POSTER ABSTRACTS - ISAKOS

E-poster #518
Thrombotic Trhombocytopenic Purpura (TTP):
A Severe Complication Following Valgus
Osteotomy of Knee
Michael Ilias Iosifidis, Thessaloniki, GREECE,
Presenter
Merkourios Ntavlis, Thessaloniki, GREECE
Leonidas Malioufas, Naoussa, GREECE
John Giannoulis, Naoussa, GREECE
Peter Sarriggiannidis, Naoussa, GREECE
Stavros Traios, Naoussa, GREECE
Antonios Ioannou, Naoussa, GREECE
George Giantsis, Naoussa, GREECE
Orthopaedic and Anaisthiology Department,
Naoussa, GREECE
Thrombotic thrombocytopenic purpura (TTP) or
Moschowitz’s syndrome, is a life threatening
illness thus should be treated immediately. Long
term patient follow up is required. Some patients
have only a single episode of TTP but in most
cases the disease is chronic with frequent
relapses. It is a very rare condition after
orthopaedic elective operations, but it causes
serious problems.
We report a case of TTP following valgus
osteotomy of knee in a 57 year old female. There
was no record for systemic disease and the
preoperative check was without anything
pathological.
During the 4th p.o. day the patient had high fever
and a strong feeling or tiredness. The blood check
showed renal dysfunction, very low Ht and
number of platelets. At the 7th p.o. the patient
was gone to haematology department, where she
had treatment with cortisone and plasmapheresis.
TTP is an acute, recurrent disease of the
circulation consisting of thrombocytopenia,
microangiopathic haemolytic anemia,
neurological signs, fever and renal dysfunction.
The etiology is still unknown, although different
factors such as large von Willebrand factor
multimers (ULvWF) released by endothelial
injuries, and the presence in plasma, of a factor
that forms platelet aggregates in vitro, have been
implicated. Surgical stress has been associated
with TTP, probably by releasing massive amounts
of ULvWF.
This syndrome is very rare in the international
literature, especially after orthopaedic operations.
We should be aware of it because of its possible
fatal result.
E-poster #519
Total Knee Arthroplasty for Old Tuberculosis of
the Knee
George Giantsis, Naoussa, GREECE,
Michael Ilias Iosifidis, Thessaloniki, GREECE
Presenter
John Giannoulis, Naoussa, GREECE
Peter Sarriggiannidis, Naoussa, GREECE
Leonidas Malioufas, Naoussa, GREECE
Konstantinos Antoniou, Naoussa, GREECE
Stavros Traios, Naoussa, GREECE
Konstantinos Tomtsis, Naoussa, GREECE
Orthopaedic Department, Naoussa, GREECE
Despite the improvement of protection and
condition of living during the last 40 years, there
is a remarkable recurrence of tuberculosis in the
last decade. When it appears in bones and joints,
it is always secondary. Knee tuberculosis (or white
tumor) affects almost always one joint and there
is installation of the vacilous in articular
membrane or in the bones metaphysis.
We present a case of a patient (60 years old
woman), who came to our department
complaining for knee pain and swelling. The
clinical examination showed severe knee arthritis
without any sign of systemic disease and from the
history there was not infectious disease. The
blood test showed slightly increased Erythrocyte
Sentimentation Rate (ESR) and C reactive protein
(CRP), and the x-rays apart from the osteoarthitic
damages showed big subchondral cysts both in
femur and tibia. We decided to operate her and
during the operation there was evidence of knee
tuberculosis. We did wide bursectomy and
cleaning of the cysts, and we send this material
for cultivation and biopsy. We put unconstrained
total knee arthroplasty using orthopaedic cement
both in femur and tibia.
The laboratory check showed knee tuberculosis
and the patient took antituberculotic treatment
for 12 p.o. months. Four years after the operation
there are no clinical or laboratory evidences for
tuberculosis.
In the international literature is proposed TKR for
knee tuberculosis with good results, when patient
takes antituberculotic treatment before and after
the operation. There is also increasing danger of
disease’s recurrence when this treatment is given
only the p.o. period. But in our patient, 4 years
p.o., the final result is completely satisfactory.