Aleksandar Radunovic

The impact of pain on functionality and health related quality of life in patients with knee osteoarthritis

Aleksandra Jurišić-Škevin1,2, Vesna Grbović1,2, Ivana Stanković3, Aleksandar Radunović4, Jasmin Nurković5, Bojan Milošević6,2, Aleksandar Cvetković6,2, Ana Divjak1, Maja Vulović7 1University of Kragujevac, Faculty of Medical Sciences, Department of Physical medicine and rehabilitation, Kragujevac, Serbia; 2Clinical center Kragujevac, Kragujevac, Serbia; 3University of Defence in Belgrade, Military Medical Academy, Institute for Medical Research, Belgrade, Serbia; 4Military medical academy, Clinic for orthopedic surgery and traumatology, Belgrade, Serbia; 5State University of Novi Pazar, Department of Biomedical Sciences, Novi Pazar, Serbia; 6University of Kragujevac, Faculty of Medical Sciences, Department of Surgery, Kragujevac, Serbia; 7University of Kragujevac, Faculty of Medical Sciences, Department of Anatomy, Kragujevac, Serbia;

Total Endoprothesis of Hip Joint: Characteristics and Application in Patients in the Central Region of Serbia

Total hip arthroplasty is a surgical procedure in which the hip joint is replaced with an artificial one. Performance of this procedure requires knowledge of the anatomical features of the joint, the characteristics of the endoprosthesis, and the needs and pathological and physiological characteristics of the patient. This retrospective analysis includes the data contained in 874 medical histories of patients of both sexes implanted with a unilateral total hip endoprosthesis who were treated at the Orthopedic Clinic of the Clinical Center, Kragujevac, from January 1st, 2009 to December 1st, 2014. Analysis of the data revealed that 69.3% of the patients were women. The most common type of implanted prosthesis was the cementless one, and the most frequent indication was degenerative joint damage. Total arthroplasty of the hip joint has become one of the most common interventions in orthopedic surgery. The increasing need for this method of treatment required the development of new biomaterials, as well as new types of prosthesis, which, in the future, will decrease the occurrence of adverse reactions and complications during and after implantation of the prosthesis, as well as extending their useful life.

Contemporary Aspects of Joint Arthroplasties and Role of Ceramics

Field of big joints arthroplasties is one of medical areas with most dynamic changes. Increased number of patients in need for this surgery as enlarged expectations they have, demands surgeon’s good knowledge and follow up of implant characteristics and materials used in their production. At this moment dynamic is most noticeable in the materials used for acetabular inserts and femoral head fabrication. Endoprosthesis components are crafted from metals and its alloys, polyethylene and ceramics. Properties that favorize ceramics are high biocompatibility and wear resistance while most significant negative feature of ceramics is inability for plastic deformation so the smallest crack can lead to catastrophic implant failure. Continuos improvement of ceramic implants composition made them of more important role in contemporary joint arthroplasty surgery.

Treatment of subacute osteoporotic vertebral compression fractures with Percutaneous vertebroplasty: A case report

Introduction. Percutaneous vertebroplasty (PVP), as a mini-invasive approach in the treatment of patients with osteoporotic vertebral compression fractures (OVCFs), provides stabilization of the spine and relives pain. The most commonly it is applied in the 3–6 weeks before bending of the spine. Complete cessation of pain is easier to achieve if you treat “less mature” fractures. The aim of the report is to show that PVP is effective and safe for old fractures too. Case report. A 77-old patient suffered from a stable compression fracture of 3th lumbar (L3) vertebral body after minor trauma. This fracture was clinically and radiologically diagnosed. The conservative treatment that included lumbo-sacral orthosis (LSO), analgesic drugs and physical therapy, was primarily applied due to permanent pain and type of fracture. After a period of two months, pain persisted, but it was localized in a thoracic spinal segment with radiologically diagnosed fractured bodies of 8th (Th8) and 10th (Th10), thoracic vertebra without neurological deficit. Thoraco-lumbo-sacral orthosis (TLSO) was prescribed and after six months the indication for vertebroplasty of the Th8 and Th10 vertebral body was given. The pain relief had been achieved and the patient was discharged from the Clinic for Orthopedics on the postoperative day 2, and was symptom free during the follow-up period. Conclusion. In patients with stable OVCFs, PVP is an effective therapy for reducing pain and improving mobility of 6 months old fractures.

Ilizarov method as limb salvage in treatment of massive femoral defect after unsuccessful tumor arthroplasty

Introduction Surgical management of massive bone defects is very challenging in terms of estimating possibilities of saving the extremity and adequate method that can make it possible. Selection of methods is additionally limited in the presence of infection at site of defect. Case report The female patient, diagnosed with Ewing sarcoma was treated by segmental bone resection and implantation of Kotz modular tumor endoprosthesis. After 5 years the signs of infection occured and persisted with low grade intensity. After falling, 12 years following implantation, the patient acquired periprosthetic fracture. Then endoprosthesis was removed, all along with surgical debridement of wound and application of the Ilizarov apparatus. The apparatus was applied, osteotomy of callus and the tibia performed with transport of bone segments, untill reconstruction of defect and arthrodesis of the knee was achieved. Conclusion The Ilizarov apparatus offered us huge possibilities for management of massive bone defects with natural bone which has superior biomechanical characteristics comparing to the implant. The most frequent complication of this method is a prolonged treatment period that demands good patient selection and preparation and wide surgical experience.

Arthroscopic findings after shoulder dislocation

BACKGROUND/AIM Recurrent instability of the shoulder joint is frequently difficult to differentiate from diseased or injured rotator cuff or tendon of the forearm flexor (m. biceps brachii). Shoulder joint arthroscopy has been only recently introduced into instable shoulder joint lesion examination. The aim of this study was to present and analyse an arthroscopic finding on instable shoulder joint in order to determine causes and mechanisms of instability, as well as principles of surgical treatment. METHODS Arthroscopy of the shoulder joint was performed in 158 patients with at least one documented shoulder joint dislocation. These patients were divided into two groups. The group I included the patients with one to three dislocations, while the group II those with more than three dislocations. Preoperative diagnosis was based on anamnestic data and clinical examination using specific tests, and on the diagnosis of shoulder joint using radiography or computed tomography. RESULTS Out of the total number of the patients 138 (87.34%) had injury of the anterior patellar brim, 119 (75.32%) had failure of the anterior capsule, 126 (79.75%) had compressive cartilage injury of the posterior part of the head of the upper arm bone (Hill-Sachs lesion), 102 (64.56%) had insufficiency of glenohumeral tendon, 11 (6.96) had complete cut of the rotator cuff, 23 (14.56%) had injury of the posterior patellar brim, 12 (7.59%) had injury of the upper anterior-posterior patellar brim (SLAP). CONCLUSION According to the obtained results it could be concluded that there is no a unique injury that leads to shoulder joint instability. It is necessary to point out to the significance of anamnesis and clinical examination in making diagnosis. Arthroscopic diagnostics is indicated in clinically unreliable findings as an additional method for determining operative treatment.

Total bilateral hip arthroplasty in one surgical procedure

BACKGROUND/AIM Primary coxarthrosis occurs often in older population. There is possibility of implanting both endoprothesis simultaneosly in bilateral coxarthrosis which decreases hospitalisation and reduces the expences and possibility of complication that can occur during general anesthesia. The most serious indications for bilateral total hip arthroplasty in one procedure are younger patients with serious bilateral osteoarthrosis of the hips, without added diseases. Absolute contraindication is found in patients with persistent ductus arteriosus and septal defect. The aim of this study was to point out the possibility and advantages of a single-staged bilateral hip arthroplasty and introducing it in our orthopaedic practice. METHODS The procedure was accomplished in 19 patients. The standard total hip arthroplasty surgical technique was performed, followed by the usual antibiotic and anticoagulant therapy. RESULTS Only one complication--acetabular part instability we recorded, followed by luxation that was surgically managed. CONCLUSION This procedure can be performed routinly in selected population and should be reserved for major medical centres capable to provide adequate postoperative care.