PURPOSE OF THE STUDY Our study aimed to assess the mid-term outcomes and complications with the ICON hip resurfacing system and to carry out a detailed analysis of pitfalls and risks associated with pairing the bearing surfaces of metal-on-metal hip implants. MATERIAL AND METHODS A total of 52 hip joints were assessed in 43 patients who received the ICON hip resurfacing system at our department between 2009 and 2013. The cohort included 34 men and 9 women. Their age at the time of primary surgery ranged from 34 to 67 years, with the mean age of 51.8 years. The mean follow-up was 7.6 years. The evaluation focused on the position and osseointegration of both components, bone remodelling around the implant, and signs of potential aseptic loosening. The functional status of the hip was assessed by Harris Hip Score. RESULTS The primary stability of both components was always good, there were no femoral neck fractures reported in our cohort. All the acetabular components were stable, showing appropriate osseointegration, with no radiolucent zones or signs of osteolysis around them. There was not a single case of the femoral component stem being in a biomechanically disadvantageous varus position. In zone I and III according to Beaulé, cancellous bone osteolysis developed in two patients. The narrowing of the femoral neck below the end of the femoral component, compared to postoperative X-rays, achieved the mean value of 1.3% according to Grammatopolouse. The HHS increased from 64 to 95.5 points. An excellent outcome was observed in 48 joints, whereas the outcome of the remaining 4 joints was very good. The mean survival rate of the resurfacing hip implant calculated using the Kaplan-Meier analysis achieved 100%. The cobalt and chromium levels in the blood of patients did not exceed the reference physiological value. DISCUSSION The resurfacing system enables to preserve the bone tissue of the metaphysis and a part of the femoral head. The reduced mechanical endurance of the peripheral part of femoral components smaller in size caused by implant malposition resulted in fatal consequences in the ASR system. Greater range of motion conditioned by the design of the resurfacing system led to a mechanical wear, with a significant increase in the concentration of metal particles in the effective joint space. The elevated levels of cobalt and chromium ions in some patients induced delayed-type hypersensitivity with subsequent development of aseptic lymphocyte-dominated vasculitis associated lesions presented as peri-acetabular changes (pseudotumors to osteolysis) with subsequent failure of implant fixation. We have not observed this complication in the ICON system as yet. In patients suffering from hip pain after the resurfacing hip arthroplasty and simultaneous high chromium and cobalt blood levels, pelvic CT/MRI is indicated with reduction of artefacts around the metal material. Surgical treatment of soft tissue affections, bone defects and reimplantation using conventional or revisioncementless components is a possible treatment option. CONCLUSIONS The ideal patient indicated for hip resurfacing is a physically active man under 60 years of age (with a femoral head size of 54-60 mm), with primary or secondary osteoarthritis, no joint deformity, with a good quality bone tissue in the femoral neck and head region. As for the functional performance, the resurfacing system allows the patients a large range of motion with very good joint stability immediately after surgery. Despite that, the metal-on-metal tribological pairing must be approached with caution. The risk of developing lesions associated with ALVAL is unpredictable. In our cohort of patients with ICON hip resurfacing system, mostly excellent outcomes with minimum complications were reported provided the indication criteria and the correct surgical procedure had been complied with. Key words: hip resurfacing system, metal articulating surfaces, adverse reaction to metal particles, aseptic lymphocytedominated vasculitis associated lesions, pseudotumor.

• MeSH
• chrom MeSH
• dospělí MeSH
• kobalt MeSH
• kovy MeSH
• kyčelní kloub diagnostické zobrazování   chirurgie   MeSH
• kyčelní protézy * škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhrada kyčelního kloubu * metody   MeSH
• osteolýza * etiologie   chirurgie   MeSH
• protézy - design MeSH
• reoperace MeSH
• selhání protézy MeSH
• senioři MeSH
• vaskulitida * komplikace   chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

INTRODUCTION The purpose of our paper is to evaluate the mid-term to long-term results and to confirm the basic criteria of a high-quality revision implant: safe bridging of bone defects, achievement of reliable primary fixation of revision acetabular cup, achievement of good secondary stability with documentable osteointegration of cup and demonstration of remodelling of transplanted bone tissue in the area of defects and in spaces between the implant ribs. MATERIAL AND METHODS Altogether 36 patients (38 cups) were evaluated who had undergone revision hip arthroplasty in the period from 2004 to 2010. The mean follow-up was 8.2 years (5.1-11.6 years after the reimplantation, more than 10 years in 16 patients who underwent surgery). The position and osseointegration of the implant were assessed by digital radiography, the remodelling of transplanted bone tissues in the area of defects and between the implant ribs by computed tomography with reducing artefacts around the metal implant (Aquilion 64 - Toshiba Medical Systems), and for the clinical outcomes the Harris Hip Score was used. RESULTS Preoperatively, the condition of the hip joint based on the Harris Hip Score was in 30 cases evaluated as poor, in 8 patients as satisfactory. At the time of final evaluation, 8 patients achieved excellent results, in 19 patients the condition of the joint was very good (in 2 patients bilaterally), in 6 patients it was considered satisfactory and in 3 patients poor. The mean value for HHS increased from 39.5 to 84.5. Based on the radiography evaluation, in 27 patients (in 2 patients bilaterally) the osseointegration of the revision cup was good, in 8 cases with a radiolucent line of 2-4 mm in width in DeLee zone III, in one case proximal migration of the cup occurred caused by deep infection. The informed consent form for pelvic CT was signed by 25 patients of our cohort. Remodelling of bone tissue in the space between the ribs of the implant was always detected, the presence of bone cysts was not reported, the bone defects following the application of autologous spongioplasty in the monitored patients were healed. In 6 patients, an ingrowth of fibrous tissue of 2-4 mm in width in the convexity of the cup was detected. The mean survival of the revision oval-shaped cup - TC type with a follow-up of 8.2 years after the reimplantation based on Kaplan-Meier analysis was 91.4 %. DISCUSSION The number of revision total hip arthroplasties due to a younger age of patients who undergo alloplasty keeps growing. The choice of a revision implant should always match the intraoperative finding and the bone tissue quality. The standard uncemented implants with osteoactive surface can be opted for when anterior and posterior column of the acetabulum are intact (IIA and IIB according to Paprosky). Starting from type IIC, also the proximal part of acetabulum shall be considered. At our department, preference is given to the revision cup - TC type. The oval shape facilitates a lower degree of bone resection and easier restoration of the anatomical centre of rotation. Careful debridement of granulating and necrotic tissue, thorough treatment of bone defects and osteoactive surface of implants in case of adequate primary fixation of the cup substantially contribute to the quality of its osseointegration. Greater rigidity of fixation verified by pull-out tests enables to insert angular stable screws into the gaps in the proximal part of the cup. There is still room for improvement in treating the bone defect. The application of allogenic bone grafts into the defects and spaces between the ribs of the TC cup is more challenging than the use of augmentation in the systems with trabecular titanium. Based on the evaluation of CT scans, remodelling of the transplanted bone occurs, therefore the defect zone is reduced. CONCLUSIONS The oval-shaped uncemented cup - type TC meets the requirements placed on a state-of the art revision implant, moreover its specific construction helps improve the conditions where another re-operation of acetabulum is necessary. By evaluating mid-term to long-term results of non-homogenous group of 36 patients (38 cups) we have obtained data on joint function comparable to similar groups with revision uncemented implants presented in our and foreign literature. Key words: revision oval-shaped cup, bone remodelling, pull-out tests, angular stable screws, computed tomography.

• MeSH
• acetabulum chirurgie   MeSH
• časové faktory MeSH
• Kaplanův-Meierův odhad MeSH
• kyčelní kloub chirurgie   MeSH
• kyčelní protézy * MeSH
• lidé MeSH
• náhrada kyčelního kloubu * mortalita   MeSH
• následné studie MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Prvotní entuziasmus širokého použití multipotentních mezenchymových kmenových buněk v medicíně odezněl. Klinické použití MSC v léčbě chrupavky zaostává za očekáváními. Ne všechna současná použití MSC jsou aplikována ve smyslu medicíny založené na důkazech. Některé terapie se zdají být prodáváním naděje, a ne léčením. Enormní regulace pokročilých terapií na jedné straně brzdí terapeutické postupy, ale na straně druhé vede k ověření bezpečnosti a efektivity terapie. V současné době existuje několik klinických studií fáze I se slibnými výsledky, ale efektivita MSC musí být ještě potvrzena ve fázích II a III. Ortopedická společnost stále čeká na efektivní buněčnou terapii a štěp vytvořený tkáňovým inženýrstvím chrupavky, ale do té doby zůstanou mikrofraktury jednou z mála možností, jak léčit chrupavku.

The enthusiasm about broad application of multipotent mesenchymal stromal cells in human medicine is gone. The clinical use of MSC in cartilage treatment is far below the expectations. Not all of the currently utilised MSC applications are used according to evidence-based medicine. Some of the therapies seem to sell hope instead of a true cure. Enormous regulations of advanced therapies medicinal products lead to a delay in therapeutic approaches on the one hand, on the other hand lead to assurance of safety and efficacy of a therapy. Currently there are only a few clinical trials on cartilage treatment, which went through phase I with promising results, but the efficacy of MSC use needs to be proved in phase II and III. The orthopaedic society still waits for an effective cell therapy and tissue engineered cartilage graft, until that time the microfracturing stays one of a few options how to treat the cartilage.

• MeSH
• buněčná a tkáňová terapie * MeSH
• hyalinní chrupavka * patofyziologie   účinky léků   MeSH
• klinické zkoušky jako téma MeSH
• lidé MeSH
• mezenchymální kmenové buňky MeSH
• řízená tkáňová regenerace MeSH
• transplantace mezenchymálních kmenových buněk MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

Multipotentní mezenchymové stromální buňky hrají ústřední roli v ontogenezi kosti, stejně tak při její regeneraci. Empirické užívání MSC v rekonstrukční chirurgii kosti má dlouhou historii. V současné době použití minimálně manipulovaných MSC z kostní dřeně v ortotopickém podání se stává běžnou metodikou ortopedie. Nicméně zavádění efektivních a bezpečných metod buněčné terapie dospělými kmenovými buňkami a tkáňového inženýrství bude ještě vyžadovat značnou míru výzkumu, a zejména klinických studií. Jedinou cestou, jak se vyhnout fatálním omylům v regenerační medicíně, je objektivní a kritické hodnocení všech fází klinických studií.

Multipotent mesenchymal stromal cells play a fundamental role in ontogenesis and bone regeneration as well. Empirical use of MSCs in reconstructive surgery of bones has a long history. Currently the use of minimally manipulated MSCs derived from bone marrow in orthotropic applications turns to be a standard procedure in orthopedics. Nonetheless the launching of efficient and safe methods of somatic stem cell therapy and tissue engineering still require substantial amount of research and clinical trials in particular. The only way how to avoid fatal errors in human regenerative medicine is to accurately and critically evaluate of all phases of clinical trials.

• MeSH
• buněčná a tkáňová terapie * MeSH
• klinické zkoušky jako téma MeSH
• lidé MeSH
• mezenchymální kmenové buňky MeSH
• regenerace kostí * MeSH
• řízená tkáňová regenerace MeSH
• transplantace kostní dřeně MeSH
• transplantace mezenchymálních kmenových buněk MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

We have studied a rapid cultivation method for human mesenchymal stromal cells based on CellGroTM medium and human serum, supplemented with insulin, ascorbic acid, dexamethasone, epidermal growth factor, platelet-derived growth factor BB, macrophage colony-stimulating factor and fibroblast growth factor 2. This study has shown that rapid expansion of human multipotent mesenchymal stromal cells using human serum could not be achieved without addition of growth factors. Furthermore, we have found that insulin and, quite probably, epidermal growth factor may be omitted from our formula without loss of colony-forming capacity or total cell yield. On the other hand, dexamethasone, ascorbic acid and fibroblast growth factor 2 were necessary for the growth and colony-forming capacity of multipotent mesenchymal stromal cells, while platelet-derived growth factor BB prevented their differentiation into adipogenic lineage. Moreover, multipotent mesenchymal stromal cells cultivated in our system expressed higher levels of bone morphogenetic protein 2, but not bone morphogenetic protein 7, than cells cultivated in α-MEM with foetal bovine serum. This shows that our system promotes differentiation of mesenchymal cells towards osteogenic and chondrogenic lineages, making them more suitable for bone and cartilage engineering than cells grown in conventional media. Furthermore, we have proved that these cells may be conveniently cultivated in a closed system, in vessels certified for clinical use (RoboFlaskTM), making the transfer of our cultivation technology to good clinical practice easier and more convenient.

• MeSH
• kostní morfogenetický protein 2 metabolismus   MeSH
• kostní morfogenetický protein 7 metabolismus   MeSH
• kultivované buňky MeSH
• lidé MeSH
• mezenchymální kmenové buňky cytologie   metabolismus   MeSH
• osteokalcin metabolismus   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• práce podpořená grantem MeSH

The aim of this study was to compare the standard laboratory method of cultivation of mesenchymal multipotent stromal cells (MSC) and a novel technique of rapid MSC expansion focused on simple clinical use. MATERIAL AND METHODS Bone marrow mononuclear cells of donors were cultured for 14 days by the standard and the new cultivation method. The standard method (STD) was based on an alpha MEM medium supplemented with foetal calf serum (FCS). The new animal protein-free method (CLI) was based on the clinical grade medium CellgroTM, pooled human serum and human recombinant growth factors (EGF, PDGF-BB, M-CSF, FGF-2) supplemented with dexamethasone, insulin and ascorbic acid. The cell product was analyzed by flow cytometry. Furthermore, the cell products of STD and CLI methods were differentiated in vitro, and histochemical and immunohistochemical analyses, electron microscopy and elemental analysis were performed. Some cells were seeded on biodegradable scaffolds, in vivo implanted into immunodeficient mice for 6 weeks and evaluated by histological methods. RESULTS Yields of the CLI method after 14 days of cultivation were 40-fold higher than those obtained by the STD technique (p<0.05). Cell products of both STD and CLI methods fulfilled the criteria of MSC in terms of antigen expression assessed by flow cytometry, as well as osteogenic, chondrogenic and adipogenic in vitro differentiation assays. Moreover, these cells seeded on three-dimensional scaffolds cultured in osteogenic medium produced mineral deposits and a fibrillar extracellular matrix seen with the electron microscope. Deposits examined by element analysis contained calcium and phosphorus at a ratio of 5 to 3, which corresponded to hydroxyapatite. The cell product seeded on biodegradable scaffolds and implanted into immunodeficient mice was able to form a bone-like calcified tissue with blood supply of mouse origin. DISCUSSION The currently used methods of cultivation have certain disadvantages compared to the CLI technique, such as a longer cultivation period, need of primary expansion and reseeding and use of FCS with all its potential risks. High yields of cells obtained by the CLI method in a very short time make the use of cultured cells potentially suitable for an acute trauma management. Other therapeutic non-orthotopic applications of CLI-cultured cells have to be further investigated. CONCLUSIONS The CLI method is unique, rapid, simple and lacking the addition of animal proteins. CLI-cultured cells fulfil the criteria of MSC. The CLI method potentially allows for closed system cultivation in good manufacturing practice (GMP) conditions. It seems to be easily transferable to good clinical practice compared to other protocols and should extend the possibilities of cell therapy and tissue engineering of cartilage and bone. The new method is protected by Czech patent 301 148 and by europian patent EP 1999250 according to Czech and international laws.

• MeSH
• buněčná diferenciace MeSH
• dospělé kmenové buňky MeSH
• elektronová mikroskopie MeSH
• financování organizované MeSH
• histologie MeSH
• imunohistochemie MeSH
• interpretace statistických dat MeSH
• kultivační techniky metody   využití   MeSH
• kultivované buňky MeSH
• lidé MeSH
• mezenchymální kmenové buňky cytologie   MeSH
• myši MeSH
• průtoková cytometrie MeSH
• regenerativní lékařství MeSH
• růstový hormon MeSH
• statistika jako téma MeSH
• techniky in vitro MeSH
• tkáňové inženýrství metody   MeSH
• transplantace mezenchymálních kmenových buněk MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• myši MeSH
• zvířata MeSH
• Publikační typ
• srovnávací studie MeSH

Využívání multipotentních mezenchymových stromálních buněk v rekonstrukční chirurgii má dlouhou historii. V současnosti se tyto buňky začínají využívat pro účely buněčné terapie dospělými kmenovými buňkami a tkáňového inženýrství. Výzkum dospěl i v ortopedii do preklinické fáze a vstupuje do klinických studií. Pro zajištění maximální bezpečnosti pro pacienta se použití těchto nových postupů musí řídit přísnými pravidly, která ještě nejsou celosvětově jednotná. Proto do doby, než budou v klinické praxi potvrzeny vědecké předpoklady, zůstane zlatým standardem pro zlepšení hojení kosti autologní štěp.

The application of multipotent mesenchymal stromal cells in reconstructive surgery has a long history. Currently these cells are used for purposes of somatic stem cell therapy and tissue engineering. Orthopedic basal research had also reached preclinical stage and entered clinical studies. For a patient safety assurance these new applications are strictly regulated but these regulations have not yet been harmonized worldwide. That is why autogenic bone graft stays a gold standard in bone regeneration until the experimental assumptions would be proven in clinical practice.

• Klíčová slova
• Fraxiparine,
• MeSH
• autologní transplantace metody   trendy   využití   MeSH
• buněčné kultury metody   normy   využití   MeSH
• lidé MeSH
• multipotentní kmenové buňky imunologie   transplantace   MeSH
• ortopedie metody   normy   trendy   MeSH
• regenerace kostí fyziologie   imunologie   MeSH
• tkáňové inženýrství metody   trendy   využití   MeSH
• transplantace mezenchymálních kmenových buněk metody   trendy   využití   MeSH
• transplantáty normy   trendy   využití   MeSH
• zákroky plastické chirurgie metody   trendy   využití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• směrnice pro lékařskou praxi MeSH

BACKGROUND: Rotator cuff tear--diagnosis; comparison of MRI, ultrasonographic and arthroscopic findings. MATERIALS AND METHODS: Retrospective study--20 patients treated for shoulder pain due to rotator cuff tear, initially conservatively and after more than 6 months by arthroscopic shoulder surgery. Comparison of intraoperative findings with preoperative US and MRI images. RESULTS: Sensitivity of USG--1.0, specificity 0.9. Sensitivity of MRI--0.92, specificity 1.0. DISCUSSION: Clinical examination and physical tests are not fully reliable diagnostic tools in patients with shoulder pain, because symptoms of different conditions overlap. Using ultrasound to visualize the shoulder area has some advantages to other imaging techniques such as CT scan or MRI, and has a very good sensitivity and good specificity. Many authors agree that MRI is one of the most effective methods for the diagnosis of rotator cuff tear. CONCLUSIONS: Ultrasound and magnetic resonance imaging are both very sensitive techniques for diagnosis of rotator cuff abnormalities. Ultrasonography can be used as a primary method owing to its fast procedure and affordable cost.

• MeSH
• artroskopie metody   MeSH
• bolest ramene diagnóza   etiologie   ultrasonografie   MeSH
• dospělí MeSH
• echoplanární zobrazování MeSH
• lacerace diagnóza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• poranění ramene MeSH
• poranění rotátorové manžety MeSH
• poranění šlachy diagnóza   ultrasonografie   MeSH
• ramenní kloub ultrasonografie   MeSH
• retrospektivní studie MeSH
• rotátorová manžeta ultrasonografie   MeSH
• senzitivita a specificita MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

Základním problémem u revizních operací TEP (totální endoprotézy) kyčelního kloubu je uvolnění vazby mezi implantátem a kostním lůžkem a následný vznik různě rozsáhlých kostních defektů. Reoperace uvolněného implantátu je vždy obtížná, neboť ukotvení nového se děje v poškozeném biologickém terénu. Použití standardních komponent je limitováno objemem zachované kostní tkáně a možností dostatečně překlenout kostní defekty vzniklé migrací uvolněné endoprotézy. Při finálním řešení jsme nejčastěji nuceni v případě acetabulární komponenty využít speciální oválné jamky odpovídající svým tvarem a velikostí rozsahu defektu, v případě femorální komponenty revizního delšího dříku s primární fixací ve zdravé části diafýzy femuru. Nedílnou součástí moderního přístupu je zabezpečit novotvorbu a remodelaci kostní tkáně v oblasti defektů s využitím různých typů spongioplastiky a vytvořením příznivější situace pro případnou následnou revizní operaci. Cílem této práce je popsat náš přístup k diagnostice a léčbě aseptického uvolnění vycházející z našich posledních pětiletých zkušeností.

The essential problem in revision hip surgery is loosing of the implant in the bone, which causes various bone defects. According to a bad quality of the tissues the revision surgery is always difficult. The use of the standard components is limited by a volume of remaining bone and by a possibility to fill in sufficiently bone defects created by a migration of a loosened endoprothesis. Most often in the final solution we are obliged to use a special oval socket corresponding to a defect by its shape and size. In the case of a loosened femoral component we are forced to use a revision stem with a primary fixation in the healthy part of a femur diaphysis. One of the essential parts of the modern way of treatment is to promote the bone tissue remodeling and a new bone formation in the area of defects by using a various types of bone grafting to create more favorable conditions for revision surgery in the future. The purpose of this article is to describe our view to diagnostics and to the treatment of aseptic loosening based on our five-year experience.

• MeSH
• chrom škodlivé účinky   terapeutické užití   MeSH
• keramika škodlivé účinky   terapeutické užití   MeSH
• kobalt škodlivé účinky   terapeutické užití   MeSH
• kyčelní protézy klasifikace   škodlivé účinky   trendy   MeSH
• miniinvazivní chirurgické výkony dějiny   metody   trendy   MeSH
• náhrada kyčelního kloubu dějiny   metody   trendy   MeSH
• polyethyleny terapeutické užití   MeSH
• Publikační typ
• přehledy MeSH