BACKGROUND: Mid-term results (clinical and radiographic) of ultra-short anatomical cementless stem total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head (ONFH) has not often been presented. The aim of this study is to evaluate THA using the Proxima stem in patients with ONFH in the mid-term. METHODS: The study consists of 73 patients (97 THAs) with a Proxima stem implanted between 2006 and 2015. The mean age of patients was 47.4 years, with a mean follow-up 105.2 months. The clinical results include preoperative and postoperative Harris Hip Scores (HHSs). Radiological follow-up reports on stem migration, bony trabecular development and radiolucent lines. The complications and revisions were registered. Kaplan-Meier survival analysis was performed to determine the implant survival. RESULTS: The average HHS improved significantly from 40.3 preoperatively to 98.0 at the final evaluation (p ˂ 0.0001). Stem migration (subsidence and "varisation") was observed in 11 hips (in 9 of them up to 6th postoperative month without any further progression, in 2 with progressive migration and radiological loosening). Bony trabecular development was detected in modified Gruen zones (1,2,4,6,7 for Proxima stem): in zone 1 (0%), 2 (67.0%), 4 (64.9%), 6 (64.9%), 7 (0%). Radiolucent lines were observed in 1 cup and 6 stems (2 were loose, 4 with fibrous stable fixation). Complications were found in 5 hips (5.1%): squeezing hip once, repeated dislocation in 1, 1 early deep infection, and 2 loose stems. 2 hips (2.1%) were revised (dislocation, infection). The implant survival was 98.9% and 97.9% clinically and radiologically, respectively. CONCLUSIONS: Observations in the mid-term show that the clinical and radiological results of the Proxima stem in patients with ONFH are promising. The stem design preserves the proximal femoral bone stock. The bony trabecular appearance confirms physiological proximal femoral load transmission.
- MeSH
- hlavice femuru chirurgie MeSH
- kyčelní protézy * MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu * škodlivé účinky metody MeSH
- následné studie MeSH
- nekróza hlavice femuru * diagnostické zobrazování chirurgie MeSH
- protézy - design MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY The aim of this study is to assess the mid-term results of this specific ultra-short, cementless stem in patients younger than 60 years with regard to clinical and radiographic outcomes, survivorship, complication rate and revisions. MATERIAL AND METHODS A consecutive series of one hundred and twenty-one patients (130 hips) younger than 60 years at the time of surgery was enrolled in the study. Primary arthritis (33.8%) and dysplastic hips (30%) were the most common diagnoses. The patients used crutches for 6 weeks to protect femoral components against subsidence and rotational stress. The mean follow-up was 118 months (range 96-156 months). RESULTS At the final evaluation, the mean Harris Hip Score was 98.8. A perioperative periprosthetic fracture occurred in two hips and a perioperative ceramic insert breakage was observed in one hip. One hip had ceramic insert fracture 3.5 years postoperatively. In one hip a dislocation occurred. These two hips (1.5%) were revised due to reasons not associated with the stem. One hip has aseptic asymptomatic polyethylene inlay wear. In two hips squeezing was reported. There were two cases of loosening and migration of stems (1.5%) with osteolysis all around the stems. These patients have moderate thigh pain. The radiological survival is 98.5% and the clinical survival is 100% after 10 years on average. DISCUSSION Although improved clinical results were reported in younger patients with standard cementless stems, some problems still prevail: thigh pain, proximal stress shielding, difficult removal of the stem. In an effort to reduce these problems, Proxima ultra-short anatomical cementless stem was developed. Several studies show that this stem design provides good short- and mid- term results, but only in a limited number of patients and relatively short follow-up. Furthermore, the initial fears of early aseptic loosening due to the absence of diaphyseal fixation were not confirmed. CONCLUSIONS Proxima ultra-short anatomical cementless stem provided excellent mid-term clinical and radiographic results in patients younger than 60 years. Key words: total hip arthroplasty, ultra-short cementless anatomical stem.
BACKGROUND: The aim of this study was to evaluate the clinical and radiological outcomes (in mid-term) after "shortening" scarf osteotomy of the fifth metatarsal for the treatment of bunionette deformity. METHODS: We retrospectively reviewed the functional score - American Orthopaedic Foot and Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Interphalangeal Scale, radiographic results - 4th/5th intermetatarsal angle, varus angle of the 5th metatarsophalangeal joint and complications in a consecutive series of 34 feet (27 patients) with bunionette. Nine males and 18 females (mean age: 45 years) were included in the study. Three males and four females were operated bilaterally The patients were operated on between 2004 and 2015, and evaluated during 2017. RESULTS: The average AOFAS score improved from 59.4 to 93 at a mean follow-up of 7.2 years. The 4th/5th intermetatarsal angle and varus angle of the 5th metatarsophalangeal joint decreased from 13.9°/19.5° preoperatively to 6°/5.9° at final follow-up. No neurovascular damage was recorded. Complications arose in five feet (14.7%): delayed union (n=1), early infection (n=1), distal screw migration (n=1), asymptomatic non-union (n=1), transverse metatarsalgia (n=1). The osteotomy healed within less than three months except twoo (delayed union, non-union). Three feet needed additional surgery: screw removal (n=2), Weil osteotomy of 2nd-4th metatarsals (n=1). CONCLUSIONS: "Shortening" scarf osteotomy is an acceptable, but not complication-free, treatment option for the bunionette deformity and offers promising results in the mid-term.
- MeSH
- bunionette deformity diagnóza chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- metatarzální kosti diagnostické zobrazování chirurgie MeSH
- metatarzofalangeální kloub diagnostické zobrazování chirurgie MeSH
- následné studie MeSH
- osteotomie metody MeSH
- rentgendiagnostika MeSH
- retrospektivní studie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: The aim of this study has been to present outcomes after cementless arthroplasty for developmental dysplasia Crowe type IV of the hip, with transverse subtrochanteric shortening osteotomy and using the S-ROM stem. METHODS: We evaluated radiographs, functional scores and complications in a consecutive series of 23 patients (28 hips) with high dislocation of the hip. The average age of patients at surgery was 49.9 (range 22-68) years. The operations were performed between 2007 and 2013. Patients were assessed retrospectively-clinically and radiographically during the year 2018. RESULTS: The mean follow-up period was 94 (range 60-134) months. The average Harris hip score improved from 39.9 to 84.0. The mean leg length discrepancy decreased from 5 cm preoperatively to 1.4 cm at the final follow-up. All acetabular components were implanted into the true acetabulum, and all prostheses were stable at the latest examination. No neurovascular damage was recorded. We have identified specific complications in seven hips (25%) in total: Intraoperative femoral fracture required fixation in four hips; three hips (10.7%) needed revision: Recurrent dislocation, with the need for cup reorientation, occurred in two hips (in one of them, this was followed by the subsequent need for resection of heterotopic ossification); there was one aseptic stem loosening with the need of one-stage revision. All the osteotomies healed within 8 months. CONCLUSION: Hip arthroplasty with transverse shortening femoral osteotomy, using S-ROM stem, is an acceptable, but not complication-free treatment method in patients with Crowe type IV developmental hip dysplasia, in the midterm.
- MeSH
- dislokace kloubu etiologie chirurgie MeSH
- dospělí MeSH
- kyčelní kloub * diagnostické zobrazování patofyziologie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu * škodlivé účinky metody MeSH
- nestejná délka dolních končetin etiologie chirurgie MeSH
- osteotomie * škodlivé účinky metody MeSH
- pooperační komplikace * diagnóza patofyziologie chirurgie MeSH
- rentgendiagnostika metody MeSH
- reoperace * škodlivé účinky metody statistika a číselné údaje MeSH
- retrospektivní studie MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) MeSH
- vývojová kyčelní dysplazie * diagnóza chirurgie 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 The purpose of our retrospective study is to evaluate 5-year functional and radiological outcomes in patients following corrective osteotomy of the distal radius and ulnar osteotomy for malposition after a distal radius fracture, to identify differences in the outcomes of corrective osteotomies depending on the type of the original fracture according to the AO classification, the grade of arthritis of radiocarpal (RC) joint, surgical approach and the way of stabilisation of the osteotomy. MATERIAL AND METHODS The followed-up group of 22 patients (8 men and 14 women) underwent osteotomy for malposition of distal radius in the period 2007-2011. The age of patients in the followed-up group ranged from 21 to 72 years, with the mean age of 51 years at the time of surgery. The indications for corrective osteotomy due to distal radius deformity were the following: functional limitation, pain and radiological parameters confirming the deformity. The opening wedge osteotomy of distal radius performed through volar or dorsal approach, isolated shortening osteotomy of ulna and a combination of both the methods were used. The observations included: the original type of fracture according to AO/OTA classification, functional outcomes - Disabilities of the Arm Shoulder and Hand (DASH) score, Mayo Wrist Score (MWS), range of motion, grade of wrist arthritis and specific complications. The follow-up period was 5 years. RESULTS Average results were obtained in the group of patients before/after the osteotomy: DASH score- 35/14, MWS- 54/77, flexion- 44°/64°, dorsiflexion- 48°/61°, supination- 75°/79°, pronation- 72°/83°, ulnar duction- 20°/23°, radial duction- 9°/16°, grip strength in percentage- 59%/83%. After osteotomy, a statistically significant increase was observed in flexion, dorsiflexion, supination, pronation, radial duction, ulnar duction, grip strength in percentage, MWS, while in the DASH score a statistically significant decrease was reported. Based on the statistical evaluation of differences in functional outcomes after osteotomy, in patients with type A and C original distal radius fractures no difference in range of motion parameters was found after osteotomy. As to the mean values, the flexion and dorsiflexion range of motion was greater by 10° in patients after extra-articular osteotomy for malposition following the type A original fracture as compared to the type C fracture. By measuring the Joint Space High (JSH) ratio, no statistically significant changes were found regarding the progression of arthrosis of the radiolunate and radioscaphoid part of the RC joint as against the arthrosis in patients up to 5 years after corrective osteotomy of the distal radius. In patients with distal radius malposition and RC joint grade 1-2 arthritis according to the Knirk and Jupiter classification, better functional outcomes were achieved than in the limited and total wrist arthrodesis. In our patients, at 5 years after osteotomy no worsening was observed of the existing wrist arthritis and no arthritis was newly diagnosed. Specific complications were found in 4 cases (18.2 %). In 2 patients after radial osteotomy from dorsal approach (extensor tendon irritation, rupture of the long extensor tendon of the thumb), removal of osteosynthesis material was necessary in both the patients. In one patient after the isolated ulnar shortening osteotomy, an intraoperative fissure of distal ulnar fragment was detected, which healed without any further complications. In one patient an iatrogenic fracture of anterior superior iliac spine was observed after harvesting the corticospongious graft from the ala of the ilium. DISCUSSION Corrective osteotomy is a well-established method for treating distal radius deformities following a fracture. Even at present, there are various opinions regarding the indications, contraindications, timing of the surgery, osteotomy technique and the need to use a bone graft. Limited or total wrist arthrodeses in the area of wrist arthrosis and deformities bring good results with respect to the pain relief, but a limited range of motion occurs mainly in younger patients. Bearing this in mind, in grade 1-2 wrist arthritis in patients with distal radius deformities, a better functional outcome can be achieved by osteotomy. By using dorsal or volar approach, comparable outcomes can be obtained, but with the dorsal approach there is higher frequency of complications and the need to remove the osteosynthesis material. CONCLUSIONS Corrective osteotomies resulted in an improved functional outcome in the treatment of deformities after a distal radius fracture. Apart from deformity correction, the treatment has been affected also by the RC joint arthritis. The study confirmed neither statistically significant differences in the osteotomy outcomes in patients with the original type A or type C distal radius fracture according to the AO classification, nor the statistical significance of the RC joint arthritis. Our results have proven better functional outcomes of deformity correction achieved by osteotomy in case of grade 1 and 2 arthritis than by the limited wrist arthrodesis. In patients showing arthritic changes, no progression was reported within five years after the osteotomy. Key words: distal radius fracture, distal radius deformity, osteotomy, functional results.
- MeSH
- fraktury vřetenní kosti * diagnóza etiologie chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- obnova funkce MeSH
- osteotomie * škodlivé účinky metody MeSH
- pooperační komplikace diagnóza MeSH
- poranění zápěstí * komplikace patofyziologie MeSH
- radius * diagnostické zobrazování zranění chirurgie MeSH
- rentgendiagnostika MeSH
- rozsah kloubních pohybů MeSH
- špatně zhojené fraktury diagnóza chirurgie MeSH
- zápěstní kloub * diagnostické zobrazování patofyziologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
V našej práci prezentujeme kazuistiku 44ročného pacienta so spontánnou bilaterálnou ruptúrou proximálnej časti ligamentum patellae. U pacienta neboli zistené systémové ochorenia ako rizikové faktory šľachových ruptúr. Diagnóza bilaterálnej ruptúry bola potvrdená fyzikálnym vyšetrením a RTG nálezom (patella alta). Druhý deň po úraze bola u pacienta realizovaná bilaterálna reinzercia ruptúr transoseálnymi stehmi cez tunely v patele spolu s odľahčením sutúry serklážnymi slučkami. Vzhľadom k re-ruptúre na pravom kolene po dvoch týždňoch od sutúry bola realizovaná revízna operácia - reinzercia šľachy pôvodnou metódou a augmentáciou šľachami musculus semitendinosus a musculus gracilis. Pooperačne boli obidve kolená fixované v ortézach po dobu 12 týždňov, flexia do 60° bola pacientovi povolená po 6 týždňoch a flexia nad 90° po 9 týždňoch. Po jednom roku od úrazu mal pacient aktívne bilaterálne plnú extenziu. Rozsah flexie v pravom kolene bol 125° a vľavo 130°. Subjektívne pociťoval pacient pravé koleno ako stabilnejšie. Klinický výsledok operačnej liečby bilaterálnej ruptúry ligamentum patellae závisí od skorej operačnej intervencie a pooperačnej rehabilitácie. V prípade re-ruptúr, sutúr s časovým odstupom a v prípadoch nedostatočnej kvality šľachy je indikovaná augmentácia šľachy autológnym štepom, alogénnym štepom alebo syntetickými materiálmi. Podobný prípad sme v slovenskej ani českej literatúre zatiaľ popísaný nenašli.
We present the case of a 44-year-old patient with spontaneous bilateral ruptures of the proximal part of the patellar ligament. There were no identified specific risk factors for tendon ruptures. The diagnosis of bilateral patellar tendon rupture was confirmed in the initial physical examination with unambiguous x-ray diagnosis of patella alta. The second day after the injury, the patient underwent bilateral reinsertion of the rupture with transosseous suture (FiberWire) through tunnels in patella, together with the protection of the primary repairs using cerclage wires. Due to re-rupture of the patella ligament of the right knee two weeks later, revision procedure was carried out. That consisted of resuture of the tendon by the original method and augmentation using the semitendinosus and gracilis tendons. Postoperatively, both knees were fixed in orthoses for 12 weeks, flexion to 60° was allowed after 6 weeks, and flexion beyond 90° after 9 weeks. After one year from injury, the patient had an active bilateral full extension. The range of the right knee flexion was 125° and 130° on the left. The range of the right knee flexion was 125° and 130° on the left. The patient subjectively felt his right knee to be more stable. The clinical results of surgical treatment of the bilateral rupture ligamentum patellae tendons depend on early surgical intervention and post-operative rehabilitation. Augmentation of the tendon with autograft, allograft, or synthetic materials is indicated in the case of re-ruptures, late sutures and in cases of deficient quality of the tendon. We found no similar case described either in the Slovak or Czech literature.
- MeSH
- autologní transplantace metody MeSH
- dospělí MeSH
- lidé MeSH
- ligamentum patellae * chirurgie patofyziologie zranění MeSH
- ortopedické výkony metody MeSH
- poranění kolena * diagnostické zobrazování chirurgie rehabilitace MeSH
- šlachy chirurgie transplantace MeSH
- výsledek terapie MeSH
- zadní stehenní svaly chirurgie patofyziologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
The study was aimed at the clinical and biomechanical analyses of the sliding hip screw breakage with the use of finite element method. We have identified two patients with the sliding screw breakage. In the first patient, the biomechanical analysis revealed the reduced stress values σHMHnot exceeding the yield limit or strength limit of the implant. The yield limit was exceeded in second one. Clinical and biomechanical analyses have demonstrated that adherence to technical requirements of the appropriate osteosynthesis implementation is the principal condition of timely healing since it prevents the material failure.
- MeSH
- biomechanika MeSH
- fraktury kyčle diagnostické zobrazování patofyziologie MeSH
- kostní šrouby * MeSH
- lidé středního věku MeSH
- lidé MeSH
- mechanický stres * MeSH
- selhání protézy * MeSH
- senioři nad 80 let MeSH
- teoretické modely MeSH
- testování materiálů MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
CIEĽ ŠTÚDIE: Autori prezentujú pooperačné výsledky u 21 pacientov ošetrených v rokoch 1999 až 2008 pre zlomeninu hlavičky radia typu Mason II. Poukazujú na výhody osteosyntézy hlavičky radia pomocou Herbertovej skrutky pri tomto type zlomenín. MATERIÁL: Hodnotili 21 pacientov po operácii zlomeniny hlavičky radia typu Mason II. V súbore bolo 9 mužov a 12 žien. Priemerný vek pacientov bol 41,10 rokov (od 17-60 rokov). Pacientov operovali priemerne do 6 dní od úrazu. Na kontrolu prišli priemerne po 3 rokoch a 8 mesiacoch (1-8 rokov). METÓDY: Retrospektívne hodnotili pacientov pomocou kontrolného funkčného, röntgenologického vyšetrenia, za použitia Mayo Elbow Performance Score (MEPS) [17], skóre Radina a Riseborougha [25|, skóre Broberga a Morreyho [2] v modifikácii podľa Judeta [8], Oxford Elbow skóre (OES) [19] a Disabilities of the Arm, Shoulder and Hand (DASH) Skóre [3]. VÝSLEDKY: Pomocou MEPS dosiahli výborný výsledok u 13 pacientov a dobrý výsledok u 8 pacientov. Pomocou skóre podľa Radina a Riseborougha zistili dobrý výsledok u 13 pacientov, vyhovujúci výsledok u 5 pacientov a zlý výsledok u 3 pacientov. Pomocou skóre podľa Broberga a Morreyho v modifikácii podľa Judeta dosiahli výborný výsledok u 9 pacientov, dobrý výsledok u 9 pacientov a u 3 pacientov vyhovujúci výsledok. Priemerná hodnota DASH bola 4,22 a priemerná hodnota OES dosiahla 44,62 bodov, čo svedčí pre vyhovujúcu funkciu kĺbu. ZÁVER: Na základe retrospektívnej štúdie autori doporučujú využitie Herbertovej skrutky pri liečbe všetkých zlomenín hlavičky radia typu Mason II, kde veľkosť fragmentu umožňuje jej použitie. Za jedno z najväčších pozitív Herbertovej skrutky považujú schopnosť zabezpečiť stabilnú fixáciu zlomeniny a z toho plynúcu možnosť včasnej funkčnej liečby pacientov.
PURPOSE OF THE STUDY: The authors present postsurgical results in 21 patients treated in 1999– 2008 for radial head fractures of Mason II type. They stress advantages of radial head osteosynthesis with Herbert screw in this type of fractures. MATERIAL: They evaluated 21 patients after surgical treatment of radial head fractures of Mason II type. Their set consisted of 9 men and 12 women. Mean age of the patients was 41.10 years (17–60 years). The patients were operated within an average of 6 days after the injury. They underwent postsurgical examination in an average of 3 years and 8 months (1–8 years). METHODS: They evaluated the patients retrospectively by means of functional and X-ray examinations, Mayo Elbow Performance Score (MEPS) [17], Radin and Riseborough score [25|, Broberg and Morrey score [2] in modification according to Judet [8], Oxford Elbow score (OES) [19] and Disabilities of the Arm, Shoulder and Hand (DASH) Score [3]. RESULTS: Using MEPS they achieved excellent results in 13 patients and good results in 8 patients. Using Radin and Riseborough score they achieved good results in 13 patients, satisfactory results in 5 patients and bad results in 3 patients. Using Broberg and Morrey score in modification according to Judet they achieved excellent results in 9 patients, good results in 9 patients and satisfactory results in 3 patients. The mean value of DASH was 4.22 and the mean value of OES was 44.62 points, which manifests satisfactory joint function. CONCLUSIONS: Based on retrospective study the authors recommend use of Herbert screw in treatment of all radial head fractures of Mason II type if size of the fragment enables its use. They consider ability to provide stable fixation of the fracture and possibility of early functional treatment of patients as the greatest positives of the Herbert screw. KEY WORDS: radial head fractures, Mason II, Herbert screw.
- Klíčová slova
- zlomeniny hlavičky radia, Mason II, Herbertova skrutka,
- MeSH
- dospělí MeSH
- fraktury vřetenní kosti chirurgie MeSH
- kostní šrouby statistika a číselné údaje využití MeSH
- lidé středního věku MeSH
- lidé MeSH
- pooperační komplikace MeSH
- retrospektivní studie MeSH
- vnitřní fixace fraktury metody využití MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
