Total Knee Arthroplasty in Patients with Ipsilateral Hip Fusion: Technical Notes and Literature Review

Numerous studies report the success and outcomes of the total knee arthroplasty (TKA); however, few papers present patients with knee osteoarthritis and ipsilateral hip fusion. One controversy when treating patients requiring a TKA with prior ipsilateral hip fusion is whether to first perform a total hip arthroplasty (THA) of the fused hip, followed by the ipsilateral TKA, or to proceed with the TKA without replacing the hip; studies suggest that the position of the fused hip is a key factor when making this therapeutical decision. In addition, performing a TKA in patients with an ipsilateral fused hip may require modifications to the surgical technique generated by the lack of joint mobility in the hip. We identified 12 studies encompassing 30 patients with hip fusion and ipsilateral TKA in current orthopedic literature, but only six offered insights on patient positioning on the operating table during surgery. This study aims to review the current literature on patients with knee osteoarthritis and prior ipsilateral hip fusion and to present some technical considerations when performing a TKA on a 75-year-old patient with hip ankylosis who underwent a total ipsilateral knee arthroplasty in our clinic.

Peri-implant distal radius fracture due to car collision

Peri-implant fractures have gained increasing importance in orthopedics as the number of surgical procedures involving orthopedic implants rises globally. These fractures pose a significant challenge in terms of diagnosis, treatment, and postoperative management. They manifest as stress fractures distal to the implant site. Developing an effective treatment strategy involves evaluating multiple influencing factors. This article presents a rare case of a peri-implant distal radius fracture in a 63-year-old man, with no comorbidities, resulting from a car accident, classified as C1U in the Michele D'Arienzo system. The surgical intervention included plate fixation for the radius and wire fixation for the ulna. The wire was used for ulna instead of a plate, due to skin injuries, with good results. As life expectancy rises and individuals remain active in their elder years, the incidence of peri-implant fractures is expected to increase. Factors such as the implant type, surgeon's approach, and patient-specific elements may influence peri-implant fracture occurrence. The widespread use of plate fixation for distal radius fractures may also contribute to a parallel increase in such fractures. Providing detailed context and specific case presentation allows better understanding and implications for clinical practice.

Updates on Biomaterials Used in Total Hip Arthroplasty (THA)

One of the most popular and effective orthopedic surgical interventions for treating a variety of hip diseases is total hip arthroplasty. Despite being a radical procedure that involves replacing bone and cartilaginous surfaces with biomaterials, it produces excellent outcomes that significantly increase the patient's quality of life. Patient factors and surgical technique, as well as biomaterials, play a role in prosthetic survival, with aseptic loosening (one of the most common causes of total hip arthroplasty failure) being linked to the quality of biomaterials utilized. Over the years, various biomaterials have been developed to limit the amount of wear particles generated over time by friction between the prosthetic head (metal alloys or ceramic) and the insert fixed in the acetabular component (polyethylene or ceramic). An ideal biomaterial must be biocompatible, have a low coefficient of friction, be corrosion resistant, and have great mechanical power. Comprehensive knowledge regarding what causes hip arthroplasty failure, as well as improvements in biomaterial quality and surgical technique, will influence the survivability of the prosthetic implant. The purpose of this article was to assess the benefits and drawbacks of various biomaterial and friction couples used in total hip arthroplasties by reviewing the scientific literature published over the last 10 years.

Hereditary Thrombophilia in the Era of COVID-19

Thrombophilia, also called hypercoagulability or prothrombotic condition, usually reflects a certain imbalance that occurs either in the coagulation cascade or in the anticoagulation/fibrinolytic system. A similar imbalance may be induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Thrombotic complications are associated with multiorgan failure and increased mortality. In this context, activation of coagulation and thrombocytopenia appeared as prognostic markers in COVID-19. Our work provides a structured and updated analysis of inherited thrombophilia and its involvement in COVID-19, emphasizing the importance of diagnosing and initiating thromboprophylaxis. Since the state of hypercoagulation is directly correlated with COVID-19, we consider that studies on the genetic profiles of proteins involved in thrombophilia in patients who have had COVID-19 and thrombotic events are of great importance, both in treating and in preventing deaths due to COVID-19.

Biocompatibility assessment of biomaterials used in orthopedic devices: An overview (Review)

Biocompatibility is one of the mandatory requirements for the clinical use of biomaterials in orthopedics. It refers to the ability of a biomaterial to perform its function without eliciting toxic or injurious effects on biological systems but producing an appropriate host response in a specific case. Today, the biocompatibility concept includes not only bio-inertia, but also biofunctionality and biostability. High biocompatibility and functional properties are highly desirable for new biomaterials. The chemical, mechanical, structural properties of biomaterials, their interaction with biological environment or even the methodology of assessment can influence the biocompatibility. The biological evaluation of biomaterials includes a broad spectrum of in vitro and in vivo tests related to the cytocompatibility, genotoxicity, sensitization, irritation, acute and chronic toxicity, hemocompatibility, reproductive and developmental toxicitity, carcinogenicity, implantation and degradation as specified in different international standards. A brief review of the main assays used in the biocompatibility testing of orthopedic biomaterials is presented. In addition, their main biocompatibility issues are overviewed.

Orthopedic surgery in hemophilic patients with musculoskeletal disorders: A systematic review

Hemophilia is a hereditary coagulopathy caused by factor VIII (hemophilia type A) or by coagulation factor IX (hemophilia type B) dysfunction, characterized by an increased bleeding predisposition, which is either spontaneous or secondary to minimal trauma. Currently, hemophilia may also be considered an 'orthopedic' condition, due to the fact that it affects the musculoskeletal system of most hemophilic patients. In recent years, constant prophylaxis using coagulation factors has led to a significant improvement in the hemophilic patient's quality of life, by reducing both life-threatening hemorrhagic phenomena, as well as the occurrence of chronic complications. Nevertheless, progressive joint bleeding remains unavoidable in this category of patients, and the onset of chronic arthropathy with secondary motor deficiency remains the main complication with an invalidating character. In such cases, orthopedic management is imperative; osteoarticular complications being managed most often with the help of conservative or surgical techniques. The purpose of this review is to provide an overview of modern orthopedic practices which are useful in the management of hemophilic patients suffering from osteoarticular disorders.

Current practices in haemophilic patients undergoing orthopedic surgery - a systematic review

Haemophilia is an inherited disease that requires a different approach in order to evaluate, monitor and treat patients. Despite the great advances in therapeutic agents that have emerged, reports on the impact of monitoring outcomes on treatment decisions are rarely presented. Haemophilia A and haemophilia B are inherited bleeding disorders caused by deficiencies in blood clotting factor proteins. A systematic review was performed to identify literature reports on the current practices in haemophilic patients undergoing orthopedic surgery. The best therapy for haemophilic patients consists in performing primary prophylaxis to prevent joint bleeding and other complications. Besides the primary prophylaxis, thromboprophylaxis is used to prevent venous thrombosis in patients with hemophilia who undergo surgical orthopedic procedures. Further research is needed to better manage the pharmacologic approaches in haemophilic patients undergoing orthopedic surgery. Although patients with haemophilia present low risk for thromboembolic complications, such events have been reported in surgical procedures. The recommendations in patients with haemophilia are considerably variable in the current guidelines and clinical practice. The best therapy for haemophilic patients consists in performing primary prophylaxis to prevent joint bleeding and other complications.

Calcium and Vitamin D Involvement in the Fragility Fracture of the Pelvis

The fragility fracture is the widest spread of the bone diseases, in elderly. It particularly affects the vertebrae, the femur, the proximal humerus, the distal radius, the pelvis, thus preventing the patient�s free movement. The most debilitating of all these fractures is the fragility fracture of the pelvis. This type of fracture raises supplementary problems compared to the other fractures due to the difficulties of diagnosis, surgical approach and to the longer recovery period. Choosing the right treatment for FFP is difficult due to health and comorbidities in elderly patients. Both conservative and surgical therapy involve equally large risks: prolonged immobilization or surgical risks. Therefore, pharmacological therapy is an alternative to surgery. Bisphosphonates prove their utility in the fracture-healing outcome, but the influence of calcium and vitamin D were overlooked. The aim of our study was to evaluate the role of calcium and vitamin D in the healing process of patients with pelvic fragility fracture in osteoporotic patients with and without calcium and vitamin D supplementation. Our study shows that calcium and vitamin D exert a positive influence on the healing process of the fragility fractures and strongly emphasizes the need to educate patients to comply with the prescription to supplement calcium and vitamin D in order to improve fracture healing and prevent additional fractures.

Clinical and Biological Profile of Patients with Non-Valvular Atrial Fibrillation and Hemodynamic Significant Valvular Heart Disease

The non-valvular AF, beyond the guidelines, include 2 types of patients. We aimed to analyze the clinical and biological profile of patients with non-valvular atrial fibrillation (AF)andhemodynamicsignificantvalvular heart disease. We includedretrospectively 513 patients admitted in our hospitalwithnon-valvular AF, and we divided into:study group(333 patients; 64.9%) andcontrole group(180 patients; 35.1%) hemodynamic significant valvular heart disease. From the studied group 5.5% of patients associated all four valvular heart disease, 26.7% ofpatients associated mitral, aortic and tricuspid regurgitation and 71.9%of patients associated two valvular heart disease: 32.7% with mitral and aortic, 31.4% with mitral and tricuspid, 4.5% with tricuspid and pulmonary, and3.3% withtricuspid and aortic. Dyslipidemia (higher cholesterol and trygliceride levels) was present in 14.5% of patients, statistic significantly more frequently in patients from the control group (11.4% vs 18.3%, P= 0.033). Dyslipidemia showed a significantly higher estimated risk for AF (RR=1.25; IC95%: 0.99-1.56), as well as diabetes mellitus (RR=1.36; IC95%: 1.12-1.64)and coronary heart disease (RR=3.70; IC95%: 1.83-7.46). Therefore patients with non-valvular AF and hemodynamic significant valvular heart disease, beyond the curent guidelines, could has a completely different profile and prognosis.

Serum Homocysteine and Reactive Species Levels in Fragility Fractures of the Pelvis

Although there are studies showing the link between homocysteine and bone quality, the relationship remains controversial. The purpose of the study was to investigate homocysteine levels in patients with fragility fractures of the pelvis and their association with serum Total Antioxidant Status.The study included a group of 60 patients, aged ]65years, with pelvic fragility fractures and osteoporosis admitted in our trauma department between January 2015 and January 2018 and a control group of 30 patients, aged ]65years without fragility fractures or osteoporosis.The total antioxidant status (TAS) and homocysteine (Hcy) concentrations were determined in serum of all the patients. TAS levels had a significantly lower values in the group with pelvic fragility fractures compared with the control group (p[0.001).We noticed a significant higher mean of Hcy levels (p[0.001) in patients with pelvic fragility fractures compared with the control group. As conclusion this study shows that patients with fragility fractures of the pelvis have moderately elevated levels of homocysteine and reduced serum Total Antioxidant Status.

Maspin and Ezrina - Biomarker Molecules in Colorectal Cancer Correlative immunohistochemical study

The results of the recent years researches support the need for personalized therapeutic of cancer by completing the clinical, imagistic and histopathological diagnosis with molecular studies to identify new useful biomarkers for diagnosis, prognosis and tumor progression. Maspin is a non-inhibitory serine protease having a proapoptotic activity, suppressor of tumor invasion, metastasis and angiogenesis. Ezrin is a member of Ezrin/Radixin/Moesin (ERM) family, involved in cellular adhesion mechanisms, motility and invasiveness of tumor cells. In colorectal tumors, there is a heterogeneity of research results regarding the clinical significance of the maspin due to a possible partnership with other molecules with which it interacts through the same signaling pathways. Our study investigated the two molecule�s immunoreactivity (IR) in 92 colorectal tumors highlighting an inverse correlation between ezrin�s and maspin�s expression, suggesting the fact that ezrin�s overexpression could influence maspin�s tumoral suppressor role. Furthermore there was observed a difference of the molecules IR within the same tumoral stage, suggesting their utility regarding the treatment protocol of these tumors.

Correlations Between Heparinated Blood Glucose Determined with Automatic Analyzers and the Severity of the Acute Coronary Disease

Diabetes is one of the most important cardiovascular risk factors. Hyperglycemia leads to several metabolic alterations, thus creating conditions for a poor cardiovascular outcome. Our study phocussed on the prevalence of glucidic metabolism alterations in the acute coronary disease, as well as the association between hyperglycemia, diabetes and severe coronary lesions. We performed a study on 58 patients with acute coronary artery disease, divided in two groups, unstable angina and acute myocardial infarction and we evaluated the severity of the disease based on the angiographical results: no vessel disease (no significant lesions), one-vessel disease (one arterial stenosis/occlusion), two-vessel disease (two stenotic coronary arteries) and three-vessel disease (lesions of all three coronary arteries). Blood samples were collected in heparinated tubes and rapidly transferred to the laboratory for analysis, using automated glucose analyzers, in order to prevent errors due to glycolysis. More than half of the patients were diabetic and glycemic values were significantly higher in patients with myocardial infarction (126.67 vs 163.64 mg/dL). The prevalence of diabetes was significantly higher among the three vessel disease patients, both with unstable angina (38.9%; p=0.037) and with myocardial infarction (35.1%; p=0.345). In conclusion, diabetes and hyperglycemia create the setting for acute coronary disease, especially with lesions of all the three coronary arteries.

Nonacog Alpha - an Efficient Therapeutic Option in Hemostase Management for Hemophilia Type B in Patients with Elective Arthropalsties

Hemophilia is a hereditary coagulopathy that is largely in the attention of developing countries, not because of its low incidence, but because of the high costs involved in the treatment of the disease and its disabling consequences of the disease, if treated inappropriately. The concentrates of coagulation factors currently available for the substitution treatment of hemophilic patients have undergone additional viral purification and inactivation techniques, in order to achieve a higher infectious safety, an aspect that also implies an increase in treatment costs for these patients. Currently, the major morbidity of patients with hemophilia is represented by the disabling articular pathology, secondary to repetitive bleeding episodes developed in the articular space. Although it has been proved that the prophylactic administration of coagulation factors helps to prevent joint disease in the case of patients that were not subject to prophylaxis, the repeated bleeding in the joints induces synovitis, which is irreversible and may progress despite subsequent prophylaxis. Under these conditions, total joint arthroplasty remains the only solution to reduce both, pain and subsequent bleeding episodes of hemophilic arthropathy. Effective hemostasis is a basic condition for successful interventions in hemophilic patients. In this regard, this paper aims to highlight the effectiveness of Nonacog Alpha, a product that contains recombinant factor IX, in the management of hemostasis, in the case of a patient with type B hemophilia, with indication of total endoprosthesis of the left hip.

Moroctocog Alfa Efficacy in Hemostasis Management in A Type Hemophilia Patients with Elective Arthroplasty

Type A haemophilia is a hereditary coagulopathy caused by coagulation factor VIII deficiency as part of the rare, life-threatening and at-risk group of diseases that has been attributed over time a life-saving substitution treatment providing to patients diagnosed with this pathology a hope for life and quality of life similar to that of healthy population. However, substitution treatment is very expensive so that nowadays globally most patients cannot benefit from proper healthcare. The quality of healthcare is dependent on the socio-economic level of each country, being decisively influenced by the power of the National Hemophilia Organizations to generate solidarity and support of decision-makers of each country. One of the bleeding manifestations specific to haemophilia is haemarthrosis. Each haemorrhagic episode causes locally a disorder that predisposes to relapse, with the onset of the main chronic complication of this condition, haemophilic arthropathy. It has a slow evolution throughout the life of the patient and generates in time severe sequelae (ankyloses) that require total arthroplasty. Effective hemostasis is the essential element for performing this type of orthopaedic surgery, due to bleeding risk that is of vital nature, in this category of patients. In this sense, this study aims to underline the efficacy of Moroctocog alfa in the management of haemostasis in haemophiliac patients with total endoprosthesis indication, aimed to reduce joint pain and improve locomotor function.

The Role of Coagulation Factor VIII Substutution Therapy in the Management of Type A Hemophilia Complications

Hemophilia is a pathologycharacterized by a disturbance in the normal clotting process of the blood, as a result of a functional deficit of clotting factor VIII or IX.There are two types of hemophilia: type A and type B, the former expressing a deficit of factor VIII, while the latter a deficit of factor IX.C.L., a 43 years old male, was diagnosed at the age of 8 months with a severe form of type A hemophilia. From that time, the patient presentedhemorrhagic episodes, resulting either from trauma or appearing spontaneously and requiring factor VIII substitution therapy and hemostatic treatment.Bloodwork show a prolonged aPTT, as well as microcytic anemia with a low iron serum level, as a result of chronic blood loss.The particularity of this case consists in the high degree of development and recurrence of hemophilia associated complications, leading to superior and inferior limb motor deficits and chronic pain which is currently managed with opioid medication. Also,the patient suffers from chronic hepatitis due to infection with B and C hepatitis viruses as a result of previous lifesaving plasma substitution therapy.Even though the clinical manifestations of hemophilia excert a high cost on the patient�s life as well as the medical system, timely prophylactic factor VIII substitution therapy from the moment of diagnosis until the age of 18 can reduce both the toll on the patient�s health and quality of life and also on the medical costs. Thus, we stress the fact that prophylactic therapy can have a beneficial effect both on patient�s life and also on the health system.

The Role of Chromogenic and Immunoturbidimetry Assays in Diagnostic of Thrombotic State in Myeloproliferative Disorders

Polycythaemia vera (PV) is a monoclonal myeloproliferative disorder characterized by a haemostatic imbalance resulting in increased risk for thrombotic events. In PV there is an important affection of the vascular endothelium, so we analized in our study three markers of endothelium disfunction- von Willbrand factor (vWF), Protein C (PC) and the inhibitor plasminogen activator type-1. (PAI-1) The study comprised 40 patients and the objective of the study was to investigate the level of the mentioned parameters in two groups of patients-the group of polycytemic patients without cardiovascular diseases (PV) and the group of polycitemic patients with cardiovascular pathology associated (PV+CVD). The levels of the studied parameters were found significantly modified in the PV group (p[0.05); for the PV+CVD group the level of vWF was higher (p[0.001), but the levels of the other parameters, didn�t show a significant statistic difference compared with the first group (p]0.05). In accordance with the presented results, the conclusions of our study was that in PV the risk of thrombotic accidents is related by the increase of the vWF level, as the vascular endothelium plays a key role in this pathology.

Strontium Ranelate in the Healing of Fractures Complicated with Delayed Union. It is Really Effective?

Osteoporosis is a systemic skeletal disease characterized by low bone strength, which leads to an increased risk of fracture. The primary objective of osteoporosis treatment is the prevention of fragility fractures and the secondary objective is their rapid healing if they occur. Strontium ranelate is an antiosteoporotic therapeutic agent with a double action mechanism: the increase of bone formation and the decrease of bone resorption, contributing thus to the improvement of bone healing. Preclinical studies have demonstrated the efficacy of strontium ranelate for the improvement of bone healing and bone microarhitecture, as well as of the osteointegration of implants. Some clinical cases have been reported regarding the efficacy of strontium ranelate in the healing of long bone fractures complicated by nonunion or delayed union. In the present study we have reported 2 clinical cases that demonstrate the effectiveness of the treatment with strontium ranelate (Osseor) for 3-6 months in the healing of complicated long bone fractures with delayed union. Our cases confirm the results of the open label study CL3-12911-036 (delayed union and non-union fracture study), where the treatment with 2 g/day of strontium ranelate improved healing and led to a better quality of life. Even if there are some cardiovascular contraindications, strontium ranelate is proven to reduce vertebral and non-vertebral fracture risk in osteoporosis and in the same time improves bone microarchitecture and accelerates fracture healing.

The Efficiency of Recombinant Alpha Eptacog in Haemostatis Management of Haemophilic Patients with Elective Arthroplasty

Haemophilia is considered to be the most severe coagulopathy, characterized by a deficiency either of factor VIII (hemophilia A) or coagulation factor IX (hemophilia B), presenting various degrees of severity depending on the residual factor level. Haemarthrosis is the most common clinical expression of a haemophiliac patient. Its repetitive character will cause irreversible lesions in the joints, which mark the beginning of a chronic condition - haemophiliac arthropathy, which slowly develops throughout the patient�s life, leading eventually to ankylosis. Over time, these joints will require total prosthesis, in order to improve locomotor activity. Achieving effective hemostasis is an essential element for the possibility of performing this type of surgery, due to the increased risk of bleeding, of a vital nature, at this category of patients. A series of clinical trials have been carried out to research the role of the Eptacog Alpha Recombinant treatment in the reduction of bleeding in haemophiliac patients with present inhibitors, to whom total arthroplasty is carried out at the level of various joints. In this regard, this paper aims to highlight the effectiveness of Eptacog Alpha Recombinant in the management of haemostasis in haemophiliac patients, with indication of total endoprosthesis.

The Importance of Fluconazole in Treatment of Endogenous Endophtalmitis in Patients Prior Treated Using Negative Pressure Therapy for Wound Closure Contaminated with Meticillin-resistant Staphylococcus aureus

Severe infections with C. albicans should be treated promptly with antifungal agents, any delay in treatment increases the risk of endophthalmitis. The systemic Amphotericin B therapy is the gold standard in the treatment of endophthalmitis, but in the case of fungal infections it has not yet been determined. Numerous studies have shown that the use of Fluconazole is effective in the treatment of fungal endophthalmitis. In this paper, we report two cases (3 eyes) that have been presented for the same accusations of significant decrease of AV (visual acuity), ocular pain and blepharospasm suddenly installed, both of which required urgent antibiotic and intravenous antifungal treatment. Both are diagnosed with endogenous endophthalmitis and vitreous biopsy + VPP (pars plana vitrectomy) are performed, with a negative result of the vitreous culture. In both situations the treatment was with antibiotic and systemic antifungals. Postoperatively, evolution was favorable in the first case and less favorable in the second one. The prognosis depends on the virulence of the microorganisms and the time elapsed until initiation of the treatment. Also, the presence of risk factors such as diabetes, sepsis, recent abdominal surgery (C. Albicans is part of the comesary flora of the digestive tract) have influenced the prognosis decisively. Severe infections with C. albicans should be promptly treated with antifungal agents, any delay in treatment increases the risk of endophthalmitis. Even when prolonged treatment of candidemia is instituted, 3% of patients can develop endogenous endophthalmitis, so ocular evaluation is particularly important for patients immobilized in anesthesia and intensive care units.

Negative Pressure Therapy in the Surgical Treatment of Diabetic Foot

The study aims to assess the significance of negative pressure therapy in the treatment of diabetic foot.The objectives intend to evaluate the healing time required after applying the method and the functional consequences for the patient. A prospective study was conducted on a sample of 37 patients with diabetic foot were monitored their clinical course between September 2014 - April 2017, following negative pressure therapy. There were used vacuum assisted closure devices (VAC � -Hartman) in order to apply negative pressure to the wound, while complying with specified settings (negative pressure, time of use of a kit) in accordance with patients� outcome.There were monitored changes in wound size (planimetric and volumetric measurement), their bacterial load and duration of treatment. Healing was obtained in all cases, to an average hospital stay of 27.3 days and 8 days of therapy application.The negative result of microbial cultures was obtained after an average of 6.45 days by simultaneous application of negative pressure and antibiotic treatment according to the antibiogram. Skin grafts were necessary to close the defect in 4 cases. After basic treatment of the wound, auxiliary methods such as negative pressure contribute to the healing.In patients with diabetic foot who were required surgical intervention, the use of negative pressure therapy yielded a significant benefit in the preservation of the affected limb, after minimal excision.The results we obtained throughout our experience recommend use of NPTW technique as indication for abdominal wall surgery in closing abdominal wall defects, compartment syndrome and surgical site infection after prosthetic mesh.

In vitro Three Dimensional Scaffold-free Construct of Human Adipose-derived Stem Cells in Coculture with Endothelial Cells and Fibroblasts

Complex interactions between stem cells, vascular cells and fibroblasts represent the substrate of building microenvironment-embedded 3D structures that can be grafted or added to bone substitute scaffolds in tissue engineering or clinical bone repair. Human Adipose-derived Stem Cells (hASCs), human umbilical vein endothelial cells (HUVECs) and normal dermal human fibroblasts (NDHF) can be mixed together in three dimensional scaffold free constructs and their behaviour will emphasize their potential use as seeding points in bone tissue engineering. Various combinations of the aforementioned cell lines were compared to single cell line culture in terms of size, viability and cell proliferation. At 5 weeks, viability dropped for single cell line spheroids while addition of NDHF to hASC maintained the viability at the same level at 5 weeks Fibroblasts addition to the 3D construct of stem cells and endothelial cells improves viability and reduces proliferation as a marker of cell differentiation toward osteogenic line.

Hyaluronic Acid and Chondroitin Sulfate Viscosupplementation in Severe Arthropathy of Hemophilic Patients

Type A hemophilia is a hereditary coagulopathy caused by coagulation factor VIII deficiency, clinically characterized by hemorrhagiparous phenomena of different intensity, depending on disease severity or on the intensity of the injury suffered by the patient. The severe forms of the condition may become complicated by spontaneous sometimes even life-threatening bleeding, in the absence of factor VIII substitution treatment. Considerable bleeding may occur at the intraarticular, intramuscular or mucosa level, whereas life-threatening bleeding may occur anywhere in severe injuries. Two types of hemorrhagiparous are specific to the disease and are also the most common: hemarthroses and hematomas. As far as hemarthroses are concerned, each joint hemorrhage episode causes a topical disorder, which predisposes to recurrence, with the onset over time of the main chronic complication of this condition, hemophilic athropathy, which progresses slowly throughout the patient�s life and generates severe sequellae (ankylosis). This paper aims at emphasizing the importance of viscosupplementation by the injection of hyaluronic acid and chondroitin sulfate in the joints of hemophilic patients with severe athropathy, with a view to improving the locomotor function, to reducing the number of bleeding episodes and joint pain.

Efficiency of Tranexamic Acid in Management of Surgical Orthopedic Bleeding in Patients with Haemophilia

Haemophilia is an inherited bleeding disorder (gonosomala recessive, related to chromosome X, with transmission from carrying women to male descendents) characterised from the clinic point of view by important bleeding, secondary to some minimum and biologic traumas by deficiency of trombo-plastino-formation, consecutive to either a deficit of factor VIII (haemophilia A), or the factor IX (haemophilia B). The most characteristic manifestation of hemophilia is intra-articular � hemarthrosis. Its repetitive character leads to irreversible lesions of the articular structures, inducing lesions of the synovium with degenerative effects over the articular cartilage and destructive effects for the subchondral bone tissue. In time, these lesions require orthopaedic surgery to improve the locomotor activity. Managing an efficient hemostasis is vital during surgery, due to high risk of bleeding triggered by coagulopathy and surgery. Numerous studies carried out underlined the efficiency of the tranexamic acid (TXA) in reducing bleeding, in different surgery branches, by inhibiting the enzymatic degradation of fibrin. In orthopaedic surgery, the tranexamic acid is frequently used in case of hip and knee arthroplasties, reducing the bleeding and blood transfusion necessary to the treatment of posthaemorrhagic anemia. This paper wants to assess the efficiency of the tranexamic acid in realization of hemostasis to another category of patients, haemophiliac patients with indication of total hip and knee endoprosthesis.

Adult multifocal pigmented villonodular synovitis--clinical review

Pigmented villonodular synovitis (PVNS) is a rare, benign proliferative disease of the synovial tissue that affects a single joint or a tendon sheath. Data from the literature present only a few cases of multifocal PVNS. This paper presents multifocal PVNS in the adult. This disease can affect bilateral shoulders, hips and knees. The diagnosis may be delayed by the slow evolution of the disease (up to ten years); some patients may be seen with late-stage degenerative joints, serious complications, painful and functionally uncompensated, with significant locomotion deficit. PVNS requires a radical treatment with prosthetic arthroplasty associated with synovectomy. Complex imaging (X-Rays, magnetic resonance imaging (MRI), ultrasound) and macroscopic appearance of the lesions during surgery confirms the clinical diagnosis of multifocal PVNS with secondary bone lesions. Histology marks the final diagnosis of multifocal PVNS. The postoperative results are good, with recovery in functional parameters of the joints with endoprosthesis.