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Polymethyl methacrylate (PMMA) bone cement has been a transformative material in orthopedics since its introduction in the mid-20th century. Originally used in dental medicine, PMMA was adopted for orthopedic applications by Sir John Charnley in the 1950s, significantly enhancing joint replacement surgeries. The primary appeal of PMMA lies in its biocompatibility, mechanical strength, and ease of handling, making it a favored choice for various orthopedic procedures, including arthroplasties and limb-salvage surgeries. However, the exothermic polymerization process of PMMA poses a risk of thermal necrosis in the surrounding bone tissue, as local temperatures can exceed 70 °C, causing damage to osteocytes. Research has sought to mitigate these risks by optimizing mixing techniques, reducing cement mantle thickness, and incorporating cooling methods. Recent advancements, such as the use of phase-change materials (PCMs) and alternative monomers, have shown promise in lowering the exothermic peak during polymerization. Other strategies include pre-cooling the cement and prosthetic components and using composite cement. Despite these innovations, managing the balance between minimizing heat generation and maintaining mechanical properties remains a challenge. The impact of thermal necrosis is significant, compromising implant stability and osseointegration. Understanding the complex interactions between PMMA's thermal properties and its clinical outcomes is essential for improving orthopedic surgical practices and patient recovery. [ABSTRACT FROM AUTHOR]

Rapidly progressive hip osteoarthritis (RPOH) is a rare and severe form of osteoarthritis (OA), marked by the rapid degeneration and destruction of the femoral head, often within months. Despite its unclear etiology, several factors such as subchondral fractures and immune responses have been proposed as possible contributors. This narrative review aims to synthesize current knowledge on the pathogenesis, risk factors, clinical presentation, imaging features, and grading systems of RPOH. Predominantly affecting elderly females, RPOH presents distinctive challenges in both diagnosis and management due to its abrupt onset and severity. Known risk factors include advanced age, female gender, obesity, intra-articular corticosteroids use, and long-term hemodialysis. Clinically, RPOH is characterized by severe pain during active weight-bearing movements, despite patients presenting a normal range of motion during passive examination in the early stages. While several classification systems exist, there is no universal standard, complicating differential diagnosis and clinical approaches. This review emphasizes the necessity for early diagnostic methods utilizing specific biomarkers, rapid differential diagnosis, and targeted, personalized interventions based on individual risk factors. [ABSTRACT FROM AUTHOR]

Biofilms can form on living or inert surfaces and prevail in natural, industrial, and hospital environments. They are made of bacteria organized in a coordinated functional community. Biofilms do not respond to antibiotic treatment due to multiple mechanisms of tolerance and resistance. If bacteria are coordinated in a biofilm form, they are significantly less susceptible to antibiotics, thus making the therapeutic approach difficult. The possibility of using drugs aimed at inhibiting the formation of biofilms in combination with current antibiotics is a therapeutic approach with a major potential for this type of persistent bacterial infection. This bibliographic study aims to present the main compounds that act by inhibiting or destroying the bacterial biofilm.

Copyright of Acta Medica Transilvanica is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Medica Transilvanica is the property of Sciendo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Alcaptonuria is a highly rare autosomal recessive metabolic illness with an aproximately 1:1.000.000 birth frequency, causing articular buildup of grey-blue pigment known as ochronotic arthropathy (OA). The etiology is represented by a mutation of the homogentisate gene 1,2-dioxygenase (HGD), deficiency that leads to accumulation of homogenetic acid in the connective tissue and blood. Case Report: We present the case of a 76- year-old patient, previously diagnosed with type IV Lobstein Osteogenesis Imperfecta, gonarthrosis, spondiloarthritis, who is admitted in 2021 in the Orthopaedic Clinic with complaints of right hip pain sensitivity, functional impairment with limited movements. Following preoperative care for total hip replacement surgery, right hip arthrotomy is initiated, during which a black friable intraarticular matter is distinguished. Hence, arthroplasty is delayed until a morphopatological examination is conducted. The examined compact bone tissue revealed microscopic area of residual cartilage with brown pigment. Upon examination, the synovial tissue presented pigmented hyaline cartilage lesions, inflammatory tissue, as well as foreign-body giant cells, thus establishing the diagnosis of ochronosis. Ultimately, the patient underwent total hip arthroplasty, with no intraoperatory complications. Discussions : While there is currently no cure or prophylactic treatment for alcaptonuria, first line of treatment involves administration of HPPD inhibitors, such as Nitisinone, which is known to be effective in decreasing homogensic acid by up to 95%, along with vitamin C supplements for their antioxidant properties. In cases of OA, patients typically seek medical attention after joint involvement, as symptoms often manifest after a latency period. Surgical intervention such as knee, hip or shoulder arthroplasty may thus be necessary. According to current studies, progression of OA cannot be effectively stopped, but rather managed through the modulation of Tyrosine and Phenylalanine metabolism. Consistently, progression of OA leads to degenerative arthritis, precipitating heightened discomfort and diminishing life quality. Ultimately, all instances of OA necessitate treatment via total hip arthroplasty or total knee arthroplasty, with outcomes akin to those observed in classical osteoarthritis interventions. Conclusions: Due to symptomatic resemblance between ochronotic and classical degenerative arthropathy, OA should be considered prior to surgical treatment, despite its rarity, based on the family history and clinical findings, which will ensure a better surgical and therapeutical management of the patient. Despite its unusual character, with merely a few reports in medical literature, total arthroplasty is still considered to be the best course of action for patients associating ochronotic degradation of the joint. [ABSTRACT FROM AUTHOR]

Introduction: Rapidly progressive coxarthrosis (RPOH) is an arthropathy with insufficiently understood etiology, which affects both articulation of the femoral head with the acetabulum determining a narrowing of the joint space of >2mm over the course of 12 months, which is a faster progression of this disease compared to the primary hip osteoarthritis. Although RPOH affects predominantly elderly women during menopause, the disease can be also triggered by trauma, infections, intra-articular corticosteroids injections and high levels of bone biomarkers in serum. Case Report: A 56-year-old woman presents in the orthopedical department with manifested hip pain and mobility disfunction interesting the left hip joint. After analyzing her symptoms, the fast progression of her state, raised the possibility that her diagnosis might be rapid progressive coxarthrosis. The radiological features of the left hip joint showed the destruction of both the femoral head and acetabulum with a complete narrowing of the joint space that causes the appearance of numerous osteophytes. Taking into consideration the results, both clinical and paraclinical investigations, we confirm our presumptive diagnosis, classifying it as being: RPOH GRADE III. Judging by the patient's age, lifestyle, and advanced diagnosis, we considered total hip arthroplasty the best course of treatment. Discussions : Due to the illness's rarity and the symptoms of coxarthrosis rapid progression sharing parallels with other age-related disorders, it is very easy to think of it as being osteoporosis or a femur head fracture- situations in which the differential diagnosis is critical to prognosis. Conclusions: Although the disease is rare and a prompt diagnosis is in most cases impossible, we should raise awareness among physicians not to exclude the possibility of this pathology in case they might encounter it during their practice. Also, they should pay special attention to high-risk groups such as: women post menopause, personal history of multiple trauma or similar symptomatology documented in their family's history. [ABSTRACT FROM AUTHOR]

Background: The three major stabilizers of the posterolateral corner (PLC) are the fibular collateral ligament (FCL), the popliteus tendon (PLT) and the popliteofibular ligament (PFL). These lesions commonly occur in association with other ligament injuries, especially posterior and anterior cruciate ligament (PCL, ACL). Objective: The purpose is to present the results of a correctly made rehabilitation after a severe knee injury. Material and methods: We present the case of a 35 year old male, professional football player, who experienced direct trauma to the left knee on the 17th of March, 2017, resulting in PLC associated with PCL lesions. Two days later, he underwent surgery in the Targu Mures Clinical County Hospital, department of Orthopedics and Traumatology, which consisted in the Larson procedure for the PLC reconstruction associated with PCL reconstruction and had favorable postoperative outcome. The patient pursued the following protocol for the recovery process: Phase 1: 0-6 weeks PO, in which the goals are to protect the surgical grafts, 0-60° ROM and to regain adequate quadriceps control. Phase 2: 7-12 weeks PO, which aims to normalize the gait pattern and regain motion beyond 90 degrees. Phase 3: 4-6 months PO and beyond when it is expected to jog at one's own pace without pain, an 80-90% quadriceps and HS strength return, ROM and gait function normalization. Results: In spite of the severe injury sustained, the athlete regained full function in his left knee 18 months after the surgery and rehabilitation program. Conclusions: The management of PLC and PCL injuries requires complex surgery and an intensive rehabilitation process which can help the patient regain full function, if followed thoroughly. [ABSTRACT FROM AUTHOR]

Background: In Total Hip Arthoplasty (THA) the most common cause of aseptic loosening, which requires revision, is worn-out-insert and osteolysis. Even if the THA with first-generation-polyethylene, was an incontestable solution in terms of pain relief and quality of life some years ago, the revision with ultramolecular high weight polyethylene (UMHWPE) reduces the number of patients undergoing more than one THA revision throughout their lifetime. Objectives: The aim of this presentation is to address the surgical management of the THA revision with UMHWPE and to discuss how its properties importantly contribute at quality of life comparing to their previous generation. Material and method: We present the case of a 64-years-old patient, operated in 2010 for a primary coxarthrosis with a uncemented total arthoplasty of left hip. 7 years later the patient presented painful mobility with restriction in amplitude of the movements, which radiographically was represented by an erosion of the acetabular insert and the slide of femoral head. The worn out PE particles, bone fragments, and metal debris are actively generating the inflammatory process and through that osteolysis. Results: The surgical management of this patient consisted of the insert's revision with a UMHWPE under general anesthesia. The postoperative radiography revealed that acetabular cup was not mobilized in the procedure, and an insert with equal distance between the femoral head and insert's ends. The patient was discharged after 10 days in a generally good condition, afebrile, hemodynamically stable. Conclusions: THA revision with UMHWPE represents a life-changing solution in case of patients with first-generation-PE inserts, so the transaction to it, will ideally reduce the number of revisons in a lifetime. [ABSTRACT FROM AUTHOR]