István Gergely

Femoral Rotation in Ligament Balanced Knee Arthroplasty: A Prospective Clinical Study

Rotational alignment of the femoral component is an important factor to achieve beneficial results in total knee arthroplasty. Femoral rotation pre versus post surgery was prospectively assessed in 40 patients who underwent ligament balanced knee arthroplasty. Computerized tomography of the knee was performed before and after the surgery to determine the femoral rotation. In 36 out of 40 patients the rotation of the femoral implants differed compared to the preoperative femur (P > 0.001). After surgery the rotational alignment of the femoral component ranged from -3° (internal rotation) to 7° (external rotation). Increased external rotation was found in 33 out of 40 patients ranging from 1° to 7°. These results highlight the importance of individually determined femoral rotation in ligament balanced knee arthroplasty.

Human vomeronasal epithelium development: An immunohistochemical overview.

The vomeronasal organ (VNO) is the receptor structure of the vomeronasal system (VNS) in vertebrates. It is found bilaterally in the submucosa of the inferior part of the nasal septum. There are ongoing controversies regarding the functionality of this organ in humans. In this study we propose the immunohistochemical evaluation of changes in components of the human vomeronasal epithelium during foetal development. We used 45 foetuses of different age, which were included in three age groups. After VNO identification immunohistochemical reactions were performed using primary antibodies against the following: neuron specific enolase, calretinin, neurofilament, chromogranin, synaptophysin, cytokeratin 7, pan-cytokeratin and S100 protein. Digital slides were obtained and following colorimetric segmentation, surface area measurements were performed. The VNO was found in less than half of the studied specimens (42.2%). Neuron specific enolase and calretinin immunoexpression showed a decreasing trend with foetal age, while the other neural/neuroendocrine markers were negative in all specimens. Cytokeratin 7 expression increased with age, while Pan-Ctk had no significant variations. S100 protein immunoexpression also decreased around the VNO. The results of the present work uphold the theory of regression of the neuroepithelium that is present during initial stages of foetal development.

The Value of Perioperative ECG Recordings in the Cardiovascular Monitoring and Risk Assessment of Asymptomatic Patients with Total Hip Arthroplasty

Abstract Aim: To evaluate the value of a more closed perioperative ECG follow-up in the investigation and forecasting of cardiovascular events during and after hospital admission. Methods: We included in the study 30 asymptomatic patients from cardiac point of view (14 women, 16 men, mean age 63 years), who underwent total hip arthroplasty. ECGs were performed on the day before surgery, on the day of surgery, after the intervention, and on the 3rd day. We looked for the correlations between ECG changes and clinical events. Results: The commonest postoperative new ECG changes were QTc prolongation (14 patients -46,6%) and sinus tachycardia (8 patients - 26,6%). There were no major cardiac events during hospitalization, and we found possible correlations in two cases between perioperative ST-T changes and postdischarge clinical events: one exitus and one case of ischemic heart disease. Conclusions: Our data do not support the efficacy of a more closed, routine ECG follow-up in the studied, low risk patient population, but new perioperative ST-T changes always have to be taken into account.

Traumás asphyxia maradandó látásvesztéssel

Absztrakt: A traumas asphyxia egy olyan ritka allapot, amely kompresszios mellkasi-hasi trauma utan kovetkezik be. Cervicofacialis cyanosissal, oedemaval, petechiakkal es kotőhartya-beverzessel jelentkezik. Sulyos, eletveszelyes mellkasi es hasi serulesekkel is tarsulhat. Az esetek tobbsegeben konzervativ kezelest kovetően a felepules teljes, de ritkan maradando idegrendszeri elvaltozasok lephetnek fel. Egy 39 eves ferfi beteg esetet mutatjuk be, aki kompresszios mellkasi-hasi serulest szenvedett. A traumat kovetően a jellegzetes „ecchymosisos maszk” alakult ki. A hasi serulesek sebeszi ellatasa es az intenziv terapia utan a beteg maradando latasvesztessel hagyta el a korhazat. A fej-nyak szintjen kialakulo retrograd venas nyomas novekedese idegsejt-ischaemiaval tarsulhat, amely maradando latoideg-sorvadast idezhet elő. Ezert fontos, a szupportiv terapia mellett, a rutinszerű, korai es teljes szemeszeti vizsgalat, kulonosen az intubalt, illetve nehezen kooperalo betegeknel. Orv Hetil. 2017; 158(22): 864–868.

Clinico-radiological diagnosis and grading of rapidly progressive osteoarthritis of the hip.

Abstract Due to the current lack of standard definitions for rapidly progressive osteoarthritis of the hip (RPOH) in the literature, this observational study aimed to describe new diagnostic criteria and a grading system for the disease. From a consecutive series of patients undergoing total hip replacement, 2 groups were selected: 1 with RPOH and 1 with primary hip osteoarthritis (POH), and their clinical, paraclinical, and demographic data were compared. The newly proposed clinico-radiological diagnostic criteria are based on characteristics of pain, joint mobility, and radiological assessment. The radiological grading systems inter- and intraobserver reliability was assessed through serial evaluations by 2 blinded reviewers. From the total 863 cases, 82 cases (9.5%) of RPOH were identified and compared with 107 cases of POH. Mean age and disease bilaterality were similar, with a predominance of female patients in the RPOH group (P = 0.03). There were significant differences between the 2 groups in disease onset and aggravation, and intraoperative blood loss. The grading system showed significant inter- and intraobserver agreement (weighted kappa 0.93, and 0.89). Our study presents distinctive, easily recognizable clinico-radiological characteristics of RPOH and confirmed the inter- and intraobserver reliability of the newly proposed grading system.

Will Total Knee Replacement Ever Provide Normal Knee Function

Abstract Knee osteoarthritis or gonarthrosis is considered the most common joint disease, affecting more than 70% of subjects aged over 65 years. Its occurrence is increasing with age and is more problematic with the current rise in the incidence of obesity. In severe and advanced cases, total knee arthroplasty is recommended as a gold standard therapy for pain relief, restoration of normal knee function, and quality of life improvement. There are numerous controversies whether total knee arthroplasty is able to reach and provide end-point outcomes and restore previous function of the knee joint. Studies suggest that the surgeons’ experience, type of prosthesis used, associated pathology, underlying pathologies, risk factors, continuous passive movement, and patient expectations about the surgery may influence the outcomes to a great extent. “Normal knee function” is a statement that is hardly defined in the current literature, as authors usually refer to subjective results when analyzing outcomes. Objective results may be more straightforward, but they do not always symbolize the actual state that the patient is reporting or the actual quality of life. Our objective was to analyze and present summaries of the current literature regarding normal knee function restoration after total knee replacement surgery. Our literature review results confirm the hypothesis that subjective and objective results are difficult to interpret and unravel. Complex future trials may bring supplementary and clearer conclusions regarding knee function and kinematics, clinical improvement, patient satisfaction, and quality of life.

Anatomic All-Inside Anterior Cruciate Ligament Reconstruction Using the TransLateral Technique

Abstract Background: Anterior cruciate ligament (ACL) reconstruction is a commonly performed procedure and considered to be the gold standard in restoring knee function and stability in ACL-deficient knees. The TransLateral all-inside technique implies the use of only two portals – anterolateral and anteromedial, without the use of an accessory portal. The work is done using the lateral portal, while the medial portal serves as a viewing site. Only a few studies have been published regarding the assessment of the functional and clinical outcomes of this novel technique. Aim of the study: To determine the clinical effectiveness of the TransLateral procedure used for ACL reconstruction and its ability to re-establish joint functionality and stability in ACL-deficient knees. Material and methods: A prospective study was conducted at the Orthopedics and Traumatology Clinic no. 2 in Tîrgu Mureș. Thirty-two patients matched our inclusion criteria and were operated using the TransLateral technique for ACL reconstruction. Outcome assessment was performed using the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lysholm score and the Tegner Activity Scale. The questionnaires include items referring to pain, physical functioning, sports activities, and quality of life. Operative time and ACL graft size were also documented. Results: All patients underwent single-bundle ACL restoration using a quadrupled semitendinosus tendon. Out of 32 patients, 21 had associated meniscus lesions and 8 collateral ligament injuries. Mean graft diameter was 8.7 mm and mean length 63.2 mm. Significantly improved KOOS values were found at 12 months post-surgery regarding the mean baseline score: 59.3 ± 5.3 vs. 95.3 ± 4.9, p <0.0001. The Lysholm score improved from a mean of 56.3 ± 4.9 to 93.9 ± 5.6, p <0.0001 at the end-point. The Tegner activity scale ranged from 3.8 ± 1.9 to 5.9 ± 2.4, p <0.0001 at the final follow-up. Conclusions: The TransLateral technique proved its clinical effectiveness and its ability to restore knee stability after ACL reconstruction surgery.

Prevention of Primary ACL Injuries: A Novel, Innovative Approach

Abstract Anterior cruciate ligament (ACL) injuries are increasing amongst professional and recreational athletes, and creating prevention programs to reduce the occurrence of ACL damages is becoming a necessity. To prevent an ACL tear, it is necessary to comprehend the mechanisms and the risk factors of injury. Biomechanical and clinical studies try to understand these complex mechanisms in order to identify factors that can be improved and to develop training programs to prevent at least non-contact ACL injuries. There are several promising programs, but there are still many questions to answer. This paper analyzes the risk factors for ACL injuries and some aspects of the modern programs developed to decrease the rate of ACL tears.

Reduced Analgesics Consumption and Pain Intensity after Injections with a New Hyaluronic Acid in Patients with Knee Osteoarthritis

Abstract Objective: To determine the influence of a new intraarticular hyaluronic acid based hydrogel (Hymovis®) injections on the amount of analgesics consumption in patients diagnosed with primary knee OA. Methods: A prospective, single-center study that included 35 patients, aged 45-80 years was conducted in our orthopaedics department. Patients received two intra-articular injections of hyaluronic acid (24 mg/3 ml; 500–730 kDa; Hymovis®) at one week apart. Follow-up was scheduled at 2 and 6 months after the injections. Assessment tools included Visual Analogue Scale (VAS) and an in-house designed questionnaire regarding analgesic consumption (quantity, period and product) during the follow-up. Results: Compared to baseline, a significant amelioration in visual analogue scale was observed at six months’ follow-up (74.2mm ± 11.7 vs. 57.3mm ± 12.1; p <.0001). 28% (n=10) of the patients reduced their total analgesic consumption at two months after the injections. At final follow-up, the analgesic intake was reduced by more than 50% in almost every case. Conclusions: Intraarticular administered injections with a novel hyaluronan-based hydrogel (Hymovis®) may reduce the amount of analgesic consumption and self-reported pain intensity in patients with knee OA.

Changes in Knee Joint Space Width in Treatment with a New Hyaluronic-Based Hydrogel

Abstract Objective: Our purpose was to assess the effect of a new hyaluronic acid-based (Hymovis®) injections on joint space width narrowing in patients diagnosed with knee osteoarthritis. Methods: A prospective clinical trial was conducted in the Department of Orthopedics and Traumatology II from the Clinical County Hospital, Tîrgu Mureș, Romania. Thirty-five patients diagnosed with idiopathic knee osteoarthritis received two intraarticular injections with hyaluronic acid-based hydrogel (24 mg of hyaluronic acid/3 ml) at one-week interval. Anteroposterior radiographs were obtained before the injections, at six and twelve months after. Minimum joint space width was measured by two senior orthopaedics surgeons at each follow up. Each radiograph was measured again by the same evaluators two weeks apart. Results: Thirty-one patients were present at the final follow-up. A minor reduction in mean weight was noticed (from 82.2 kg ± 16.2 kg to 80.9 kg ± 16.0, p > 0.398) without any correlation with joint space width narrowing. There were no major changes at the first follow up (6 months) regarding joint space narrowing. A reduction in joint space width was observed however at 12 months varying from 4.4 mm (SD ± 1.64, range 1.8-7.1) at the first assessment to 4.3 mm (SD ± 1.26, range 0.0-6.8) at the final follow-up but with no statistical difference (p=0.237). Conclusion: No significant modification in joint space width at the final follow-up secondarily proved that two injections of Hymovis® may slow down narrowing in the knee joint space over a one-year period.