Gábor Vásárhelyi | Semmelweis University (original) (raw)

Papers by Gábor Vásárhelyi

PubMed, Mar 1, 2004

Background: The successful treatment of chondral and osteochondral defects of the weight-bearing ... more Background: The successful treatment of chondral and osteochondral defects of the weight-bearing surfaces is a challenge for orthopaedic surgeons. Autologous osteochondral transplantation is one method that can be used to create hyaline or hyaline-like repair in the defect area. This paper describes the results after ten years of clinical experience with autologous osteochondral mosaicplasty. Methods: Clinical scores, imaging techniques, arthroscopy, histological examination of biopsy samples, and cartilage stiffness measurements were used to evaluate the clinical outcomes and quality of the transplanted cartilage in 831 patients undergoing mosaicplasty. Results: According to these investigations, good-to-excellent results were achieved in 92% of the patients treated with femoral condylar implantations, 87% of those treated with tibial resurfacing, 79% of those treated with patellar and/or trochlear mosaicplasties, and 94% of those treated with talar procedures. Long-term donor-site disturbances, assessed with use of the Bandi score, showed that patients had 3% morbidity after mosaicplasty. Sixty-nine of eighty-three patients who were followed arthroscopically showed congruent gliding surfaces, histological evidence of the survival of the transplanted hyaline cartilage, and fibrocartilage filling of the donor sites. Complications of the surgery included four deep infections and thirty-six painful postoperative hemarthroses. Conclusions: On the basis of these promising results and those of other similar studies, autologous osteochondral mosaicplasty appears to be an alternative for the treatment of small and medium-sized focal chondral and osteochondral defects of the weight-bearing surfaces of the knee and other weight-bearing synovial joints.

Magyar traumatológia, ortopédia, kézsebészet, plasztikai sebészet, 2018

Az álízület kezelése mindig nagy kihívás egy mozgásszervi sebésznek. A megfelelő stabilizáló eljá... more Az álízület kezelése mindig nagy kihívás egy mozgásszervi sebésznek. A megfelelő stabilizáló eljárás után oligo-, illetve atrophiás álízületnél valamilyen csontátültetésre van szükség. Ezt az esetek többségében a csípőlapátból kell eltávolítani, ahol magas a donor területi morbiditás. Ennek elkerülésére alkalmaztunk egy általunk kifejlesztett minimál invazív eljárást. Cikkünkben egy 41 éves nőbeteg esetén keresztül mutatjuk be, akinek a fibula álízületét kezeltük a tibia proximalis részből vett csont allografttal a mozaikplasztikához készült műszerkészlet segítségével. Kulcsszavak: Álízület; Csontátültetés; Minimál invazív technika; K. Pap, O. Domaraczki, B. Tácsik, G. Vásárhelyi, L. Hangody: Usage of cancellous bone autograft harvested with minimally invasive technique for non-union treatment. Case report A variety of treatment options are available for patients with oligo-and atrophic non-unions without bone defects, but the optimal surgical approach remains a challenge for orthopedic surgeons. Several treatments are used in clinical practice; however most of the surgical procedures need to be combined with autologous bone grafting. The bone graft regularly comes from the iliac crest. This treatment often suffers donor site morbidity. In the next case report we present our new minimally invasive technique for bone autograft harvesting

Journal of Bone and Joint Surgery, American Volume, 2004

Magyar traumatológia, ortopédia, kézsebészet, plasztikai sebészet, 2014

A medialis combnyaktörések operatív kezeléséről napjainkban is vita folyik. Nincs egységes állásp... more A medialis combnyaktörések operatív kezeléséről napjainkban is vita folyik. Nincs egységes álláspont, osteosynthesis vagy protézis a jobban célravezető módszer? Friss törés esetében jelenleg a dislocatio típusától függően döntünk. Garden I–II-es töréseknél osteosynthesis, míg Garden IV-es töréseknél protézis a választott megoldás. A Garden III-as törés esetében mindkét út járható. Az osteosynthesisben a Manninger és munkacsoportja által kidolgozott, kettős kanülált csavarozást alkalmazzuk, az AO csavarozás mellett. Ez utóbbi kritériuma a jó csontszerkezet, ezért csak fiatal felnőtteknél jön szóba. A cikk szerzői, az osteosynthesis egy új formáját fejlesztették ki, a dinamikus HLS (HeadLessScrew) csavarozást. A csavar két fő részből áll, összeszerelt állapotban kompressziós hatást fejt ki. 27 betegnél végezték el a műtétet, majd az eredményeket a Manninger és munkacsoportja által kidolgozott módszer szerint értékelték. Eddigi tapasztalataik bizakodásra adnak okot. Nőtt a stabilitás, kevesebb lett a szövődmény.

Joint Diseases and Related Surgery

The treatment of deep and large-sized osteochondral defects still remains a challenge in orthoped... more The treatment of deep and large-sized osteochondral defects still remains a challenge in orthopedic surgery worldwide. [1] Fresh osteochondral allograft (OCA) transplantation is an increasingly and widely used technique and is currently almost the only option for treating massive osteochondral lesions, particularly in young patients. Long-term follow-up published in the international literature reports a success rate of 50 to 89% 10 years after implantation for this method. [2-7] The basic concept behind fresh OCA transplantation is to transplant a mature, bone-based hyaline cartilage that survives hypothermic (or isothermal) storage, while retaining its metabolic activity and collagen matrix. Hyalin cartilage is a tissue with properties that are ideal for transplantation. Primarily, given that it is an Objectives: This study aims to investigate whether ultra-fresh osteochondral allograft (OCA) transplantation was a good therapeutic alternative for the treatment of otherwise challenging, massive osteochondral defects in the knee joint. Patients and methods: Between April 2011 and July 2022, a total of 16 ultra-fresh knee transplantations (9 males, 7 females; median age: 30.2 years; range, 14 to 62 years) having large osteochondral defects on femoral condyles were included. The operations were performed by two surgeons. The condition of the patients were evaluated based on regular follow-up physical examinations, imaging studies and by recording and evaluating clinical scores (modified Cincinnati scores, and 2000 International Knee Documentation Committee [IKDC] scores). Results: The median follow-up was 65±48 (range, 6 months to 12 years). At two years after transplantation, there was a significant improvement in the modified Cincinnati scores (preoperative score of 35.75 increased to 83.75; p<0.001) and also to the IKDC scores (preoperative score of 28.7 increased to 76.3; p<0.001). One patient developed an early septic complication, and another three patients underwent reoperation after the OCA transplantations for non-septic reasons. Conclusion: Ultra-fresh OCA transplantation is a good therapeutic alternative for the treatment of otherwise challenging, massive osteochondral defects in the knee joint. Such a shortening of the transplantation time and its positive effect on the better long-term survival of transplanted chondrocytes has not yet been proven; however, the minimizing of transplantation time may create the conditions necessary for successful OCA transplantations many years after the implantation.

Joint Diseases and Related Surgery, 2021

Objectives In this study, we present our 10-year postoperative follow-up results of Sanat Swing® ... more Objectives In this study, we present our 10-year postoperative follow-up results of Sanat Swing® and NexGen® total knee implants. Patients and methods A total of 189 patients (93 males, 96 females; mean age: 68 years; range, 48 to 86 years) who underwent total knee replacement between January 2008 and September 2010 were retrospectively analyzed. A total of 105 patients (Group A) were implanted a cemented Sanat Swing knee prosthesis and 84 patients (Group B) were implanted a cemented NexGen knee prosthesis. Operation time, range of motion (ROM), pain level, Knee Society Score (KSS), distance of painless walking, and the ability to climb stairs were evaluated between the groups. Results The mean follow-up was 10.8 (range, 9.8 to 12.3) years. No significant difference was observed in the survival of the prostheses, ROM, pain level, KSS, walking distance, and in the ability to climb stairs between the two groups at 10 years. With an experienced team, the operation time was about 4 to 5...

Case Reports in Orthopedics, 2020

Introduction Wakeboarding is an extreme sport that has shown increasing popularity in recent year... more Introduction Wakeboarding is an extreme sport that has shown increasing popularity in recent years, with an estimated 2.9 million participants in 2017. Due to this trend, injuries related to this sport are likely to become more common. Isolated femoral shaft are rare; however, they occur much more frequently in youth as a result of high velocity events, such as dashboard-related injuries. Few studies have addressed injuries related to wakeboarding, and of those that have, most have reported on muscle injuries, ligament ruptures, and sprains. Due to the dearth in literature, we want to present two cases of isolated noncontact femoral shaft fractures that resulted from wakeboarding. Case Presentation. Two 28-year-old, otherwise healthy, wakeboarders—patient A, male, and patient B, female—presented to our Department of Orthopaedics and Sports Medicine with isolated femoral shaft fractures. Both were admitted due to wakeboard-related noncontact injuries, where patient A fell while perfo...

Magyar Traumatológia Ortopédia Kézsebészet Plasztikai Sebészet

Objectives: Patellar dislocation is a common problem in skeletally immature subjects. Nonoperativ... more Objectives: Patellar dislocation is a common problem in skeletally immature subjects. Nonoperative treatment of these dislocations results in unsatisfactory outcomes. The aim of this study was to evaluate the results of minimally invasive arthroscopic treatment for acute and recurrent patellar dislocations. Patients and methods: Twelve patients underwent arthroscopic medial retinaculum suture for patellar dislocations. The dislocations were acute in seven patients (mean age 14 years; range 13 to 17 years) and recurrent in five patients (mean age 22 years; range 17 to 32 years). In some cases, arthroscopic medial retinaculum suture was combined with a lateral release. The patients were evaluated by physical examination and with the Lysholm-Gillquist score and the Bandi knee global assessment score. The mean follow-up period was 9.8 months (range 2 to 28 months). Two patients were excluded from the final evaluations: one was lost to follow-up and the other underwent surgery. Results: ...

Journal of Virus Eradication, 2015

Wakeboarding is a common water sport which may cause serious injuries. Especially joints are affe... more Wakeboarding is a common water sport which may cause serious injuries. Especially joints are affected like anterior cruciate ligament tears, shoulder dislocations or sprained ankles and have frequently been described. In contrast, because of the largeness, length and strength of the femur, femoral shaft fractures are mainly caused by high-energy trauma in young people in an ordinary population. Among athletic population numerous studies evaluated stress fractures of the femur. According to their results this type of injury is relatively uncommon, and data from the literature suggest that they constitute only 2.8–7% of all sport related stress fractures. There are only few data about highenergy trauma of the femoral shaft in sport although the incidence of acute femoral fractures is quite high in certain sports’ like motocross (10%), and alpine skiing among inpatient athletes. Despite multiple reports in various sports of stress fracture of the femur and few publications of direct tr...

Applied Sciences, 2020

Scaffolds are thought to be a key element needed for successful cartilage repair treatments, and ... more Scaffolds are thought to be a key element needed for successful cartilage repair treatments, and this prospective extension study aimed to evaluate long-term structural and clinical outcomes following osteochondral defect treatment with a cell-free biphasic scaffold. Structural outcomes were assessed using quantitative 3-D magnetic resonance imaging (MRI) and morphological segmentation to determine the percentage of defect filling and repair cartilage T2 relaxation times, and clinical outcomes were determined with the modified Cincinnati Rating System, and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Seventeen subjects with osteochondral defects in the knee were treated with ChondroMimetic scaffolds, from which 15 returned for long-term evaluation at a mean follow-up of 7.9 ± 0.3 years. The defects treated were trochlear donor sites for mosaicplasty in 13 subjects, and medial femoral condyle defects in 2 subjects. MRI analysis of scaffold-treated defects found a mean tot...

Joint Diseases and Related Surgery, 2018

Bu çalışmada, titanyum plazma sprey ve hidroksiapatit gözenekli kaplama kombinasyonu ile kaplanmı... more Bu çalışmada, titanyum plazma sprey ve hidroksiapatit gözenekli kaplama kombinasyonu ile kaplanmış SanatSwing çimentosuz total diz protezi tanıtıldı ve erken sonuçları SanatSwing çimentolu diz protezi ile karşılaştırıldı. Hastalar ve yöntemler: Eylül 2012-Şubat 2017 arasında total diz replasmanı yapılan 278 hasta karşılaştırıldı. Toplam 142 hastada (Group A; 78 erkek, 64 kadın; ort. yaş 69±14), çimentolu SanatSwing diz protezi ve 136 hastada (Group B; 83 erkek, 53 kadın; ort. yaş 59±10) çimentosuz SanatSwing diz protezi implante edildi. Ortalama iki yıllık takip süresinden sonra radyografilerde implant pozisyonu ve periprostetik kemik koşulları araştırıldı. Hareket açıklığı, ağrı seviyesi, ağrısız yürüyüş mesafesi ve merdiven çıkma yeteneği değerlendirildi. Bulgular: Ameliyat öncesi skorlar, son ziyaretlerinin skorları ile karşılaştırıldığında hem çimentolu hem de çimentosuz gruplarda belirgin iyileşme gözlendi, ancak çimentolu ve çimentosuz gruplar arasında ölçülen puanlarda bir fark bulunmadı. Her iki grupta da komplikasyon oranları düşük ve neredeyse benzerdi ve aralarında anlamlı bir fark yoktu. Sonuç: Titanyum plazma spreyi ile hidroksiapatit gözenekli kaplama tekniğinin kombinasyonunu çimentosuz protezlerde kullandık. Elde ettiğimiz sonuçlar bize, yeni SanatSwing çimentosuz total diz protezi serisinin çimentolu total diz artroplastisine mükemmel bir alternatif olabileceğini gösterdi.

Magyar Traumatológia Ortopédia Kézsebészet Plasztikai Sebészet, 2018

A recidív patella ficamok etiológiájában a lateralis trochlea veleszületett vagy szerzett hypopla... more A recidív patella ficamok etiológiájában a lateralis trochlea veleszületett vagy szerzett hypoplasiája fontos szerepet játszik. Sajnálatosan a hazai gyakorlat a mai napig a térdkalács ficamok kezelésében főleg konzervatív, illetve műtét esetén is csak az ezen betegeknél szintén meglévő patológiás húzási irány korrekciójára irányul. A szerzők véleménye szerint, amennyiben a lateralis trochlea, mint patológiai faktor kimutatható, ennek korrekciója is mindenképpen indokolt a húzási irány korrekciójával egy időben. Ismertetik az intézetükben alkalmazott diagnosztikus algoritmust, bemutatják az általuk javasolt, mára már főleg minimál invazív technikával végzett műtét lépéseit, valamint az alkalmazott posztoperatív rehabilitációs protokollt. Saját 10 éves anyagukat összegezve azt a megállapítást teszik, hogy jó kooperációjú betegnél az általuk javasolt műtéti technika jól alkalmazható, és jól vezetett rehabilitációval akár az élsport is elérhető.

Cartilage, 2017

To evaluate the efficacy and safety of an intraarticular injection of Cingal (Anika Therapeutics,... more To evaluate the efficacy and safety of an intraarticular injection of Cingal (Anika Therapeutics, Inc., Bedford, MA) compared with Monovisc (Anika Therapeutics, Inc., Bedford, MA) or saline for the treatment of knee osteoarthritis. This multicenter, double-blind, saline-controlled clinical trial randomized subjects with knee osteoarthritis (Kellgren-Lawrence grades I-III) to a single injection of Cingal (4 mL, 88 mg hyaluronic acid [HA] plus 18 mg triamcinolone hexacetonide [TH]), Monovisc (4 mL, 88 mg HA), or saline (4 mL, 0.9%). The primary efficacy outcome was change in WOMAC (Western Ontario and McMaster Universities Arthritis Index) Pain Score through 12 weeks with Cingal versus saline. Secondary outcomes included Patient and Evaluator Global Assessments, OMERACT-OARSI Responder index, and WOMAC Total, Stiffness, and Physical Function scores through 26 weeks. A total of 368 patients were treated (Cingal, n = 149; Monovisc, n = 150; saline, n = 69). Cingal improvement from basel...

Acta veterinaria Hungarica, 2016

The purpose of this study was to evaluate changes in biomarker and synovial parameters following ... more The purpose of this study was to evaluate changes in biomarker and synovial parameters following autologous osteochondral transplantation (AOT) in the equine stifle joint, to test the hypothesis whether synovial parameters would show significant differences at selected time points following the surgery (at days 3, 14, 60 and 180) compared to baseline level (at day 0). Surgical intervention was performed in both stifles of nine horses (n = 18). The joints were randomly assigned to operated and sham-operated groups. Grafts 8.5 mm in diameter were harvested from the femoropatellar (FP) joint under arthroscopic control and the medial femorotibial (MFT) joints had AOT using mosaicplasty (MP) instrumentation, while the sham FP and sham MFT joints underwent arthroscopy and miniarthrotomy without transplantation, respectively. Synovial fluid (SF) parameters were evaluated at days 4, 14, 60 and 180. Data were analysed by two-way repeated- measures analysis of variance (ANOVA), and P < 0.0...

European Journal of Orthopaedic Surgery & Traumatology, 2011

Mosaicplasty has become a well-accepted treatment modality for articular cartilage lesions in the... more Mosaicplasty has become a well-accepted treatment modality for articular cartilage lesions in the knee. Postoperative bleeding remains potentially concerning. This study evaluates the porous poly(ethylene oxide)terephthalate/poly(butylene terephthalate) (PEOT/ PBT) implants used for donor site filling. Empty donor sites were the controls. After 9 months, MRI, macroscopical and histological analysis were carried out. Treated defects did not cause postoperative bleeding. No adverse events or inflammatory response was observed. PEOT/PBT implants were well integrated. Empty controls occasionally showed protrusion of repair tissue at the defect margins. Surface stiffness was minimally improved compared to controls. Existing polymer fragments indicated considerable biodegradation. Histological evaluation of the filled donor sites revealed congruent fibrocartilaginous surface repair with proteoglycan-rich domains and subchondral cancellous bone formation with interspersed fibrous tissue in all implanted sites. The PEOT/PBT implants successfully reduce donor site morbidity and postoperative bleeding after mosaicplasty. Level of evidence II. Keywords Cartilage Á Bone remodeling Á Copolymer Á In vivo Á Biocompatibility Á Biodegradation Lajos Bartha and Doreen Hamann authors contributed equally to the paper.