BACKGROUND: The diagnosis of joint replacement infection is a difficult clinical challenge that often occurs when the implant cannot be salvaged. We hypothesize that the pH value of synovial fluid could be an important indicator of the inflammatory status of the joint. However, in the literature, there is a lack of data on the pH changes in hip and knee joint replacements and their relation to infection and implant failure. In this study, we aimed to measure the pH levels of synovial fluid in patients with hip and knee joint replacements. We also investigated the potential of pH measurement as a diagnostic tool for joint replacement infection. In this study, we recorded the pH values to be 7.55 and 7.46 in patients where Pseudomonas aeruginosa was identified as the cause of the prosthetic joint infection. We attribute this to the different environments created by this specific bacterium. In other cases where the pH was higher, chronic mitigated infections were diagnosed, caused by strains of Staphylococcus aureus, Streptococcus agalactiase, and coagulase negative staphylococcus. MATERIALS AND METHODS: In our cohort of 155 patients with implanted hip (THA; n = 85) or knee (TKA; n = 70) joint replacements, we conducted a prospective study with a pH measurement. Out of the whole cohort, 44 patients had confirmed joint replacement infection (28.4%) (44/155). In 111 patients, infection was ruled out (71.6%) (111/155). Joint replacement infection was classified according to the criteria of the Musculoskeletal Infection Society (MSIS) from 2018. Based on the measured values, we determined the cut-off level for the probability of ongoing inflammation. We also determined the sensitivity and specificity of the measurement. RESULTS: The group of patients with infection (n = 44) had a significantly lower synovial fluid pH (pH = 6.98 ± 0.48) than the group of patients with no infection (n = 111, pH = 7.82 ± 0.29, p < 0.001). The corresponding median pH values were 7.08 for the patients with infection and 7.83 for the patients with no infection. When we determined the cut-off level of pH 7.4, the sensitivity level of infected replacements was 88.6%, and the specificity level of the measurement was 95.5%. The predictive value of a positive test was 88.6%, and the predictive value of a negative test was 95.5%. CONCLUSIONS: Our results confirm that it is appropriate to include a pH measurement in the diagnostic spectrum of hip and knee replacements. This diagnostic approach has the potential to provide continuous in vivo feedback, facilitated by specialized biosensors. The advantage of this method is the future incorporation of a pH-detecting sensor into intelligent knee and hip replacements that will assess pH levels over time. By integrating these biosensors into intelligent implants, the early detection of joint replacement infections could be achieved, enhancing proactive intervention strategies.
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY Total arthroplasty of the first metatarsophalangeal joint is one of the surgical treatment options for patients with advanced hallux rigidus. This study evaluates the pressure changes in the propulsion phase of the gait cycle using dynamic pedobarography after the total arthroplasty of the first metatarsophalangeal joint by Medin PH-Flex and their comparison with the control groups of patients with hallux rigidus and with asymptomatic patients. MATERIAL AND METHODS Dynamic pedobarograph was used to evaluate 15 first MTP joint replacements by Medin PH-Flex implants in 12 female patients, the average time since joint replacement was 3.5 years (1.5 to 5.5 years). The control group consisted of 13 forefeet in 12 patients with hallux rigidus of Grade 3 and Grade 4 according to the Coughlin classification and 17 healthy patients with no clear foot deformity, i.e. of a total of 34 forefeet. A zone for each metatarsal (M1-M5) and the big toe area (T1) were defined with the use of an integrated software. The difference between the pressure under the big toe area and the first metatarsal bone - hallux stiffness (T1-M1) and the forefoot balance parameter, i.e. the difference between the pressures under the medial and lateral half of the forefoot ((M1+M2)-(M3+M4+M5)), was obtained. The parameters were evaluated for each group during the propulsion phase of the gait, i.e. from 55% to 100% of the stance phase and from 75% to 100% of the stance phase, i.e. that part of propulsion when the greatest pressure is exerted on the big toe. RESULTS For the HS parameter (T1-M1) in 55% to 100% of the stance phase, the median value was -0.66 ± 1.22 (-1.90 to 1.45) in the control group, -0.85 ± 1.94 (-1.40 to 3.80) in patients with hallux rigidus, and -0.10 ± 1.48 (-1.30 to 2.40) in patients after the first MTP joint replacement. The median forefoot balance parameter from 55% of the stance phase was -3.48 ± 2.45 (-6.90 to 0.68) in healthy patients and -4.43 ± 2.72 (-6.98 to 0.23) in hallux rigidus patients. In patients after the joint replacement, the value was -3.00 ± 2.46 (-6.20 to 0.40). The data were statistically analysed by the Dunnett's and Tukey's multiple comparison tests. The hallux stiffness parameter showed a significant improvement after the joint replacement compared to patients with hallux rigidus (p<0.0001). No statistical significance was confirmed when comparing the joint replacement cases and the healthy patients from the control group (p=0.0007 and p=0.0010, respectively). As concerns the forefoot balance parameter, a significant difference was reported in patients with joint replacement compared to healthy patients from the control group and patients with hallux rigidus (p <0.0001). DISCUSSION The published pedobarographic studies differ in terms of the methodology used, the patient population and the parameters examined. The pedobarographic studies after the replacement of the first MTP joint or after its arthrodesis present inconclusive outcomes. According to the available literature, the joint replacement has the potential to improve mediolateral forefoot loading and to partially restore the weight-bearing function of the first ray. Our analysis of the HS parameter suggests that the MTP joint replacement can improve the big toe function compared to patients with hallux rigidus but fails to achieve the functional outcomes of healthy patients. When evaluating the forefoot balance (FB) parameter, we can observe less loading on the lateral half of the forefoot in the propulsion phase compared to hallux rigidus. Nonetheless, the joint replacement is unable to restore the physiological loading of the foot. CONCLUSIONS The first MTP joint replacement has the potential to improve forefoot function and to bring it closer to that of a healthy person, even though achieving physiological loading of the forefoot is unrealistic. Additional studies will be needed to confirm that the indication for the first MTP joint replacement is justified in hallux rigidus in terms of the effect on forefoot biomechanics. Key words: hallux rigidus, total replacement of the first MTP joint, dynamic pedobarography, footscan.
- MeSH
- biomechanika MeSH
- chůze (způsob) MeSH
- hallux rigidus * chirurgie MeSH
- lidé MeSH
- noha (od hlezna dolů) MeSH
- palec nohy * MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
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In this paper, we present a review of how the various aspects of any study using an eye tracker (such as the instrument, methodology, environment, participant, etc.) affect the quality of the recorded eye-tracking data and the obtained eye-movement and gaze measures. We take this review to represent the empirical foundation for reporting guidelines of any study involving an eye tracker. We compare this empirical foundation to five existing reporting guidelines and to a database of 207 published eye-tracking studies. We find that reporting guidelines vary substantially and do not match with actual reporting practices. We end by deriving a minimal, flexible reporting guideline based on empirical research (Section "An empirically based minimal reporting guideline").
- MeSH
- empirický výzkum MeSH
- lidé MeSH
- pohyby očí * MeSH
- technologie sledování pohybu očí * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Research Support, N.I.H., Extramural MeSH
PURPOSE OF THE STUDY The Minimally Invasive Chevron Akin (MICA) is a percutaneous technique used to correct hallux valgus deformity. The combination of distal osteotomy of the first metatarsal and the proximal phalanx of the big toe stabilized with internal fixation was used over the last decade. The retrospective study presents the results of measurements performed on preoperative and postoperative X-rays and offers a comparison with conventional osteotomies. MATERIAL AND METHODS The study population consists of 76 patients who underwent 93 operations between 2015 and 2018 at the Department of Orthopaedics, 1st Faculty of Medicine, Charles University in Prague. The mean age of patients was 50.2 years (range 18-74 years). The study evaluates and measures the parameters and the attributes of interest on weight-bearing X-rays of the foot before and after the operation at 6-week or 3-month follow-ups. The first intermetatarsal angle was measured according to the mechanical and the anatomic axis of the first metatarsal bone. Apart from that, the displacement of the first metatarsal head in the osteotomy, hallux valgus angle and distal metatarsal articular angle were analysed. The position of the medial sesamoid bone and the congruency of the first metatarsophalangeal joint were evaluated as well. RESULTS The mean hallux valgus angle was 33.2° ± 7.3° and 10.2° ± 5.8° postoperatively. The mean value of the first mechanical intermetatarsal angle decreased from 12.4° ± 2.8° to 7.4° ± 2.5° postoperatively. The mean value of the first anatomic intermetatarsal angle increased from 13.7° ± 3.6° to 17.4° ± 4.6°. The used technique restored the congruency of the first metatarsophalangeal joint in 85 cases (91%). The mean lateral displacement of the metatarsal head fragment was 50% of its width (range 18% to 84%). The mean X-ray exposure during the operation was 0.58 mGy and the personnel were exposed to radiation for 79 seconds on average. DISCUSSION One of many questions raised with regard to hallux valgus surgery is the choice of the right technique in order to achieve proper position of the big toe. The surgeon should have the opportunity to use a technique that provides the possibility to change orientation of the metatarsal head articular surface in three anatomic planes. Our study found out that the displacement of the metatarsal head using the MICA technique in transversal plane is from 4 mm to 18 mm (in 20 mm diameter of the head). The method thus offers a possibility to correct mild, moderate and partially severe deformities as well. The main disadvantage of the method is the necessity to use a C-arm at the operating theatre. CONCLUSIONS The Minimally Invasive Chevron Akin (MICA) is a percutaneous technique to correct hallux valgus deformity based on two extraarticular osteotomies of the proximal phalanx of the big toe and the distal part of the first metatarsal bone. The method using stable internal fixation with two screws offers a possibility to change the orientation of the articular surface of the metatarsal head in sagittal, transversal, and even in frontal plane, and is useful to correct mild and moderate deformities. Key words: hallux valgus, minimally invasive technique, percutaneous technique, chevron osteotomy, Akin osteotomy.
- MeSH
- bunion * MeSH
- dospělí MeSH
- hallux valgus * diagnostické zobrazování chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- metatarzální kosti * diagnostické zobrazování chirurgie MeSH
- metatarzofalangeální kloub * MeSH
- mladiství MeSH
- mladý dospělý MeSH
- retrospektivní studie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
The aim of this study was to compare the performance of two bivariate visualizations by measuring response correctness (error rate) and response time, and to identify the differences in cognitive processes involved in map-reading tasks by using eye-tracking methods. The present study is based on our previous research and the hypothesis that the use of different visualization methods may lead to significant cognitive-processing differences. We applied extrinsic and intrinsic visualizations in the study. Participants in the experiment were presented maps which depicted two variables (soil moisture and soil depth) and asked to identify the areas which displayed either a single condition (e.g., "find an area with low soil depth") or both conditions (e.g., "find an area with high soil moisture and low soil depth"). The research sample was composed of 31 social sciences and humanities university students. The experiment was performed under laboratory conditions, and Hypothesis software was used for data collection. Eye-tracking data were collected for 23 of the participants. An SMI RED-m eye-tracker was used to determine whether either of the two visualization methods was more efficient for solving the given map-reading tasks. Our results showed that with the intrinsic visualization method, the participants spent significantly more time with the map legend. This result suggests that extrinsic and intrinsic visualizations induce different cognitive processes. The intrinsic method was observed to generally require more time and led to higher error rates. In summary, the extrinsic method was found to be more efficient than the intrinsic method, although the difference was less pronounced in the tasks which contained two variables, which proved to be better suited to intrinsic visualization.
- MeSH
- čtení MeSH
- dospělí MeSH
- humanitní vědy psychologie MeSH
- kognice fyziologie MeSH
- lidé MeSH
- mladý dospělý MeSH
- reakční čas fyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- srovnávací studie MeSH
BACKGROUND: We report the outcomes of a prospective consecutive series of 267 total ankle replacements (TARs) using a new mobile bearing Rebalance® prosthesis. METHODS: Between April 2011 and December 2018, 267 consecutive Rebalance® prostheses were implanted in 255 patients at 3 different centers. Estimated survival curves with 95% confidence intervals were produced with the Kaplan-Meier method. 110 ankles were followed for at least 5 years and clinical and radiological outcomes were assessed in 92 of these ankles. RESULTS: Twenty-one ankles were revised at a mean of 34 (7-60) months. The estimated survival was 90% (95% CI 86-95) at 5 years and 88.3% (95% CI 83.-94 at 6 years. The ankles followed for at least 5 years demonstrated a median Likert score of 1 (1-4). Radiolucent zones were detected in 14% and osteolytic cysts in 3%. CONCLUSION: The survival rate of the Rebalance prosthesis conforms with other reports of similar designs. The satisfaction rate was high. Radiological zones and osteolytic cysts were found at a lower rate than usually reported for mobile bearing TARs. These results favour further use of this implant.
- MeSH
- časové faktory MeSH
- dospělí MeSH
- hlezenní kloub diagnostické zobrazování chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- prospektivní studie MeSH
- protézy - design MeSH
- protézy kloubů * MeSH
- radiografie MeSH
- reoperace MeSH
- selhání protézy MeSH
- senioři MeSH
- totální endoprotéza hlezenního kloubu metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY Periprosthetic joint infections in total knee arthroplasty (TKA) represent one of the most limiting factors of implantation. Frequency of this complication is up to 2.5% in primary implantation. Revision TKA with the use of DAIR (Debridement, Antibiotics and Implant Retention) procedure is a widely accepted method in treating infection, but the indication criteria have not been clearly defined as yet. The lack of uniformity prevails also with respect to the surgical technique and the importance of respective techniques for successful treatment. The purpose of this study was to evaluate the factors affecting the twoyear survival of TKA after treating the infection by DAIR. MATERIAL AND METHODS We conducted a monocentric retrospective analysis involving 52 cases of infected TKA managed with DAIR in the period between 2007 and 2016. The evaluation took into account such factors as the sex, age, history of revision surgery for aseptic or septic reasons, and pathogens. The patients were divided into groups based on the McPherson criteria. As to the procedure, we monitored the effect of administered antibiotics, time interval between the manifestation of symptoms of TKA infection and surgery, exchange of modular parts, and use of pulse lavage, continual lavage, local antibiotic carrier, or combination of these techniques. Treatment failure was defined as persistent infection and transition to chronic suppressive antibiotic therapy or need for revision surgery of the respective joint due to recurrent infection of TKA, or death directly associated with the treatment of infected TKA in the follow-up period of 2 years after DAIR. The R software (Team Development Core, 2017) was used to carry out the statistical analysis. The target variable was the failure at two years after surgery. The Generalized Linear Model (GLM) was used for the binary dependent variable - the socalled logistic model with a logit link function. RESULTS 32 of 52 patients (61.5%) were successfully treated, of whom 18 women (62.1%) and 14 men (60.9%). The effect of causative agent, administered antibiotics, polyethylene insert exchange, McPherson score or history of revision surgery of the respective joint for aseptic reasons was not confirmed. The history of revision surgery for infection of the affected joint had a strong negative impact on treatment success, 10 of 13 (76.9%) implants failed as against 10 of 39 (25.6%) implants with negative history of infection. The mean time from surgery to the manifestation of infection was 5.9 weeks (0.5-47.5). When surgery was performed within 2 weeks from the manifestation of infection, 1 of 15 (6.7%) cases failed. In case of a later surgery, 19 of 37 (51.4%) cases failed. As concerns the used surgical technique, 60% (9/15) failure was reported in case of the combination of pulse lavage and continual lavage, 36.4% (4/11) in case of the combination of pulse lavage and local antibiotic carrier, 25% (4/16) in case of separate continual lavage, and 66.7% (2/3) in case of continual lavage with local antibiotic carrier. DISCUSSION The importance of individual factors in revision surgery of periprosthetic joint infections of TKA remains unclear. The world literature indicates as a major negative effect the time factor, the positive history of infection of the affected implant, or other previous revision surgery for aseptic reasons. Ambiguous results are achieved in assessing the effect of the pathogen, administered antibiotics or presence of fistula, the statistical significance of which has not been confirmed in our study. Questionable is also the importance of individual surgical techniques. CONCLUSIONS DAIR is a suitable method in treating infections of stable TKA without the history of revision surgery for infection. The surgery should be performed within 2 weeks from the manifestation of symptoms. Key words: debridement, antibiotics, infection, implant retention, total knee arthroplasty.
- MeSH
- antibakteriální látky terapeutické užití MeSH
- debridement MeSH
- infekce spojené s protézou * chirurgie MeSH
- lidé MeSH
- míra přežití MeSH
- reoperace MeSH
- retrospektivní studie MeSH
- totální endoprotéza kolene * škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Ulnární deviace prstů je součástí rozvinuté kolapsové deformity zápěstí a ruky. Porucha centrálního pilíře ruky začíná ulnární translokací karpu ve frontální rovině. Dle Shapirovy teorie se karpus a metakarpální krajina biomechanicky chovají jako celek a ulnární posun zápěstí a jeho inklinace radiálně je sledován radiální inklinací metakarpů a ulnární deviací prstů. V oblasti MCP kloubů vzniká vlivem uvolnění vazivového aparátu tendence k dislokaci průběhu extenzorových šlach II. až V. prstu ulnárně. Jejich sklouznutí z vrcholu MCP kloubu do intermetakarpálních prostorů má za následek omezení jejich extenční schopnosti. Extenzory se v novém, patologickém průběhu stávají i ulnárními duktory prstů a dále zesilují a fixují ulnární deviaci. Operační výkony, které vedou k zachycení posunu karpu ulnárně jsou prevencí vzniku kolapsové deformity a tím i ulnární deviace prstů. Základním výkonem je časná synovektomie dorzální části karpu a peritenosynovektomie extenzorových šlach doplněná šlachovou transpozicí, dále synovektomie MCP kloubů spolu s výkony, které reponují fyziologický průběh extenzorových šlach. Používají se i limitované dézy v proximální řadě karpálních kostí. Tonizace radiálních kolaterálních vazů a transpozice úponů ulnárních interoseálních a lumbrikálních svalů na radiální část základního článku vedlejšího prstu patří k nejsložitějším operačním výkonům v této krajině. Jejich kombinace s implantacemi umělých náhrad MCP kloubů bývá v rozvinutých případech nezbytná.
The ulnar deviation of the fingers is a part of a developed collapse deformity of the wrist and hand. The central pillar disorder of the hand begins with ulnar translocation of the carp in the frontal plane. According to Shapiro's theory, the carpus and metacarpal landscape behave biomechanically as one unit and the ulnar deviation and radial inclination of the wrist is followed by the radial inclination of the metacarpus and the ulnar deviation of the fingers. In the area of MCP joints, there is a tendency to ulnarly dislocate the course of the extensor tendons of the 2nd to 5th finger due to the loosening of the ligament apparatus. Their slipping from the top of the MCP joint into the intermetacarpal spaces results in a limitation of their extension ability. Extensors in their new, pathological course become ulnar ductors of the fingers and further strengthen and fix ulnar deviation.Surgical interventions that lead to the capture of the ulnar carpus deviation prevent the collapse deformity and thus ulnar deviation of the fingers. The basic procedure comprises early synovectomy of the dorsal portion of the carpus and peritenosynovectomy of the extensor tendons followed by tendon transposition, synovectomy of the MCP joints together with interventions that repose the physiological course of the extensor tendons. Limited joint fusions in the proximal row of carpal bones are also used. Tonalization of radial collateral ligaments and transposition of insertions of ulnar interosseal and lumbrical muscles to the radial part of the proximal phalanx of the next finger is one of the most complicated surgical procedures in this region. Their combination with implantation of artificial MCP joint replacements is necessary in developed cases.
- Klíčová slova
- revmatická ruka, revmatochirurgie ruky, revmatická deformita, ulnární deviace prstů,
- MeSH
- chirurgie operační metody MeSH
- deformity ruky * chirurgie MeSH
- lidé MeSH
- revmatické nemoci chirurgie patologie MeSH
- ruka chirurgie patologie MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
