Papers by Vassilios Nikolaou
Purpose: To investigate the accuracy of the MRI of the knee for the detection of injuries of the ... more Purpose: To investigate the accuracy of the MRI of the knee for the detection of injuries of the meniscus, cruciate ligaments and articular cartilage, in comparison with the preoperative clinical examination and intraoperative findings. Material and methods: During 2002 88 patients underwent surgical arthroscopy in our institution, with the diagnosis of meniscal and or cruciate tear. 56 from these patients had preoperative MRI of the affected knee. The accuracy, sensitivity and specificity of the MRI findings were correlated with the lesions identified during arthroscopy. Furthermore, the predictive value of the preoperative MRI was compared with the preoperative clinical evaluation, as well as definitive intraoperative findings. Results : The accuracy for tears of the medial, lateral meniscus, anterior and posterior cruciate ligaments and articular cartilage was 81%, 77%, 86%, 98% and 60% respectively. The specificity was 69%, 88%, 89%, 75% and 73% respectively. The positive predic...
European Journal of Orthopaedic Surgery & Traumatology, 2015
Aim A morphometric analysis of the odontoid process of the A2 vertebra, in the Greek population, ... more Aim A morphometric analysis of the odontoid process of the A2 vertebra, in the Greek population, was conducted using CT scan. We aimed to determine the feasibility to use one or two screws when treating fractures of this anatomic element. Patients and methods One hundred and fifteen patients (57 men) of a mean age of 48 years (16-95 years) underwent a cervical spine CT scan examination. The anteriorposterior and transverse diameters of the odontoid process were measured from the base, at 1-mm interval upward on axial CT images. The length from the tip of the odontoid process to the anterior-inferior angle of the body of the axis was calculated. Data concerning the height and weight of the examined patients were collected. Results The mean transverse and anterior-posterior distances were found to be 11.46 and 10.45 mm, respectively, for the upper end of the odontoid process. At the neck level of the odontoid process, the equivalent mean values were 11.12 and 8.73 mm, respectively, while at the base, these distances were found to be 13.84 and 12.3 mm, respectively. The mean distance from the tip of the odontoid to its base was 17.25 and 17.28 mm, respectively, while the mean distance from the tip of the dens to the anteriorinferior corner of the axis' body was 39.2 mm. Men showed greater values than women. Conclusions In this study, it was shown that in the Greek population there is enough room for one 4.5-mm or one 3.5-mm cannulated screw to be used. The application of two 3.5-mm screws is feasible in 58.6 % of the male and 26.3 % of the female population. This confirms that the knowledge of the true dimensions of the odontoid process is of paramount importance before the proper management of fractured dens using the anterior screw technique.
European Journal of Orthopaedic Surgery & Traumatology, 2008
Aim Paraspinal desmoid tumors are rare and only few cases have been reported in the literature. ... more Aim Paraspinal desmoid tumors are rare and only few cases have been reported in the literature. This report describes a case of successful excision of a parasacral desmoid tumor in a 34 years old female. Methods The patient presented with a tender mass over her right sacral region. Radiological examination with CT and MRI demonstrated two adjacent well circumscribed masses measuring 4 × 3 and
Orthopedics, 2014
Adrenal hemorrhage (AH) is a rare but serious condition that is often diagnosed at autopsy. Unila... more Adrenal hemorrhage (AH) is a rare but serious condition that is often diagnosed at autopsy. Unilateral adrenal hemorrhage (UAH) in adults is extremely rare and is often due to trauma or anticoagulation or is associated with systemic illness. The case of a 73-year-old man who was diagnosed with UAH several days after an elective total knee replacement is presented. The patient had an uncomplicated procedure and he was treated postoperatively with a prophylactic dose of subcutaneous low-molecular– weight heparin and compression sleeves. On postoperative day 8, he reported sustained epigastric and midback pain at the lower thoracic level. He had a temperature of 38.5°C. On clinical examination, the patient expressed only mild tenderness at the lumbar area. Abdominal ultrasound and computed tomography (CT) scan were inconclusive. On postoperative day 13, the patient experienced no pain but remained febrile. An abdominal CT scan revealed a high-density mass on the left adrenal gland sugg...
The Bone & Joint Journal, 2021
American journal of orthopedics (Belle Mead, N.J.), 2009
Tibial stress fractures are not rare--they have been extensively studied in young athletes and so... more Tibial stress fractures are not rare--they have been extensively studied in young athletes and soldiers and in elderly people with rheumatoid arthritis, osteoporosis, Paget's disease, pyrophosphate arthropathy, and hyperparathyroidism--but they seldom occur in patients with severe primary degenerative knee osteoarthritis. The etiology, diagnosis, and optimal treatment of these fractures remain a challenge. In this article, we review the English-language literature on the symptoms, diagnosis, treatment options, and final outcomes of these fractures, and we report 2 new cases of proximal tibial stress fractures in elderly women with severe primary degenerative knee osteoarthritis.
Injury Extra, 2009
The following three abstracts, presented during the 2009 Annual Meeting of the British Trauma Soc... more The following three abstracts, presented during the 2009 Annual Meeting of the British Trauma Society, were the winners of the Injury Journal Awards.
Journal of Research on History of Medicine, 2014
Spine Surgery began its evolution in the beginning of the 19th century in order to reach nowadays... more Spine Surgery began its evolution in the beginning of the 19th century in order to reach nowadays the point of being considered an important subspecialty of Neurosurgery and Orthopaedics. The purpose of this historical review is the search and evaluation of the progress in spine surgery until the middle of the 20th century. This review concerns the inauguration and evolution of this field in Greece. Special references are made to the first achievements of this field, to the pioneers physicians and surgeons (general surgeons, orthopaedic surgeons and neurosurgeons) who inaugurated this subspecialty and to clinical and scientific work of that era. Eventually, the progress of medicine and technology who led to the first achievements of this subspecialty are shown and also the difficulties (both social and scientific) that the pioneers of this field faced are demonstrated. In Greece, with small exceptions, the new techniques emerged with a certain delay.
Bulletin of the NYU hospital for joint diseases, 2009
Evaluation and treatment of pain following hip resurfacing arthroplasty can be challenging, even ... more Evaluation and treatment of pain following hip resurfacing arthroplasty can be challenging, even for the most experienced arthroplasty surgeon. As in any total hip replacement, there are a number of investigative tools at the disposal of orthopaedic surgeons to elicit the underlying causes of pain for diagnosis and treatment. A detailed history and physical examination are the most important first steps in the differential diagnosis of the intrinsic and extrinsic etiologies of hip pain. Serial radiographs from the time of surgery also should be reviewed and compared for changes indicative of loosening, migration, and osteolysis, in combination or alone. Diagnostic injections with local anesthetic agents additionally can be performed to localize the origin of pain. Bone scintigraphy, hip joint aspiration, and laboratory tests, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), should be requested routinely to exclude an occult infection. The use of ultrasoun...
Journal of surgical orthopaedic advances, 2011
We prospectively studied 110 consecutive patients with intertrochanteric hip fractures treated wi... more We prospectively studied 110 consecutive patients with intertrochanteric hip fractures treated with the 130 degree angle, 10-mm short IMHS intramedullary hip screw (IMHS, Smith & Nephew, Richards, Memphis, TN). Surgery was performed within 36 hours from admission; all patients were mobilized immediately postoperatively. Fracture union, pre- and post-operative mobility status and complications were evaluated. Eighty patients were included in the postoperative evaluation for a mean followup of 14 (range, 9 to 25) months. Mortality was 19%. Union occurred in 79 fractures within 6 months from surgery; there was one case of screw cut-out and one case of deep venous thrombosis. Periprosthetic femoral shaft fractures were not observed. At the latest examination, the mean mobility score decreased from 8.4 +/- 1.6 to 7.1 +/- 2.1 (p = 0.0001); 26 patients (32%) fully achieved the preoperative mobility score and 54 patients (68%) achieved more than 90% of the preoperative mobility score. The I...
Journal of Bone Joint Surgery British Volume, Jun 1, 2012
To review prospectively collected data on patients undergoing primary total hip arthroplasty util... more To review prospectively collected data on patients undergoing primary total hip arthroplasty utilizing two different cementless acetabular components. All patients undergoing primary total hip replacement surgery at our institution are entered prospectively into a database which includes history and physical examination, radiology, WOMAC and SF-36 scores. The patients are re-examined, re-x-rayed and re-scored at 3 months, 6 months and 1 year after surgery and yearly thereafter. Using this database we are able to identify patients who have undergone total hip replacement using one of two geometric variants of the acetabular component. The first design is hemispherical and the second design has a peripheral rim expansion designed to increase initial press-fit stability. Five hundred and twenty-seven consecutive primary total hip replacements were identified using either of the geometric variants of the acetabular component. Results at a mean of 7 years revealed a 95.6% survivorship with no significant difference between the two component designs with revision for aseptic loosening as the end point. Functional scores between the two groups of patients also demonstrated no statistically significant difference. Radiologic assessment, however, showed a difference between the two designs. The hemispherical design which matches the reamer line-to-line had 80% complete osseointegration on final radiologic review while the second design with a peripheral rim expansion had only 57% complete osseointegration. This was statistically significant. The peripherally expanded components also had a greater number of screws inserted at the time of surgery, felt by us to be a reflection of initial surgeon dissatisfaction with component stability at the time of insertion of the component. The difference in screw numbers was also statistically significant. This study demonstrates that a hemispherical design with line-to-line contact between the acetabular component surface and the acetabular bone is statistically superior in terms of bone ingrowth and probably statistically superior in terms of initial press-fit stability when compared to a peripherally expanded component. Peripherally expanded components appear to offer no advantage over hemispherical components in terms of clinical outcome and are statistically inferior to hemispherical components in radiologic parameters at 7 years follow-up.
Eur J Orthop Surg Traumatol, 2006
European Journal of Orthopaedic Surgery Traumatologie, 2006
Journal of Bone Joint Surgery British Volume, Nov 1, 2011
Purpose: Several studies have shown elevated levels of metal ions in blood of patients with metal... more Purpose: Several studies have shown elevated levels of metal ions in blood of patients with metal-on-metal (MM) total hip arthroplasty (THA). The outstanding question that remains is the clinical impact of these elevated ion levels. Even though it is well known that exposure to heavy metals such as lead, copper, mercury, nickel, and cadmium) may lead to significant alterations in human sperm morphology and motility, less is known on the effect of Co and Cr on semen parameters. The aim of the present study was to investigate the effect of metal ions on the semen of males of child fathering age with MM hip arthroplasty. Method: Semen was collected form 10 patients between 41 and 49 years old (mean = 45±6 years) by masturbation after 2–3 days of abstinence. Samples were examined within 1h after ejaculation for morphology, motility, and number of sperm cells following standard criteria from the World Health Organization (WHO). Co and Cr concentrations were measured in both the seminal plasma and in the blood of patients by inductively coupled plasma-mass spectroscopy (ICP-MS). Since spermatozoa membrane polyunsaturated fatty acids are vulnerable to attack by reactive oxygen species (leading to peroxide formation), peroxide concentrations were measured in both the seminal plasma and the blood of patients. Results: Results showed that the concentration of both Co and Cr ions was significantly lower in the seminal plasma than in the blood of the patients. Results also showed that the levels of peroxides were lower in the seminal plasma than in the blood plasma of these patients. Importantly, the ejaculate volume, the sperm density, the total sperm count, the pH, and the percentage of cells with normal morphology were in the range of the WHO criteria for fertile population and also in the range of reference patients in the city of measurements. However, the viability was a little bit lower than what was observed in a fertile population without prosthesis. Conclusion: The presence of Co and Cr ions in the blood of males of child fathering age with MM hip arthroplasty raised concerns about the quality of semen in these patients. Results of the present study strongly suggest that the raised of Co and Cr had no significant effect on sperm parameters of young patients with MM prosthesis. The methods used to identify potential normal and fertile semen samples are still contradictory and not exactly defined. Studies showed for example that only total numbers of sperm with progressive mobility are significantly different in the fertile than in sub-fertile men, while others suggested that the fertile population should be defined by sperm concentration or sperm morphology. In conclusion, results suggest that Co and Cr ions generated from MM prosthesis have no significant effect on the sperm parameters of young patients of child fathering age. Further longitudinal studies are however necessary to conclusively determine the effect of metal ions from MM prosthesis on sperm parameters.
Bulletin of the Nyu Hospital For Joint Diseases, Feb 1, 2009
Hip resurfacing has recently been offered as an attractive alternative to conventional total hip ... more Hip resurfacing has recently been offered as an attractive alternative to conventional total hip arthroplasty. This report evaluated the short-term functional outcome and longevity of a newer generation resurfacing device and includes the results of 228 consecutive hip resurfacing in 209 patients at a minimum of two-year follow-up. All resurfacing were performed by a single surgeon using a posterior approach. Excluding infections, there were only three failures (1.3%). The overall survival at 4.6 years was 96.9%. The survival of resurfacing in this study was comparable to that of other published studies of hip resurfacing. Surface hip arthroplasty appears to be an effective alternative to conventional total hip arthroplasty in patients suffering from osteoarthritis.
Journal of Bone Joint Surgery British Volume, Sep 1, 2012
ABSTRACT
Hepato Gastroenterology, 2004
Journal of Bone Joint Surgery British Volume, 2011
The purpose of this study was to evaluate the efficacy of autologous cancellous bone grafting (AB... more The purpose of this study was to evaluate the efficacy of autologous cancellous bone grafting (ABG) for the treatment of long bone fracture non-unions. Patients who were treated with ABG for fracture non-unions of the lower extremities were identified from our prospectively entered database. Non-union was defined as failure of the fracture to unite within a period of 9 months. Demographics, comorbidities, medications, complications and surgical outcomes were all recorded and subsequently analysed. Chi square test was used to analyse the results. In total 82(54 male) patients met the inclusion criteria. The mean age was 43.6 years (range 18–78). Ten patients were diagnosed with femoral and 72 with tibial fracture non-unions. Fifty three (64.6%) were open fractures at presentation. In the tibial non-union group, initially, 67 fractures were stabilised with IM nailing and 5 with plating. During revision surgery, 33 patients underwent exchanged nailing and ABG whereas 34 received ABG without revision of the metal work. All five tibial plantings required re-plating and ABG. In the femoral non-union group, five fractures were initially stabilised with IM nailing and the rest with plating. During revision surgery, six patients underwent change of fixation (exchange nailing) and ABG and four received only ABG. Overall 73/82 patients progress uneventfully to union and the success rate was 89%. A second and a third attempt of ABG was made for 6/86 patients (7.31%) and 2/82 patients (2.44%) respectively, till clinical and radiological union. All but one of the patients united their fractures. One patient underwent amputation due to underlying osteomyelitis. The mean time to union following the ABG procedures was 8.4 months (range 3–18). Autologous bone grafting is an effective method of treating fracture non-unions. Success rates of as high as 89% can be achieved as seen in this series of patients.
Spine Surgery began its evolution in the beginning of the 19th century in order to reach nowadays... more Spine Surgery began its evolution in the beginning of the 19th century in order to reach nowadays the point of being considered an important subspecialty of Neurosurgery and Orthopaedics. The purpose of this historical review is the search and evaluation of the progress in spine surgery in the second half of the 20th century. This review concerns the evolution of this field in Greece. Special references are made to the achievements of this field, to the departments that practised it, to physicians and surgeons (orthopaedic surgeons, neurosurgeons, radiologists and rheumatologists) who developed this subspecialty and to clinical and scientific work of this time period. Eventually, the progress of medicine and technology who led to the first achievements of this subspecialty are shown and also that this progress followed the development of the National Healthcare System. In Greece, with small exceptions, the new techniques emerged with a certain delay.
Spine Surgery began its evolution in the beginning of the 19th century in order to reach nowadays... more Spine Surgery began its evolution in the beginning of the 19th century in order to reach nowadays the point of being considered an important subspecialty of Neurosurgery and Orthopaedics. The purpose of this historical review is the search and evaluation of the progress in spine surgery until the 2nd World War. This review concerns the inauguration and evolution of this field in Greece. Special references are made to the first achievements of this field, to the pioneers physicians and surgeons (general surgeons, orthopaedic surgeons and neurosurgeons) who inaugurated this subspecialty and to clinical and scientific work of that era. Eventually, the progress of medicine and technology who led to the first achievements of this subspecialty are shown and also the difficulties (both social and scientific) that the pioneers of this field faced are demonstrated. In Greece, with small exceptions, the new techniques emerged with a certain delay.
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Papers by Vassilios Nikolaou