Účel studie: Radiosynoviortéza (RSO), dříve též nazývána slovem radiosynovektomie (RS), je metoda zaměřená na léčbu bolesti a otoku kloubů způsobených synovitidou u artritid a dekompenzovaných artróz prostřednictvím lokální aplikace beta zářičů. Zářením vyvolaná povrchová nekróza části buněk v synoviální membráně ve svém výsledku může zmírnit bolest, snížit otoky a zlepšit funkci kloubů. Materiál a metoda: V období 2013–2024 bylo RSO léčeno celkem 436 pacientů, z toho 291 pro otok kolenního kloubu vzniklý v důsledku dekompenzované artrózy a 172 kvůli artritidě. Kolenní kloub byl RSO ošetřen 268krát a malé a střední klouby 50krát. Používalo se yttrium u kolenních kloubů, rhenium u středních nebo erbium u malých kloubů. Samotný zákrok spočíval v punkci kloubu a odsátí případného kloubního výpotku, následné aplikaci radiofarmaka a imobilizaci kloubu po dobu 2–3 dnů. Výsledky: K hodnocení klinického efektu RSO jsme vybrali aplikace v letech 2022 a 2023. V roce 2022 bylo provedeno 45 ošetření a v roce 2023 dalších 26. Po jednom roce bylo 61 % pacientů s léčbou kolenních kloubů zcela spokojeno, přičemž uváděli zmenšení otoku a zlepšení rozsahu pohybu. U pacientů léčených s malými a středně velkými klouby se celkové zlepšení objevilo u 57 % z nich. Někteří zaznamenali recidivující výpotek menšího objemu nebo jen částečné zlepšení. Závěr: Radiosynoviortéza je účinná léčba otoků a bolesti kloubů způsobených synovitidou s pozitivními výsledky jak u kolenních, tak i menších kloubů, což je doloženo jak objektivními, tak subjektivními zlepšeními.

Purpose of the study: Radiosynoviorthesis (RSO), previously also called radiosynovectomy (RS), is a method focused on the treatment of joint pain and swelling caused by synovitis in arthritis and decompensated osteoarthrosis using beta emitters. Radiation-induced surface necrosis of part of the cells in the synovial membrane can, as a result, relieve pain, reduce swelling, and improve joint function. Material and method: Between 2013-2024, 436 patients were treated with RSO, primarily for knee joint swelling due to decompensated osteoarthrosis (291 patients) and arthritis (172 patients). RSO was performed on the knee (268 cases) and on small/medium joints (50 cases), using yttrium for knee joints, rhenium for medium joins or erbium for small joints. The procedure involved puncture of the joint and suction of any joint effusion, injecting the radioactive isotope, and subsequently immobilizing the joint for 2–3 days. Results: We selected treatments in 2022 and 2023 to evaluate the clinical effect of RSO. In 2022, 45 treatments were performed, and in 2023 another 26. One year post-treatment, 61 % of patients with knee joint involvement were fully satisfied, reporting reduced swelling and improved range of motion. Among patients treated for small and medium-sized joints, 57 % experienced overall improvement. Some patients observed recurring effusions of smaller volume or only partial improvement. Conclusion: Radiosynoviorthesis is an effective treatment for joint swelling and pain caused by synovitis, with positive outcomes seen in knee as well as smaller joints. Both objective and subjective assessments confirmed significant benefits.

• Klíčová slova
• radiosynoviortéza,
• MeSH
• artritida diagnostické zobrazování   radioterapie   MeSH
• erbium aplikace a dávkování   terapeutické užití   MeSH
• injekce intraartikulární MeSH
• klinické zkoušky jako téma MeSH
• osteoartróza diagnostické zobrazování   radioterapie   MeSH
• radiofarmaka * aplikace a dávkování   terapeutické užití   MeSH
• radioizotopy ytria aplikace a dávkování   terapeutické užití   MeSH
• rhenium aplikace a dávkování   terapeutické užití   MeSH
• synovitida * diagnostické zobrazování   radioterapie   MeSH

• Publikační typ
• abstrakt z konference MeSH

PURPOSE OF THE STUDY The failure of arthroplasties and above all the issue of infection and its detection have become an ever more frequently discussed problem. The purpose of our study was to determine the frequency and the type of complications after revision total knee arthroplasties and to compare them with the frequency of complications after primary implantations. MATERIAL AND METHODS In our group of patients followed up in the period from January 2007 to December 2016, in 50 patients the revision surgery was performed for aseptic loosening and in 24 patients for deep infection. In the case of revision surgery for aseptic loosening, in 18 patients original sterilised components were used as a spacer, in 6 patients an articulating cement spacer was applied. Only the complications resulting in the performance of further revision were included in the statistics. A total of 13 patients underwent a primary implantation at another centre. The number of revisions and the reason for implant failure were monitored. The results were compared with the frequency of revision surgeries after primary total knee arthroplasty, of which 2,436 were carried out in the referred to period. RESULTS Of 2,436 primary endoprostheses, altogether 3.1 % failed. In 50 (2.1 %) patients aseptic loosening was reported, 24 patients (1 %) suffered from infection. The median time from primary implantation to revision was 11 years for aseptic loosening, 2 years for infection. The most frequent cause of failure was aseptic loosening. In the group of patients who underwent a revision surgery for aseptic loosening, another revision was necessary in 6 cases (12 %), in the group of patients after the two-stage revision surgery for infection, in 9 cases (37.5 %). The most frequent reason for revision surgery was infection - in both the groups this was the reason for 67 % of revision surgeries. DISCUSSION Our results obtained with respect to primary as well as revision surgeries for aseptic loosening correspond with the results reported by other authors. In the case of two-stage revision implantation, the reported frequency of recurrent infections is the same, the frequency of revision surgeries for aseptic causes is slightly lower in our group. The most frequent causes of revision surgery are also in agreement. In the case of primary implantation, the patients most frequently suffer from aseptic loosening, after revision surgeries another revision surgery is most often performed due to infection. The literature refers to studies suggesting the potential use of original components as a spacer with the same success rate as that achieved with the cement spacer. The original components produced good results in two thirds of two-stage revision implantations, which is why we can agree with these studies. CONCLUSIONS The results clearly show a noticeable increase in the frequency of complications in revision surgeries compared to primary surgeries. In comparison with primary implantations, a subsequent revision after the revision implantation for aseptic loosening was necessary three times more frequently, after the two-stage revision implantation for infection it was ten times more frequently. As the most problematic complication can be considered the infection in case of primary as well as revision interventions. It is obvious that aseptic loosening of the primary implant usually occurs later (the median of 11 years) than the development of deep infection (the median of 2 years). Key words: total knee arthroplasty, revision, failure, complications, aseptic loosening, infection, spacer.

• MeSH
• infekce chirurgické rány * etiologie   MeSH
• lidé MeSH
• následné studie MeSH
• reoperace MeSH
• selhání protézy MeSH
• totální endoprotéza kolene * škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY To evaluate the efficacy of the systemic administration of two doses of tranexamic acid (TXA) in total knee (TKA) and hip arthroplasty (THA). MATERIAL AND METHODS The study evaluated a total of 295 patients who underwent total knee and hip arthroplasty for osteoarthritis, prospectively followed up were the patients who had been administered the tranexamic acid (TXA), and this group was subsequently compared against the cohort - control group. Our evaluation was focused on perioperative and postoperative period. The amount of blood loss was monitored during the surgery as well as postoperatively. Moreover, the frequency and the volume of administered allogeneic blood transfusions and in TKA also autotransfusion requirement were observed. The patients postoperative hemoglobin levels were compared in both the groups when the patients were in the ICU and the frequency of all postoperative complications was monitored. The statistical analysis was carried out separately for hip and knee replacement. RESULTS Our study confirmed that the systemic application of tranexamic acid in two 10-15 mg/kg doses in knee arthroplasty resulted in a statistically significant reduction of perioperative and postoperative blood loss, lower frequency of administration of allogeneic blood transfusion, but also in lower frequency in the administration of any transfusion, including autotransfusion. In patients who underwent total hip arthroplasty, the administration of TXA led to a statistically significant reduction of postoperative bleeding. The patients with total knee as well as hip arthroplasty, who had been administered TXA, showed significantly higher haemoglobin levels when transferred from the ICU. No significant difference was found in deep vein thrombosis, pulmonary embolism or other postoperative complications among the study groups. DISCUSSION There is no homogeneity in the already published studies proving the efficacy of TXA in TKA and THA, they differ considerably as to the method of administration of the tranexamic acid. The differences concern the systemic and local application, dosage and time of administration. In some studies, TXA was administered in a single dose only, whereas in other studies it was administered repeatedly, in the form of a bolus or continuously. In our study we confirmed the efficacy of systemic administration of tranexamic acid in two repeated bolus doses of 10-15 mg/kg, namely before the commencement of the surgery and at the end of the surgery. CONCLUSIONS The administration of tranexamic acid in two IV doses of 10-15 mg/kg to patients with total knee and hip arthroplasty has proven to be efficient. A higher efficacy of TXA was reported in TKA and due to routine administration of TXA the postoperative autotransfusion system (ORTHO P.A.S.) ceased to be used in knee replacement surgery. Key words:total hip arthroplasty, total knee arthroplasty, tranexamic acid, blood loss, allogeneic transfusion, autotransfusion, postoperative complications.

• MeSH
• antifibrinolytika * MeSH
• krvácení při operaci MeSH
• kyselina tranexamová * terapeutické užití   MeSH
• lidé MeSH
• náhrada kyčelního kloubu * MeSH
• prospektivní studie MeSH
• totální endoprotéza kolene * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Úvod: Cílem této práce je srovnání pooperačních výsledků mezi interferenčním šroubem a kortikální závěsnou fixací ToggleLoc pro femorální fixaci štěpu při náhradě předního zkříženého vazu. Materiál a metodika: Zhodnotili jsme pooperační výsledky u 97 pacientů - 55 pacientů s fixací pomocí interferenčního šroubu a 42 pacientů s kortikální závěsnou fixací. Hodnoceny byly pohyb, stabilita a diference předozadní stability kolenního kloubu ve srovnání s druhostranným zdravým kloubem. Dále byly hodnoceny subjektivní dotazníkové formy - Lysholmovo a IKDC skóre. Rozdíly jednotlivých fixací byly zhodnoceny nezávislým statistikem. Výsledky: Replastika byla provedena u tří pacientů v každé skupině. Medián stranových rozdílů ventrální laxity kolena byl 1,7 mm u interferenčního šroubu a 1,85 mm u kortikální závěsné fixace. Rozdíl mezi skupinami byl tedy 0,15 mm. Hodnoty Lysholmova skóre, IDKC skóre, Lachmanův test a omezení pohybu byly mezi sledovanými skupinami obdobné a statisticky nevýznamné. Diskuse: V literatuře jsou popisovány přednosti a nevýhody jednotlivých fixací, avšak při zhodnocení pooperační výsledků většina autorů publikuje obdobné výsledky obou fixací. Stejných výsledků jsme dosáhli i v naší studii. Závěr: V našem souboru jsme dosáhli u obou skupin obdobných pooperačních výsledků a neprokázali jsme statisticky významný rozdíl v pooperačních výsledcích jednotlivých fixací.

Introduction: The aim of this work is to compare postoperative results between interference screws and cortical suspension device ToggleLoc for femoral fixation while replacing anterior cruciate ligament.

• Klíčová slova
• kortikální závěsná fixace, interferenční šroub,
• MeSH
• artroplastiky kloubů metody   MeSH
• autologní transplantace MeSH
• dospělí MeSH
• hodnocení výsledků péče pacientem MeSH
• klinická studie jako téma MeSH
• kolenní kloub chirurgie   MeSH
• kostní šrouby MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• nestabilita kloubu chirurgie   MeSH
• poranění předního zkříženého vazu * chirurgie   terapie   MeSH
• rekonstrukce předního zkříženého vazu * metody   MeSH
• rozsah kloubních pohybů MeSH
• šlachy transplantace   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH

PURPOSE OF THE STUDY Osteoarthritis of the thumb's basal joint is a frequent and, in some cases, very painful condition that usually affects middle-aged and elderly women. Several surgical procedures have been proposed for severe carpometacarpal (CMC) joint arthritis; of these, joint replacement has proved to be an effective approach to its treatment. The aim of this study is to present the outcomes of the total non-cemented trapeziometacarpal implant Maïa in the treatment of more advanced stages of this disease. MATERIAL AND METHODS Thirty-six total trapeziometacarpal joint replacements in 34 patients treated in 2008 for advanced CMC arthritis (Eaton and Littler stages III and IV) were evaluated. Indications for surgery after failure of conservative treatment included: pain, reduced grip and pinch strength and restricted range of thumb motion, all of them interfering with daily activities. The average follow-up time was 42 months, with a minimum of 37 months. RESULTS At the final follow-up, thumb opposition to the base of the little finger was present in all patients. The average grip strength of the hand increased from 15.8 kg pre-operatively to 26.8 kg post-operatively The average key pinch strength increased from 2.7 kg to 5.7 kg and the average tip pinch strength from 2.3 kg to 4.9 kg. All patients reported substantial pain relief. The average VAS values were 8.4 points before surgery and 0.4 points at 3 years after surgery. Pre- and post-operative DASH scores were 71.7 and 22.5, respectively. One patient had aseptic cup loosening that required revision surgery. No signs of implant loosening in any other patient were shown by radiographic studies at the final follow-up. One patient sustained a traumatic implant dislocation that was treated by open reduction. DISCUSSION Total replacement of the CMC joint is a method with functional outcomes comparable with or better than other surgical procedures. Rapid post-surgery recovery is its clear advantage. The implant provides good stability and no prolonged immobilisation is needed. CONCLUSIONS In our group, total arthroplasty of the thumb CMC joint provided pain relief, improved thumb motion and pinch strength. At present, CMC joint arthroplasty is recommended to elderly patients with symptoms of advanced arthritis (stage III or early stage IV) refractory to conservative treatment or to well-informed younger persons accepting reduced demands on the treated hand's activities.

• MeSH
• artroplastika prstů * metody   MeSH
• karpometakarpální klouby * chirurgie   MeSH
• lidé MeSH
• obnova funkce MeSH
• osteoartróza chirurgie   komplikace   radiografie   MeSH
• palec ruky * chirurgie   patologie   MeSH
• prospektivní studie MeSH
• protézy a implantáty * využití   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH

The kinematics of an intact knee joint and that of a knee replacement have been studied in many research centres. In the 1987 radiographic study, Bradley, Goodfellow and O'Connor reported the movement of a polyethylene insert in patients with unicompartmental Oxford knee replacement. Views with the knee at full extension and 90° of flexion were obtained and the movement of the meniscal bearings over this range of flexion was measured. The bearings were found to move backwards on the tibia through an average distance of 4.4 mm in all 16 patients. This measurement was in agreement with the then valid concept of knee biomechanics and a roll-back phenomenon. However, our observations had not always agreed with the results of these authors, but gave an impetus for a detailed evaluation of our own patient group. The aim of the study was to evaluate the dynamic relationship between the components of a unicompartmental Oxford knee replacement and elucidate it with the use of recent information from the field of biomechanics. A relationship of the obtained kinematic values to clinical outcomes was also investigated. Answers to the following hypotheses were sought: Would our results be in agreement with the British authors' findings? Would clinical outcomes depend on the kinematic properties of knee replacements? MATERIAL AND METHODS The group comprised 33 patients, 23 women and 10 men. They all had replacement of the medial compartment of the knee. The construction of the unicompartmental Oxford Phase III knee replacement enabled us to locate the centre of rotation of the medial femoral condyle in relation to the tibial component at flexion and extension of the knee, using radiography. The patients were examined in a supine position with the knee at full extension, and subsequently views of the knee were obtained at 80°-90° flexion in accordance with the method used by the British authors. The clinical findings of knee joints were assessed using the American Knee Society (AKS) scoring system (Insall et al.). Pain was rated on the Visual Analogue Scale (VAS). The results were statistically evaluated with the t-test and Chi-square test. RESULTS On moving the knee from extension to flexion, movement of the polyethylene insert ventrally by an average of 3.4 mm in relation to the tibia was recorded, i.e., "paradoxical" ventral translocation. In the patients with insert movement less than or equal to 3 mm, the average AKS score was 89 points, in those with movement over 3 mm it was 87 points. The average functional scores were 87 and 83 points in the patients with movement less than 3 mm and more than 3 mm, respectively. The average VAS score was 1.55 in the former and 1.18 in the latter. DISCUSSION The unicompartmental Oxford Phase III knee replacement substitutes a flexion femoral facet and eliminates the role of an extension femoral facet. This is the reason why, at knee extension between -5° and +20°, the centre of rotation of the medial femoral condyle is in the centre of the flexion facet and not in that of the extension facet. When the stabilising functions of the extension tibial facet in the ventral direction and of the dorsal part of the insert in the dorsal direction are missing, the position of the contact surface centre becomes much dependent also on the strength and direction of external forces acting in the knee joint vicinity. CONCLUSIONS The kinematic parameters of the unicompartmental Oxford Phase III knee replacement investigated in our group differed from the findings of the British authors. However, neither the magnitude nor the direction of movement had any effect on the clinical outcome of knee arthroplasty.

• MeSH
• biomechanika MeSH
• kolenní kloub patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• protézy kolene MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• totální endoprotéza kolene MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH