PURPOSE OF THE STUDY Cementless stems in highly dysplastic hips are considered to increase the risk of femoral fracture and associated morbidity. Several authors speculated to use prophylactic cabling in this patient group to prevent intraoperative fractures. This study aims to reveal objective results regarding the perioperative complications in a large and consecutive patient group with respect to use of prophylactic cabling. MATERIAL AND METHODS A retrospective comparative study was planned. A total of 122 consecutive patients with dysplastic hips of Crowe type 3 or 4, operated on with total hip arthroplasty (THA) and shortening osteotomy using a rectangular femoral stem were included. Patients were stratified according to use of a diaphyseal prophylactic cerclage cable. Perioperative complications were recorded. Clinical outcome was measured in terms of Harris Hip Score and Visual Analog Scale (VAS) for pain. All results were compared between the groups. RESULTS The mean follow-up time was 27 months. Two (2%) versus five (14%) patients had a fracture at the diaphyseal level in cabled versus non-cabled groups. Difference between groups was statistically significant (p=0.01). Relative risk of fracture in case of a non-cabling was 5.8 (p=0.03). Eleven (9%) patients had a non-displaced fracture at the metaphyseal level. No significant differences were detected with respect to preoperative clinical outcome scores or change in these scores between groups. CONCLUSIONS Femoral diaphyseal fracture rates are low when cementless, rectangular stems are used in dysplastic high riding hips. Prophylactic cerclage cabling further decreases the fracture risk and eases treatment in case of a fracture without causing additional complications and therefore is recommended. Key words: intraoperative fracture, periprosthetic fracture, total hip arthroplasty, cerclage cabling, developmental hip dysplasia, transverse shortening osteotomy.

• MeSH
• fraktury femuru * etiologie   prevence a kontrola   chirurgie   MeSH
• kostní cementy MeSH
• lidé MeSH
• náhrada kyčelního kloubu * škodlivé účinky   metody   MeSH
• periprotetické fraktury * etiologie   prevence a kontrola   chirurgie   MeSH
• retrospektivní studie MeSH
• vývojová dysplazie kyčelního kloubu * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY Total knee arthroplasty is commonly used procedure with advanced stage arthritis which causes extensive blood loss intraoperatively and postoperatively. Purpose of this study is to show the effectiveness of sealing of femoral tunnel with bone grafting in preventing blood loss. MATERIAL AND METHODS 288 patients with primary bicompartmental knee arthroplasty who were operated in between April 2012 and June 2015 are retrospectively studied. Two groups are formed according to sealing of femoral tunnel with autologous bone graft or not. Group 1 was the plugged group with 192 patients and group 2 was the unplugged group with 96 patients. Operation time, arthrotomy method, anticoagulant therapy, postoperative care were similar in between two groups.'Independent sample t-test' is used to compare two groups as statistical method. RESULTS Postoperative lowest hemoglobin levels are higher in plugged group (p < 0.001). Drain outputs are much less than unplugged group (p < 0.001). There is no statistically significant difference between amount of given erythrocyte suspensions. DISCUSSION In the literature there are many attempts to reduce blood loss and allogenic blood transfusion. Some systemic or local usage of medical therapies, mechanical interventions such as cold application or intraoperative fibrin sealers are some of them. There are a few studies favoring usage of plugs and a few do not. Our findings showed less blood loss with usage of autologous bone grafting but did not significantly affect the blood transfusion amount. CONCLUSION Autologous bone grafting is a free to use, non-time consuming and an effective method to reduce blood loss. Key words: knee arthroplasty, plug, sealing of femoral tunnel, blood loss.

• MeSH
• antikoagulancia terapeutické užití   MeSH
• artritida chirurgie   MeSH
• autologní krevní transfuze statistika a číselné údaje   MeSH
• autologní transplantace MeSH
• délka operace MeSH
• krvácení při operaci prevence a kontrola   MeSH
• lidé MeSH
• pooperační péče MeSH
• retrospektivní studie MeSH
• totální endoprotéza kolene škodlivé účinky   metody   MeSH
• transplantace kostí metody   statistika a číselné údaje   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH