Vysokoškolská učebnice, která se zaměřuje na základy ortopedie a traumatologie.

• MeSH
• ortopedie MeSH
• traumatologie MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• Učební osnovy. Vyučovací předměty. Učebnice
• NLK Obory
• ortopedie
• traumatologie
• NLK Publikační typ
• učebnice vysokých škol
• kolektivní monografie

BACKGROUND: Despite the fact that many synovial fluid biomarkers have found application in the routine diagnosis of periprosthetic joint infection (PJI), this process still remains a challenge for orthopaedic surgeons. To simplify this process, fast point-of-care (POC) tests can be used during ambulatory visits and in operating room conditions. However, before such tests can be routinely used in clinical practice, they require validation. The purpose of the present study was to evaluate the diagnostic accuracy of different fast POC tests for detecting C-reactive protein (CRP) in synovial fluid for the diagnosis of PJI. METHODS: Synovial fluid samples were collected from 120 consecutive patients who underwent revision total joint arthroplasty (TJA). The patients were divided into 2 groups. The first group included 76 patients who underwent revision for reasons other than infection (the aseptic revision TJA [arTJA] group), and the second group included 44 patients who underwent revision because of periprosthetic joint infection (PJI). The diagnosis of infection was made according to the International Consensus Meeting (ICM) 2018 criteria. All patients were operatively treated at a single orthopaedic center from January 2022 to February 2023. Four fast CRP tests with different cutoff values (1 and 3 mg/L, ≥8 mg/L, ≥10 mg/L [cassette], ≥10 mg/L [strip]) were used off-label for synovial fluid testing. Tests were performed on the same synovial fluid samples, and the results of these tests were compared with those obtained with the laboratory method. RESULTS: The cassette test with a minimum cutoff value of ≥8 mg/L demonstrated the best accuracy for the diagnosis of chronic PJI, with a sensitivity and specificity of 90.9% and 90.8%, respectively. For the cassette test with a cutoff value of >3 mg/L, the sensitivity and specificity were 68.2% and 77.6%, respectively. For the tests with a minimum cutoff value of ≥10 mg/L, the sensitivity and specificity were 77.3% and 94.7%, respectively, for the cassette test and 77.3% and 96.1%, respectively, for the strip test. The laboratory method with the statistically calculated threshold (2.7 mg/L) revealed the highest AUC (area under the receiver operating characteristic curve) value (0.95), with 90.9% sensitivity and 94.7% specificity. CONCLUSIONS: The cassette POC test with the minimum cutoff value of ≥8 mg/L had very good accuracy for the diagnosis of chronic PJI. This test had comparable sensitivity and slightly lower specificity in comparison with the laboratory method with the calculated threshold of 2.7 mg/L. LEVEL OF EVIDENCE: Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.

• MeSH
• biologické markery MeSH
• C-reaktivní protein analýza   MeSH
• infekce spojené s protézou * etiologie   MeSH
• infekční artritida * chirurgie   MeSH
• lidé MeSH
• náhrada kyčelního kloubu * škodlivé účinky   MeSH
• senzitivita a specificita MeSH
• synoviální tekutina chemie   MeSH
• totální endoprotéza kolene * škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• ortopedie MeSH
• Publikační typ
• biografie MeSH

• O autorovi
• Sosna, Antonín, 1943- Autorita

PURPOSE OF THE STUDY Infections of joint replacements represent one of the most serious problems in contemporary orthopedics. The joint infections treatment is usually multimodal and involves various combinations of drug delivery and surgical procedures. The aim of this study was to evaluate and compare the bacteriostatic and bactericidal properties of the most common antibiotic carriers used in orthopedic surgery: bone cements mixed with antibiotic and porous calcium sulfate mixed with antibiotic. MATERIAL AND METHODS Three commercial bone cements (Palacos®, Palacos® R+G, Vancogenx®) and commercial porous sulfate (Stimulan®) were prepared with a known concentration of vancomycin (a glycopeptide antibiotic). Specifically, for the purpose of our study, the testing specimens were prepared to release 0, 1, 2, 4, 8, 16, 32, 64, 128, 256, and 512 mg of vancomycin into 1 liter of solution. The specimens with increasing amount of antibiotic were placed in a separate tubes containing 5 mL of Mueller-Hinton broth inoculated with a suspension (0.1 m, McFarland 1) of the reference strain CCM 4223 Staphylococcus aureus to evaluate their bacteriostatic properties (broth dilution method). After this initial incubation and evaluation of the broth dilution method, an inoculum from each tube was transferred onto blood agar plates. After another 24-hour incubation under the same conditions, we evaluated the bactericidal properties (agar plate method). As many as 132 of independent experiments were performed (4 specimens × 11 concentrations × 3 repetitions = 132). RESULTS The bacteriostatic properties of all investigated samples were excellent, perhaps with the exception of the first bone cement (Palacos®). The sample Palacos® started to exhibit bacteriostatic properties at concentrations ≥ 8 mg/mL, while all other samples (Palacos R+G®, Vancogenx®, and Stimulan®) were bacteriostatic in the whole concentration range starting from 1 mg/mL. The bacteriocidic properties did not show such clear trends, but correlated quite well with different properties of the investigated samples during mixing - the most homogeneous samples seemed to exhibit the best and the most reproducible results. DISCUSSION The reliable and reproducible comparison of ATB carriers is a difficult task. The situation is complicated by high numbers of local antibiotic carriers on the market, numerous antibiotics used, and differences in clinical trials at different laboratories. Simple in vitro testing of bacteriostatic and bacteriocidic properties represents a simple and efficient approach to the problem. CONCLUSIONS The study confirmed that the two most common commercial systems used in the orthopedic surgery (bone cements and porous calcium sulfate) prevent bacterial growth (bacteriostatic effect), but they may not be 100% efficient in complete elimination of bacteria (bacteriocidic effect). The scattered results in the case of bacteriocidic tests seemed to be connected with the homogeneity of ATB dispersion in the systems and with the lower reproducibility of the employed agar plate method. Key words: local release of antibiotics; bone cements; calcium sulfate; antimicrobial susceptibility.

• MeSH
• agar MeSH
• antibakteriální látky farmakologie   terapeutické užití   MeSH
• kostní cementy farmakologie   terapeutické užití   MeSH
• lidé MeSH
• ortopedické výkony * MeSH
• ortopedie * MeSH
• polymethylmethakrylát chemie   MeSH
• reprodukovatelnost výsledků MeSH
• síran vápenatý MeSH
• vankomycin farmakologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: To investigate the relationship between osseous variations of the glenoid fossa and thinning of the overlaying articular cartilage. MATERIALS AND METHODS: In total, 360 dry scapulae, comprising adult, children and fetal specimens, were observed for potential presence of osseous variants inside the glenoid fossa. Subsequently, the appearance of the observed variants was evaluated using CT and MRI (each 300 scans), and in-time arthroscopic findings (20 procedures). New terminology of the observed variants was proposed by an expert panel formed by orthopaedic surgeons, anatomists and radiologists. RESULTS: Tubercle of Assaky was observed in 140 (46.7%) adult scapulae, and an innominate osseous depression was identified in 27 (9.0%) adult scapulae. Upon radiological imaging, the tubercle of Assaky was found in 128 (42.7%) CTs and 118 (39.3%) MRIs, while the depression was identified in 12 (4.0%) CTs and 14 (4.7%) MRIs. Articular cartilage above the osseous variations appeared relatively thinner and in several young individuals was found completely absent. Moreover, the tubercle of Assaky featured an increasing prevalence with aging, while the osseous depression develops in the second decade. Macroscopic articular cartilage thinning was identified in 11 (55.0%) arthroscopies. Consequently, four new terms were invented to describe the presented findings. CONCLUSION: Physiological articular cartilage thinning occurs due to the presence of the intraglenoid tubercle or the glenoid fovea. In teenagers, the cartilage above the glenoid fovea may be naturally absent. Screening for these variations increases the diagnostic accuracy of glenoid defects. In addition, implementing the proposed terminological updates would optimize communication accuracy.

• MeSH
• dítě MeSH
• dospělí MeSH
• kloubní chrupavka * diagnostické zobrazování   MeSH
• kloubní jamka lopatky * diagnostické zobrazování   MeSH
• lidé MeSH
• lopatka MeSH
• magnetická rezonanční tomografie MeSH
• mladiství MeSH
• počítačová rentgenová tomografie MeSH
• ramenní kloub * MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The aim of this study was to analyze the treatment results of fungal periprosthetic joint infections (PJI) caused by Candida species from a single orthopedic center and to compare them with reports from other institutions. METHODS: Eight patients operated on from January 2014 to December 2021 met the inclusion criteria and were analyzed in terms of clinical outcomes. A systematic review of the literature identified 153 patients with Candida PJIs extracted from 12 studies according to the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. RESULTS: The success rate of the treatment in the case series was 50%. The most frequent pathogens were Candida albicans (three cases; 37.5%) and Candida parapsilosis (three cases; 37.5%). In one patient (12.5%), bacterial co-infection was noted, and in five patients (62.5%) significant risk factors of PJI were confirmed. The overall success rate on the basis of data collected for systematic review was 65.5%. A sub-analysis of 127 patients revealed statistically significant differences (p = 0.02) with a higher success rate for the knees (77.6%) than for the hips (58%). In 10 studies the analysis of risk factors was performed and among 106 patients in 77 (72.6%) comorbidities predispose to fungal PJI were confirmed. Bacterial co-infection was noted in 84 patients (54.9%). In 93 patients (60.7%) Candida albicans was the culprit pathogen, and in 39 patients (25.5%) Candida parapsilosis was the culprit pathogen. Based on these two most frequent Candida species causing PJI, the success rate of the treatment was statistically different (p = 0.03), and was 60.3% and 83.3%, respectively. The two-stage strategy was more favorable for patients with Candida parapsilosis infections (94.4% success rate) than the one-stage protocol (50% success rate; p = 0.02); as well as in comparison to the two-stage treatment of Candida albicans (65% success rate; p = 0.04). CONCLUSIONS: The analysis of the literature showed no differences in the overall success rate between one- and two-stage surgical strategies for all Candida species, but differed significantly comparing the two most frequent strains and concerning PJI localization. The frequent presence of bacterial co-infections makes it necessary to consider the additional administration of antibiotics in the case of fungal PJI.

• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

The coronavirus disease (COVID-19) has significantly affected society, especially healthcare systems worldwide. The aim of this retrospective study is to evaluate the impact of the COVID-19 pandemic on orthopaedic and trauma healthcare at the largest university hospital in the Czech Republic. The evaluated periods were in accordance with three waves of the disease and three respective lockdowns. To correlate the results, we evaluated the number of patients (inpatients and outpatients) treated in the same period in the last 3 years before the pandemic. The number of orthopaedic outpatients during the lockdown period decreased by 54.12% (p = 0.002), 42.88% (p <0.001), and 34.53% (p = 0.03) in the first, second, and third lockdowns, respectively. The number of elective surgeries decreased by 69.01% (p <0.001), 87.57% (p <0.001), and 74.89% (p = 0.007) and the number of acute surgeries decreased by 33.15% (p = 0.002), 37.46% (p <0.001), and 27.24% (p = 0.034) in the first, second, and third lockdowns, respectively. This study showed a significant reduction in the healthcare of orthopaedic and trauma patients owing to the COVID-19 pandemic and emphasised the shortcomings of the healthcare system. In our study, there was a reduction in both outpatient (reduction of care by 24-54%) and inpatient care. The elective surgeries were reduced by 69-87% during different lockdown periods compared with the reference period. Based on the results of this study, we can formulate organisational measures to mitigate the impact of the pandemic on orthopaedic healthcare. Organisational procedures created based on acquired data and experience should maximise the bed capacity of the workplace and work efficiency with regard to the safety of medical staff.

• MeSH
• COVID-19 * epidemiologie   MeSH
• kontrola infekčních nemocí MeSH
• lidé MeSH
• ortopedie * MeSH
• pandemie MeSH
• retrospektivní studie MeSH
• SARS-CoV-2 MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

PURPOSE OF THE STUDY In clinical practice UHMWPE is the most commonly used material for manufacturing articular components of joint replacements. The purpose of this study is to find out whether repeated ethylene oxide sterilization results in oxidative degradation of UHMWPE or not and also whether the oxidative degradation of various types of ethylene oxide-sterilized UHMWPE depends on storage time or not. MATERIAL AND METHODS The set included 12 samples of UHMWPE (three samples with different modifications (virgin PE, with E vitamin and cross-linked with thermal treatment) and different number of sterilizations (0×-3×)). The set also included 8 samples of commercial components of hip or knee replacements sterilized with ethylene oxide and stored for different storage periods. The oxidative degradation was assessed by infrared microspectroscopy, based on which the oxidation index (OI), transvinylene index (VI), crystallinity index (CI) and E vitamin index (EI) were calculated. Mechanical properties of UHMWPE were obtained through microhardness measurements. Statistical processing of the results was performed. RESULTS In all the samples, very low oxidative degradation values were reported (most OI values < 0.1). All radiation crosslinked UHMWPE samples showed an increased VI index and a slightly lower crystallinity index. All unmodified samples (irrespective of whether or not and how many times or how long ago the samples were sterilized with EtO) had almost zero value of VI. Changes in crystallinity were negligible (in the rage of 0.56-0.63), which required very accurate measurements of micromechanical properties. Yet, linear correlation was established between microhardness and crystallinity. DISCUSSION All the mentioned indices changed as anticipated: OIs were very low and slightly increased with time of storage, VIs of radiation crosslinked samples grew in proportion to the total gama radiation dose, CIs decreased in samples thermally treated by remelting, and EIs were very low due to negligible concentration of stabiliser (0.1%) in the samples of medical grade UHMWPE. CONCLUSIONS All samples showed zero or minimum oxidative degradation. This confirmed that neither ethylene oxide sterilization, nor multiple EtO sterilization or longer storage of polymer after ethylene oxide sterilization result in major oxidative degradation. Key words: UHMWPE, ethylene oxide, sterilization, oxidation, infrared spectroscopy, microhardness.

• MeSH
• artroplastiky kloubů * MeSH
• ethylenoxid * MeSH
• lidé MeSH
• polyethyleny MeSH
• sterilizace metody   MeSH
• vitaminy MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY In the last number of years, the anatomic hemiarthoplasty has gradually been pushed out of clinical practice by modern reverse shoulder arthroplasty (RSA) designs. This is due to the clear excellent functional results of RSAs in a wide spectrum of indication criteria. Nevertheless, RSAs have several possible complications that cannot occur in an anatomic hemiarthroplasty. In anatomic hemiarthoplasty, the importance of correct indication criteria and observing correct operative technique including soft tissue reconstruction is much more important than in RSA. Furthermore, there is a clear recent trend of increased use of humeral components fixed only in the proximal metaphyseal cancellous bone. Our aim was to summarise our six-year experience with the SMR® Stemless (LimaCorporate, Italy) system which is one of the most modern ones. MATERIAL AND METHODS Twenty cases of SMR® Stemless anatomic shoulder hemiarthroplasty performed between 2016 and 2021 were included in the study. All patients were followed up prospectively. The function was evaluated preoperatively and at the last follow-up. We evaluated the range of active elevation, classic Constant Score (CS) and pain level according to the visual analogue scale (VAS). Statistical evaluation was performed by using basic statistical methods and the statistical significance of the results was assessed with a paired t-test. Level of statistical significance was set at p= 0.01. RESULTS The mean follow-up in our cohort was 3.01 years (range 0.32-5.69, Median 2.82, SD 1.56) All cases were indicated for surgery due to primary osteoarthritis with a limitation of movement and pain. The mean postoperative CS was 85.7 (range 70-96, Median 86, SD 6.83). The mean active elevation postoperatively was 143° (range 100-170°, Median 150°, SD 20.76). Mean postoperative pain according to VAS was 1.05 (range 0-4, Median 1, SD 1.02). The mean preoperative elevation was 60.5° (range 30-100°, Median 65°, SD 18.83). After surgery the mean elevation increased to 143° (range 100-170°, Median 150°, SD 20.76). Statistical evaluation showed a statistically significant increase in the CS (41.7 preoperatively to 85.7 postoperatively), range of active elevation (60.5° preoperatively to 143° postoperatively) and a statistically significant decrease in pain (VAS 6.95 preoperatively to 1.05 postoperatively). We observed no cases of failure or loosening of the implant. A statistically significant increase in post-operative range of motion was demonstrated. DISCUSSION Most modern shoulder arthroplasty designs now include implants allowing for proximal humerus metaphyseal fixation in hemiarthroplasty and even RSA designs. The advantage of metaphyseal fixation without the use of a longer stem is clear. Notably, treatment of periprosthetic humeral fractures is simpler, extraction of the implant for any reason is easier and the preoperative anatomic position of the humeral head can be respected. As with any anatomic shoulder arthroplasty, the functional result is dependent on correct indication criteria, precise surgical technique, correct humeral head position and soft tissue reconstruction - primarily the rotator cuff. CONCLUSIONS Between 2016 and 2021, we performed 20 SMR® stemless shoulder hemiarthroplasties for primary osteoarthritis. The mean follow up was 3 years. The shoulder function improved significantly post-operatively in all patients. There were no cases of implant loosening or failure. Radiographic evaluation showed no implant loosening or change in implant position in the humeral metaphysis. Key words: shoulder joint replacement, reverse shoulder arthroplasty, SMR, stemless, total shoulder arthroplasty, shoulder hemiarthroplasty, EPOCA, wear.

• MeSH
• artroplastika ramenního kloubu * škodlivé účinky   metody   MeSH
• hemiartroplastika * škodlivé účinky   MeSH
• hlavice humeru MeSH
• lidé MeSH
• osteoartróza * chirurgie   MeSH
• pooperační bolest etiologie   MeSH
• ramenní kloub * chirurgie   MeSH
• rameno MeSH
• rozsah kloubních pohybů MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH