Péter Than

Comparative study of autograft or allograft in primary anterior cruciate ligament reconstruction

Between December 1996 and December 2002, we treated 79 patients with arthroscopy-assisted anterior cruciate ligament (ACL) reconstructions. In 53 patients we used autografts and in 26 patients allografts. Patients were followed up for 38 (12–72) months. The two groups did not differ in preoperative sport activity level. The postoperative Lysholm score was 89.9±8.1 in the autograft group and 84.1±18.6 in the allograft group. Comparing the patients’ Lysholm score according to whether they had a low (1–5) or a high (6–10) postoperative Tegner score, we found no statistically significant difference between the groups. On one occasion, the allograft ruptured during the implantation procedure just prior to the fixation. Postoperatively, we performed three revisions—two in the allograft group and one in the autograft group—and three second-look arthroscopies. There were no bacterial infections and no cases of viral transmission. No immune rejection, resorption, or immunsynovitis occurred during the follow-up.RésuméEntre décembre 1996 et décembre 2002 nous avons traité 79 malades par reconstruction du LCA sous arthroscopie. Chez 53 malades nous avons utilisé une autogreffe et, pour 26, une allogreffe. Les malades ont été suivis 38 mois (12–72). Les deux groupes n’étaient pas différents dans le niveau de l’activité sportive préopératoire. Le score Lysholm postopératoire était de 89,9±8,1 dans le groupe autogreffe et de 84,1±18,6 dans le groupe allogreffe. En comparant le score Lysholm des malades selon qu’ils avaient un score postopératoire de Tegner haut(6–10) ou bas (1–5), nous n’avons pas trouvé de différence significative entre les deux groupes. Dans un cas l’allogreffe s’est rompue pendant la procédure d’implantation, juste avant la fixation. Après l’intervention nous avons fait trois révisions, deux dans le groupe allogreffe et un dans le groupe autogreffe, et trois arthroscopies de seconde vision. Il n’y avait pas d’infection bactérienne, aucuns cas de transmission virale. Aucun rejet immunitaire, résorption ou synovite immune ne se sont produits pendant le suivi.

Geometrical values of the normal and arthritic hip and knee detected with the EOS imaging system

PurposeEOS 2D/3D is an integrated, low-dose orthopedic digital radioimaging solution, which, due to its groundbreaking properties, has recently shown an increasing application in scoliosis surgery. Its integrated sterEOS 3D software allows creation of patient-specific three-dimensional (3D) lower limb models, and can produce geometrical parameters in 3D. Currently there are a limited number of reports on EOS for lower limb applications.MethodsThree-dimensional reconstructions of 256 hip and knee joints of 128 healthy subjects, as well as 53 hips and 46 knees of 69 patients with hip or knee arthritis, were evaluated based on orthogonal EOS two-dimensional (2D) images. Measurements for hips included femur and tibia length, total length of the extremity, femoral antetorsion and offset, femoral neck length, neck-shaft and hip-knee-shaft (HKS) angles. Lower limb alignment in both frontal and sagittal planes were determined in normal and arthritic knees. Values were compared with those obtained by standard methods published by others.ResultsNormal hip and knee geometrical parameters were found in our healthy subjects. In osteoarthritic cases, values for neck-shaft angle, femoral antetorsion, femur length and total length of the extremity were shown to decrease non-significantly. Evaluation of lower limb alignment in healthy and arthritic knees showed normal values in healthy subjects apart from three cases with an average six degrees varus. Arthritic knees were most frequently found to have a varus angulation, with the exception of 11 cases with normal or valgus alignment.ConclusionEOS 2D/3D with its sterEOS 3D reconstruction is useful for a comprehensive 3D examination of the lower limb. In the near future it may be suitable for daily routine diagnostics of orthopedic lower limb deformities as a primary examination method.

Prevalence of low back pain and lumbar spine degenerative disorders. Questionnaire survey and clinical–radiological analysis of a representative Hungarian population

A cross-sectional epidemiological study via personal interviews was performed regarding low back pain and its related clinical aspects in a Hungarian sample of 10,000 people. Joining the international campaign of the “Bone and Joint Decade”, our aim was to give data on low back pain prevalence and to explore the underlying possible clinical conditions in a Central European adult and adolescent population. Ten thousand people aged 14–65, selected randomly by the Hungarian central office of statistics from three counties of the south-western Hungarian region, were surveyed using a special questionnaire focusing on low back pain and other degenerative spinal symptoms. People with low back pain complaints and written consent were asked to participate in a further clinical investigation, where radiological and clinical assessment was performed. A total of 4,389 persons (44.1%) reported low back pain in the last month at the time of the survey. Work absenteeism due to low back pain affected 2,140 persons (21.5%). A total of 292 people (2.9%) had already undergone spinal surgery. Upon request 682 people came for a clinical follow-up, where thorough physical examination and radiological analysis was performed and results were statistically interpreted. The Oswestry disability index (ODI) in the examined group of patients averaged 35.1%; radiological degenerative signs were observed in 392/682 (57.5%). Individuals with signs of radiological degeneration had a statistically significant higher ODI value, age, and a higher, yet not significantly increased BMI value than radiographically negative patients (p < 0.05). Co-existence of hip and knee osteoarthritis was also investigated. Higher osteoarthritis prevalence was found in individuals with radiographic signs of spinal degeneration. Details of the survey and clinical investigations are discussed.

Long-Term Results of the Operative Treatment of Clubfoot: A Representative Study

This study reports the long-term results of operative treatment of clubfoot. Of the patients who underwent posteromedial release for congenital clubfoot between 1972 and 1975 at the Medical University in Pécs, Hungary, 41 feet of 30 patients have been under control examination. Control consisted of the distribution of questionnaires, physical examination, and in some cases, radiologic analysis. At an average of 20 years postsurgery, good clinical results were observed in 31 (75%) feet. In these patients, satisfying foot form and good function were achieved, yet the characteristic atrophy of the calf and shortening of the foot were visible. Abnormal conditions were found in 10 feet, consisting of overcorrection in 6 and undercorrection in 4 cases. Subjective judgment of the patients was considerably better; only 5 (12%) feet had no satisfying results. Data of feet in an incorrect position were analyzed and compared with other cases. In cases of feet operated on in patients aged > or = 1 year and in patients who underwent multiple operations, abnormalities were found in a significantly higher percentage.

Prevalence of radiographic primary hip and knee osteoarthritis in a representative Central European population

The aim of our study was to determine the radiographic prevalence of hip and knee osteoarthritis and compare our results with prevalence data reported by other studies, as no similar study had been performed in Hungary previously. Our aim was also to investigate the usefulness of the different radiological scoring methods for the definition of osteoarthritis. Patients who earlier reported complaints and gave written consent were asked to participate in a clinical follow-up. In the 682 participants Harris hip score, visual analogue pain scale values for both joints, Knee Society score and knee functional score were calculated. Weight-bearing radiographs were taken of both joints. Kellgren-Lawrence radiological evaluation was performed and osteoarthritis prevalence was defined. Hip osteoarthritis was found in 109 cases (16.49%), and knee osteoarthritis was found in 111 cases (16.54%). Harris hip score, Knee Society score, functional score and visual analogue scale values were significantly worse in people with radiographically proven osteoarthritis compared to the control group (p < 0.05). Significantly higher osteoarthritis prevalence of both joints was found in those with increased body mass index values. Age also plays a significant role in the development of both hip and knee osteoarthritis. No significant difference was observed between male and female participants regarding osteoarthritis prevalence. The Kellgren-Lawrence score with a cut-off value of 2 or more is a useful evaluation method for the detection of osteoarthritis prevalence in epidemiological studies; according to our observations, in clinical practice a cut-off value of three or more is more relevant.

Prevalence of degenerative joint complaints of the lower extremity: a representative study

As part of the international campaign of the bone and joint decade, we aimed to present epidemiological data on the prevalence of major joint complaints in a Central European region. Ten thousand subjects aged between 14 and 65, selected randomly by the Hungarian central office of statistics from three counties in southern Hungary, were surveyed using our own questionnaire based on widely accepted scoring systems in the literature, focusing on major degenerative joint complaints, and using the short form 36 (SF-36) questionnaire. We found that the prevalence of hip pain in the observed group was 22.2%, the prevalence of knee pain 30.3%, and frequent ankle pain occurred in 9.7%. The results of the SF-36 questionnaire showed that with the exception of social function, neither of the values of the examined health dimensions reached levels of other international surveys. Details of the survey and the possible causes of the higher prevalence are discussed, along with the results of the SF-36 questionnaire.RésuméEn collaboration avec la campagne internationale sur la bone and joint decade, notre but a été de mettre en évidence des données épidémiologiques sur la prévalence des lésions articulaires, dans une région du centre Europe. Pour cela, 10.000 patients âgés entre 14 et 65 ans ont été sélectionnés par l’Office Cental Hongrois de Statistiques, patients provenant de trois comtés du Sud de la Hongrie en usant d’un questionnaire, rempli par les patients eux-mêmes et basé sur des scores largement acceptés par la population orthopédique et, notamment, le score SF 36. Nous avons trouvé une prédominance de douleur de la hanche dans ce groupe, avec un taux de 22,8%, le pourcentage de douleur du genou étant de 30,8% et, celle de la cheville, de 9,7%. Les résultats du questionnaire SF 36 ont montré qu’en dehors des problèmes sociaux, les valeurs retrouvées se situaient à des niveaux comparables à ceux d’autres études internationales. Les détails de cette étude et les étiologies possibles sont discutés avec les résultats du questionnaire SF 36.

Prospective analysis of human leukocyte functional tests reveals metal sensitivity in patients with hip implant.

BackgroundThe aim of the study was to examine the reactivity of peripheral human leukocytes to various metal ions prior and following hip replacement in order to investigate implant-induced metal sensitivity.MethodsThree patient groups were set up: (1) individuals without implants and no history of metal allergy (7 cases), (2) individuals without implants and known history of metal allergy (7 cases), and (3) patients undergoing cementless hip replacement (40 cases). Blood samples were taken in groups 1 and 2 at three different occasions; in group 3, prior and 3, 6, 12, 24, and 36 months after surgery. Peripheral leukocytes were separated and left either untreated or challenged with Ti, NiCl2, CoCl2, CrCl3, and phytohemagglutinin. Cell proliferation, cytokine release, and leukocyte migration inhibition assays were performed. Metal-induced reactivity was considered when all three assays showed significant change. Skin patch tests were also carried out.ResultsBoth skin patch tests and leukocyte functional tests were negative in group 1, and both were positive in group 2. In group 3, after 6 months, 12% of the patients showed reactivity to the tested metals except for NiCl2. Following the 36-month period, 18% of group three became sensitive to metals (including all the earlier 12%). In contrast, patch tests were negative at each time point in group 3.ConclusionsOrthopedic implant material may induce metal reactivity after implantation in a manner where susceptibility is yet to be elucidated. Leukocyte triple assay technique might be a useful tool to test implant material-related sensitivity.

Reconstruction of the patellar tendon using a Y-shaped flap folded back from the vastus lateralis fascia.

BACKGROUND Neglected and repeated ruptures of the patellar tendon are fortunately an uncommon event. These ruptures are often difficult to repair because they are generally accompanied by contractures of the quadriceps muscle and extensive scar tissue formation, and clinical findings are similar regardless of whether the rupture occurred during or after total knee arthroplasty. In both cases, reconstruction is the treatment. METHODS Here, we present data on reconstruction of the patellar tendon using our own method, which is performed in the following manner: the fascia flap shafted in the distal direction is separated from the vastus lateralis fascia of the quadriceps muscle, then folded back and fixed to the tibial tuberosity enclosing the patella in a Y shape. We used this new method in sixteen cases. All of the patients were examined clinically for an average of twenty-eight months. The Knee Society score was determined prior to surgery and on follow up. RESULTS Both the physical and ultrasound monitoring showed that all sixteen tendons healed properly, indicating that there was no need for any further surgical interventions. The mean Knee Society pain and function scores as well as the average range of motion of the knee increased significantly after the operations. CONCLUSION We believe that the presented method is an acceptable option for functional and biomechanical repair of the patellar tendon for the following reasons: the static balance of the knee joint remains unaltered, the quadriceps muscle is not damaged, and the central pulling direction remains steady.

Radiographic parameters of the hip joint from birth to adolescence

BackgroundVarious qualitative and quantitative radiological geometrical parameters can be of great help when assessing dysplasia of the hip joint and in understanding developmental processes of the infant hip. There are few data on the normal values of the hip joint at different ages.ObjectiveTo perform radiographic measurements on hip joints considered to be anatomically normal and to provide data for each age group, thus describing features of the radiographic development of the hip.Materials and methodsRadiographs were examined from 355 children (age 0–16 years) undergoing examination for scoliosis (long film), urography or plain abdominal radiography. Qualitative and quantitative signs were observed and measured, focusing on the Hilgenreiner, Wiberg and Idelberger angles and the decentric distance.ResultsBefore the age of 9 years measurable data from neighbouring age groups differed significantly, indicating typical radiological changes of the joint. For the same age range, qualitative changes could also be observed. After 9 years of age, radiological development of the normal hip joint during childhood is much slower.

Long-term results of derotational femoral varus osteotomy in Legg-Calvé-Perthes disease: 26-year follow-up.

The long-term results of 30 patients (31 hips) who underwent derotational femoral varus osteotomy for Legg-Calvé-Perthes disease are presented. Pain, leg-length discrepancy, Trendelenburg sign, and range of motion at the operated hip were examined clinically. Radiographic analysis included measurement of the Wiberg angle, epiphyseal index, acetabular index, and the Mose index. All were found to be satisfactory for patients in the good/fair category. Good/fair results were obtained in 27 (87%) of 31 hips according to Catteralls postoperative classification. Four patients were classified in the poor category due to severe restriction of movement and constant hip pain. Therefore, derotational femoral varus osteotomy is recommended for the treatment of patients with Legg-Calvé-Perthes disease.