Stergios N. Lallos

Cemented Müller straight stem total hip replacement: 18 year survival, clinical and radiological outcomes

AIM To present the 18 year survival and the clinical and radiological outcomes of the Müller straight stem, cemented, total hip arthroplasty (THA). METHODS Between 1989 and 2007, 176 primary total hip arthroplasties in 164 consecutive patients were performed in our institution by the senior author. All patients received a Müller cemented straight stem and a cemented polyethylene liner. The mean age of the patients was 62 years (45-78). The diagnosis was primary osteoarthritis in 151 hips, dysplasia of the hip in 12 and subcapital fracture of the femur in 13. Following discharge, serial follow-up consisted of clinical evaluation based on the Harris Hip Score and radiological assessment. The survival of the prosthesis using revision for any reason as an end-point was calculated by Kaplan-Meier analysis. RESULTS Twenty-four (15%) patients died during the follow-up study, 6 (4%) patients were lost, while the remaining 134 patients (141 hips) were followed-up for a mean of 10 years (3-18 years). HSS score at the latest follow-up revealed that 84 hips (59.5%) had excellent results, 30 (22.2%) good, 11 (7.8%) fair and 9 (6.3%) poor. There were 3 acetabular revisions due to aseptic loosening. Six (4.2%) stems were diagnosed as having radiographic definitive loosening; however, only 1 was revised. 30% of the surviving stems showed no radiological changes of radiolucency, while 70% showed some changes. Survival of the prosthesis for any reason was 96% at 10 years and 81% at 18 years. CONCLUSION The 18 year survival of the Müller straight stem, cemented THA is comparable to those of other successful cemented systems.

Experimental Osteomyelitis Caused by Methicillin-Resistant Staphylococcus aureus Treated with a Polylactide Carrier Releasing Linezolid

BACKGROUND The effectiveness of a new delivery system consisting of polymerized dilactide (PLA) with incorporated linezolid was investigated in a rabbit model as a means of treating methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis. METHODS The PLA-linezolid system was prepared after thorough stirring of PLA with linezolid at a 10:1 ratio. Experimental osteomyelitis was established in 40 rabbits by a modification of the Norden model with MRSA as the test isolate. After a hole had been drilled in the upper right femur, the isolate was inoculated using a thin needle working as a foreign body. At three weeks, the needle was removed and cultured, and the PLA-linezolid system was implanted in half the animals (group B); the remaining half was the control group (group A). Animals were sacrificed at regular intervals; tissue around the site of implantation was examined for pathologic changes and cultured quantitatively. RESULTS The prepared system eluted linezolid in vitro at concentrations much greater than the minimum inhibitory concentration (MIC) of the test pathogen for 11 days. At three weeks after inoculation of the test isolate, all animals had osteomyelitis. By the sixth week, bacterial growth from cancellous bone of group B was significantly lower than that in group A. However, this effect was not maintained until the end of the study (weeks 8 and 10), when the differences in bacterial growth in the two groups were not significant. CONCLUSION Polymerized dilactide mixed with 10% linezolid achieved partial arrest of the offending pathogen in an experimental model of osteomyelitis caused by MRSA.

Early increase of serum angiopoietin-2 are associated with early progression to death in experimental injury.

Severe trauma induces systemic inflammatory response syndrome (SIRS) through the release of proinflammatory mediators. Angiopoietin-2 (Ang-2) is over-produced in sepsis and leads to dysfunction of endothelial cells and subsequent multiple organ dysfunction. In order to define the role of Ang-2 in lethal injury, 45 rabbits were studied; eight were administered anesthesia; 11 were sham-operated and 26 were subject to femoral injury. Concentrations of Ang-2, malondialdehyde (MDA), tumor necrosis factor-alpha (TNFα) and endotoxins (LPS) were determined in serum and of Ang-2 in tissues; vital signs and overall survival were recorded. Bacterial growth was quantitatively assessed in liver, spleen and lung of animal that died. Survival of injured animals was shorter than sham operated ones. Serum concentrations of Ang-2 at 4 h was greater among animals where death supervened early, i.e. within 48 h after injury than among rabbits that died later. That was also the case for systolic, diastolic and mean arterial pressures. Serum MDA and TNFα and tissue bacterial growth did not differ between rabbits that died early and rabbits that died late. Serum LPS remained below the limit of detection. These results suggest that circulating Ang-2 participates in the pathogenesis of SIRS after injury connected with early haemodynamic instability.

Unilateral or bilateral V-Y fasciocutaneous flaps for the coverage of soft tissue defects following total knee arthroplasty

BackgroundSoft tissue necrosis following total knee arthroplasty (TKA) may be the cause of the devastating complication of deep infection. It necessitates an immediate operative intervention because it could potentially jeopardise the arthroplasty or even the limb.MethodsSixteen consecutive patients with a mean age of 73,8 years (range 47 to76 years) over a 6-year period (January 2003 to December 2008) with wound dehiscence after TKA were enrolled in the present study. Unilateral or bilateral fasciocutaneous V-Y flaps that are differently oriented, depending on the local conditions of the tissues were used to reconstruct the soft tissues defects.ResultsIn 15 of the 16 cases studied, the wound was successfully covered with the presented technique while in 1 patient a partial flap loss occurred, which was healed after surgical debridement and the application of vacuum system. No other complications occurred. Knee prosthesis was salvaged in all the patients with a good functional and esthetical outcome.ConclusionsThe presented reconstructive technique is a simple, quick, versatile and reliable solution for the coverage of soft tissue defects following TKA, more than 2 cm width and grade 1 and 2 according to Laing classification, provided the V-Y flaps are applied early in the postoperative period and no complex defects are involved.

Atlantoaxial rotational dislocation and associated multiple-level fractures to the spine

We present a case of a young woman with multilevel spinal injuries. The injury includes a rotational atlantoaxial dislocation associated with concomitant injury at C5 and at the sacrum. Rotational dislocation at C1–C2 level is not frequently encountered in young adults, and the presence of associated lesions to the spine makes this condition a challenging one. The medical record of a patient who sustained three spinal injuries at different levels of the spine was evaluated. The prevalence of this type of injury, the diagnosis, the clinical behavior, and the applied treatment are evaluated. The patient was treated non-operatively, and a satisfactory clinical outcome was recorded at the last follow-up visit.

Boxing trauma in ancient games

Cause of this enquiry is the research and the analysis of sport injuries during the conduction of boxing games in ancient Greece. The methodology of the study was included the use of systematic review of the writings in the Greek and the world literature. We visited museums, sports clubs, libraries and open-air archaeological sites. Furthermore, we conducted a systematic examination of the items, which are preserved in the creations of antiquity (sculpture, art angiography and angioplasty). According to the main findings of the study in boxing game, various sports injuries were recognised, such as scratches, lacerations, bleeding under the conjunctiva, skin oedema, ‘cauliflower ear’, nose bleeding and fractures of the nasal bones. After the fight, the athletes had deformities of the face, nose bleeding, fractures of the nose, ripped ears and swollen eyes. We concluded that the cases where the boxing athletes were wounded were usual in this era.

Serum kinetics of soluble triggering receptor expressed on myeloid cells-1 differs in relation to the type of arthroplasty.

Context: Soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) participates in the inflammatory process. Purpose: To describe changes of sTREM-1 in the serum after hemiarthroplasty (HA) and total hip arthroplasty (THA). Methods: Serial blood samples were drawn from 122 patients with hip fracture. Interleukin-6 (IL-6), sTREM-1, and C-reactive protein (CRP) were measured. Results: IL-6 and CRP were similarly increased after both HA and THA. sTREM-1 was increased early in HA and late after THA. The only parameter that was higher among patients who developed systemic inflammatory response syndrome was IL-6. Conclusions: Kinetics of sTREM-1 differs among patients undergoing HA of the hip and those undergoing THA.