Gábor Skaliczki

Freeze-dried human serum albumin improves the adherence and proliferation of mesenchymal stem cells on mineralized human bone allografts

Mineralized scaffolds are widely used as bone grafts with the assumption that bone marrow derived cells colonize and remodel them. This process is slow and often unreliable so we aimed to improve the biocompatibility of bone grafts by pre‐seeding them with human mesenchymal stem cells from either bone marrow or dental pulp. Under standard cell culture conditions very low number of seeded cells remained on the surface of freeze‐dried human or bovine bone graft or hydroxyapatite. Coating the scaffolds with fibronectin or collagen improved seeding efficiency but the cells failed to grow on the surface until the 18th day. In contrast, human albumin was a very potent facilitator of both seeding and proliferation on allografts which was further improved by culturing in a rotating bioreactor. Electron microscopy revealed that cells do not form a monolayer but span the pores, emphasizing the importance of pore size and microstructure. Albumin coated bone chips were able to unite a rat femoral segmental defect, while uncoated ones did not. Micro‐hardness measurements confirmed that albumin coating does not influence the physical characteristics of the scaffold, so it is possible to introduce albumin coating into the manufacturing process of lyophilized bone allografts.

Mitigation and Education

Delegates: Joseph A. Abboud, MD, Mark Altena, MD, Thomas L. Bradbury, MD, Jason H. Calhoun, MD, FACS, Douglas A. Dennis, MD, Daniel J. Del Gaizo, MD, Lluis Font-Vizcarra, MD, Kaisa Huotari, MD, Stephen L. Kates, MD, Kyung-Hoi Koo, PhD, Tad M. Mabry, MD, Calin Stefan Moucha, MD, Julio Cesar Palacio, MD, Trisha Nicole Peel, MBBS, Rudolf W. Poolman, MD, PhD, William J. Robb III, MD, Ralph Salvagno, MD, Thorsten Seyler, MD, Gabor Skaliczki, MD, Edward M. Vasarhelyi, MD, William Charles Watters III, MD

Functional outcome and life quality after endoprosthetic reconstruction following malignant tumours around the knee.

Between 1993 and 2002, we treated 43 patients with malignant musculoskeletal tumours of the knee region. All patients had partial resection of the femur or tibia together with endoprosthetic replacement. We were able to follow-up 23 patients with an average follow-up of 30 (12–97) months. Complications occurred in ten cases, of which one was a case of local recurrence. Most of the patients were completely satisfied with their condition, with a decreased walking distance as the only notable restriction. There was no correlation between the functional outcome and life quality assessment and the type of the implanted prosthesis, length of resected bone and type of resection. However, patients with tumours in the distal femur had significantly better functional and life quality outcome than those with a proximal tibial tumour.RésuméEntre 1993 et 2002 nous avons traité 43 malades avec une tumeur musculo-squelettique maligne de la région du genou. Tous les malades avaient une résection partielle du fémur ou du tibia avec remplacement prothétique. Nous avons suivi 23 malades avec un délai moyen de 30 (12–97) mois. Des complications se sont produites dans 10 cas dont une récidive locale. La plupart des malades ont été satisfaits du résultat avec un périmètre de marche diminué comme seule restriction notable. Il n’y avait aucune corrélation entre, d’une part les résultats fonctionnels et la qualité de vie et, d’autre part, le type de résection, la longueur de résection osseuse et le type de prothèse implantée. Cependant, les malades avec une tumeur du fémur distal avaient de meilleurs résultats pour la fonction et la qualité de vie que ceux atteints d’une tumeur du tibia proximal

The Not-So-Good Prognosis of Streptococcal Periprosthetic Joint Infection Managed by Implant Retention: The Results of a Large Multicenter Study

Background. Streptococci are not an infrequent cause of periprosthetic joint infection (PJI). Management by debridement, antibiotics, and implant retention (DAIR) is thought to produce a good prognosis, but little is known about the real likelihood of success. Methods. A retrospective, observational, multicenter, international study was performed during 2003-2012. Eligible patients had a streptococcal PJI that was managed with DAIR. The primary endpoint was failure, defined as death related to infection, relapse/persistence of infection, or the need for salvage therapy. Results. Overall, 462 cases were included (median age 72 years, 50% men). The most frequent species was Streptococcus agalactiae (34%), and 52% of all cases were hematogenous. Antibiotic treatment was primarily using β-lactams, and 37% of patients received rifampin. Outcomes were evaluable in 444 patients: failure occurred in 187 (42.1%; 95% confidence interval, 37.5%-46.7%) after a median of 62 days from debridement; patients without failure were followed up for a median of 802 days. Independent predictors (hazard ratios) of failure were rheumatoid arthritis (2.36), late post-surgical infection (2.20), and bacteremia (1.69). Independent predictors of success were exchange of removable components (0.60), early use of rifampin (0.98 per day of treatment within the first 30 days), and long treatments (≥21 days) with β-lactams, either as monotherapy (0.48) or in combination with rifampin (0.34). Conclusions. This is the largest series to our knowledge of streptococcal PJI managed by DAIR, showing a worse prognosis than previously reported. The beneficial effects of exchanging the removable components and of β-lactams are confirmed and maybe also a potential benefit from adding rifampin.

Mitigation and education

Liaisons: Vinay K Aggarwal MD, Eric H Tischler BA Leaders: Charles Lautenbach MD, Gerald R Williams Jr MD Delegates: Joseph A Abboud MD, Mark Altena MD, Thomas Bradbury MD, Jason Calhoun MD, FACS, Douglas Dennis MD, Daniel J Del Gaizo MD, Lluı́s Font-Vizcarra MD, Kaisa Huotari MD, Stephen Kates MD, Kyung-Hoi Koo PhD, Tad M Mabry MD, Calin Stefan Moucha MD, Julio Cesar Palacio MD, Trisha Nicole Peel MBBS, Rudolf W Poolman MD, PhD, William J Robb III MD, Ralph Salvagno MD, Thorsten Seyler MD, Gabor Skaliczki MD, Edward M Vasarhelyi MD, William Charles Watters III, MD

Compromised bone healing following spacer removal in a rat femoral defect model

PURPOSE The clinical demand for bone grafting materials necessitated the development of animal models. Critical size defect model has been criticized recently, mainly for its inaccuracy. Our objective was to develop a dependable animal model that would provide compromised bone healing, and would allow the investigation of bone substitutes. METHODS In the first group a critical size defect was created in the femur of adult male Wistar rats, and a non-critical defect in the remaining animals (Groups II, III and IV). The defect was left empty in group II, while in groups III and IV a spacer was interposed into the gap. Osteoblast activity was evaluated by NanoSPECT/CT imaging system. New bone formation and assessment of a union or non-union was observed by μCT and histology. RESULTS The interposition model proved to be highly reproducible and provided a bone defect with compromised bone healing. Significant bone regeneration processes were observed four weeks after removal of the spacer. CONCLUSION Our results have shown that when early bone healing is inhibited by the physical interposition of a spacer, the regeneration process is compromised for a further 4 weeks and results in a bone defect during the time-course of the study.

Midterm outcome after rotator cuff reconstruction

UNLABELLED Rotator cuff tear is a common degenerative shoulder disorder that often requires surgical treatment. However, the correlation between the size of the tear and the functional results is somewhat controversial, which generates inconsistency among orthopaedic surgeons about the indications for and methods of rotator cuff reconstruction. AIMS The aim of the authors was to evaluate the midterm functional outcome after rotator cuff reconstruction and the possible connection between the results and the surgical technique or the postoperative ultrasound examination. In addition, recently published corresponding studies are also reviewed by the authors. METHODS Twenty-seven patients with full thickness rotator cuff tear were enrolled into the study who were treated either by arthroscopic (14 patients) or by open repair (13 patients) technique. Functional results were assessed using clinical tests. Ultrasound examination was also performed. RESULTS The average postoperative Constant Score was 73, the average DASH (Disabilities of the arm, shoulder and hand score) was 14. The Constant scores averaged 80 for the arthroscopic and 70 for the open group. Ultrasound examination showed partial or full thickness retear of the cuff in 40% of the cases. CONCLUSION More than 70% of the patients had excellent or good results two years after the reconstruction. The change in the acromiohumeral distance or partial retear failed to affect the results significantly, but full thickness tear had an effect on them.

Functional outcome of arthroscopic rotator cuff repair

INTRODUCTION Functional outcome after rotator cuff reconstruction is influenced by several factors of which re-rupture is probably the most important. AIM The aim of the study was to evaluate the postoperative outcome including re-rupture rate after arthroscopic rotator cuff reconstruction. METHOD 23 shoulders of 22 patients were examined prospectively. Physical examination, ultrasound and radiography were performed. Quality of life and functional outcome were evaluated using Constant Score and Visual Analog Scale. RESULTS Excellent or good results were found in 80% of the patients. The Constant Score has increased from 45 to 79, and the level of pain decreased from 6.6 to 2.5. Full-thickness rotator cuff tear was absent, but partial tear occurred in 7 cases (30%). Average acromiohumeral distance in the operated side was 8.5 mm compared to 9.5 mm measured on the contralateral shoulder. CONCLUSIONS Arthroscopic rotator cuff repair is a safe and reliable procedure that provides good results.

Rhodococcus equi által okozott nagyízületi endoprotézis körül kialakult fertőzés

Rhodococcus equi is a rare pathogen in humans causing infections mostly in immunocompromised hosts. We present the first case of periprosthetic joint infection caused by Rhodococcus equi. An 88-year-old male patient was referred to our clinic with a history of fever and right hip pain. The patient had multiple hip surgeries including total joint arthroplasty and revision for aseptic loosening on the right side. He was immunocompetent, but his additional medical history was remarkable for diabetes mellitus, diabetic nephropathy and stroke with hemiplegia resulting in immobilization. Radiography showed stable components, joint aspirate yielded Rhodococcus equi. Irrigation and debridement was proposed, but the patient refused any surgical intervention. Therefore antibiotic therapy was administered. At the last follow-up the patient is free of complaints but the C-reactive protein level is still elevated. This case illustrates the possible role of Rhodococcus equi in medical device-associated infections. Orv Hetil. 2017; 158(27): 1071-1074.Absztrakt: A Rhodococcus equi ritka patogen, amely főkent gyengult immunrendszerű vagy immunszupprimalt betegekben okoz fertőzest. Esetbemutatasunkban Rhodococcus equi altal okozott nagyizuleti endoprotezis korul kialakult fertőzest mutatunk be, amelynek leirasara meg nem volt pelda a nemzetkozi irodalomban. A 88 eves ferfi beteget laz es jobb oldali csipőfajdalom miatt vettuk fel klinikankra. A beteg anamneziseben tobb, mindket oldalt erintő csipőműtet szerepelt, es a jobb oldalon aszeptikus lazulas miatt korabban revizios arthroplastica is tortent. Ismert betegsegei kozott szerepelt cukorbetegseg, diabeteses nephropathia, valamint korabbi stroke miatt bal oldali hemiplegia, azonban kifejezett immunszuppresszio nem. A kepalkoto vizsgalatok a jobb oldali csipőprotezis komponenseit stabilnak mutattak, az izuleti punkciobol pedig Rhodococcus equi tenyeszett ki. A betegnek azonnali feltarast es a protezis koruli terulet tisztitasat javasoltuk, amit visszautasitott. Konzervativ kezelest, parenteralis antibiot...

Szükség van szívódrénre elektív csípőprotézis-műtétek során?

Absztrakt Bevezetes: Az utobbi időben tobb tanulmany latott napvilagot, amelyek megkerdőjeleztek a szivodren hasznalatanak szuksegesseget elektiv csipőprotezis-beultetes soran. Celkitűzes: Prospektiv tanulmanyban azt vizsgaltak, hogy a perioperativ verveszteseget es a verzessel kapcsolatos szovődmenyeket a szivodren hasznalata hogyan befolyasolja. Modszer: 86, csipőprotezis-beultetesre erkező beteget ket csoportra osztottak. A „drencsoportban” (54 beteg) a műtetet kovetően szivodrent helyeztek be, mig a „dren nelkuli (kontroll)csoportban” (32 beteg) nem hasznaltak szivodrent. Perioperativ verveszteseget szamoltak es feljegyeztek a tranexamsav hasznalatat, a trombozisprofilaxis modjat, a transzfuzioigenyt, az esetlegesen kialakulo posztoperativ verzeseket, szeptikus komplikaciokat, illetve minden egyeb posztoperativ szovődmenyt. Eredmenyek: A perioperativ vervesztest a tranexamsav hasznalata igen, mig a drenhasznalat nem befolyasolta szignifikansan (p = 0,94). A dren nelkuli csoportban ugyanakkor tendencio...