Perka, C* Dotaz Zobrazit nápovědu
PURPOUSE OF THE STUDY Wound drainage in surgical interventions has a long tradition. Regarding the primary TKA there are no valid data concerning the ideal point of time for removal. The objective of this prospective randomized study was to investigate which drainage procedure should be given preference with regard to wound healing, blood loss, development of intraarticular hematomas and early postoperative function. MATERIAL AND METHODS We documented the ROM, the knee circumference at the upper patellar pole preoperatively and on days 2, 4 and 6 post-operatively. The blood volume and loss was calculated. As surrogate parameter for wound healing we counted the amount of days until no residual secretion was observed via the wound/drainage site. RESULTS The results of our investigation do not show any significant difference with regard to the mentioned parameters. CONCLUSIONS In our investigation, we were unable to find any significant advantage of intraarticular drainage for 48 hours over 24 hours after primary total knee arthroplasty. After uncomplicated total knee arthroplasty we recommend removing drainage after 24 hours.
- MeSH
- drenáž * metody MeSH
- hematom etiologie MeSH
- hojení ran MeSH
- kolenní kloub * MeSH
- krvácení při operaci MeSH
- lidé středního věku MeSH
- lidé MeSH
- odstranění implantátu MeSH
- pooperační komplikace MeSH
- pooperační péče * MeSH
- senioři MeSH
- totální endoprotéza kolene * MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie 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
- Publikační typ
- abstrakt z konference MeSH
PURPOSE OF THE STUDY Although total hip arthroplasty (THA) is one of the most successful orthopedic operations, the soft tissue trauma towards the periarticular musculature during surgical approaches remains a critical concern. However, the actual microstructural proof of muscle trauma on the level of the myofiber due to the surgical approach has never been claimed. MATERIAL AND METHODS Patients undergoing THA were prospectively enrolled and either operated by a direct lateral (DL) or a anterolateral minimally invasive approach (ALMI). Intraoperatively and at 6 months follow-up a needle biopsy was taken from the gluteus medius muscle and the tensor fasciae latae. Pre- and post-operative fiber diameter and composition, of gluteal medius muscle (GMM) and the tensor fasciae latae muscle (TFLM) were compared in both surgical approaches. RESULTS A total of 19 patients (12 F; 7 M) were included in this study. The average pre-operative fiber diameter or fiber type composition did not differ significantly in the GMM and TFLM, nor did it vary among patients with different approaches. The muscle fiber diameter significantly increased post-operatively in the TFLM, in both, the DL (p = 0.043) and the ALMI (p = 0.043) approach. There was a trend towards more pronounced muscle fiber changes in the DL (TFLM: p = 0.077; GMM: p = 0.150), compared to the ALMI. DISCUSSION AND CONCLUSIONS Our results show microstructural changes to the periarticular musculature following THA by a compensatory hypertrophy of the TFLM and GMM. These adaptions directly next to the surgical trauma were observed in DL and AMLI. Key words: total hip arthroplasty, skeletal muscle, muscle biopsy, iatrogenic trauma, muscle scar.
- MeSH
- kosterní svaly zranění chirurgie ultrastruktura MeSH
- lidé středního věku MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony škodlivé účinky metody MeSH
- náhrada kyčelního kloubu škodlivé účinky metody MeSH
- pánev zranění chirurgie MeSH
- prospektivní studie MeSH
- senioři MeSH
- stehno zranění chirurgie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
Effective treatment of periprosthetic fractures following TKA continues to represent a surgical challenge. The incidence and frequency of these complicated type of fractures is expected to increase as the number of TKA as well as the activity level of these patients steadily rises. A careful and correct analysis of the fracture pattern, its classification, the quality of the existing bone stock and the fixation / loosening of the underlying prosthetic system has to precede decision making for successful conservative or surgical treatment. Therefore, improved diagnostic radiographic imaging of fracture patterns and reliable assessment of prosthesis loosening progressive development of new implant methods and refinement of soft tissue preserving surgical techniques will hold the key for regaining the functional level prior to the fracture.
- MeSH
- algoritmy MeSH
- fraktury femuru chirurgie klasifikace terapie MeSH
- fraktury tibie chirurgie klasifikace terapie MeSH
- lidé MeSH
- patela chirurgie zranění MeSH
- periprotetické fraktury chirurgie klasifikace terapie MeSH
- radiografie MeSH
- reoperace využití MeSH
- rizikové faktory MeSH
- selhání protézy etiologie účinky léků MeSH
- totální endoprotéza kolene metody využití MeSH
- vnitřní fixace fraktury metody trendy využití MeSH
- výsledek terapie MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) MeSH
- Check Tag
- lidé MeSH
PURPOSE OF THE STUDY Bone marrow oedema (BMO) syndrome is a multifactorial condition. Various conservative treatment options include analgesic therapy, immobilisation of the affected joint and/or systemic intravenous iloprost therapy. Many studies have confirmed the positive effect of iloprost therapy, but only after short-term follow-up. The purpose of this study was to show that treatment with iloprost leads to positive long-term functional and radiological outcomes for BMO of the knee. MATERIAL AND METHODS Fifteen patients with BMO of the knee joint, ARCO stage 1-2, were included in this study. Various questionnaires, the Lysholm Score, the SF-36, WOMAC, Knee Society Score, and a visual analogue pain scale (VAS), were evaluated before and after iloprost therapy. All patients underwent MRI for radiological follow-up three months after treatment. RESULTS Significant improvements were found in the Lysholm Score, SF-36, WOMAC and KSS. In 80% of patients, follow-up MRI after three months showed complete regression of the oedema. Three patients received additional surgery after a follow-up period of 33 ± 7 months. CONCLUSIONS Based on the positive results of our study, we recommend treatment with iloprost for BMO of the knee in ARCO stage 1-2 patients. Key words:iloprost, bone marrow oedema, knee joint.
- MeSH
- edém * diagnóza farmakoterapie MeSH
- iloprost aplikace a dávkování MeSH
- intravenózní podání MeSH
- kolenní kloub * diagnostické zobrazování účinky léků patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- měření bolesti metody MeSH
- monitorování léčiv metody MeSH
- nemoci kostní dřeně * diagnóza farmakoterapie patofyziologie MeSH
- radiografie metody MeSH
- vazodilatancia aplikace a dávkování MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Německo MeSH
PURPOSE OF THE STUDY There is limited evidence on survival and complication rates in patients after total knee arthroplasty for posttraumatic osteoarthritis. The failure mechanisms leading to revision remain an issue of constant debate. The purpose of this study was to analyze the mid-term survival of primary total knee arthroplasties as well as to evaluate complications and failure mechanisms in patients with posttraumatic knee osteoarthritis. MATERIAL AND METHODS This retrospective study included 79 patients with an average age of 59 years at the time of primary total knee arthroplasty. A functional and radiographic assessment was obtained during outpatient clinical follow-up at 3 and 12 months postoperatively and yearly intervals after that. Survival rates were calculated using Kaplan-Meier analyses. The mean postoperative follow-up was 69 months. RESULTS At 69 month the revision-free survival rate was 88.6%. In nine cases (11.4%) a revision procedure was performed. The leading cause of revision was a periprosthetic infection (n = 6, 66.6%). An age of fewer than 55 years at the time of total knee arthroplasty had a significant influence on implant survival (p = 0.018) with superior survival in favor of the older patient population. At most recent follow-up, a mean Knee Society Score of 82 points and an average Function Score of 77 points were observed. CONCLUSIONS Periprosthetic joint infection is the primary failure mechanism leading to a revision in patients with total knee arthroplasty for posttraumatic osteoarthritis. Apart from the increased infection rate, total knee arthroplasties in patients with posttraumatic osteoarthritis revealed results that were comparable to patients with primary osteoarthritis. Key words:posttraumatic knee osteoarthritis, total knee replacement, survival, complications, revision, outcome.
- MeSH
- artróza kolenních kloubů chirurgie MeSH
- infekční artritida komplikace MeSH
- kolenní kloub diagnostické zobrazování patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- míra přežití MeSH
- následná péče MeSH
- pooperační komplikace epidemiologie MeSH
- poranění kolena chirurgie MeSH
- reoperace statistika a číselné údaje MeSH
- retrospektivní studie MeSH
- senioři MeSH
- totální endoprotéza kolene škodlivé účinky mortalita MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
