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  • Author: Konstantīns Kalnbērzs x
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Abstract

Published studies on the accuracy of digital templating in total knee replacement (TKR) have employed standard knee, but not hip-to-ankle radiographs. A retrospective study was conducted in our hospital on patients undergoing TKR due to osteoarthritis in a period of six consecutive months. Templating was performed using a calibrating 25 mm metallic ball and Agfa Orthopaedic Tools software by a surgeon not involved with the operation. The surgeon performing the templating was blinded to the size of the implants inserted. Postoperative knee anteroposterior and lateral radiographs were then checked for the presence of prosthetic overhang of ≥ 3 mm. In total, 132 Caucasian adults were included in the study. Femoral overhang occurred in 33%, whereas tibial overhang in only 6% of cases. The exclusion of prosthetic overhang cases significantly improved the accuracy of size detection; exact match for femur increased from 55% to 69%, and for tibia from 70% to 73%. All implants were predicted to within one size in all cases. Digital templating using a calibrating 25 mm metallic ball, Agfa Orthopaedic Tools software and hip-to-ankle and knee lateral radiographs is an accurate method of predicting the knee implant to within one size. Ignoring this procedure leads to prosthetic overhang.

Abstract

Surgical intervention in cervical disease can relieve neurological symptoms and improve life quality. This study aimed to analyse retrospective data of microscope-assisted anterior cervical discectomy and fusion (ACDF) surgeries. The retrospective study was carried out at the ORTO clinic, Rīga, Latvia, from 2013 to 2017. Data from 198 patients were extracted retrospectively. Data on patient gender, age, diagnosis, extent of operation, type of cage and the overall height of the implants were used. Comparative analysis was carried out with the SPSS 22 software. P < 0.05 represented statistical significance. During the study period, 198 elective ACDF were carried out with increasing number of surgeries: 25 cases in 2013, 43 in 2014, 38 in 2015, 44 in 2016, and 48 in 2017. ACDF were significantly more often performed for females (n = 117, 59%) compared to males (n = 81, 41%; p < 0.003). Women were older with an average age of 50 ± 1 years than men (age 46 ± 1; p = 0.007). The mean surgery time was 1.5 ± 1 hours and the mean hospitalisation time was 3 ± 1 days. Four types of cages were used in similar number of operation: Cervios Peek Chronos C (24%), Syncage C (21%), EIT 3D print (29%), Cervios C Peek (26%); p = 0.2, regardless of patient age or gender. Most often, in 98 cases, the overall height of implants was 6–10 mm. The maximal height was 22 mm, where two patients underwent three-level, and one had a four-level discectomy. The most prevalent disc lesion levels were C5/6 and C6/7, followed by C4/5 and C3/4. One- and two-level discectomies were performed in similar numbers: 95 and 81 cases. However, only 20 patients underwent three level and two patients had four level discectomies in 2016 and 2017. Two level discectomy at C5/6, C6/7 was carried out significantly more often for women (55 vs. 26; p = 0.01), and for men 1-level lesion was more common in C6/7; p = 0.04. The overall incidence of cage subsidence was 5.5%, and the highest incidence was 24% when a Syncage C was used. The ACDF appears to be performed increasingly more often, particularly, in females. The most frequent operation was in one or two cervical levels; including level C6/7 in both genders. In the last years, three- and four-level cervical discectomies have become one of the surgical opportunities. Choice of cage was not influenced by patient gender and age, while cage biophysical and biochemical properties may influence the choice.

Abstract

The clinical effects on knee osteoarthritis (OA) symptoms and tissue structure were evaluated after bone marrow-derived mononuclear cell intraarticular injection. A group of 32 patients with 34 knee joints in stage II–III osteoarthritis were treated by intraarticular injection of mononuclear cell suspension. Clinical results were obtained by KOOS (Knee Osteoarthritis Outcome Score) and KSS (Knee Society Score) scores during a 12 months follow-up period. Radiological evaluation was performed using magnetic resonance imaging. A comparison with a control group of 28 patients treated with routinely used three hyaluronic acid intra-articular injections was made. No adverse effects were observed after the bone marrow derived mononuclear cells (BM-MNC) injection. At the end point of the follow up all score results had improved, compared to those at to the starting point. 65% of patients maintained minimal perceptible clinical improvement of the score results. The Whole Organ Magnetic Resonance Imaging Score showed improvement from 44.31 to 42.93 points (p < 0.05) during a 6–7 month period. Comparing score results to the control group, a statistically significant (p < 0.05) improvement in the KOOS pain subscale score at the 6 and 12 months was observed in the mononuclear cell group. BM-MNC injection leads to a decrease of knee OA symptoms and slows changes in structure of the degenerative joint tissue.