Aim: To evaluate the efficacy of a application of analgesic discography in the diagnosis of lumbar DPS and to analyze the correlation of the procedure results with clinical and structural (MRI) predictors. Materials and Methods. A retrospective multicenter study was conducted involving 103 patients with intractable CLBP (duration 3 months, NRS score 4) caused by isolated single-level intervertebral disc lesion (Pfirrmann II-IV). AD was performed with the administration of 1.0–1.5 ml of local anesthetic without creating excessive pressure. A positive result was defined as a more than 50% reduction in NRS pain score. The association of AD outcomes with the presence of Modic endplate changes, High-Intensity Zones (HIZ) on MRI, Pfirrmann degeneration grade, and the clinical pattern of pain was evaluated. Results. A positive AD result was recorded in 31.1% (32/103) of patients; the median pain intensity in this group decreased from 7 to 2 points on the NRS (p 0,001). Atypical prolonged analgesia, interpreted as a false-positive effect, was noted in 4 patients (3.9%). A strong statistically significant association was found between positive discography and Modic 1 changes (OR = 14.60; 95% CI: 3.74–56.80), as well as a moderate association with HIZ (OR = 3.93; 95% CI: 1.60–9.68). Modic 2 changes (fatty degeneration) showed no significant association with discography outcome (OR = 0.87; p = 0.82). The association with the clinical pain pattern, as well as with the degree of structural disc degeneration (Pfirrmann) and the topical level of the lesion, was not statistically significant (p 0.05). Conclusion. Analgesic discography is an effective and safe method for verifying DPS. A strong correlation was found between a positive response to intradiscal anesthetic and MRI predictors (Modic 1, HIZ), which substantiates the chemical sensitization of nociceptors as the leading mechanism of the pain syndrome. Structural disc degeneration (loss of height) is not a reliable predictor of discogenic pain. Keywords: chronic low back pain, discogenic pain, analgesic discography, provocative discography, Modic changes, HIZ, minimally invasive spine surgery.
Introduction. Patellar chondromalacia is a leading cause of chronic anterior knee pain in young and working-age individuals. Conventional conservative therapy provides primarily symptomatic relief without proven structure-modifying effects. Comparative data on PRP and SVF for this condition remain scarce. Objective. To compare clinical and morphological outcomes of PRP, standard SVF, and modified SVF in patients with patellar chondromalacia. Materials and methods. A non-randomized retrospective cohort study included 63 patients with grade I–III patellar chondromalacia (Outerbridge, 2021–2024). Group I (n=22) received three PRP injections; Group II (n=20) received a single standard SVF+PRP injection; Group III (n=21) received SVF prepared by a modified protocol (lipoaspirate washing, emulsification through a 0.6 mm mesh, double centrifugation with ACD-A). Follow-up was 12 months; outcomes were assessed by VAS, KOOS-PS, PSS, PGIC, and MRI morphometry of the chondral defect. Results. PRP reduced pain in the early period with a tendency toward partial regression by month 12 and minimal structural changes (defect area −7.5%, volume −15.1%). In both SVF groups, clinical improvement was progressive without regression (VAS median at 12 months — 1.0); defect area decreased by 27.4% and 40.2%, volume by 44.6% and 53.8% for standard and modified SVF, respectively. Mean cartilage thickness gain was 0.37 mm in the standard SVF group and 0.48 mm in the modified SVF group, compared to 0.09 mm in the PRP group (p0.001). Modified SVF produced earlier clinical response at 1 month with comparable long-term morphological outcomes. Conclusion. SVF therapy demonstrated significantly greater and more durable structure-modifying effects than PRP. PRP is appropriate for symptomatic management in early-stage disease; SVF is indicated when structural correction of the chondral defect is required.
Background: Highly Crosslinked Polyethylene was introduced to decrease plastic wear and subsequent osteolysis. However, this was at the expense of the mechanical properties of the polyethylene slightly reducing its overall physical strength. Fracture of the polyethylene tibial post is a rare but catastrophic complication in posterior-stabilized (PS) total knee arthroplasty (TKA). Aim of the study: We report 4 cases of fractured tibial post in a posterior stabilized total knee with highly Crosslinked Polyethylene. Clinical presentations, intraoperative findings, and failure mechanisms are evaluated, alongside a systematic literature review. Methods: Between May 2019 and September 2024, four cases with fractured tibial posts were presented and managed at our institution. Clinical records, pre- and postoperative radiographs, failure timeframes, and surgical intervention were retrospectively reviewed. Results: Patients predominantly presented with unexplained acute onset of instability and effusion in a previously well-functioning total knee arthroplasty. Mean time from the primary knee replacement procedure to the onset of symptoms was 11.25 years (range 9–14). Revision surgery was successfully performed in all four cases ranging from isolated liner exchange to full components revision with a constrained non hinged prosthesis. Conclusions: Tibial post fracture should be strongly suspected in patients with late instability following PS TKA. Surgeons should be aware of this rare complication. The regular use of highly crosslinked polyethylene in Posterior stabilized total knee arthroplasty is not advisable, with a better shift to stronger and newer types of plastic. Keywords: Posterior stabilized total knee arthroplasty; Highly cross linked polyethylene; Tibial post fracture; Revision knee surgery
Introduction. The radial head is one of the main stabilizing structures of the elbow joint, and radial head arthroplasty is becoming one of the necessary measures for elbow stabilization in cases when osteosynthesis of the radial head is not feasible or is expected to lead to an unsatisfactory outcome. Objective – based on the literature, to determine the significance, unresolved issues, and prospects of using a radial head prosthesis in the treatment of its fractures in adult patients. Material. Electronic resources PubMed, eLIBRARY, and CyberLeninka were used to search for literature data. The analysis included studies on the treatment of radial head fractures in patients over 18 years of age, regardless of sex. When reviewing the literature, special attention was paid to publications on radial head arthroplasty, types of implants, and long-term outcomes of surgical treatment. Results. In the analysis of studies devoted to radial head arthroplasty for its fractures, most reports showed no statistically significant differences between monopolar and bipolar implants. However, less favorable clinical and radiographic outcomes were observed in patients with short-stem implants. Implants with a loose-fit fixation in the radial canal have shown promising results. Conclusion. Radial head arthroplasty is a justified treatment of choice for unreconstructable fractures. The key role is played by the design features of the implant (stem length and type), rather than its polarity.
For many years, two-stage revision arthroplasty has been considered the gold standard for the treatment of chronic periprosthetic joint infection (PJI) of the knee. Recently, increasing attention has been paid to “1.5-stage” revision arthroplasty using spacer-prostheses, which provide infection eradication, restoration of knee function and limb weight-bearing ability, and may eliminate the need for a second-stage procedure. Purpose. To evaluate the effectiveness of a newly developed antibacterial articulating knee spacer in the treatment of chronic PJI. Materials and Methods. A single-center prospective open-label randomized controlled study included two patient groups. In the control group (n = 26), an articulating spacer with a “metal-on-cement” articulation was implanted, while the study group (n = 28) received the proposed spacer design. Outcomes were assessed using laboratory inflammatory markers (white blood cell count, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], and fibrinogen), KOOS, Lysholm Knee Score, and FJS-12 questionnaires, as well as the number of repeat surgical interventions at 1, 3, 6, and 12 months after surgery. Results. At 12 months, statistically significant differences were observed between the control and study groups. ESR values were 10.50 (9.00;15.75) and 5.00 (5.00;7.00), respectively (p 0.001); CRP values were 16.35 (11.30;24.48) and 7.70 (5.43;11.98), respectively (p 0.010). KOOS scores were 79.0 (69;102) and 67.0 (59.0;74.0), respectively; Lysholm Knee Score values were 79 (71;81) and 87.00 (82.25;88.75), respectively; FJS-12 scores were 17.0 (14.0;19.0) and 7.00 (6.00;8.00), respectively (p 0.023). Repeat surgical interventions were required in 19 (73.1%) control patients and 4 (14.3%) study patients (p 0.001). Conclusion. The proposed articulating spacer effectively controls infection, improves joint and limb function, and provides a high level of patient adaptation to the implant in the late postoperative period.
