[Early complications associated with total hip arthroplasty due to femoral neck fracture]. / Casné komplikace provázející TEP kycle u fraktur krcku femuru.

PURPOSE OF THE STUDY: 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. MATERIAL AND METHODS: 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. RESULTS: The average age of the patients with femoral neck fracture was 77 years and that of the control patients was 75 years. The ratio of men to women was similar in both groups; the groups differed in body height, weight, preoperative morbidity, ASA score, lymphocyte counts, severity of brain atherosclerosis, independence in walking, and self-sufficient living. The number of complications in the hip-fracture group was 87 while, in the control group, it was only 15 (p = 0.0002). The hip- fracture group showed significantly higher occurrence of postoperative delirium (34 versus 4; p = 0.001) and prosthesis dis- location (12 versus 0; p = 0.009). The subsequent multifactorial analysis showed that the risk of postoperative delirium was associated with preoperative lack of self-sufficiency (odds ratio, OR = 4.814; 95 % CI, 1.551-14.942) and the length of operative time (OR = 0.970; 95% CI, 0.951-0.989). Prosthesis dislocation was predicted by an increased height of the patient (OR = 1.087 per each cm; 95% CI 1.001-1.159). An interval between injury and surgery longer than 48 hours was not associated with higher mortality. DISCUSSION: Postoperative delirium is a complication found in up to 60% of the patients with surgery for femoral neck fracture. The frequency of this complication depends on the instruments used to identify cognitive dysfunction - with a more sensitive instrument cognitive dysfunction is probably detected in more patients.The higher occurrence of dislocation in the hip-fracture group is also in agreement with the literature data. On the other hand, its association with patient height should not be overestimated, because a coincidence of several other factors may have been involved in the mechanism of dislocation. Displacement can be prevented by the use of offset acetabular components and 36-mm femoral heads for primary implantation in such patients. CONCLUSIONS: A significantly higher frequency of prosthesis dislocation and postoperative delirium was found in the patients undergoing total hip arthroplasty for traumatic indication than in the patients after elective surgery. A subsequent multifactorial analysis revealed a potential association of prosthesis dislocation with the patient's height and that of postoperative delirium with the duration of operative time and the degree of preoperative self-sufficiency.

Comparison of Hydroxyapatite-coated stems in total hip arthroplasty after a minimum 10-years follow-up.

PURPOSE OF THE STUDY Hydroxypatite coating (HAC) was introduced into total hip arthroplasty (THA) practice to improve the fixation interface between bone and prosthesis. To test this assumption however, long-term follow-up investigations are needed. In this study, we present data for two consecutive series of THA stems with HAC and a minimum ten-year follow-up. MATERIAL Overall, 249 patients (271 hips) were included in the study, of these 122 (135 hips) had Walter hip arthroplasty (WHA group) with a two-layered TiO2/HAC at the proximal part of the stem and 127 (136 hips) had ABG I prostheses (ABG I group) with a single-layered HAC at the proximal part of the stem. Mean length of follow-up was 11.4 years (0.8-13) and 9.8 years (4-12) in WHA and ABG I groups, respectively. Mean age at the time of surgery was 62 years (23-79) and 47 years (21-65) in WHA and ABG I groups, respectively. METHODS Probabilities of implant survival were estimated using the Kaplan-Meier method. Radiographic data were included to construct the worst-case scenario. Differences in survival curves were evaluated by Gehan's Wilcoxon test. Harris hip score was used to compare preoperative status with that of final follow-up. RESULTS The overall survival of WHA was significantly better than the ABG I (0.85 versus 0.66; p < 0.05). The main reason for a high revision rate in ABG I was periprosthetic osteolysis followed by aseptic loosening. With regard to stems, the survivorship curve for the Walter stem was significantly better than for the ABG I stem even when radiographic results were included (p = 0.0002). In the WHA group, two stems (1.5%) were revised due to sepsis, in contrast to thirty-one stems (23.5%) revised in the ABG I group due to osteolysis and aseptic loosening (p < 0.05). Significant improvement was achieved in both groups under study in terms of Harris hip score. DISCUSSION Data presented here appear surprising at first glance because the differences between the stems under study are only minor. The failure in ABG I was most probably caused by poor polyethylene quality and poor locking mechanism of polyethylene liner in the metallic shell. In addition, HAC used in ABG I prosthesis was not able to prevent the development of polyethylene disease stimulated by high wear rate. CONCLUSION This study revealed excellent survivorship for WHA stems after a minimum ten-year survival and significantly poorer survivorship for the ABG I stems.This may be explained at least particularly by combined two-layered HAC used in WHA stems which provide simultaneously endurable bone interlocking and effective barrier against expansion of polyethylene disease.

Toxicological assessment of a particulate yeast (1,3/1,6)-beta-D-glucan in rats.

This study investigates the toxicity of WGP 3-6, a yeast-derived beta-glucan ingredient, during single-dose acute and sub-chronic toxicity studies in rats. For the acute study, Fisher-344 rats were administered WGP 3-6 via gavage at a dose of 2000 mg/kg body weight, and any evidence of toxicity was monitored over a 14-day period. WGP 3-6 was well tolerated, indicating that the LD(50) value is greater than 2000 mg/kg body weight. For the sub-chronic study, Fisher-344 rats (10/sex/group) were randomly allocated to receive daily gavage treatment with WGP 3-6 at doses of 0, 2, 33.3, or 100 mg/kg body weight. Control and high-dose satellite recovery groups of each sex also were included. Full toxicological monitoring and endpoint investigations were performed throughout and upon completion of the study. No negative effects on animal weights or food consumption attributable to WGP 3-6 were evident at any dose. In addition, no mortality, clinical pathology, functional/behavioral, microscopic, or gross observations indicating toxicity were observed. Sporadic changes in some biochemical and hematological parameters were observed; however, since the effects were within the physiological ranges in historical controls, were not dose-responsive, or were not observed in both sexes, they were determined to be of no toxicological significance. In conclusion, no adverse or toxic effects were observed after subchronic oral administration of 2, 33.3, or 100mg/kg body weight/day of WGP 3-6 in Fisher-344 rats, and therefore, a no observed adverse effect level (NOAEL) of 100 mg/kg body weight/day, the highest dose tested, was determined.

[Surgical therapy of osteolysis around stable cementless hip arthroplasty]. / Operacní lécba osteolýzy kolem stabilní necementované TEP kycelního kloubu.

PURPOSE OF THE STUDY: The article presents results of surgical treatment of osteolysis around stable cementless THA. MATERIAL AND METHODS: The authors evaluated 18 operated on cases of osteolysis around stable THA of ABG 1 type with a minimal follow-up of 4 years (49-70 months). The group included 6 men and 12 women who were at the time of revision 47 years old (36-56, SD 6.52). The average period between the primary and revision surgery was 45 months (23-66, SD 13.84), the average size of the original cup was 49.6 mm (44-54, SD 3.03), the median thickness of polyethylene was 7.5 mm (4.9-8.9). The average HHS prior to reoperation was 68.5 points (10-98, SD 18.3) and only three hips were completely asymptomatic (3/18, 17%). Polyethylene inlay was replaced twice, both acetabular components in twelve cases, the acetabular and femoral components in four cases. In 16 cases radical debridement and treatment of defects by bone grafting was an important part of surgery. OUTCOMES: By the time of the latest check, in total three revision surgeries were performed (3/18, 17%). Neither of them was necessitated by loosening of the revision cup or use of bone grafts. Revised were both hips after the replacement of polyethylene cup inlay. Stable bone fixation and healing of bone defect was achieved in 15 hips in which the implant replacement was combined with bone grafting (15/16, 94%). The revision cup was on average by 3.16 mm bigger than the original cup (p = 0.001). The average HHS during the latest check was 79 points (p = 0.056). DISCUSSION: In osteolysis around a stable implant, many North-American authors prefer the replacement of polyethylene cup inlay in case of an undamaged well-oriented metal cup with a functional lock. By contrast, the authors of this study in such indication replace the whole acetabular component. This discrepancy may be explained by the ABG 1 THA which often triggers an extensive osteolysis and fails relatively soon. CONCLUSION: Despite a small number of cases the study has proved that the bone bed damaged by osteolysis is able to accommodate a new cementless implant. A necessary part of the surgery is radical debridement and in more extensive defects also bone grafting.

[Is osteolysis associated with a stable total hip replacement asymptomatic?]. / Je osteolýza kolem stabilní TEP kycelního kloubu asymptomatická?

PURPOSE OF THE STUDY: It has been reported that periprosthetic osteolysis in a stable cementless total hip prosthesis is often free from symptoms. The aim of this study is to check this assumption and provide details on the clinical presentation of this troublesome and worrying complication of hip arthroplasty. MATERIAL: Between March 1999 and June 2002, 76 hips in 72 patients underwent revision arthroplasty for periprosthetic osteolysis associated with stable ABG I prostheses. This patient group included 53 females and 19 males. The average age at the time of revision was 49 years (range, 32 to 63). The average time between the primary and revision surgery was 54.6 months (range, 23 to 85). The average cup size was 49.7 mm (range, 44 to 60), the modular 28-mm CoCr head was used in 69 hips, 28-mm ceramic head in six hips, and 22-mm CoCr head in one patient. METHODS: The following characteristics were recorded: gender, age, type of patient, height, weight, symptoms, diagnosis, ERS, CRP, Harris hip score, cup size, abduction angle and extent of bony defects. The data of symptomatic and asymptomatic patients were compared by parametric or non-parametric tests. RESULTS: Before revision, 61 hips (80%) were symptomatic. The patients complained of pain or signs of instability or both, and these complaints were taken as indications for revision surgery. The remaining 15 hips (20%) were asymptomatic. The average period from the primary surgery to the appearance of the first symptoms was 43 months (range, 5 to 80). The average Harris hip score before revision was 68 points (range, 37 to 90) and 82 points (range, 10 to 98) in the symptomatic and asymptomatic patients, respectively (p = 0.002). There were no other significant differences between these patients. DISCUSSION: The results of our study are in agreement with the findings of Hozack et al., but not with those of Maloney et al. and others who have reported that the progression of osteolysis developing in association with hip arthroplasty can be without symptoms. CONCLUSIONS: Osteolysis developing around a stable cementless hip prosthesis is generally symptomatic, with pain being the most frequent symptom. Even without a periprosthetic fracture, osteolysis may seriously impair the function of a joint and comfort of the patient. Since symptomatic patients are likely to see their attending physicians, it is emphasized that attention should also be paid to asymptomatic patients who have prostheses with unsuitable designs or pairings.

[Early failure of the polyethylene liner in the ABG I total hip prosthesis]. / Predcasné selhání polyetylenové vlozky u TEP kycelního kloubu ABG I.

PURPOSE OF THE STUDY: The polyethylene liner has appeared to be a weak point in total hip arthroplasty. An early wear-through or a fracture of the polyethylene liner have been referred to as a catastrophic failure. The aim of the present study is to report our experience with this rare complication in ABG I hip prostheses. MATERIAL: Between September 1994 and January 2000 a total of 506 ABG I prostheses were implanted at our clinic. Due to wear-related complications, revision arthroplasty had to be performed in 90 hips in 23 male and 63 female patients by January 2002. Extensive titanium metallosis associated with polyethylene failure was found in 11 hips of 11 female patients. The remaining 56 hips of 52 female patients served as a control group. METHODS: The characteristics recorded in every patient's included age, type of patient, sex, height, weight, ESR, CRP, diagnosis, Harris hip score before revision, cup size, abduction angle of the cup, time between the primary and revision surgery and implant stability. Student's t-test, the Mann-Whitney U-test and Pearson's chi 2 test were used to evaluate the results. RESULTS: The complete failure of ABG I prostheses occurred in 2.17% of the replaced hips (11/506). A fracture or complete wear-through were the causes of failure in three (3/11, 27%) and eight (8/11, 73%) hips, respectively. The average cup size in hips without metallosis was 48.9 mm (range, 44-58; SD, 3.1) and that in hips with metallosis was 46.5 mm (range, 46-48; SD, 0.9). This difference was highly significant (t-test, p = 0.00002; U-test, p = 0.014). In the hips with metallosis, the average thickness of the polyethylene liner was 5.17 mm (range, 4.9-5.9; SD, 0.45) and the Harris hip scores before revision were significantly lower than in the hips without metallosis (59 versus 70.3 points; t-test, p = 0.023; U-test, p = 0.044). There were no other significant differences between the hips with early catastrophic failure of the polyethylene liner and those without it. DISCUSSION: Several studies have shown an indirect relationship between polyethylene thickness and its wear. Berry et al. reported catastrophic failure in hip prostheses with a polyethylene thickness of less than 5 mm; in our study, the three failed polyethylene liners were 5.9 mm in thickness. CONCLUSIONS: This is the first report on a wear-through of the polyethylene liner in ABG I cups. It is suggested that a thin polyethylene liner, design characteristics and probably also poor polyethylene quality are crucial factors responsible for rapid wear in ABG I cup. The highest risk is associated with the combination of a 46 mm cup and a 28 mm head. Patients who have prostheses of this size should be checked up more frequently.

[Conversion of external fixation to an intramedullary nail in complicated fractures.]. / Konverze zevní fixace na nitrodrenový hreb u komplikovaných zlomenin diafýzy - první zkusenosti.

The authors present the method of conversion of external fixation to an intramedullary nail in treatment of complicated fractures of the diaphysis of the leg. This procedure is useful in particular in open fractures and in fractures associated traumatological issue. Conversion gives very satisfactory therapeutic result with a minimum of complications. The purpose of the present paper is to elucidate the procedure and make the readers familiar with the autors' experience assembled with the method in the first six patients. Key words: external fixation, conversion, intramedullary nail.

[The role of osteotomy in the treatment of pseudoarthroses.]. / Uloha osteotomie v lécbe pakloubu

Osteotomies in the area of pseudoarthroses ensue from the necessity to correct biomechanical conditions at these sites. Depending on the site of osteotomy, we speak of intrafocal osteotomies, i. e. wedge-shaped resection (total or partial) of the pseudoarthrosis. The second type of osteotomy is transfocal osteotomy which is normal to the longitudinal axis of each fragment. The third type is parafocal osteotomy which is several centimeters from the pseudoarthrosis and the correction of biomechanical conditions is implemented in this osteotomy. The implementation of osteotomy markedly facilitates the procedure and shortens the time of operation. Healing of the pseudoarthrosis after osteotomy takes on average 5 months, of the osteotomy 7 months. The authors evaluate a group of 27 patients operated in 1982-1995. In all patients the pseudoarthrosis was cured. Key words: osteotomy, treatment of pseudoarthroses.

[Monitoring of selected biochemical markers of tissue ischemia, particularly of the digestive tract, in experiments and clinical practice]. / Monitorování vytypovaných biochemických markeru tkánové ischémie, zejména trávicího ústrojí v experimentu a klinice.

The increase of organ transposition ill tile reconstruction of digestive tract, particularly transposition of the stomach and colon, is essential ill gullet surgery. The transposition is always accompanied by certain bigger or less degree of ischemia. In this study the authors followed the biochemical markers of tissue ischaemia, capable to lay down both pre- and postoperative vitality of the tucked organ an the anastomosis. Disclosing of the initial and later stadium of intestine ischemia is tile aim. Monitoring of the lactate in the serum is very useful. Its using was proved in the rich experimental group and it was certified in clinical practice.

[An instrument for hepatic artery compression in palliative treatment of liver metastases using repeated ischemia. A model and experimental study]. / Kompresní zarízení na jaterní tepnu pro paliativní lécbu jaterních metastáz prerusovanou ischemizací. Modelová a experimentální studie.

Method of interrupted ischaemization of the liver afflicted with metastases from colorectal cancer is not definitively evaluated yet. Using the literary reports the authors proposed (in cooperation with MEDIN) a instrument for compression of the liver artery, economically easy available. The reability of this instrument was tested in model conditions and his safety to the tested artery was proved on the experimental animal.

[Results of surgical repositioning of congenital hip dislocation]. / Výsledky krvavé repozice vrozené luxace kycelního kloubu.

The authors submit an analysis of the results of surgical treatment of inborn dislocation of the hip joint in children from the age of one year to completed growth. Decisive for inclusion into this group was surgical reposition. The operated patients were divided into the following three groups by age at the time of operation: 1. first year up to 17 months; 2. 18 to 48 months; 3. patients older than 4 years up to 15 years. Between 1978 and 1992 96 children with inborn dislocation of the hip joint were operated (103 hip joints). Complete documentation was available for 59 hip joints of 54 patients. The follow up period varies between 1 and 14 years after operation. In the first group 24 hip joints of 21 patients were checked, the average age at the time of operation being 8 months. In 17 hip joints at the same time subtrochanteric osteotomy with abbreviation was performed. In these operated hip joints surgical reposition was preceded by distraction either using the "overhead" system or the Pavlanský's method. All hip joints in this group were operated from an anterolateral approach according to Scaglietti's principles. In the second group 19 hip joints of 16 patients were checked, the mean age at the time of operation being 28 months. A standard component of the operation was in addition to surgical reposition also pelvic osteotomy according to Salter's method, in 16 cases at the same time derotation varus osteotomy was performed. The third group comprises 16 hip joints of 15 patients operated at an average age of 9 years and 8 months. Fourteen of the hip joints had been operated previously at least once by different methods. In acetabular dysplasia different techniques were used, most frequently Chiari's osteotomy. The surgical reposition proper was preceded in four instances of high iliac dislocation by preoperative distraction by external fixation. For evaluation of the results clinical and radiological parameters were used, essentially identical with Severin's classification. X-ray evaluation was supplemented y values of the distance between the head and Köhler's protrusion. The best clinical and X-ray results were achieved in the first group; wih the number of previous operations and advancing age the perspective of excellent results declines. In the group as a whole five, i. e. 8.5%, avascular necroses were recorded. From the total number of operated patients good radiological results were achieved in 83%, 17% of the results are considered satisfactory.(ABSTRACT TRUNCATED AT 250 WORDS)

[Serum fatty acids in premature neonates]. / Mastné kyseliny v séru predcasne narozených novorozencu.

In the past we have published several papers concerning the evolution of large spectrum of fatty acids in the brain or in the blood-serum in rats or in human newborns (and their mothers just after the delivery). Therefore we realized this study: the blood-serum spectrum of fatty acids in the healthy human newborns (n = 32) was compared with the spectrum of fatty acids detected in the blood-serum of human premature neonates (n = 22). The birth-weight in the control group was 3,882, in the premature neonates 2,137 g only. Fatty acids were measured as methylesters (FAME) using the method of gas chromatography and absolutely the same methodological approach as in our previous studies (33, 22, 23). The results were computed by biocybernet. dep. of Physiological institute and the statistics were evaluated by Mann-Whitney U test. It was established that the premature neonates show a distinct greater content (expressed in percentage) of saturated fatty acids and a smaller share of polyenoic FA (PUFA). A further marked difference consists in a significant lower of the n-3 FA and consequently a higher n-6/n-3 index. In premature neonates a significant increase of caprylic acid and arachidonic acid in the blood-serum was detected. The significance of described changes in the participation of single fatty acids in the premature neonates for their maturation, structural evolution especially of the brain cells and for therapy, is discussed.

Proportion of individual fatty acids in the non-esterified (free) fatty acid (FFA) fraction in the serum of laboratory rats of different ages.

In experiments on Wistar strain rats of both sexes, aged 5, 10 and 14 days and adult (90-120 days), of their own breed, the authors determined the quantitative proportion of individual fatty acids in the serum free non-esterified fatty acid (FFA) fraction, using mixed blood (obtained by decapitation) and the titration method of Trout et al. (1960). The proportion of the individual fatty acids was then determined in this fraction by gas chromatography (Base 1978) and their concentration (in mumol.1-1) was determined by simple calculation from the relative chromatogram data. Animals in the first three age groups were killed in the morning, directly from the nest; in adult rats the FFA fraction was measured after a 20 h fast. It was demonstrated that the increase in the proportion of monoenoic acids was highly statistically significant (about fivefold) during ontogenesis and that there was also a marked increase in the quantitative expression of polyenic acids, especially in group (n-6). The n-6/n-3 acid index in the FFA fraction altered during maturation (despite some fluctuation it basically rose from 4.3 in 5-day-old young to 10.0 in adult rats). It was further demonstrated that the concentration of fatty acids with a very short chain fell significantly during development, so that C 8:0, for example, could be detected only in the first two age groups, but not in 14-day-old and adult rats. The concentration of the saturated fatty acids C 15:0 to C 18:0 in the serum FFA fraction showed a statistically significant increase, while the index expressing the ratio of saturated to unsaturated fatty acids displayed a downward trend during development.

[Determination of hepatotoxicity using the texture analysis method]. / Stanovení hepatotoxicity metodou analýzy obrazu.

To determine the hepatotoxic effects of hydrazine sulphate by means of a complex of methods of morphological examinations, ten sheep were used as a model of acute liver lesions induced by this compound. The hepatotoxic effects were demonstrated by a general histological examination of liver tissue and by a quantitative evaluation of percent proportions of intact liver parenchyma. Among quantitative indicators, the areas of histochemically detectable neutral lipids and of glycogen in liver tissue were also evaluated. Quantitative evaluation was performed by means of an automatic texture analysis using a texture analyzer T.A.S. plus (Leitz Texture Analyzer System) and a programme devised by the authors in the TASIC language. Similar steatotic changes in liver tissue were found in sheep which were treated with a dose of 0.4 mmol of hydrazine sulphate per 1 kg of live weight, as earlier reported for laboratory animals, carnivores, and monkeys. The above methods of morphological examination can be used for a basal determination of hepatotoxic effects of substances tested in pharmacological research.