The use of osteochondral allograft with bone marrow-derived mesenchymal cells and hinge joint distraction in the treatment of post-collapse stage of osteonecrosis of the femoral head.

Osteonecrosis of the femoral head is an entity which occurs mainly in young and active patients aged between 20 and 50. The success of hip joint preserving treatments ranges from 15% to 50% depending on the stage and amount of osteonecrotic lesion. Total hip replacement is indicated in late post-collapse hips but it has unsatisfactory survival because of the wear and osteolysis in young and active patients. Osteochondral allografts have been reported in the treatment of large articular lesions with defects in underlying bone in knee, talus and shoulder. By combining osteoconductive properties of osteochondral allograft with osteogenic abilities of bone marrow-derived mesenchymal cells it has a potential to be an alternative to an autologous graft. The adjunct of hinged joint distraction should minimize stresses in subchondral bone to promote creeping substitution and prevent femoral head collapse. Unlike current treatment modalities, it would provide both structural support and allow bony and articular substitution.

Clinical and radiological results of hydroxyapatite-coated acetabular cups.

We prospectively studied a consecutive series of 60 primary total hip arthroplasties in 52 patients. All patients had a hydroxyapatite-coated hemispherical acetabular cup (OCTOFIT). Mean patient age was 52.5 (34-73) years. In 38 hips, a 28-mm and in 22 hips a 32-mm diameter cobalt-chrome femoral head was used. We could follow 53 hips for a mean of 81 (28-125) months. Four cups were revised because of osteolysis, and in another six cups, slight osteolysis without migration was seen. The average annual linear wear rate was 0.05 mm (+/-0.05) for 28-mm heads and 0.16 mm (+/-0.09) for 32-mm heads (p<0.0001). Survivorship analysis predicted a survival rate of 86+/-6.7% at 10 years.

Outcome of revision hip arthroplasty.

Background. Clinical material collected from 1989 to 1999 from three orthopedic centers is discussed: the Orthopedic Clinic at the Center for Postgraduate Medical Education in Otwock, the Orthopedic Clinic at the Lublin Academy of Medicine, and the Orthopedic Clinic at the Warsaw Academy of Medicine.
Material and methods. During this period 511 patients with an average age of 66 were treated. The authors explain the reasons for aseptic loosening of hip prostheses, the types of implants replaced, and the methods of surgical treatment.
Analysis of results. The importance of correct surgical technique and modern cementing methods during primary arthroplasty for the duration of good prosthesis functioning is discussed. A good outcome from revision arthroplasty can be expected only when the decision to treat is made early. The authors confirm the usability of impacted camcellous allografts for revision hip arthroplasty. Complications during and after surgery are also discussed. Difficulties in the clinical and radiological evaluation of treatment outcomes caused by differing criteria used in each orthopedic treatment are also discussed in this article.
Conclusions. In the conclusion the authors propose rules for surgical treatment to reduce the number of revision procedures.

[Differences in human and rat FSH receptors promote activity as a result of the transcriptional factors: E2F1, E2F4 and E2F5 overexpression]. / Zmiany w aktywnosci promotora genu receptora FSH czlowieka i szczura pod wplywem czynników transkrypcyjnych E2F1, E2F4 i E2F5.

UNLABELLED: FSH-R expression in granulosa cells varies during the course of ovarian ontogenesis, as well as, during each menstrual cycle. Expression of follicle-stimulating hormone receptors (FSH-R) on Sertoli cells of the testis and ovarian granulosa cells depend on many paracrine and autocrine factors. The modulation of FSH-R synthesis is accomplished via a number of mechanisms including regulation of the promoter activity. Little is known about factors involved in control of FSH-R transcription in different species. The aim of the present study was to investigate differences in the regulation of human and rat FSH-R promoter activity by E2F transcriptional factors. MATERIAL AND METHODS: The 5'-flanking regions of human and rat FSH receptor gene subcloned in the pGL3 plasmid were transiently transfected into cultured CHO cells and rat granulosa cells. Rat granulosa cells were obtained by puncturing ovaries from DES primed immature Sprague-Dawley rats. Promoter activity was determined by measuring firefly luciferase luminescence of the cell lysate. Transfection efficiency was normalized by the renilla luciferase activity generated by co-transfected pRL-CMV vector. In order to determine the influence of E2F1, E2F4 and E2F5, on FSH-R promoter activity, cells were transfected either with promoter construct alone or with its mixture with selected expression vector. RESULTS: Rat FSH-R promoter construct (-1033/+6 bp) and human FSH-R promoter construct (-1485/-1 bp) were both active in transfected cells. Overexpression of E2F1 protein decreased both, human and rat wild type FSH-R promoter activity. Overexpression of E2F4 did not affect neither rat nor human FSH-R gene transcription. Expression vector for E2F5 increased both, human and rat, FSH-R promoter activity. Folds of increase were markedly higher in case of rat FSH-R construct transfection, comparing to human FSH-R promoter. CONCLUSIONS: Results suggest, that the E2F1 and E2F5 factors might play an opposite role in the regulation of FSH-R promoter activity. More pronounced stimulatory effect of E2F5 on the rat FSH-R can be explained by the presence of E2F site in the promoter. Since there is no E2F sensitive element in the human FSH-R promoter sequence, E2F1 and E2F5 can also indirectly influence FSH-R promoter activity.

[Mecring threaded cup in total arthroplasty of the hip with acetabular protrusion]. / Zastosowanie panewek Mecring w protezoplastykach stawów biodrowych z protruzja panewki.

Results of total arthroplasty of the hip with acetabular protrusion with the use of Mecring cup in 21 patients (25 hips) aged 25-75 years (mean 62) are reported. Morsalised impacted autografts were used to fill acetabular defect in all cases. There were 14 rheumatoid arthritis patients, 4 cases of osteoarthritis and 3 cases of Otto-Chrobak disease. Mean follow-up was 2.5 years (range 6 months-5 years). All autografts were incorporated after 6-9 months. Only one loosening and migration of the cup occurred. One patient died because of pulmonary embolism. Harris Hip Score increased from 37 points (22-49) preoperatively to 81 points (65-89) at the latest follow-up. Incorporation of autografts reinforced acetabular bottom and prevented recurrence of protrusion. Bone remodeling indicates restoring normal biomechanics of the hip.

[Clinical and radiological assessment of proximally coated stems in growth in total hip replacement]. / Kliniczna i radiologiczna analiza wgajania trzpieni mocowanych w okolicy kretarzowej w alloplastykach stawów biodrowych.

Clinical and radiological results of total hip replacement with proximally coated stems are discussed. Material included 90 hips (50 ABG stems, 40 Level III stems) in 83 patients (59 females, 24 males), mean age 48 years (range 17-22) and mean follow-up of 27 months (range 1-5 years). No stems were revised, the average Harris Hip Score at last follow-up ranged from 89 to 91 points. Stress transfer around the proximal part of the stem resulted in endosteal osteogenesis in the 2nd and 6th Gruen zones and changed trabecular orientation. There was no evidence of bone resorption due to stress shielding. Peri- and endosteal bone reaction in the 3rd and 5th Gruen zones need longer follow-up.

[Hemispheric hydroxyapatite coated cups in total hip arthroplasty]. / Pólkuliste panewki pokrywane hydroksyapatytem w alloplastykach stawów biodrowych.

The paper presents principles of implantation as well as clinical and radiological results of hemispheric hydroxyapatite coated cups use in total hip replacement. Eighty-seven patients (60 females, 27 males) aged from 16 to 72 years (mean 49 years) underwent 96 total hip replacements with the use of 51 ABG and 45 OCTOFIT hemispheric cups. Clinical results were satisfactory with an average Harris Hip Score of 89 to 91 at final follow-up. We have found total ingrowth and osteointegration of nearly all cups. In one case of acetabular reconstruction with bone grafts cup migration has been observed and revision was necessary.

[Biomechanical principles, indications and early results of bipolar hip arthroplasty]. / Zasady biomechaniczne, wskazania i wczesne wyniki bipolarnej endoprotezoplastyki biodra.

The authors present indications and early results of bipolar hip arthroplasty in 58 patients (46 females, 12 males) aged 38-84 (mean 65 years). Femoral neck fracture in 51 patients, femoral neck pseudoarthrosis in 3, pathological fracture of the femoral neck in 2 and early type of hip osteoarthritis constituted the indication for bipolar hip replacement. No infection or dislocation has occurred. Mean follow-up was 1.5 years (6-36 months). Revision of the replacement was necessary in one patient due to faulty size of chosen implant. Results in remaining patients were rated excellent to good (mean Harris Hip Score was 93 points) with great range of movement in the operated hip. No signs of acetabular cartilage deterioration or prosthetic protrusion was observed.