Marta Tarczyńska

Fixation of femoral head fractures with autologous osteochondral transfer (mosaicplasty).

Summary: Posterior fracture dislocation of the femoral head is a rare entity usually requiring open reduction and internal fixation. Results of different fixation methods have been reported, including countersinking screws, headless screws, and bioabsorbable implants. Osteochondral autologous transfer (mosaicplasty) is an established method of treatment of full thickness cartilage defects of the knee, ankle, and elbow. At our institution, posterior fracture-dislocations of the femoral head were treated with femoral head fragment fixation using osteochondral autografts through surgical hip dislocation. Osteochondral plugs were harvested from the non-weight–bearing area of the lateral femoral condyle of the knee and used for fixation of the reduced fragment. This article details the technique and its application.

Comparação dos resultados do tratamento de lesões agudas e tardias da articulação de Lisfranc

Objective A retrospective comparison of treatment difficulties and treatment outcomes in Lisfranc joint injuries with late and early diagnosis. Methods The study group consisted of 10 patients diagnosed and treated properly within six months to 20 years of the accident causing the injury (mean six years). The control group consisted of the same number of randomly selected patients with a similar type of injury treated immediately after the accident. Mean follow-up was 13 years in the study group and eight years in the control group. The analysis evaluated the causes of the delay and the foot function at the time of follow up, measured using the AOFAS Midfoot Scale and the Lublin Foot Functional Score. The scores of the patients were analyzed using the non-parametric Mann-Whitney U test and the non-parametric Wilcoxon test. Results The control group had statistically significantly better scores on both scales. Conclusion The main cause of treatment delay was misdiagnosis by the primary care physician. Level of Evidence III, Retrospective Comparative Study.

The use of osteochondral allograft with bone marrow-derived mesenchymal cells and hinge joint distraction in the treatment of post-collapse stage of osteonecrosis of the femoral head.

Osteonecrosis of the femoral head is an entity which occurs mainly in young and active patients aged between 20 and 50. The success of hip joint preserving treatments ranges from 15% to 50% depending on the stage and amount of osteonecrotic lesion. Total hip replacement is indicated in late post-collapse hips but it has unsatisfactory survival because of the wear and osteolysis in young and active patients. Osteochondral allografts have been reported in the treatment of large articular lesions with defects in underlying bone in knee, talus and shoulder. By combining osteoconductive properties of osteochondral allograft with osteogenic abilities of bone marrow-derived mesenchymal cells it has a potential to be an alternative to an autologous graft. The adjunct of hinged joint distraction should minimize stresses in subchondral bone to promote creeping substitution and prevent femoral head collapse. Unlike current treatment modalities, it would provide both structural support and allow bony and articular substitution.

A seven- to 14-year follow-up study of bipolar hip arthroplasty in the treatment of osteonecrosis of the femoral head.

Introduction Bipolar hip arthroplasty (BHA) in the treatment of Ficat stage III osteonecrosis of the femoral head (ONFH) has theoretical advantages over total hip replacement (THR) in that it preserves the natural acetabulum and uses an implant that allows better stability and larger range of movement. The purpose of this study was to evaluate the clinical and radiological outcomes of BHA with uncemented ingrowth stems in the treatment of ONFH. Material and methods Thirty-nine hips in 34 patients (two women and 32 men) with a mean age at the time of surgery of 45.31 years (range 30–66 years) operated between 1998 and 2005 were examined in a retrospective evaluation. Mean follow-up was 9.5 years (range 3–14 years). Patients were evaluated with the Harris hip score (HHS). Kaplan-Meier survivorship was calculated to examine the revision rate. Radiographic analysis included evaluation of bipolar head migration, radiolucent lines around the stem and osteolysis in the acetabulum and the femur. Results Evaluation of clinical results revealed an increase in HHS from 28 points preoperatively to 88.6 points at the most recent follow-up. Radiographic evaluation showed bipolar head migration in 3 hips (7.7%). Survival rate of BHA, with revision THR defined as the endpoint, was 92.31% at ten years (CI 95%). All implanted uncemented stems were stable without any radiographic signs of loosening or osteolysis. Conclusions The results of the present study show that implantation of BHA with uncemented ingrowth stem in Ficat stage III is still justified.

Response to comment on Gagala et al.: Clinical and radiological outcomes of treatment of avascular necrosis of the femoral head using autologous osteochondral transfer (mosaicplasty). Preliminary report

Dear Dr. Siddhartha Sharma, Thank you very much in your interest in our article [1]. We would like to answer your questions point by point as below. The OATS/allograft was performed as a salvage procedure in patients with ARCO III and IV who refused total hip replacement and asked for a joint preserving operation. The use of OATS in osteonecrosis of the femoral head (ONFH) was approved by the local ethical committee. A written consent was obtained from every single patient. MRI is a better tool to observe ONFH progression and graft incorporation than X-rays, but unfortunately the Polish National Health Fund covers the cost of MRI examination performed as a diagnostic but not as a scientific method. Follow-up examinations from recently published papers presenting novel ONFH treatment also use only X-ray results [2]. The exact location of drill bits for OATS was planned upon preoperative MRI examination. We did not have any problems either in necrotic segment identification during the procedure or in inspection of complete removal. Bone defects were packed with morsellised allogenic bone; no osteochondrall allografts were implanted in the OATS/allograft group. The indication for subtrochanteric osteotomy in one case was excessive femoral neck anteversion. Up to 2013, seven papers, mainly case reports and case series, were published presenting outcomes of 31 hips in which OATS had been performed for different indications [3–9]. The aim of our preliminary report was to present the outcomes of OATS in 21 patients with ONFH and to share with the orthopaedic community our experiences of this novel technique. As mentioned above our paper is a preliminary report so we think there is no need for a control group to confirm our conclusions.

Mosaicplasty for the treatment of osteochondritis dissecans following Legg-Calvé-Perthes disease: a case report and literature review

Legg-Calvé-Perthes disease leads to hip joint deformity. Osteochondritis dissecans following Perthes disease (OCDP) is a less common entity. Treatment options of OCDP are limited. Osteochondral autologous transfer (OATS) is an established method of treatment of full thickness cartilage defects in different locations. This paper presents the case of a 42-year-old patient diagnosed with symptomatic OCDP and treated with lesion fixation using autologous osteochondral grafts via surgical hip dislocation. At the most recent follow-up, 5.5 years after the surgery, the patient did not complain of any pain during rest or activity. He had painless motion with persisting abduction and internal rotation reduction. Harris hip score (HHS) improved from preoperative 62 to 92 points at most recent follow-up. Treatment protocol was discussed in relation to the literature regarding this clinical topic.

PRP in the Ambulatory Therapy of Tendinopathy of the Elbow, Knee and Foot

The majority of orthopaedic problems, which up to now were treated with autogenous growth factors are able to function in life and do not require hospitalization. From our ambulatory experience we regularly deal with patients who are occupationally active. Due to chronic ailments of a tendinopathy or enthesopathy nature in various locations they have rejected rare proposals of surgical treatment as being too risky, excluding them from the previous activity for a long time. These requirements caused us to introduce therapy with platelet-rich plasma in ambulatory settings. We have chosen the Curasan PRP kit, which fully meets the requirements for use, outside of a hospital. In this way there were treated 34 patients with tennis elbow, 32 persons with golfer’s elbow, 17 with jumper’s knee and 29 with Achilles noninsertional tendinopathy. Ambulatory treatment of tendinopathy of the elbow, patellar ligaments and Achilles tendons by injections with L-PRP is an effective method of treatment. It provides a solid improvement and, despite requiring double injections for advanced form of changes, it is not expensive. The procedure can be performed in ambulatory setting by two physicians, of which one has extensive experience in ultrasound evaluation of motor organs.

Noninsertional Achilles Tendinopathy - Treatment with Platelet Rich Plasma (PRP)

According to Schepsis this was an incorrect approach, resulting from insufficient knowledge and understanding of the variable nature of pathological lesions in the course of these processes (5). Clinical, imaging or histological features of inflammation were rarely observed (6,7). These were only seen in the peritendineum (7). They were often symptomless, did not cause any complaints and were only found by accident (5). However, considering the results of other studies, lesions in the Achilles tendon were found to involve neurogenic inflammation (8,9).