Širka, Aurimas

Conversion of knee arthrodesis to total knee arthroplasty is a technically demanding procedure, particularly in young patients with a history of trauma and infection. This report outlines the surgical strategy and 1-year functional outcome of a 24-year-old patient who underwent total knee arthroplasty 4 years after knee fusion. Management included soft tissue reconstruction, tibial tubercle osteotomy, gastrocnemius flap coverage, and rotating hinge knee implantation. At 1-year follow-up, the patient showed marked clinical improvement, with improved in KOOS and WOMAC scores, pain relief, and quality of life. Markerless 3D kinematic gait analysis was also performed post-conversion. This report describes key surgical considerations and preoperative work-up for the successful conversion of knee arthrodesis to arthroplasty.

Background and Clinical Significance: Trichoderma is a rare cause of human fungal infections. These infections are often severe and can be life-threatening, involving various organs and tissues. Although Trichoderma is not commonly encountered in clinical practice, its ability to cause infections is particularly significant in immunocompromised patients. As a result, cases in which Trichoderma is identified in human specimens are not only uncommon but also pose complex diagnostic and therapeutic challenges for clinicians. Although it can be associated with various organs, its clinical significance in joints, especially in periprosthetic joint infections, remains unclear. Case Presentation: This case report presents a 63-year-old immunocompromised woman with a suspected periprosthetic joint infection caused by Trichoderma. After total hip arthroplasty and subsequent bacterial periprosthetic joint infection, Trichoderma was revealed from two intraoperative samples. Given the unusual pathogen and the patient’s immunosuppression, antifungal therapy with amphotericin B was initiated. However, due to severe intolerance, the antifungal treatment had to be discontinued shortly after initiation, and the patient continued under close monitoring. We closely monitored the patient’s clinical status and laboratory test results, continuously considering whether the findings represented contamination or true infection. The patient exhibited clinical and radiological stability, reinforcing the hypothesis of contamination rather than active infection. Conclusions: This case explores the rarity of Trichoderma periprosthetic joint infections, the diagnostic and treatment challenges, and the importance of multidisciplinary input in managing such uncommon and complex cases. Further studies are needed to clarify the pathogenic significance, optimal management, and long-term outcomes of Trichoderma in bone and joint infections.

Introduction Fungal periprosthetic joint infection is considered atypical and occurs in around 1-2% of all periprosthetic joint infections [1]. Trichoderma, known for its pathogenic potential in immunocompromised hosts [2], has been documented to cause lethal infections in various organ systems before [3,4,5]. However, this report delineates a novel occurrence of Trichoderma-induced bone infection. Case Presentation A 63-year-old immunocompromised woman underwent left hip total arthroplasty in April 2023. In October, the patient developed a periprosthetic joint infection attributable to Staphylococcus epidermidis, necessitating a two-stage surgical approach. The infection was initially treated with vancomycin in conjunction with trimethoprimsulfamethoxazole. Upon completion of the second stage in November, vancomycin therapy was maintained, followed by the subsequent initiation of rifampicin and levofloxacin. Three weeks post-second stage, the growth of Trichoderma in two tissue samples obtained intraoperatively prompted an international multidisciplinary discussion, which resulted in the initiation of antifungal therapy. The administration of amphotericin B was commenced, but due to the patient's intolerance, treatment had to be discontinued after 8 days, leaving rifampicin and levofloxacin as the remaining therapeutic regimen. At the three-month post-operative assessment, the patient remained in satisfactory health with no reported issues. Discussion Trichoderma growth in two consecutive tissue samples obtained intraoperatively resembles clear clinical evidence of a fungal periprosthetic joint infection. Despite an incomplete antifungal therapy course, leaving only broad spectrum antibiotics in continued use, the patient shown no signs of infection at the three-month postoperative follow-up visit, that could suggest that the Trichoderma growth was an instance of contamination. Conclusions Trichoderma infections are seldom observed, yet can exhibit severe and perilous clinical manifestations in patients with immunodeficiency. In this particular instance, the patient demonstrated clinical evidence of a Trichoderma infection presenting in bone.

Introduction. Trichoderma, a fungus known to cause infections, poses a unique challenge in clinical settings, especially among immunocompromised patients. While fatal cases in other organs have been documented, this report presents the first instance of Trichoderma bone infection. Notably, the patient’s immunocompromised state heightened the infection risk, yet discerning whether Trichoderma growth signified contamination or true infection remains challenging. Case Presentation. This report details the clinical data of a 63-year-old immunocompromised woman who underwent left hip total arthroplasty in April 2023. In October, she developed a Staphylococcus epidermidis periprosthetic joint infection, managed via a two-stage surgical procedure and treated initially with vancomycin and trimethoprim-sulfamethoxazole. Subsequently, vancomycin was administered post-second stage in November, followed by rifampicin and levofloxacin. Three weeks post-second stage, Trichoderma growth in two samples prompted international multidisciplinary discussion, leading to antifungal therapy initiation. Despite initiating amphotericin B, the patient’s intolerance required its discontinuation after 8 days, leaving only rifampicin and levofloxacin in continued use. At three-month follow-up post-operation, the patient remained in good condition without complaints. Conclusion. While Trichoderma infections are rare, this case offers crucial insights. Despite initiating treatment due to positive cultures, the patient’s intolerance led to therapy discontinuation. Ongoing observation is vital to determine if Trichoderma growth constituted periprosthetic joint infection or contamination.

Introduction Arthrodesis, or fusion of the knee, is a reliable primary or salvage option for several complex problems [1]. A knee fusion is associated with considerable restrictions, including the inability to sit properly, use public transportation, and climb stairs [2].

Introduction: Trichoderma, a fungus known to cause infections, poses a unique challenge in clinical settings, especially among immunocompromised patients. While fatal cases in other organs have been documented, this report presents the first instance of Trichoderma bone infection. Notably, the patient’s immunocompromised state heightened the infection risk, yet discerning whether Trichoderma growth signified contamination or true infection remains challenging. Case Presentation: This report details the clinical data of a 63-year-old immunocompromised woman who underwent left hip total arthroplasty in April 2023. In October, she developed a Staphylococcus epidermidis periprosthetic joint infection, managed via a two-stage surgical procedure and treated initially with vancomycin and trimethoprim-sulfamethoxazole. Subsequently, vancomycin was administered post-second stage in November, followed by rifampicin and levofloxacin. Three weeks post-second stage, Trichoderma growth in two samples prompted international multidisciplinary discussion, leading to antifungal therapy initiation. Despite initiating amphotericin B, the patient’s intolerance required its discontinuation after 8 days, leaving only rifampicin and levofloxacin in continued use. At three-month follow-up postoperation, the patient remained in good condition without complaints. Conclusion: While Trichoderma infections are rare, this case offers crucial insights. Despite initiating treatment due to positive cultures, the patient’s intolerance led to therapy discontinuation. Ongoing observation is vital to determine if Trichoderma growth constituted periprosthetic joint infection or contamination.

Calcium sulfate/hydroxyapatite (CaS/HA) biomaterials have been investigated for use in several orthopedic applications. However, the mechanical interactions between the composite of CaS/HA and bone at the microscale are still unknown. The aim of this study was to determine if and how augmentation with CaS/HA alters the fracture behavior of bone. Eleven cylinders of trabecular bone were drilled from human femoral heads and cleaned from bone marrow. Among them, five cylinders were injected with CaS/HA to generate composite specimens, while the others were kept intact. One extra specimen of pure CaS/HA was prepared. All specimens were compressed in situ using synchrotron X-ray tomography and imaged at ∼2% strain intervals. Structural properties were calculated from the images in unloaded state and mechanical properties were determined from the load-curves. CaS/HA alone displayed the highest peak force and stiffness and the lowest strain at fracture. All composite specimens had a higher peak force than the pure bone specimens and the composite specimens had higher toughness than the pure CaS/HA specimen. Furthermore, the fracture behavior was analyzed further to characterize the local deformations. The pure bone specimens presented damage in multiple trabeculae and the CaS/HA specimen displayed sharp transition in strains, with low strain in one load step and large cracks in the next. The composite specimens deformed uniformly, with the CaS/HA preventing tissue damage and the bone preventing cracks in the CaS/HA from propagating through the specimen. In conclusion, using tomography with in situ loading, it was possible to show how CaS/HA can help prevent bone tissue damage before global failure.

Objectives: This study aims to test the feasibility of the Fracture and Mortality Risk Evaluation (FAME) Index. Patients and methods: Two academic centers in Lithuania and Turkey participated in this retrospective study conducted between November 2018 and July 2019. A total of 100 consecutive patients (22 males, 78 females; mean age 78.9 years; range, 45 to 100 years) with low energy proximal femur fractures admitted for surgery were included in the study. Fracture Risk Assessment tool (FRAX) and the Sernbo scores were calculated and patients were classified into one of the nine subcategories of the FAME Index. Results: Demographics and FAME Index classifications were similar between centers. Patients with high risk of fracture and low risk of mortality accounted for 18% of all patients, which is the FAME Index subcategory to theoretically benefit from cancellous bone augmentation during internal fixation of a fragility hip fracture the most. Conclusion: The FAME Index was successfully applied in clinical emergency setting utilizing a simple form, and demonstrated promising potential in stratification of hip fractures most suitable for screw and device augmentation. Larger studies with at least one-year of follow-up are warranted to verify the validity of FAME Index.

Osteoporozė – kaulų medžiagų apykaitos sutrikimas, pasireiškiantis vyresnio amžiaus žmonėms, susijęs su menopauzės ar amžiaus sąlygotos kaulinės masės bei jos kokybės sumažėjimu ir dėl to padidėjusiu kaulų trapumu bei lūžių dažnumu. Literatūros duomenimis intervencijos, skirtos kaulinio audinio regeneraciniam atsakui sustiprinti naudojant farmakologinius vaistus ir aktyvatorius leidžia padidinti kaulo kiekį lūžio vietoje stimuliuojant anabolinius arba slopinant katabolinius procesus. Biologiškai aktyvių medžiagų naudojimas kaulo regeneracijai sukelia didelių iššūkių, nes šis procesas yra rezultatas sudėtingos ląstelių ir molekulinių procesų visumos bei sąveikos. Literatūroje nėra duomenų apie tinkamo nešėjo, kuris užtikrintų ilgalaikį bei pastovų ir kontroliuojamą biologiškai aktyvių medžiagų ir jų derinių išsiskyrimą lokaliai. Šiame moksliniame tyrime panaudotas naujas gyvūnų modelis, skirtas ištirti kaulų regeneracijos procesą šlaunikaulio kaklo kanale osteoporoze sergančioms žiurkėms. Literatūroje neaptikta tyrimų, kuriuose būtų vertinta ar kalcio sulfato/hidroksiapatito pagrindu pagaminta biomedžiaga–nešėjas, lokaliai tiekiantis bifosfonatą, arba bifosfonatą ir rekombinantį žmogaus kaulo morfogeninį baltymą derinyje gali pagerinti kaulo regeneraciją osteoporotinių žiurkių šlaunikaulio kakle vertinant kaulinės masės prieaugį, mechaninį atsparumą lūžiui bei histologinę kaulo sandarą taip ilgalaikėje perspektyvoje siekiant sumažinti riziką įvykti osteoporotiniui lūžiui.

Fragility fractures are common among the elderly. Zoledronic acid (ZA) is a potent bisphosphonate used clinically with documented positive preventive effect on fragility fractures. Systemic use of ZA has shown positive results, furthermore, studies indicated local usage of low-dose ZA, leads to improved bone formation. We aimed to evaluate the long-term effects of local ZA and rhBMP-2 delivery on bone remodeling in the femoral neck canal of osteoporotic rats. In ovariectomized rats femoral neck canals holes were drilled and defects were treated as follows: G1) empty (n=8), G2) Calcium sulphate(CaS)/hydroxyapatite(HA) biomaterial (n=8), G3) CaS/HA biomaterial+systemic ZA (n=11), G4) CaS/HA+Local ZA(10 μg) (n=11), G5) CaS/HA+Local ZA(10 μg)+rhBMP-2(5 μg) (n=9). To establish that the CaS/HA biomaterial is an optimal carrier for local ZA delivery, we used 14C-ZA to study the bioavailability of ZA during the entire course of bone regeneration and compare it to the ZA available in the femoral neck canal when ZA was delivered systemically (s.c injection). Animals were sacrificed after 24-weeks and both legs were subjected to micro-CT imaging, then the specimens that received 14C-ZA were subjected to scintillation counting while the rest of the specimens were tested mechanically to evaluate the peak force to fracture of the femoral neck. Significantly higher bone volume/tissue volume was observed in G4-G5 compared to G1-G3, indicating that local delivery of ZA or ZA+rhBMP-2 is necessary for bone regeneration. Scintillation counting results indicated similar amount of 14C-ZA accumulation in both legs in G3. In the local treatment group (G4), higher amount of 14C-ZA was observed in the defect leg. The results indicate that local delivery of ZA via the CaS/HA biomaterial carrier can aid in regeneration of large volumes bone within the femoral neck. This method could potentially be used in poor quality bone where hardwa[...].