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PURPOSE OF THE STUDY The aim of this retrospective study was to assess functional and radiographic results of the first metatarsophalangeal joint replacement with use of unconstrained, modular, three components, porous titanium and hydroxyapatite coated, press-fit METIS? prosthesis. According to author's knowledge, results of that type of prosthesis have never been published before. MATERIAL AND METHODS 25 prosthesis were implanted in 24 patients between February 2009 and May 2011. American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal Interphalangeal scoring system (AOFAS-HMI) was used to assess functional results. Patients were also asked if they would undergo procedure again or recommend it to other people. Weight bearing radiographs ware made at final follow up and analyzed for presence of osteolysis and radiolucencies. In 8 patients total joint replacement was introduced as a salvage after failure of previous surgery like Keller resection arthroplasty, failed arthrodesis, avascular necrosis and postoperative arthritis. In 11 patients the reason for prosthetic replacement were hallux rigidus, in 4 cases rheumatoid arthritis and gout in one patient. In two patients additional procedures like Akin phalangeal osteotomy and in one case fifth metatarsal osteotomy, was performed. There were 20 females and 4 males in presented group. The mean age at the operation was 56 years. The average follow up period was 18 months (from 12 to 36 months). RESULTS The median postoperative value of AOFAS-HMI scores was 88 points (from 75 to 95 points). First metatarsophalangeal joint motion (dorsiflexion plus plantarflexion) was classified according to AOFAS-HMI ranges as: moderately restricted (between 30 to 70 degrees) in 19 patients 80% (20 prosthesis) and severely restricted (less then 30 degrees) in 5 patients (20%). 15 (64%) patients were completely satisfied, 5 (20%) reported moderate satisfaction and (16%) 4 were totally disappointed and would not undergo this procedure again. A limited hallux dorsiflexion was the main dissatisfaction reason. Partial radiolucent line was seen in one patient (4%). Authors noticed two serious complications. In one patient, with rheumatoid arthritis, deep infection occurred 12 months after prosthesis implantation. In second case phalangeal implant was revised due to misalignment. CONCLUSIONS METIS? metatarsophalangeal joint replacement allows alleviate of pain relating to hallux rigidus and partial restoration of joint movement, even in patients after failures of primary metatarsophalangeal joint surgery. AOFAS-HMI results are better than previously reported in the literature in assessment of the first metatarsophalangeal joint replacement. Radiographic results imply satisfactory bone ingrowth into the cementless implants.

MeSH
artroplastika prstů * metody MeSH
lidé MeSH
metatarzofalangeální kloub * chirurgie MeSH
protézy kloubů * využití MeSH
retrospektivní studie MeSH
výsledek terapie MeSH
Check Tag
lidé MeSH

Článek online

Náhrada prvního metatarzofalangeálního skloubení Medin
[MEDIN implant of the first metatarsophalangeal joint]

Acta chirurgiae orthopaedicae et traumatologiae Čechoslovaca. 2012 ; 79 (2) : 124-130.

Acta chir. orthop. traumatol. Čechoslovaca
ISSN 0001-5415
Medvik
Zdroj

PURPOSE OF THE STUDY Hemiarthoplasty or total replacement of the first metatarsophalangeal (MTP) joint has been used in orthopaedic surgery for the last 60 year, but good post-operative outcomes have been achieved only in the last ten years. Joint replacement is mainly used in stage 3 and stage 4 hallux rigidus conditions for which arthrodesis is not indicated. The operation on the first MTP joint has its place in the present-day orthopaedics. This study describes anatomical measurements and the development of the first Czech implant (MEDIN Orthopaedics) to replace this joint. MATERIAL AND METHODS Thirty cadaver specimens were used to develop basic shapes of phalangeal and metatarsal components. A standard technique was used for anatomical dissection of the first MTP joint. Fifteen specimens were cut in the sagittal plane and fifteen in the transverse plane in order to open the intramedullary cavity of the proximal phalanx of the great toe and the first metatarsal bone. The basic shapes of phalangeal and metatarseal components were designed based on the shape of cortical bone of their inner surfaces. Data for the shape, size and scale of articular components were obtained by measurement on 58 dry bone specimens of the first metatarsus and on 30 calibrated X-ray images. In order to adjust the scale and size of components, the final shape and the range of implant size were tested on 50 specimens of dissected lower extremities fixed in formaldehyde, acetone, ethyl-alcohol and glycerol. RESULTS The new type of a first MTP implant designed by us was based on cone-shaped anchor components coated with hydroxyapatite. The implants can be used in hemiarthroplasty or total joint replacement. The metatarsal insert was designed with a declination angle of 20 degrees to facilitate good dorsiflexion and with a flattening to ensure good function of the sesamoid bones, The phalangeal articular insert was made of either CoCr alloy or low-weight polyethylene for use in hemiarthroplasty and total joint replacement, respectively. DISCUSSION The new implants are designed for treatment of stage 3 or stage 4 hallux rigidus. We recommend to use hemiarthroplasty or total joint replacement only in the case of first metatarsal head destruction or severe joint destruction due to rheumatoid arthritis. CONSLUSIONS Our anatomical study of the first MTP joint, proximal phalanx of the great toe and first metatarsal bone was used to design the first Czech implant of this joint.

MeSH
artroplastika prstů metody přístrojové vybavení MeSH
hallux limitus chirurgie MeSH
hallux rigidus chirurgie MeSH
lidé MeSH
metatarzofalangeální kloub anatomie a histologie chirurgie patologie MeSH
palec nohy chirurgie patologie MeSH
protézy kloubů využití MeSH
Check Tag
lidé MeSH
Publikační typ
klinické zkoušky MeSH

Článek online

Reverzní kloubní náhrada ramene

Sestra (Praha). 2011 ; 21 (7-8) : 49-50.

Medvik
Zdroj

Reverzní náhrada ramene je operací technicky náročnou, ale při správném provedení a doléčení umožňuje pacientům návrat k plnému, bezbolestnému rozsahu pohybu tohoto kloubu. Používá se v indikacích nejtěžšího kostního postižení ramene v kombinaci s insuficiencí svalů rotátorové manžety.

Reverse shoulder replacement is technically challenging but in the case of proper treatment enables the return of the full range of motion of the joint without pain. It is indicated in cases of the most serious impairment of the bone tissue combined with the insufficiency of the rotator cuff muscles.

Článek online

Reverzní náhrada ramenního kloubu z pohledu sálové sestry

Sestra (Praha). 2010 ; 20 (2) : 50-51.

Medvik
Zdroj

Obsahem sdělení je seznámení s novými operačními výkony na pracovišti autorek, anatomickými poměry v ramenním kloubu, průběhem operačního výkonu při operaci reverzní náhrady ramenního kloubu, pooperačním průběhem, postojem instrumentářky k zavádění nových operací a statistickým zhodnocením provedených operací.

The article brings information on new surgical procedures, anatomical structure of the shoulder, surgical placement of a reversible shoulder prosthesis, care after the procedure, the attitude of a perioperative nurse to introducing new surgical procedures, and statistical data on performed surgeries.

Klíčová slova
instrumentárium, humerální náhrada, endoprotetika,
MeSH
lidé MeSH
ošetřovatelství na operačním sále MeSH
protézy a implantáty trendy MeSH
protézy kloubů využití MeSH
ramenní kloub anatomie a histologie chirurgie MeSH
Check Tag
lidé MeSH

Článek ve sborníku

Současné možnosti endoprotetiky

Jihočeská konference nelékařských zdravotnických pracovníků. 2010 ; () : 3-4.

Medvik
Zdroj

Článek

Pevnostní analýza necementovaných bikonických závitořezných jamek Zweymüller
[Strength analysis of cementless biconical threaded Zweymüller cups]

Ortopedie. 2009 ; 3 (3) : 112-116.

ISSN 1802-1727
Medvik
Zdroj

Cíl studie Bikonická závitořezná jamka Zweymüller od svého zavedení na trh v roce 1993 prošla tvarovými úpravami. Na obvodu jamky se snižovaly počty zářezů sloužících pro dokonalé usazení jamky. Pro zvýšené nebezpečí nalomení či rozlomení objímky v místech zářezů se původní počet 8 snížil na 4, poslední inovovaný typ je již bez zářezů. Cílem práce je srovnávající pevnostní analýza původních jamek se zářezy s inovovanými bez zářezů. Materiál Autoři uvádějí přednosti bikonické závitořezné jamky. Popisují materiál objímky i polyetylenové vložky. Zdůvodňují snížení zářezů na obvodu objímky. Hlavní autor udává zkušenosti s implantací téměř 400 bikonů se 4 zářezy v období od března 1996 do prosince 2007. Od ledna 2008 již používá výhradně objímky bez zářezů. Uvádí kazuistiku s rozlomenou jamkou. Metody Pro pevnostní analýzu byl vybrán systém Pro/ENGINEER, který umožňuje vytvoření 3D animace modelů jednotlivých typů objímek včetně PE vložky a jejich umístění do acetabula. Po vydefinování výpočtových modelů na podkladě jejich mechanických vlastností systém Pro/ENGINEER vypočítal špičky napětí v místech zářezů a na obvodu objímek. Výsledky Provedené analýzy jednoznačně prokázaly nepříznivý vliv zářezů na rozložení a velikost napětí v bikonických jamkách. Varianta objímky bez zářezů má příznivější mechanické vlastnosti. Závěr Pevnostní analýzy potvrdily hlavnímu autorovi jeho správné rozhodnutí implantovat pouze nové typy objímek bez zářezů. Snižuje tím riziko mechanického selhání implantátu. Dokonalá mechanická stabilita implantátu prodlužuje životnost celé totální náhrady.

Study objective Since it was first introduced onto the market in 1993, several modifications have been made in the shape of the biconical threaded Zweymüller cup. The number of indentations on the perimeter, intended for perfect positioning of the cup, has been decreased. Due to an increased risk of possible warping or breakage of the rim at the place of indentations, the original number of 8 indentations was reduced to 4. The last innovated type is without indentations. The aim of the study is to perform a strength analysis of new cups without indentations and compare them with the control cups with indentations. Material The authors point out the advantages of biconical threaded cup, describe the material of the rim and the polyethylene liner. The decreased number of indentations on the rim perimeter has been justified. Main author presents his experience with implanting almost 400 biconical cups with 4 indentations from March 1996 to December 2007. Since January 2008, he has been only using rims without indentations. A case-report of a broken cup is also included. Methods The strength analysis was performed using Pro/ENGINEER system, enabling a creation of 3 D animated models of individual cup types, including the PE liner, and their positioning in the acetabulum. Once the calculating models were defined on the basis of mechanical characteristics, the system calculated the strain peaks in the place of indentations on the perimeters of the rims. Results The analysis clearly showed an adverse effect of indentations upon the distribution and size of strain in biconical cups. The type with no indentations showed better mechanical properties. Conclusion The strength analysis confirmed that the decision of the main author to implant only new types of rims without indentations was correct. It results in reducing the risk of mechanical failure of the implant. A perfect mechanical stability of the implant prolongs durability of the whole total hip replacement.