Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca, 2015
PURPOSE OF THE STUDY A consensual classification of the periprosthetic interface membrane obtaine... more PURPOSE OF THE STUDY A consensual classification of the periprosthetic interface membrane obtained at revision total joint arthroplasty was published by Morawietz et al. in 2006. Based on histomorphological criteria, four types of periprosthetic membrane were proposed: type I, aseptic failure; type II, septic failure; type III, combined type (carrying signs of both type I and II); and type IV, indeterminate type. The aim of this study was to find out whether and to what extent the Morawietz system would be suitable for use at an independent institution involved in the evaluation of periprosthetic membranes for a long time. Should it appear that the institution achieved an equally good or even better agreement between the clinical diagnosis and the histopathological finding, this consensus classification could be recommended for routine use. MATERIAL AND METHODS The samples of periprosthetic tissue evaluated in this study were obtained during surgery from the following groups of pati...
PURPOSE OF THE STUDY No study has so far been published in the Czech Republic that would try to a... more PURPOSE OF THE STUDY No study has so far been published in the Czech Republic that would try to at least estimate the costs associated with revision total knee arthroplasties (TKA). The purpose of our study was to determine the total costs of primary and revision TKA for aseptic and septic failure and to determine the structure of costs, all with respect to a single workplace in the Czech Republic. MATERIAL AND METHODS The group included a total of 43 patients aged 55 to 82 years, of whom 23 (53.5%) with primary TKA implantation, 10 (23.3%) patients with revision surgery for aseptic failure, and 10 patients for septic failure of TKA. The costs of TKA were calculated retrospectively, factoring in all the items of reported care sent to the health insurance company system. The resulting costs reflected the appropriate payments in CZK based on the point value in the year concerned. RESULTS The average costs of uncomplicated primary TKA implantation amounted to CZK 136,279; the surgical ...
Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca, 2018
PURPOSE OF THE STUDY This study deals with the possibilities and application of immunohistochemic... more PURPOSE OF THE STUDY This study deals with the possibilities and application of immunohistochemical methods to detect mast and dendritic cells in periprosthetic tissues in patients with aseptically loosened total joint replacements of the knee and hip. The purpose of the study was to quantify and characterize the distribution of mast and dendritic cells in the examined samples and to study the statistically significant relations between the aforementioned cell populations and selected parameters characterizing the patients, implants or tissue response. Based on the proved findings, a possible relation between mast and dendritic cells and histomorphological patterns of aseptic loosening and the benefit of the applied immunohistochemical methods was evaluated. MATERIAL AND METHODS Periprosthetic tissues from a total of 31 patients (17 patients after a revision surgery of hip prosthesis, 14 patients after a revision surgery of knee prosthesis) were examined. The collected samples were ...
PURPOSE OF THE STUDY The aim of the study was to present our own method of measuring acetabular p... more PURPOSE OF THE STUDY The aim of the study was to present our own method of measuring acetabular polyethylene wear in total hip arthroplasty, including assessment of basic measurement characteristics. It is a well known fact that, in total hip replacement, polyethylene liners wear out with use. The rate of acetabular polyethylene wear can then be related to clinical or demographic data. MATERIAL AND METHODS Our method, using a universal measuring microscope, is based on the ability of exact identification of central positions of the head of total hip replacement before implantation and after prosthesis removal. The difference between the original and final positions allows us to calculate both linear and volumetric wear of polyethylene. During one month, the same components were repeatedly measured by two independent investigators and a total of 10 ABG 1 acetabular components were checked.The results of measurements were evaluated by a series of statistical tests, including correlati...
Aseptic loosening and osteolysis are the most frequent causes of total hip or total knee arthropl... more Aseptic loosening and osteolysis are the most frequent causes of total hip or total knee arthroplasty failure. Osteolysis is induced predominantly by polyethylene particles that are produced by adhesive wear of the prosthesis.The particles trigger a complex host’s reaction varying in intensity even in response to the same number of particles. These differences indicate that individual predisposition may have an important role in the pathogenesis of osteolysis. The major key mediators of wear-induced osteolysis include the cytokines RANKL, TNF-a, IL-1, IL-6 and IL-8. The inter-individual differences in the extent of bone destruction may therefore be related to variation in the amount and/or activity of these cytokines based on their gene polymorphism. Our pilot study suggests an association of some variants of the cytokine genes (e.g., IL1A-889) with a predisposition to development of severe osteolysis. If this assumption is confirmed by future investigations, this approach can facil...
Bone remodeling is a tightly coupled process consisting of repetitive cycles of bone resorption a... more Bone remodeling is a tightly coupled process consisting of repetitive cycles of bone resorption and formation. Both processes are governed by mechanical signals, which operate in conjunction with local and systemic factors in a discrete anatomic structure designated a basic multicellular unit (BMU). The microenvironment around total joint arthroplasty is a dynamic and complex milieu influenced by the chemical and physical stimuli associated with servicing the prosthesis. A key factor limiting the longevity of the prosthesis is polyethylene wear, which induces particle disease, and this may lead to increased and prolonged activity of BMUs resulting in periprosthetic osteolysis. Several pathways regulating BMU function have been reported in the past, including RANKL/RANK/OPG/TRAF6, TNF-α/TNFR/TRAF1, and IL-6/CD126/JAK/STAT. Moreover, the expression and functional activity of all these molecules can be affected by variations in their genes. These may explain the differences in severity...
Aim. To determine the most effective administration of tranexamic acid (TXA) in patients with pri... more Aim. To determine the most effective administration of tranexamic acid (TXA) in patients with primary total knee arthroplasty (TKA). Material and Method. We enrolled a total of 400 patients (154 men and 346 women) in this randomized trial (4 groups, each of 100 patients). The first group (IV1) had a single intravenous dose (15 mg TXA/kg) prior to skin incision. Group 2 (IV2) had TXA in 2 intravenous doses (15 mg TXA/kg): prior to skin incision and 6 hours after the first dose. Group 3 (TOP) had 2 g TXA in 50 mL of saline irrigated topically at the end of the surgery. The fourth group (COMB) combined IV1 and TOP regimens. We monitored the amount of total blood loss (TBL), haemoglobin drop, use of blood transfusions (BTs), and complications in each patient. Results. The amount of TBL was significantly lower in IV1, IV2 and COMB regimens compared to the TOP (P<0.0001). The lowest decrease in haemoglobin within 12 hours after surgery was observed in intravenous regimens (P=0.045). A significant difference in haemoglobin decrease on day 1 after the surgery was demonstrated in the COMB and intravenous regimens (P=0.011). Conclusion. In primary TKA, it is preferable to administer TXA intravenously in two doses or in a combined regimen. Simple topical administration of TXA was not as effective and is indicated only in cases where systemic administration of TXA is contraindicated. No substantial complications occurred in either group of patients.
Background. The objective of the study was to determine the association between periprosthetic co... more Background. The objective of the study was to determine the association between periprosthetic concentrations of selected metals and changes induced in periprosthetic tissues (PT). Methods. PT from 24 patients with metal-on-polyethylene or ceramic-on-polyethylene total joint replacements (TJRs) were examined. Samples underwent histological examination including quantification of cellular populations. Determination of metals was performed according to the published methodology. Results were processed using correlation analysis and Principal Component Analysis (PCA), respectively. Results. Growing concentration of metals in the PT was found as a function of length of exposure (LoE). Differences in Ti, Co, Cr and V concentrations (per α = 0.05) depended on the type of alloy the implants were made from. On the contrary, the implant composition did not reflect in the different numbers of immune cells per 1 high power field, not even in distribution of the membrane type according to the Krenn classification. PCA revealed several clusters in dependence on the LoE, type of the membrane and presence of immune cells. High representation of lymphocytes in the PT was typical for clusters with the longest LoE while a higher representation of neutrophils was typical for a shorter time to reoperation. Conclusions. Correlation between the LoE and concentrations of metals in its surroundings was demonstrated. However, the tissue image analysis cannot differentiate finer, potentially metal-induced tissue changes. Importantly, the tissues become more similar with an increasing LoE. We draw a conclusion about predominantly non-specific stimulation of the PT jointly by metal and polyethylene particles in non-metal-on-metal TJRs.
Introduction-Total joint replacement is one of the most common, safe, and efficacious operations ... more Introduction-Total joint replacement is one of the most common, safe, and efficacious operations in all of surgery. However, one major long-standing and unresolved issue is the adverse biological reaction to byproducts of wear from the bearing surfaces and modular articulations. These inflammatory reactions are mediated by the innate and adaptive immune systems. Areas covered-We review the etiology and pathophysiology of implant debris-associated inflammation, the clinical presentation and detailed work-up of these cases, and the principles and outcomes of non-operative and operative management. Furthermore, we suggest future strategies for prevention and novel treatments of implant-related adverse biological reactions. Expert opinion-The generation of byproducts from joint replacements is inevitable, due to repetitive loading of the implants. A clear understanding of the relevant biological principles, clinical presentations, investigative measures and treatments for implant-associated inflammatory reactions and periprosthetic osteolysis will help identify and treat patients with this issue earlier and more effectively. Although progressive implant-associated osteolysis is currently a condition that is treated surgically, with further research, it is hoped that non-operative biological interventions could prolong the lifetime of joint replacements that are otherwise functional and still salvageable.
Aim. We assessed various ways of tranexamic acid (TXA) administration on the fibrinolytic system.... more Aim. We assessed various ways of tranexamic acid (TXA) administration on the fibrinolytic system. Blood loss, transfusions, drainage and haematoma were secondary outcomes. Methods. In this prospective study, we examined 100 patients undergoing primary total knee arthroplasty (TKA) between June and November 2018. Patients were randomly assigned to 4 groups according to the following TXA regimens: 1) loading dose 15 mg TXA/kg single intravenous administration applied at initiation of anesthesia (IV1); 2) loading dose 15 mg TXA/kg + additional dose 15 mg TXA/kg 6 h after the first application of TXA (IV2); 3) IV1 regime in combination with a local wash of 2 g of TXA in 50 mL of saline (COMB); 4) topical administration of 2 g of TXA in 50 mL of saline (TOP). Results. Systemic fibrinolysis interference was insignificant in all of the regimens; we did not detect significant differences between IV1, IV2 and COMB in the monitored parameters within the elapsed time after the TKA; IV regimes had the lowest total drainage blood loss; the lowest blood loss was associated with the IV1 and IV2 regimens (IV1, IV2 < COMB < TOP); the lowest incidence of haematomas was in patients treated with TXA topically (i.e., in COMB + TOP). Conclusion. The largest antifibrinolytic effect was associated with intravenous administration of TXA. In terms of blood loss, intravenously administered TXA can interfere with the processes associated with the formation of the fibrin plug more efficiently than the simple washing of wound surfaces with TXA.
Objective Aseptic loosening (AL) is the most frequent long-term reason for revision of total knee... more Objective Aseptic loosening (AL) is the most frequent long-term reason for revision of total knee arthroplasty (TKA) affecting about 15-20% patients within 20 years after the surgery. Although there is a solid body of evidence about the crucial role of inflammation in the AL pathogenesis, scared information on inflammation signature and its time-axis in tissues around TKA exists. Design The inflammation protein signatures in pseudosynovial tissues collected at revision surgery from patients with AL (AL, n = 12) and those with no clinical/radiographic signs of AL (non-AL, n = 9) were investigated by Proximity Extension Assay (PEA)-Immunoassay and immunohistochemistry. Results AL tissues had elevated levels of TNF-family members sTNFR2, TNFSF14, sFasL, sBAFF, cytokines/chemokines IL8, CCL2, IL1RA/IL36, sIL6R, and growth factors sAREG, CSF1, comparing to non-AL. High interindividual variability in protein levels was evident particularly in non-AL. Levels of sTNFR2, sBAFF, IL8, sIL6R, and MPO discriminated between AL and non-AL and were associated with the time from index surgery, suggesting the cumulative character of inflammatory osteolytic response to prosthetic byproducts. The source of elevated inflammatory molecules was macrophages and multinucleated osteoclast-like cells in AL and histiocytes and osteoclast-like cells in non-AL tissues, respectively. All proteins were present in higher levels in osteoclast-like cells than in macrophages.
The diagnosis of prosthetic joint infection (PJI) is still a challenge in some patients after tot... more The diagnosis of prosthetic joint infection (PJI) is still a challenge in some patients after total joint replacement. Interleukin-6 (IL-6) strongly participates in the arrangement of the host-bacteria response. Therefore, increased levels of IL-6 should accompany every PJI. The aim of the study was to show diagnostic characteristics of serum IL-6 for the diagnosis of prosthetic joint infection (PJI). We also compared the diagnostic values of serum IL-6 with synovial IL-6 (sIL-6) and synovial C-reactive protein (sCRP). We performed a prospective study of 240 patients in whom serum IL-6 was determined before total hip (n = 124) or knee (n = 116) reoperations. The PJI diagnosis was based on the MSIS (Musculoskeletal Infection Society) criteria (2011). Receiver operating characteristic plots were constructed for IL-6, sIL-6, and sCRP. PJI was diagnosed in 93 patients, and aseptic revision was diagnosed in 147 patients. The AUC (area under curve) for IL-6 was 0.938 (95% CI; 0.904-0.971)...
Journal of biomedical materials research. Part B, Applied biomaterials, Jan 16, 2017
The type of tissue response to implant by-products can be determined by examination of periprosth... more The type of tissue response to implant by-products can be determined by examination of periprosthetic tissues. However, little is known about the most suitable location for tissue sampling. The main goal of this study was to evaluate the extent of variability in tissue response in relation to location of tissue sampling, implant fixation, age and sex in total joint arthroplasties with metal-on-polyethylene or ceramic-on-polyethylene bearing pairs. We processed 236 histology slides from 21 patients and focused on the association between the location of tissue samples and histological features. The presence of the synovial hyperplasia showed a significant association with the particular sampling site. A higher density of high endothelial cell venules was seen in the samples from around the joint, and polyethylene particles were more abundant in noncemented TJA but both findings did not show statistically significant association with the sampling site. The results showed a relatively s...
PURPOSE OF THE STUDY The aim of the study was to present our own method of measuring acetabular p... more PURPOSE OF THE STUDY The aim of the study was to present our own method of measuring acetabular polyethylene wear in total hip arthro- plasty, including assessment of basic measurement characteristics. It is a well known fact that, in total hip replacement, polyethylene liners wear out with use. The rate of acetabular polyethylene wear can then be related to clinical or demo- graphic data. MATERIAL AND METHODS Our method, using a universal measuring microscope, is based on the ability of exact identification of central positions of the head of total hip replacement before implantation and after prosthesis removal. The difference between the original and final positions allows us to calculate both linear and volumetric wear of polyethylene. During one month, the same components were repeatedly measured by two independent investigators and a total of 10 ABG 1 acetabular components were checked. The results of measurements were evaluated by a series of statistical tests, including corr...
Periprosthetic osteolysis is associated with accelerated wear rates. The goal of this study was t... more Periprosthetic osteolysis is associated with accelerated wear rates. The goal of this study was to investigate the influence of demographic and technical variables on wear rates and size of osteolytic lesions. Eighty retrieved ABG I prostheses were analyzed according to prospectively established criteria. There were 22 men and 58 women with an average age of 52 years (34-65) at the time of revision. The average time from index surgery to revision was 67 months (26 to 106). Polyethylene wear measurements were performed using a Universal-type measuring microscope. The average linear wear and volumetric wear rate was 0.363 mm per year (0-0.939, SD 0.241) and 161 mm 3 per year (0-467, SD 118.2), respectively. The wear rates were significantly higher (a) in patients with primary osteoarthritis in comparison with postdysplastic hips, (b) in hips where zirconia prosthetic heads articulated against the polyethylene liner, and (c) in cups placed laterally to Kohler's line. Risk that linear wear rate could be more than 0.2 mm per year was three times higher in patients who were operated in 1997 and later (OR 3.0, 95 % CI 1.126-7.993, p = 0.03). A strong association was revealed between magnitude of wear and size of femoral osteolysis.
Background: Polyethylene wear is considered a most important part of periprosthetic osteolysis de... more Background: Polyethylene wear is considered a most important part of periprosthetic osteolysis development. Thus, its measurement is central to contemporary orthopaedics. Aims: The aim of this paper was to compare the accuracy of three radiographic techniques for wear measurement. Secondly, the influence of the abduction angle of the cup on measurement accuracy was investigated. Methods: Wear was measured manually in 80 patients by a single observer according to the Livermore, Charnley, and Dorr description. A multi-component statistical analysis was used to test the hypothesis that the Livermore technique was superior. In vitro data obtained from a Universal-type measuring microscope served as a gold standard. Results: In vitro measurements showed an average linear wear of 0.363 mm per year (0.000-0.939, SD 0.241) with a corresponding volumetric wear rate of 161 mm 3 per year (0-467, SD 118.2). The Livermore technique showed the least deviation from the optical reference standard and a superior position from the viewpoint of error analysis but the correlation coefficient was slightly less (r = 0.761) than for the Dorr and Charnley techniques (r = 0.795 and r = 0.778, respectively). In addition, the mean error of the Dorr method differed significantly from zero (p = 0.036). Overall, the Livermore technique was the most accurate method for polyethylene wear measurement regardless of the abduction angle of the cup. Conclusions: The Livermore technique performed manually was more accurate than the Charnley and Dorr methods. Nevertheless, we consider the Dorr technique an adequate tool for day-today wear measurements, mainly due to its simplicity.
Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society, 2014
To identify expression profiles (EP) associated with aseptic loosening of total knee arthroplasty... more To identify expression profiles (EP) associated with aseptic loosening of total knee arthroplasty (TKA) and to compare them with EP observed in total hip arthroplasty (THA), and primary knee and hip osteoarthritis (OA). Gene EP of TNF, IL-6, IL-8, CHIT1, BMP4, CCL3, CCL18, MMP9, RANKL, OPG, DC-STAMP and SOCS3 were assessed using quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) on tissues retrieved from patients with aseptically failed TKA (n = 21), THA (n = 41) and primary knee (n = 20) and hip (n = 17) OA. Immunohistochemistry was applied to localize the proteins. When compared to knee OA, the pseudosynovial tissue in TKA exhibit (1) elevation of alternative macrophage activation marker (CHIT1), chemokine (IL-8), and a proteolytic enzyme (MMP9); (2) downregulation of pro-inflammatory cytokine (TNF), osteoclastic regulator (OPG) and a stimulator of bone formation (BMP4); (3) no difference in IL-6, CCL3, CCL18, RANKL, DC-STAMP and SOCS3. The EP in TKA differed f...
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2014
Cervico-facial actinomycosis is an infectious, suppurative, and granulomatous disease due to Acti... more Cervico-facial actinomycosis is an infectious, suppurative, and granulomatous disease due to Actinomyces species. Usually, the diagnosis is confirmed by microbiological cultures; however, the need for careful anaerobic handling of specimens often makes it difficult to obtain an effective microbial growth. Therefore, we conducted a retrospective study on biopsy samples from patients with a clinical suspicion of cervico-facial actinomycosis, in order to determine whether accurate histopathological examination could reliably confirm the diagnosis. A retrospective revision of formalin-fixed, paraffin-embedded archival material from 68 cases of cervico-facial lesions, with negative culture for anaerobic/microaerophilic microorganisms, was performed. Twelve serial sections for each case were cut from the paraffin blocks, individually collected on positively charged slides to obtain good section-to-slide adhesion, and stained with hematoxylin and eosin (H&E) and periodic acid-Schiff (PAS)....
Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca, 2010
Fractures of the femoral neck have been serious health and social issues of the recent decades. A... more Fractures of the femoral neck have been serious health and social issues of the recent decades. Although up-to-date implants and perioperative care are now available, the treatment is still associated with an increased risk of postoperative complications. The aim of this study was to specify early postoperative complications and to ascertain which factors, if any, can predict them. Between October 2005 and February 2007, a total of 155 patients were treated for femoral neck fractures in our department. The group of elderly patients (n = 82) who underwent elective total hip arthroplasty for osteoarthritis served as controls. The selected pre-, peri- and post-operative characteristics were prospectively collected. Each patient was followed- up for at least one month after surgery. The data were first compared by univariate analysis and then, for statistically significant factors, their predictors were identified by the logistic regression. The average age of the patients with femoral ...
Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca, 2015
PURPOSE OF THE STUDY A consensual classification of the periprosthetic interface membrane obtaine... more PURPOSE OF THE STUDY A consensual classification of the periprosthetic interface membrane obtained at revision total joint arthroplasty was published by Morawietz et al. in 2006. Based on histomorphological criteria, four types of periprosthetic membrane were proposed: type I, aseptic failure; type II, septic failure; type III, combined type (carrying signs of both type I and II); and type IV, indeterminate type. The aim of this study was to find out whether and to what extent the Morawietz system would be suitable for use at an independent institution involved in the evaluation of periprosthetic membranes for a long time. Should it appear that the institution achieved an equally good or even better agreement between the clinical diagnosis and the histopathological finding, this consensus classification could be recommended for routine use. MATERIAL AND METHODS The samples of periprosthetic tissue evaluated in this study were obtained during surgery from the following groups of pati...
PURPOSE OF THE STUDY No study has so far been published in the Czech Republic that would try to a... more PURPOSE OF THE STUDY No study has so far been published in the Czech Republic that would try to at least estimate the costs associated with revision total knee arthroplasties (TKA). The purpose of our study was to determine the total costs of primary and revision TKA for aseptic and septic failure and to determine the structure of costs, all with respect to a single workplace in the Czech Republic. MATERIAL AND METHODS The group included a total of 43 patients aged 55 to 82 years, of whom 23 (53.5%) with primary TKA implantation, 10 (23.3%) patients with revision surgery for aseptic failure, and 10 patients for septic failure of TKA. The costs of TKA were calculated retrospectively, factoring in all the items of reported care sent to the health insurance company system. The resulting costs reflected the appropriate payments in CZK based on the point value in the year concerned. RESULTS The average costs of uncomplicated primary TKA implantation amounted to CZK 136,279; the surgical ...
Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca, 2018
PURPOSE OF THE STUDY This study deals with the possibilities and application of immunohistochemic... more PURPOSE OF THE STUDY This study deals with the possibilities and application of immunohistochemical methods to detect mast and dendritic cells in periprosthetic tissues in patients with aseptically loosened total joint replacements of the knee and hip. The purpose of the study was to quantify and characterize the distribution of mast and dendritic cells in the examined samples and to study the statistically significant relations between the aforementioned cell populations and selected parameters characterizing the patients, implants or tissue response. Based on the proved findings, a possible relation between mast and dendritic cells and histomorphological patterns of aseptic loosening and the benefit of the applied immunohistochemical methods was evaluated. MATERIAL AND METHODS Periprosthetic tissues from a total of 31 patients (17 patients after a revision surgery of hip prosthesis, 14 patients after a revision surgery of knee prosthesis) were examined. The collected samples were ...
PURPOSE OF THE STUDY The aim of the study was to present our own method of measuring acetabular p... more PURPOSE OF THE STUDY The aim of the study was to present our own method of measuring acetabular polyethylene wear in total hip arthroplasty, including assessment of basic measurement characteristics. It is a well known fact that, in total hip replacement, polyethylene liners wear out with use. The rate of acetabular polyethylene wear can then be related to clinical or demographic data. MATERIAL AND METHODS Our method, using a universal measuring microscope, is based on the ability of exact identification of central positions of the head of total hip replacement before implantation and after prosthesis removal. The difference between the original and final positions allows us to calculate both linear and volumetric wear of polyethylene. During one month, the same components were repeatedly measured by two independent investigators and a total of 10 ABG 1 acetabular components were checked.The results of measurements were evaluated by a series of statistical tests, including correlati...
Aseptic loosening and osteolysis are the most frequent causes of total hip or total knee arthropl... more Aseptic loosening and osteolysis are the most frequent causes of total hip or total knee arthroplasty failure. Osteolysis is induced predominantly by polyethylene particles that are produced by adhesive wear of the prosthesis.The particles trigger a complex host’s reaction varying in intensity even in response to the same number of particles. These differences indicate that individual predisposition may have an important role in the pathogenesis of osteolysis. The major key mediators of wear-induced osteolysis include the cytokines RANKL, TNF-a, IL-1, IL-6 and IL-8. The inter-individual differences in the extent of bone destruction may therefore be related to variation in the amount and/or activity of these cytokines based on their gene polymorphism. Our pilot study suggests an association of some variants of the cytokine genes (e.g., IL1A-889) with a predisposition to development of severe osteolysis. If this assumption is confirmed by future investigations, this approach can facil...
Bone remodeling is a tightly coupled process consisting of repetitive cycles of bone resorption a... more Bone remodeling is a tightly coupled process consisting of repetitive cycles of bone resorption and formation. Both processes are governed by mechanical signals, which operate in conjunction with local and systemic factors in a discrete anatomic structure designated a basic multicellular unit (BMU). The microenvironment around total joint arthroplasty is a dynamic and complex milieu influenced by the chemical and physical stimuli associated with servicing the prosthesis. A key factor limiting the longevity of the prosthesis is polyethylene wear, which induces particle disease, and this may lead to increased and prolonged activity of BMUs resulting in periprosthetic osteolysis. Several pathways regulating BMU function have been reported in the past, including RANKL/RANK/OPG/TRAF6, TNF-α/TNFR/TRAF1, and IL-6/CD126/JAK/STAT. Moreover, the expression and functional activity of all these molecules can be affected by variations in their genes. These may explain the differences in severity...
Aim. To determine the most effective administration of tranexamic acid (TXA) in patients with pri... more Aim. To determine the most effective administration of tranexamic acid (TXA) in patients with primary total knee arthroplasty (TKA). Material and Method. We enrolled a total of 400 patients (154 men and 346 women) in this randomized trial (4 groups, each of 100 patients). The first group (IV1) had a single intravenous dose (15 mg TXA/kg) prior to skin incision. Group 2 (IV2) had TXA in 2 intravenous doses (15 mg TXA/kg): prior to skin incision and 6 hours after the first dose. Group 3 (TOP) had 2 g TXA in 50 mL of saline irrigated topically at the end of the surgery. The fourth group (COMB) combined IV1 and TOP regimens. We monitored the amount of total blood loss (TBL), haemoglobin drop, use of blood transfusions (BTs), and complications in each patient. Results. The amount of TBL was significantly lower in IV1, IV2 and COMB regimens compared to the TOP (P<0.0001). The lowest decrease in haemoglobin within 12 hours after surgery was observed in intravenous regimens (P=0.045). A significant difference in haemoglobin decrease on day 1 after the surgery was demonstrated in the COMB and intravenous regimens (P=0.011). Conclusion. In primary TKA, it is preferable to administer TXA intravenously in two doses or in a combined regimen. Simple topical administration of TXA was not as effective and is indicated only in cases where systemic administration of TXA is contraindicated. No substantial complications occurred in either group of patients.
Background. The objective of the study was to determine the association between periprosthetic co... more Background. The objective of the study was to determine the association between periprosthetic concentrations of selected metals and changes induced in periprosthetic tissues (PT). Methods. PT from 24 patients with metal-on-polyethylene or ceramic-on-polyethylene total joint replacements (TJRs) were examined. Samples underwent histological examination including quantification of cellular populations. Determination of metals was performed according to the published methodology. Results were processed using correlation analysis and Principal Component Analysis (PCA), respectively. Results. Growing concentration of metals in the PT was found as a function of length of exposure (LoE). Differences in Ti, Co, Cr and V concentrations (per α = 0.05) depended on the type of alloy the implants were made from. On the contrary, the implant composition did not reflect in the different numbers of immune cells per 1 high power field, not even in distribution of the membrane type according to the Krenn classification. PCA revealed several clusters in dependence on the LoE, type of the membrane and presence of immune cells. High representation of lymphocytes in the PT was typical for clusters with the longest LoE while a higher representation of neutrophils was typical for a shorter time to reoperation. Conclusions. Correlation between the LoE and concentrations of metals in its surroundings was demonstrated. However, the tissue image analysis cannot differentiate finer, potentially metal-induced tissue changes. Importantly, the tissues become more similar with an increasing LoE. We draw a conclusion about predominantly non-specific stimulation of the PT jointly by metal and polyethylene particles in non-metal-on-metal TJRs.
Introduction-Total joint replacement is one of the most common, safe, and efficacious operations ... more Introduction-Total joint replacement is one of the most common, safe, and efficacious operations in all of surgery. However, one major long-standing and unresolved issue is the adverse biological reaction to byproducts of wear from the bearing surfaces and modular articulations. These inflammatory reactions are mediated by the innate and adaptive immune systems. Areas covered-We review the etiology and pathophysiology of implant debris-associated inflammation, the clinical presentation and detailed work-up of these cases, and the principles and outcomes of non-operative and operative management. Furthermore, we suggest future strategies for prevention and novel treatments of implant-related adverse biological reactions. Expert opinion-The generation of byproducts from joint replacements is inevitable, due to repetitive loading of the implants. A clear understanding of the relevant biological principles, clinical presentations, investigative measures and treatments for implant-associated inflammatory reactions and periprosthetic osteolysis will help identify and treat patients with this issue earlier and more effectively. Although progressive implant-associated osteolysis is currently a condition that is treated surgically, with further research, it is hoped that non-operative biological interventions could prolong the lifetime of joint replacements that are otherwise functional and still salvageable.
Aim. We assessed various ways of tranexamic acid (TXA) administration on the fibrinolytic system.... more Aim. We assessed various ways of tranexamic acid (TXA) administration on the fibrinolytic system. Blood loss, transfusions, drainage and haematoma were secondary outcomes. Methods. In this prospective study, we examined 100 patients undergoing primary total knee arthroplasty (TKA) between June and November 2018. Patients were randomly assigned to 4 groups according to the following TXA regimens: 1) loading dose 15 mg TXA/kg single intravenous administration applied at initiation of anesthesia (IV1); 2) loading dose 15 mg TXA/kg + additional dose 15 mg TXA/kg 6 h after the first application of TXA (IV2); 3) IV1 regime in combination with a local wash of 2 g of TXA in 50 mL of saline (COMB); 4) topical administration of 2 g of TXA in 50 mL of saline (TOP). Results. Systemic fibrinolysis interference was insignificant in all of the regimens; we did not detect significant differences between IV1, IV2 and COMB in the monitored parameters within the elapsed time after the TKA; IV regimes had the lowest total drainage blood loss; the lowest blood loss was associated with the IV1 and IV2 regimens (IV1, IV2 < COMB < TOP); the lowest incidence of haematomas was in patients treated with TXA topically (i.e., in COMB + TOP). Conclusion. The largest antifibrinolytic effect was associated with intravenous administration of TXA. In terms of blood loss, intravenously administered TXA can interfere with the processes associated with the formation of the fibrin plug more efficiently than the simple washing of wound surfaces with TXA.
Objective Aseptic loosening (AL) is the most frequent long-term reason for revision of total knee... more Objective Aseptic loosening (AL) is the most frequent long-term reason for revision of total knee arthroplasty (TKA) affecting about 15-20% patients within 20 years after the surgery. Although there is a solid body of evidence about the crucial role of inflammation in the AL pathogenesis, scared information on inflammation signature and its time-axis in tissues around TKA exists. Design The inflammation protein signatures in pseudosynovial tissues collected at revision surgery from patients with AL (AL, n = 12) and those with no clinical/radiographic signs of AL (non-AL, n = 9) were investigated by Proximity Extension Assay (PEA)-Immunoassay and immunohistochemistry. Results AL tissues had elevated levels of TNF-family members sTNFR2, TNFSF14, sFasL, sBAFF, cytokines/chemokines IL8, CCL2, IL1RA/IL36, sIL6R, and growth factors sAREG, CSF1, comparing to non-AL. High interindividual variability in protein levels was evident particularly in non-AL. Levels of sTNFR2, sBAFF, IL8, sIL6R, and MPO discriminated between AL and non-AL and were associated with the time from index surgery, suggesting the cumulative character of inflammatory osteolytic response to prosthetic byproducts. The source of elevated inflammatory molecules was macrophages and multinucleated osteoclast-like cells in AL and histiocytes and osteoclast-like cells in non-AL tissues, respectively. All proteins were present in higher levels in osteoclast-like cells than in macrophages.
The diagnosis of prosthetic joint infection (PJI) is still a challenge in some patients after tot... more The diagnosis of prosthetic joint infection (PJI) is still a challenge in some patients after total joint replacement. Interleukin-6 (IL-6) strongly participates in the arrangement of the host-bacteria response. Therefore, increased levels of IL-6 should accompany every PJI. The aim of the study was to show diagnostic characteristics of serum IL-6 for the diagnosis of prosthetic joint infection (PJI). We also compared the diagnostic values of serum IL-6 with synovial IL-6 (sIL-6) and synovial C-reactive protein (sCRP). We performed a prospective study of 240 patients in whom serum IL-6 was determined before total hip (n = 124) or knee (n = 116) reoperations. The PJI diagnosis was based on the MSIS (Musculoskeletal Infection Society) criteria (2011). Receiver operating characteristic plots were constructed for IL-6, sIL-6, and sCRP. PJI was diagnosed in 93 patients, and aseptic revision was diagnosed in 147 patients. The AUC (area under curve) for IL-6 was 0.938 (95% CI; 0.904-0.971)...
Journal of biomedical materials research. Part B, Applied biomaterials, Jan 16, 2017
The type of tissue response to implant by-products can be determined by examination of periprosth... more The type of tissue response to implant by-products can be determined by examination of periprosthetic tissues. However, little is known about the most suitable location for tissue sampling. The main goal of this study was to evaluate the extent of variability in tissue response in relation to location of tissue sampling, implant fixation, age and sex in total joint arthroplasties with metal-on-polyethylene or ceramic-on-polyethylene bearing pairs. We processed 236 histology slides from 21 patients and focused on the association between the location of tissue samples and histological features. The presence of the synovial hyperplasia showed a significant association with the particular sampling site. A higher density of high endothelial cell venules was seen in the samples from around the joint, and polyethylene particles were more abundant in noncemented TJA but both findings did not show statistically significant association with the sampling site. The results showed a relatively s...
PURPOSE OF THE STUDY The aim of the study was to present our own method of measuring acetabular p... more PURPOSE OF THE STUDY The aim of the study was to present our own method of measuring acetabular polyethylene wear in total hip arthro- plasty, including assessment of basic measurement characteristics. It is a well known fact that, in total hip replacement, polyethylene liners wear out with use. The rate of acetabular polyethylene wear can then be related to clinical or demo- graphic data. MATERIAL AND METHODS Our method, using a universal measuring microscope, is based on the ability of exact identification of central positions of the head of total hip replacement before implantation and after prosthesis removal. The difference between the original and final positions allows us to calculate both linear and volumetric wear of polyethylene. During one month, the same components were repeatedly measured by two independent investigators and a total of 10 ABG 1 acetabular components were checked. The results of measurements were evaluated by a series of statistical tests, including corr...
Periprosthetic osteolysis is associated with accelerated wear rates. The goal of this study was t... more Periprosthetic osteolysis is associated with accelerated wear rates. The goal of this study was to investigate the influence of demographic and technical variables on wear rates and size of osteolytic lesions. Eighty retrieved ABG I prostheses were analyzed according to prospectively established criteria. There were 22 men and 58 women with an average age of 52 years (34-65) at the time of revision. The average time from index surgery to revision was 67 months (26 to 106). Polyethylene wear measurements were performed using a Universal-type measuring microscope. The average linear wear and volumetric wear rate was 0.363 mm per year (0-0.939, SD 0.241) and 161 mm 3 per year (0-467, SD 118.2), respectively. The wear rates were significantly higher (a) in patients with primary osteoarthritis in comparison with postdysplastic hips, (b) in hips where zirconia prosthetic heads articulated against the polyethylene liner, and (c) in cups placed laterally to Kohler's line. Risk that linear wear rate could be more than 0.2 mm per year was three times higher in patients who were operated in 1997 and later (OR 3.0, 95 % CI 1.126-7.993, p = 0.03). A strong association was revealed between magnitude of wear and size of femoral osteolysis.
Background: Polyethylene wear is considered a most important part of periprosthetic osteolysis de... more Background: Polyethylene wear is considered a most important part of periprosthetic osteolysis development. Thus, its measurement is central to contemporary orthopaedics. Aims: The aim of this paper was to compare the accuracy of three radiographic techniques for wear measurement. Secondly, the influence of the abduction angle of the cup on measurement accuracy was investigated. Methods: Wear was measured manually in 80 patients by a single observer according to the Livermore, Charnley, and Dorr description. A multi-component statistical analysis was used to test the hypothesis that the Livermore technique was superior. In vitro data obtained from a Universal-type measuring microscope served as a gold standard. Results: In vitro measurements showed an average linear wear of 0.363 mm per year (0.000-0.939, SD 0.241) with a corresponding volumetric wear rate of 161 mm 3 per year (0-467, SD 118.2). The Livermore technique showed the least deviation from the optical reference standard and a superior position from the viewpoint of error analysis but the correlation coefficient was slightly less (r = 0.761) than for the Dorr and Charnley techniques (r = 0.795 and r = 0.778, respectively). In addition, the mean error of the Dorr method differed significantly from zero (p = 0.036). Overall, the Livermore technique was the most accurate method for polyethylene wear measurement regardless of the abduction angle of the cup. Conclusions: The Livermore technique performed manually was more accurate than the Charnley and Dorr methods. Nevertheless, we consider the Dorr technique an adequate tool for day-today wear measurements, mainly due to its simplicity.
Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society, 2014
To identify expression profiles (EP) associated with aseptic loosening of total knee arthroplasty... more To identify expression profiles (EP) associated with aseptic loosening of total knee arthroplasty (TKA) and to compare them with EP observed in total hip arthroplasty (THA), and primary knee and hip osteoarthritis (OA). Gene EP of TNF, IL-6, IL-8, CHIT1, BMP4, CCL3, CCL18, MMP9, RANKL, OPG, DC-STAMP and SOCS3 were assessed using quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) on tissues retrieved from patients with aseptically failed TKA (n = 21), THA (n = 41) and primary knee (n = 20) and hip (n = 17) OA. Immunohistochemistry was applied to localize the proteins. When compared to knee OA, the pseudosynovial tissue in TKA exhibit (1) elevation of alternative macrophage activation marker (CHIT1), chemokine (IL-8), and a proteolytic enzyme (MMP9); (2) downregulation of pro-inflammatory cytokine (TNF), osteoclastic regulator (OPG) and a stimulator of bone formation (BMP4); (3) no difference in IL-6, CCL3, CCL18, RANKL, DC-STAMP and SOCS3. The EP in TKA differed f...
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2014
Cervico-facial actinomycosis is an infectious, suppurative, and granulomatous disease due to Acti... more Cervico-facial actinomycosis is an infectious, suppurative, and granulomatous disease due to Actinomyces species. Usually, the diagnosis is confirmed by microbiological cultures; however, the need for careful anaerobic handling of specimens often makes it difficult to obtain an effective microbial growth. Therefore, we conducted a retrospective study on biopsy samples from patients with a clinical suspicion of cervico-facial actinomycosis, in order to determine whether accurate histopathological examination could reliably confirm the diagnosis. A retrospective revision of formalin-fixed, paraffin-embedded archival material from 68 cases of cervico-facial lesions, with negative culture for anaerobic/microaerophilic microorganisms, was performed. Twelve serial sections for each case were cut from the paraffin blocks, individually collected on positively charged slides to obtain good section-to-slide adhesion, and stained with hematoxylin and eosin (H&E) and periodic acid-Schiff (PAS)....
Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca, 2010
Fractures of the femoral neck have been serious health and social issues of the recent decades. A... more Fractures of the femoral neck have been serious health and social issues of the recent decades. Although up-to-date implants and perioperative care are now available, the treatment is still associated with an increased risk of postoperative complications. The aim of this study was to specify early postoperative complications and to ascertain which factors, if any, can predict them. Between October 2005 and February 2007, a total of 155 patients were treated for femoral neck fractures in our department. The group of elderly patients (n = 82) who underwent elective total hip arthroplasty for osteoarthritis served as controls. The selected pre-, peri- and post-operative characteristics were prospectively collected. Each patient was followed- up for at least one month after surgery. The data were first compared by univariate analysis and then, for statistically significant factors, their predictors were identified by the logistic regression. The average age of the patients with femoral ...
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Papers by Jiri Gallo