Kinematic and Kinetic Waveform Changes of the Knee Joint Following a Mobile Bearing Total Knee Arthroplasty-Gait Analysis and Single Step Ascent.

The objective of this study is to analyze the kinetic and kinematic changes of the osteoarthritic knee after a mobile bearing total knee arthroplasty. Kinematic and kinetic gait analysis of level walking was performed in 15 patients (eight female and seven male) with knee ostoarthritis. All patients were free of any neurological diseases that could affect their normal gait. Mean age was 68.6 ± 5.2 years, mean height 159.8 ± 6.9 cm, and mean weight was 78.5 ± 10.1 kg. Full body gait analysis was performed using the BioKin three-dimensional (3D) motion analysis system preoperatively and 9 months after total knee arthroplasty. A single-step ascending kinetic analysis and a plantar pressure distribution analysis were also performed in all patients. An increased average cadence (mean 99.39 step/min preoperatively and 104.64 step/min postoperatively; p = 0.152), step length (0.44 m preoperatively and 0.52 m postoperatively; p < 0.001), stride length (0.89 m preoperatively and 1.0 m postoperatively; p < 0.007), and walking velocity (0.73 m/sec preoperatively and 0.90 m/sec postoperatively; p = 0.005) were noted postoperatively and postoperatively. A decrease in the stance duration percentage and the knee adduction moment was also reported postoperatively. All patients showed a significant improvement of knee kinetics and kinematics after a mobile bearing total knee arthroplasty. Statistically significant differences were found in the step length, stride length, and walk velocity postoperatively. The knee adduction moment was also significantly reduced. Further research is warranted to determine the clinical relevance of these findings. This study is a prospective comparative one and reflects level II evidence.

[Prisoners in Greek prisons: Correlation of demographic and psychosocial data with committed crimes].

Previous literature shows an association between several psychosocial factors or life events in general and delinquency. Factors such as gender, cannabis and drugs use are firmly connected to delinquency. Similarly, interpersonal violent behavior appears to be more frequent in people with lower socioeconomic status and people with lower education. The association of these factors with the violent or non-violent crimes, especially in Greek research literature, is very limited. The present study is an attempt to examine in a Greek prison population the correlation of demographic and psychosocial factors with violent and non-violent crime. The prison population sample comprised of 308 males from a total of 1300 prisoners, aged between 18 and 77 years old. The survey was conducted from January 2012 until August 2013 in Korydallos and Domokos prisons. In our prison population sample most of the crimes were non-violent. The prisoners were urban dwellers, of young age, were not married and were in short-term relationships on average. They had completed their military obligations, were not live alone, and have been working in the last six months before being imprisoned, in manual labor. They had low-grade education and poor school achievements, had been brawling with classmates and had history of antisocial behavior (liked to "put fire" and abuse animals). They report good relationships with their parents; however, they had experienced violence in parental relationships and some kind of violence, mainly by the father and secondarily by the mother. They have not been involved in gangs necessarily and have a history from a young age, of alcohol, cannabis and drugs use. Cannabis use history was reported by 208 prisoners (67.5%) and 133 (63.9%) of them started using at the age of 10-15 years old. A total of 179 prisoners (58.5%) reported a history of drug use, about half of them (50.3%) reported being addicted to a combination of drugs. For 40.8% (n=73) drug use was initiated in the age of 10-15 years old, while the largest percentage (46.4%) of prisoners mentioned as starting age 16-20 years old. Although the above features underline the great differences between prison population and the general population, there are no significant associations of these factors with violent or non-violent crime. However, the prisoners with drug use history were 65% less likely to have been sentenced for violent crime. Also, the prisoners exempted from their military duties, were 49% less likely to have committed violent crime.

The incidence of infrapatellar plicae in the elderly Welsh population.

There are several studies reporting the incidence of suprapatellar, medial, and lateral plicae, but there is very limited information regarding the incidence of the infrapatellar plica. The purpose of our study was to record the incidence of infrapatellar plicae in the elderly Welsh population suffering from knee osteoarthritis. A prospective study was performed and 90 knees with severe osteoarthritis of the knee joint (Kellgren-Lawrence type III and IV) were investigated during total knee arthroplasty surgery. Documentation was performed at every total knee replacement surgery for the length of the study. Knee replacement was performed by one senior surgeon. Infrapatellar plica was investigated by a medial parapatellar approach and was classified into five types according to Kim's classification. The overall incidence of infrapatellar plicae was 37.7%. The most common type of plicae was the separate type (23.3%). There was no significant difference found between male and female patients. The fenestra type was the least common (2.22%). The incidence of infrapatellar plicae in the elderly Welsh population suffering from knee osteoarthritis was significantly lower when compared to a study that recorded the incidence of infrapatellar plica in young patients. Possibly, the degenerative changes of the knee joint can cause the resorption of the infrapatellar plica, thus decreasing its incidence in the elderly population.

Fixed versus mobile bearing knee arthroplasty: a review of kinematics and results.

There are several total knee arthroplasty designs available with wide variation in features. The long-term results of total knee replacement with a fixed bearing design have shown a high degree of clinical success. However, implant loosening and polyethylene wear became recognized as long-term causes of late failure. Mobile bearing knee replacements were designed to create a durable surface articulation by using a polyethylene insert that articulates with a metallic femoral component and a metallic tibial tray. The purpose of this article is to review clinical and basic scientific studies comparing the clinical results, the biomechanical features, and the kinematic patterns of fixed versus mobile bearing knee designs. Beside the fact that in vitro kinematic studies have shown reduced polyethylene wear in mobile bearings due to increased implant conformity and reduced polyethylene contact stresses, which should hypothetically prolong polyethylene life, various independent studies for both mobile bearing and fixed bearing prostheses have documented results that are comparable in terms of survival and performance.

Total knee arthroplasty in severe valgus knee deformity: comparison of a standard medial parapatellar approach combined with tibial tubercle osteotomy.

PURPOSE: Primary TKA in valgus knees with a deformity of more than ten degrees may prove challenging, since bone and soft tissue abnormalities make accurate axis restoration, component orientation and joint stability attainment a difficult task. The purpose of this study was to determine which approach is optimal in these patients, by comparing the standard medial parapatellar approach to a lateral parapatellar combined with a tibial tubercle osteotomy (TTO). METHODS: Forty-four valgus knees--with an axis deviation ranging from 15 to 36 degrees (mean 24°)--were dealt with primary TKA and followed up for a minimum period of 7 years. Lateral parapatellar arthrotomy combined with TTO was performed in 22 individuals (Group A) and a standard medial parapatellar capsulotomy in the remaining patients (Group B). The International Knee Society System Score (IKSS) was used for clinical evaluation. Radiological assessment was performed yearly postoperatively using long films for assessment of the anatomical axis. RESULTS: The postoperative IKSS scores showed no significant statistical difference between groups A and B (P < 0.05). In the alignment parameter, however, residual valgus deviation occurred in 9% of patients from Group A and in 32% from Group B. No late-onset instability was displayed. CONCLUSION: Lateral parapatellar approach combined with TTO may prove highly beneficial in significant valgus deformities, as the anatomical axis is restored accurately and soft tissue release of the lateral contracted structures facilitated to an important extent.

Total knee arthroplasty in severe valgus deformity: interest of combining a lateral approach with a tibial tubercle osteotomy.

INTRODUCTION: Among the patients requiring total knee arthroplasty (TKA), approximately 10-15% presents with a valgus deformity (VD). Severely deformed valgus knees represent a surgical challenge. The purpose of this study is to evaluate the results of TKA in grade II and III valgus knee deformities (Ranawat classification), focusing on axis correction, by using a lateral parapatellar capsulotomy combined with tibial tubercle osteotomy. HYPOTHESIS: The lateral approach in combination with a tibial tuberosity osteotomy is highly beneficial in the treatment of severe valgus knees in patients undergoing primary TKA, for correction of anatomical axis. PATIENTS AND METHODS: Between January 1995 and December 2001, 33 patients with severe VD, grade II and III, were treated with TKA by one surgeon. Twenty-six patients (19 male, seven female) with mean age of 72 years (57-79) were dealt with a resurfacing posterior stabilized design; whereas in seven cases, a constrained type implant was used. These seven patients were excluded from the study. Two more patients were lost for follow-up and were also excluded. The axis deviation of the remaining 24 patients ranged from 15 to 35 degrees, (average 23°). A lateral parapatellar arthrotomy, in combination with tibial tubercle osteotomy was used. Patients' clinical evaluation - using the International Knee Society (IKS) score - with simultaneous radiological assessment was performed yearly after the operation; and for a mean follow-up time of 11.5 years (8 to 15 years). RESULTS: The mean IKS score improved from 44 points (34 to 52) preoperatively, to 91 points (68 to 100) postoperatively, at the last follow-up. In terms of alignment parameter, only two knees had a residual valgus deviation greater than 7° (ideal range : 3-7°). One knee exhibited a 9° valgus, and another one 10°, according to anatomical axis measurments. In one case, there was a 5mm proximal migration of the osteotomised tuberosity fragment, due to breakage of the screw. However, the final outcome was not affected. There were no cases of tibial tubercle's non-union; neither of delayed instability. CONCLUSION: The lateral approach is a useful approach in the treatment of severe valgus knee deformity in patients undergoing primary TKA. Anatomical axis restoration is facilitated, as the contracted structures are easily accessed and, in severe cases, the patellar alignment may be achieved by displacing the osteotomised tubercle. However, careful fixation of the tuberosity is mandatory. LEVEL OF EVIDENCE: Level IV, prospective study of case series.

The effectiveness of reinfusion after total knee replacement. A prospective randomised controlled study.

The purpose of our study was to determine the effectiveness of a postoperative autologous blood reinfusion system as an alternative to homologous, banked blood transfusions in total knee arthroplasty. We carried out a prospective randomised controlled study on 60 patients having unilateral total knee replacements. In all these patients, the same surgical team applied the same surgical technique, and all patients followed the same rehabilitation program. In 30 of these patients (group A), a reinfusion system of unwashed salvaged blood was applied, and they were supplemented postoperatively with banked blood transfusions when required. A control group of 30 patients (group B), in whom standard suction drains were used, received one unit of homologous banked blood transfusion intraoperatively and additional blood transfusions postoperatively when required. The administration of banked blood transfusion was determined by the haemoglobin value (<9 mg/dl) and/or clinical signs (blood pressure, pulse, etc.). The values of haemoglobin, haematocrit and platelets were recorded preoperatively and the first, fifth and 15th postoperative days, respectively. Five patients of group A required nine units of homologous blood (0.3 units/patient) postoperatively. Ten patients of group B required an additional 15 banked blood units postoperatively (in total 45 banked blood units for group B; 1.5 units/patient). In the study group, the total homologous blood requirements were reduced by 80%, while the postoperative blood requirements were reduced by 50%. There was no significant difference in the postoperative haematocrit and haemoglobin values between the two groups. The cost of the blood management in the study group was reduced by 36%. The use of an autologous blood reinfusion system reduces highly effectively the demands of homologous banked blood transfusion in total knee arthroplasty.

Dental attendance patterns and oral hygiene habits of 5-year-old children in Athens and in south London.

This study compared the dental attendance patterns and oral hygiene habits of 5-year-old children in the London boroughs of Lambeth, Lewisham and Southwark with those in the municipality of Athens in the light of differing provision of oral health education. Questionnaires were sent to the parents of 384 children in London and 318 children in Athens who took part in a survey of dental health. Response rates of 51% and 53% respectively were obtained. More children visit the dentist in South London than in Athens, the difference being highly significant. In South London the majority of children visit every 6 months, whereas in Athens they only visit when they have toothache. More London children brush their teeth than Athens children, the difference being significant. Of those brushing in London, most brush twice daily. The above findings indicate marked differences in dental attendance patterns and oral hygiene habits, and this may be partly attributable to differences in the delivery of dental care and oral health education in the two countries.

Caries prevalence of 5-year-old children in Athens and in South London.

This study compared the dental health of 5-year-old children in the London boroughs of Lambeth, Lewisham and Southwark with that in the municipality of Athens, Greece. Three hundred and eighty-four children were examined in London, and 318 in Athens; both samples had a mean age of 5 years 6 months. The proportion of London children who were caries free was 56%, and of Athens children 57.5%, and the mean dmft was 1.63 and 1.48, respectively; these differences were not statistically significant. However, excluding caries-free children from the analysis, the London children had significantly fewer decayed teeth (mean 2.35 compared with 2.93 in Athens) and significantly more missing teeth (mean 0.63 compared with 0.02), indicating marked differences in treatment patterns.

Dental caries changes between 1982 and 1991 in children aged 6-12 in Athens, Greece.

The aim of this study was to compare dental caries and oral hygiene status in children aged 6-12 years in the Athens area between 1982 and 1991. Dental examinations were carried out by the same examiners in 773 children attending the same randomly selected schools sited in areas of different socioeconomic levels. The findings concerning the deciduous dention showed that the percentage of caries-free children increased in 1991 compared to 1982 by 38%. The mean deft scores were reduced by an amount ranging from 21 to 34%. Changes in caries prevalence were also observed in the permanent dention. The percentage of caries-free children for the total examined population increased by 94% while the reduction in DMFT index ranged between 38 and 70%. Treatment need was significantly lower in 1991 compared to 1982 in both dentitions. Debris index scores were similar while oral hygiene habits had slightly improved by 1991. The decline in caries levels may be attributed to the increased use of various forms of fluoride. Furthermore, dental health awareness of the population has improved.

Effect of LongoVital treatment on development of periodontal disease in rats.

LongoVital is a herbal tablet with documented immunostimulatory effects in man. In the present study the effect of LongoVital on development of periodontal disease was investigated in a rat model. Fifty-four conventional rats, 5 wk old, were distributed into the following groups: A) untreated, uninfected; B) untreated, infected with Actinomyces viscosus and Porphyromonas gingivalis wk 8; C) treated with LongoVital 80 mg x 3/wk, wk 5-14, uninfected; D) treated with LongoVital 80 mg x 3/wk, wk 5-14, infected with A. viscosus and P. gingivalis wk 8; E) treated with LongoVital 200 mg x 1 in wk 8 and 80 mg wk 9-14, uninfected; F) infected with A. viscosus and P. gingivalis wk 8, subsequently treated with LongoVital 200 mg x 1 in wk 8 and 80 mg wk 9-14. All animals were killed when they were 15 wk old, and periodontal bone support was assessed radiographically. Statistically significant bone loss was found in untreated, infected rats, as compared with untreated, uninfected rats. In LongoVital-treated animals, no significant difference was seen in bone level between infected and uninfected rats. These results indicate that LongoVital-treated rats were protected against periodontal bone loss caused by infection with A. viscosus and P. gingivalis. Furthermore, the protection seemed effective both when LongoVital was administered prophylactically and after exposure to periodontal pathogens. The active components of LongoVital, as well as the mechanisms responsible for the protection, remain obscure.

[Use of experimental animals in caries research]. / Chrese peiramatozoon se meletes teredonas.

Animal models have been used extensively in biomedical research. The choice of the most appropriate model for a given research project is fundamental and depends upon specific characteristics of the animal. In the field of Preventive Dentistry the rodent species possess certain advantages which make them extremely useful in caries research and in dental plague pathogenicity. In caries research, rats have been used successfully to study anticaries efficacy of chemical agents, immunization, cariogenicity of diet, maturation of enamel and bacterial involvement in caries process. In this paper the dental characteristics of the rats are discussed emphasizing on the structure of their teeth, oral flora and composition of the saliva. Some of the experimental methods and procedures commonly used for microbial sampling, caries scoring and preparing diet are also described. In addition, an emphasis in given to certain experimental variables, which if not identified and strictly controlled, can attribute to a great variability and inaccuracy of the results. Finally, a basic experimental design for animal caries tests is suggested. In the last few decades, progress in caries research has substantially resulted from the utilization of the animal model system which have enabled examination of various facets of this disease under controlled laboratory conditions. The knowledge gained so far has been successfully applied on man with regard to diagnosis, treatment and prevention on dental caries.

Prognostic significance of immune function parameters in patients with chronic lymphocytic leukaemia.

We determined immune function parameters in 41 newly diagnosed patients with chronic lymphocytic leukaemia (CLL) and correlated these findings with the clinical data and the subsequent course of the disease. The ratio of helper to suppressor T cells (CD4/CD8), the proportion of circulating natural killer (NK) cells and the NK activity were significantly low in clinical stage B and C patients. Among patients presenting with advanced disease, those who subsequently had a more severe course, characterised mainly by frequent respiratory infections, were found to have at presentation a significantly lower CD4/CD8 ratio (x +/- SEM = 0.95 +/- 0.09, vs 1.28 +/- 0.14), a very low proportion of NK cells (4.78 +/- 0.85, vs 11.75 +/- 2.1%) and decreased amount of gamma-globulins (0.66 +/- 0.08, vs 0.97 +/- 0.09 g/dl), in comparison with patients with a much milder later course. These simple parameters of immune function seem to have prognostic value for patients with CLL.

[Glucosyltransferase (GTF) and immunization against dental caries in humans]. / Glykosyltranspherase (GTF) kai anosopoiese kata tes teredonas ston anthropo.

Glucosyltransferase (GTF) is an extracellular or cell-associated enzyme synthesized by the "mutans" group of streptococci as well as the S. sanguis and is responsible for the biosynthesis of extracellular polysaccharides. Glucan formation in dental plaque mediates binding of S. mutans and S. sanguis to one another as well as to other bacteria. Although the production of organic acids is an indispensable property of the cariogenic strains of bacteria, their ability to stick and accumulate on tooth surfaces is an almost equally significant parameter of virulence. Furthermore, GTF has been proven to be an effective antigen in eliciting caries-protective secretory IgA antibodies in rodent models. That led to the identification of GTF as a potential antigen for use in a human caries vaccine. The results of recent studies suggest that oral immunization with GTF, has the potential to elicit a secretory IgA antibody response and to interfere with accumulation and permanent colonization of S. mutans on smooth tooth surfaces. However, it cannot be inferred from the available data whether such a vaccine is effective in caries prevention in human beings. Although many modifications seem to be necessary with regard to the composition, dose, frequency and route of administration of the antigen, the preparation of a safe and effective vaccine against human caries is considered to be feasible in the near future.

[Quality assessment of fillings by place and type of provider]. / Axiologese tes poiotetas emphraxeon kata topo kai phorea therapeias.

The purpose of this study was to determine the quality of 1310 fillings among third-year dental students of Athens University. The mean age of fillings was 5.6 years. The classification of fillings into three categories of quality showed that 41.4% were satisfactory, 47.2% were acceptable but needed to be refinished, and finally 11.4% had to be replaced. The main reasons for failure were poor performance of anatomic form, secondary caries, poor marginal adaptation and soft tissues damage. The comparison of quality of fillings by place and type of provider showed that University Dental Clinic's fillings were of significantly better quality than those rendered in private or public dental clinics either in Athens or elsewhere. On the contrary the comparison of quality of fillings by place and type of provider (University Clinic excluded) did not show any significant differences.

[Evaluation of dental behaviour in adults with an advanced level of education in Athens]. / Diereunese tes odontiatrikes symperiphoras enelikon atomon ypselou ekpaideutikou epipedou sten Athena.

The purpose of this study was to evaluate the dental health behaviour in adults of advanced education. Ninety adults, aged 31-60, men and women were randomly selected from a population of advanced education. All the subjects had a thorough oral examination in order to record their dental health indices. Before the examination each participant was interviewed personally for determining, among others, their knowledge about oral health in general and more specifically about prevention of oral diseases. Their responses were correlated with the dental health indices that were determined by the dental examination. The results of the study indicate that this segment of the population demonstrates better oral health status than other population groups of the same age in Greece; the values of the restorative treatment indices were especially very high. From their responses it was found that although their theoretical knowledge on general dental health was satisfactory their information on prevention of oral disease was very limited. It is therefore concluded that although the level of education of adult population correlates well with the level of dental care received, an effective control of oral disease could be realised only if prevention procedures and dental health education is initiated early in life.