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

BACKGROUND: This paper compares long term success rate of MTP joint replacement for hallux rigidus. We provide long term results of MTP joint replacement with the use of the ToeFit PlusTM System. MATERIALS AND METHODS: Our group consisted of 19 total joint replacements and 12 hemiarthroplasties in 18 and 11 patients respectively, performed between 2005-2009. The average follow-up period was 12.2 years (range 9.8-13.7, SD 1.1) for total arthroplasty group and 11.1 years (range 9.5-13.9, SD 1.7) for hemiarthroplasty group. In all followed patients AOFAS score was calculated along with the range of motion assessment. RESULTS: Average AOFAS score improved from 37 preoperatively to 79 at the time of last follow-up in total arthroplasty group and from 45 to 86 in the hemiarthroplasty group, with consideration to the statistically considerable difference of both groups. The total range of motion improved on average from 14° to the current 32° in patients with total arthroplasty and from 15° to 32° with hemiarthroplasty. The total number of cases that required surgical revision was 7 (37%) in total arthroplasty group and 2 (17%) in hemiarthroplasty group. CONCLUSION: Due to the high percentage of failure that was shown in our long term results, we no longer utilise the ToeFit PlusTM System.

• MeSH
• artroplastiky kloubů * MeSH
• hallux rigidus * diagnostické zobrazování   chirurgie   MeSH
• hemiartroplastika * MeSH
• lidé MeSH
• metatarzofalangeální kloub * chirurgie   MeSH
• následné studie MeSH
• protézy kloubů * MeSH
• rozsah kloubních pohybů MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY Unsatisfactory functional results following hemiarthroplasty (HA) are seen in the treatment of 3- and 4-part proximal humeral fractures due to tuberosity healing problems and rotator cuff tears. Reverse shoulder arthroplasty (RSA) has been popular for improving functional outcomes. This study compares the results of HA and RSA in the treatment of comminuted proximal humeral fractures in the elderly. MATERIAL AND METHODS Patients over 60 years of age with three- or four-part proximal humeral fractures were included in the study. Twenty-five patients were treated with HA and 33 patients with RSA. The patients were evaluated with/using the American Shoulder and Elbow Surgeons (ASES) and Constant scores, active and passive ranges of motions of the shoulders and muscle strength measurements of HA and RSA patients were compared. RESULTS The mean age of the patients was 66 (60-85) years in the HA group and 73 (60-83) years in the RSA group. The mean ASES and Constant scores were 44.6 and 70 (p=0.06), 24 and 49 (p=0.022), respectively. The mean active abduction was measured as 50° and 90° (p=0.001), flexions as 70° and 120° (p=0.02), and external rotation as 30° and 50° (p=0.210), respectively. CONCLUSIONS In the treatment of three- or four-part proximal humeral fractures of the elderly, RSA gives significantly better functional results compared to HA. Key words: proximal humeral fractures, hemiarthroplasty, reverse shoulder arthroplasty.

• MeSH
• artroplastika ramenního kloubu * MeSH
• fraktury proximálního humeru * chirurgie   MeSH
• hemiartroplastika * škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• ramenní kloub * chirurgie   MeSH
• retrospektivní studie MeSH
• rozsah kloubních pohybů MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY The postoperative outcomes of total hip replacement and hemiarthroplasty after femoral neck fractures in elderly patients were analysed to determine general and local complications as well as morbidity and mortality rates in order to detect risk profiles and assess the best individual treatment option. MATERIALS AND METHODS One hundred sixty-one femoral neck fractures among patients aged ≥ 65 years treated with cemented hemiarthroplasty (HA) or uncemented total hip arthroplasty (THA) between January 2005 and October 2013 were evaluated. In the presence of articular pathologies as well as a fracture type Garden III or IV, the indication for joint replacement was given. Criteria for performing hemiarthroplasty were previously limited mobility. Freely and fully mobilised patients and patients with manifested osteoarthritis received a cementless THA. A comparison of the observed complications was made, differentiating between general and surgery-specific hip-related complications. Furthermore, the mortality rates were analysed in relation to the respective surgical treatment. RESULTS Seventy cemented HA and ninety-one uncemented THA were performed. There was a high complication rate of approximately 19% in both surgical intervention groups. The patients were more likely to develop general complications (HA 12.8%; THA 10.8%) even though cardiopulmonary complications occurred more frequently in the cemented HA group. Four patients died after cemented hemiarthroplasty due to thromboembolic events (5.7% mortality rate), whereas no deaths occurred after total hip replacement. Surgery-specific complications rates were 7.8% in THA and 5.7% in HA patients. CONCLUSIONS THA in eldery patients with femoral neck fractures is associated with a higher complication rate, mostly of general medical entity. After cemented HA, our study reveals a high mortality rate due to thromboembolic events. For patients with multimorbidity in particular, these findings therefore suggest that uncemented THA should be considered to prevent lethal complications. Key words: femoral neck fracture; total hip arthroplasty; hemiarthroplasty; complications.

• MeSH
• analýza přežití MeSH
• cementování škodlivé účinky   MeSH
• fraktury krčku femuru chirurgie   MeSH
• hemiartroplastika škodlivé účinky   metody   MeSH
• kostní cementy MeSH
• lidé MeSH
• náhrada kyčelního kloubu škodlivé účinky   metody   MeSH
• pooperační komplikace MeSH
• senioři MeSH
• tromboembolie etiologie   MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

Cíl: Cílem práce je seznámit čtenáře se syndromem implantace kostního cementu, připomenout rizikové faktory a doporučené postupy. Typ práce: Přehledový článek s kazuistikou. Materiál a výsledky: Na prezentované kazuistice popisuje autor fatální průběh syndromu implantace kostního cementu. V následné diskuzi se pak zabývá etiologií vzniku a postupy, které mohou být použity jako prevence při vzniku syndromu implantace kostního cementu. Závěr: Bone cement implantation syndrome neboli syndrom implantace kostního cementu je reakce, která může nastat při použití kostního cementu. Projevuje se hypotenzí, hypoxií a může vyústit až v srdeční zástavu a smrt pacienta. Příčina BCIS není plně známa, ale nejspíše se na ní podílí více faktorů. Je dobré, pokud na něj operatér myslí před operací i během ní a u rizikových pacientů provede preventivní opatření, aby riziko vzniku BCIS snížil.

Aim: The aim of the work is to inform the readers about the bone cement implantation syndrome, and to remind them about various risk factors and recommended procedures. Type of work: Review article with a case report. Materials and results: The author illustrates a fatal course of bone cement implantation syndrome on a case report. In the following discussion, the author deals with the aetiology of origin and procedures, which may be applied as a prevention of bone cement implantation syndrome. Conclusion: Bone cement implantation syndrome is a reaction, which may occur with the use of bone cement. It is manifested with hypotension, hypoxia, and may result in cardiac arrest and death of the patient. The cause of BCIS is not precisely known, and is most probably multifactorial. It is advisable for the operating surgeons to bear this threat in mind and take preventive measures, in order to decrease the risk of BCIS development.

• Klíčová slova
• syndrom implantace kostního cementu, mikroembolizace, BCIS,
• MeSH
• fraktury krčku femuru * diagnostické zobrazování   chirurgie   komplikace   MeSH
• hemiartroplastika metody   přístrojové vybavení   škodlivé účinky   MeSH
• hypotenze etiologie   MeSH
• kostní cementy * škodlivé účinky   MeSH
• lidé MeSH
• methylmetakrylát škodlivé účinky   MeSH
• noradrenalin terapeutické užití   MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• syndrom * MeSH
• Check Tag
• lidé MeSH
• senioři nad 80 let MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• přehledy MeSH

UNLABELLED: PURPOSE OF THE STUDY The aim of this prospective study; The Trauma Assisted Discharge Scheme (TADS), was to set up a new model of postoperative care for patients following a fractured hip, addressing the need for efficiency, cost effectiveness and meeting local demand. MATERIAL AND METHODS All patients with hip fractures between December 2010 and December 2011, meeting the TADS inclusion criteria were enrolled in the study. Innovative use of staff within existing budgets helped create a TAD team who with the use of defined patient goals and a link nurse provided a seamless transition from acute to community services. RESULTS One hundred and sixteen patients followed the TADS pathway; the majority aged 80-89 years and independent prior to falling. A total of 35 patients underwent dynamic hip screw fixation; 55 hemiarthroplasty, 11 total hip replacement and 11 cannulated screw fixation. The average length of in-hospital stay was 8.6 nights. The TADS reduced the average length of stay by 4.78 days. CONCLUSION TADS has the potential to be used as a model of care in other specialities and is easily transferable to the wider NHS. KEY WORDS: continuous quality improvement, quality improvement, surgery, cost-effectiveness, ambulatory care.

• MeSH
• analýza nákladů a výnosů MeSH
• délka pobytu trendy   MeSH
• fraktury kyčle ekonomika   chirurgie   MeSH
• hemiartroplastika ekonomika   statistika a číselné údaje   MeSH
• kostní šrouby statistika a číselné údaje   MeSH
• lidé MeSH
• náhrada kyčelního kloubu ekonomika   statistika a číselné údaje   MeSH
• pooperační péče MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• vnitřní fixace fraktury ekonomika   statistika a číselné údaje   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Anatomická hemiartroplastika ramenního kloubu je výkon, u kterého je funkční výsledek velmi závislý na správné indikaci, operační technice a následné rehabilitaci. Operační technika se odlišuje u chronických degenerativních onemocnění ramena a u traumatických stavů. V těchto případech je zásadní optimální rekonstrukce a refixace velkého a malého hrbolu humeru s neporušenými úpony rotátorové manžety.

Anatomical hemiarthroplasty of the shoulder joint is a procedure for which the functional outcome highly depends on correct indication, surgical technique and subsequent rehabilitation. Surgical technique differs for chronic degenerative diseases and traumatic conditions of the shoulders. In these cases optimal reconstruction and fixation of the fixation of the greater and lesser tuberosity of the humerus with intact rotator cuff insertions is essential.

• Klíčová slova
• anatomická náhrada,
• MeSH
• hemiartroplastika * metody   přístrojové vybavení   MeSH
• humerus chirurgie   MeSH
• lidé MeSH
• protézy - design * MeSH
• protézy kloubů MeSH
• ramenní kloub * chirurgie   MeSH
• rotátorová manžeta chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

Náhrady ramenního kloubu dnes tvoří nedílnou součást moderní ortopedické péče. Přestože se nikdy nebudou implantovat v takových počtech, v jakých se implantují endoprotézy kyčle nebo kolena, je nutné analyzovat jejich výsledky stejným způsobem, tj. z pohledu přežití, užitné hodnoty a komplikací. Na základě dosud publikovaných studií je možné konstatovat, že: 1. přežití nejlepších endoprotéz ramenního kloubu je srovnatelné s nejlepšími TEP kyčlí a kolen, a to jak v horizontu 10 (>90% přežívání), tak 20 roků (>80% přežívání) od operace; 2. klinické výsledky jsou u náhrady ramenního kloubu ve srovnání s TEP kyčle relativně nehomogenní, zejména u traumatických indikací a artropatií z chronické léze rotátorové manžety; 3. četnost komplikací je vyšší u TEP ramenního kloubu oproti TEP kyčle. Pokud bychom však přiřadili ke komplikacím TEP kolena „bolesti, které si nevynutily reoperaci“, pak jsou z hlediska četnosti komplikací obě intervence dokonce srovnatelné.

The shoulder arthroplasty is today an integral part of modern orthopaedic care. Although shoulder arthroplasties are not implanted in such number of patients like total knee (TKR) and hip (THR) replacements, they have to be analysed in the same manner, i.e. in terms of implant survival, subjective and functional outcomes, and complications. Based on available studies, it is possible to conclude that: 1) survivorship of the best shoulder replacements is comparable with the best THRs and TKRs (i.e. > 90% at 10 years and > 80% at 20 years of follow-up); 2) clinical outcomes of shoulder arthroplasty are relatively heterogeneous in comparison with THR, especially in traumatic indications and rotator cuff arthropathy; 3) the complication rate is higher in the total shoulder arthroplasty compared to THR. However, with adding "unexplainable pain” that does not induce reoperation to the complications of TKR then both interventions seem to be comparable in terms of complications.

• Klíčová slova
• reverzní endoprotéza ramena, anatomická náhrada ramena, náhrada ramene,
• MeSH
• artroplastiky kloubů * metody   MeSH
• časové faktory MeSH
• činnosti denního života MeSH
• hemiartroplastika MeSH
• lidé MeSH
• nestabilita kloubu komplikace   MeSH
• obnova funkce MeSH
• pooperační komplikace MeSH
• pooperační období MeSH
• protézy - design MeSH
• protézy kloubů MeSH
• ramenní kloub * chirurgie   MeSH
• reoperace MeSH
• rozsah kloubních pohybů MeSH
• selhání protézy MeSH
• spokojenost pacientů MeSH
• výsledek terapie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

PURPOSE: Several methods to restore the appropriate length of the humerus in the case of proximal humeral fractures treated by hemiarthroplasty have been previously published. Our study evaluates the possibility of using the medial calcar of humerus for humeral length reconstruction not based on preoperative planning. METHODS: Preparations of 320 dry humeral bones were used for the purpose of the study. Points of interest were marked on each bone: the most proximal point of the humeral head, the crest of greater tuberosity, diameters of the head, the anatomical and surgical necks. Proximal parts of bones were then scanned from two angles with a digital camera and all measurements were performed on calibrated photographs. We compared accuracy in humeral length reconstruction using insertion of the pectoralis major and the area of medial calcar where usually a fracture develops. RESULTS: The distance between the top part of the humeral head and the insertion of pectoralis major was 54.1 ± 6.0 mm. The distance between the lateral margin of the anatomical neck and the medial calcar was 51.4 ± 4.3 mm. We compared these data with diameters of the humeral head. CONCLUSIONS: The site of the fracture can be used for the reconstruction of the humeral length with greater accuracy than area of the pectoralis major insertion. We suggest that to obtain the final distance between the lateral margin of the artificial head and medial calcar of the fracture 2-3 mm should be added to the diameter of the head.

• MeSH
• algoritmy MeSH
• fraktury humeru chirurgie   MeSH
• hemiartroplastika MeSH
• humerus anatomie a histologie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• Klíčová slova
• reverzní náhrada ramenního kloubu, zlomenina proximálního humeru,
• MeSH
• artroplastika metody   využití   MeSH
• chirurgie operační metody   využití   MeSH
• fraktury humeru chirurgie   MeSH
• fraktury proximálního humeru chirurgie   MeSH
• hemiartroplastika MeSH
• lidé MeSH
• protézy kloubů MeSH
• ramenní kloub MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• senioři MeSH