BACKGROUND:Total knee arthroplasty (TKA) aims to restore motion and alleviate pain, enabling patients to return to daily activities. Despite advances in implants, surgery, and perioperative care, patient dissatisfaction rates remain significant. AIM:To determine whether ankle symptoms are associated with inferior results of functional recovery of the knee following TKA. METHODS:This prospective study included all patients with advanced knee osteoarthritis who underwent a primary unilateral TKA between August 2019 and December 2019 with data documented by the treating surgeon and outpatient physical therapists. Patients were categorized based on ankle symptoms using the American Orthopaedic Foot and Ankle Society (AOFAS) score: (1) Group 1 (AOFAS ≤ 85, n = 30); and (2) Group 2 (AOFAS > 85, n = 49). Active range of motion (ROM), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the visual analogue scale (VAS) were compared between two groups. RESULTS:Postoperative KOOS, ROM, and VAS significantly improved in both groups (P < 0.001). However, at three months, KOOS (P = 0.02) and extension motion (P = 0.01) improvements were significantly greater in group 2. CONCLUSION:These findings suggest that preoperative ankle symptoms may negatively impact early knee functional recovery, particularly in KOOS scores and extension motion.

Background: The aim of this study was to investigate differences in functional recovery eight years after total hip arthroplasty in patients who underwent hip joint surgery using two different approaches: the classic lateral approach and the anterolateral minimally invasive surgical approach. Methods: Eight years after the hip replacement, 68 subjects, 32 in the classic and 36 in the minimally invasive group, underwent follow-up measurements involving the Harris Hip Score (HHS), range of motion, strength of the abductor muscles, 50-m walk time, body mass index (BMI), physical activity questionnaire, and visual analogue scale (VAS) pain during general activities. Results: Higher HHS (p < 0.001), hip abduction (p < 0.001), and hip flexion (p = 0.018) range of motion values were obtained in the minimally invasive approach group. A correlation between physical activity (PA) and the hip abduction muscle strength in the classic group (r = 0.43; p = 0.011) and a correlation between PA and the HHS in the minimally invasive group (r = 0.34, p = 0.041) was found. BMI was correlated with the 50-m walk time in both groups (classical: r = 0.39; p = 0.027; minimally invasive r = 0.35; p = 0.030); meanwhile, in the minimally invasive group, BMI was negatively correlated with hip flexion (r = −0.37; p = 0.020). Conclusions: Eight years after total hip arthroplasty, performed using either an anterolateral minimally invasive or lateral approach, there was no difference in the patients’ functional outcome in relation to BMI. The minimally invasive approach benefits patients by granting them better functional abilities. A clinical difference was found in the HHS, in favour of the minimally invasive group.

Osteoartritis (OA) je multifaktorijalna i poligenska bolest koja zahvaća cijeli zglob, ali i periartikularno tkivo te predstavlja golem ekonomski trošak za javno zdravstvo u cijelom svijetu. Poznati su brojni geni za koje se smatra da sudjeluju u patogenezi OA, a u novije vrijeme sve se više istražuju epigenetski mehanizmi kao potencijalni rizični čimbenici zaslužni za nastanak OA. MikroRNK (miRNK) su male nekodirajuće molekule koje imaju ulogu u postranskripcijskoj regulaciji genskog izražaja. Njihovi geni čine 1 – 2 % ukupnog genoma i smatra se da bi potencijalno mogli regulirati i do 30 % kodirajućih gena. MiRNK molekule imaju bitnu ulogu u patogenezi nekih karcinoma, kardiovaskularnih, autoimunih kožnih te nekih neuroloških bolesti. Također, navedene molekule imaju važnu ulogu u patogenezi osteoartritisa. Velik broj miRNK molekula drugačije je izražen u hrskavici zahvaćenoj osteoartritisom u odnosu na zdravu hrskavicu. Dokazano je da određene miRNK molekule reguliraju neke enzime zaslužne za razgradnju hrskavice, dok se neke povezuju s regulacijom apoptoze hondrocita, a neke s procesom regeneracije hrskavice. U svjetlu tih spoznaja napravljene su i prve studije koje nastoje dokazati povezanost određenih jednonukleotidnih polimorfizama nekih miRNK gena s predispozicijom za nastanak osteoartritisa. Budući da su svi današnji oblici terapije bolesnika s osteoartritisom usmjereni na liječenje posljedice bolesti, a ne uzroka, potrebna su daljnja istraživanja etiopatogeneze osteoartritisa. MiRNK molekule mogle bi igrati važnu ulogu u patogenezi OA te predstavljati jednu od potencijalnih meta za nove farmakoterapijske oblike liječenja.

Poliklinika Rakovac Porec Faculty of Medicine, University of Pula, Croatia, Faculty of Medicine, University of Rijeka, Croatia Department of Pediatric Orthopaedics, Children’s Hospital Zagreb, Croatia University Hospital of Orthopaedic Surgery, Lovran, Croatia Nemec Special Hospital, Rijeka, Croatia Department of Traumatology and Orthopaedics, Dubrava University Hospital, Zagreb, Croatia University of Applied Sciences, Zagreb, Croatia Josip Juraj Strossmayer University of Osijek, School of Medicine, Osijek, Croatia University of Zagreb, School of Medicine, Zagreb, Croatia

Background: The muscle sparing total hip arthroplasty had generated a distinguishable interest, in both the patients and the surgeons, but its benefits are still often questioned. The main idea of this study was to compare the functional clinical outcome of the patients operated by the anterolateral approach with a muscle-sparing technique (modified Watson-Jones approach), and the patients operated by modified direct lateral approach without the muscle-sparing technique (Bauer/Hardinge approach).Methods: The patients (N = 130) were divided into two groups: 68 in a standard method group (STAND) and 62 patients in a muscle sparing surgery group (MSS). The hip flexibility, mobility, the strength of the hip abduction, the pain scale, Harris hip scores, the duration of the hospital stay and the overall satisfaction were measured seven days, three months, one year and three years (in 80 patients) after the surgery. There were no differences in any of the parameters between the groups prior to the procedure.Results: The statistically significant differences in first three follow-ups (up to one year) were determined between the groups in passive and active hip flexion ability but the hip abduction strength, which is a crucial parameter for functional recovery, and 50 m walk test remained better in MSS group even after three years. Patients, who underwent MSS suffered also less pain, stayed in hospital shorter and were more satisfied with the operation outcome.Conclusions: The functional recovery in patients treated with muscle sparing method was faster than in patients operated with conventional lateral approach. Based on the results, we could recommend anterolateral muscle sparing approach for a total hip replacement for its faster and fuller functional recovery. (C) 2015 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Arthroscopic shoulder stabilization is a widely accepted method. Very often, an arthroscopic treatment is preferred by patients and surgeons because it is minimally invasive, spares the subscapularis muscle, and because it enables better identification and treatment of associated pathological conditions, and decreases morbidity. Furthermore, recent studies have demonstrated that the results of arthroscopic treatment of recurrent traumatic anterior instability are comparable with those achieved historically with open procedures1-3. However, arthroscopy is not always effective and there are cases which require open surgical techniques. There is a variety of reports regarding recurrence rates after arthroscopic Bankart repair, depending on arthroscopic skill, but also on the severity of the instability4. Therefore, the patient selection plays an important role on the success rate. After the first traumatic dislocation, a closed reduction has to be done, and the shoulder is put in the sling for two weeks. This rule is indicated for the general population, but if we treat top athletes, sometimes an immediate arthroscopy is indicated. After the period of rehabilitation, some shoulders will remain unstable, and the dislocation can occur during swimming, jumping or even during sleeping. The redislocation rate in the general population is around 50 %5. In younger patients or those with hyperlaxity, the percentage is higher, even up to 80 % or 92 %6-9. In Germany, in 73 % of hospitals surgery will be indicated for active younger patients under 3010,11. In case of recurrent instability, surgical therapy must be considered. For young patients with 2-6 redislocations after traumatic dislocation, arthroscopic treatment is indicated. The lesion of the anterior labrum is called the Bankart lesion and has several forms. There are several arthroscopic techniques, which include placement of titanium or resorbable implants into the anterior glenoid rim, and labrum repair is performed (Figure 1). In decision making regarding the selection of the surgical technique, we try to perform an anatomical repair, either open or arthroscopic. Therefore, the glenoid labrum repair together with capsular shift is generally accepted as the “gold standard”. In patient selection, the first step is a careful clinical *Corresponding author: Radovan Mihelic, MD, PhD Clinic for Orthopaedic Surgery Lovran, Faculty of Medicine University of Rijeka Setaliste Marsala Tita 1, 51 415 Lovran, Croatia e-mail: radovan.mihelic@gmail.com Clinic for Orthopaedic Surgery Lovran, Faculty of Medicine University of Rijeka, Rijeka, Croatia

Zadnjih 60-ak godina primarna zamjena zgloba kuka predstavlja jednu od najucinkovitijih i najizvođenijih operacija u ortopediji. Tijekom godina nave

medicina fluminensis 2015, Vol. 51, No. 1, p. 41-51 41 Abstract. In the past 60 years, primary THA has been one of the most successful and most performed orthopaedic procedure. Over the years, hip arthroplasty has changed, and research continues to improve its results. Better materials and design provide patients with an increased range of motion with enhanced stability and very low wear. In recent years, there have been a number of reports describing the performance of THA through smaller incisions using minimally invasive surgical techniques, aimed to spare the soft tissue, especially the abductor musculature. These techniques allow less post-operative pain, reduced blood loss, shorter hospitalization, better functional recovery and faster return to everyday routine. However, tissue sparing techniques can result in numerous complications related to the learning curve. Today four minimally invasive approaches have been described and many of their modifications. All of them are technically demanding, and may require specialized instruments and equipments. This article describes in detail the surgical technique of a minimally invasive anterolateral hip approach with patients in the supine position, including the preoperative setting, with pearls and tips based on the authors’ experience.

Purpose The aim of the present study was to examine the acute effects of graded physiological strain on soccer kicking performance.Methods Twenty-eight semi-professional soccer players completed both experimental and control procedure. The experimental protocol incorporated repeated shooting trials combined with a progressive discontinuous maximal shuttle-run intervention. The initial running velocity was 8 km/h and increasing for 1 km/h every 3 min until exhaustion. The control protocol comprised only eight subsequent shooting trials. The soccer-specific kicking accuracy (KA; average distance from the ball-entry point to the goal center), kicking velocity (KV), and kicking quality (KQ; kicking accuracy divided by the time elapsed from hitting the ball to the point of entry) were evaluated via reproducible and valid test over five individually determined exercise intensity zones.Results Compared with baseline or exercise at intensities below the second lactate threshold (LT2), physiological exertion above the LT2 (blood lactate >4 mmol/L) resulted in meaningful decrease in KA (11-13 %; p < 0.05), KV (3-4 %; p < 0.05), and overall KQ (13-15 %; p < 0.01). The light and moderate-intensity exercise below the LT2 had no significant effect on soccer kicking performance.Conclusions The results suggest that high-intensity physiological exertion above the player's LT2 impairs soccer kicking performance. In contrast, light to moderate physiological stress appears to be neither harmful nor beneficial for kicking performance.

The results of the anterolateral minimally invasive total hip arthroplasty in comparison to the classical lateral approach in the early functional recovery

The aim of the study was to evaluate the influence of the physiological load on postural control. Special attention was directed toward the identifying the intensity level in which the major deterioration in balance abilities occurs. Thirty subjects randomly divided into two groups performed multistage all-out exertion protocol on cycle-ergometer with measurements of ventilatory-metabolic and subjective parameters of exertion. Each stage lasted three minutes and was followed with three minute breaks during which the subjects underwent the static (keeping the cursor in the center of the screen) and the dynamic balance testing (following the cursor clockwise or counter clock wise by body movements) on balance platform. In a control group, the protocol encompassed only balance testing procedures followed by 3 min rest. After the completion of the testing procedures, the five intensity zones were determined according to the ventilatory-metabolic parameters. The significant differences in both static and dynamic balance tests were found between the test stages in exercising group. The post hoc analyses revealed the significant negative effect of exercise on the static balance with three visible "balance thresholds". The first threshold was at the rest to work transition, the second at the anaerobic threshold and the third at the maximal exertion level. The dynamic balance was also negatively affected with exercise, however no "balance thresholds" were clearly identified. No significant changes in neither static nor dynamic balance abilities were observed in the control group so the changes in the experimental group could have been attributed to the exercise intensity.

Total knee arthroplasty is more than fifty years used for treatment of terminally arthrotic knee joint. Medial parapatellar approach is golden standard when considering implantation of total knee prosthesis. There are many advantages of medial parapatellar approach, however its main disadvantage is disruption of vastus medialis insertion on patella. Several approaches have been developed with a goal of good operative field overview but without collateral muscle damage. This article presents minimally invasive approaches to the knee used for implantation of total knee prosthesis with special emphasis on subvastus approach. Of all this approaches, only subvastus approach preserves musculature in total. Herein, we point out that what makes approach minimally invasive is degree of muscle preservation rather than skin incision size. Subvastus approach to the knee is here explained in detail.

Aim: To compare clinical results of two groups of patients which recieved treatment with total knee arthroplasty (TKA) for osteoarthritis. Influence of minimally invasive subvastus and standard, medial parapatellar approach to the knee on treatment outcome was invastigated. Methods: During 2012. prospective, randomized study was conducted on 60 patients which had had indication for TKA. Patients were randomized in experimental group of 30 patients which recieved subvastus approach for TKA (SV group) and control group of 30 patients where standard, medial parapatellar approach was used for the same surgery (STD group). We invastigated duration of surgery, perioperative blood loss, Knee Society Score, Up and Go test, VAS scale for pain and implant alignment. Incidence of postoperative complications was compared, aswell. Results were evaluated day before surgery and afterwards 12. day and 12 weeks post surgery. Results: Patients in SV group earlier achieved full active knee extension, better knee flexion compared 12 days and 12 weeks after surgery. Results of Knee Society Score an Up and Go test were better for SV group, aswell. Less lateral releases of patella was observed in SV group. There was no statistically significant difference between groups when postoperative pain, duration of surgery, blood loss, postoperative complication rate and implant alignment were compared (level of significance has been set at 5 %). Conclusion: Subvastus approach for total knee arthroplasty is good alternative to standard, medial parapatellar approach in early postoperative period.