PURPOSE OF THE STUDY In the last number of years, the anatomic hemiarthoplasty has gradually been pushed out of clinical practice by modern reverse shoulder arthroplasty (RSA) designs. This is due to the clear excellent functional results of RSAs in a wide spectrum of indication criteria. Nevertheless, RSAs have several possible complications that cannot occur in an anatomic hemiarthroplasty. In anatomic hemiarthoplasty, the importance of correct indication criteria and observing correct operative technique including soft tissue reconstruction is much more important than in RSA. Furthermore, there is a clear recent trend of increased use of humeral components fixed only in the proximal metaphyseal cancellous bone. Our aim was to summarise our six-year experience with the SMR® Stemless (LimaCorporate, Italy) system which is one of the most modern ones. MATERIAL AND METHODS Twenty cases of SMR® Stemless anatomic shoulder hemiarthroplasty performed between 2016 and 2021 were included in the study. All patients were followed up prospectively. The function was evaluated preoperatively and at the last follow-up. We evaluated the range of active elevation, classic Constant Score (CS) and pain level according to the visual analogue scale (VAS). Statistical evaluation was performed by using basic statistical methods and the statistical significance of the results was assessed with a paired t-test. Level of statistical significance was set at p= 0.01. RESULTS The mean follow-up in our cohort was 3.01 years (range 0.32-5.69, Median 2.82, SD 1.56) All cases were indicated for surgery due to primary osteoarthritis with a limitation of movement and pain. The mean postoperative CS was 85.7 (range 70-96, Median 86, SD 6.83). The mean active elevation postoperatively was 143° (range 100-170°, Median 150°, SD 20.76). Mean postoperative pain according to VAS was 1.05 (range 0-4, Median 1, SD 1.02). The mean preoperative elevation was 60.5° (range 30-100°, Median 65°, SD 18.83). After surgery the mean elevation increased to 143° (range 100-170°, Median 150°, SD 20.76). Statistical evaluation showed a statistically significant increase in the CS (41.7 preoperatively to 85.7 postoperatively), range of active elevation (60.5° preoperatively to 143° postoperatively) and a statistically significant decrease in pain (VAS 6.95 preoperatively to 1.05 postoperatively). We observed no cases of failure or loosening of the implant. A statistically significant increase in post-operative range of motion was demonstrated. DISCUSSION Most modern shoulder arthroplasty designs now include implants allowing for proximal humerus metaphyseal fixation in hemiarthroplasty and even RSA designs. The advantage of metaphyseal fixation without the use of a longer stem is clear. Notably, treatment of periprosthetic humeral fractures is simpler, extraction of the implant for any reason is easier and the preoperative anatomic position of the humeral head can be respected. As with any anatomic shoulder arthroplasty, the functional result is dependent on correct indication criteria, precise surgical technique, correct humeral head position and soft tissue reconstruction - primarily the rotator cuff. CONCLUSIONS Between 2016 and 2021, we performed 20 SMR® stemless shoulder hemiarthroplasties for primary osteoarthritis. The mean follow up was 3 years. The shoulder function improved significantly post-operatively in all patients. There were no cases of implant loosening or failure. Radiographic evaluation showed no implant loosening or change in implant position in the humeral metaphysis. Key words: shoulder joint replacement, reverse shoulder arthroplasty, SMR, stemless, total shoulder arthroplasty, shoulder hemiarthroplasty, EPOCA, wear.
- MeSH
- artroplastika ramenního kloubu * škodlivé účinky metody MeSH
- hemiartroplastika * škodlivé účinky MeSH
- hlavice humeru MeSH
- lidé MeSH
- osteoartróza * chirurgie MeSH
- pooperační bolest etiologie MeSH
- ramenní kloub * chirurgie MeSH
- rameno MeSH
- rozsah kloubních pohybů MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY Reverse total shoulder arthroplasty (RSA) can be considered a proven method for the treatment of the most severe shoulder joint affections. In this study, we present 14-year experiences of the authors with the LimaCorporate SMR® RSA system in 496 cases. MATERIAL AND METHODS Included in the study are 496 RSAs performed between 2007 and 2020. We successfully followed up 368 shoulders in 358 patients. This was a prospective study with function being evaluated preoperatively and at the last follow-up in 2020. We evaluated the range of motion in active elevation and the classic Constant Score (CS). According to this score, the pain level was also evaluated. Standard statistical methods were used with a paired t-test used for comparisons of values. RESULTS The mean follow-up in our group was 5.5 years (0.7-13.6, SD 3.22, median 4.96). Indications were: primary osteoarthritis (84), acute trauma (69), posttraumatic sequelae (79), cuff tear arthropathy (37), RA (29), chronic dislocations (18), final treatment of infectious complications (7), avascular necrosis (6), tumours (4) and TSA revisions (9). The mean post-operative CS of all patients was 71.9 (2-94, SD 11.26, median 73). The mean post-operative active elevation was 127.35° (30°-180°, SD 28.36, median 130°). The mean pain level at final follow-up was 0.65 (0-3, SD 0.65, median 1). There was a statistically significant improvement In the CS (26.9 to 71) and the final achieved elevation (48.5° to 127.35°) in all groups except acute traumas for obvious reasons. A significant decrease in pain (2.8 to 0.65) was observed in all groups. We saw no implant failures or UHMWPE component wear. DISCUSSION We compared our results with those published by other authors. When considering the functional outcomes, our results are comparable with those published previously. Compared to other studies, an interesting result is the low incidence of scapular notching. In our cohort of patients, it was only present in 10 (2.7%) cases. We attribute this to the design of the SMR® implant which meets the main criterium of a modern shoulder arthroplasty system: modularity of both glenoid components. The glenospheres are available in 36, 40 and 44mm sizes with standard and distalised options. Furthermore, the system also contains the Axioma® revision glenoid component. Humeral stems are available in a range of sizes and lengths including revision stems. The humeral body is also available in two sizes. The short variant is optimal for revision with hemiarthroplasty to reverse conversion. CONCLUSIONS During a period of 14 years, we performed 496 implantations of RSAs using the SMR® system. We evaluated 368 cases with an average follow-up of 5.5 years. During long-term follow-up we experienced no implant failures or complications indicative of any constructional insufficiencies. We saw no signs of UHMWPE liner wear. The SMR® system allows for treatment of even the most complex shoulder affections due to its high modularity. Key words: shoulder joint replacement, reverse shoulder arthroplasty, SMR®, Axioma®, outcomes, ROM, scapular notching, complication, polyethylene wear, UHMWPE.
PURPOSE OF THE STUDY This study aims to ascertain whether a high anteversion of the femoral neck can influence the measurement of the caputcollum-diaphyseal (CCD) angle on a plain anteroposterior (AP) radiograph of the proximal femur. MATERIAL AND METHODS We developed a new method of measuring the CCD angle and femoral neck version of the femur. This was done with the use of a computer program that utilised the measurement of the entire visualised area of femoral neck and shaft to calculate their long axis. Using this method, we measured the CCD angle and femoral neck version (FNV) of 100 photographed cadaveric femurs in two projections: The condylar line (CL) projection and the femoral neck (FN) projection. The same method was applied to 50 radiographs of the same femurs. The femurs were divided into three groups depending on the femoral neck version: Retro (FNV of <0°), Normal (FNV of 0-15°) and Ante (FNV of >15°) RESULTS We found a statistically significant difference in the CCD angle measured in the FN and CL projections in the Normal and Ante groups but not in the Retro group. There is a significant correlation between the increase in FNV and the difference between the measured CCD values in the FL and CL projections. The femoral neck version of our cadaveric femurs varied from -14. 4° to 31. 5° which is a range of more than 35°. CONCLUSIONS From the results, it is clear that with an increase in femoral neck anteversion, there is a statistically significant difference in the CCD angle measured between the two projections. This difference can be up to almost 10°. Surgeons should be aware of the limitation of the AP projection when planning for surgery on the hip. Key words: femoral neck anteversion, CCD angle, templating, preoperative planning.
- MeSH
- diafýzy MeSH
- femur * diagnostické zobrazování MeSH
- krček femuru diagnostické zobrazování MeSH
- lidé MeSH
- počítačová rentgenová tomografie * MeSH
- rentgendiagnostika MeSH
- Check Tag
- 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.
PURPOSE OF THE STUDY Periprosthetic joint infections in total knee arthroplasty (TKA) represent one of the most limiting factors of implantation. Frequency of this complication is up to 2.5% in primary implantation. Revision TKA with the use of DAIR (Debridement, Antibiotics and Implant Retention) procedure is a widely accepted method in treating infection, but the indication criteria have not been clearly defined as yet. The lack of uniformity prevails also with respect to the surgical technique and the importance of respective techniques for successful treatment. The purpose of this study was to evaluate the factors affecting the twoyear survival of TKA after treating the infection by DAIR. MATERIAL AND METHODS We conducted a monocentric retrospective analysis involving 52 cases of infected TKA managed with DAIR in the period between 2007 and 2016. The evaluation took into account such factors as the sex, age, history of revision surgery for aseptic or septic reasons, and pathogens. The patients were divided into groups based on the McPherson criteria. As to the procedure, we monitored the effect of administered antibiotics, time interval between the manifestation of symptoms of TKA infection and surgery, exchange of modular parts, and use of pulse lavage, continual lavage, local antibiotic carrier, or combination of these techniques. Treatment failure was defined as persistent infection and transition to chronic suppressive antibiotic therapy or need for revision surgery of the respective joint due to recurrent infection of TKA, or death directly associated with the treatment of infected TKA in the follow-up period of 2 years after DAIR. The R software (Team Development Core, 2017) was used to carry out the statistical analysis. The target variable was the failure at two years after surgery. The Generalized Linear Model (GLM) was used for the binary dependent variable - the socalled logistic model with a logit link function. RESULTS 32 of 52 patients (61.5%) were successfully treated, of whom 18 women (62.1%) and 14 men (60.9%). The effect of causative agent, administered antibiotics, polyethylene insert exchange, McPherson score or history of revision surgery of the respective joint for aseptic reasons was not confirmed. The history of revision surgery for infection of the affected joint had a strong negative impact on treatment success, 10 of 13 (76.9%) implants failed as against 10 of 39 (25.6%) implants with negative history of infection. The mean time from surgery to the manifestation of infection was 5.9 weeks (0.5-47.5). When surgery was performed within 2 weeks from the manifestation of infection, 1 of 15 (6.7%) cases failed. In case of a later surgery, 19 of 37 (51.4%) cases failed. As concerns the used surgical technique, 60% (9/15) failure was reported in case of the combination of pulse lavage and continual lavage, 36.4% (4/11) in case of the combination of pulse lavage and local antibiotic carrier, 25% (4/16) in case of separate continual lavage, and 66.7% (2/3) in case of continual lavage with local antibiotic carrier. DISCUSSION The importance of individual factors in revision surgery of periprosthetic joint infections of TKA remains unclear. The world literature indicates as a major negative effect the time factor, the positive history of infection of the affected implant, or other previous revision surgery for aseptic reasons. Ambiguous results are achieved in assessing the effect of the pathogen, administered antibiotics or presence of fistula, the statistical significance of which has not been confirmed in our study. Questionable is also the importance of individual surgical techniques. CONCLUSIONS DAIR is a suitable method in treating infections of stable TKA without the history of revision surgery for infection. The surgery should be performed within 2 weeks from the manifestation of symptoms. Key words: debridement, antibiotics, infection, implant retention, total knee arthroplasty.
- MeSH
- antibakteriální látky terapeutické užití MeSH
- debridement MeSH
- infekce spojené s protézou * chirurgie MeSH
- lidé MeSH
- míra přežití MeSH
- reoperace MeSH
- retrospektivní studie MeSH
- totální endoprotéza kolene * škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Nocardiosis is a rare infection caused by the aerobic actinomycete of the Nocardia genus. In most cases, nocardiosis manifests as a lung infection or a bone lesion. Due to the nonspecific and mild clinical manifestations of nocardiosis, the establishment of definite diagnosis can be difficult. When antibiotic therapy is incorrectly targeted, only the symptoms of the disease are suppressed. The mainstay in the treatment of Nocardia osteomyelitis has so far been the combined surgical debridement with long-term, initially intravenous, antibiotic administration. We present the successful conservative treatment of a nocardiosis osteomyelitis of the tibia caused by the Nocardia cyriacigeorgica species in an 81-year-old female patient that manifested itself as a secondary affection on top of a primary nocardiosis infection of the lung. From microbiological examination, N. cyriacigeorgica was discovered; the identification was made using matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) with an identification score of 1.9. The sensitivity was evaluated using E test. Sensitivity to trimethoprim/sulfamethoxazole, amikacin, imipenem, and linezolid was demonstrated. The bacteria were shown to be resistant to ciprofloxacin. For treatment, trimethoprim/sulfamethoxazole was used due to the value of minimum inhibitory concentration, which was 0.25 mg/L. The initial dose of 960 mg of trimethoprim/sulfamethoxazole every 8 h was reduced to 960 mg every 12 h after 3 months. The total duration of treatment was 7.5 months. Under the established treatment, the bone and lung lesions healed. Nocardiosis of the long bone is considered a rare disease and its precise diagnosis has not yet been standardized. We used the MALDI-TOF MS method for the identification of the causal organism which is a fast and reliable method according to current world literature even when compared with the rRNA genetic sequencing reference method. Our case study presents a rare case of osteomyelitis of tibial shaft caused by N. cyriacigeorgica and its successful conservative treatment.
- MeSH
- antibakteriální látky aplikace a dávkování farmakologie MeSH
- kombinace léků trimethoprim a sulfamethoxazol aplikace a dávkování MeSH
- lidé MeSH
- mikrobiální testy citlivosti MeSH
- Nocardia izolace a purifikace MeSH
- nokardióza diagnóza farmakoterapie mikrobiologie patologie MeSH
- osteomyelitida diagnóza farmakoterapie mikrobiologie patologie MeSH
- senioři nad 80 let MeSH
- spektrometrie hmotnostní - ionizace laserem za účasti matrice MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- senioři nad 80 let MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
