Zoltán Bejek

Experiences with computer navigated total knee arthroplasty

The successful outcome of total knee arthroplasty (TKA) is very much dependent on precise positioning of the components. Inaccuracy may result in complaints as well as in early mechanical failure. Between March 2003 and September 2005, 69 TKA procedures were performed by the computer navigated technique. The postoperative outcome of this cohort was compared with the same number of TKAs done by the traditional technique. The lower limb anatomical axis was determined in all cases pre- and postoperatively by weight-bearing anteroposterior (AP) and lateral full length X-rays. The positions of femoral and tibial components were recorded. Comparing the data in the navigation group on the AP view, 96.6% of femoral and 96.9% of tibial components and on the lateral view in 95.4% of femoral and in 95.4% of tibial components, the overall postoperative axis in 95.4% fell in the range considered in the literature as optimal. In the traditional group on the AP view, 75.7% of femoral and 68.1% of tibial components and on the lateral view 81.8% of femoral and 63.6% of tibial components, the overall postoperative axis in 60.6% fell between the values considered optimal in the literature. It seems to be proven that the computer navigated total knee arthroplasty technique ensures positioning of components significantly more precisely compared with the traditional surgical method. Accuracy of navigation depends on the software used, on the correct detection of anatomical reference points, and on a potentially uneven thickness of the cement layer during final insertion of the components. The computer navigated technique does not substitute professional skill and experience, since it merely transmits information for the surgeon. The decision is in the hands of the doctor during the entire procedure. The real benefits of the computer navigated technique require further research and can be determined only after long-term analyses.RésuméLe succés de l’arthroplastie totale de genou dépend beaucoup du positionnement des implants. Entre mars 2003 et septembre 2005, 69 athroplasties étaient réalisées avec une technique de navigation informatique. Le devenir de ce groupe était comparé avec le même nombre d’arthroplasties faites avec la technique traditionnelle. L’axe anatomique du membre inférieur était déterminé par des radiographies antéro-postérieures en charge et de profil en extension. Dans le groupe navigué, la position des implants était optimale sur les radio de face pour 96,6% des pièces fémorales, 96,9% des pièces tibiales, sur les radio de profil pour 95,4% des pièces fémorales et tibiales, avec un bon axe dans 95,4% des cas. Dans le groupe traditionnel, les chiffres étaient: 75,7% pour les pièces fémorales, 68,1% pour les pièces tibiales sur les radio de face et 81,8% pour les pièces fémorales, 63,6% pour les pièces tibiales sur les radio de profil avec un bon axe dans 60,6% des cas. Il semble prouvé que l’utilisation de la navigation informatique permette un meilleur positionnement des implants que la méthode conventionnelle. L’efficacité de la navigation dépend du logiciel utilisé, de la précision du repérage anatomique et éventuellement de l’épaisseur de la couche de ciment lors de l’implantation définitive. Cette technique ne remplace pas l’expérience du chirurgien mais transmet des informations fiables, les décisions restant entre les mains de l’opérateur pendant toute l’intervention. Le bénéfice réel sera établi après des études à long terme.

The effect of knee arthroplasty on balancing ability in response to sudden unidirectional perturbation in the early postoperative period.

INTRODUCTION AND OBJECTIVE Total knee arthroplasty (TKA) affects 1-3% of the entire population. The effectiveness of surgery and rehabilitation are of great significance. The goal of this study was to determine how different surgical methods (i.e., conventional and minimally invasive) influence balancing ability in response to sudden unidirectional perturbation during the first 12 weeks of the postoperative period. MATERIALS AND METHODS The balancing capacity after sudden unidirectional (horizontal) perturbation of 10 patients who had undergone TKA operations via the conventional method and 10 patients who had undergone TKA operations via the minimally invasive method were examined before and six and 12 weeks after TKA. Forty-five health age-matched participants composed the control group. The balancing capacities following unidirectional perturbation were characterised by the Lehrs damping ratio, which was calculated based on the results of the provocation tests that were performed with the patients standing on both the affected and non-affected limbs. RESULTS In both patient groups, the Lehrs damping ratios increased during the postoperative period. However, in both patient groups, the Lehrs damping ratios calculated from the results of all three of the testing methods decreased compared to values obtained from the controls even at 12 weeks postoperatively. Six and 12 weeks after TKA, the Lehrs damping ratios of the patients who underwent operations utilising the minimally invasive exposure method were significantly higher than the values obtained from the patients who underwent operations by conventional exposure. DISCUSSION AND CONCLUSIONS In both patient groups, the balancing capacities continuously improved over the first 12 weeks of the postoperative period, but the dynamic balancing capacities while standing on both limbs, on the affected limb and on the non-affected limb significantly differed from those of the controls. The balancing capacities of the patients who underwent the minimally invasive exposure procedures improved more rapidly than did the capacities of the patients who underwent operations utilising the conventional exposure method. This reduced balancing capacity should be considered when developing dynamic balancing abilities and abandoning therapeutic aids, and the difference in dynamic balancing abilities between the two patient groups should also be considered.

Rhodococcus equi által okozott nagyízületi endoprotézis körül kialakult fertőzés

Rhodococcus equi is a rare pathogen in humans causing infections mostly in immunocompromised hosts. We present the first case of periprosthetic joint infection caused by Rhodococcus equi. An 88-year-old male patient was referred to our clinic with a history of fever and right hip pain. The patient had multiple hip surgeries including total joint arthroplasty and revision for aseptic loosening on the right side. He was immunocompetent, but his additional medical history was remarkable for diabetes mellitus, diabetic nephropathy and stroke with hemiplegia resulting in immobilization. Radiography showed stable components, joint aspirate yielded Rhodococcus equi. Irrigation and debridement was proposed, but the patient refused any surgical intervention. Therefore antibiotic therapy was administered. At the last follow-up the patient is free of complaints but the C-reactive protein level is still elevated. This case illustrates the possible role of Rhodococcus equi in medical device-associated infections. Orv Hetil. 2017; 158(27): 1071-1074.Absztrakt: A Rhodococcus equi ritka patogen, amely főkent gyengult immunrendszerű vagy immunszupprimalt betegekben okoz fertőzest. Esetbemutatasunkban Rhodococcus equi altal okozott nagyizuleti endoprotezis korul kialakult fertőzest mutatunk be, amelynek leirasara meg nem volt pelda a nemzetkozi irodalomban. A 88 eves ferfi beteget laz es jobb oldali csipőfajdalom miatt vettuk fel klinikankra. A beteg anamneziseben tobb, mindket oldalt erintő csipőműtet szerepelt, es a jobb oldalon aszeptikus lazulas miatt korabban revizios arthroplastica is tortent. Ismert betegsegei kozott szerepelt cukorbetegseg, diabeteses nephropathia, valamint korabbi stroke miatt bal oldali hemiplegia, azonban kifejezett immunszuppresszio nem. A kepalkoto vizsgalatok a jobb oldali csipőprotezis komponenseit stabilnak mutattak, az izuleti punkciobol pedig Rhodococcus equi tenyeszett ki. A betegnek azonnali feltarast es a protezis koruli terulet tisztitasat javasoltuk, amit visszautasitott. Konzervativ kezelest, parenteralis antibiot...

Szükség van szívódrénre elektív csípőprotézis-műtétek során?

Absztrakt Bevezetes: Az utobbi időben tobb tanulmany latott napvilagot, amelyek megkerdőjeleztek a szivodren hasznalatanak szuksegesseget elektiv csipőprotezis-beultetes soran. Celkitűzes: Prospektiv tanulmanyban azt vizsgaltak, hogy a perioperativ verveszteseget es a verzessel kapcsolatos szovődmenyeket a szivodren hasznalata hogyan befolyasolja. Modszer: 86, csipőprotezis-beultetesre erkező beteget ket csoportra osztottak. A „drencsoportban” (54 beteg) a műtetet kovetően szivodrent helyeztek be, mig a „dren nelkuli (kontroll)csoportban” (32 beteg) nem hasznaltak szivodrent. Perioperativ verveszteseget szamoltak es feljegyeztek a tranexamsav hasznalatat, a trombozisprofilaxis modjat, a transzfuzioigenyt, az esetlegesen kialakulo posztoperativ verzeseket, szeptikus komplikaciokat, illetve minden egyeb posztoperativ szovődmenyt. Eredmenyek: A perioperativ vervesztest a tranexamsav hasznalata igen, mig a drenhasznalat nem befolyasolta szignifikansan (p = 0,94). A dren nelkuli csoportban ugyanakkor tendencio...