BACKGROUND: Mid-term results (clinical and radiographic) of ultra-short anatomical cementless stem total hip arthroplasty (THA) in patients with osteonecrosis of the femoral head (ONFH) has not often been presented. The aim of this study is to evaluate THA using the Proxima stem in patients with ONFH in the mid-term. METHODS: The study consists of 73 patients (97 THAs) with a Proxima stem implanted between 2006 and 2015. The mean age of patients was 47.4 years, with a mean follow-up 105.2 months. The clinical results include preoperative and postoperative Harris Hip Scores (HHSs). Radiological follow-up reports on stem migration, bony trabecular development and radiolucent lines. The complications and revisions were registered. Kaplan-Meier survival analysis was performed to determine the implant survival. RESULTS: The average HHS improved significantly from 40.3 preoperatively to 98.0 at the final evaluation (p ˂ 0.0001). Stem migration (subsidence and "varisation") was observed in 11 hips (in 9 of them up to 6th postoperative month without any further progression, in 2 with progressive migration and radiological loosening). Bony trabecular development was detected in modified Gruen zones (1,2,4,6,7 for Proxima stem): in zone 1 (0%), 2 (67.0%), 4 (64.9%), 6 (64.9%), 7 (0%). Radiolucent lines were observed in 1 cup and 6 stems (2 were loose, 4 with fibrous stable fixation). Complications were found in 5 hips (5.1%): squeezing hip once, repeated dislocation in 1, 1 early deep infection, and 2 loose stems. 2 hips (2.1%) were revised (dislocation, infection). The implant survival was 98.9% and 97.9% clinically and radiologically, respectively. CONCLUSIONS: Observations in the mid-term show that the clinical and radiological results of the Proxima stem in patients with ONFH are promising. The stem design preserves the proximal femoral bone stock. The bony trabecular appearance confirms physiological proximal femoral load transmission.

• Klíčová slova
• Bony trabecular development, osteonecrosis of the femoral head, total hip arthroplasty, ultra-short anatomical cementless stem,
• MeSH
• hlavice femuru chirurgie   MeSH
• kyčelní protézy * MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhrada kyčelního kloubu * škodlivé účinky   metody   MeSH
• následné studie MeSH
• nekróza hlavice femuru * diagnostické zobrazování   chirurgie   MeSH
• protézy - design MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The aim of this study was to evaluate the clinical and radiological outcomes (in mid-term) after "shortening" scarf osteotomy of the fifth metatarsal for the treatment of bunionette deformity. METHODS: We retrospectively reviewed the functional score - American Orthopaedic Foot and Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Interphalangeal Scale, radiographic results - 4th/5th intermetatarsal angle, varus angle of the 5th metatarsophalangeal joint and complications in a consecutive series of 34 feet (27 patients) with bunionette. Nine males and 18 females (mean age: 45 years) were included in the study. Three males and four females were operated bilaterally The patients were operated on between 2004 and 2015, and evaluated during 2017. RESULTS: The average AOFAS score improved from 59.4 to 93 at a mean follow-up of 7.2 years. The 4th/5th intermetatarsal angle and varus angle of the 5th metatarsophalangeal joint decreased from 13.9°/19.5° preoperatively to 6°/5.9° at final follow-up. No neurovascular damage was recorded. Complications arose in five feet (14.7%): delayed union (n=1), early infection (n=1), distal screw migration (n=1), asymptomatic non-union (n=1), transverse metatarsalgia (n=1). The osteotomy healed within less than three months except twoo (delayed union, non-union). Three feet needed additional surgery: screw removal (n=2), Weil osteotomy of 2nd-4th metatarsals (n=1). CONCLUSIONS: "Shortening" scarf osteotomy is an acceptable, but not complication-free, treatment option for the bunionette deformity and offers promising results in the mid-term.

• Klíčová slova
• Bunionette, Fifth metatarsal osteotomy, Scarf osteotomy,
• MeSH
• bunionette deformity diagnóza   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• metatarzální kosti diagnostické zobrazování   chirurgie   MeSH
• metatarzofalangeální kloub diagnostické zobrazování   chirurgie   MeSH
• následné studie MeSH
• osteotomie metody   MeSH
• rentgendiagnostika MeSH
• retrospektivní studie MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: The aim of this study has been to present outcomes after cementless arthroplasty for developmental dysplasia Crowe type IV of the hip, with transverse subtrochanteric shortening osteotomy and using the S-ROM stem. METHODS: We evaluated radiographs, functional scores and complications in a consecutive series of 23 patients (28 hips) with high dislocation of the hip. The average age of patients at surgery was 49.9 (range 22-68) years. The operations were performed between 2007 and 2013. Patients were assessed retrospectively-clinically and radiographically during the year 2018. RESULTS: The mean follow-up period was 94 (range 60-134) months. The average Harris hip score improved from 39.9 to 84.0. The mean leg length discrepancy decreased from 5 cm preoperatively to 1.4 cm at the final follow-up. All acetabular components were implanted into the true acetabulum, and all prostheses were stable at the latest examination. No neurovascular damage was recorded. We have identified specific complications in seven hips (25%) in total: Intraoperative femoral fracture required fixation in four hips; three hips (10.7%) needed revision: Recurrent dislocation, with the need for cup reorientation, occurred in two hips (in one of them, this was followed by the subsequent need for resection of heterotopic ossification); there was one aseptic stem loosening with the need of one-stage revision. All the osteotomies healed within 8 months. CONCLUSION: Hip arthroplasty with transverse shortening femoral osteotomy, using S-ROM stem, is an acceptable, but not complication-free treatment method in patients with Crowe type IV developmental hip dysplasia, in the midterm.

• Klíčová slova
• Hip dysplasia, S-ROM stem, Shortening femoral osteotomy,
• MeSH
• dislokace kloubu etiologie   chirurgie   MeSH
• dospělí MeSH
• kyčelní kloub * diagnostické zobrazování   patofyziologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhrada kyčelního kloubu * škodlivé účinky   metody   MeSH
• nestejná délka dolních končetin etiologie   chirurgie   MeSH
• osteotomie * škodlivé účinky   metody   MeSH
• pooperační komplikace * diagnóza   patofyziologie   chirurgie   MeSH
• rentgendiagnostika metody   MeSH
• reoperace * škodlivé účinky   metody   statistika a číselné údaje   MeSH
• retrospektivní studie MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) MeSH
• vývojová kyčelní dysplazie * diagnóza   chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH