The role of cytokines in inflammatory response after total knee arthroplasty in patients with rheumatoid arthritis.

Surgery and trauma is accompanied by changes in blood levels of certain cytokines and chemokines including interleukin-6 (IL-6) and interleukin-8 (IL-8). However, there is little data on correlations between local and systemic levels of these mediators during orthopedic surgeries in rheumatoid arthritis (RA) patients who already show increased levels of proinflammatory cytokines due to their disease. We aimed to measure dynamics of blood and drainage fluid levels of IL-6 and IL-8 in postoperative period in rheumatoid arthritis patients undergoing knee replacement surgery and correlate these changes with blood levels of C-reactive protein (CRP), body temperature and pain. We report that blood and drainage fluid levels of IL-6 and IL-8 showed significantly increasing trend during the 36-h period after the surgery. Drainage fluid levels of both cytokines were significantly higher in comparison with blood, indicating their local production in the operated joint. In contrast, levels of CRP were higher in blood than in drainage fluid. Despite the fact that the levels of tested cytokines had already been high in RA patients before surgery, we conclude that after surgery their levels were being much significantly enough high in drainage fluid to reflect dominated local inflammatory reaction to surgical stress and trauma.

The activity of exoglycosidases in the synovial membrane and knee fluid of patients with rheumatoid arthritis and juvenile idiopathic arthritis.

OBJECTIVE: To determine the activities of the five exoglycosidases that catabolize glycoconjugates (proteoglycans, glycoproteins, and glycolipids) in the synovial membrane and knee joint fluid of patients with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA). METHODS: The following exoglycosidases were analysed with the p-nitrophenyl derivatives of appropriate sugars as substrates: hexosaminidase (HEX) and its isoenzymes A and B, beta-glucuronidase, beta-galactosidase, alpha-mannosidase, and alpha-fucosidase. RESULTS: Our results show that the activity of all exoglycosidases tested in the synovial membrane of patients with RA and JIA was significantly higher than in synovial fluid. We demonstrated that only the enzymatic activity of HEX was significantly higher in the tissue of patients with inflammatory diseases in comparison to the activity in the control group. CONCLUSION: These data support the concept that the synovial cells of patients with RA and JIA are the main source of exoglycosidases, which catabolize glycoconjugates of cartilage.

[Endoprostheses for one hip and both knee joints in a patient with rheumatoid arthritis after supracondylar fractures of both femurs]. / Endoprotezoplastyka jednego stawu biodrowego i obu stawów kolanowych u chorej na reumatoidalne zapalenie stawów po zlamaniu dalszych przynasad obu kosci udowych.

The paper presents a case of hip prosthesis and ambilateral knee prosthesis after ambilateral supracondylar fractures of the femur healed in malposition in a patient with rheumatoid arthritis. The knee prosthesis were implanted without application of the femoral intramedullare rod. Three prosthesis were successfully implanted over a period of 8 weeks, obtaining pain relief and satisfactory range of movement.

[Fatigue tibial fracture coexistent with severe degenerative changes of the knee in a patient with rheumatoid arthritis]. / Zmeczeniowe zlamanie goleni wspólistniejace ze zmianami destrukcyjnymi stawu kolanowego u chorej na reumatoidalne zapalenie stawów.

The authors present a case of fatigue fracture of the proximal tibia with concurrent degenerative changes of the knee in a 53 year old patient with rheumatoid arthritis. The patient was treated surgically with a hinge-rotation prothesis. The procedure yielded pain relief, correction of the axis of the lower limb with progressive bone union.

[Shape optimization of the femoral component of hip prosthesis using the finite element method]. / Optymalizacja ksztaltu czesci udowej endoprotezy stawu biodrowego metoda elementów skonczonych.

Aseptic loosening of implants in bone is the main reason of prosthesis failure. Stress distribution around the implant surface plays a major role in this process, which can be minimized by implant shape optimization. Numerical methods, particularly the finite element method, are an important tool in the analysis of stress distribution and design optimization. The paper presents the problem formulation for this method, illustrated by computational examples.

The Rheumatoid hip.

Rheumatoid Arthritis (RA) is among the most common systemic diseases of connective tissue, affecting 1,5% of the population. In recent years about 30 000 new cases of RA have been reported annually. The rheumatoid process has a progressive course, leading to system-wide destruction of bones and joints, along with damage to many other organs and systems. The treatment team involved in managing cases of RA must be composed of specialists from many different fields: orthopedic surgeons, rheumatologists, physiotherapists, social workers, occupational therapists, and visiting nurses.
The treatment goal is to improve the patient's quality of life, to reduce or eliminate pain, and in the most severe cases to facilitate nursing care. In the surgical treatment of these patients the procedures used include synovectomy, joint debridement, soft tissue relaxation operations, arthrodesis, osteotomy, resection arthroplasty, and joint replacement. Among the more than 100 known connective tissue diseases, the hip joint is most commonly involved in cases of rheumatoid arthritis and ankylosing spondylitis. In cases of substantial destruction of the hip, the treatment of choice is joint replacement. Both cemented and cementless prostheses are used in the treatment of RA patients, depending on the surgeon's experience and the patient's age, general clinical status, and the quality of the bone tissue. Postoperative treatment in these patients does not differ from the generally accepted standards for the treatment of degenerative diseases. Based on the author's own experience in the Rheumatoorthopedic Department at the Institute of Rheumatology, it can safely be stated that hip joint replacement is a valuable and well tested method in the treatment of destructive changes to the hip joints in RA patients.

Tissue engineering in reconstructive surgery of bone and cartilage.

Molecular research has Bern the subject of considerable interest in recent years. The same can also be said for tissue engineering, which has ushered us into a world previously accessible only in science fiction. The possibility of creating human tissue opens the road for reconstructive surgery using biologically matched grafts. Some of the tissue engineering methods that pertain to orthopedics have already found application in the clinic. Among these are operations to reconstruct defects of joint cartilage, based on the in vitro multiplication of chondrocytes isolated from cartilage fragments previously collected arthroscopically. By applying tissue engineering technology we will soon be able to culture the patient's own bone tissue needed to fill defects in the bone bed. At some point in the not too distant future we will be able to graft entire joint ends, instead of the joint endoprosthesoplastic procedures currently in use. Tissue engineering, like every new field of science, prompts emotional reactions not only in medical circles, but also in many social groups. Let us hoper for fulfillment of the anticipation that a way will be found to overcome disabilities involving the locomotor apparatus.
The authors, who come from varying theoretical and clinical settings, present a short history of tissue engineering, based on their own experience and the available literature, the current possibilities to use tissue engineering in the reconstruction of bone and cartilage, and the prospects for development in the field in the near future.