Evolution) or dovetail locking mechanism (Zimmer NexGen, Smith and Nephew Genesis II) was examined. Articular and backside surface damage was evaluated using the semiquantitative Hood scale. Inlays were examined using scanning electron microscopy (SEM) to determine backside wear mechanisms. Results — Mean Hood scores for articular (A) and backside (B) surfaces were similar in most implants—Triathlon (A: 46, B: 22), Genesis II (A: 55, B: 24), Scorpio (A: 57, B: 24), PFC (A: 52, B: 20); Search (A: 56, B: 24)—except the NexGen knee (A: 57, B: 60), which had statistically significantly higher backside wear scores. SEM studies showed backside damage caused by abrasion related to micromotion in designs with dovetail locking mechanisms, especially in the unpolished NexGen trays. In implants with peripheral liner locking mechanism, there were no signs of micromotion or abrasion. Instead, “tray transfer” of polyethylene and flattening of machining was observed. Interpretation — Although this retrieval study may not represent well-functioning TKRs, we found that a smooth surface finish and a peripheral locking mechanism reduce backside wear in vivo, but further studies are required to determine whether this actually leads to reduced osteolysis and lower failure rates

Ocena metod rehabilitacji pooperacyjnej u chorych po endoprotezoplastyce stawu kolanowe stawu kolanowego w zakresie funkcji kończyny dolnej z uwzględnieniem propriocepcji.

In advanced stages of osteoarthritis of the knee joints arthoplasty is the only effective treatment for joint replacement. However, in the postoperative phase, due to its wide area, it influences patient’s health and their lower limb. It requires skilfull rehabilitation. The objective was to determine the relationship between the function of the lower limb proprioception in patients after implantation of knee replacement for osteoarthritis and type of rehabilitation treatment, used in this patients. The material included 45 patients who underwent knee replacement in Department of Orthopedics and Traumatology Collegium Medicum in Bydgoszcz (from October 2005 year - to March 2006 year) and then patients were randomly assigned to one of three groups of 15 people with a different way of rehabilitation: I - traditional, II - aggressive and III - proprioceptive. Improvement of lower limb function was achieved after 3 months in group 2 and 3, in group 1 only after 6 months. Improvement of proprioception already noted in the early postoperative period in group 3, and in the other groups - outright deterioration. In subsequent periods the improvement was significant only in group 3, and only after 6 months in group 2. Studies have allowed drawing following conclusions:1. Proprioceptive rehabilitation has advantages over the traditional model and aggressive rehabilitation in terms of improving lower limb function and deep sensory.2. The worst results of rehabilitation treatment in the assessment of lower limb function are given by a traditional model of rehabilitation.W zaawansowanych stadiach choroby zwyrodnieniowej stawów kolanowych jedynym skutecznym leczeniem jest endoprotezoplastyka, która jednak , z uwagi na swoją rozległość obciąża w fazie pooperacyjnej ogólny stan zdrowia, jak i stan operowanej kończyny dolnej. Wymaga to więc prowadzenia umiejętnej i racjonalnej rehabilitacji. Celem badań było ustalenie związku między funkcją kończyny dolnej, w tym propriocepcji u chorych po implantacji endoprotezy stawu kolanowego z powodu choroby zwyrodnieniowej, a rodzajem leczenia usprawniającego, zastosowanego u tych chorych. Materiał obejmował 45 chorych poddanych endoprotezoplastyce stawu kolanowego w okresie od października 2005 do marca 2006 w Klinice Ortopedii i Traumatologii Narządu Ruchu CM w Bydgoszczy UMK, a następnie przydzielonych losowo do jednej z trzech 15-osobowych grup o odmiennym sposobie rehabilitacji: I-tradycyjnym, II-agresywnym i IIIproprioceptywnym. Poprawę funkcji kończyny dolnej uzyskano po 3 miesiącach w grupie II i III, w I dopiero po 6 miesiącach. Poprawę propriocepcji odnotowano już we wczesnym okresie pooperacyjnym w grupie III, zaś w pozostałych grupach wręcz pogorszenie. W kolejnych okresach obserwacji poprawa ta była istotna tylko w grupie III i dopiero po 6 miesiącach w grupie II. Przeprowadzone badania pozwoliły na wyciągnięcienastępujących wniosków:1. Rehabilitacja proprioceptywna ma przewagę nad tradycyjnym i agresywnym modelem usprawniania chorych po endoprotezoplastyce stawu kolanowego pod względem poprawy funkcji kończyny dolnej i czucia głębokiego.2. Najgorsze wyniki leczenia usprawniającego, w zakresie oceny funkcji kończyny dolnej i propriocepcji, daje tradycyjny model rehabilitacj

Genetics in Cartilage Lesions: Basic Science and Therapy Approaches

Cartilage lesions have a multifactorial nature, and genetic factors are their strongest determinants. As biochemical and genetic studies have dramatically progressed over the past decade, the molecular basis of cartilage pathologies has become clearer. Several homeostasis abnormalities within cartilaginous tissue have been found, including various structural changes, differential gene expression patterns, as well as altered epigenetic regulation. However, the efficient treatment of cartilage pathologies represents a substantial challenge. Understanding the complex genetic background pertaining to cartilage pathologies is useful primarily in the context of seeking new pathways leading to disease progression as well as in developing new targeted therapies. A technology utilizing gene transfer to deliver therapeutic genes to the site of injury is quickly becoming an emerging approach in cartilage renewal. The goal of this work is to provide an overview of the genetic basis of chondral lesions and the different approaches of the most recent systems exploiting therapeutic gene transfer in cartilage repair. The integration of tissue engineering with viral gene vectors is a novel and active area of research. However, despite promising preclinical data, this therapeutic concept needs to be supported by the growing body of clinical trials