Prevalence of radiographic primary hip and knee osteoarthritis in a representative Central European population.

The aim of our study was to determine the radiographic prevalence of hip and knee osteoarthritis and compare our results with prevalence data reported by other studies, as no similar study had been performed in Hungary previously. Our aim was also to investigate the usefulness of the different radiological scoring methods for the definition of osteoarthritis. Patients who earlier reported complaints and gave written consent were asked to participate in a clinical follow-up. In the 682 participants Harris hip score, visual analogue pain scale values for both joints, Knee Society score and knee functional score were calculated. Weight-bearing radiographs were taken of both joints. Kellgren-Lawrence radiological evaluation was performed and osteoarthritis prevalence was defined. Hip osteoarthritis was found in 109 cases (16.49%), and knee osteoarthritis was found in 111 cases (16.54%). Harris hip score, Knee Society score, functional score and visual analogue scale values were significantly worse in people with radiographically proven osteoarthritis compared to the control group (p < 0.05). Significantly higher osteoarthritis prevalence of both joints was found in those with increased body mass index values. Age also plays a significant role in the development of both hip and knee osteoarthritis. No significant difference was observed between male and female participants regarding osteoarthritis prevalence. The Kellgren-Lawrence score with a cut-off value of 2 or more is a useful evaluation method for the detection of osteoarthritis prevalence in epidemiological studies; according to our observations, in clinical practice a cut-off value of three or more is more relevant.

[Prevalence of knee osteoarthritis in Hungary. Study conducted in a representative Hungarian population]. / Térdízületi arthrosis hazai elofordulása a dél-dunántúli betegpopuláción történt felmérés alapján.

UNLABELLED: In an earlier publication, authors have already reported the result of a survey conducted in a representative Hungarian population, where joint complaint prevalence data were presented, including those of the knee joint. AIMS: Following the above mentioned publication, in the current study authors aimed to determine the clinical and radiological prevalence of knee osteoarthritis using internationally accepted scoring methods for evaluation. METHODS: 2422 patients with complaints and consent were invited for a clinical follow up. 682 people (244 male; 438 female) came to participate in the study. After recording case history, and anthropometric parameters, a thorough musculoskeletal examination was carried out. Using these data Knee Society Score, Functional score and visual analogue pain scale values were calculated. On the AP and lateral view X-rays joint space width was measured, Kellgren-Lawrence radiological evaluation was performed and osteoarthritis prevalence was defined. RESULTS: radiological evaluation was possible in 676 cases. Knee osteoarthritis was found in 91 people (13.3%), severe osteoarthritis in 20 people (2.9%). Functional parameters of radiologically negative and positive cases were compared. Knee Society Score, functional score and visual analogue scale values were significantly worse in people with defined osteoarthritis (p<0.05). Regarding Body Mass Index, significantly higher values were found in those with osteoarthritis as well. CONCLUSIONS: Authors presented radiographic knee osteoarthritis prevalence data for the first time in the Hungarian literature. According to their observations, age and higher BMI values play a significant role in the development of knee osteoarthritis. After discussing the details of the survey, an overview and comparison with data of international literature is given.

Osteochondral integration of multiply incised pure cartilage allograft: repair method of focal chondral defects in a porcine model.

BACKGROUND: A focal cartilage lesion has limited capacity to heal, and the repair modalities used at present are still unable to provide a universal solution. Pure cartilage graft implantation appears to be a simple option, but it has not been applied widely as cartilage will not reattach easily to the subchondral bone. HYPOTHESIS: We used a multiple-incision technique (processed chondrograft) to increase cartilage graft surface. We hypothesized that pure cartilage graft with augmented osteochondral fusion capacity may be used for cartilage repair and we compared this method with other repair techniques. STUDY DESIGN: Controlled laboratory study. METHODS: Full-thickness focal cartilage defects were created on the medial femoral condyle of 9-month-old pigs; defects were repaired using various methods including bone marrow stimulation, autologous chondrocyte implantation, and processed chondrograft. After the repair, at weeks 6 and 24, macroscopic and histologic evaluation was carried out. RESULTS: Compared with other methods, processed chondrograft was found to be similarly effective in cartilage repair. Defects without repair and defects treated with bone marrow stimulation appeared slightly irregular with fibrocartilage filling. Autologous chondrocyte implantation produced hyalinelike cartilage, although its cellular organization was distinguishable from the surrounding articular cartilage. Processed chondrograft demonstrated good osteochondral integration, and the resulting tissue appeared to be hyaline cartilage. CONCLUSION: The applied cartilage surface processing method allows acceptable osteochondral integration, and the repair tissue appears to have good macroscopic and histologic characteristics. CLINICAL RELEVANCE: If further studies confirm its efficacy, this technique could be considered for human application in the future.

[Legal regulation in the field of tissue engineering]. / A sejt- és szövettenyésztés jogi vonatkozásai. Hazai és külföldi tapasztalatok.

In the past few years, biotechnology and tissue engineering have developed a great deal. Legislation, however, has not been able to keep pace with the rapid changes in the research and treatment using tissue-engineered products. The authors tried to explore and compare all the regulatory factors concerning cell and tissue engineering in the Hungarian and foreign law. The thorough study elucidated that the Hungarian regulation in this area is fairly deficient when compared with the regulations of other European countries, where quite extensive directives are applied. A currently accepted regulation fills this void efficiently in the European Union providing strong base for tissue engineering-related research and therapy for the future.

[Prevalence of musculoskeletal symptoms in adulthood and adolescence (survey conducted in the Southern Transdanubian region in a representative sample of 10.000 people]. / Mozgásszervi panaszok gyakorisága felnott- es serdülokorban (Reprezentatív felmérés a Dél-Dunántúlon 10 ezer fos mintán).

UNLABELLED: The time period between 2000-2010 has been declared the "bone and joint decade" by the World Health Organisation. Throughout this time the international scientific interest focuses mainly on the muskuloskeletal diseases: epidemiology, preventive and therapeutic measures. OBJECTIVE: Joining this international effort authors aim was to define the prevalence of the musculoskeletal symptoms and the general musculoskeletal state of health of a representative sample in the hungarian population. METHOD: Obtaining data from the Central Office of Statistics, a sample of 10 thousand people living in the South Transdanubian Region aged between 14-65 years was selected. The sample was representative concerning age, employment and municipal structure. A survey was performed by asking the people to fill out a questionnaire made by the authors, which consisted of questions focusing on musculoskeletal symptoms, and the Short Form-36 questionnaire. RESULTS: Based on questionnaire data, approximate prevalence values of the different musculoskeletal complaints were obtained. Thus, the prevalence of low back pain was 44.1%, hip pain occurred in 22.2%, knee pain in 30.3%, and ankle pain in 9.7% in the observed population. CONCLUSION: Compared with the international data, authors conclude that the prevalence of the musculoskeletal symptoms: low back pain, hip and knee pain is superior in the observed sample. Based on the results of the Short Form-36 questionnaire it seems that in the majority of the examined parameters the state of health is worse in the Southern Transdanubian population compared to the Western European and the North American Populations.

Repair of steps and gaps in articular fracture models.

To examine the healing of surface defects in articular fractures, gaps measuring 0.5 mm wide and 2 mm deep were created in 0.5-mm coronal step-offs on the medial femoral condyles of 16 rabbits, and identical gaps without step-offs were created in another set of 13 rabbits. Evaluation of repair was done 6, 12, and 24 weeks postoperatively. Histologically, subchondral bone restoration of gaps in step-offs was complete by 24 weeks, whereas restoration was incomplete in most gap-only lesions. Bone density measured by peripheral quantitative computed tomography was normal in gaps in step-offs by 24 weeks, but values were less than in controls in the gap-only group. A moderate degree of degeneration was detected only at the high sides of step-off + gap lesions. The joint surface was restored by fibrous cartilage that showed gradually improving maturity in all defects, however, real integration with adjacent original cartilage did not occur. Immunohistologic examination showed decreasing collagen Type I and increasing Type II staining intensity in repair tissue of both types of lesions. These observations suggest that minor surface gaps and steps of articular fractures may regenerate without inducing severe early joint degeneration. However, certain repair features make the long-term outcome of these defects uncertain.

[Treatment options of bone defects in revision of total knee replacement]. / Csontdefektusok megoldási lehetoségei revíziós térdprotetikában.

UNLABELLED: Total condylar knee replacement presently has more than 10 years of history in Hungary. Besides a large number of routine primary implantations, the number of exchange arthroplasties performed due to aseptic loosening is continuously growing as well. One of the most significant difficulties of revision interventions is the management of bone defects. OBJECTIVE: Aim of present study is to describe the treatment options of bone deficiencies found during knee arthroplasties. Indication criteria of different methods are introduced together with the results of revision operations dealing with bone defects in the authors' patient sample. METHOD: Between 1995 and 2001, 35 revision total knee replacements have been performed at the authors' institute where significant bone defects had to be dealt with. Because of aseptic loosening, unior bicondylar implant revision has been carried out in 24 cases and total condylar prosthesis revision in 11 cases. With 14 patients autologous bone, in 7 cases allogenic cancellous bone and in two cases structural allografts have been used. Metal augmentation of the prosthesis in itself was applied in 4 patients, in 8 further patients in combination with bone grafts. RESULTS: During physical and radiological control examination of 31 knees in average 3 years after the operation, authors found good clinical results in all cases except one. Bone grafts showed good remodeling, and the implants were all fixed well on the control radiographs except of the one failed case. With this patient, collapse of the structural allograft used for reconstruction of a large medial tibial defect was evident and the tibial component became loose. CONCLUSIONS: Based on international literature data and their own experiences, authors conclude that aseptic loosening of total knee endoprostheses can be managed with good results even if it is combined with massive bone loss. For a successful revision, an appropriate technical background, personal skills and a well-functioning bone bank is unavoidable. For the management of tibial defects, authors highly recommend the usage of long stem extensions.

Radiographic parameters of the hip joint from birth to adolescence.

BACKGROUND: Various qualitative and quantitative radiological geometrical parameters can be of great help when assessing dysplasia of the hip joint and in understanding developmental processes of the infant hip. There are few data on the normal values of the hip joint at different ages. OBJECTIVE: To perform radiographic measurements on hip joints considered to be anatomically normal and to provide data for each age group, thus describing features of the radiographic development of the hip. MATERIALS AND METHODS: Radiographs were examined from 355 children (age 0-16 years) undergoing examination for scoliosis (long film), urography or plain abdominal radiography. Qualitative and quantitative signs were observed and measured, focusing on the Hilgenreiner, Wiberg and Idelberger angles and the decentric distance. RESULTS: Before the age of 9 years measurable data from neighbouring age groups differed significantly, indicating typical radiological changes of the joint. For the same age range, qualitative changes could also be observed. After 9 years of age, radiological development of the normal hip joint during childhood is much slower.

Long-term results of derotational femoral varus osteotomy in Legg-Calvé-Perthes disease: 26-year follow-up.

The long-term results of 30 patients (31 hips) who underwent derotational femoral varus osteotomy for Legg-Calvé-Perthes disease are presented. Pain, leg-length discrepancy, Trendelenburg sign, and range of motion at the operated hip were examined clinically. Radiographic analysis included measurement of the Wiberg angle, epiphyseal index, acetabular index, and the Mose index. All were found to be satisfactory for patients in the good/fair category. Good/fair results were obtained in 27 (87%) of 31 hips according to Catterall's postoperative classification. Four patients were classified in the poor category due to severe restriction of movement and constant hip pain. Therefore, derotational femoral varus osteotomy is recommended for the treatment of patients with Legg-Calvé-Perthes disease.

[Surgical complications and their treatment options in total knee replacement]. / A teljes condylaris térdprotetika sebészi komplikációi és azok megoldási lehetóségei.

INTRODUCTION: One of the most important achievements of modern orthopedics is the treatment of degenerative disorders of the knee joint with endoprostheses. The most often used type of knee prosthesis implanted in our times is the total condylar one. With increasing numbers of prosthesis operations the number of complications is also increasing. AIM: Knowledge of diagnostic and treatment principles of complications is important for all institutions applying knee prostheses. The aim of present study is to report the authors' experience with the most important surgical problems following knee arthroplasty. PATIENTS/METHODS: At the Department of Orthopedics of the University of Pécs between 1993 and 1999 344 primary total condylar prostheses were implanted. Based on their own cases, the authors show the most important surgical problems after total knee arthroplasty. RESULTS: In their patient sample they observed infections, patellofemoral complaints and supracondylar femoral fractures being the commonest complications. Besides these problems they faced with some rare ones, like instability of the artificial joint and temporary peroneal palsy. Probably because of the relatively short follow up period, the authors had to perform only one revision procedure due to aseptic mechanical problems. The incidence of the most common complications in the authors' patient material is described as well as the principles and results of the applied treatment methods. Own experiences are compared with data from the literature. CONCLUSIONS: Although knee arthroplasty complications can be variable and followed by serious consequences, even the most significant ones can be managed with methods which provide the option of healing and restoration of knee functions.