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Background. Osteoarthritis of the hand joints in systemic sclerosis (SSc) patients might be an independent manifestation leading to limitation of upper extremity function. There is no publication quantitatively assessing the thickness of articular cartilage within the hand joints of SSc patients by MRI. The purpose of our study was to quantify the condition and thickness of hand joints cartilage with three-dimensional quantitative MRI (3D q-MRI). Methods. The study was conducted in twenty people: ten patients with SSc and ten healthy individuals. All participants were examined with the 3D q-MRI with 3T scanner. The cartilage thickness of proximal (PIP) and distal interphalangeal (DIP) joints as well as metacarpophalangeal joints was measured. Results. There was no significant difference in cartilage thickness between both groups. However, the joint cartilage was thinner in fingers with acro-osteolysis. In PIP joint of the fingers with acro-osteolysis, the mean cartilage thickness was 0.5 mm (p = 0.0043) and 0.4 mm (p = 0.0034) in DIP joints. Conclusions. Quantitative MRI analysis of the joints of the hands of SSc patients does not indicate changes in thickness of the articular cartilage. A significant reduction in the articular cartilage thickness of the fingers with acro-osteolysis indicates the potential of an ischemic basis of articular cartilage destruction in SSc patients. [ABSTRACT FROM AUTHOR]

Introduction: Osteoarthritis (OA) is the most common degenerative joint disease, and its aetiology is not entirely known. The aim of the study was to evaluate the involvement of interleukin-18 (IL-18) and interleukin-20 (IL-20) in the pathogenesis of knee OA and their correlations with other markers of inflammation and destruction of joint cartilage, as well as clinical and radiological changes.Material and methods: The study included 25 patients with knee OA and a control group. The concentration of IL-18, IL-20, IL-6, MMP-1, MMP-3, COMP, PG-AG, and YKL-40 in serum and synovial fluid (SF) were determined. We also evaluated radiological lesions of the knee joint according to the Kellgren-Lawrence (K-L) scale, and clinical severity of the disease according to Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne Index.Results: The concentrations of IL-18 and IL-20 were statistically significantly higher in serum of patients with OA than in the control group (106.00 ±189.76 pg/ml vs. 16.73 ±16.99 pg/ml, p < 0.001, 17.69 ±13.45 pg/ml vs. 9.76 ±9.00 pg/ml, p < 0.014). Serum concentration of IL-18 positively correlated with MMP-3 (R = 0.58; p = 0.006) and YKL-40 (R = 0.48; p = 0.002). The degree of radiological advancement of OA (K-L scale) correlated positively with clinical evaluation (WOMAC, R = 0.74, p ≤ 0.001; Lequesne Index, R = 0.57, p = 0.003).Conclusions: The analysis of ROC curves showed that IL-20 as well as COMP, MMP-3, and YKL-40 may be diagnostic markers of knee OA. The observations indicate that IL-18 potentially mediates mainly in intra-articular processes and IL-20 could be primarily responsible for the systemic inflammatory reaction. [ABSTRACT FROM AUTHOR]

Introduction: Effective treatment in psoriatic arthritis (PsA) patients can protect them from severe musculoskeletal complications. For appropriate monitoring of anti-tumour necrosis factor a (anti-TNF-a) treatment in PsA, specific biomarkers are needed. Aim: To investigate whether biological treatment with anti-TNF-a (etanercept 50 mg once a week subcutaneously) affects the activity of selected mediators of inflammation and destruction of articular cartilage: interleukin-6 (IL-6), interleukin-18 (IL-18), matrix metalloproteinases 1 and 3 (MMP-1, MMP-3), cartilage oligomeric matrix protein (COMP), human cartilage glycoprotein (YKL-40) in serum of patients with PsA. Material and methods: The study included 25 patients with PsA. The concentration of IL-6, IL-18, MMP-1, MMP-3, COMP and YKL-40 in serum was determined before, and 6 and 12 weeks after the beginning of anti-TNF-a treatment. Clinical severity of the disease according to the Body Surface Area, Psoriasis Area and Severity Index and Dermatology Life Quality Index as well as tender and swollen joint count (TJC, SJC) were also evaluated. Results: The study disclosed a statistically significant reduction in the serum concentration of IL-6, MMP-1 and YKL-40 in PsA patients after 6 and 12 weeks from the beginning of anti-TNF-a treatment (p = 0.00018 for IL-6; p = 0.01242 for MMP-1; p = 0.03263 for YKL-40). [ABSTRACT FROM AUTHOR]

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The aim of this study was to find characteristic biomarkers in the serum of patients with osteoarthritis (OA) and psoriatic arthritis (PsA) responsible for inflammation and destruction of joint cartilage, which could differentiate these two diseases. The study included 67 people: 22 patients with knee OA, 22 patients with PsA, and 23 individuals who were the control group of healthy individuals (HC). The concentration of IL-18, IL-20, IL-6, MMP-1, MMP-3, COMP, PG-AG, and YKL-40 in serum were determined. Among the OA and PsA patients group, the radiological assessment and clinical assessment were also performed. The concentration of 7 out of 8 of examined biomarkers (except MMP-1) was statistically significantly higher in the serum of patients with OA and PsA than in the control group. Compering OA and PsA groups only, the serum PG-AG level in OA patients was statistically significantly higher than in PsA patients (p < 0.001). The results of univariate and multivariate logistic regression analysis comparing OA and PsA biomarker serum levels identified PG-AG and COMP as markers that are significantly different between patients with OA and PsA (odds ratio 0.995 and 1.003, respectively). The ROC curve constructed using the model with age showed PG-AG and COMP had an AUC of 0.907. The results of this study show that COMP and PG-AG may be sensitive markers differentiating patients with osteoarthiritis from psoriatic arthritis. [ABSTRACT FROM AUTHOR]

Introduction: Effective treatment in psoriatic arthritis (PsA) patients can protect them from severe musculoskeletal complications. For appropriate monitoring of anti-tumour necrosis factor α (anti-TNF-α) treatment in PsA, specific biomarkers are needed., Aim: To investigate whether biological treatment with anti-TNF-α (etanercept 50 mg once a week subcutaneously) affects the activity of selected mediators of inflammation and destruction of articular cartilage: interleukin-6 (IL-6), interleukin-18 (IL-18), matrix metalloproteinases 1 and 3 (MMP-1, MMP-3), cartilage oligomeric matrix protein (COMP), human cartilage glycoprotein (YKL-40) in serum of patients with PsA., Material and Methods: The study included 25 patients with PsA. The concentration of IL-6, IL-18, MMP-1, MMP-3, COMP and YKL-40 in serum was determined before, and 6 and 12 weeks after the beginning of anti-TNF-α treatment. Clinical severity of the disease according to the Body Surface Area, Psoriasis Area and Severity Index and Dermatology Life Quality Index as well as tender and swollen joint count (TJC, SJC) were also evaluated., Results: The study disclosed a statistically significant reduction in the serum concentration of IL-6, MMP-1 and YKL-40 in PsA patients after 6 and 12 weeks from the beginning of anti-TNF-α treatment ( p = 0.00018 for IL-6; p = 0.01242 for MMP-1; p = 0.03263 for YKL-40)., Conclusions: IL-6, MMP-1 and YKL-40 may be useful for monitoring the effectiveness of anti-TNF-α treatment., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2020 Termedia Sp. z o. o.)

Introduction: Psoriatic arthritis (PsA) is a chronic, seronegative spondyloarthropathy characterised by joint inflammation and psoriatic skin changes. Recent data indicate that interleukin-18 (IL-18) and interleukin-20 (IL-20) may be involved in the aetiopathogenesis of PsA., Aim: To evaluate the potential role of IL-18, IL-20, and matrix metalloproteinases (MMP-1, MMP-3) in the pathogenesis of PsA and their correlations with other markers of inflammation and destruction of joint cartilage, as well as clinical changes., Material and Methods: The study included 24 patients with PsA and 26 healthy volunteers as a control group. The concentration of IL-18 and IL-20, c-reactive protein (CRP), metalloproteinase-1 and -3 (MMP-1, MMP-3), cartilage oligomeric matrix protein (COMP), aggrecan (PG-AG), and human cartilage glycoprotein (YKL-40) in serum was determined. Clinical severity of the disease according to the BSA, PASI, and DLQI as well as tender and swollen joint count (TJC, SJC) were also evaluated., Results: The concentration of IL-18 was statistically significantly higher in the serum of patients with PsA than in the control group (62.87 pg/ml vs. 16.73 pg/ml, p < 0.0049). Serum IL-20 levels in PsA patients were also higher than in the control group, but without statistical significance ( p = 0.2939). The ROC curves showed: AUC = 0.81 for IL-18, AUC = 0.75 for IL-20, AUC = 0.96 for COMP, and AUC = 0.89 for MMP-3., Conclusions: IL-18 and IL-20 as well as MMP-3 and COMP may be sensitive markers in the diagnosis of PsA., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2020 Termedia Sp. z o. o.)

Background: Anterior knee pain (AKP) is a frequent serious clinical problem after anterior cruciate ligament (ACL) reconstruction, regardless of the graft material used. The author conducted prospective studies of the correlation between AKP and disturbed geometry of patello-femoral joint observed in magnetic resonance imaging (MRI), in patients with injured ACL reconstructed with the use of hamstrings., Material and Methods: The study included 60 patients (34 males and 26 females), at the mean age of 31, who underwent ACL reconstruction with flexors. Only patients without clinical AKP symptoms or AKP factors after reconstruction were included in the study. Before surgery, in all patients MRI was performed in order to evaluate the patellar height, excessive patellar pressure (EPP) and patellar lateralization (PL). In the postoperative course, AKP and its correlation with the ratios mentioned above were observed., Results: In the group of patients included in the study, pathological patellar height was not observed, EPP was diagnosed in 15%, PL in 13.3% and EPP and PL jointly in 11.9% of the patients. AKP was observed in 8 out of 9 patients with abnormal lateral pressure, 7 patients with EPP and 7 patients with concomitant excessive lateral pressure and PL. The first symptoms of AKP appeared between the seventh and twelfth week after surgery and increased after 12 weeks., Conclusions: The occurrence of excessive lateral pressure syndrom (EPP) and PL confirmed in MRI was very strongly correlated (89% and 100%, respectively) with the occurrence of AKP after ACL reconstruction. The evaluation of the patellofemoral joint geometry, taking into account the EPP and PL ratios in pre-operative magnetic resonance image (MRI) in patients with injured anterior cruciate ligament, may allow us to establish the AKP risk group and administer suitable preventive treatment (prophylaxis).

Background: Knee infection after anterior cruciate ligament reconstruction is a very serious complication. The aim of the paper is to present our experience relating diagnosis and management of this complication with concomitant graft salvage., Material and Methods: The study included 5 patients diagnosed with acute knee infection after anterior cruciate ligament arthroscopic reconstruction with hamstring with Rigid Fix graft fixation system. The treatment involved intravenous and oral antibiotic therapy combined with arthroscopic debridement and through drainage insertion. All patients were males with a mean age of 29 years. Evaluation was performed in reference to clinical symptoms of infection, laboratory tests results and effectiveness of the applied management. Mean observation period was 9.1 years (range from 7.2 to 10.5 years)., Results: Management that we undertook led to successful infection treatment with concomitant graft retention without the necessity to inspect the fixation site. There was no recurrence of infection during the 9.1 years of observation., Conclusions: 1. Plain monitoring of patient body temperature in the morning and in the afternoon at fixed times with the elimination of the effect of anti-inflammatory drugs on the temperature values enables early detection of acute knee infection after ACL reconstruction and rapid implementation of appropriate management. 2. Targeted antibiotic therapy combined with arthroscopic debridement and through drainage is an effective means of treatment of acute knee infection after anterior cruciate ligament arthroscopic reconstruction with hamstring without sacrificing the graft. 3. The conducted studies indicate that the primary source of infection is the knee joint and, consequently, there is no need to inspect graft fixation sites as long as the clinical symptoms from these sites do not cause suspicions of infection.

We report an unusual case of clinical improvement after 2 years from one stage bilateral open reduction of chronic anterior shoulder dislocations with internal fixation of greater tuberosity fractures. The chronic bilateral anterior shoulder dislocations with greater tuberosity fractures were caused by electric shock. After the injury the patient was hospitalized on a medical ward and the dislocations were not diagnosed. Four weeks later the diagnosis of both anterior shoulders dislocations with greater tuberosity fractures was confirmed by X-ray. The patient was treated with one stage bilateral open reduction of chronic shoulder dislocations with internal fixation of greater tuberosity fractures by means of a deltopectoral approach. The shoulders were kept immobilized for six week, next the patient was rehabilitated. He underwent a thorough first evaluation 1 year after the procedure and second ewaluation after 2 years. He had a very good and comfortable range of motion in both shoulders at a follow-up. The modified Constant score was very good in both shoulders (95 points). To the best of our knowledge, such a case has not yet been described in the literature. Our case proved the chronic anterior bilateral humeral head dislocation may be successfully treated in one stage procedure provided the patient is carefully selected and his consent obtained. Moreover, the clinical improvement may be expected even two years after the surgery.

Introduction: The porpuse of this animal study was to assess chondrocyte apoptosis and MMP-1, MMP-3 and TIMP-2 expression in rabbit tibial cartilage 6 months after viable medial meniscal autografts and allografts., Material and Methods: Twenty white male New Zealand rabbits were chosen for the study. The medial meniscus was excised from 14 animals and stored under tissue culture conditions for 2 weeks, following which t of them were implantated as autografts and 7 as allografts. The control group consisted of 6 animals which underwent arthtrotomy. When the animals were eutanized, the tibial cartilage was used for immunohisochemical examination. Apoptosis (TUNEL method) and MMP-1, MMP-3 and TIMP-2 expression were estimated semiquantatively., Results: An increased level of chodrocyte apoptosis in the tibail cartilage was observed after both kinds of transplants (p < 0.05), allografts (1.43 ±0.98) and autografts (0.86 ±0.69); no statistical diferences existed between them. An increased level of metalloproteinases and TIMP-2 expression was obreved only after allografts with statistical differences among the allograft group, the autograft group nad the control group (p < 0.05)., Conclusions: Our findings suggest that the meniscal graft does not protect the hyaline cartilage against excessive apoptosis. The results of experimantal studies on humans indicate the need to device a method of apoptosis inhibition in the hyaline cartilage to improve long-term results of meniscal transplantation.

Background: We evaluated the clinical possibility of using 0.25 mm calibration and its effect on bone tunnel surface areas of varied length in comparison to the standardized graft calibration by every 0.5 mm in case of ACL reconstruction with hamstrings., Material/methods: The ACL reconstruction with hamstrings were done in 30 patients aged 18 to 28 years.The inclusion criteria were the graft diameter between 7-8.5 mm with its calibration by every 0.5 mm. and the length of the femoral tunnel minimum 4 cm. The calculation of surface area of a bone tunnels length ranging from 2.5 to 5 cm was done., Results: 0.25 mm decrease in bone-tunnel diameter was possible in 56.7% of cases and decreased tunnel surface area of 3.4% in relation to primary value of graft diameter calibrated by every 0.5 mm, irrespective of its length. 0.5 cm change of bone tunnel length from 2.5 cm to 5 cm results in surface area increase of 17% (3 cm), 37.5% (4 cm) and 50% (5 cm) respectively, regardless of calibration rate., Conclusions: 0.25 mm reduction of bone tunnel diameter in relation to graft one calibrated by every 0.5 mm changes its surface area of 3.4%, regardless of tunnel length within range of 2.5-5 cm. Change of tunnel length from 2.5 to 3, 4 and 5 cm increase surface area by 17, 38 and 50% respectively, regardless of its diameter within range of 6.75-8.5 mm with 0.25 mm calibration rate. The 0.25 mm bone tunnel calibration should be a standard option in ACL reconstruction with hamstrings.

Background: Commonly used knee evaluation scoring systems differ according to their range of influence over the overall grade which is a composite of both subjective and objective category. Due to this fact the final outcomes obtained with individual scores may differ in relation to the evaluation of the same patient. The aim of the study was to compare the results obtained with the use of three most common knee evaluation scoring systems: Lysholm, HSS and IKDC., Material/methods: We evaluated 27 knees in 26 patients following meniscus repair and anterior cruciate ligament reconstruction. The mean patient age was 25.7 years., Results: Result compatibility obtained for individual knees in all the three scoring systems was 41%. The highest, 70% compatibility rate concerned Lysholm and HSS scores, compatibility rate of the results between HSS and IKDC was less significant amounting to 56%, the lowest compatibility rate-24%--was noted between Lysholm and IKDC scores. In 7% of the evaluated knees the results were different for each scoring system incorporated., Conclusions: On the basis of the analysis of knee evaluation results after meniscus repair and anterior cruciate ligament reconstruction the lack of total result compatibility between Lysholm, HSS and IKDC scores was noted.

Background: The term frozen shoulder refers to an inflammatory condition characterized by pain and reduced range of passive and active motion of the shoulder. Initial management is mostly conservative. In some cases, however, invasive treatment is necessary. Given the dearth of available data on long-term operative outcomes, it appears interesting to present a comprehensive discussion of this issue. The aim of this study was to evaluate the improvement of range of motion and function of the affected shoulder after a minimum of two-year follow-up following arthroscopic capsular release of idiopathic and posttraumatic frozen shoulder., Material and Methods: The study enrolled 30 patients with frozen shoulder, including 16 patients with idiopathic FS and 14 patients with posttraumatic frozen shoulder. All patients had an anteroinferior capsular release and three additionally had a posterior capsulotomy. After a minimum of two-years of follow-up, the shoulder's range of motion and limb function were evaluated according to a modified version of the Constant-Murley Score (0-75), the ASES (American Shoulder and Elbow Surgeons) score and a subjective scale designed by the authors., Results: The improvement in the range of motion after arthroscopic capsular release was considerable and statistically significant (p<0.05) compared to pre-operative values both intraoperatively and after a minimum of two years of follow-up in both groups and across all planes of movement tested. The improvement of function of the shoulder after a minimum two years following arthroscopic capsular release was significant (p<0.05) according to the Constant-Murley score (from 19.3 preoperatively to 65.9 postoperatively, 0-75) and the ASES score (from 22.8 preoperatively to 92.7 postoperatively, 0-100)., Conclusion: Arthroscopic capsular release significantly improved the range of motion and function in idiopathic and posttraumatic frozen shoulder.

Background: The paper presents the results of clinical assessment of meniscal repair outcomes after a minimum of two years post-suturing., Material and Methods: The first stage of the treatment involved arthroscopic repair of 34 menisci in 31 knees of 30 patients, and the second stage was anterior cruciate ligament reconstruction. The menisci were repaired mainly with PDS sutures, using an inside-out technique. A clinical evaluation of meniscal healing was performed at a mean of 3.9 years following the meniscal repair and involved an orthopaedic examination and a Lysholm score-based assessment of the knees. It was determined which factor (such as age, sex, trauma-to-suturing time, meniscal type, location and extent of tear, and extent of anterior tibial laxity) had had an effect on the results., Results: 26 out of the 31 menisci evaluated (84%) were healed. Five menisci had failed to heal (16%). Lysholm scoring classified 16 results as excellent, nine as good and two as fair. A statistical analysis revealed that the location of the meniscal tear was the only factor possessing a statistically significant effect on the results., Conclusion: 1. In this study, 84% of meniscal symptoms and 13% of the evaluated meniscal healing after a minimum of two years post-surgery, whereas 3% showed meniscal symptoms and 13% of the evaluated menisci were resected. 2. Out of all analysed factors (patient age, sex, trauma-to-repair time, meniscus type, and the location, length and extent of the tear), only the location of the meniscal tear correlated significantly with the result of meniscal healing determined by clinical evaluation. 3. There was no statistically significant relationship between Lysholm scores and patient age, sex, trauma-to-repair time, or the location of the meniscal tear.

Background: The purpose of this study was to evaluate the peak torque of the knee flexors (H) and the quadriceps muscle (Q) at 12 and 24 weeks after isolated anterior cruciate ligament reconstruction with semitendinosus and gracilis autografts., Materials and Methods: There were 20 patients (8 females, 12 males), with the mean age of 31.5 years. An isokinetic examination of the muscles was performed with a Biodex System 3 isokinetic dynamometer at a speed of 180 degrees/sec. All patients underwent 12 weeks of isokinetic training for 20 minutes 5 times a week (240 degrees/sec for 6 weeks and 180 degrees/sec for 6 weeks) beginning 12 weeks after surgery., Results: The average peak torque difference between the healthy and operated limb at 12 and 24 weeks postoperatively was 38% and 14% for Q and 25% and 4.3% for H respectively. The decrease in peak torque differences was statistically significant for both H and Q (p=0.05). The decrease in Q peak torque was significantly higher than that of H peak torque 12 and 24 weeks after surgery., Conclusions: These results indicate that 12-week isokinetic training can increase the peak torque of H and Q by 20% and 24% respectively. An isokinetic examination of Q and H peak torques should become a standard procedure for evidence-based monitoring of the rehabilitation process after anterior cruciate ligament reconstruction.

The paper presents results of objective isokinetic evaluation of shoulder abductors and external rotators peak torque in 4 cases (2 women and 2 men) suffering from suprascapular nerve neuropathy (SNN). The mean age of patients was 25 years. The clinical diagnosis of SSN involvement was confirmed by electromyographic study in all cases. The radiological, sonographic and additionally magnetic resonas (2 cases operated on) examinations proved the absence of bone and soft tissues pathologies (ganglion and rotator cuff). The arthroscopic decompression of SSN was done in 2 cases. Isokinetic evaluation (180 degrees/s) disclosed weakness of shoulder abductors and external rotators in all cases and decrease of side to side difference of their peak torque 6 months after surgery. The patients operated on refused control EMG evaluation since they experience complete pain relief and improvement of function. There were no complications. Arthroscopic suprascapular nerve decompression can be done safely and effectively in properly selected cases. The isokinetics offers objective pre and postoperative evaluation of muscles involved by SNN.

The aim of this paper is an evaluation of specificity, sensitivity and accuracy of clinical examination in intraarticular disorders of the knee joint. Study was performed on 100 patients (31 female, 69 male) (age 15-61 years) treated by arthroscopy. Our study showed the high sensitivity and specificity in assessment of leasions of the medial meniscus and leasions of the anterior cruciate ligament. Leasions of the medial meniscus and of the anterior cruciate ligamnet one. Leasions of the medialis meniscus may be painless and may not be associated with trauma.

The purpose of this study was to verify the arthroscopic meniscus repair by second-look arthroscopy. From November 2001 to October 2005, 28 meniscus (18 medial and 10 lateral) were repaired in 26 patients (two patients had both menisci in one knee repaired). There were 11 females and 15 males. The average age at surgery was 25.5 (range, 13 to 52 years of age). The indication for repair was a full-thickness, vertical tear > or = 8 mm. Meniscus repair was combined with partial meniscectomy of posterior horn because of horizontal tear in 3 cases. In 1 zone 14 meniscus were injured and in 2 zone--also 14 meniscus, according to Cooper's classification. All patients had anterior cruciate ligament rupture. The average time interval between the injury and the repair was 22 weeks (range, 2 weeks to 2 years). The inside-out suture was used in 18 repairs, all inside--3 repairs, outside-in--2 repairs and a mixed technique--5 repairs. Arthroscopic evaluation of meniscus repair was performed on average after 15 weeks (range, 2 months to 37 weeks) since the suture. That was done during the second stage of treatment--ACL reconstruction. There were 78.6% of completely healed repairs, 10.7% of incompletely healed and 10.7% were not healed.

We present a case of a 35 year-old man, an office employee, who got ill when working hard building his own house. At the same time shoulder pain and fever occurred, the latter due to the tooth apical abscess. Several months later atrophy of the left supraspinatus and infraspinatus muscles was found. The imaging study (MRI, USG) did not show changes which might affect the suprascapular nerve. Electromyography of the left infraspinatus and supraspinatus muscles revealed fibrillation and positive sharp waves. Distal motor latency to the infraspinatus and supraspinatus muscles, examined by electroneurography, was normal. Mechanical irritation of the spinoglenoid notch is only one of possible mechanisms of the suprascpular nerve impairment in this case. The second is the inflammatory process. Suprascapular nerve impairment does not play an important role in pathogenesis of shoulder pain, but probably it is taken too rarely into consideration in differential diagnosis of shoulder pain.

This paper presents rare case of the double recurrent humerus osteochondroma in 18 years old man. Tumour was removed twice, in the age 5 and 10 years. In 18 years after tiny injury odoema and pain associated double, recurrent exostosis. Precise analysis of radiograms allowed diagnosis of infracture of one of exostosis and excluded malignant transformation. Whole tumour resection could patient's heal and make final diagnosis--double recurrent humerus osteochondroma.

Based on clinical material of 21 patients age from 9 to 67 years (average 32.8 years) at whom bone defects were supplemented by Pyrost our own observations were presented. Only Pyrost was used in 10 cases, in 9 cases it was used together with homogenous bone grafts and in 2 with autogenous bone grafts. The indications for using Pyrost were following: non union in 9 cases, realloplasty of the hip in 5, after tumour bone resection in 5, inflammation of bone in 1 and supplementation after augenous bone grafting in 1. Analysis of medical documentation and control examinations of 16 patients with follow-up 11.8 years shown good patients' tolerance of Pyrost and absence of locally and generally unuseful reactions. First signs of osteogenesis were observed after 6 weeks. Successive evaluations shown rebuilding of bone to the end of it. Long term results confirmed whole rebuildings of Pyrost to the bone tissue and absence of resorption of Pyrost, without weakness of bone structure. Non-satisfactory results were observed in 3 cases: no consolidations of 2 non unions and 1 septic failed hip realloplasty.

There is no doubt, that local anesthesia for knee arthroscopic surgery is rather simple, reliable, well tolerated, cost-effective and safe procedure acceptable also for one-day-surgery and outpatients. Patient's acceptance and satisfaction are behind those measurable data and could be predicted only after the question if the patients would prefer intraarticular analgesia when they should need to have another arthroscopy performed. The aim of the investigation was to compare this prediction with real patients feeling. Comparison was made between the types of anesthesia (regional, intraarticular) used for knee surgery, twice the same knee and patient. The retrospective data (mean 9 months after the last surgery) showed higher patients satisfaction (93.5%) with local anesthesia if compare with regional (2.6%) and femoral nerve block (3.9%).