• MeSH
• artroplastika MeSH
• koleno chirurgie   patologie   MeSH
• osteoartróza chirurgie   MeSH

Autori v článku zameriavajú pozornosť na osteotómie v oblasti kolena. V súčasnej ére totálnych náhrad kolenného kĺbu má osteotómia v oblasti kolena stále svoje pevné miesto a výhody. Po totálnej endoprotéze kolena sú výsledky veľmi dobré. Z praxe vieme, že totálna endoprotéza má však svoje časové obmedzenie. Z tohto dôvodu, pokiaľ je to možné, zvažujeme u mladších vekových skupín osteotómiu. Najideálnejšie je to ešte v tom štádiu, kedy nie sú ešte pokročilé známky primárnej či sekundárnej gonartrózy. Autori uvádzajú, že na II. ortopedickej klinike bolo v roku 1998 vykonaných v oblasti kolena 22 % operácií, z toho osteotómie predstavovali 7 %, totálne endoprotézy 5 % výkonov. Typ osteotómie na klinike je väčšinou klinovitá osteotó- mia s fixáciou osteosyntetickým materiálom. Osteotómia tíbie bola vykonaná vo veku priemer 59 rokov u 56 % mužov a 44 % žien. Osteotómie distálneho femoru boli vykonané v priemernom veku 43 rokov u 44 % mužov a 56 % žien. TEP kolien bol vykonaný v priemernom veku 65 rokov 38 % mužov a 62 % žien. Autori ukazujú niektoré typy osteotómii v oblasti kolena, s ktorými majú dobré skúsenosti.

The authors draw attention to osteotomy in the region of the knee. During the present era of total endoprostheses of the knee iont osteotomy in the region of the knee still holds its firm place and has certain advantages. After total endoprosthesis of the knee the results are very good. From practice it is however known that total endoprostheses have their limitations in time. This is why in younger age groups, if possible, osteotomy is considered. It is best to perform it in the stage before advanced signs of primary and secondary gonathreitis develop. The authors mention that at the Second Orthopaedic Clinic in 1998 some 22% operations in the region of the know were made, incl. 7% osteotomies. 5% total endoprostheses. The type of osteotomy used at the Clinic is in the majority wedge-shaped osteotomy with fixation by means of osteosynthetic material. Osteotomy of the tibia was performed on average at an age of 59 years in 56% men and 44% women. Osteotomy of the distal femur was made at an average age of 43 years in 44% men and 56% women. TEP of the knee was administered at an average age of 65 years in 38% men and 56% women. The authors demonstrate some types of osteotomies in the area of the knee which proved useful according to their experience.

• MeSH
• dospělí MeSH
• femur chirurgie   MeSH
• kolenní kloub chirurgie   MeSH
• lidé MeSH
• osteotomie metody   MeSH
• poměr pohlaví MeSH
• tibie chirurgie   MeSH
• totální endoprotéza kolene MeSH
• věkové rozložení MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH

OBJECTIVE: Aseptic loosening (AL) is the most frequent long-term reason for revision of total knee arthroplasty (TKA) affecting about 15-20% patients within 20 years after the surgery. Although there is a solid body of evidence about the crucial role of inflammation in the AL pathogenesis, scared information on inflammation signature and its time-axis in tissues around TKA exists. DESIGN: The inflammation protein signatures in pseudosynovial tissues collected at revision surgery from patients with AL (AL, n = 12) and those with no clinical/radiographic signs of AL (non-AL, n = 9) were investigated by Proximity Extension Assay (PEA)-Immunoassay and immunohistochemistry. RESULTS: AL tissues had elevated levels of TNF-family members sTNFR2, TNFSF14, sFasL, sBAFF, cytokines/chemokines IL8, CCL2, IL1RA/IL36, sIL6R, and growth factors sAREG, CSF1, comparing to non-AL. High interindividual variability in protein levels was evident particularly in non-AL. Levels of sTNFR2, sBAFF, IL8, sIL6R, and MPO discriminated between AL and non-AL and were associated with the time from index surgery, suggesting the cumulative character of inflammatory osteolytic response to prosthetic byproducts. The source of elevated inflammatory molecules was macrophages and multinucleated osteoclast-like cells in AL and histiocytes and osteoclast-like cells in non-AL tissues, respectively. All proteins were present in higher levels in osteoclast-like cells than in macrophages. CONCLUSIONS: Our study revealed a differential inflammation signature between AL and non-AL stages of TKA. It also highlighted the unique patient's response to TKA in non-AL stages. Further confirmation of our preliminary results on a larger cohort is needed. Analysis of the time-axis of processes ongoing around TKA implantation may help to understand the mechanisms driving periprosthetic bone resorption needed for diagnostic/preventative strategies.

• MeSH
• cytokiny metabolismus   MeSH
• histiocyty metabolismus   patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• makrofágy metabolismus   patologie   MeSH
• osteoklasty metabolismus   patologie   MeSH
• reoperace MeSH
• resorpce kosti komplikace   metabolismus   patofyziologie   chirurgie   MeSH
• selhání protézy škodlivé účinky   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• totální endoprotéza kolene škodlivé účinky   MeSH
• zánět komplikace   metabolismus   patofyziologie   chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

PURPOSE OF THE STUDY The study presents the monocentric retrospective study of a group of patients with malignant tumours around the knee, treated by a wide resection and a reconstruction with megaprosthesis due to infectious complications. Provided is a detailed analysis of each operative treatment due to the manifestation and process of periprostethic infection of the knee megaprosthesis and the use of external fixator during a two-stage revision. MATERIAL AND METHODS Between 01/1993 and 12/2013, a total of 67 cemented megaprostheses were assessed, with a detailed analysis of 12 patients with periprosthetic infection. The Kaplan-Meier method and MSTS for lower extremity clinical assessment were used and a range of motion was evaluated. RESULTS The endoprosthesis failed due to all kinds of complications (mechanical, biological, infection) in 27 (40.3%) patients. The estimated one-year survival rate from the surgery was 94%, the five-year survival rate was 72%, and the ten-year survival rate was 46%. Based on the statistical analysis of the implant survival due to infection, the one-year survival rate was 94%, the five-year survival rate was 75%, and the ten-year survival rate was 57%. Three patients were treated with radical surgical debridement. Five patients were treated with a two-stage revision with a cement spacer and external fixator, and three patients underwent nail fixation. Clinical values before and two years after the revision surgery for periprosthetic infection using MSTS were assessed. The mean of the difference of clinical values was 1.91 and the p value of paired t-test was 0.24, therefore there was no prove of the clinical result difference using MSTS before and after the revision surgery. DISCUSSION The acute radical debridement and lavage is preferred, if the surgery can be done up to three weeks after the first clinical signs of infection under the condition of good retention of the implant. In case of extensive infectious damage, when abscess, fistula and loosening of the implant are present and when the patient has a good oncological prognosis, we prefer a twostage revision with a cement spacer stabilized by an external fixator. In patients with mitigated infection or uncertain oncological prognosis we prefer a two-stage revision with the combination of a cement spacer and intramedullary nail fixation. CONCLUSIONS The study presents the results of operative treatment of periprosthetic infection of megaprosthesis and the modification of the two-stage replantation of infected MP with the use of external fixation for stabilisation of a non-articulated cement spacer allowing the patient to remain active during the time before the second stage. Key words: periprosthetic infection, megaprosthesis, bone tumour, external fixator, two-stage revision.

• MeSH
• analýza přežití MeSH
• debridement metody   MeSH
• kolenní kloub mikrobiologie   patologie   chirurgie   MeSH
• lidé MeSH
• nádory kostí mikrobiologie   patologie   chirurgie   MeSH
• protézy kolene mikrobiologie   MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• selhání protézy MeSH
• totální endoprotéza kolene škodlivé účinky   přístrojové vybavení   metody   MeSH
• vnitřní fixace fraktury metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY The study aims to quantify the costs of a hospital stay of patients with total knee periprosthetic joint infection throughout the period of treatment. MATERIAL AND METHODS The group included patients who have been treated at our department for infection as a complication of total knee replacement since 1 January 2011, who have been provided with treatment (including complications) exclusively at the departments of Nemocnice České Budějovice, a.s. and whose treatment can be considered completed in 2018. The patients were included in the study regardless of the type of infection and method of treatment. The group consisted of 24 patients (11 men and 13 women). There were 2 cases of early postoperative infection, 6 cases of late postoperative infection and 16 cases of hematogenous infection. The group includes 17 patients treated by a two-stage reimplantation, 6 patients treated by a revision surgery with implant retention, and 1 patient treated by a one-stage replacement. In selected patients, all the reported points for all the hospital stays and costs incurred on a separately charged material were ascertained and the final sum was compared with the reimbursement obtained by the hospital in the DRG system valid for the respective year of treatment. The total costs were analysed and moreover, an analysis by type of infection and method of treatment was carried out. RESULTS The average costs of managing infection as a complication of TKA in our department amounted to CZK 405 864 (CZK 66 768-CZK 181 17). The average cost of a two-stage revision was CZK 497 487, the cost of a revision surgery with original implant retention was CZK 175 312. The reimbursement in respect of the monitored cases in the DRG system equalled CZK 276 230 (CZK 40 943-CZK 848 401). The aforementioned suggests that the average loss per a treated patient is CZK 129 635 (CZK + 26 066Kč-CZK -332 774). DISCUSION Our study is in agreement with recent literature, when confirming that the care associated with infections as a complication of TKA is very costly (especially in case of a two-stage reimplantation) and also that this care is not fully covered by the health insurance company. The reimbursement made by the health insurance companies does not cover on average 1/3 of the costs of care for an infectious patient. Theoretically, the reasons behind the reduced reimbursement may be sanctions which, however, cannot be accepted in case of late hematogenous infections which constituted more than 50% in our group. CONCLUSIONS Our study presented the actual costs associated with the care of TKA infection. It makes sense that the most expensive is the two-stage reimplantation, which is nevertheless still considered to be the gold standard procedure in chronic TKA infection. High costs of therapy together with the requirement of expert care would justify the introduction of care provided by specialised centres. In this case, centralisation could result in a more efficient use of funds and improvement of the quality of provided care. Key words:total knee arthroplasty, PJI - periprostetic joint infection, economic analysis. ÚVOD.

• MeSH
• délka pobytu ekonomika   MeSH
• infekce spojené s protézou ekonomika   etiologie   chirurgie   MeSH
• kolenní kloub chirurgie   MeSH
• lidé MeSH
• reoperace ekonomika   MeSH
• totální endoprotéza kolene škodlivé účinky   ekonomika   MeSH
• úhrada zdravotního pojištění ekonomika   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Úvod: Dvoudobá replantace je považována metodu volby při infekci TKA. Použití artikulačního spaceru dle Aarona Hofmanna se jeví jako optimální metoda prvního kroku terapie – revize infikované TKA. Principem je zachování maximální možné pohyblivosti kolenního kloubu, prevence atrofie kolem kloubních svalů a efektivní sanace infektu. Materiál a metoda: Autoři prezentují soubor 41 pacientů s infikovanou totální endoprotézou kolene operovaných v letech 1998 – 2016 na I. ortopedické klinice FN u sv. Anny v Brně. Autoři hodnotí úspěšnost operace jak stran sanace infektu, tak stran funkčního výsledku spaceru. Výsledky: Sanace infekce byla úspěšná u 39 pacientů, 27 z nich má již replantovánu TKA. Ostatní pacienti jsou buď chystáni k replantaci, nebo je kvůli závažným komorbiditám či uspokojivému funkčnímu výsledku artikulačního spaceru operace odložena. TKA jsme replantovali v období mezi 3.-31. měsícem po implantaci spaceru, průměrně po 10 měsících. Funkčně se artikulační spacer osvědčil, po běžné rehabilitaci zcela bez pomůcek chodilo 6 pacientů, s ortézou 16 pacientů, o berli bez ortézy 10 pacientů, s použitím ortézy i berlí 7 pacientů a s invalidním vozíkem 1 pacientka. Při následné reimplantaci byla s výhodou kvalitní kostní tkáň s minimální nutností použití dříkových variant. Běžně jsme při revizi použili PS variantu endoportézy. Diskuze a závěr: Autoři v souladu s ostatními pracemi konstatují dobré výsledky metody jak stran sanace infektu tak stran funkčnosti artikulačního spaceru. Prezentují alternativní metody jiných autorů, které využívají statické spacery, popřípadě rozdílný přístup k lokálnímu působení antibiotik. Autoři se také zamýšlejí nad indikacemi a nad časovým odstupem před případnou replantací endoprotézy.

Introduction: Two-stage replantation is considered as the method of choice in the treatment of TKA infections. Using of articulating spacer by Aaron Hofmann seems to be the optimal method of the first step of therapy - revision of infected TKA. The principle is to maintain the maximum possible mobility of the knee joint, preventing muscle atrophy and ensure effective treatment of infection. Materials and Methods: The authors present a group of 41 patients with infected total knee arthroplasty, operated on in ages 1998 – 2016 at Ist. Orthopedic department of MF MU and St. Anna’s university hospital in Brno. The authors evaluate the success of the operation according to treatment of infection and according to functionality of the knee with spacer. Results: Treatment of infection was successful in 39 patients, 27 of them have already been replanted. Other patients are prepared for replantation, or because of serious co-morbidities or satisfactory functional outcome of articulating spacer is surgery delayed. TKA has been replanted between 3 to 31 months after implantation of the spacer, average after 10 months. Functionally articulating spacer approved. After the usual rehabilitation 6 patients didn’t need any crutches and braces, 16 patients used only knee braces, crutches without brace needed 10 patients, 7 patients used both, crutches and brace and one patient used wheelchair. 27 patients were able to walk and provide self-care. During subsequent reimplantation, the good quality of bone was an advantage. Only in few cases, the stem variants of revision knee endoprostheses were necessary. Usually, PS variants were used. Discussion and Conclusion: Excellent results in infect treatment are in concordance with other authors. Authors present alternative methods using static spacers or another preview on using of local acting antibiotics. Indications and laps of time to endoprothesis revision are discussed.

• Klíčová slova
• artikulační spacer,
• MeSH
• antibakteriální látky aplikace a dávkování   MeSH
• aplikace lokální MeSH
• bakteriální infekce diagnóza   farmakoterapie   chirurgie   MeSH
• biokompatibilní potahované materiály MeSH
• časové faktory MeSH
• dospělí MeSH
• gentamiciny aplikace a dávkování   MeSH
• infekce spojené s protézou * etiologie   farmakoterapie   chirurgie   MeSH
• kostní cementy * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• odstranění implantátu MeSH
• protézy - design MeSH
• protézy kolene škodlivé účinky   MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• totální endoprotéza kolene * škodlivé účinky   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH