INTRODUCTION: During the 20th century, the life expectancy increased by 30 years. At the same time, the number of people living longer than that has grown significantly. The aim of this study was to investigate whether total hip or knee arthroplasty (THA or TKA) in patients over 80 years of age does not reduce their life expectancy. MATERIAL AND METHODS: The study examined the data of patients who had undergone THA or TKA between 1994 and 2002 and were older than 80 years at the time of surgery. The study group was divided into a group of patients in whom elective total hip or knee arthroplasty was performed for arthritis and into a group of patients who underwent the same procedure for proximal femur fracture. The investigated parameter was the real survival, which was compared with the life expectancy predicted by the Institute of Health Information and Statistics of the Czech Republic. We also monitored postoperative mortality and postoperative interval after which the life expectancy was no longer reduced. RESULTS: The study included 547 patients. Of whom, 96 patients underwent elective surgery (36%) and 351 patients underwent surgery for intracapsular hip fracture (64%). In the elective surgery group, the survival was longer than the national average: In the 80-84-year group, the median survival was 6.0 years vs. median life expectancy of 5.6 years; in the 85-89-year group, the median survival was 6.3 years vs. median life expectancy of 3.9 years. The fracture surgery group showed a decrease in the life expectancy compared to the national average - in the 80-84-year group, the median survival was 3.5 years vs. median life expectancy of 5.6 years, and in the 85-89-year group, the median survival was 2.9 years vs. median life expectancy of 3.9 years. The likelihood of postoperative mortality was significantly higher in the fracture group than in the elective group (p = 0.05 vs. 0.01), with the difference being the highest in the first 8 weeks after surgery. CONCLUSIONS: Correctly indicated THA or TKA in patients over 80 years of age improves the quality of life of these patients and does not reduce the life expectancy. Intracapsular femoral neck fractures in patients of that age can still be considered as an indication for surgical treatment as a life-saving procedure. KEY WORDS: total hip arthroplasty, total knee arthroplasty, osteoarthritis, hip fracture, life expectancy.
- MeSH
- lidé MeSH
- míra přežití MeSH
- naděje dožití * MeSH
- náhrada kyčelního kloubu * mortalita metody MeSH
- senioři nad 80 let MeSH
- totální endoprotéza kolene * mortalita MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
BACKGROUND: Patients with hemophilia (PWH) develop hemophilic arthropathy of the major joints due to recurrent hemarthrosis. This study retrospectively estimated the age at which PWH may expect to develop hemophilic arthropathy and undergo joint replacement surgery. RESEARCH DESIGN AND METHODS: Using retrospective data from PWH at a Czech orthopedic center, Kaplan Meier analyses were used to estimate the cumulative proportions of patients with hemophilic arthropathy and undergoing joint replacement surgery as a function of age. RESULTS: Based on 1028 joint examinations in 167 PWH, hemophilic arthropathy of the knees, elbows, ankles and hips was estimated to develop by a median age of 48, 51, 52 and 61 years, respectively, with ≈80% of patients having such damage by ≈70 years of age. Hemophilic arthropathy of the shoulder occurred much later (median >80 years). In patients undergoing knee or hip replacement surgery, hemophilic arthropathy of the knee and hip occurred at a median age of ≈50 and ≈60 years, respectively, with replacement surgery occurring at a median of ≈70 and >75 years. CONCLUSIONS: In PWH, the risk of developing hemophilic arthropathy accumulates continuously over the patient's lifetime, allowing predictions about the ages at which such damage and joint replacement surgery may occur.
- MeSH
- hemartróza diagnóza etiologie MeSH
- hemofilie A * komplikace MeSH
- kolenní kloub MeSH
- lidé středního věku MeSH
- lidé MeSH
- loketní kloub * MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Outcomes of total knee replacement in cases of hemophilic patients are worse than in patients who undergo operations due to osteoarthritis. Previous publications have reported varying rates of complications in hemophilic patients, such as infection and an unsatisfactory range of motion, which have influenced the survival of prostheses. Our retrospective study evaluated the data of hemophilic patients regarding changes in the development of the range of motion. METHODS: The data and clinical outcomes of 72 total knee replacements in 45 patients with hemophilia types A and B were reviewed retrospectively. Patients were operated between 1998 and 2013. All of the patients were systematically followed up to record the range of motion and other parameters before and after surgery. RESULTS: The mean preoperative flexion contracture was 17° ± 11° (range, 0°-40°), and it was 7° ± 12° (range, 0°-60°) postoperatively. The mean flexion of the knee was 73° ± 30° (range, 5°-135°) before the operation and 80° ± 19° (range, 30°-110°) at the last follow-up. The mean range of motion was 56° ± 34° (range, 0°-130°) before the operation and 73° ± 24° (range, 10°-110°) at the last follow-up. CONCLUSIONS: Statistical analysis suggested that the range of motion could be improved until the 9th postoperative week. The patient should be operated on until the flexion contracture reaches 22° to obtain a contracture < 15° postoperatively or until the contracture reaches 12° to obtain less than 5°. The operation generally does not change the flexion of the knee in cases of hemophilic patients, but it reduces the flexion contracture and therefore improves the range.
- MeSH
- dospělí MeSH
- hemofilie A diagnostické zobrazování psychologie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- nemoci kloubů diagnostické zobrazování psychologie chirurgie MeSH
- retrospektivní studie MeSH
- rozsah kloubních pohybů fyziologie MeSH
- totální endoprotéza kolene metody psychologie trendy MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY Minimally invasive surgery (MIS) techniques have recently become a powerful and effective marketing instruments that are often perceived by the patient as the criterion of the surgeon?s and institution?s standard. In addition to studies reporting the benefits of minimally invasive procedures, some authors have recently found no such benefits or even pointed out some disadvantages. In this paper we present our own view of this issue. Our definition of minimally invasive surgery: a minimally invasive procedure is such that an optimally placed incision using anatomical intervals without damage to muscle insertions allows us to gain a good view of the operating field and to safely perform the planned surgery. Because of this optimal approach it is possible to make skin incisions shorter. MATERIAL Between April 21, 2005, and December 28, 2006, the first 40 MIS hip procedures were performed at the Department of Orthopaedic Surgery of the ILF Bulovka. Forty patients who, in the same period, were operated on from an anterolateral standard approach and who met the same indication criteria, including age, comprised a control group. In both groups all routinely used types of implants were included. METHODS For objective assessment of potential differences between surgical outcomes of the two techniques, the following parameters were recorded: operating time, peri-operative blood loss, pre- and post-operative Hb levels, Hb level on the first postoperative morning, amount of blood drained away with a Redon drain, number of anodyne applications (indirect evaluation of post-operative pain) and length of hospital stay. The parameters were compared for the cemented and the uncemented implants separately. The results were evaluated using the paired t-test, with the significance level set at a value of p?0.05. RESULTS A comparison of the MIS-AL results with those of the standard total hip replacement procedure did not show any significant differences, not even during further follow-up; by the end of 2008 no implant failure or necessity of revision arthroplasty was reported. DISCUSSION So far the only indisputable fact is that all the benefits of minimally invasive techniques described until now are merely related to time, as they facilitate a faster rate of soft tissue repair; therefore, these techniques only shorten recovery and thus speed up return of the operated hip to full function. CONCLUSIONS Based on comparison of the standard anterolateral and minimally invasive techniques it can be concluded that the MIS-AL approach is effective even without the use of special instrumentation. However, the results of this study failed to give unambiguous support to its advantage over the classical technique.
- MeSH
- cementování MeSH
- kyčelní protézy MeSH
- lidé středního věku MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony MeSH
- náhrada kyčelního kloubu metody MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- srovnávací studie MeSH
- MeSH
- chirurgie s pomocí počítače MeSH
- lidé MeSH
- totální endoprotéza kolene metody MeSH
- Check Tag
- lidé MeSH
- MeSH
- klinické protokoly MeSH
- lidé středního věku MeSH
- lidé MeSH
- protézy a implantáty MeSH
- radiografie MeSH
- senioři MeSH
- totální endoprotéza kolene metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
- srovnávací studie MeSH
- MeSH
- faktor IX aplikace a dávkování MeSH
- faktor VIII aplikace a dávkování MeSH
- farmakoterapie metody MeSH
- hemartróza etiologie chirurgie terapie MeSH
- hemofilie A genetika komplikace terapie MeSH
- hemofilie B MeSH
- lidé MeSH
- muskuloskeletální nemoci etiologie chirurgie terapie MeSH
- nemoci kloubů etiologie farmakoterapie chirurgie MeSH
- Check Tag
- lidé MeSH
- MeSH
- dospělí MeSH
- kosti zápěstní chirurgie patologie MeSH
- lidé MeSH
- pseudoartróza chirurgie MeSH
- transplantace kostí metody MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- diferenciální diagnóza MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- longitudinální studie MeSH
- mladiství MeSH
- myositis ossificans chirurgie klasifikace patofyziologie MeSH
- sporty MeSH
- svaly chirurgie zranění MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
V úvodu článku autoři neiprve vysvětlují a definují terminologii používanou u probatorních operací v ortopedii. Dále jsou rozebírány všechny typy probatorních operací, zavřeně i otevřené, které jsou dále děleny na excizionální a incizionální. K provedení vlastní probatorní operace musíme přistupovat stejně zodpovědně jako k provedení definitivního výkonu po úkončení a pečlivém zhodnocení všech nezbytných zejména klinických a rentgenoiogických předoperačních vyšetření. Jednotlivé techniky jsou dále podrobně popsány. Probatorní operace by měla být provedena co nejzodpovědněji tak, aby umístění řezu umožnilo při definitivním výkonu excizi přístupového kanálu en bloc, s minimálním krvácením a kontaminací okolí, a umožnilo odběr dostatečného množství hodnotitelné patologické tkáně. V závěru jsou uváděny možné komplikace probatorních operací.
At the begging of the article the authors are giving he explanation and definition of the terms of biopsy in orthopedic surgery. Then they are in details explaining all types of biopsy - closed and open, which is further divided into excisional and incisional. Prior to the performance of a biopsy procedure, all necessary clinical snd radiological evaluations must be performed and a biopsy procedure must be planned as carefully as the definitive procedure. The details of all biopsy technilues are well-described. Biopsy should be done meticulously, with emphasis on proper placement of incision, avoidance of excessive dissection and hemorr"lage, receiving proper amount and quality of pathologic tissue and must be finished with tight closure; and done in such a way that biopsy tract re-excision as mm- part of an en bloc excision is later possible. Finally, possible complications of these procedures are discussed.
