• MeSH
• lidé MeSH
• protézy kolene přístrojové vybavení   metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články 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
• Názvy látek
• cytokiny MeSH

PURPOSE OF THE STUDY: To present and evaluate short-term clinical results of total knee arthroplasty using the Beznoska S. V. L. implant and to compare them with the results of other authors. MATERIAL: In the period from April 1997 to October 2002, 197 total knee replacements with a S. V. L. implant were carried out of these, 164 implants were evaluated in 146 patients. This group comprised 116 women (78 %) and 48 men (22 %), with an average age of 73.6 years (range, 63 to 83) at the time of surgery. The patients were evaluated on average at 4.3 years (range, 1.5 to 6.5) after surgery. Indications for replacement were primary knee arthritis in 151, rheumatoid arthritis in nine, secondary post-traumatic arthritis in two and conditions following tibial osteotomy in two cases. METHODS: The results were evaluated using the Knee Society Clinical Rating System which consists of three parts: Knee Score (100 points), Knee Function Score (100 points) and Categorical Score (allocating patients to three groups according to function deficiencies of other joints). X-ray images were examined for implant position, the presence of radiolucent lines and patellar position, and assessed on the basis of the Knee Society Total Knee Arthroplasty Roentgenographic and Scoring System. RESULTS: No or mild pain in the treated joint was reported by 90.2 % of the patients. Severe pain was not recorded at all. The average maximal range of flexion increased from 94 degrees preoperatively to 104 degrees post-operatively. The range of motion more than 90 degrees and that of more than 100 degrees were recorded in 96 % and 76.8 % of the operated-on knees, respectively. An anteroposterior mild instability of 5 to 10 mm was objectively found in nine knees (5.5 %) a medial laxity of 6 to 9 degrees was detected in 36 knees (22 %) and that of 10 to 15 degrees only in one patient. Severe instability was not recorded. The leg axis achieved after surgery was on average 6.4 degrees valgus, compared to 5.5 degrees varus before surgery. The total Knee Score was 85.1 points (range, 53 to 100), with excellent or good outcomes in 151 knee replacements (92 %). Six patients (4.6 %) reported failure to walk a distance of more than 500 m on an even terrain, six (4.6 %) could not manage the stairs and five (3 %) required a permanent use of two crutches or a walking frame. The average function score, which also included the effect of concomitant diseases of other joints, was 64.9 points (range, 40 to 100), with excellent or very good outcomes being achieved in 64 implants (39 %). On X-ray examination of implant position in anteroposterior projection, the average valgus angle of the femoral component was 94.8 degrees (range, 92 to 100) and the tibial angle was 90.3 degrees (range, 85 to 94). In lateral projection the flexion angle of the femoral component was 2.5 degrees (-1 to 6) and the average dorsal tilt of the tibia was 3 degrees. Distinct radiolucent lines up to 1 mm in width were seen in the femoral component in 10 (6 %) cases and in the tibial component in 27 (16.5 %) cases, this occurred in zones 1, 2 or 4. Wider lines of 2 mm were present in both components in 6 (3 %) cases. Radiolucent lines were recorded in 43 (26 %) implants. The patella examined in axial projection was correctly centered in 140 (85 %) total knee replacements. Eleven patients reported femoropatellar problems and, in three of them, patella replacement was subsequently performed. No aseptic loosening occurred and one deep infection (0.6 %) was treated by a two-stage reimplantation. DISCUSSION: Excellent to very good outcomes, with an average Knee Score of 85.1 points, were achieved in 92 % of the implants. The total outcome characterized by an average Functional Score of 64.9 points was related to a higher average age of our patients and a high proportion of patients with diseases of other joints, which interfered with overall mobility and self-sufficiency. The results of implant position evaluation, based on X-ray examination, showed good values, which testifies to the use of an appropriate surgical technique and accuracy of the instrumentation applied. The occurrence of radiolucent lines was low, as was the number of complications. Our results are comparable with those reported in the literature. CONCLUSIONS: Our short-term evaluation shows that the S. V. L. implant is fully useful for total knee replacement in patients of higher age categories.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace MeSH
• protézy - design MeSH
• protézy kolene * MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• totální endoprotéza kolene * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• 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

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