PURPOSE OF THE STUDY Total arthroplasty of the first metatarsophalangeal joint is one of the surgical treatment options for patients with advanced hallux rigidus. This study evaluates the pressure changes in the propulsion phase of the gait cycle using dynamic pedobarography after the total arthroplasty of the first metatarsophalangeal joint by Medin PH-Flex and their comparison with the control groups of patients with hallux rigidus and with asymptomatic patients. MATERIAL AND METHODS Dynamic pedobarograph was used to evaluate 15 first MTP joint replacements by Medin PH-Flex implants in 12 female patients, the average time since joint replacement was 3.5 years (1.5 to 5.5 years). The control group consisted of 13 forefeet in 12 patients with hallux rigidus of Grade 3 and Grade 4 according to the Coughlin classification and 17 healthy patients with no clear foot deformity, i.e. of a total of 34 forefeet. A zone for each metatarsal (M1-M5) and the big toe area (T1) were defined with the use of an integrated software. The difference between the pressure under the big toe area and the first metatarsal bone - hallux stiffness (T1-M1) and the forefoot balance parameter, i.e. the difference between the pressures under the medial and lateral half of the forefoot ((M1+M2)-(M3+M4+M5)), was obtained. The parameters were evaluated for each group during the propulsion phase of the gait, i.e. from 55% to 100% of the stance phase and from 75% to 100% of the stance phase, i.e. that part of propulsion when the greatest pressure is exerted on the big toe. RESULTS For the HS parameter (T1-M1) in 55% to 100% of the stance phase, the median value was -0.66 ± 1.22 (-1.90 to 1.45) in the control group, -0.85 ± 1.94 (-1.40 to 3.80) in patients with hallux rigidus, and -0.10 ± 1.48 (-1.30 to 2.40) in patients after the first MTP joint replacement. The median forefoot balance parameter from 55% of the stance phase was -3.48 ± 2.45 (-6.90 to 0.68) in healthy patients and -4.43 ± 2.72 (-6.98 to 0.23) in hallux rigidus patients. In patients after the joint replacement, the value was -3.00 ± 2.46 (-6.20 to 0.40). The data were statistically analysed by the Dunnett's and Tukey's multiple comparison tests. The hallux stiffness parameter showed a significant improvement after the joint replacement compared to patients with hallux rigidus (p<0.0001). No statistical significance was confirmed when comparing the joint replacement cases and the healthy patients from the control group (p=0.0007 and p=0.0010, respectively). As concerns the forefoot balance parameter, a significant difference was reported in patients with joint replacement compared to healthy patients from the control group and patients with hallux rigidus (p <0.0001). DISCUSSION The published pedobarographic studies differ in terms of the methodology used, the patient population and the parameters examined. The pedobarographic studies after the replacement of the first MTP joint or after its arthrodesis present inconclusive outcomes. According to the available literature, the joint replacement has the potential to improve mediolateral forefoot loading and to partially restore the weight-bearing function of the first ray. Our analysis of the HS parameter suggests that the MTP joint replacement can improve the big toe function compared to patients with hallux rigidus but fails to achieve the functional outcomes of healthy patients. When evaluating the forefoot balance (FB) parameter, we can observe less loading on the lateral half of the forefoot in the propulsion phase compared to hallux rigidus. Nonetheless, the joint replacement is unable to restore the physiological loading of the foot. CONCLUSIONS The first MTP joint replacement has the potential to improve forefoot function and to bring it closer to that of a healthy person, even though achieving physiological loading of the forefoot is unrealistic. Additional studies will be needed to confirm that the indication for the first MTP joint replacement is justified in hallux rigidus in terms of the effect on forefoot biomechanics. Key words: hallux rigidus, total replacement of the first MTP joint, dynamic pedobarography, footscan.

• MeSH
• biomechanika MeSH
• chůze (způsob) MeSH
• hallux rigidus * chirurgie   MeSH
• lidé MeSH
• noha (od hlezna dolů) MeSH
• palec nohy * MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

PURPOSE OF THE STUDY Developmental dysplasia of the hip still remains one of the most discussed topics in paediatric orthopaedics. The comprehensive care of paediatric patients with congenital developmental dysplasia of the hip at our department in the period from 1970 to 1985 included, among other things, the open reduction using Ludloff s approach in hip joints where closed reduction was not possible. This technique was supported by some of our own previous observations, such as the original classification of intraoperative findings on acetabular labrum (limbus). This study aims to evaluate the long-term results of treatment of our patients where Ludloff s open reduction was used and seeks to establish a conclusive correlation between the final result and the method of treatment of individual types of limbus, possibly confirming or ruling out that the dependence of later development of the acetabulum is dependent on correct and sparing treatment of this barrier to reduction. MATERIAL AND METHODS In the period from 1970 to 1985, the Ludloff s open reduction was performed in 70 patients. In 8 cases bilateral surgery was carried out. A total of 78 hip joints were operated on. The patients underwent the surgery at the age of 5-23 months. Postoperatively, the Hanausek biomechanical apparatus was applied to complete the treatment. In total, documentation of 21 surgeries performed in 20 patients was successfully tracked down. Two patients were removed from the group for incomplete documentation. The final group of patients included a total of 18 patients, of whom there were 13 women and 5 men. In one female patient the surgery was performed bilaterally. The shape of the femoral head, the center-edge (CE) angle and the degree of osteoarthritic changes were assessed on the pelvic radiograph of each patient. The functional result was evaluated using the Harris Hip Score (HHS). RESULTS For the purpose of assessment, the patients were divided into sub-groups based on the intraoperative finding on acetabular labrum. Type I limbus was found in a total of 5 cases. The mean HHS was 93, the mean CE angle was 22.5°. Aseptic necrosis occurred in one patient. Type II limbus was found in a total of 3 patients. The mean HHS was 84, the mean CE angle was 22°. Aseptic necrosis was observed in one patient. Type III limbus was found in 8 patients. The mean HHS was 79, the mean CE angle was 19.4°. Osteoarthritic changes of degree II-III were identified. Necrosis of the femoral head was recorded in 2 patients. Type IV limbus was found three times. The mean HHS was 73, the mean CE angle was 13.3°. Osteoarthritic changes of type III were present. Necrosis of the femoral head was recorded altogether in 2 patients. DISCUSSION The results of the Ludloff procedure reported in the available literature differ markedly as to the resulting function of the hip joint and the incidence of avascular necrosis. No author gave a description of the actual acetabular labrum deformity or showed a detailed description of individual vessel ligations. The advantage of this method is beyond any doubt its low invasiveness and when correctly performed also the minimal burden to the child. Its disadvantage is a certain degree of difficulty in performing this surgery, a worse visualisation of all barriers to reduction and a more challenging treatment of the posterior portion of the hip joint compared to techniques using the anterior approach. CONCLUSIONS Our outcomes indicate that the resulting Harris Hip Score was best in patients with the intraoperative finding of type I limbus. All the other types (ll-IV) showed worse HHS results. From the current perspective, it is in all likelihood more advantageous to use surgical approaches that enable better visualisation of the anatomical deformities and allow for better options for their treatment.

• Klíčová slova
• otevřená repozice dle Ludloffa,
• MeSH
• acetabulum patologie   růst a vývoj   MeSH
• kojenec MeSH
• lidé MeSH
• vývojová kyčelní dysplazie * chirurgie   patologie   MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

• MeSH
• lidé MeSH
• pooperační komplikace MeSH
• replantace metody   MeSH
• selhání protézy MeSH
• totální endoprotéza hlezenního kloubu * MeSH
• Check Tag
• lidé MeSH

Publikace nabízí komplexní pohled na využití sledování pohybu očí při hodnocení a optimalizaci map. Čtenáři se v ní dozvědí teoretické základy, na kterých technologie eye-tracking funguje, seznámí se s různými způsoby měření pohybu očí a rovněž získají základní přehled o oblastech, ve kterých je eye-tracking využíván, samozřejmě s důrazem na kartografii. Značná část knihy je zaměřena prakticky.; Publikace nabízí komplexní pohled na využití sledování pohybu očí při hodnocení a optimalizaci map. Čtenáři se v ní dozvědí teoretické základy, na kterých technologie eye-tracking funguje, seznámí se s různými způsoby měření pohybu očí a rovněž získají základní přehled o oblastech, ve kterých je eye-tracking využíván, samozřejmě s důrazem na kartografii. Značná část knihy je zaměřena prakticky. Nejprve je popsáno doporučené vybavení eye-tracking laboratoře a jsou představeny tři typy eye-trackerů. Následují kapitoly zaměřené na přípravu, design a průběh experimentu, pre-processing, validaci a čištění dat, a konečně na samotné vyhodnocení naměřených pohybů očí. V těchto kapitolách autor vycházel z vlastních zkušeností, jež se snažil prostřednictvím této publikace předat dalším výzkumníkům.

Příručka, která se zaměřuje na eye-tracking při hodnocení a optimalizaci map, zejména na praktickou stránku výzkumu. Určeno odborné veřejnosti.; Publikace nabízí komplexní pohled na využití sledování pohybu očí při hodnocení a optimalizaci map. Čtenáři se v ní dozvědí teoretické základy, na kterých technologie eye-tracking funguje, seznámí se s různými způsoby měření pohybu očí a rovněž získají základní přehled o oblastech, ve kterých je eye-tracking využíván, samozřejmě s důrazem na kartografii. Značná část knihy je zaměřena prakticky. Nejprve je popsáno doporučené vybavení eye-tracking laboratoře a jsou představeny tři typy eye-trackerů. Následují kapitoly zaměřené na přípravu, design a průběh experimentu, pre-processing, validaci a čištění dat, a konečně na samotné vyhodnocení naměřených pohybů očí. V těchto kapitolách autor vycházel z vlastních zkušeností, jež se snažil prostřednictvím této publikace předat dalším výzkumníkům.

• MeSH
• automatizované zpracování dat MeSH
• geografická kartografie MeSH
• kognitivní věda MeSH
• pohyby očí MeSH
• technologie sledování pohybu očí MeSH
• výzkum MeSH
• zrak MeSH
• Publikační typ
• příručky MeSH

• Konspekt
• Geodezie. Kartografie
• NLK Obory
• věda a výzkum
• neurovědy

• MeSH
• artrodéza MeSH
• lidé MeSH
• pooperační bolest chirurgie   etiologie   MeSH
• pooperační komplikace * chirurgie   MeSH
• protézy kloubů MeSH
• reoperace * metody   MeSH
• talus * chirurgie   patologie   MeSH
• Check Tag
• lidé MeSH

PURPOSE OF THE STUDY: The first metatarsophalangeal (MTP) joint replacement ranks among the treatment methods of patients with hallux rigidus. The paper aims to evaluate the short-term to mid-term outcomes and to present clinical experience with our Medin PH-flex implant. MATERIAL AND METHODS In the period from January 2011 to 2016 we performed total replacement of the first MTP joint in 31 patients, in 4 cases bilaterally. In total, 35 implants were evaluated. The mean age of the patient at the time of surgery was 57.7 years (39-72 years). The surgery was conducted in 29 women and 2 men. The patients were evaluated using the AOFAS score (American Orthopaedic Foot and Ankle Society score), the radiographs were assessed as to the potential occurrence of radiolucent lines, with major stress put on the assessment of the mobility in MTP joint and its position. The pain was assessed based on the VAS score. RESULTS Prior to the joint replacement surgery, the mean AOFAS score in patients was 55.6 (35-65). Postoperatively, the mean AOFAS score was 80.8 (65-95). The pain suffered by patients was evaluated with the use of the Pain Visual Analogue Scale (VAS score). The preoperative mean VAS score was 5 (2-8), whereas the postoperative score improved to mean VAS 2 (0-4). The range of motion was clinically assessed with a goniometer. The mean range of motion of plantar flexion and dorsiflexion was 16.00° (5-35°) and 28.60° (10-55°), respectively. The mean range of motion was 36° (15-60°). No intraoperative complications were observed. In all the patients, the surgical wound healed per primam. In 2 female - (5.7 %) of the whole group of patients who underwent surgery a deep infection occurred, namely 10 and 21 months following the implantation. In both the female patients their condition was managed by joint revision operation and by a simple removal of the implant. DISCUSSION Joint replacement related matters were repeatedly discussed in professional literature. There are many papers published in the literature on this topic. A whole range of the first MTP joint implants of different shapes have been developed, with extremely different clinical results. CONCLUSIONS An appropriately chosen type of the implant, a fitting indication and a correctly applied implantation technique can lead to the desired good outcome. The first MTP joint replacement should be indicated after careful consideration since the management of a potential joint replacement failure can often be very technically challenging and quite mutilating for the patient. The mid-term outcomes of the Medin a.s. first MTP implant seem to be promising. It will, however, be necessary to wait for long-term outcomes in order to evaluate the final benefits of this type of implant in patients with hallux rigidus. Key words: hallux rigidus, arthroplasty of the MTP joint, hemiarthroplasty, silicone implant.

• MeSH
• artroplastiky kloubů škodlivé účinky   metody   MeSH
• dospělí MeSH
• hallux rigidus diagnostické zobrazování   chirurgie   MeSH
• infekce spojené s protézou etiologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• měření bolesti metody   MeSH
• metatarzofalangeální kloub diagnostické zobrazování   patofyziologie   chirurgie   MeSH
• protézy - design MeSH
• protézy kloubů * škodlivé účinky   MeSH
• radiografie MeSH
• reoperace MeSH
• rozsah kloubních pohybů MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Úvod: Aponeurosis plantaris je důležitou strukturou v oblasti předonoží. Prostorové uspořádání jednotlivých jejích částí je důležité pro udržování stability nohy. V dostupné anatomické literatuře je zejména v grafickém znázornění množství chyb a nepřesností. V našem článku jsme se rozhodli poukázat na některé důležité aspekty týkající se anatomie plantární aponeurózy a z nich vyplývající biomechaniky. Materiál a metoda: Ve studii bylo použito celkem 20 preparátů prvních metatarzofalangových skloubení 12 kadáverů v Anatomickém ústavu 1. lékařské fakulty Univerzity Karlovy v Praze. Do studie byly zařazeny pouze končetiny, které nevykazovaly deformitu předonoží a proběhlé operace. Zvláštní pozornost jsme pak věnovali uspořádání distální části plantární aponeurózy, sagitálním septům, která se upínají do plantárních plotének (fibrocartilago art. metatarsophalangeae) jednotlivých metatarzofalangových skloubení. Výsledky: Ve studii bylo vyhodnoceno 20 plantárních aponeuróz u 12 kadáverů. V souboru preparátů bylo 8 žen a 4 muži. U všech preparátů byly vždy přítomny a plně vyvinuty pruhy centrální části, mediální i laterální části. Ve všech případech byly vyvinuty distální pruhy centrální části v podkoží stáčející se do meziprstních prostor. Pruhy distální části byly značně variabilní a jejich okraje se vytrácely do podkoží okolní tkáně. Průměrná šíře byla 7 mm (2–13 mm). Sumací jednotlivých šířek a směrů těchto distálních pruhů vznikla rekonstrukce a schéma, které jsou součástí této publikace. Diskuze: Komplex aponeurosis plantaris a na ní napojených struktur tvoří důležitou funkční jednotku, která je základem pro fungování stabilizačního mechanismu nohy, takzvaného navijákového (windlass) mechanismu. Mnoho autorů se ve svých pracích zabývá úlohou plantární aponeurózy při rozvoji některých patologií prvního paprsku nohy. Napříč literaturou pak panuje shoda ohledně důležitosti obnovení fyziologických poměrů při chirurgické léčbě nejčastějších deformit prvního paprsku, jako jsou hallux valgus a hallux rigidus. Distální část plantární aponeurózy tvoří prostorovou síť, která slouží nejenom pro udržování správného postavení skeletu nohy, ale rovněž pro ukotvení nášlapných polštářů. Při poruchách funkce aponeurosis plantaris vznikají deformity nohy typu hallux valgus anebo hallux rigidus.

Introduction: Aponeurosis plantaris is an important structure in the forefoot. The spatial arrangement of its parts is important in maintaining the stability of the foot. The anatomical literature available often contains many number of errors and inaccuracies, mainly in the graphical representation. In this article, we decided to highlight some important aspects relating to the anatomy of plantar aponeurosis and biomechanics resulting from them. Materials and methods: In this study, a total of 20 specimens of metatarsophalangeal articulation in 12 cadavers at the Department of Anatomy, 1st Medical Faculty of Charles University in Prague. The study included only limbs that did not show deformity of the forefoot and or any surgery to it. Special attention was then devoted to the arrangement of the distal part of the plantar aponeurosis, sagittal septum that was clamped into the plantar discs (fibrocartilage art. Metatarsophalangeae) and each individual metatarsophalangeal articulation. Results: The study evaluated 20 plantar aponeurosis in 12 cadavers. The samples came from 8 women and 4 men. All samples always had present and fully developed streaks in the central portion, medial and lateral parts. In all cases, distal stripes on the central part in the dermis were developed, curving into the interdigital spaces. Stripes on the distal part were highly variable and their edges faded into the hypodermic tissue. The average width was 7 mm (2-13 mm). By summarising the various widths and orientations of the distal bands a reconstruction and a scheme were constructed, which are included in this publication. Discussion: The complex aponeurosis plantaris and its associated structures form an important functional unit, which is the basis for the functioning of the stabilization mechanism of the legs, the so-called windlass mechanism. Many authors in their papers deal with the role of plantar aponeurosis in the development of some pathologies of the first ray of the foot. Across the literature, there is a consensus on the importance of restoring physiological conditions during surgical treatment of the most common deformities of the first ray, such as hallux valgus and hallux rigidus. The distal part of the plantar aponeurosis creates a spatial network, which serves not only to maintain the correct position of the bones of the legs, but also as an anchor for the sole of the foot. Malfunctions to the aponeurosis plantaris lead to foot deformities such as hallux valgus or hallux rigidus.

• MeSH
• biomechanika * MeSH
• fascie anatomie a histologie   patologie   MeSH
• fasciotomie MeSH
• hallux rigidus etiologie   MeSH
• hallux valgus etiologie   MeSH
• kloubní ligamenta anatomie a histologie   patologie   MeSH
• lidé MeSH
• mechanický stres MeSH
• metatarzalgie etiologie   MeSH
• metatarzofalangeální kloub anatomie a histologie   MeSH
• metatarzus anatomie a histologie   patologie   MeSH
• mrtvola MeSH
• plantární plocha anatomie a histologie   MeSH
• plochá noha etiologie   MeSH
• přednoží člověka * anatomie a histologie   patologie   MeSH
• zatížení muskuloskeletálního systému MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

The mixed research design is a progressive methodological discourse that combines the advantages of quantitative and qualitative methods. Its possibilities of application are, however, dependent on the efficiency with which the particular research techniques are used and combined. The aim of the paper is to introduce the possible combination of Hypothesis with EyeTribe tracker. The Hypothesis is intended for quantitative data acquisition and the EyeTribe is intended for qualitative (eye-tracking) data recording. In the first part of the paper, Hypothesis software is described. The Hypothesis platform provides an environment for web-based computerized experiment design and mass data collection. Then, evaluation of the accuracy of data recorded by EyeTribe tracker was performed with the use of concurrent recording together with the SMI RED 250 eye-tracker. Both qualitative and quantitative results showed that data accuracy is sufficient for cartographic research. In the third part of the paper, a system for connecting EyeTribe tracker and Hypothesis software is presented. The interconnection was performed with the help of developed web application HypOgama. The created system uses open-source software OGAMA for recording the eye-movements of participants together with quantitative data from Hypothesis. The final part of the paper describes the integrated research system combining Hypothesis and EyeTribe.

• MeSH
• lidé MeSH
• pohyby očí * MeSH
• software * MeSH
• správnost dat MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

UNLABELLED: PURPOSE OF THE STUDY Total joint replacement is one of the options in surgical treatment of advanced ankle arthritis. It allows the ankle to remain mobile but, unfortunately, it does not provide the same longevity as total knee or hip replacements. Therefore, decisions concerning the kind of treatment are very individual and depend on the clinical status and opinion of each patient. MATERIAL AND METHODS A total of 132 total ankle replacements were carried out in the period from 2004 to 2015. The prostheses used included the Ankle Evolutive System (AES) in 52 patients, Mobility Total Ankle System (DePuy) in 24 patients and, recently, Rebalance Total Ankle Replacement implant in 53 patients. Three patients allergic to metal received the Taric prosthesis. Revision arthroplasty using the Hintegra prosthesis was carried out in four patients. The outcome of arthroplasty was evaluated on the American Orthopaedic Foot and Ankle Society (AOFAS) scoring scale. Indications for total ankle arthroplasty included post-traumatic arthritis in 83 patients, rheumatoid arthritis in 37 and primary arthritis in 12 patients. There were 78 women and 54 men, with an average age of 55.6 years at the time of surgery. RESULTS The average follow-up was 6.1 years (1-11 years). The average AOFAS score of the whole group increased from 33.2 before surgery to 82.5 after it. The primary indication had an important role. Arthroplasty outcomes were poorer in patients with post-traumatic arthritis than in those with rheumatoid arthritis or primary arthritis. In patients with post-traumatic arthritis, the average AOFAS score rose to 78.6 due to restricted motion of the ankle, and some patients continued to have pain when walking. The average AOFAS score in a total of 49 patients who had rheumatoid arthritis or primary arthritis reached a value of 86.4. Post-operative complications were recorded in ten patients (7.6%) in whom part of the wound was healing by second intention. Ossification was also a frequent complication and had to be removed in six patients (4.5%). No early infection was recorded and late infection was treated in three patients. The prosthesis had to be removed and ankle arthrodesis performed in seven patients (5.3%). All had necrosis of the talus with ankle instability. In five, the retrograde nail Medin was used and extensive defects remaining after talar necrosis were filled with massive bone grafts obtained from a bone bank. One patient required tibio-calcaneal arthrodesis with external fixator; surgery in one case involved the use of a Zimmer Trabecular Metal Ankle Fusion Spacer with retrograde nail fixation. The development of cystic radiolucencies adjacent to tibial or talar components presents another post-operative complication. It was recorded mostly in the patients after AES implantation, in whom eight of 52 (15.3%) had these findings. DISCUSSION Total ankle arthroplasty is a complicated surgical procedure potentially associated with various technical problems. The occurrence of complications is indirectly related to the experience of the orthopaedist performing surgery; literature data show that the number of complication decreases with an increased frequency of ankle replacements done. CONCLUSIONS Total ankle arthroplasty, as every orthopaedic surgery, has its advantages and disadvantages. The positive aspects are pain relief and improved mobility of the ankle allowing for physiological gait. However, it shows a lower survivorship rate that the other large joint replacements. A successful outcome depends on the correct indication. The ankle should be stable, the talus without signs of necrosis and valgus or varus deviations of the ankle should not exceed 10 to 15 degrees. KEY WORDS: total ankle arthroplasty, re-implantation, aseptic loosening, retrograde nail, Trabecular Metal spacer, revision arthroplasty.

• MeSH
• artritida chirurgie   MeSH
• artrodéza statistika a číselné údaje   MeSH
• hlezenní kloub chirurgie   MeSH
• lidé MeSH
• pooperační komplikace epidemiologie   MeSH
• reoperace statistika a číselné údaje   MeSH
• selhání protézy MeSH
• totální endoprotéza hlezenního kloubu přístrojové vybavení   statistika a číselné údaje   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH