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  • Author: Bogdan Cretu x
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Lower Limb Deformity and Total Knee Replacement

Abstract

As the population becomes more active and life expectancy increases, gonarthrosis has proportions of epidemics. Total knee arthroplasty (TKA) is an intervention that decreases pain and gives the patients the possibility of quickly returning to the desired level of activity. It is an intervention with a patient satisfaction rate of about 90-95% with a survival of the implant over 15 years of 90%. When dealing with TKA the following elements should be taken into account: clinical examination (walking analysis), leg deformities and knee alignment (foot deformation management), posterior tibial tendon dysfunction, cavovarus foot, posttraumatic deformity, neuropathic arthropathies, ankle arthrosis, foot deformities and knee arthroplasty. Ankle or foot deformity may be causes of progression of gonarthrosis or a TKA failure. Post-operative alignment of TKA is an extremely important element in the long-term survival of the prosthesis. By improving biomechanical alignment of the complete pelvic limb, TKA survival and patient satisfaction will increase.

Open access
The impact of extreme genu varum and genu valgum on postoperative outcomes using mini-subvastus approach in TKA

Abstract

Increasing interest in using minimally invasive approaches in TKA has led to the question: how much deformity is accepted for using MIS in TKA? A single surgeon performed 87 consecutive TKAs with mini-subvastus approach, using unconstrained prosthesis in 84 knees and constrained prosthesis in 3 knees. We conducted a prospective study in which patients were divided into two groups according to preoperative tibiofemoral axes (TFM), one group with 160°<TFM<195° and the second group with 160°≥TFM≥195°. Clinical and radiographic outcomes were compared. Postoperative ROM and knee score were improved in both groups, with similar results (p<0.01). Postoperative radiographic analyses showed that TFM was improved in both groups (p<0.01) with the coronal alignment inferior in 160°≥TFM≥195° group than the 160°<TFM<195° group. The results of this study suggest that mini-subvastus approach is a proper technique to use in primary TKA in patients with a TFM angle less than 160° and more than 195° with similar results with TFM angle between 160° and 195°, and for the use of constrained prosthesis designs with promising results. Preoperative TFM angle less than 160° and greater than 195° increases the risk of component malposition in coronal plane.

Open access
Prediction of fracture risk and prophylactic intervention in metastatic bone disease: a systematic review

Abstract

Pathological fractures occur in an area of bone where either the quantity or quality of bone is modified and the main cause of bone metastases that weaken the structure and will lead to fractures are in high proportion given by visceral tumors or primary hematopoietic tumors like myeloma.

This paper’s objective was to review the actual knowledge in the treatment of fractures secondary to metastases. Spinal lesions were not discussed in this paper.

Literature search was performed using MEDLINE and Web of Science to find literature relevant to fracture risk and prophylactic intervention in metastatic bone disease. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline was used for this review. As results, we identified 30 papers that were suitable for this review. Most of them concluded that it is difficult to assess the amount of bone involvement on radiographs alone. Using the actual guidelines for prophylactic fixation may result in an under treatment or overtreatment of patients with metastatic bone disease. Their ability to determine which metastatic bone lesions will fracture is altered mainly because of the small number of patients included in the studies. The prediction factors for fracture risk are still to be evaluated. CT, FDG-PET or CT scan-based finite element analysis may be useful tools for the identification of impending pathological fractures requiring prophylactic stabilization.

Open access
Postoperative TKA alignment in sagittal and axial plane, a systematic review

Abstract

The aim of this paper was to review the existing described methods for measuring postoperative TKA alignment in sagittal and axial plane and to review the existing literature regarding the axial plane evaluation with the use of the computer tomography. The most frequent mistakes when positioning the total knee arthroplasty (TKA) components are done in the axial plane, so it is necessary to know what the limits of the radiographic evaluation are and, for this evaluation, the CT scan is the most valuable in assessing the rotation of the components.

Open access
Incidence and location of bone metastases in breast cancer

Abstract

This report represents an analysis of 19 confirmed cases of breast cancer throughout a period of 14 months (January 2018 - February 2019), in which we assessed the incidence and sites of osseous metastases, in correlation with their histopathologic classification. This retrospective analysis is based on medical imaging techniques (X-ray radiography and nuclear medicine functional imaging).

Open access
Osseous metastases and ovarian cancer

Abstract

This article analyses a series of 22 confirmed cases of ovarian cancer throughout a period of 14 months (January 2018 - February 2019), in which we assessed the incidence of osseous metastases, in correlation with their histological features. This retrospective study, based on medical imaging techniques, demonstrates that bone metastases are not uncommon in ovarian cancer.

Open access
The Comparative Analysis of Hydrodynamic Pressures in Cylindrical Tanks

Abstract

This article presents a comparative study of the values of hydrodynamic pressure and their resultants occurred during the seismic action using P100-1/2013 technical rules and the relations defined in the papers: [1], [3], [5] and the Romanian standard [2] SR EN 1998-4 (silos, tanks and pipelines), which is implemented in Romania. Two cylindrical tanks placed in the same seismic zone have been chosen, with the same amount of storage (about 5000 m3), but of different geometries, to illustrate the influence of hydrodynamic pressures on the construction size (long and short wall behavior) as a function of ratio of the fluid height on the cylinder radius and ratio of corner period on the eigenperiod of the fluid mass. Also in the analyses, in order to evaluate the hydrodynamic convective pressure both the fundamental period of oscillation of the fluid mass and the first ten periods of oscillation were used.

Open access
The Influence of Flexibility Coefficient on the Size of Internal Forces and Deformations in Circular Plates on Elastic Medium

Abstract

This paper presents an analytical study which deals with the behavior of the circular plates in bending theory, considering the soil-structure interaction under Winkler's hypothesis. It was intended to illustrate the variation of internal forces and deformations according to the flexibility coefficient of plates considering three models: a fixed solid circular plate subjected to a uniformly distributed load, a fixed solid circular plate acted by a displacement applied on the exterior contour and a solid plate subjected to a temperature gradient. For this study the computation relations were written as a product between a dimensional and a non-dimensional factor, the last one indicating the variation of internal forces and deformations. For each type of action there are presented results obtained using the finite element method to illustrate the differences between this method and the analytical computation.

Open access
The Relationship between Hepatic Steatosis, inflammation and insulin Resistance in type 2 Diabetes with Metabolic Imbalance

Abstract

Aim. Non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) are in a bidirectional relationship. This prospective study focused on associations between parameters common to the pathogenesis of insulin resistance, inflammation and hepatic steatosis in T2DM patients with metabolic imbalance.

Methods. We used clinical data, insulin resistance and inflammation indices, and hepatic steatosis markers from 120 patients.

Results. The patients (44% men, mean age 58) had a mean body mass index (BMI) of 32 kg/m2 and mean T2DM history of 6 years. With exceptions, significant correlations were found between metabolic, inflammatory and hepatic parameters.

Conclusions. In T2DM patients with poor glycemic control, hepatic steatosis correlates significantly with insulin resistance and inflammation. Increased prevalence and poor prognosis of these diseases together justify the need for NAFLD screening of diabetic patients.

Open access