Károly Pap

Open adductor tenotomy in the prevention of hip subluxation in cerebral palsy

We reviewed radiographs of 76 hips in 41 patients with cerebral palsy treated with open adductor tenotomy because of hip subluxation. The majority of patients suffered from spastic diplegia. The aim of our study was to evaluate the effect of adductor release on hip subluxation. We measured the centre-edge angle and migration percentage pre-operatively and 1 and 3 years post-operatively. We considered the results according to patients’ age at time of surgery (younger or older than 4 years of age) and ability to walk. Children younger than 4 years of age had better results than children older than 4 years of age. In children without walking ability, more than half of the hips had further radiological subluxation. In children with walking ability, we observed stabilisation or improvement of femoral-head subluxation in more than three quarters of the cases.RésuméNous avons examiné les radiographies de 76 hanches de 41 malades avec une paralysie cérébrale traitée par ténotomie à ciel ouvert des adducteurs en raison d’une subluxation de la hanche. La majorité des malades souffrait de diplégie spasmodique. Le but de notre étude était d’évaluer l’effet de la suppression des adducteurs sur la subluxation de la hanche. Nous avons mesuré l’angle de couverture externe et le pourcentage de migration avant l’intervention et à un an et trois ans post-opératoires. Nous avons considéré les résultats en fonction de l’âge des malades à la chirurgie (en dessous ou au-dessus de quatre années d’âge) et de la capacité de marche. Les enfants de moins de quatre ans avaient des meilleurs résultats que les enfants plus agés. Chez les enfants sans capacité de marche, plus de la moitié des hanches avait une plus grande subluxation radiologique. Chez les enfants avec capacité de marche, nous avons observé une stabilisation ou amélioration de la subluxation de la tête fémorale dans plus de trois quarts des cas.

The incidence of avascular necrosis of the healthy, contralateral femoral head at the end of the use of Pavlik harness in unilateral hip dysplasia.

We examined the incidence of avascular necrosis (AVN) of the healthy femoral head in unilateral hip dysplasia at the end of the use of the Pavlik harness. The evaluation of AVN was done with the help of standardised roentgenograms. Between 1974 and 1982, 1,064 dysplastic hips (869 children) were treated with the Pavlik harness at the Orthopaedic Department of Semmelweis University. Of these, 674 children who had unilateral hip dysplasia were chosen for this study. In the period of our investigation, ultrasonography was not yet used routinely, so in some cases the hip was mistakenly diagnosed as dysplastic. The average patient age was 3.2 months, and the average length of treatment was 4.9 months. We found no correlation between the appearance of AVN in the healthy hips at the end of treatment with the Pavlik harness and the age of the child at the start of treatment. On the other hand, there was a strong significant correlation between the appearance of AVN and the length of treatment.

Osteochondritis (Calvé’s disease) of a vertebral body—a rare form of vertebra plana

In 1925, Calvé described vertebra plana as an aseptic necrosis of bone involving a single vertebral body of the spinal column. This theory was set aside in 1954 by Compere, who concluded that vertebra plana is caused by eosinophilic granuloma and not by osteochondritis as suggested by Calvé. It has been well documented in literature that many factors other than eosinophilic granuloma can cause vertebra plana-like destruction of the vertebral body. However, the definition of the terms was not clear, and there was no consensus on whether to call these cases vertebra plana or not. Some authors did, some did not. Anyhow, no publication so far has reported on osteochondritis as a rare cause of vertebra plana. The case of a 12-year-old girl, presented here by the authors, suggests this explanation. Some important conclusions can be drawn from this regarding the nomenclature, the diagnosis, and the therapy.

Mosaicplasty of Osteochondral Lesions of the Ankle

The presence of cartilaginous bodies in the ankle joint was first reported by Monro in 1856 [1]. Term and nature of osteochondritis dissecans (OCD) were described in classic reports of Konig and Rendu [2, 3]. Davidson et al., Flick and Gould and Nash and Baker have all discussed the late finding of OCD lesions after an initially diagnosed “sprained ankle” [4–6]. Canale and Bending further emphasised trauma as a causative factor [7]. Lateral lesions cause more symptoms than medial OCDs. Also, lateral lesions have a higher incidence of a previous traumatic event. The head of the talus represents a less frequent location of talar OCD lesions, although recently, this location has also been described [8].

Glial cell type-specific changes in spinal dipeptidyl peptidase 4 expression and effects of its inhibitors in inflammatory and neuropatic pain

Altered pain sensations such as hyperalgesia and allodynia are characteristic features of various pain states, and remain difficult to treat. We have shown previously that spinal application of dipeptidyl peptidase 4 (DPP4) inhibitors induces strong antihyperalgesic effect during inflammatory pain. In this study we observed low level of DPP4 mRNA in the rat spinal dorsal horn in physiological conditions, which did not change significantly either in carrageenan-induced inflammatory or partial nerve ligation-generated neuropathic states. In naïve animals, microglia and astrocytes expressed DPP4 protein with one and two orders of magnitude higher than neurons, respectively. DPP4 significantly increased in astrocytes during inflammation and in microglia in neuropathy. Intrathecal application of two DPP4 inhibitors tripeptide isoleucin-prolin-isoleucin (IPI) and the antidiabetic drug vildagliptin resulted in robust opioid-dependent antihyperalgesic effect during inflammation, and milder but significant opioid-independent antihyperalgesic action in the neuropathic model. The opioid-mediated antihyperalgesic effect of IPI was exclusively related to mu-opioid receptors, while vildagliptin affected mainly delta-receptor activity, although mu- and kappa-receptors were also involved. None of the inhibitors influenced allodynia. Our results suggest pathology and glia-type specific changes of DPP4 activity in the spinal cord, which contribute to the development and maintenance of hyperalgesia and interact with endogenous opioid systems.

Evaluation of clinical outcomes of cemented vs uncemented knee prostheses covered with titanium plasma spray and hydroxyapatite: A minimum two years follow-up

OBJECTIVES In this study, we introduce the SanatSwing cementless total knee prosthesis coated with a combination of titanium plasma spray and hydroxyapatite porous coating and compared its early results to the SanatSwing cemented knee prosthesis. PATIENTS AND METHODS We compared 278 patients, who underwent total knee replacement between September 2012 and February 2017. A total of 142 patients (Group A; 78 male, 64 female, mean age 69±14) were implanted a cemented SanatSwing and 136 patients (Group B; 83 male, 53 female, mean age 59±10), a cementless SanatSwing knee prosthesis was implanted. Implant position and periprosthetic bone conditions were investigated over time on radiographs after a mean follow-up period of two years. Range of motion, pain level, distance of painless walk, and the ability to climb stairs were evaluated. RESULTS Significant improvement was observed in both the cemented and uncemented groups when the preoperative scores were compared to the scores of their final visit, but we did not find any difference in measured scores between the cemented and uncemented group. Complication rates were low and almost similar in both groups without any significant difference. CONCLUSION We used the combination of titanium plasma spray and the hydroxyapatite porous coating technique in cementless prostheses. Our results showed us that the novel SanatSwing cementless total knee prosthesis could be a great alternative to cemented total knee arthroplasty.

[The use of structural proximal tibial allografts coated with human albumin in treating extensive periprosthetic knee-joint bone deficiency and averting late complications. Case report].

The authors report the history of a 74-year-old patient who underwent surgical treatment for segmental knee-joint periprosthetic bone loss using structural proximal tibial allografts coated with serum albumin. Successful treatment of late complications which occurred in the postoperative period is also described. The authors emphasize that bone replacement with allografts is a physiological process that enables the stable positioning of the implant and the reconstruction of the soft tissues, the replacement of extensive bone loss, and also it is a less expensive operation. It has been already confirmed that treatment of lyophilised allografts with albumin improves the ability of bone marrow-derived mesenchymal stem cells to adhere and proliferate the surface of the allografts, penetrate the pores and reach deeper layers of the graft. Earlier studies have shown osteoblast activity on the surface and interior of the graft.A szerzők 74 eves beteg kortortenetet ismertetik, akinel kiterjedt szegmentalis terdizuleti periprotetikus csontvesztes műteti kezelese soran strukturalis proximalis tibialis allograftot alkalmaztak es beszamolnak a műtet utan kialakult kesői szovődmeny ellatasarol. Kiemelik, hogy az allograftokkal tortenő csontpotlas fiziologias eljaras, amely lehetőseget ad stabil implantatum rogzitesere, lagyresz-rekonstrukciora, kiterjedt csontvesztes potlasara, es a beavatkozas koltsege is kevesebb. A liofilizalt allograft albuminnal tortenő kezelese bizonyitottan javitja azt a kepesseget, hogy a csontvelő-eredetű mesenchymalis őssejtek az allograft felszinen megtapadjanak, azon proliferaljanak, valamint annak porusaiba is beterjedjenek es ezaltal a graft melyebb retegeibe is eljussanak. Kimutathato osteoblast tevekenyseg alakult ki a graft felszinen es a belsejeben is. Orv. Hetil., 2015, 156(2), 67–70.

Humán albuminnal kezelt strukturális proximalis tibialis allograft alkalmazása kiterjedt térdízületi periprotetikus csonthiány esetén és a késoi szövodmény elhárítása

The authors report the history of a 74-year-old patient who underwent surgical treatment for segmental knee-joint periprosthetic bone loss using structural proximal tibial allografts coated with serum albumin. Successful treatment of late complications which occurred in the postoperative period is also described. The authors emphasize that bone replacement with allografts is a physiological process that enables the stable positioning of the implant and the reconstruction of the soft tissues, the replacement of extensive bone loss, and also it is a less expensive operation. It has been already confirmed that treatment of lyophilised allografts with albumin improves the ability of bone marrow-derived mesenchymal stem cells to adhere and proliferate the surface of the allografts, penetrate the pores and reach deeper layers of the graft. Earlier studies have shown osteoblast activity on the surface and interior of the graft.A szerzők 74 eves beteg kortortenetet ismertetik, akinel kiterjedt szegmentalis terdizuleti periprotetikus csontvesztes műteti kezelese soran strukturalis proximalis tibialis allograftot alkalmaztak es beszamolnak a műtet utan kialakult kesői szovődmeny ellatasarol. Kiemelik, hogy az allograftokkal tortenő csontpotlas fiziologias eljaras, amely lehetőseget ad stabil implantatum rogzitesere, lagyresz-rekonstrukciora, kiterjedt csontvesztes potlasara, es a beavatkozas koltsege is kevesebb. A liofilizalt allograft albuminnal tortenő kezelese bizonyitottan javitja azt a kepesseget, hogy a csontvelő-eredetű mesenchymalis őssejtek az allograft felszinen megtapadjanak, azon proliferaljanak, valamint annak porusaiba is beterjedjenek es ezaltal a graft melyebb retegeibe is eljussanak. Kimutathato osteoblast tevekenyseg alakult ki a graft felszinen es a belsejeben is. Orv. Hetil., 2015, 156(2), 67–70.

Humán albuminnal kezelt strukturális proximalis tibialis allograft alkalmazása kiterjedt térdízületi periprotetikus csonthiány esetén és a késői szövődmény elhárítása@@@The use of structural proximal tibial allografts coated with human albumin in treating extensive periprosthetic knee-joint bone deficiency and averting late complications. Case report

The authors report the history of a 74-year-old patient who underwent surgical treatment for segmental knee-joint periprosthetic bone loss using structural proximal tibial allografts coated with serum albumin. Successful treatment of late complications which occurred in the postoperative period is also described. The authors emphasize that bone replacement with allografts is a physiological process that enables the stable positioning of the implant and the reconstruction of the soft tissues, the replacement of extensive bone loss, and also it is a less expensive operation. It has been already confirmed that treatment of lyophilised allografts with albumin improves the ability of bone marrow-derived mesenchymal stem cells to adhere and proliferate the surface of the allografts, penetrate the pores and reach deeper layers of the graft. Earlier studies have shown osteoblast activity on the surface and interior of the graft.A szerzők 74 eves beteg kortortenetet ismertetik, akinel kiterjedt szegmentalis terdizuleti periprotetikus csontvesztes műteti kezelese soran strukturalis proximalis tibialis allograftot alkalmaztak es beszamolnak a műtet utan kialakult kesői szovődmeny ellatasarol. Kiemelik, hogy az allograftokkal tortenő csontpotlas fiziologias eljaras, amely lehetőseget ad stabil implantatum rogzitesere, lagyresz-rekonstrukciora, kiterjedt csontvesztes potlasara, es a beavatkozas koltsege is kevesebb. A liofilizalt allograft albuminnal tortenő kezelese bizonyitottan javitja azt a kepesseget, hogy a csontvelő-eredetű mesenchymalis őssejtek az allograft felszinen megtapadjanak, azon proliferaljanak, valamint annak porusaiba is beterjedjenek es ezaltal a graft melyebb retegeibe is eljussanak. Kimutathato osteoblast tevekenyseg alakult ki a graft felszinen es a belsejeben is. Orv. Hetil., 2015, 156(2), 67–70.

A rabbit model for studying degeneration and regeneration properties of young striated muscle at different distraction rates

The present study evaluated the histological changes in the muscle tissue after limb lengthening in skeletally immature rabbits and assessed the effect of different lengthening rates on the regeneration and degeneration properties of striated muscle. Thirteen different lengthening protocols were applied on a total of 16 male domestic white rabbits divided into four groups. The histopathological changes were analysed by a semiquantitative method according to the scoring system of Lee et al. (1993). After evaluation of the five main degenerative parameters (muscle atrophy, internalisation of muscle nuclei, degeneration of the muscle fibre, perimysial and endomysial fibrosis, haematomas), it is evident that rabbits subjected to limb lengthening at a rate of 3.2 mm/day showed more degenerative changes than those limb-lengthened at 0.8 or 1.6 mm/day. Our study showed that the regenerative mechanisms were not endless. If the daily lengthening rate reached the 3.2 mm/day limit, the regenerating ability of the muscle decreased, and signs of degeneration increased significantly.