This report describes the case of a young athlete, who presented with a painful foot and was eventually diagnosed with early-stage Mueller-Weiss syndrome (spontaneous osteonecrosis of the navicular) by MRI. As non-operative management was unsuccessful, a percutaneous decompression of the navicular was performed. The patient made a full recovery and was able to return to her previous level of sporting activity. Subsequent imaging showed complete remodelling of the bony architecture of the affected navicular.

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.

Metaphyseal, proximally anchored uncemented stems for total hip arthroplasty provide bone preservation and decrease the incidence of proximal stress shielding and thigh pain. Our study investigated the clinical and radiological outcome of the DePuy Proxima™ short stem at a minimum of 7 years. Methods: Eighty-one consecutive patients (86 procedures) under the age of 70 undergoing primary total hip replacement at two arthroplasty centres were enrolled. Follow-up was clinical (Harris Hip Score (HHS), thigh pain and satisfaction) and radiological (subsidence, malalignment and loosening) at 6 months and yearly thereafter. Results: Average age was 50 (range 32-65) with 79% (68 of 86) being male. Preoperative diagnosis included primary osteoarthritis (OA) 36%, avascular necrosis of femoral head 51%, dysplasia 9% and post-traumatic OA 4%. HHS improved 51 points at latest follow-up (from 40 to 91). We had 3.5% (3 of 86) periprosthetic fractures, one requiring revision. We had one dislocation, no infections and no thigh pain. Malalignment rate (5 off neutral) was 12% (10 of 86), not affecting clinical results. Conclusion: Overall stem survival was over 97% at 7 years. The DePuy Proxima provides excellent clinical results at a minimum of 7 years post-operatively.

BackgroundSalmonella species can be rarely isolated from periprosthetic joint infections, however when present, are usually part of a severe septic clinical picture.Case presentationsTwo patients presented with late infected hip replacements to our institution. The first patient with multiple comorbidities had a confirmed Salmonella Enteridis infection with an abscess in the groin, with loosening of both components. He underwent a successful one stage cemented revision hip replacement, followed by 6 weeks of antibiotic therapy (ciprofloxacin). He had no recurrence or complications. The second patient was admitted in a septic condition with ARDS to the Intensive Care Unit 7 years following an uncemented total hip replacement. From an ultrasound guided hip aspirate Salmonella cholerae-suis was isolated. He underwent a successful a two-stage revision hip replacement.ConclusionsSuccessful treatment of such potentially life threatening infections is achievable using modern orthopaedic techniques and close collaboration with the infectious diseases specialists.

A szerzők 74 éves beteg kórtörténetét ismertetik, akinél kiterjedt szegmentális térdízületi periprotetikus csontvesztés műtéti kezelése során strukturális proximalis tibialis allograftot alkalmaztak és beszámolnak a műtét után kialakult késői szövődmény ellátásáról. Kiemelik, hogy az allograftokkal történő csontpótlás fi ziológiás eljárás, amely lehetősé-get ad stabil implantátum rögzítésére, lágyrész-rekonstrukcióra, kiterjedt csontvesztés pótlására, és a beavatkozás költsége is kevesebb. A liofi lizált allograft albuminnal történő kezelése bizonyítottan javítja azt a képességet, hogy a csontvelő-eredetű mesenchymalis őssejtek az allograft felszínén megtapadjanak, azon proliferáljanak, valamint annak pórusaiba is beterjedjenek és ezáltal a graft mélyebb rétegeibe is eljussanak. Kimutatható osteoblast tevékenység alakult ki a graft felszínén és a belsejében is. Orv. Hetil., 2015, 156(2), 67-70.Kulcsszavak: albuminnal bevont allograft, fagyasztva szárított allograft, protézis-allograft kompozit, térdprotézis-revízió, szövődmény ellátásaThe use of structural proximal tibial allografts coated with human albumin in treating extensive periprosthetic knee-joint bone defi ciency and averting late complications. Case reportThe authors report the history of a 74-year-old patient who underwent surgical treatment for segmental knee-joint periprosthetic bone loss using structural proximal tibial allografts coated with serum albumin. Successful treatment of late complications which occurred in the postoperative period is also described. The authors emphasize that bone replacement with allografts is a physiological process that enables the stable positioning of the implant and the reconstruction of the soft tissues, the replacement of extensive bone loss, and also it is a less expensive operation. It has been already confi rmed that treatment of lyophilised allografts with albumin improves the ability of bone marrowderived mesenchymal stem cells to adhere and proliferate the surface of the allografts, penetrate the pores and reach deeper layers of the graft. Earlier studies have shown osteoblast activity on the surface and interior of the graft.