PURPOSE OF THE STUDY: Periprosthetic fracture is one of the most serious complication of total knee arthroplasty. In our retrospective clinical study we designed our classification with rules for treatment of those fractures. MATERIAL AND METHODS: During the last thirty years we treated 53 distal femoral periprosthetic fractures in our orthopaedic department. In our clinical study we reviewed our group of distal femoral periprosthetic fractures with on the basis of X-ray findings, the treatment method used and treatment outcomes. RESULTS: According to our findings we divided distal femoral periprosthetic fractures into six groups: Type I Nondisplaced fractures, 5.7%; treatment failure rate, 33%. Type II a Fractures with lateral comminution (the most often type of fractures), 37.7%; treatment failure rate, 20%. Type II b Fractures with medial comminution, 7.5%; treatment failure rate, 60%. Type II c Fractures above TKA (the second most often type), 34%; treatment failure rate, 18%. Type II d Comminuted fractures, 5.7%; treatment failure rate, 18%. Type IIIFractures with loosening of TKA, 9.4%; treatment failure rate, 20%. For the treatment of fractures we used various methods according to the type of fracture: Plate osteosynthesis in 32 cases, with failure in seven. Three failures in IIa group due to incorrect osteosynthesis with condylar plate, treated by reosteosteosynthesis with same implant. One in IIb group treated primarily with cement plomb, after second failure treated with revision total knee arthroplasty. Two failures in IIc group, treated by reosteosynthesis with spongioplasty using the same implant. One failure in III group solved with revision TKA. Intramedullary nail in nine cases , with failure in two. One failure in IIb group treated by reosteosynthesis with condylar plate and cement plombage. One in IIc group due to infection, solved with extraction of material and second stage revision TKA. Conservative treatment in three cases,with failure in two. One in I group treated with condylar plate. One in IId group solved with revision TKA. Miniosteosynthesis in three cases, with failure in two.One failure in IIa group treated with condylar plate, one in IIb group treated with intramedullary nail and additional hydroxyapatite plombage. Revision total knee arthroplasty in five cases with no failure. Extraction of TKA, external fixation, and arthrodesis in 1 case with no failure. DISCUSSION: The rules for treatment of distal femoral periprosthetic fractures are not definite yet. For fractures above TKA is recommended nail osteosynthesis; for fractures at the level of femoral component is preferable to use osteosynthetic material, condylar plate or LCP. Bone grafts, bone cement, and artificial bone are used to augment osteosynthesis in comminuted fractures. Fractures at the site of loosening are indicated for revision TKA. CONCLUSIONS: According to our results: Type I: Conservative treatment possible. Osteosynthesis with condylar plate is recommended. Type IIa: Indication for condylar plate osteosynthesis. Type IIb: The most problematic group. Osteosynthesis with condylar plate with augmentation or condylar plate placed from medial side. Type IIc: Plate osteosynthesis possible, intramedullary nail is recommended. Type IId: Osteosynthesis with augmentation is possible in some cases; revision TKA is recommended. Type III: Indication for revision TKA.
- MeSH
- fraktury femuru etiologie chirurgie radiografie MeSH
- lidé středního věku MeSH
- lidé MeSH
- protézy kolene MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- totální endoprotéza kolene škodlivé účinky MeSH
- vnitřní fixace fraktury MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
PURPOSE OF THE STUDY The aim of this retrospective study was to assess the results of varus osteotomy of the proximal femur in adults with coxa valga after developmental dysplasia of the hip (DDH) and to evaluate the efficacy of this method. MATERIAL AND METHODS Thirty hips in 28 patients treated by proximal femoral varus osteotomy in the period from 1983 to 1990 were evaluated. The indication for surgery involved coxa valga (145°-168°) with grade I- III of osteoarthritis and mild acetabular dysplasia. The patient group comprised twenty six women and two men with an average age of 28 years (18 to 42) at the time of surgery. The mean follow-up was 22 years (19 to 26). The preoperative radiographic examination included an AP view of the pelvis, AP views of the hip in neutral and in frog-leg position and AP views of the hip in 30° of abduction and neutral rotation. Varus osteotomy was indicated when the best position of the hip joint was achieved in abduction. The procedure was performed according to M. Muller. Hip assessment was based on the grade of osteoarthritis, CCD angle, Wiberg angle and AHI index. The results were statistically evaluated using the life table analysis of clinical survivorship of osteotomy and the Kaplan-Meier curve. Clinical failure was defined as conversion of osteotomy to total hip replacement (THR). RESULTS At the latest follow-up of 22 years on the average, 18 patients (19 hips) still had osteotomy and 10 patients (11 hips) had undergone conversion to THR. The life table analysis showed the cumulative proportion of osteotomy with a clinical survivorship of 0.97 at 5 years, 0.75 at 10 and 15 years, and 0.68 at 20 and 25 years after surgery. The cumulative rate of clinical survivorship of osteotomy, as shown by the Kaplan-Meier curve, was 0.89 at 10 years, 0.75 at 20 years and 0.67 at 25 years after surgery. Nineteen patients were satisfied with the osteotomy outcome. The median of Harris hip scores in the patients with osteotomy was 48 points before surgery and 78 points at the latest follow-up. Conversion to THR in 10 patients (11 hips) was done at an average of 12 years after osteotomy. The median values before surgery and at the latest follow-up were: CCD angle, 158° and 118°; Wiberg angle, 13° and 20°; and AHI index, 56 % and 79 %, respectively. DISCUSSION The prerequisite for a good result of proximal femoral varus osteotomy is the correct indication, i.e., younger age (18 to 30 years), a lower grade of osteoarthritis, mild dysplasia and a spherical shape of the femoral head. A disadvantage of the procedure is a shortening of the limb. The best indication for femoral varus osteotomy is unilateral coxa valga with a longer leg. CONCLUSIONS This study shows favourable long-term results after isolated proximal femoral varus osteotomy in young adults with developmental dysplasia of the hip. A good function had been preserved in 18 of 28 DDH patients for an average of 22 years.
Mladí pacienti s osteoartrózou kyčelního kloubu trpí výrazným snížením kvality života. Ta zahrnuje faktory tělesného a psychického zdraví, sociální pohodu a uplatnění v životě. V našem příspěvku se pokoušíme kvantitativně zhodnotit ovlivnění kvality života mladých pacientů operační a konzervativní léčbou. Využíváme k tomu specifická skóre hodnotící funkci zejména kyčelního kloubu, ale i multidimenzionální hodnocení celkové kvality života. Článek dále nabízí využití hodnotících systémů pro praxi.
Young patients with osteoarthritis of the hip suffer by significant decrease in quality of life. That includes factors of both physical and psychological health, social well-being and living a fit and active life. In our study, we try to quantitatively evaluate the influence on quality of life by operating and conservative treatment. Based on that, we apply specific score systems evaluating especially the function of the hip joint and also multidimensional score systems evaluating the general quality of life. Thereinafter, the study presents the use of rating systems for practice.
- Klíčová slova
- Arcoxia,
- MeSH
- artróza kyčelních kloubů chirurgie komplikace terapie MeSH
- dospělí MeSH
- interpretace statistických dat MeSH
- kvalita života MeSH
- lidé MeSH
- náhrada kyčelního kloubu metody statistika a číselné údaje využití MeSH
- ortopedické výkony metody statistika a číselné údaje využití MeSH
- výsledek terapie MeSH
- životní styl MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- srovnávací studie MeSH
U pacientů s revmatoidní artritidou je noha postižena v 85–95 %. Vlivem revmatického procesu dochází k poklesu příčné i podélné klenby, na plosce se tvoří bolestivé otlaky, palec je ve valgozitě a prsty v kladívkovitém postavení. Pacienti mají bolesti při stoji a chůzi. Autoři v práci popisují etiopatogenezi deformity, indikace k operačnímu řešení dle Hoffmana, operační postup i možné komplikace. Hodnotí také dlouhodobé výsledky u pacientů operovaných v letech 1990–2005. Zkontrolovali jsme 54 pacientů (72 přednoží), průměrná doba od operace byla 8,7 let. Pro hodnocení klinického výsledku operace jsme použili jednoduché Gainorovo skóre. Výsledek operace hodnotí 20 operovaných (37 %) jako výborný, 16 (30 %) jako dobrý, 12 (22 %) jako vyhovující a 6 (11 %) jako špatný. Spokojení pacienti vyzdvihují zejména bezbolestnou chůzi a stoj. Respektování indikačních kritérií, pečlivá operační technika i pooperační péče vedou k dobré korekci revmatické deformity přednoží a ke spokojenosti pacientů.
In patients with rheumatoid arthritis is forefoot disabled in 85-95% cases: transversal and longitudinal instep, painful callosities, Hallux valgus and hammertoes are formed due to rheumatic disease. The authors present etiopathogenesis of rheumatoid forefoot deformity, indications for surgical treatment described by Hoffmann, surgery procedure and possible complications. We made assessment of long-term results in patients operated at out Orthopedic Department between the years 1990 and 2005. We made control examinations in 54 patients (72 forefoot). The average follow up was 8.7 years. For clinical outcome we used simple Gainor foot score. We had 37% excellent, 30% good, 22% satisfactory and 11% poor results according to assessment of 20 operated patients. The satisfied patients can stand and walk without forefoot pain. In conclusion, long-term results of surgical correction of rheumatoid forefoot are generally excellent if indication criteria are respected, special surgery technique is used and excellent postoperative care applied.
- MeSH
- chirurgie operační metody využití MeSH
- lidé MeSH
- následné studie MeSH
- pooperační komplikace MeSH
- přednoží člověka chirurgie patofyziologie MeSH
- revmatoidní artritida chirurgie MeSH
- stupeň závažnosti nemoci MeSH
- výsledek terapie MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) MeSH
- získané deformity nohy (od hlezna dolů) chirurgie patofyziologie MeSH
- Check Tag
- lidé MeSH
Ruptury předního zkříženého vazu patří mezi poměrně častá závažná poranění. Autoři se ve svém sdělení snaží podat stručný přehled o této velmi složité problematice. V několika základních bodech se snaží zdůraznit základní anatomické uspořádání a funkci předního zkříženého vazu. Stručně nastiňují klinické příznaky a vyšetřovací metody ke stanovení ruptury vazu. Dále se zabývají možnostmi terapie s důrazem na individuální přístup k pacientovi. V šesti základních bodech popisují principy úspěšné náhrady předního zkříženého vazu a také popisují základní operační techniky. Na závěr se zmiňují o rehabilitačních postupech.
Rupture of anterior cruciate ligament belongs to a relatively common and rather serious injury. The authors are presenting a brief summary about this very complicated matter. In a couple of essential points they highlight the basic anatomic system and function of the anterior cruciate ligament. They describe the clinical symptoms and examination methods for the determination of a ligament rupture. Further they are concerned with therapy possibilities with emphasis on individual approach to a patient. In six main points they describe both the principles of a successful replacement and also basic operative technologies. Rehabilitation procedures are mentioned at the end of the presentation.
- MeSH
- chirurgie operační metody využití MeSH
- diferenciální diagnóza MeSH
- lidé MeSH
- ligamentum cruciatum anterius anatomie a histologie chirurgie MeSH
- ortopedické výkony metody využití MeSH
- poranění předního zkříženého vazu MeSH
- příznaky a symptomy MeSH
- terapie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Infection of the total joint replacement is the most severe complication seen in prosthetics. Besides a number of other factors, the rise of infection is also influenced by the material applied, not only by its chemical composition but even by the surface texture. This, together with the properties of the contaminating bacteria, has effects on the development of biofilm formation on the implant surface. A set of 91 infective complications of the total hip replacement was used to evaluate clinically the influence of implanted materials on the infection development. The relation between cemented, hybrid, and non-cemented substitutions, particularly the relation of various metals used for implantation and especially the effects of polyethylene were assessed. The time factor of the infection development was also evaluated. Statistical significance was found between the sets in all surveyed parameters. The implants with polymer materials were revealed to become contaminated more easily. Non-cemented implants with porous surfaces are infected less often; here infection appears earlier than in cemented implants with polished metal surfaces. This report aims at better understanding the problems of biomaterial surfaces and, thus, at decreasing the incidence of infections in total joint replacements.
- MeSH
- artroplastiky kloubů škodlivé účinky MeSH
- biokompatibilní materiály škodlivé účinky terapeutické užití MeSH
- infekce spojené s protézou MeSH
- interpretace statistických dat MeSH
- lidé MeSH
- protézy kloubů škodlivé účinky využití MeSH
- statistika jako téma MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- grafy a diagramy MeSH
- Publikační typ
- abstrakt z konference MeSH
