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Periprosthetic osteolysis
Veigl, David ; Vavřík, Pavel (advisor) ; Vencovský, Jiří (referee) ; Koudela, Karel (referee)
Periprosthetic osteolysis remains the leading complication of total hip arthroplasty. It often results in aseptic loosening of the implant with a requirement for a revision surgery. Wear-generated particular debris is the main cause of initiating this destructive process. The most important cellular target for wear debris is a macrophage, which responds to particle challenge by activatig proinflamatory signals, which contribute to increased bone resorption. The activation of the RANKL/RANK/OPG system is considered to be a likely cause of periprosthetic osteolysis leading to implant failure. The aim of this study was to examine the possible correlation between the clinical extent of osteolysis, the number of wear particles and the expression of the osteoclastic mediator RANKL in the tissues around aseptically loosened cemented and non-cemened total hip replacements. Periprosthetic tissues were harvested from 59 patients undergoing revision hip replacement for aseptic loosening. We had observed RANKL-positive cells in 23 of our 59 patients, their presence was noted predominantly in tissues with a loosened cemented endoprosthesis. We have shown that RANKL is present only in the tissues with a large amount of wear debris and predominantly in the cases involving lacunar type of osteolysis. Key words:...
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Morphology of the Proximal Human Femur in Relation to Fractures of Trochanteric Massif
Báča, Václav ; Stingl, Josef (advisor) ; Koudela, Karel (referee) ; Chomiak, Jiří (referee) ; Laichman, Stanislav (referee)
AIM: Fractures of proximal end, especially fractures of trochanteric massif are very common particularly in old patients. The aim of the work was to try to find a morphological correlate of trochanteric fractures in the region of proximal end of the human femur. It means to find if a "locus minoris resistentiae" for trochanteric fractures origin exists. METHOD: The detailed overview of literature on femur as a bone, classification of trochanteric fractures and treatment of proximal end of the femur was accomplished (sources from medieval books to recent anatomical and clinical studies). Czech and Latin terminological aspect (Terminologia anatomica 1998) of the femur as well as their development were carefully studied. 40 femurs from embalmed bodies with muscles and ligaments were studied by detailed dissection. 99 X-ray pictures of pertrochanteric fractures were checked. 106 dry femurs from the vascular canal distribution point of view were evaluated and compared with previous group of X-rays. Statistic evaluation of normal distribution according to Kolmogorov-Smirnov's test and Liliefors's modification was made in 15 regions of trochanteric massif. 20 dry femurs according to Heřt, Fiala and Petrtýl's method were repeatedly ground to depict the central vascular canals and to describe the course of osteons...
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Minimally-invasive approaches for the hip replacements
Kubeš, Radovan ; Koudela, Karel (advisor) ; Poul, Jan (referee) ; Landor, Ivan (referee)
Contemporary world and medicine are marked by very rapid development of miniaturization, which surprisingly not missed also endoprothetics and arised thankfully to the strong medial attention gigantic wave of public interest about possibility of mini - invasive operative. In public media was this method presented like revolutionary and almost like a nonstrum, first medical publications (especially from pioneers those techniques) were also generally positive, but also since the begginnig had this method also its non-supporters. Own idea of mini- invasive operative is without any doubt correct step into the future, theoretical benefits are indisputable and logical. In wiew of this facts, that it was for me "no man's land" , I decided as a first step to study all published facts and later than I began practical testing of mini-invasive approaches on cadavers studies and than finally after very carefully evaluation of all facts I started to perform mini-invasive approaches. In an effort to deprese maximally the learnig curve, I started my mini-invasive implantation with femoral component only - so cervicocapital endoprosthesis, only after estimation of this group and with newly acquired experiences I came up to perform MIS- THR .. Our statistically prooved final results tell us, that implantation THR...
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Injury to the distal tibiofibular junction in the growing skeleton
Pešl, Tomáš ; Bartoníček, Jan (advisor) ; Koudela, Karel (referee) ; Krbec, Martin (referee)
In adults the complex fractures of the ankle joint have been thoroughly discussed and there are several therapeutic schedules proposed. Weber distinguished three types of ankle joint fractures according to the type of fibular fractures. In agreement with this classification we are certain that fibula is an important element of the immature ankle joint. We concentrated on the anatomy of immature ankle joint, especially on the mutual position of the distal fibular physis and the plane of the tibiotalar joint. The results are summarized as follows: 9.1. AUTOPSY At first we performed autopsy of six ankle joints in stillborns in which there were no orthopaedic and/or neurological lesions. We paid attention to anatomy of the distal tibiofibular junction. Two adult ankles were anatomised for correlation the findings. We ascertained, that in all preparations there was articulation between tibia and fibula, as it is formerly described in the literature. In all six stillborn joints we found well formed ligaments of the distal tibiofibular junction: anterior, posterior and interosseal tibiofibular ligaments. The anterior and posterior tibiofibular ligaments begin at the anterior, respectively posterior surface of the distal tibial epiphysis and terminate at the anterior, respectively posterior surface of the distal...
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Treatment of Deep Chondral Defects with Autologous Chondrocytes
Podškubka, Aleš ; Koudela, Karel (advisor) ; Karpaš, Karel (referee) ; Musiálek, Jaroslav (referee) ; Vavřík, Pavel (referee)
Treatment of Deep Chondral Defects in the Knee with Autologous Chondrocytes Fixed on a Scaffold Form of Hyaluronic Acid Esters (Hyalograft C) Abstract Aim of the study In the past few years we have seen further progress in the treatment of chondral defects by transplanting autologous chondrocytes. Different biomaterials are used as temporary carriers for fixation and an even distribution of chondrocytes in the defects. Since 2003 we have implemented a clinical trial for the treatment of deep chondral defects in the knee by transplanting autologous chondrocytes fixed in a scaffold from hyaluronic acid esters (Hyalograft C). This material has been evaluated in a prospective study. Material We evaluated results in 8 transplanted patients (7 males and 1 female, average age 31 years) with a minimal follow up of 9 months after surgery. Defects of an average size of 3,9 cm2 were localized on femoral condyles. Method We evaluated the functional outcomes (IKDC, K.OOS, Lysholm score) and performed MRI before and 3, 6 and 12 months after surgery. The newly formed cartilage was controlled visually (ICRS visual score) during a second-look arthroscopy at 9 to 12 months after transplantation. We compared the stiffness of the repair tissue at the site of the original defect with the surrounding cartilage using a specially...
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Problems of the hip in patients with childhood cerebral palsy in childhood and adolescence. Experimentally influenced centering of the hip by a combination of operational tactics
Schejbalová, Alena ; Trč, Tomáš (advisor) ; Koudela, Karel (referee) ; Karpaš, Karel (referee) ; Kokavec, Milan (referee)
Cerebral palsy it must be nonprogressive brain lesion or lesions. The original lesion must occur prenatally, at birth, or early in the postnatal period. The primary disorder involves the musculoskeletal systém and lack of motor control, mental retardation or defects of hearing, language. Prevalence of cerebral palsy is different - between 0,6- 5,9 per 1000 births. In Western countries, the birth prevalence rate is about 2,0 per 1000. In children with cerebral palsy the hip joint appears to be relative nornmal at birth. There is abnormally increased femoral anteversion and neck-shaft angle. Increasing adduction-flexion contractures of the hip, acetabular dysplasia, subluxation eventual dislocation of the hip.Adduction deformity of the hip is caused by spasticity and contracture of the hip adductors and the medial hamstrings. Flexion deformity of the hip is primarily caused by spasticity and contracture of the iliopsoas and secondarily by rectus femoris muscles. When the rectus femoris is the cause, hip flexion deformity is increased with the knee in flexion and decreased with the knee in extension. When it is due to the iliopsoas muscle, the position of the knee has no effect on the degree of hip flexion contracture ( Thomas test). On passive flexion of the knee, if the test is positive, the pelvis will...
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