The effect of plasma cytokines on the expression of adiponectin and its receptors in the synovial membrane of joints and the infrapatellar fat pad in patients with rheumatoid arthritis and osteoarthritis

BACKGROUND

Rheumatoid arthritis (RA) is an autoimmune inflammatory disease that leads to joint destruction. Numerous pro-inflammatory mediators, including adipokines, play an important role in the pathogenesis of RA.

OBJECTIVE

The aim of the study was to investigate the relationships between selected plasma cytokines and expression of adiponectin and its receptors in the synovium and the infrapatellar fat pad in patients with RA and osteoarthritis (OA).

METHODS

Blood, synovium and fat pad samples from 18 patients with RA and 18 with OA were collected during joint replacement surgery. Spearman rank correlations between plasma concentrations of selected cytokines (IL-1β, IL-2, IL-4, IL-6, IL-7, IL-8, IL-10, IL-12 p40, IL-13, IL-17, G-CSF and GM-CSF) and the expression of adiponectin and its receptors were determined. Plasma levels of cytokines were determined using a magnetic bead-based multiplex assay, mRNA expression of adiponectin and its receptors were determined by real-time PCR.

RESULTS

In OA patients, there were significant positive correlations between adiponectin expression in the synovial membrane and plasma levels of IL-1β, IL-4, G-CSF and GM-CSF, as well as a significant positive correlation between adiponectin expression in the fat pad and plasma levels of GM-CSF. In addition, OA patients showed significant negative correlations between AdipoR1 and AdipoR2 expression in the synovial membrane and plasma IL-6 levels, as well as between AdipoR2 expression in the synovial membrane and plasma MCP-1 and TNF-α levels. In patients with RA, there were no significant correlations between adiponectin expression in the synovial membrane and infrapatellar fat pad and plasma levels of the cytokines studied. In addition, RA patients showed a statistically significant negative correlation between AdipoR1 expression in the synovial membrane and plasma levels of TNF-α, IL-7, IL-12 and IL-13, and a significant negative correlation between AdipoR1 expression in the infrapatellar fat pad and plasma levels of IL-1β.

CONCLUSIONS

Adiponectin and its receptors showed the correlations with several plasma cytokines, however, a thorough understanding of the role of adiponectin in RA and OA requires further investigation.

Controversies in orthopaedic oncology

Chondrosarcoma is the second most common surgically treated primary bone sarcoma. Despite a large number of scientific papers in the literature, there is still significant controversy about diagnostics, treatment of the primary tumour, subtypes, and complications. Therefore, consensus on its day-to-day treatment decisions is needed. In January 2024, the Birmingham Orthopaedic Oncology Meeting (BOOM) attempted to gain global consensus from 300 delegates from over 50 countries. The meeting focused on these critical areas and aimed to generate consensus statements based on evidence amalgamation and expert opinion from diverse geographical regions. In parallel, periprosthetic joint infection (PJI) in oncological reconstructions poses unique challenges due to factors such as adjuvant treatments, large exposures, and the complexity of surgery. The meeting debated two-stage revisions, antibiotic prophylaxis, managing acute PJI in patients undergoing chemotherapy, and defining the best strategies for wound management and allograft reconstruction. The objectives of the meeting extended beyond resolving immediate controversies. It sought to foster global collaboration among specialists attending the meeting, and to encourage future research projects to address unsolved dilemmas. By highlighting areas of disagreement and promoting collaborative research endeavours, this initiative aims to enhance treatment standards and potentially improve outcomes for patients globally. This paper sets out some of the controversies and questions that were debated in the meeting.

3D printing for patient-specific implants in musculoskeletal oncology

Satisfactory results in terms of functional and oncological outcomes can be obtained in sacral and pelvic malignant bone tumors. Preoperative planning, adequate imaging, and a multidisciplinary approach are needed. 3D-printed prostheses have to fulfill several requirements: (i) mechanical stability, (ii) biocompatibility, (iii) implantability, and (iv) diagnostic compatibility. In this review, we highlight current standards in the use of 3D-printed technology for sacropelvic reconstruction.

Spinal tumours: recommendations of the Polish Society of Spine Surgery, the Polish Society of Oncology, the Polish Society of Neurosurgeons, the Polish Society of Oncologic Surgery, the Polish Society of Oncologic Radiotherapy, and the Polish Society of Orthopaedics and Traumatology

PURPOSE

The purpose of these recommendations is to spread the available evidence for evaluating and managing spinal tumours among clinicians who encounter such entities.

METHODS

The recommendations were developed by members of the Development Recommendations Group representing seven stakeholder scientific societies and organizations of specialists involved in various forms of care for patients with spinal tumours in Poland. The recommendations are based on data yielded from systematic reviews of the literature identified through electronic database searches. The strength of the recommendations was graded according to the North American Spine Society's grades of recommendation for summaries or reviews of studies.

RESULTS

The recommendation group developed 89 level A-C recommendations and a supplementary list of institutions able to manage primary malignant spinal tumours, namely, spinal sarcomas, at the expert level. This list, further called an appendix, helps clinicians who encounter spinal tumours refer patients with suspected spinal sarcoma or chordoma for pathological diagnosis, surgery and radiosurgery. The list constitutes a basis of the network of expertise for the management of primary malignant spinal tumours and should be understood as a communication network of specialists involved in the care of primary spinal malignancies.

CONCLUSION

The developed recommendations together with the national network of expertise should optimize the management of patients with spinal tumours, especially rare malignancies, and optimize their referral and allocation within the Polish national health service system.

Delay in Diagnosis and Treatment of Primary Bone Tumors

BACKGROUND

Delay in the diagnosis and treatment of bone tumors continues to be a common problem. Prolonged diagnosis can significantly reduce the chances of successful treatment of the disease. Accordingly, the aim of this study was to assess the delay in the diagnosis of primary bone tumors, identify the most common symptoms and analyze the course of the diagnostic and therapeutic path.

MATERIAL AND METHODS

Thirty-two (K=18; M=14) patients treated surgically for primary bone tumors were included in the retrospective study. Patient records were analyzed. Delay in diagnosis was defined as the time from the onset of symptoms to the initial diagnosis and referral to an orthopedic oncology center.

RESULTS

The median delay in diagnosis was 7 (3-12) months. For tumors located in the pelvis, the delay was 10 months, compared to 5 months for the upper limb and 7 months for the lower limb (p=0.2312). The delay was 6 months In patients with osteosarcoma, and 8 months in chondrosarcoma patients (p=0.1786). At the first office visit, an x-ray was ordered in 19 cases (59.4%), of whom 9 patients (47.4%) were referred on to the oncology center. The most common symptoms were pain in the affected area (90.6%), limited mobility (28.1%) and pathological fracture (25%). After admission to an orthopedic department, a biopsy was performed after 5.5 (3-8.2) days. The histology results were ready after another 14 (8-18) days, and surgical treatment was performed after 95 (76-100) days.

CONCLUSIONS

1. Although patients show typical symptoms of bone tumors, only a small proportion are referred directly to an oncology center. After a primary bone tumor is suspected, further diagnostic and therapeutic activities proceed efficiently, in accordance with the current guidelines.

Does the use of 3D-printed cones give a chance to postpone the use of megaprostheses in patients with large bone defects in the knee joint?

Revision procedures and the resulting bone loss are a big challenge for orthopedic surgeons. Therefore, we checked what functional outcomes that 3D-printed cone augments can offer to patients with bone defects (Anderson Orthopedic Research Institute [AORI] classification type 2B and 3) in the knee and whether the use of cones can delay the necessity to use a megaprotheses. Data from 64 patients (M = 22; W = 42) who underwent total knee arthroplasty (TKA) revision were included in the analysis. The Knee Society Clinical Rating System (KSS) and the range of motion in the knee joint were used for the functional assessment. The mean follow-up was 28 months (range: 18–44 months). The survival rate for aseptic loosening at follow-up was 100%. Infection occurred in two (3.1%) patients. The mean KSS score increased from 12.75 points preoperatively to 66.56 postoperatively (p < 0.001). The mean range of motion in the knee changed from 61.15° preoperatively to 115.93° postoperatively (p < 0.001). 3D-printed cone augments seem to be a good solution for patients requiring a TKA revision procedure. When used in patients with bone defects classified as 2B and 3 (AORI), they can be a good alternative, delaying the need for megaprotheses.

Adiponectin Is a Component of the Inflammatory Cascade in Rheumatoid Arthritis

Adiponectin is a secretory protein of adipocytes that plays an important role in pathological processes by participation in modulating the immune and inflammatory responses. The pro-inflammatory effect of adiponectin is observed in rheumatoid arthritis (RA). In this study, we examined adiponectin plasma levels and the expression of adiponectin in bone marrow tissue samples, synovium samples, and infrapatellar fat pad samples from patients with osteoarthritis (OA) and RA. Additionally we examined the expression of adiponectin receptors AdipoR1 and AdipoR2 in synovium samples and infrapatellar fat pad samples from patients with OA and RA. We also assessed the correlations between adiponectin plasma concentrations, adiponectin expression in bone marrow, synovium, infrapatellar fat pad, and plasma levels of selected cytokines. We found increased expression of adiponectin in synovium samples and infrapatellar fat pad samples from patients with RA as compared to patients with OA. There were no statistically significant differences of adiponectin plasma levels and adiponectin expression in bone marrow tissue samples between OA and RA patients. There were no differences in the expression of AdipoR1 and AdipoR2 at the mRNA level in synovial tissue and the infrapatellar fat pad between RA and OA patients. However, in immunohistochemical analysis in samples of the synovial membrane from RA patients, we observed very strong expression of adiponectin in intima cells, macrophages, and subintimal fibroblasts, such as synoviocytes, vs. strong expression in OA samples. Very strong expression of adiponectin was also noted in adipocytes of Hoffa’s fat pad of RA patients. Expression of AdipoR1 was stronger in RA tissue samples, while AdipoR2 expression was very similar in both RA and OA samples. Our results showed increased adiponectin expression in the synovial membrane and Hoffa’s pad in RA patients compared to that of OA patients. However, there were no differences in plasma adiponectin concentrations and its expression in bone marrow. The results suggest that adiponectin is a component of the inflammatory cascade that is present in RA. Pro-inflammatory factors enhance the expression of adiponectin, especially in joint tissues—the synovial membrane and Hoffa’s fat pad. In turn, adiponectin also increases the expression of further pro-inflammatory mediators.

The Use of a Megaprosthesis in the Management of Stem Loosening after Revision Hip Arthroplasty in a Patient with Extensive Femoral Bone Destruction. Case Study

This paper presents the case of a female patient who underwent eleven revision surgeries after primary hip arthroplasty due to infection and loosening of the stem and acetabulum. We decided that in order to save the limb, it was necessary to use a total femur prosthesis. Three years' follow-up showed that the patient was satis-fied with the outcome of the surgery.

Thermography in the diagnosis of carpal tunnel syndrome

INTRODUCTION

Carpal tunnel syndrome (CTS) is a condition caused by chronic compression of the median nerve. The diagnosis is made mainly on the basis of clinical image and confirmed with electrodiagnostic testing (electromyography and nerve conduction study); however, these methods do not always aid in reaching the diagnosis of CTS. Moreover, they are invasive examinations, unpleasant for the patient and have to be performed by a qualified physician.

AIM

An evaluation of the usefulness of dynamic thermography in the diagnosis of CTS.

MATERIAL AND METHODS

Forty patients were included in the study group. CTS was diagnosed based on clinical examination and electromyography. Forty healthy volunteers were included in the control group. Each of the participants was examined thrice with dynamic thermography. The patient's hands were first cooled down and then a thermal camera measured their return to normal temperature. The measurement was repeated on the dorsal and volar aspects of each hand.

RESULTS

The results obtained in the study show that a relief of symptoms after carpal tunnel release does not correlate with thermal image. Moreover, the return to normal hand temperature was faster in the control group. In patients with unilateral CTS, no difference was observed in thermographic images of the affected and healthy hands.

CONCLUSIONS

Dynamic thermography can be useful in confirming CTS diagnosis.Dynamic thermography does not allow for objective assessment of patient's complaints in the postoperative period.This method has currently limited clinical application. Due to complexity, it presently serves mainly scientific purposes.

Surgical Management of Multifocal Chondrosarcoma in Ollier Disease

Ollier disease is a rare congenital disease in which multiple enchondromas occur. The tumors can transform to malignant chondrosarcomas of various histologic grades. The patient we described has been treated in our orthopedic department six times, always being referred on account of new lesions. The tumors were excised with margins of healthy tissue. Each tumor was subjected to a histological examination to determine its type and grade. Chondroid tumors should be diagnosed carefully, because the treatment depends on their histologic features. If surgery is performed, removal of the tumor with a margin of healthy tissue is crucial for the patient's well-being and good prognosis.

Electromyography as an intraoperative test to assess the quality of nerve anastomosis - experimental study on rats

Background

Many factors contribute to successful nerve reconstruction. The correct technique of anastomosis is one of the key elements that determine the final result of a surgery. The aim of this study is to examine how useful an electromyography (EMG) can be as an objective intraoperative anastomosis assessment method.

Methods

The study material included 12 rats. Before the surgery, the function of the sciatic nerve was tested using hind paw prints. Then, both nerves were cut. The left nerve was sutured side-to-side, and the right nerve was sutured end-to-end. Intraoperative electromyography was performed. After 4 weeks, the rats were reassessed using the hind paw print analysis and electromyography.

Results

An analysis of left and right hind paw prints did not reveal any significant differences between the length of the steps, the spread of the digits in the paws, or the deviation of a paw. The width of the steps also did not change.Electromyography revealed that immediately after a nerve anastomosis (as well as 4 weeks after the surgery), better nerve conduction was observed through an end-to-end anastomosis. Four weeks after the surgery, better nerve conduction was seen distally to the end-to-end anastomosis.

Conclusions

The results indicate that in acute nerve injuries intraoperative electromyography may be useful to obtain unbiased information on whether the nerve anastomosis has been performed correctly - for example, in limb replantation.When assessing a nerve during a procedure, EMG should be first performed distally to the anastomosis (the part of the nerve leading to muscle fibers) and then proximally to the anastomosis (the proximal part of the nerve). Similar EMG results can be interpreted as a correct nerve anastomosis.The function of the distal part of the nerve and the muscle remains intact if the neuromuscular transmission is sustained.

The complexity of molecular processes in osteoarthritis of the knee joint

Osteoarthritis (OA) is a common medical problem leading to chronic pain and physical disability among the world's population. Analyzing the molecular background of the degenerative arthritis creates the potential for developing novel targeted methods of treatment. Fifty samples of meniscus, anterior cruciate ligaments (ACLs) and articular surfaces were collected from patients who underwent total knee arthroplasty in 2016. Enzyme-linked immunosorbent assay was used to assess the levels of interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF), transforming growth factor-β1 and LUMINEX for MMP-1, MMP-2, MMP-3, MMP-9 and MMP-13. The collected data were correlated with the severity of radiological OA, demographic data and clinical scales. Strong positive correlations in the concentration of metalloproteinases and proinflammatory cytokines, TNF-α (MMP-2 and MMP-13) and IL-6 (MMP-13), were identified. MMP-13 had a positive correlation with the concentration of MMP-1, MMP-2 and MMP-9. Negative correlation coefficient exists between clinical conditions measured with the Western Ontario and McMaster Universities Osteoarthritis Index scale and the level of TNF-α and MMP-1. The TNF-α concentration was lower in the cartilage of the articular surface among patients who took non-steroidal anti-inflammatory drugs periodically. The decrease in MMP-2 in the cartilage of the articular surface corresponded with the severity of radiological OA on the Kellgren-Lawrence scale. Current treatment methods for OA do not stop disease progression. Identifying signaling pathways and molecular particles engaged in OA and their correlations with the patient's clinical condition brings new therapeutic possibilities.

Analysis of principles inspiring design of three-dimensional-printed custom-made prostheses in two referral centres

BACKGROUND

Three-dimensional (3D) printing is an emerging technology used in numerous medical fields. Reconstruction of large bone defects after tumor resections or complex revision surgeries is challenging especially in specific sites where modular prostheses are not available. The possibility to realize custom-made 3D-printed prostheses improves their application in surgical field despite the complication rate, gaining a lot of attention for potential benefits.

OBJECTIVES

We asked: (1) What are the emerging indications and designs of 3D-printed prostheses for complex bone reconstructions? (2) What complications occur with the use of custom implants considering site?

STUDY DESIGN AND METHODS

We performed a retrospective analysis of every patient in whom a custom-made 3D-printed prosthesis was used to reconstruct a bone defect after resection for a bone tumour or challenging revision surgery from 2009 to 2018 in two referral centres. Forty-one patients (11 males [27%], 30 females [73%]) with a mean age of 41 years (range, 10-78 years) were included. Our general indications for using these implants were complex reconstructions of massive bone defects, in the absence of available modular prostheses. Seven were non-oncologic patients, whereas 24 patients were mainly treated for their malignant bone tumours. Custom-made 3D-printed prostheses were used in pelvis (29), forearm (6), scapula (2), distal tibia (2), calcaneus (1), and femoral diaphysis (1). The reconstruction included complete articular replacement in 24 cases (58%) whereas a combined spinopelvic implant has been used in two cases. Flaps were used in 25 cases (61%). Statistical analyses include Kaplan-Meier curves of survival.

RESULTS

The mean follow-up was 20 months. In the oncologic group, overall survival was 89% at five year follow-up and only three patients died of disease. Only one patient required implant removal due to deep infection. Overall major and minor complication rate was 22% (14 complications in 9/41 patients), mainly wound-related problems. One patient reported a periprosthetic fracture, one had hip dislocation, and four (12% [4/34 cases]) had local recurrence. Mean MSTS functional outcome score at follow-up was 73% (range, 23-100%), with a full weight bearing at an average time of 73 days from surgery of lower limbs.

CONCLUSIONS

Custom-made 3D-printed prostheses represent at today a promising reconstructive technique, maintaining however the correct indications for their use in musculoskeletal oncology and challenging revision surgery. Complication rate is acceptable, with infection and wound healing problems relatively common after complex pelvic reconstructions. We will continue to follow our patients over the longer term to ascertain the role of these implants; however, larger studies will need to confirm indications and control for prognostic factors.

Bone Diaphysis Metastases, the Ways and Results of Surgical Treatment Saving the Joints

BACKGROUND

A consequence of the progress in oncological treatment is an increasing number of bone complications asso-ciated with metastases. With appropriate choice of oncological treatment and appropriate surgical management, patients may recover their physical function and maintain the previous level of quality of life. Available surgical techniques include intrame-dullary nailing, stabilisation with plates and screws and the use of modular prostheses.

AIM OF THE STUDY

to retrospectively assess the techniques and outcomes of surgical treatment of long bone metastases at the Oncology Orthopaedics Department of the Speciality Hospital in Brzozów, present the possibilities of surgical management and benefits of the chosen method and tentatively choose the most effective approach for restoring function.

MATERIAL AND METHODS

Between 2013 and 2017, a total of 82 patients were treated for long bone metastases at the Depart-ment of Oncological Orthopaedics. The most common cancers causing bone metastases were breast cancer (37%), myeloma (16%), lung cancer (8%), kidney (15%), prostate (8%), thyroid 4%, colon 1%, uterus 1%, with other sites accounting for 10%. Pathological fractures were diagnosed in 68 patients. Before the surgical treatment, the patients' quality of life was assessed using the Karnofsky scale, Bollen prognostic scale, severity of pain in a VAS scale, and MSTS performance scale. Metastasis morpho-logy was evaluated with conventional radiographs, CT and PET-CT. Types of surgery comprised intramedullary nailing, the use of plates and screws and the placement of modular prostheses. Patients were divided into three groups with regard to the stabi-li-sation systems used and another three related to tumour location (humerus, femur or tibia).

RESULTS

Post-operatively, there was a reduction of pain in the VAS scale. Function (MSTS) was best in patients treated with minimally invasive methods and modular prostheses (p &lt;0.05). An improvement in quality of life in the Karnofsky scale was also noted. The complication rate was 7% and was related to wound healing and thromboembolic complications.

CONCLUSIONS

1. Patients with long-bone cancer metastases with pathological fractures or risk of fracture require surgical management. 2. Nailing or modular prosthesis produced the best functional result at 6 weeks post-operatively. 3. All methods of surgical treatment reduced pain and improved the quality of life.

Preliminary Results of Highly Injectable Bi-Phasic Bone Substitute (CERAMENT) in the Treatment of Benign Bone Tumors and Tumor-like Lesions

Background: CERAMENT™|BONE VOID FILLER is an injectable and moldable ceramic bone substitute material intended for bone voids. The material consists of hydroxyapatite and calcium sulfate hemihydrate. The aim of this study is to present the first long-term results following open curettage of benign bone tumors and tumor-like lesions and void filling with this novel injectable and synthetic bone graft. Methods: Thirty three patients were enrolled into the study between June 2013 and October 2014 .Totally, we treated 24 women and 9 men with a median age of 47 years (range: 22-74). All patients suffered from primary musculoskeletal system disorders (enchondroma 63,6%, giant cell tumor 18%, aneurysmal bone cyst 9%, fibrous dysplasia 9%, Gaucher disease 3%). We performed curettage of pathological lesions, then the bone substitute was administered by means of needle to the void. Results: The average follow-up was 13 months (range: 2-13 months, median 10 months). No metastasis or recurrence had been detected. We received significant clinical improvement relating to VAS, MSTS, and oncological results. Conclusions: The results of our study report that CERAMENT can be successfully used as a bone substitute in patients with various bone diseases, as well as benign bone tumors. CERAMENT can provide an effective and long-term solution for reconstructive procedures following curettage of bone tumors and tumor like lesions.

The Effect of Smoking on Posttraumatic Pseudoarthrosis Healing after Internal Stabilization, Treated with Platelet Rich Plasma (PRP)

Disturbed or delayed healing remains one of the most serious fracture-related complications, despite bone capacity for internal regeneration and reabsorption. Considerable progress in the understanding and treatment of fractures has been noted. The aim of our study was to evaluate treatment outcome in patients (smokers and non-smokers) with post-traumatic pseudoarthrosis.

Hypothesis

Determinate when administration of growth factors is most beneficial, and whether it accelerates bone union.

Material and methods

The study included patients treated for post-traumatic pseudoarthrosis resulting from multiple bone fractures. The study group and controls were further subdivided into: non-smokers, non-smokers >2 years after quitting, and smokers. Independent tests were performed for men and women. The study group, apart from other methods of treatment, received concentrated PRP (platelet-rich plasma) to aid the process of bone healing, or in cases of delayed healing confirmed by radiological assessment on follow-up visits.

Results

Mean time of fracture healing was 8 weeks for non-smokers and non-smokers >2 years after quitting, whereas in smokers the healing process was significantly prolonged (18 weeks in both, men and women).

Conclusions

The risk for infection is smaller in non-smokers as compared to smokers, with the latter being at an elevated risk for bone inflammation and delayed union.

LUMiC® Endoprosthetic Reconstruction After Periacetabular Tumor Resection: Short-term Results

BACKGROUND

Reconstruction of periacetabular defects after pelvic tumor resection ranks among the most challenging procedures in orthopaedic oncology, and reconstructive techniques are generally associated with dissatisfying mechanical and nonmechanical complication rates. In an attempt to reduce the risk of dislocation, aseptic loosening, and infection, we introduced the LUMiC^® prosthesis (implantcast, Buxtehude, Germany) in 2008. The LUMiC^® prosthesis is a modular device, built of a separate stem (hydroxyapatite-coated uncemented or cemented) and acetabular cup. The stem and cup are available in different sizes (the latter of which is also available with silver coating for infection prevention) and are equipped with sawteeth at the junction to allow for rotational adjustment of cup position after implantation of the stem. Whether this implant indeed is durable at short-term followup has not been evaluated.

QUESTIONS/PURPOSES

(1) What proportion of patients experience mechanical complications and what are the associated risk factors of periacetabular reconstruction with the LUMiC^® after pelvic tumor resection? (2) What proportion of patients experience nonmechanical complications and what are the associated risk factors of periacetabular reconstruction with the LUMiC^® after pelvic tumor resection? (3) What is the cumulative incidence of implant failure at 2 and 5 years and what are the mechanisms of reconstruction failure? (4) What is the functional outcome as assessed by Musculoskeletal Tumor Society (MSTS) score at final followup?

METHODS

We performed a retrospective chart review of every patient in whom a LUMiC^® prosthesis was used to reconstruct a periacetabular defect after internal hemipelvectomy for a pelvic tumor from July 2008 to June 2014 in eight centers of orthopaedic oncology with a minimum followup of 24 months. Forty-seven patients (26 men [55%]) with a mean age of 50 years (range, 12-78 years) were included. At review, 32 patients (68%) were alive. The reverse Kaplan-Meier method was used to calculate median followup, which was equal to 3.9 years (95% confidence interval [CI], 3.4-4.3). During the period under study, our general indications for using this implant were reconstruction of periacetabular defects after pelvic tumor resections in which the medial ilium adjacent to the sacroiliac joint was preserved; alternative treatments included hip transposition and saddle or custom-made prostheses in some of the contributing centers; these were generally used when the medial ilium was involved in the tumorous process or if the LUMiC^® was not yet available in the specific country at that time. Conventional chondrosarcoma was the predominant diagnosis (n = 22 [47%]); five patients (11%) had osseous metastases of a distant carcinoma and three (6%) had multiple myeloma. Uncemented fixation (n = 43 [91%]) was preferred. Dual-mobility cups (n = 24 [51%]) were mainly used in case of a higher presumed risk of dislocation in the early period of our study; later, dual-mobility cups became the standard for the majority of the reconstructions. Silver-coated acetabular cups were used in 29 reconstructions (62%); because only the largest cup size was available with silver coating, its use depended on the cup size that was chosen. We used a competing risk model to estimate the cumulative incidence of implant failure.

RESULTS

Six patients (13%) had a single dislocation; four (9%) had recurrent dislocations. The risk of dislocation was lower in reconstructions with a dual-mobility cup (one of 24 [4%]) than in those without (nine of 23 [39%]) (hazard ratio, 0.11; 95% CI, 0.01-0.89; p = 0.038). Three patients (6%; one with a preceding structural allograft reconstruction, one with poor initial fixation as a result of an intraoperative fracture, and one with a cemented stem) had loosening and underwent revision. Infections occurred in 13 reconstructions (28%). Median duration of surgery was 6.5 hours (range, 4.0-13.6 hours) for patients with an infection and 5.3 hours (range, 2.8-9.9 hours) for those without (p = 0.060); blood loss was 2.3 L (range, 0.8-8.2 L) for patients with an infection and 1.5 L (range, 0.4-3.8 L) for those without (p = 0.039). The cumulative incidences of implant failure at 2 and 5 years were 2.1% (95% CI, 0-6.3) and 17.3% (95% CI, 0.7-33.9) for mechanical reasons and 6.4% (95% CI, 0-13.4) and 9.2% (95% CI, 0.5-17.9) for infection, respectively. Reasons for reconstruction failure were instability (n = 1 [2%]), loosening (n = 3 [6%]), and infection (n = 4 [9%]). Mean MSTS functional outcome score at followup was 70% (range, 33%-93%).

CONCLUSIONS

At short-term followup, the LUMiC^® prosthesis demonstrated a low frequency of mechanical complications and failure when used to reconstruct the acetabulum in patients who underwent major pelvic tumor resections, and we believe this is a useful reconstruction for periacetabular resections for tumor or failed prior reconstructions. Still, infection and dislocation are relatively common after these complex reconstructions. Dual-mobility articulation in our experience is associated with a lower risk of dislocation. Future, larger studies will need to further control for factors such as dual-mobility articulation and silver coating. We will continue to follow our patients over the longer term to ascertain the role of this implant in this setting.

LEVEL OF EVIDENCE

Level IV, therapeutic study.

The Impact of Caregivers' Anxiety on Patients' Anxiety before Fast-Track Knee Arthroplasty

PURPOSE OF THE STUDY Anxiety may have negative repercussions on the surgery including poorer outcomes. On the other hand, the majority of patients reporting preoperative anxiety fear not receiving enough attention from a caregiver. In patients undergoing fast-track knee arthroplasty, we determined the relationship between patients' preoperative anxiety and the anxiety the patient's caregiver. We also analyzed the influence of selected psychosocial and demographic variables on the relationship between caregivers' and patients' anxiety. MATERIAL AND METHODS We conducted a prospective, descriptive study in which baseline assessments of patients scheduled to undergo fast-track total knee arthroplasty between 1st November 2014 and 30th April 2015 were compared with those of their caregivers. Patients were recruited from a large teaching hospital through the orthopedics joint replacement clinic. Information on sex, age, body mass index (BMI), educational status, employment status, marital status, and living status was recorded for all patients. Patients and their caregivers completed the Spielberger State-Trait Anxiety Inventory. Baseline trait anxiety was assessed with STAI scores in the initial interview, 2 weeks before hospitalization, and state anxiety was assessed the day before the surgery. The patients' caregivers were contacted during a scheduled postoperative clinic visit and asked to complete the STAI and to provide information on their age, degree of consanguinity with patient, and living status. RESULTS The mean age was 66.4 years for the 118 patients and 55.7 years for the 93 caregivers. In male caregivers, caregiver anxiety and patient anxiety were positively related but not statistically so, and in women was not significant. In male patients, a relationship between caregiver's anxiety and patient's anxiety was positive, although not statistically significant, and in women was neither present nor significant. DISCUSSION Given the widespread impacts of anxiety before knee arthroplasty, it is critical for surgeons to gain a better understanding of how to identify and reduce preoperative anxiety in operated patients. We found that male sex among caregivers was associated with more preoperative anxiety among patients than was female sex and that male patients more quickly accepted anxiety from their caregivers than did female patients. CONCLUSIONS Anxious male caregivers appear to impart their anxiety to male patients but not to female patients. The anxiety of unrelated caregivers is associated with low preoperative anxiety among patients. Preoperative interventions should focus on caregivers, especially male caregivers, and to related caregivers to help patients cope with anxiety before knee arthroplasty. Key words: knee arthroplasty. knee replacement. fast track, anxiety, caregiver, preoperative stress.

TNF-α concentrations in pre-operative synovial fluid for predicting early post-operative function and pain after fast-track total knee arthroplasty

BACKGROUND

Tumor necrosis factor-alpha (TNF-α) helps regulate neuroinflammation and anxiety and could conceivable predict early post-operative pain and function after fast-track total knee arthroplasty (TKA).

METHODS

In patients with severe osteoarthritic knees undergoing TKA, we assessed: the correlations between pre-operative concentrations of TNF-α in synovial fluid; pre- and six-week post-operative knee function and pain; pre- and post-operative anxiety; pre- and post-operative synovial fluid concentrations of cartilage oligomeric matrix protein (COMP); age and body mass index (BMI).

RESULTS

Of 100 enrolled patients, 78 had evaluable TNF-α data, and 58 had evaluable COMP data. Pre-operative TNF-α concentrations were inversely correlated with post-operative pain scores during walking (r_S=-0.26, P=0.03) and with change of pain at rest during six weeks after TKA (r_s=-0.28, P=0.03) and were directly correlated with a higher post-operative Knee Society score (KSS) (r_S=0.43, P<0.001) and with greater increases in this score during six weeks after TKA (r_S=0.33, P=0.001). Mean TNF-α concentrations were higher in the 39 patients reporting any pre-operative pain at rest than in 36 patients reporting no pre-operative pain (P=0.015) and were the only independent predictor of pre-operative pain at rest (OR=13, P=0.02). Independent predictors of better post-operative knee function were higher log-transformed TNF-α concentrations (β=0.38, P=0.002) and male sex (β=0.28, P=0.02).

CONCLUSIONS

High levels of pre-operative TNF-α concentrations could be used as an independent predictor of better knee function at six weeks of follow-up. In patients with lower pre-operative TNF-α concentrations, post-operative pain management may improve the early outcome of the operated joint.

IL17A and IL17F gene polymorphisms in patients with rheumatoid arthritis

Background

Interleukin-17 plays important role in the pathogenesis of rheumatoid arthritis (RA). The aim of this study was to examine the associations between polymorphisms in the IL17A and IL17F genes and RA.

Methods

We examined 422 RA patients and 337 subjects as a control group. Single nucleotide polymorphism (SNP) in the IL17A (rs2275913) and IL17F (rs763780, rs11465553, rs2397084) genes were genotyped using TaqMan genotyping assays from Life Technologies Genomic.

Results

There were no significant differences in distribution of IL17A and IL17F genotypes and alleles between RA patients and control group. There were no significant associations between IL17A and IL17F genotypes and age of disease diagnosis rheumatoid factor, erosive disease as well as extra-articular manifestations.

Conclusions

The results of this study suggest, that IL17A and IL17F gene polymorphism are not the important factors associated with susceptibility and some clinical parameters of RA in a Polish population.

The effect of chronic estrogen application on bile and gallstone composition in women with cholelithiasis

BACKGROUND

Chronic application of third generation progestagens as contraceptives or hormone replacement therapy (HRT) could influence the serum lipid profile, and consequently the bile and gallstone composition. The aim of this study was to determine components of serum, bile and gallstones in women of reproductive age or postmenopausal women using hormonal third generation for at least two years.

METHODS

We enrolled 101 Caucasian women with cholelithiasis. The study included 45 women of reproductive age and 56 postmenopausal women who were divided into subgroups receiving or not exogenous female hormones. In patients we determined serum levels of 17β-estradiol, triglycerides, HDL and LDL cholesterol as well as composition of gallstones and bile.

RESULTS

The postmenopausal women showed a significant reduction in the concentration of bile acids in serum while the application of HRT caused an increase in their contents. Serum total and LDL cholesterol in postmenopausal women was higher than in women without hormonal contraception and postmenopausal patients with HRT. Moreover, women taking the exogenous hormones showed a reduced content of calcium ions in both serum, bile and gallstones.

CONCLUSIONS

Our observations confirm that the chronic use of oral contraceptives and hormone replacement therapy cause an increase in bile lithogenity.

TNF-α and IL10 gene polymorphisms in women with postmenopausal osteoporosis

OBJECTIVE

Postmenopausal osteoporosis is a common disorder characterized by decreased bone mineral density (BMD). Proinflammatory cytokines are among the significant factors involved in bone turnover. They are the stimulants of bone resorption, acting directly on osteoclasts and osteoclast precursors. In this study, we examined the TNF-α (-308G>A) (rs1800629) and IL10 (-1082G>A) (rs1800896), (-592C>A) (rs1800872) polymorphisms in postmenopausal women with BMD T-scores less than and greater than or equal to -2.5 SD.

STUDY DESIGN

This study included 224 postmenopausal women with BMD T-scores lower than -2.5 SD (mean: -3.02±0.53) and 238 postmenopausal women with BMD T-scores -2.5 SD and greater (mean: -1.33±0.51).

RESULTS

There was a decrease in the frequency of IL10 1082 G allele carriers (GG and GA genotypes) in women with T-scores below -2.5 SD (GG+GA vs AA: OR=0.65, 95% CI=0.44-0.97, p=0.037). With regard to the TNF-α -308 G>A polymorphism, in the women with T-scores below -2.5 SD, the increased frequency of GG homozygotes and G allele carriers was detected (AA+GA vs GG: OR=0.54, 95% CI=0.35-0.82, p=0.004).

CONCLUSIONS

The results of our study suggest an association between TNF-α -308G>A and IL10 -1082G>A polymorphisms and postmenopausal osteoporosis.

Expression of allograft inflammatory factor-1 in peripheral blood monocytes and synovial membranes in patients with rheumatoid arthritis

OBJECTIVE

Allograft inflammatory factor-1 (AIF-1) is a cytoplasmic protein expressed in various human cells such as monocyte/macrophages and activated T lymphocytes. A recent study showed that AIF-1 is strongly expressed in infiltrating mononuclear cells and synovial fibroblasts in rheumatoid arthritis and that AIF-1 induces the proliferation of cultured synovial cells. In this study we analysed the expression of AIF-1 in peripheral blood monocytes and synovial membranes from patients with rheumatoid arthritis (RA).

METHODS

We examined 71 patients with rheumatoid arthritis and 25 control subjects.

RESULTS

Using flow cytometry we found significantly increased numbers of circulating AIF-1(+) monocytes in peripheral blood from RA patients compared with controls. Moreover, there were statistically significant positive correlations between AIF-1(+) monocytes, DAS28 and the Sharp erosion score. Immunofluorescence staining showed strong expression of AIF-1 by infiltrating mononuclear cells - predominantly macrophages in RA synovial tissues - compared with tissues derived from joints affected by osteoarthritis.

CONCLUSION

The results of this study suggest that AIF-1 may be associated with the pathogenesis of RA and may be a novel cytokine involved in the immunological process underlying RA.

Survivin in ovary tumors

INTRODUCTION

Survivin is a member of the inhibitor of apoptosis protein (IAP) family which are selectively overexpressed in human neoplasms, and its expression has been shown to be connected with cell proliferation. We analyzed survivin expression in ovarian epithelial neoplasms to evaluate its role in the development of ovarian tumors.

MATERIAL AND METHODS

Immunohistochemistry assays were conducted in 137 cases (48 ovarian carcinoma, 43 borderline ovarian carcinoma, 46 benign ovarian tumor and 20 samples of normal ovarian tissue of ovarian epithelial neoplasms. Histological types included serous (n = 68) and mucinous (n = 69) tumors. All tumors were reviewed histopathologically and classified according to the WHO criteria.

RESULTS

Survivin expression in the group of serous neoplasms was detected in 24.0% (6 of 25) of benign cases, in 60.0% (12 of 20) of borderline tumors, and 91.0% (24 of 47) of ovarian carcinomas. In the group of mucinous tumors, survivin expression was found in 33.5% (7 of 21) of benign cases, 43.5% (10 of 23) of borderline tumors, and 80.0% (20 of 25) of malignant tumors.

CONCLUSIONS

Our results demonstrate that survivin overexpression may play a crucial role in the development of epithelial ovarian neoplasms and be an important prognostic factor for the influence of survivin expression on epithelial ovarian cancers.

Lack of association between CXCL9 and CXCL10 gene polymorphisms and the outcome of rheumatoid arthritis treatment with methotrexate

OBJECTIVE

Methotrexate (MTX) in low doses is used in the therapy of rheumatoid arthritis (RA). The aim of many studies is to identify factors predicting the outcome of treatment with methotrexate in rheumatoid arthritis. The action of MTX in RA is associated with the inhibition of inflammatory mediators synthesis. CXCL9 and CXCL10 chemokines play the important role in inflammatory response in RA patients. The aim of this study was to examine the association between CXCL9/10 gene polymorphisms and response to therapy of RA patients with MTX.

PATIENTS AND METHODS

The study included 422 patients diagnosed with rheumatoid arthritis, treated with MTX in doses 20 mg weekly. Good responders were defined as patients who were receiving MTX and had a DAS28 of ≤ 2.5 at 6 months of therapy. Poor-responders were defined as patients who were receiving MTX and had a DAS28 of > 2.5.

RESULTS

There were not statistically significant associations between studied polymorphisms and the outcome of rheumatoid arthritis treatment with methotrexate.

CONCLUSIONS

The results of this study suggest lack of associations between the polymorphisms in CXCL9 and CXCL10 genes and the response to MTX in RA patients.

Polymorphism of vitamin D3 receptor and its relation to mineral bone density in perimenopausal women

Postmenopausal osteoporosis is the most common metabolic bone disease with important genetic factors. We evaluated the frequency of polymorphism 283G/A of the vitamin D3 VDR gene receptor. The study included 800 women at the postmenopausal (505) and reproductive (295) age. Statistically significant changes, depending on the genotype, were shown.

INTRODUCTION

Postmenopausal osteoporosis is the most common metabolic bone disease of strong genetic origin with population variability determined by the interaction of genetic and environmental factors. Recognition of different genetic variants underlying development of osteoporosis would make it possible to administer individual symptomatic treatment as well as early prophylactics of osteoporosis.

METHODS

The aim of the study was to evaluate the frequency of polymorphism 283G/A of the vitamin D3 VDR gene receptor and assessment of its relations with the clinical parameters of osseous turnover and degree of postmenopausal osteoporosis. The study included 800 women at the postmenopausal (505) and reproductive (295) age throughout the Wielkopolska region in Poland. The postmenopausal group included women with osteoporosis and osteopenia and the healthy ones. Women at the reproductive age were healthy. Frequency of the tested gene polymorphism was evaluated in the group where bone mineral density (BMD) was marked and in the control group.

RESULTS

The obtained test results pointed to correlation of polymorphism VDR 283G/A with the BMD scores for the lumbar vertebrae in women with osteopenia and osteoporosis, therefore the ones at risk of fractures. Vitamin D receptor (VDR) polymorphism correlated with reduced BMD values.

CONCLUSIONS

Polymorphism 283G/A of the vitamin D3 receptor gene has been proved to be the genetic factor of postmenopausal osteoporosis. The polymorphism mentioned above has been proved to be a factor of mineral bone density changes of women.

[The prevalence of spinal osteoporosis in relation to the clinical forms and advance of cervical spondylosis in male patients]

The research was performed on 36 male patients between 65 and 83 years who were either hospitalised or treated in the out-patients clinic due to cervical spondylosis. The aim of the research was to evaluate the frequency of spinal osteoporosis relating to the type and severity of degenerative lesions in cervical spine. The study showed significant relation between the degree of advance of cervical spondylosis and the prevalence of osteoporosis in the study group. The authors have emphasized the need of precise evaluation and differentiation of presented forms of degenerative spine disease.

[Arthrodesis of the first metatarsophalangeal joint using a spherical reamer and titanium compression staples--preliminary report]

BACKGROUND

The role of arthrodesis of the first metatarsophalangeal joint (MTP I) for the treatment of many primary foot problems or as a salvage procedure is an well accepted procedure. In this study, authors present the results of a surgical technique using spherical reaming and compression with two titanium staples in perpendicular planes to achieve fusion. Compression across arthrodesis site is achieved by difference in width between holes in drill guide and width of titanium staple.

MATERIALS AND METHODS

27 metatarsophalangeal joint arthrodeses were performed in 24 patients with different forefoot deformities. The average age of the patients was 53 years and average followup period was 28 months.

RESULTS

The authors obtained MTP I joint fusion in 26 treated feet within 6-12 weeks. The mean AOFAS score was 49 points preoperatively and increased to 76 points at last followup.

CONCLUSION

Arthrodesis of the first metatarsophalangeal joint with spherical reaming and fixation with two titanium compression staples placed in perpendicular planes is a valuable and reproducible procedure for achieving fusion in a majority of patients.

The association of IL-1beta, IL-2, and IL-6 gene polymorphisms with bone mineral density and osteoporosis in postmenopausal women

OBJECTIVE

Osteoporosis is a common disorder with a strong genetic component. The genetics of osteoporosis impacts on the prediction, diagnosis, prognosis, and treatment of the disease.

STUDY DESIGN

The aim of the present study was to examine associations between cytokine gene polymorphisms (IL-1beta, IL-2, IL-6) and bone mineral density (BMD) values in postmenopausal women. The study included 226 postmenopausal women with a diagnosed BMD T-score lower than -2.5 SD (mean: -3.02+/-.053) and 224 postmenopausal women with a BMD T-score greater than -2.5 SD (mean: -1.33+/-0.51).

RESULTS

Among the women with T-scores below -2.5 SD, the BMD values were significantly lower in the carriers of the IL-6 GG genotype compared with those with the CC and GC genotypes (0.70+/-0.38 vs. 0.73+/-0.25 and 0.74+/-0.23 for the lumbar spine, 0.54+/-0.18 vs. 0.56+/-0.15 and 0.58+/-0.22 for the femoral neck). There were no statistically significant associations between the IL-1beta and IL-2 genotypes and BMD values in the group of women with T-scores below -2.5 SD.

CONCLUSION

The results of the present study suggest an association of the IL-6 -174 G/C polymorphism with osteoporosis in postmenopausal women.

Penetration of screw into the wall of thoracic aorta after stabilization of thoracic spine--case report

In our research we have discussed a rare case of penetration of screw into the thoracic aorta after stabilization of thoracic spine due to compressive fracture of IV thoracic vertebra. We have focused on existence of potential danger of damage of aorta during stabilization of the posterior part of thoracic spine. We have emphasized the meaning of prophylactic implantation of stent-graft into the site of potential damage of aorta before the restabilization of the vertebral column.

[Chosen aspects of the surgical procedure during shoulder arthroplasty]

Chosen aspects of the surgical-technique during shoulder arthroplasty were presented. In the description the most important stages of the implantation of shoulder prosthesis were taken into account. The necessity of the warnings during the surgical procedure of basic aspects of the anatomy and rules of shoulder biomechanics was pointed out. One underlined that an experience of the operator and correctly managed postoperative rehabilitation influence good final result of shoulder arthroplasty.

[Hip arthroplasty in osteopetrosis: technical problems and operative solutions. Case report]

We present a patient with marble bone disease, who went through hip arthroplasty due to femoral neck fracture. We focused on large technical difficulties during the operation, resulting from sclerotisation and total atresia of femoral bone marrow cavity. We discussed some operative solutions which facilitate prosthesis implantation in patients with osteopetrosis.

[Clinical and radiological evaluation of malignant metaplasia of benign primary bone tumors on the material of University Orthopaedic Department of Szczecin between 2002-2007]

The study presents clinical and diagnostic problems in patients with malignant bone metaplasia. Material is composed of 13 patients treated surgically between april 2002 and august 2007. In three cases tumors were localised in tibia, in 5 patients around distal femur, in 2 in pelvis, in 2 in humerus and in 1 in lumbar spine. None of the patients has had recurrence by february 2006 r, 12 patients have been free of the disease so far. However, one individual diagnosed with giant cell tumor metaplasia to osteosarcoma did not accept proposed therapy. The authors have particularly emphasized thorough clinical and radiological evaluation and the need of team work before surgical procedure.

[Tibiotalocalcaneal arthrodesis with a retrograde, locked intramedullary nail in treatment of posttraumatic hindfoot and distal tibia deformity--preliminary report]

The authors reviewed their results of tibiotalocalcaneal arthrodesis by retrograde intramedullary nail as a salvage procedure in treatment of the most severe squeal of talar, calcanear, ankle and pilon fractures in twelve patients. Their average age was 55 years. The average follow up ranged from 8 to 25 months. Patients were assessed by AOFAS hindfoot scale and patient satisfaction. The arthrodesis was performed via lateral, transfibular approach. Solid fusion was achieved in all but one patient. In four patients final foot position was not an optimal one for hindfoot arthrodesis. 15 months after surgery a below knee amputation was performed in one patient because of limb ischemia due to posttraumatic lesion of booth tibialis anterior and posterior arteries. Nail construct allows to perform an intrafragmentry compression between bone ends what enhances bone healing and fusion but in some cases nail introducing must be accompanied by osteotomies or pseudoarthrosis resection. The transfibular, lateral approach is extremely useful in exploration of talocalcaneal ant talocrulaljoints. Resection of lateral malleolus reduces soft tissue tension and serve as a source of bone grafts, necessary in many reconstructive procedure.

Congenital pseudoarthrosis of the clavicle: is operative treatment necessary? A report of four cases and literature review

Congenital pseudoarthrosis of the clavicle (CPC) is not a common condition. The exact number of cases reported in literature is fewer than two hundred. We present four well-documented cases of true congenital pseudoarthrosis of the clavicle, including two cases of familial occurrence. None of the patients in this study were treated surgically. Evaluation of upper extremity function was done with use of the Constant-Murley method. In spite of clavicle pseudoarthrosis the score results were similar to the unaffected shoulder. Although vertical elevation of the upper ribs or cervical ribs has been suggested as a cause of congenital clavicle lesions, radiological examination failed to reveal such pathology in any of the patients described here. Clavicle pseudoarthrosis is generally regarded as a benign condition. The majority of patients who underwent surgery because of cosmetic or functional heal well and proceed with a normal, unrestricted life. However, for those patients who are not bothered by the cosmetic appearance of their CPC and are asymptomatic in that they are not functionally limited, non-surgical treatment is a viable option.

[The new bone formation and bone metabolism in Forestier disease]

The study was performed on 36 male patients between 65 and 83 years who were either hospitalised or treated in the out-patients clinic due to Forestier's disease. The aim of the study was to evaluate the advance of ectopic bone formation process in cervical spine and bony metabolic changes in treated patients. The study showed reverse corelation between the degree of advance of cervical hyperostosis and the prevalence of osteoporosis and metabolic disorders in the tested group. The authors have emphasized the need of precise evaluation and differentiation of Forestier's disease and degenerative spine disease.

[Neglected case of chondrosarcoma causing deformity of the shoulder girdle--case report]

We have presented a patient's case with advanced form of chondrosarcoma in the scapula causing enormous deformity of shoulder girdle and additionally presenting with metastases in both lungs. Monstrous extent of deformity was developed due to patient's disagreement with proposed therapy which lasted over two years. We wish to present the adaptation ability allowing the patient to perform active form of life and run business in spite of the huge deformity of the shoulder.

Is retrieval of bone material from multiorgan donors effective enough to cover demand for biostatic bone tissue grafts in Poland?

In Poland there is growing demand for biostatic allogeneic bone transplantation mostly for traumatologic operations and orthopedic reconstructions. The bone material is primarily harvested during postmortem examinations in forensic and pathology laboratories. Nevertheless, the collected amounts are not sufficient, so that material needs to be acquired from alternative sources, such as multiorgan donors. Between 1998 and 2003, 2331 potential donors were registered by the Transplantation Coordinating Center in Warsaw, which was adjusted to 1794 donors who would have been accepted as donors of the bone tissue. Unfortunately, due to denials from family members and public prosecutors, the sample was only 1416 donors, which would cover about 40% of the clinical orthopedic demand in Poland.

[Imitation of metastatic lesions in patients with brown tumor]

The authors have presented two cases of hyperparathyroidism in male patients at the age of 52 and 77 years in whom radiological findings imitated osteolytic, metastatic bone lesions. It has been emphasised that the difficulties with proper diagnosis of brown tumor often occur and the final diagnosis is based on the exact pathology test. In patients with pathological fracture resection with margins and intramedullary fixation, as well as total hip replacement were performed. Postoperative observation revealed that the pain and radiological changes stopped after parathyroid gland resection as the main reason of the brown tumor. The authors have confirmed that open biopsy should be a routine procedure in patients with suspicion of brown tumor.

Surgical treatment of chondrosarcoma with massive bone destruction

Background. The purpose of the study is to present the results of surgical treatment of chondrosarcoma in patients with massive bone destruction. Material and methods. Surgical treatment involved 10 male patients with chondrosarcoma of pelvis (4 cases), shoulder (4 cases), femur (1 case) and ankle (1 case). We performed the following surgical procedures: complete resection without reconstruction, resection with arthroplasty, resection with bonegraft, amputation or disarticulation. Results. Surgical resection without reconstruction was done in 6 patients. Cemented hip and shoulder arthroplasties were performedin 2 patients. Resection en bloc and bone graft was used in one patient. Amputation of the upper limb was performed in one case due to the enormous size of tumor. None of the patients had perioperative complications. Good outcome and no sign of recurrence was seen in 8 cases. One patient had local recurrence and had to be reoperated 6 months after surgery and another one died 12 months following surgery due to lung metastases. Conclusion. The surgical techniques we used allowed most patients to preserve the limb and its function. The apropriate surgical treatment may be one of the most important factors determining good prognosis in chondrosarcoma.

[The prevalence and character of neurologic deficit relating to clinical forms of cervical spondylosis]

The research was performed on 86 male patients between 41 and 83 years who were either hospitalised or treated in the out-patients clinic due to cervical spondylosis. The aim of the research was to evaluate the frequency and advance of neurologic, complications relating to the type and severity of lesions in cervical spine. The study showed significant relation between the degree of advance of cervical spondylosis and age, pain as well as prevalence and severity of neurologic deficit in the tested group. The authors have emphasized the need of precise evaluation and differentiation of presented forms of degenerative spine disease.

Dysphagia in Forestier's disease

Background. The purpose of the study is to present preliminary results of treatment of dysphagia in patients with Forestier's disease. Material and methods.3 patients with Forestier's disease were treated surgically due to increasing difficulties swallowing. The average age was 57 yrs. All three patients presented with cough and hoarseness. Results. Surgical intervention relieved the patients from dysphagia. All three regained the ability to swallow and obtained relief from hoarseness and cough within a few months after surgery. Conclusion. We observed that dysphagia due to skeletal hyperostosis may be the main symptom in Forestier's disease. Pharmacological treatment in the initial period of the disease decreases edema of the mucous membrane in the esophagus.

[The role of intramedullary nailing in polytraumatized patients]

The authors present the results and methods of long bone fracture treatment by means of intramedullary nailing in polytraumatized patients. The study involved 34 patients hospitalized at The Department of Orthopaedics and Traumatology of Pomeranian Medical University of Szczecin between 2001 and January 2003. The results were estimated both in early period and 12 months after surgery. One year treatment period gave us full recovery and mobility of operated limbs in 20 patients, in 9 there was inability to move resulting from coexisting brain injury, 3 of the whole group presented with bone infections and 5 died due to the extent of trauma.