PURPOSE OF THE STUDY The study aims to evaluate the long-term results of computer-navigated total knee arthroplasties performed by less experienced surgeon performing a small number of procedures per year. MATERIAL AND METHODS In the prospective randomised study functional and radiological results, rate of revision and probability of clinical and radiological survival were compared in 30 computer-navigated (in 28 patients: 19 women, 9 men, with the mean age of 66.9 years) and 31 conventionally implanted (in 30 patients: 27 women, 3 men, with the mean age of 66.5 years) cemented total knee replacements without patellar resurfacing. The group was composed of patients who underwent surgery performed by the same surgeon who at the time of enrolment of patient in the study had no previous experience with the total knee replacement surgery and performed up to 30 such procedures annually. The mean follow-up of patients was 11 years. RESULTS No statistically significant differences were detected regarding the mean age, sex, body mass index and etiology of osteoarthritis of the operated knee. The mean duration of computer-navigated surgeries (101±14.1; 80-140 min) was considerably longer than the duration of conventional joint replacements (94±8.2; 80-100 min; p = 0.01). When evaluating the radiological results, a statistically significant difference was found between the groups only with respect to the mean value of dorsal inclination of the tibial component (88.2 ̊±2.1 vs 86.2 ̊±3, p = 0.02). The mean values of other monitored angles did not show any significant differences. The number of correct implants (with a deviation of 3 degrees from the target values) was statistically significantly higher in the group of computer-navigated joint replacement surgeries in all the monitored parameters (aFT: 87% vs. 67%, p = 0.04; α: 87% vs. 71%, p = 0.04; β: 87% vs. 65%, p = 0.03; γ: 93% vs. 74%, p = 0.02; δ: 90% vs. 77%, p = 0.04). Radiologic signs of unstable fixation were detected in 2 cases of computer-navigated joint replacement surgeries and in 7 cases of conventional replacements. Cumulative probability of radiologic survival at 10 years reached 93% in the compute-navigated surgery and 77.4% (p = 0.047) in the group with conventional procedure. In total, 4 revision surgeries with a reimplantation of at least one prosthetic component were reported. All the cases came from the conventional implantation group due to aseptic loosening of the endoprosthesis. In the computer-navigated group, one revision was performed for patellar pain, without replacing or adding any endoprosthetic component. The probability of clinical survival in computer-navigated replacements after 10 years was 100%, in conventional total knee replacements it was 87% (p = 0.04). The cumulative total endoprosthesis revision rate in the computer-navigated group was 3.3%, whereas in the group with conventional total knee replacements it was 12.9% (p = 0.04). The clinical assessment based on the WOMAC and Knee Society Scores showed no statistically significant differences. DISCUSSION The most common cause of the failure of total knee arthroplasties is the malposition of implants which results in early aseptic loosening. The radiologically correct position of knee endoprosthesis is seen in 80% of standard replacement surgeries performed by experienced surgeons. The potential error rate can even increase if the arthroplasties are performed by less experienced orthopaedic surgeons. The computer-navigated total knee replacement was introduced to make the position of implants more accurate. However, the question remains unanswered if more accurate positioning of the implants achieved with computer navigation decrease the revision rate and extend the long-term survival of knee endoprostheses. CONCLUSIONS Kinematic computer navigation allowed a less experienced and low-volume orthopaedic surgeon to make the implantation of endoprostheses more accurate, to decrease the total revision rate, and thus to ensure a higher probability of long-term survival of total knee arthroplasties. Key words:computer navigation, total replacement, knee joint, long-term outcomes, low-volume surgeon, less experienced surgeon.
- MeSH
- chirurgie s pomocí počítače * škodlivé účinky metody MeSH
- dlouhodobé vedlejší účinky prevence a kontrola MeSH
- hodnocení výsledků zdravotní péče MeSH
- klinické kompetence normy MeSH
- lidé MeSH
- osteoartróza chirurgie MeSH
- protézy kolene škodlivé účinky MeSH
- selhání protézy etiologie MeSH
- senioři MeSH
- totální endoprotéza kolene * škodlivé účinky metody MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
PURPOSE OF THE STUDY: The aim of the study was to evaluate the incidence of osteopenia and osteoporosis in the patients elected to cementless total hip replacement. MATERIAL AND METHODS: The group evaluated comprised 100 patients with primary or secondary forms of coxarthrosis who underwent cementless total hip arthroplasty (THA). The results of densitometric examination of the lumbar spine and proximal femur were analysed. Based on the lowest T-score value, the patients were divided into three groups, i.e., fist, normal bone density; second, osteopenia; third, osteoporosis. Clinical examination included patient medical history, Harris hip scores and visual analogue scale assessment for pain intensity; the Kellgren-Lawrence classification was used to measure the grade of hip osteoarthritis; blood tests were made to assess the levels of total calcium, ionised calcium, phosphorus, vitamin D and the markers of bone resorption and formation. RESULTS: Osteoporosis was found in 32 and osteopenia in 21 patients; 47 patients had normal bone density. Osteoporosis was detected in the lumbar spine of 21 patients, in the proximal femur of nine patients and at both sites in two patients. In 13 patients this diagnosis was made for the fist time. The patients with osteoporosis had a significantly lower body mass index. There were no differences in the other characteristics, i.e., age, functional, radiological and laboratory findings, among the groups; all three showed the mean vitamin D concentration below the lowest level of its physiological range. Insufficient vitamin D levels were found in 54 women and 18 men. Of all patients, only 13 women and four men took vitamin D supplements. DISCUSSION Osteoarthritis and osteoporosis are the most frequent complex musculoskeletal diseases. Several studies have suggested that these disorders are mutually exclusive. This assumption has been based on the absence of radiographic evidence of osteoarthritis seen in many elderly patients with femoral neck fractures. Our relatively frequent findings of osteopenia and osteoporosis in this study show that patients with osteoarthritis may not be protected from the development of generalised osteoporosis. Our results are compared with the relevant literature data and potential effects of osteoporosis and vitamin D deficiency on total hip arthroplasty are discussed. CONCLUSIONS: Hip osteoarthritis does not reduce the risk of generalised osteoporosis. We found a relative high incidence of osteopenia and osteoporosis as well as vitamin D deficiency in patient with advanced form of hip osteoarthritis.
- MeSH
- artróza kyčelních kloubů komplikace patofyziologie chirurgie MeSH
- bederní obratle patofyziologie MeSH
- femur patofyziologie MeSH
- index tělesné hmotnosti MeSH
- kostní cementy MeSH
- kostní denzita fyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- metabolické nemoci kostí komplikace patofyziologie MeSH
- náhrada kyčelního kloubu * MeSH
- nedostatek vitaminu D komplikace MeSH
- osteoporóza komplikace patofyziologie MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
PURPOSE OF THE STUDY: The aim of the study was to investigate the involvement of osteoporosis during remodelling of the proximal femur after uncemented total hip arthroplasty (THA) and the effect of bisphospohonate treatment on these changes. MATERIAL AND METHODS: Sixty evaluated patients with non-cemented THA were divided into three groups on the basis of pre-operative densitometric examinations. Group 1 (15 patients with osteoporosis) received a single dose of 5 mg zoledronic acid in infusion during the second post-operative week. Group 2 (15 patients with osteoporosis) were not treated by bisphospohonate. The patients of both groups took oral calcium and vitamin D medication. Group 3 (control) comprised 30 patients with normal bone density who did not take any osteoactive drugs. By measurement of bone mineral density (BMD) at 12 months after surgery, changes in periprosthetic bone of the proximal femur in 7 Gruen zones were recorded by densitometry. In addition, radiological findings on native X-ray images were assessed and the patients' clinical health status was rated by the Harris hip score. RESULTS: No significant differences in either the average age or the body mass index were found between the groups at the time of THA surgery. The mean BMD value in all assessed Gruen zones measured at the first post-operative week was higher in patients with normal bone density than in those with osteoporosis. The mean BMD value measured at 12 months decreased in all Gruen zones in comparison with the initial value, and this was found in all three groups. The lowest values were recorded in the untreated patients (group 2); in comparison with the patients who had normal bone density, the difference was statistically significant in Gruen zones 1, 2, 6 and 7. Although the patients with treated osteoporosis also showed lower BMD values, these were not statistically significant compared to group 3. The worst post-operative outcome in clinical health status was recorded in the patients with untreated osteoporosis. X-ray examination revealed stable fibrous ingrowth in one patient with untreated osteoporosis and in one with normal bone density. All remaining patients had stable bone ingrowth fixation. DISCUSSION: In THA the majority of compressive loads are transferred through the stem to the femoral bone below the apex of the stem. This results in reduction of bone density in the calcar and greater trochanter regions. Osteoporosis is the most important factor related to changes in periprosthetic bone mass. Therefore, it can be anticipated that an excess loss of bone mass in the proximal femur may, in a long term, interfere with THA stability and may increase the risk of periprosthetic fractures and aseptic loosening. CONCLUSIONS: The results of our study showed that the patients with untreated osteoporosis, who underwent uncemented THA, experienced a considerable decrease in the periprosthetic bone density of the proximal femur and were in worse clinical health. A bisphospohonate therapy was effective in eliminating this negative outcome. Both the clinical and densitometric findings in patients with treated osteoporosis were similar to those in patients with no osteoporosis.
- MeSH
- absorpční fotometrie MeSH
- bisfosfonáty terapeutické užití MeSH
- femur fyziologie chirurgie MeSH
- imidazoly terapeutické užití MeSH
- inhibitory kostní resorpce terapeutické užití MeSH
- kostní denzita MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu metody MeSH
- osteoporóza komplikace farmakoterapie patofyziologie MeSH
- prospektivní studie MeSH
- remodelace kosti * MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY: The aim of the study was to evaluate the clinical and radiographic results of total hip arthroplasty (THA) with the Metha short hip stem and their comparison with the outcomes of THA using a conventional cementless stem. MATERIAL AND METHODS: A total of 30 Metha stems and 30 standard Biocontact stems implanted in the period from 2007 to 2012 were evaluated. The Metha patient group comprised 22 women and six men, with the mean age of 58.9 ± SD 8.7 years (43-75), mean height of 164.2 ± 6.3 cm (156-178), mean body mass of 68.2 ± 12 (48-91) and mean BMI of 25 ± 3.9 (19-32). The Biocontact group included 19 women and 11 men, with the mean age of 63.6 ± 10.8 years (45-77), mean height of 166.6 ± 6.6 cm (152-175), mean body mass of 77.6 ± 13.1 (46-104) and mean BMI of 27.6 ± 4.3 (20-37). The evaluation was based on plain X-ray findings and clinical status assessed using the Harris hip score and 10-point visual analogue scale (VAS) for pain before surgery and at final follow-up. RESULTS: In the Metha group the mean pre- and post-operative Harris hip scores were 41.7 ± 9.9 (28-57) and 94.4 ± 5.1 (82-100), respectively. In the Biocontact group the values were 41.5 ± 11.9 (32-64) and 89.3 ± 11.2 (57-100), respectively. The mean VAS for low back and thigh pain improved from the pre-operative value of 7.41 ± 2.1 (4-9) to 0.56 ± 1.0 (0-3) in the Metha group and from 7.29 ± 2.2 (4-9) to 1.64 ± 1.8 (0-5) in the Biocontact group. The post-operative results in both rating systems were significantly better (p<0.05) in the Metha than the Biocontact group patients. All stems showed radiographic evidence of good osteointegration. Stem subsidence and calcar atrophy were recorded in one patient of the Metha group. In the Biocontact group stem subsidence was found in two patients and signs of stress shielding in 14 patients. DISCUSSION: Short hip stems have been introduced in THA implantation with the aim to restore physiological biomechanics as much as possible and to ensure good long-term functioning of the joint replacement as well as to save the proximal femoral bone tissue for potential THA re-implantation. Our results of short hip stem implantation presented in this study are compared with the results of relevant recently published literature. CONCLUSIONS: Short hip stems show adequate osteointegration without need for diaphyseal fixation and allow for more natural weightbearing distribution in the proximal femur. The short- and mid-term clinical results are better than with the use of conventional cementless stems. They can be recommended as an optimal choice for use in younger patients with good bone quality who are expected to require THA re-implantation.
- MeSH
- kyčelní kloub * radiografie chirurgie MeSH
- kyčelní protézy klasifikace MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu * škodlivé účinky přístrojové vybavení metody MeSH
- pooperační období MeSH
- protézy - design * MeSH
- selhání protézy MeSH
- senioři MeSH
- srovnávací výzkum účinnosti MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- srovnávací studie MeSH
PURPOSE OF THE STUDY Based on a retrospective analysis, the authors present their experience with treatment of subtalar dislocation of the foot. MATERIAL AND METHODS Between 1999 and 2011 six patients, all of them men, with the average age of 31 years were treated for subtalar fractures. Five patients were diagnosed with medial dislocation and one with lateral dislocation. In one patient with medial subtalar dislocation it was an open injury. The clinical and radiographic results of the patients followed up for 1 to 12 years (average, 7.8 years) were retrospectively evaluated. RESULTS The achieved average score, based on the AOFAS ankle and hindfoot scale, was 91.3 points (? 9.77; minimum, 73; maximum, 100). Excellent results were recorded in four patients, good in one and satisfactory in the patient with lateral dislocation. Radiographic signs of subtalar joint osteoarthritis were found in one patient. No neurological or circulation disorders, skin necrosis, signs of reflex sympathetic dystrophy, aseptic bone necrosis of the talus, infection or joint instability were recorded. DISCUSSION A subtalar dislocation of the foot involves simultaneous dislocation of the talocalcaneal and talonavicular joints. It is a rare injury accounting for about 1 to 2% of all traumatic dislocations. It may occur as medial, lateral, anterior or posterior subtalar dislocation. The results of treatment depend on several factors, such as the type of dislocation (medial and open dislocations are at higher risk), associated injuries, or damage to deep skin layers, and also on an exact diagnosis, early and accurate reduction and sufficiently long foot immobilisation.
- Klíčová slova
- subtalární luxace,
- MeSH
- dislokace kloubu * etiologie chirurgie terapie MeSH
- dospělí MeSH
- imobilizace metody MeSH
- klouby nohy (od hlezna dolů) chirurgie zranění MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- ortopedické výkony metody MeSH
- retrospektivní studie MeSH
- subtalární kloub * chirurgie zranění MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- hodnotící studie MeSH
Úvod: Plazma bohatá na trombocyty je definovaná ako koncentrát ľudských trombocytov v malom množstve plazmy. Jej liečebné vlastnosti sú založené na účinku faktorov, ktoré sa uvoľňujú z aktivovaných trombocytov. Tieto faktory majú kľúčovú úlohu v regulácii a stimulácii procesu hojenia a tkanivovej regenerácie. Cieľ práce: Cieľom našej práce bolo overiť účinnosť a bezpečnosť intraartikulárne podávaného prípravku autológnej krvnej plazmy bohatej na trombocyty, ktorý je pripravovaný na našom pracovisku, pre pacientov s osteoartrózou kolenného kĺbu. Materiál a metódy: Do prospektívnej náborovej štúdie bolo zaradených 60 pacientov s osteoartrózou kolenného kĺbu. Pacienti boli náhodne rozdelení do dvoch skupín zložených z 30 pacientov. Prvá skupina pacientov bola liečená prípravkom z autológnej krvnej plazmy bohatej na trombocyty. Pacientom kontrolnej skupiny bol dovnútra kĺbu aplikovaný prípravok kyseliny hyalurónovej. Liečba v oboch skupinách pozostávala z troch podaní liečebného prípravku v týždňových intervaloch. Klinický stav pacientov bol hodnotený pred začatím liečby a 3 mesiace po poslednej aplikácii liečebného prípravku pomocou indexu osteoartrózy WOMAC, schémy NRS a PGIC. Výsledky: Pri hodnotení WOMAC a NRS pred začatím liečby a po 3 mesiacoch od ukončenia liečby sme zaznamenali signifikantné zlepšenie v obidvoch skupinách. Pri porovnávaní výsledkov WOMAC a NRS medzi skupinami sme zistili signifikantne lepšie výsledky v skupine pacientov s aplikovanou autológnou plazmou bohatou na trombocyty. Nezaznamenali sme žiadne komplikácie liečby. Priemerná koncentrácia trombocytov v prípravku autológnej plazmy bohatej na trombocyty bola 4,5-násobne vyššia ako koncentrácia trombocytov v periférnej krvi v jednotke objemu. Záver: Vzhľadom na biologický potenciál autológnej plazmy bohatej na trombocyty pri regenerácii tkanív, jej relatívne jednoduchú prípravu a aplikáciu, bezpečnosť z hľadiska vylúčenia rizika prenosu infekčných ochorení a vzniku alergických reakcií a v súlade s priaznivými, aj keď zatiaľ len krátkodobými výsledkami nášho klinického skúšania, považujeme aplikáciu autológnej plazmy bohatej na trombocyty pri liečbe osteoartrózy kolenného kĺbu v počiatočných štádiách za bezpečnú a efektívnu metódu liečby.
Poranenia väzov členkového kĺbu patria k najčastejším poraneniam pohybového aparátu. Pri nesprávnej diagnostike a nevhodnej liečbe môže dôjsť k vážnym poruchám členkového kĺbu, ktoré dokážu pacienta obmedzovať už pri bežných pohybových aktivitách. Cieľom práce bolo vyhodnotiť výskyt jednotlivých stupňov akútnych poranení laterálneho väzivového aparátu členkového kĺbu v našom súbore pacientov a porovnať výsledky operačnej a konzervatívnej liečby u pacientov s poranením tretieho stupňa. V priebehu 5 rokov sme ošetrili 3148 pacientov s poranením laterálneho väzivového aparátu členka. Z 234 pacientov, ktorí mali diagnostikované poranenie tretieho stupňa, sme do štúdie zaradili 39 pacientov konzervatívne liečených a 18 operačne liečených pacientov. Hodnotili sme funkčné výsledky po 12 a 24 mesiacoch od úrazu. Pri porovnaní výsledkov operačnej a konzervatívnej liečby u pacientov s tretím stupňom poškodenia väzov laterálneho členka bola potvrdená štatistická významnosť v prospech operačnej liečby. Signifikantne lepšie výsledky sme zistili u operačne liečených pacientov v závislosti od veku, v prospech pacientov do 25 rokov. V skupine konzervatívne liečených pacientov s tretím stupňom poškodenia sme nezistili štatisticky významnú odlišnosť v závislosti na vekovej hranici 25 rokov. Na základe dlhoročných skúseností, ako aj výsledkov hodnoteného súboru pacientov, môžeme konštatovať, že operačná liečba v indikovaných prípadoch dáva lepšie dlhodobé výsledky ako konzervatívna liečba z hľadiska reziduálnej bolesti a stability členkového kĺbu.
Acute injuries of the lateral ankle ligaments are one of the most common form of injury involving the musculoskeletal apparatus. Treatment usually range from cast immobilisation or acute surgical repair to functional rehabilitation. The aim of our study was to evaluate the incidence of different grades of acute injuries of lateral ligaments of the ankle joint in our patients group and to compare the results of non surgical versus surgical treatment of third grade injuries. 3148 patients were treated for acute lateral ankle sprain in a period of 5 years at our department. Each patient had stress X-ray of the ankle for evaluation of instability at the first visit. From the 234 patients with third grade injury, 39 were enrolled in our study with non surgical treatment and 18 with surgical treatment. Each group was divided regarding to the age in two subgroups. Functional outcome was evaluated 12 and 24 months after injury with AOFAS clinical rating scale and Sports Ankle Rating System--Single Assessment Numeric Evaluation. Statistical analysis was done with Pearson's Chi quadrate test with P < 0.05. First grade injury was present in 62%, second grade in 31% and only 7% of the patients had third grade injury of the lateral ankle ligaments. Further only third grade injuries were studied. Statistically significant better results were seen in patients under the age of 25, in the patient group with surgical treatment compared to patients over 25 years of age. Also statistically significant better results were seen in patient with surgical treatment to non surgical treatment in each age group. No significant difference was observed in the non surgical treatment group regarding to age. Although the injuries of the ankle ligaments belong to the most common injuries of the musculoskeletal system, there is no consensus in the treatment of such disorders. Our experiences and the results of our study show, that surgical treatment in indicated cases provides better results in residual pain and instability of the ankle joint after acute injury of the lateral ankle ligaments.
