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In this study, metal 3D printing technology was used to create lattice-shaped test specimens of orthopedic implants to determine the effect of different lattice shapes on bone ingrowth. Six different lattice shapes were used: gyroid, cube, cylinder, tetrahedron, double pyramid, and Voronoi. The lattice-structured implants were produced from Ti6Al4V alloy using direct metal laser sintering 3D printing technology with an EOS M290 printer. The implants were implanted into the femoral condyles of sheep, and the animals were euthanized 8 and 12 weeks after surgery. To determine the degree of bone ingrowth for different lattice-shaped implants, mechanical, histological, and image processing tests on ground samples and optical microscopic images were performed. In the mechanical test, the force required to compress the different lattice-shaped implants and the force required for a solid implant were compared, and significant differences were found in several instances. Statistically evaluating the results of our image processing algorithm, it was found that the digitally segmented areas clearly consisted of ingrown bone tissue; this finding is also supported by the results of classical histological processing. Our main goal was realized, so the bone ingrowth efficiencies of the six lattice shapes were ranked. It was found that the gyroid, double pyramid, and cube-shaped lattice implants had the highest degree of bone tissue growth per unit time. This ranking of the three lattice shapes remained the same at both 8 and 12 weeks after euthanasia. In accordance with the study, as a side project, a new image processing algorithm was developed that proved suitable for determining the degree of bone ingrowth in lattice implants from optical microscopic images. Along with the cube lattice shape, whose high bone ingrowth values have been previously reported in many studies, it was found that the gyroid and double pyramid lattice shapes produced similarly good results.

A cranioplastica egy olyan sebészi eljárás, amely során helyreállítják a koponyán keletkezett defektust. A modern orvostudományt a beteg specifikus eljárások térhódítása jellemzi, ennek egyik formája a 3D nyomtatók alkalmazása. Az általunk alkalmazott módszer során ezt a technológiát használjuk a geometriailag megfelelő pótlások elkészítéséhez. Kutatásunk alapgondolata, hogy az implantátumok beültetés után azonos mechanikai hatásoknak vannak kitéve, mint az ép koponya, így ezeknek az implantátumoknak nemcsak esztétikai és biokompatibilitási, hanem teherbírási szempontból is meg kell felelniük. Vizsgálatunk ennek mérését tűzte ki célul. 10 macerált calvarian dolgoztunk. Elméletünk alapja, hogy a koponyák szimmetrikusak. Ebből kifolyólag, ha az egyik oldalon készítünk egy defektust, és a másik oldal tükrözésével előállítunk egy pótlást, akkor a két oldalt külön-külön mechanikai hatásnak kitéve mérni tudjuk az ép és a pótolt koponya felek teherbíró képességét, ezek alapján pedig összehasonlíthatjuk az azonos koponyák ép és pótolt felének adatait. A vizsgálat során a nyomtatáshoz MED 610 fényre keményedő műgyantát, az öntőforma elkészítéséhez RTV 245 kétkomponensű szilikont használtunk, a végleges pótláshoz pedig polimetil-metakrilát (PMMA) alapú Cemfix 3 csontcementet. Első lépésként létrehoztuk a defektusokat, majd CT felvételt készítettünk, amik alapján erre a célra tervezett számítógépes szoftverrel (Mimics Innovation Suite) megalkottuk a koponyák 3D modelljét, majd megszerkesztettük a pótlást. A pótlások nyomtatása után a szilikon öntőformákat gyártottuk le, amelyekbe később csontcementet öntve elkészültek a végleges implantátumok. A mechanikai teherbírás vizsgálatokat egy Instron 8874 típusú biomechanikai anyagvizsgáló berendezéssel végeztük el. A tönkremenetelhez szükséges erők a koponyák különbözősége miatt elég nagy változatosságot mutattak mind a pótlással rendelkező, mind a pótlás nélküli modelleken. Pótlással átlagban 1585,6 N-t 57,5%- os szórással; pótlás nélkül 2785,7 N-t kaptunk 69,35%-os szórás mellett. Ezek alapján a pótolt és ép koponyák teherbírásának aránya 2,97-nek adódott. A vastagságot is figyelembe véve ez az érték 2,64-re módosult, a szórás csökkenése mellett. A törés gyakorlatilag minden esetben a pótláson következett be. A pótlással történt mérés során az átlagos teherbírás több mint 150 kg-nak, a legkisebb érték 38,58 kgnyi behatásnak felel meg, amely a mindennapi tevékenység során a koponyát érő terheléseknél kevesebb. Az eredmények alapján jelentős erőbehatás esetén a pótlások törése megakadályozza a koponya törését, amely jóval veszélyesebb sérüléssel járna.

A 3D nyomtatás az új digitális technológiákhoz tartozik, de ma már rengeteg felhasználási területe létezik. Felhasználási területei között a mozgásszervi sebészetben is fontos, hogy a módszer az egyedi igényeket is ki tudja szolgálni. A módszer ezen előnyét kihasználva munkánk során Lawrence Lenke által kidolgozott scoliosis klasszifikáció 3D nyomtatással való modellezését tűztük ki célul. A modellgyűjtemény létrehozása a Pécsi Tudományegyetemen üzemelő EOS röntgenberendezéssel (EOS Imaging, Párizs, Franciaország) készült 3D csigolya- és medencemodellek adatain alapult. A berendezés saját szoftverével (SterEOS programcsomag) exportált adatokat a 3-matic Medical (Materialise, Leuven, Belgium) segítségével feldolgozva az Inventor Professional (Autodesk, San Rafael, USA) rendszerrel történt a porckorongok szerkesztése, majd ismét a 3-matic képességeit kihasználva készült el a 3D nyomtatáshoz szükséges fájlformátum. A folyamat utolsó lépése a modellek nyomtatása és egy fali tartóban való összerendezése volt. A Lenke-féle scoliosis klasszifikáció kézzel fogható modellekből álló gyűjteménye mind a kezelőorvosok, mind az orvostanhallgatók, mind a betegek számára rendkívül hasznos és hiánypótló is egyben. Kiemelt jelentőségét látjuk a gerincferdülés, mint térbeli elváltozás megértése szempontjából. A jövőben további elváltozás klasszifikációk 3D nyomtatással előállított modellgyűjteményének a létrehozását is tervezzük, így pl. a Paprosky által, csípőprotézis revíziót igénylő vápa defektusos esetek klas - szifikációs rendszerének kivitelezését.

A csontszövet az emberi szervezet egyetlen olyan szövete, mely teljes regenerációra képes, a sérü- lések gyógyulását azonban számos tényező befolyásolhatja. A csontdefektusok pótlására már szá- mos mesterségesen előállított, nemfémes és fémes anyagot is kipróbáltak. A beültetésre használt fémekkel kapcsolatban hatalmas fejlődés tapasztalható, a titán és tantál kiemelkedő jelentőségűvé vált. Ezekkel az anyagokkal kapcsolatban számos kísérleti állaton próbáltak és próbálnak tapasztalatokat szerezni. A modellállatok kiválasztásánál a legkülönbözőbb szempontok jönnek szóba, a mozgásszervi sebészet is számos modellállatot használt az elmúlt évtizedekben. Az állatfajok széles spektruma a kutatások különböző mértékű előrehaladottságával csak részben magyarázható. Az állatkísérletek során különböző rácstípusú fémek viselkedését vizsgálták és vizsgálják abból a szempontból, hogy a csontszövet melyikbe tud eredményesebben belenőni különféle paraméterek tükrében. A különböző fémekből, fémötvözetekből készült implantátumok előállítási módjaként teret nyert a 3D nyomtatás, ennek gyors fejlődése és terjedése fogja lehetővé tenni, hogy custommade módon és megfizethető áron, kivárható időintervallumban álljanak rendelkezésünkre a szükséges pótlások, speciális implantátumok.

A koponyacsont veleszületett, vagy szerzett hiányainak pótlása az intracraniális tér különleges fizikai és élettani viszonyai miatt rendkívül fontos. Nem hanyagolható el a műtét esztétikai hatása sem. Az intézetünkben kidolgozott cranioplasztikai eljárás folyamán, a koponyáról készült vékony réteg CT felvételek 3D rekonstrukciója során az ép oldalt szoftveresen a sérült régióra tükrözzük, majd az átfedő pontokat kivonjuk egymásból. Így előállítható a defektus pótlására alkalmas alak-és méretpontos 3D modell. A sérült koponyarészletet kinyomtatva a pótlás pontos illeszkedése könnyen ellenőrizhető, probléma esetén a modell módosítható. A végleges modellről sterilizálható szilikon öntőmintát készítünk, melynek felhasználásával műtét közben a megfelelő pótlás poly(methyl methacrylate) (PMMA) alapú csontcementből steril körülmények között kiönthető és beültethető. 2013-tól 2020-ig a Szegedi Tudományegyetem Általános Orvostudományi Karának Idegsebészeti Tanszékével és a Magyar Honvédség Egészségügyi Központ Honvédkórház Idegsebészeti Osztályával együttműködve 51 esetben készítettünk ezzel a módszerrel cranioplasztika öntőformát. Műtéttechnikai probléma nem volt. 2 beteg esetében 3 pótlást érintően lépett fel szeptikus, a bemutatott implantátum-előállító eljárástól független szövődmény, emiatt a pótlások eltávolítására kényszerültünk. Véleményünk szerint a 3D nyomtatási technológiával előállított szilikon öntőformában, csontcementből készülő egyedi implantátumok igen jó eredménnyel alkalmazhatóak a koponya csontos hiányainak pótlására.

The American Society for Testing and Materials (ASTM), considered the gold standard worldwide, requires only testing in physiological saline solution to simulate in vivo conditions in standard testing of spinal implants.We conducted an in vitro study to identify an industrial lubricant with characteristics that are most similar to those of biologically lubricating fat, blood, and tissue fluids. The use of such a material could standardize the results of in vitro mechanical tests for better clinical applications.Our study has shown that the lubricity of physiological saline was well below that of human soft tissues and tissue fluids, and among the motor oils, Castrol GTX3 provided a testing environment similar to that of a living organism.With the intention of standardizing and preventing a biological hazard, we have developed a reproducible mechanical testing proposal based on our experiments, which, in addition, would allow us to avoid many misunderstandings and contingencies.

This study aims to present a new technique, the roof step cut (RSC), for acetabular augmentation of hip dysplasia.Between December 2008 and March 2020, we applied the RSC technique in a total of 48 hips of 41 patients (2 males, 39 females; mean age: 50.1±9.5 years; range, 30 to 75 years) with Hartofilakidis type A, B, C hip dysplasia. The RSC technique uses a L-shaped graft cut from the femoral head. The graft is partially inside the acetabulum and partially on the lateral aspect of the ilium. It is fixed with two screws at a 45° angle allowing simultaneous distalization and lateral covering of the cementless cup. Follow-up was done at six weeks, three months, and annually thereafter using standard pelvis anteroposterior X-ray and function scores. The 99mTc bone scintigraphy examination was also performed at around two weeks, six months, and 12 months postoperatively to evaluate the healing process of the graft.The mean follow-up time was 59.6±25.6 (range, 12 to 109) months. No significant center-edge angle changes and no contiguous radiolucent zones at the bone prosthesis interface were observed at the final follow-up. The single-photon emission tomography (SPECT) showed the activity of the bone graft gradually increased after surgery and became almost the same as the reference area after 12 months. Functional evaluation showed a significant improvement after the operation. No complication directly related to the technique was observed.In the short-term follow-up, the RSC technique is a reliable procedure for acetabular augmentation of hip dysplasia, providing enough coverage for the cementless cup and assuring proper stability.

This study aims to assess the effectiveness of psychosocial techniques to decrease postoperative pain and improve perioperative clinical care in orthopedic surgery. A systematic review and meta-analysis was performed to evaluate the effects of psychosocial methods among adults undergoing orthopedic surgeries. The systematic review included both randomized and nonrandomized trials, but only randomized controlled clinical trials (RCTs) were included in the meta-analysis. Key outcomes were postoperative pain, analgesic requirement, perioperative anxiety, quality of life, and recovery. After searching the databases from January 1980 to September 2016, a total of 62 RCTs were included with a pooled sample size of 4,908. Psychosocial interventions significantly reduced postoperative pain (Hedges’ g = 0.31 [95% confidence interval = 0.14, 0.48]), and preoperative and postoperative anxiety (g = 0.26 [0.11, 0.42] and g = 0.4 [0.21, 0.59], respectively). Furthermore, psychosocial interventions improved recovery (g = 0.38 [0.22, 0.54]). However, no significant effects were found for postoperative analgesic use (g = 0.16 [−0.01, 0.32]) and quality of life (g = 0.14 [−0.05, 0.33]). Patient education and relaxation techniques produced the most consistent positive effects, showing benefits on pain, anxiety, and recovery. Cognitive or behavioral techniques improved recovery. Furthermore, larger effects were found for studies that included acute surgeries compared to elective surgeries. The results indicate that psychosocial interventions, especially patient education and relaxation training, may reduce perioperative side effects and improve recovery in patients undergoing orthopedic procedures, but the quality of evidence is generally low. More well-powered, high-quality studies are needed to increase confidence. Perspective In this meta-analysis of RCTs in orthopedic surgeries, significant benefits in postoperative pain, perioperative anxiety, and recovery were found, suggesting that psychosocial interventions, especially patient education and relaxation techniques, are useful in improving clinical care.

This study examined whether positive suggestions applied without a hypnotic induction in the perioperative period reduces the need for red blood cell transfusions in patients who underwent total hip or knee arthroplasties with spinal anesthesia. No hypnotic assessment was performed. Ninety-five patients were randomly assigned to the suggestion group (n = 45) and to the control group (n = 50). Patients in the suggestion group received verbal suggestions before and audiotaped suggestions during the surgery for reducing blood loss, anxiety, postoperative pain, and fast recovery. Our study showed that using positive suggestions in the perioperative period significantly decreases the necessity for transfusion.

Aims Pain and anxiety are commonly reported among those undergoing orthopaedic surgery. Improvement in anxiety and pain control might be achieved by supplementing standard care with psychological interventions. However, the effectiveness of adjunctive psychosocial interventions in anxiety and pain control have not been addressed sufficiently by previous systematic reviews in orthopaedic surgeries. The present study aimed to assess the effectiveness of adjunctive psychosocial techniques to improve perioperative clinical care in orthopaedic surgery, to identify the most effective intervention types and to evaluate potential moderators. Methods We will perform a systematic review and meta-analysis to address the study aims. PubMed, PsycINFO, CINAHL and ProQuest Dissertations & Theses will be searched between 1980 and 2015. Prospective controlled clinical trials completed in adults, contrasting standard care and standard care supplemented with psychosocial methods, will be eligible for inclusion. Effectiveness will be assessed through the outcomes of postoperative pain intensity, analgesic requirement, perioperative anxiety, quality of life and postoperative recovery. The results of a random-effect meta-analysis will be reported. To aid implementation of best practice, moderating effects of the type and timing of psychosocial intervention, type of surgical intervention and type of anaesthesia will be evaluated through meta-regression. Sensitivity analyses and subgroup contrasts will follow as necessary. Discussion Recommendations will be made to improve medical care in orthopaedic procedures. The quality of evidence will be rated using GRADE criteria. Copyright © 2016 John Wiley & Sons, Ltd.

Hip and knee replacement surgery is very demanding for patients. Medication consumption is further increased by perioperative anxiety. Besides pain killer and anxiolytic medications, patients' recovery can be enhanced by applying therapeutic suggestions, which are easily applicable during the patient-physician communication.In our prospective, randomized, controlled study we examined the effects of positive suggestions on patients undergoing hip or knee arthroplasty in spinal anaesthesia. Members of the suggestion group received the therapeutic suggestions during a pre-surgery physician visit, and by listening to an audio recording during surgery.Compared to the control group (n = 50), in the suggestion group (n = 45) the need of medication (pain killer and adjuvant pain medication) during the surgery was lower (p = 0.037), the mean change from baseline in the well-being of the patients was better on the 2nd [1.31 (0.57; 2.04); p0.001] and 4th [0.97 (0.23; 1.7); p = 0.011] postoperative day and less transfusion had to be administered (OR: 2.37; p = 0.004). However, there was no difference between the two groups in the postoperative need of medications, in the length of hospitalisation and in the frequency of complications. Conslusion: Our results indicate that the administration of therapeutic suggestions in the perioperative period may be beneficial for orthopaedic surgery patients. Orv Hetil. 2018; 159(48): 2011-2020.Absztrakt: Bevezetés és célkitűzés: A csípő- és térdprotézisműtétek jelentős megterheléssel járnak a betegek számára. A műtétek körüli gyógyszeres fájdalomcsillapítás és szorongásoldás mellett a betegek gyógyulása az orvos–beteg kommunikáció során könnyen alkalmazható terápiás szuggesztiókkal is segíthető. Módszer: Prospektív, randomizált, kontrollált tanulmányunkban csípő- és térdprotézisműtéten spinalis anesztéziában átesett betegeken vizsgáltuk a pozitív szuggesztiók hatását. A szuggesztiós csoport tagjai műtét előtti beszélgetés során, valamint műtét alatt hangfelvételről kapták a szuggesztiókat. Eredmények: A kontrollcsoporthoz (n = 50) képest a szuggesztiós csoportban (n = 45) alacsonyabb volt a műtét alatti fájdalomcsillapítók és adjuváns szerek iránti összesített igény (p = 0,037), jobb volt a betegek közérzetének átlagos változása a műtét utáni 2. [1,31 (0,57; 2,04); p0,001], illetve 4. [0,97 (0,23; 1,7); p = 0,011] napon, és kevesebb transzfúzió adására (OR: 2,37; p = 0,004) volt szükség. Ugyanakkor nem mutatkozott különbség a műtét utáni gyógyszerek iránti igényben, a hospitalizáció időtartamában és a szövődmények gyakoriságában. Következtetés: Eredményeink igazolják, hogy a terápiás szuggesztiók alkalmazása a műtét körüli időszakban kedvezően befolyásolja a gyógyulási folyamatot. Orv Hetil. 2018; 159(48): 2011–2020.

Abstract: Introduction and aim: Hip and knee replacement surgery is very demanding for patients. Medication consumption is further increased by perioperative anxiety. Besides pain killer and anxiolytic medications, patients’ recovery can be enhanced by applying therapeutic suggestions, which are easily applicable during the patient–physician communication. Method: In our prospective, randomized, controlled study we examined the effects of positive suggestions on patients undergoing hip or knee arthroplasty in spinal anaesthesia. Members of the suggestion group received the therapeutic suggestions during a pre-surgery physician visit, and by listening to an audio recording during surgery. Results: Compared to the control group (n = 50), in the suggestion group (n = 45) the need of medication (pain killer and adjuvant pain medication) during the surgery was lower (p = 0.037), the mean change from baseline in the well-being of the patients was better on the 2nd [1.31 (0.57; 2.04); p

The beneficial effects of hippotherapy lie in the transmission of the horse's movements to the patient. The aim of our work was to create a measurement method for objective evaluation that can be used in natural settings without interfering with therapy. Methodology/Principal findings Our measurement system consists of three treble axis accelerometers connected to a data logger. Software was developed for data analysis and post processing. A commercial DVD recording camera was used to document the hippotherapy session. In this paper we present the results obtained in pilot measurements on ten children with cerebral palsy. For reference, a skilled rider was measured on the same horse using a passive following seat. Conclusions The acceleration diagrams show common characteristics useful to the interpretation of the movement transfer during hippotherapy as well as individual patterns indicating alterations in the movement reactions of different patients.

Bone replacement and the use of bone supplementary biological substances have become widespread in clinical practice. Although autografts have excellent properties, their limited availability, difficulties with shaping and donor site morbidity have made allografts a viable and increasingly preferred alternative. The main drawback of allografts is that the preparation destroys osteogenic cells and results in denaturation of osteoinductive proteins. Serum albumin is a well-known constituent of stem cell culture media and we found that lyophilizing albumin onto bone allografts markedly improves stem-cell attachment and bone healing in animal models thus replacing some of the osteoinductive potential. As a first step in the clinical introduction of albumin coated grafts, we aimed to test surgical handling and early incorporation in aseptic revision arthroplasty in humans. We selected patients who needed large structural allografts and the current operation was the last attempt at preserving a moving joint. In a series of 10 cases of hip and knee revision surgery we did not experience any drawbacks of the albumin-coated grafts during handling and implantation. Twelve months radiographic and SPECT-CT follow-up showed that the graft was well received by the host and active remodelling was observed. The lack of graft-related complications and the good 1-year results indicate that controlled trials may be initiated in more common bone grafting indications where long-term effectiveness can be evaluated.

We present the results - assessed after bony maturation - of an early anterior approach open reduction performed using our modified technique on 49 hips at 6-24 months of age. We start postoperative functional treatment using a Pavlik harness and an abduction splint, abandoning plaster cast. Secondary surgeries were performed in 11 hips (22.4%) at 3-7 years of age. Our results were 'satisfactory' (Severin Grade I, II) in 96% of the cases. According to the joints' Severin Grade, the total hip replacement probability at an early age is 8.16% in our series. Our principles and practice, introduced in 1980 in terms of secondary surgeries, are in total harmony with the recent literature.

The purpose of the study was to assess the stability provided by an ilio-iliac dorsal plate fixation technique using an AO narrow DCP on the pelvic brim in vertically and rotationally unstable type-C pelvic ring injuries.We examined 12 fresh cadaver pelvises in a single limb stance load. A type-C pelvic ring injury (a type I lateral sacral fracture in the classification of Denis with symphysis pubis rupture) was performed on the cadaver specimen and fixed with a four-hole narrow dynamic compression plate to stabilize the symphysis pubis rupture; the sacrum fracture was stabilized either anteriorly with two 3-hole reconstruction plates ("anterior plate osteosynthesis") or with a posterior fixation using a 12-hole narrow DCP. A cyclic load of between 100 and 250 N was applied to the fifth lumbar vertebra of the specimen. An extensometer was attached to both sides of the sacrum fracture to detect movements at the fracture site.We were able to achieve usable measurements in nine specimens. Three measurements were performed on each specimen, and the movements recorded at the fracture gap in trans-sacral plate fixation were higher than or similar to those observed for anterior plate synthesis in 23 out of 27 cases.Dorsal ilio-iliac bridge plate fixation provides somewhat reduced stability compared to anterior plate fixation, but the difference is not significant.

Our objective was to examine the load-bearing capacity of the transverse processes of human cadaveric thoracic vertebrae to vertical loads and axial rotation moments (i.e., moment applied in the transverse plane). A secondary objective was to examine the effect of the attached rib stumps. We wanted to demonstrate that the transverse process is durable enough to support the CAB hook—a complementary hook to the CD system—and can handle the vertical load or axial rotation moment during correction of scoliosis. We used 107 thoracic vertebrae removed from 10 cadavers. They were prepared in vertebral pairs, and were fixed into a material testing apparatus. Superoinferior vertical loads and axial rotation moments were applied to the transverse process using the CAB hooks at a rate of 30 mm/min and 8.5°/s respectively until it fractured. We recorded 142 measurements, 99 were for vertical load and 43 for axial rotation moment. The average ultimate vertical load was 338 (SD = 128) N and the average ultimate axial rotation moment was 14.4 (SD = 4.52) Nm. The ultimate axial rotation moment for specimens with rib stumps attached was significantly greater than for specimens without rib stumps 15.9 (SD = 4.1) Nm versus 12.5 (SD = 4.4) Nm. Our results showed that both the vertical and axial rotation loading capability of the transverse process are large enough to withstand significant correctional forces, without fracture, through the CAB hooks. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29:1904–1909, 2011

The inaccuracy of full extension measurements can lead to errors, especially in reconstructive surgery of the knee and in the rehabilitation period following total knee replacement. The goal of this study was to first determine whether plain lateral X-rays of the knee can be used to measure the axis of the bones of the lower limb. The second goal was to determine whether the angle from which the X-ray is taken influences the true angle of the knee. We analyzed 620 digital photographs of cadaver knees to measure the difference between the true axis of the femur and tibia compared with lines drawn on the anterior and posterior cortex of the femur and tibia. We also analyzed 150 photographs of cadaver lower limbs to determine how the true flexion angle compares to the angles measured if the picture was taken from different rotated positions (maximum of 30°). Our results concluded that lines drawn onto the distal anterior cortex of the femur and proximal posterior cortex of the tibia can determine the true flexion angle with 2° of accuracy. We also concluded that lateral X-rays of the knee taken within ±30° of the true lateral position only causes a maximum of a 2% discrepancy in the true flexion angle.

Additive manufacturing (AM) technologies are potential future-shaping solutions throughout many special applications in medicine. The mechanical behaviour of the related materials has not yet been fully explored. Here we compared five different industrial quality 3D printing materials produced using various AM processes that can be potentially used in limb-prosthetic development. We focused on the anisotropy of the mechanical and structural properties of these materials by using static and dynamic testing methods and electron microscopy imaging. Both static and dynamic experiments confirmed that amongst the three investigated directions (X, Y and Z), the Z orientation demonstrated, with the exception of polyamide test specimens, the lowest resistance against mechanical forces. Electron microscopy images revealed that greater mechanical stability appeared presumably due to the lengthier cooling time of the individual printed lines. Varying the printing resolution we showed how greater mechanical stability could be achieved, and concluded that special care should be taken when designing the AM processes intended for the fabrication of objects in support of medical applications. Often, the use of poor resolution in respect to quality of printing is desirable and can provide better solutions for actual purposes. These results provide important guidelines in the planning, manufacturing and implementation of higher developed, well-constructed assistive devices.

Coccygodynia can cause severe pain and disability in patients. There are contradictions in the literature regarding the final results of coccygectomy for coccygodynia. We evaluated the long-term effects of coccygectomy on the intensity, characteristics, and manifestation of pain caused by coccygodynia to determine the adequacy of operation among treatment modalities. Thirty-four patients with coccygodynia were treated by coccygectomy. In 22 cases, trauma, and in one case childbirth was the cause. 11 cases were regarded as idiopathic. The intensity, characteristics of pain, and the most painful activities were evaluated at an average of 7.6 (3–18) years of follow-up time. Before the operation, all 34 patients had pain while sitting, moreover, 26 of them had pain during standing, walking, at night or a combination of these. 21 patients had intolerable or very intensive, mainly acute, sharp or burning pain. 11 patients had dyschesia, 2 had dysuria and 6 had dyspareunia. At follow-up, 7 patients were completely free of pain, 15 others had moderate, 11 medium, and only one patient had severe, but none had intolerable pain. Only seven patients had acute, sharp or burning pain postoperatively. The decrease of average pain score from 8.0 to 3.2 was significant (P

High tibial osteotomy changes the patella and tibial condyle position, which makes the subsequent total knee replacement technically demanding. From 1 January 1993 to 31 December 2000, combined osteotomy [After the first osteotomy made 2 cm distally to the joint line, a bone wedge is removed based laterally. Its tip ends at the center of the tibial condyle (half bone wedge). The distal part of the tibia is placed into the valgus position and the half bone wedge is placed into the gap opened medially.] was performed on 103 knees and closing wedge osteotomy was performed on 47 consecutive knees. Eighty combined (group A) and 41 closing wedge (group B) osteotomy were studied. All knees were assessed radiologically before surgery, in the 10th postoperative week, in the 12th postoperative month and at the time of the final follow-up (in group A-66.15 months, in group B-66.61 months). We examined the change of the femorotibial angle, of the patellar height according to the method of Insall and Salvati, of the tibial slope angle according to the method of Bonnin, of the tibial condylar offset according to the method of Yoshida and of the distance between the lateral tibial plateau and the top of the fibular head. In group A and B, the recurrence of the varus deformity was not noted and valgus alignment did not increase in any case. In group-A, the Insall-Salvati ratio remained unchanged in 65% of knees. The tibial slope angle decreased in both groups. There was correlation between the change of the tibial condylar offset and the angle of the correction in both groups. There was correlation between the change of the distance between the lateral tibial plateau and the top of the fibular head. After combined osteotomy, the transposition of the tibial condyle and the decrease of the distance between the lateral tibial plateau and the top of the fibular head was less than after closing wedge osteotomy, although the average angle of correction was more after combined osteotomy (11.835 degrees ), than after closing wedge osteotomy (9.465 degrees ). Theoretically, the recurrence of the varus deformity, the increase of the valgus alignment and (in majority of cases) the shortening of the patellar tendon do not compromise the likelihood of successful conversion to the subsequent total knee replacement, either after combined or after closing wedge osteotomy. The combined osteotomy does not lead to considerable transposition of the tibial condyle and to considerable lateral tibial bone loss; therefore, theoretically, the combined osteotomy does not impair the subsequent total knee replacement.

We want to help to the technical preparation of the implantation of individual prosthesis by using the newest means of computer aided manufacturing. There are such cases when the factory-made implantations available are not suitable to replace the missing bone or joint. We have solved the replacement of an osteal skull defect with the Rapid Prototyping method in this paper. The advanced techniques has assured greater accuracy and simpler operative-technique in this case.

We studied changes of pain intensity and functional impairment in 22 patients with osteoarthrosis undergoing total hip replacement. Using a visual analogue scale, the mean scores for pain and disability before surgery were 71.7 and 70.9 respectively. Both scores showed gradual improvement during a 1-year follow-up period, with more than 90% of the total improvement occurring within the first 3 months. After 1 year, the scores for pain and disability were 11.9 and 4.1 respectively. The hip joint capsule was studied using immunohistochemistry to detect neurofilaments. Neurofilament immunoreactivity was observed in 16/22 cases and was correlated with pain and disability scores. However, there were no correlations between pre- and postoperative pain scores, the score changes, and the quantity of capsular neurofilaments. Thus, other factors than capsular neurofilaments influence the scores of pain and disability in osteoarthritis.

One of the causes of anterior knee pain may be symptomatic mediopatellar plica. The pain is usually attributed to the mechanical damage caused by the plica inside the joint, or, more precisely, to the synovitis induced as a result. Recent observations seem to suggest, however, that the pain is, in addition, likely to be engendered by an increased number of nerve-elements present in the substance of the plica. The present study used up-to-date histochemical methods to reveal in the symptomatic mediopatellar plicae nerve-elements that may be made responsible for the pain. Semi-quantitative methods were used to establish the number of nerve-elements in the tissue samples obtained from 21 symptomatic mediopatellar plicae (Group 'A'), exposing them to view with the aid of synaptophysin and neurofilament serum, coupled with routine light microscope as well as polarising microscope examinations following H&E and van Gieson staining. Tissue samples taken from the asymptomatic mediopatellar plica of 11 patients served as control (Group 'B'). A significantly larger number of nerve-elements were found in the substance of the plicae of Group 'A' 6.9 (S.D.+/-2.9) than in Group 'B' 3 (S.D.+/-1.2). Within Group 'A', more nerve-elements were revealed in trauma-related case histories than in those with no recollections of trauma (an average of 9.6 vs. 5.2, respectively). Similarly, the reduction of pain achieved by surgery was greater in the trauma-related group than in the non-traumatic one (3.0 vs. 1.8, respectively). Relying on our observations, we claim that the painfulness of the knee joint plicae is in all probability also attributable to the fact that their tissue substance contains an increased number of nerve-elements. A major trauma in a particular case history contributes, in all likelihood, to an increase in the number of nerve-elements, but further examinations are required to clarify the pathomechanism involved.

The High-Mobility Group Box 1 protein (HMGB1) is a known nuclear protein which may be released from the nucleus into the cytoplasm and the extracellular space. It is believed that the mobilized HMGB1 plays role in the autoimmune processes as an alarmin, stimulating the immune response. In addition, muscle regeneration and differentiation may also be altered in the inflammatory surroundings. Biopsy specimens derived from patients with idiopathic inflammatory myopathies (IIM) such as polymyositis or dermatomyositis were compared to muscle samples from patients undergoing surgical interventions for coxarthrosis. The biopsy and surgery specimens were used for Western blot analysis, for immunohistochemical detection of HMGB1 in histological preparations and for cell culturing to examine cell proliferation and differentiation. Our data show lower HMGB1 expression, impaired proliferation and slightly altered fusion capacity in the primary cell cultures started from IIM specimens than in cultures of coxarthrotic muscles. The ratio of regenerating muscle fibres with centralised nuclei (myotubes) is lower in the IIM samples than in the coxarthrotic ones but corticosteroid treatment shifts the ratio towards the coxarthrotic value. Our data suggest that the impaired regeneration capacity should also be considered to be behind the muscle weakness in IIM patients. The role of HMGB1 as a pathogenic signal requires further investigation.

Monolithic silica aerogels are nanostructured solids characterized with exceptionally high porosity and specific surface area. Although their strength can be improved by surface treatment with polymers, none of them has been tested yet as a filler in biocompatible polymer composites. The new aerogel–poly(methyl methacrylate) composites were prepared by free radical bulk polymerization of neat methyl methacrylate in the presence of natural and functionalized silica aerogels at 60°C, using cumene hydroperoxide initiator and 4,N,N-trimethyl-aniline redox pair. Synthetic conditions were set to be most similar to the setting of orthopedic bone cements. Structures, compositions, and molecular weight distributions were determined by scanning electron microscopy, combustion analysis, and gel permeation chromatography, respectively. Compressive strength, Shore D hardness and Gardner's impact strength were measured, and the fracture properties were compared to the matrices. All four aerogel fillers resulted in significant enhancement in compressive strength, reaching a maximum value of 123 MPa. Dissolution of H103PC-1 natural and H106PB-1 C16 modified aerogel containing specimens in simulated body fluid occurred in 20 days, leaving porous surfaces behind, which may give rise to higher tissue adhesion potential in bone cements. Heat treated silica aerogel in H112PA-1 showed no leaching out, and its composites might be usefull in high-load technical applications. POLYM. COMPOS., 36:348–358, 2015. © 2014 Society of Plastics Engineers

The effects of adenosine 5'-triphosphate (ATP) on human and mouse skeletal muscle fibres in primary culture were investigated. ATP-evoked changes in intracellular calcium concentration ([Ca(2+)](i)) were measured and compared with those induced by agonists of the nicotinic acetylcholine (Ach)- and P2X purinoreceptors. While ATP was effective on both myoblasts and multi-nucleated myotubes in the micromolar range, Ach failed to induce any change in [Ca(2+)](i) at early stages of development. In contrast, myofibres with peripheral nuclei showed little response to ATP but responded to Ach with a large change in [Ca(2+)](i). The responsiveness of the myotubes to Ach paralleled that to potassium. The removal of external calcium abolished the response to ATP. P2X receptor agonists mimicked the response to ATP with the order of potency being ATP2',3'- O-(4-benzoyl)-benzoyl-ATPbeta,gamma-methylene-ATPalpha,beta-methylene-ATP. Under voltage-clamp conditions ATP induced an inward current that showed little inactivation. These results are consistent with the existence of P2X receptor-mediated signal transduction pathway in cultured mammalian skeletal muscle cells.

The results of the surgical correction of scoliosis through posterior approach have significantly improved by the introduction of new implants during the past decades. Even with these improvements the available implants only allow limited correction especially regarding axial rotation, and also their application is rather complicated. We developed a new implant which simultaneously grasps and exerts forces on both transverse processes of the vertebrae, to achieve a more efficient and safer correction with a simple surgical technique. In our paper we report on the concept of the new implant, its most important features, its mechanical tests, cadaver experimentations, and biomechanical assessments.

The authors present the results of surgical treatment of plantar fasciitis done at the University of Debrecen, Department of Orthopaedics, between 1996 and 2004 on 52 feet of 42 patients. The surgical indication was heel pain unresponsive to at least 6 months of conservative treatment with the exclusion of all differential diagnosis. During surgery, the partial detachment of the plantar aponeurosis origin was performed. The American Orthopaedic Foot and Ankle Society score was used for assessment. The average preoperative score of 43 increased to 85 postoperatively. Postoperatively 69% of the patients had excellent (86–100), 12% good (71–85), 4% average (61–70) and 15% had bad (fewer than 60) results. The patients 66% was very satisfied, 11% was satisfied, 12% was slightly satisfied, and 11% was unsatisfied with the surgical result. Based on our retrospective study, we recommend the surgical treatment of plantar fasciitis unresponsive to conservative treatment.

The incorporation of bulk bone grafts in the replacement of dysplastic acetabulum is determined by the biological environment of the recipient site, the size of the contact surface, and the stability of the osteosynthesis used. Based on these, the present study compares the Harris acetabular plasty used routinely by us with the Radojević L-shaped graft technique.For our measurements, we used 20 hemi-pelvises removed from 10 cadavers. In 10 cases, acetabular plasty according to Harris, in 10 cases Radojević L-plasty, was performed. The biological environment was analyzed; with geometric calculations, the contact surface was determined, and with a material testing apparatus, the primary stability of the osetosynthesis was measured. For the measurements, a new method was developed.The Radojević technique provides a better biological environment for graft ingrowth. The contact surface is nearly twice as much as in Harris plasty. No significant difference was found in the primary stability of the osteosynthesis used. The deviation on the value of the stability measurements is explained by the differences in the bone quality of the cadavers used.Based on the 3 aspects examined, the Radojević L-shaped graft technique has similar stability when compared to the Harris acetabular plasty, but provides better biological circumstances and larger graft host bone contact. Based on this, we started using the L-shaped technique in our department.

The replacement of the dysplastic hip, despite the numerous available surgical techniques, is not entirely solved. One of the reasons for this is the relative lack of bone in the acetabulum. In this study, we present a new concept (intraosseous structural graft technique), with the aim to improve the primary stability and biological environment of the graft. During the procedure in the cranial quadrant of the acetabulum, a proximally hinged cortico-spongious plate is fashioned that is opened laterally and a wedge-shaped graft made from the femoral head is impacted. The precisely fitted graft has good primary rotational and cranial stability which is further improved by a bicortical screw. The hypothesis is supported by examination on 3D models. Cadaver experimentations were performed on 19 hips of 10 cadavers, and stability testing was done on a further 20 hips of 10 cadavers with a material testing apparatus. Also the analysis of the biological and mechanical properties of the graft and the implant were examined. Based on our results, it can be concluded that our technique provides good primary stability with a more favorable biological condition for bony incorporation compared to other bulk bone graft techniques.