Browsing by Author "Baščarević, Zoran (6506868841)"

Background/Aim. Although the number of new primary implantation of hip and knee prostheses every year increases, the rate of failed arthroplasty is nearly the same. The main question is whether it is an aseptic instability or instability caused by infection. The aim of this preliminary study was an attempt with combined 99mTc-ciprofloxacin and 99mTc-methylene diphosphonate (MDP) bone scintigraphy to improve diagnostic accuracy in the differentiation of hip and knee prosthesis aseptic loosening and periprosthetic joint infection. Methods. Inclusion criteria of patients for this study were based on suspected periprosthetic joint infection: painful prosthetic joint, restricted joint movements and increased value of erythrocyte sedimentation rate or levels of C-reactive protein. We examined 20 patients with implanted 14 hip and 6 knee prosthesis. All patients also underwent plain radiography of suspected joint. In all patients, three-phase 99mTc-MDP bone scintigraphy was performed. Three to five days after the bone scan, we performed scintigraphy using 99mTc-ciprofloxacin with the calculation of accumulation index. Periprosthetic joint infection was confirmed on the basis of microbiological findings. Results. Periprosthetic joint infection was confirmed in fourteen of twenty observed joints, in five of them the aseptic loosening was present and in one patient’s symptoms were not related to the prosthesis (poor biomechanics of prosthetic joints caused by weaknesses of muscle). Estimated sensitivity/specificity for 99mTc-MDP bone scintigraphy alone were 100/17%; for 99mTc-ciprofloxacin scintigraphy were 85,7/100%. Sensitivity and specificity were 92,3% and 83,3%, respectively for results obtained with combined assessment by both methods. Our study confirmed the high negative predictive value of 99mTc-MDP bone scan. The negative result of bone scan virtually excludes the possibility of periprosthetic infection. On the other hand, positive findings of 99mTc-MDP scintigraphy cannot with certainty confirm the infection. Conclusion. Combined 99mTc-MDP scintigraphy with 99mTc-ciprofloxacin scintigraphy significantly increases the ability of differentiation of aseptic loosening from periprosthetic joint infection. © 2017, Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All rights reserved.

Background/Aim. Total hip arthroplasty is the replacement of the hip joint with an artificial one. Standard surgical procedures involve a long skin incision and extensive dissection of healthy tissue. Mini-incision surgery is a modification of standard operative approaches. In addition to a significantly smaller skin incision, the main difference is based on much less damage to soft tissues, especially the muscles that move the hip. The aim of this study was to compare the early results of the mini-incision and a standard approach in total hip arthroplasty and to determine the advantages and disadvantages of the mini-incision surgical technique. Methods. A retrospective study analyzed data based on 63 patients who underwent total hip arthroplasty with a mini-incision and standard approach at the Institute of Orthopaedic Surgery “Banjica”, Belgrade from 2004 to 2010. All the patients suffered from primary coxarthrosis. All operations were carried out by the same surgical team. All patients were clinically evaluated before and after the surgery using the Harris Hip Score (HHS). Results. The group of patients operated on with the mini-incision approach included 32 patients, while 31 patients made up the group of patients operated on with the standard approach. Comparing these groups did not reveal a statistically significant difference in age, body mass index, surgery duration, and HHS before the surgery. A statistically significant difference was determined by comparing intraoperative blood loss, the amount of drainage fluid after the surgery, and the HHS after the surgery. Conclusion. The mini-incision posterolateral approach, compared to the standard approach, apart from an esthetically more acceptable scar, achieves significantly less intraoperative blood loss and better hip function with almost the same risk of complications. © 2022 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Background: Osteoarthritis (OA) is a chronic degenerative joint disease and is considered to be the fourth leading cause of disability and the second cause of inability to work in men. Recently, adipose-derived mesenchymal stem cells (AD-MSCs) came into focus for regenerative medicine as a promising tool for the treatment of OA. The administration of stem cells into impaired joints results in pain relief and improves quality of life, accompanied by restoration of hyaline articular cartilage. Methods: In the present study, nine patients (including two patients with bilateral symptoms) diagnosed with osteoarthritis (International Knee Documentation grade B in 5 and grade D in six knees) were treated using a single injection of AD-MSCs at a concentration of 0.5–1.0 × 107 cells and were followed up for 18 months. During follow-up, all the cases were evaluated clinically by Knee Society score (KSS), Hospital for Special Surgery knee score (HSS-KS), Tegner–Lysholm (T–L) score and visual analogue scale (VAS) of pain, as well as by plain radiography and by magnetic resonance imaging visualization with 2D Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score assessment. Results: Significant improvement of all four clinical scores was observed within the first 6 months (KSS for 41.4 points, HSS-KS for 33.9 points, T–L score for 44.8 points, VAS of pain from 54.5 to 9.3) and improvement persisted throughout the rest of the follow-up. MOCART score showed significant cartilage restoration (from 43 ± 7.2 to 63 ± 17.1), whereas radiography showed neither improvement, nor further joint degeneration. Conclusions: The results obtained in the present study provide good basis for prospective randomized controlled clinical trials with respect to the use of AD-MSCs in the treatment of osteoarthritis. Copyright © 2017 John Wiley & Sons, Ltd.

Background: Osteoarthritis (OA) is a chronic degenerative joint disease and is considered to be the fourth leading cause of disability and the second cause of inability to work in men. Recently, adipose-derived mesenchymal stem cells (AD-MSCs) came into focus for regenerative medicine as a promising tool for the treatment of OA. The administration of stem cells into impaired joints results in pain relief and improves quality of life, accompanied by restoration of hyaline articular cartilage. Methods: In the present study, nine patients (including two patients with bilateral symptoms) diagnosed with osteoarthritis (International Knee Documentation grade B in 5 and grade D in six knees) were treated using a single injection of AD-MSCs at a concentration of 0.5–1.0 × 107 cells and were followed up for 18 months. During follow-up, all the cases were evaluated clinically by Knee Society score (KSS), Hospital for Special Surgery knee score (HSS-KS), Tegner–Lysholm (T–L) score and visual analogue scale (VAS) of pain, as well as by plain radiography and by magnetic resonance imaging visualization with 2D Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score assessment. Results: Significant improvement of all four clinical scores was observed within the first 6 months (KSS for 41.4 points, HSS-KS for 33.9 points, T–L score for 44.8 points, VAS of pain from 54.5 to 9.3) and improvement persisted throughout the rest of the follow-up. MOCART score showed significant cartilage restoration (from 43 ± 7.2 to 63 ± 17.1), whereas radiography showed neither improvement, nor further joint degeneration. Conclusions: The results obtained in the present study provide good basis for prospective randomized controlled clinical trials with respect to the use of AD-MSCs in the treatment of osteoarthritis. Copyright © 2017 John Wiley & Sons, Ltd.

Introduction/Objective The knee joint is prone to injuries caused by direct or indirect trauma. The meniscus and ligament injuries, cannot be completely diagnosed with clinical examination; therefore, we use additional non-invasive and invasive diagnostic methods such as magnetic resonance imaging (MRI) and arthroscopy. The aim was to compare the accuracy of MRI and objective knee findings based on arthroscopic examination in case of meniscus and anterior cruciate ligament injuries. Methods The study involved 50 patients treated with elective surgery which mandatory involved arthroscopic visualization of the knee structures. We compared the MRI findings, obtained from different institutions, and arthroscopic knee findings for all the patients involved in the study. Results There were 50 patients included in the study with mean age of 31 years. MRI showed that Anterior cruciate ligament was damaged in 41 patients, while arthroscopy confirmed damage in 43 patients. Medial meniscus was damaged in 31 patients on MRI and in 27 on arthroscopic examination. Lateral meniscus was injured in 35 patients on MRI and arthroscopy showed damage in 32 patients. Using χ2 test we found no significant difference between MRI and arthroscopy as diagnostic methods. Wilcoxon signed-rank test shows similar results between MRI and arthroscopy findings. Conclusion A comparative analysis of MRI and arthroscopy diagnostic value in case of anterior cruciate ligament, medial meniscus and lateral meniscus injuries have shown that there is no significant difference between these two methods. © 2022, Serbia Medical Society. All rights reserved.

Perthes disease is one of the most common forms of pediatric femoral head osteonecrosis with an unknown etiology. Coagulation factors were the first genetic factors suspected to have a role in the pathogenesis of this disease, but studies showed inconsistent results. It is described that inflammation is present during early stages of Perthes disease, but its genetic aspect has not been studied extensively. Little is known regarding the status of apoptotic factors during the repair process that leads to the occurrence of hip deformity in patients. Therefore, the aim of this study was to analyze major mediators involved in coagulation, inflammation, and apoptotic processes as possible causative factors of Perthes disease. The study cohort consisted of 37 patients. Gene variants of TNF-α, FV, FII, and MTHFR genes were determined by PCR-RFLP, while IL-3 and PAI-1 were genotyped by direct sequencing. The expression level of Bax, Bcl-2, Bcl2L12, Fas and FasL was analyzed by quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) technique. Our results showed a significantly increased level of expression of pro-apoptotic factor Bax along with significantly higher Bax/Bcl-2 ratio in the patient group. Conclusion: The results presented indicate that apoptosis could be one of the factors contributing to the lack of balanced bone remodeling process in Perthes patients. © 2015, Springer-Verlag Berlin Heidelberg.

Background/Objectives: Bone marrow adipose tissue (BMAT) has been described as an important biomechanic and lipotoxic factor with negative impacts on skeletal and hematopoietic system regeneration. BMAT undergoes metabolic and cellular adaptations with age and disease, being a source of potential biomarkers. However, there is no evidence on the lipid profile and cellularity at different skeletal locations in osteoarthritis patients undergoing primary hip arthroplasty. Methods: Acetabular and femoral bone marrow (BM) and gluteofemoral subcutaneous adipose tissue (gfSAT) were obtained from matched patients undergoing hip replacement surgery. BM, BMAT, and gfSAT were explored at the levels of total lipids, fatty acids, and cells by using thin-layerand gas chromatography, ex vivo cellular assays, and flow cytometry. Results: BMAT content was significantly higher in femoral than in acetabular BM. Total lipid analyses revealed significantly lower triglyceride content in femoral than in acetabular BMAT and gfSAT. Frequencies of saturated palmitic, myristic, and stearic acids were higher in femoral than in acetabular BMAT and gfSAT. The content of CD45+CD34+ cells within femoral BMAT was higher than in acetabular BMAT or gfSAT. This was associated with a higher incidence of total clonogenic hematopoietic progenitors and late erythroid colonies CFU-E in femoral BMAT when compared to acetabular BMAT, similar to their BM counterparts. Conclusions: Collectively, our results indicate that the lipid profiles of hip bone and femoral BMAT impose significantly different microenvironments and distributions of cells with hematopoietic potential. These findings might bring forth new inputs for defining BMAT biology and setting novel directions in OA disease investigations. © 2025 by the authors.

Background/Objectives: Bone marrow adipose tissue (BMAT) has been described as an important biomechanic and lipotoxic factor with negative impacts on skeletal and hematopoietic system regeneration. BMAT undergoes metabolic and cellular adaptations with age and disease, being a source of potential biomarkers. However, there is no evidence on the lipid profile and cellularity at different skeletal locations in osteoarthritis patients undergoing primary hip arthroplasty. Methods: Acetabular and femoral bone marrow (BM) and gluteofemoral subcutaneous adipose tissue (gfSAT) were obtained from matched patients undergoing hip replacement surgery. BM, BMAT, and gfSAT were explored at the levels of total lipids, fatty acids, and cells by using thin-layerand gas chromatography, ex vivo cellular assays, and flow cytometry. Results: BMAT content was significantly higher in femoral than in acetabular BM. Total lipid analyses revealed significantly lower triglyceride content in femoral than in acetabular BMAT and gfSAT. Frequencies of saturated palmitic, myristic, and stearic acids were higher in femoral than in acetabular BMAT and gfSAT. The content of CD45+CD34+ cells within femoral BMAT was higher than in acetabular BMAT or gfSAT. This was associated with a higher incidence of total clonogenic hematopoietic progenitors and late erythroid colonies CFU-E in femoral BMAT when compared to acetabular BMAT, similar to their BM counterparts. Conclusions: Collectively, our results indicate that the lipid profiles of hip bone and femoral BMAT impose significantly different microenvironments and distributions of cells with hematopoietic potential. These findings might bring forth new inputs for defining BMAT biology and setting novel directions in OA disease investigations. © 2025 by the authors.

Background/Aim. In the last five decades primary hip and knee arthroplasty is the most common and effective surgical intervention worldwide. Infection, although unfrequented, is the most serious complication. Nuclear medicine imaging, not affected by metallic hardware, is the current imaging modality of choice for the evaluation of suspected joint replacement infection. The aim of this study was to estimate the diagnostic accuracy of three phase 99m technetium methylene diphosphonate (99mTc-MDP) bone scintigraphy in periprosthetic hip and knee joint infection. Methods. Inclusion criteria of patients in the study were suspected knee or hip periprosthetic joint infections. In this study, we examined 45 patients (14 men and 31 women) with 39 hip and 24 knee prosthesis (total 63). In all patients, three-phase bone scintigraphy was performed after intravenous application of 555 MBq of 99mTc-MDP. The final confirmation of infection was microbiological or pathohistology finding. Results. Infection was confirmed in 29 prosthetic joints, in 13 (44.8%) knee and 16 (55.2%) hip joints while there was no infection in 34 prosthetic joints. The connection of different modalities of negative and positive findings 99mTc-MDP three-phase bone scintigraphy with the final confirmation of infection showed a high statistical significance (p < 0.001). Three phase bone scintigraphy showed a high sensitivity of 90% but a modest specificity of 69.7% in the detection of periprosthetic infection with the diagnostic accuracy of 79%. The calculated positive predictive value was 73% but the negative predictive value was high 89%. Our results of three-phase bone scintigraphy with calculated sensitivity, specificity and diagnostic accuracy of 79% are in consent with the majority of published studies, or even slightly better. Conclusion. Bone scintigraphy is sensitive in the diagnosis of periprosthetic infection but insufficiently specific. In the detection of periprosthetic infections three-phase bone scan can be used as a diagnostic method of the first line only aimed at its exclusion. The only reasonable use of bone scintigraphy is in combination with other radionuclide methods with high specificity. © 2017, Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All Rights Reserved.