PURPOSE OF THE STUDY: Evaluation of a group of patients with coxarthrosis who sustained fractures of the proximal femur and were treated by dynamic hip screw (DHS) osteosynthesis. MATERIAL AND METHODS: The group comprised 23 DHS osteosyntheses in 22 patients treated between the years 1997 and 2012. The indication to osteosynthesis in all 23 cases was a stable pertrochanteric fracture of the femur; all patients had grade III or grade IV coxarthrosis (assessed on the Kellgren & Lawrence scale) and their physical health was classified as ASA 3 or 4. Preventive antibiotic therapy was administered within 48 hours of surgery. The evaluated factors included operative time, blood loss, specific complications such as infection, osteosynthetic material fractiure or osteosynthesis failure, requirement of revision surgery, post-operative mobility and patient survival. The follow-up was 2 years. RESULTS: The operative time was 35 min to 85 min (average, 49 min); blood losses ranged from 50 ml to 450 ml (average, 189 ml). Of the 23 hips, infectious complication was found in one (4.3%) and osteosynthetic material fractiure also in one (4.3%). There was no necessity of revision surgery due to osteosynthesis failure, nor any conversion to total hip arthroplasty. Postoperative mobility (with use of walking aids or forearm crutches) was achieved in 17 (77.3%) patients. The average survival of the patients was 6.3 months, the range from 7 days to 3 years. DISCUSSION: DHS osteosynthesis is a reliable method for the treatment of proximal femoral fractures due to osteoporosis. These fractures in patients with coxarthosis are primarily indicated to total hip arthroplasty. However, this is questionable in polymorbid elderly patients in whom hip replacement carries high risk. In such patients DHS osteosynthesis is preferred as a less risky procedure. CONCLUSIONS: DHS osteosynthesis is indicated for stable pertrochanteric fractures of the femur in a limited number of patients with advanced coxarthrosis in whom total hip replacement would be associated with an undue risk. The majority of patients after surgery became mobile, but with short-term survival.
- MeSH
- artróza kyčelních kloubů komplikace MeSH
- délka operace MeSH
- fraktury kyčle etiologie chirurgie MeSH
- kostní šrouby * MeSH
- krvácení při operaci MeSH
- lidé MeSH
- náhrada kyčelního kloubu kontraindikace MeSH
- následné studie MeSH
- osteoporotické fraktury etiologie chirurgie MeSH
- senioři MeSH
- vnitřní fixace fraktury škodlivé účinky přístrojové vybavení metody MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- hodnotící studie MeSH
- MeSH
- analýza metodou konečných prvků MeSH
- femur chirurgie MeSH
- fraktury kyčle chirurgie MeSH
- kostní destičky MeSH
- kostní šrouby MeSH
- lidé středního věku MeSH
- lidé MeSH
- reoperace MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- vnitřní fixace fraktury metody přístrojové vybavení MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
- MeSH
- dospělí MeSH
- infekce močového ústrojí * MeSH
- infekce spojené s protézou * diagnóza terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu * škodlivé účinky MeSH
- pooperační komplikace * MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- totální endoprotéza kolene * škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Klíčová slova
- dynamický skluzný šroub, zlomeniny osteosyntetického materiálu,
- MeSH
- časové faktory MeSH
- fraktury femuru chirurgie MeSH
- kostní šrouby škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- pooperační komplikace MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- vnitřní fixace fraktury škodlivé účinky MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
PURPOSE OF THE STUDY The authors evaluated the mid-term results in 133 patients to whom 143 uncemented Beznoska (BMT) acetabular cups were implanted. MATERIAL A total of 143 acetabular cups were implanted to 133 patients in the period from 1994 to 2002. Thirteen patients died or dropped out of the study during follow-up. METHODS The patients were followed up at 3, 6 and 12 months after surgery and then, according to their conditions, every one or two years. In each patient, the following information was recorded: age at the time of implantation, gender, pre-operative diagnosis, physical activity, body mass index, Harris hip score, acetabular cup size, stem type, cup and stem alignment immediately after arthroplasty, intra-operative complications, early complications during hospital stay, and late complications. Attention was paid to infection, aseptic loosening and polyethylene wear. Loosening of both the cup and the stem was evaluated in each zone, using the criteria of Krbec and Čech. Malalignment of the stem and cup as well as thinning of the acetabular wall, as signs of loosening, were also recorded. RESULTS Of the 133 patients treated, 35 had poor results (24.5 %) and 17 of them underwent revision surgery. Deep wound infection was recorded in seven hips, the prosthesis was removed from six, and subsequently three of them had reimplantation. Loosening of the stem occurred in nine patients and two were revised. In three patients with a thin acetabular wall, indication for surgery was not correct; in another patient an operative fault occurred. All of them underwent revision arthroplasty. One hip showed asymmetric wear of the polyethylene liner without sings of acetabular cup loosening. Aseptic loosening was found in 15 patients (10.5 %), eight were revised. In the group of patients who had surgery 5 and more years before, 13 cups out of 81 implanted ones were loosened (16 %). In the group operated on at 8 and more years earlier, aseptic loosening was found in nine hips out of 49 (18.4 %). DISCUSSION The mid-term results of the use of uncemented Beznoska acetabular cups are fully comparable with those of cemented Beznoska acetabular cups. However, the outcomes initially hoped for in relation to this component have not been achieved. CONCLUSIONS The uncemented BMT acetabular cup cannot be recommended for the same indications as are those for which other uncemented components are used. It is not suitable for young and active patients under 70 years of age and for patients who have a thin wall of the acetabulum. Also, it is not recommended to combine this component with an uncemented femoral component. In our opinion, it is not suitable for revision hip arthroplasty, either.
