ABSTRACT
BACKGROUND: The aim of the study was to analyse the outcomes of hip replacement complicated by intraoperative femoral fractures and to analyse their effective management. MATERIALS AND METHODS: The medical records of 43 cases of intraoperative femoral fractures (1.4% of all hip replacements) were retrospectively reviewed. The patient group included 29 females. Patients' age ranged from 20 to 66 years (mean age: 48.4 years). Follow-up duration ranged from 8 to 89 months (mean duration: 44 months). RESULTS: There were 13 fractures of the greater trochanter, 21 fractures of the lesser trochanter involving the calcar, 7 at the implant stem level, and two below the implant stem. In 3 cases, the fracture was treated with a revision stem, with cerclage used in 17 other cases. In the remaining cases, the fractures were stable and did not require any internal fixation. Eighteen patients had very good final results, 19 had good and 6, fair results, according to Merle D'Aubigne- Postel's classification in Charnley's modification. None of our patients demonstrated evidence of stem loosening at the final follow-up. CONCLUSIONS: Unstable intraoperative femoral fractures during a hip replacement procedure are rare and occur mostly in patients with post-dysplastic hips with a narrow intramedullary canal. In cases of stable fractures of the trochanter and calcar region, 12 weeks of partial weight bearing without additional immobilization is a sufficient approach. The final results are satisfactory in most cases of intraoperative femoral fractures.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Femoral Fractures/surgery , Fracture Fixation, Internal/methods , Hip Prosthesis/adverse effects , Intraoperative Complications/surgery , Adult , Arthroplasty, Replacement, Hip/instrumentation , Arthroplasty, Replacement, Hip/methods , Female , Femoral Fractures/diagnostic imaging , Femoral Fractures/etiology , Follow-Up Studies , Humans , Intraoperative Complications/etiology , Intraoperative Period , Male , Middle Aged , Poland , Prosthesis Design , Radiography , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
AIM OF THE STUDY: The purpose of the study is to estimate the preliminary results of the medial patellofemoral ligament reconstruction with medial strip of patellar tendon autograft. MATERIALS AND METHODS: The study was conducted on 6 patients with post-traumatic recurrent patellar dislocation, with an equal number of males and females, aged 18-35 years (mean 27). Follow-up assessments were performed in 4, 12 weeks and 6, 12 months after the surgery. Patients were surveyed pre- and postoperatively with questionnaires, such as: the Kujala score, Knee Injury and Osteoarthritis Outcome Study (KOOS) and SF-36 Health Survey, version 2. RESULTS: No recurrent dislocation was found in patients after the surgery. The mean Kujala score was 49 points (range 38-64) preoperatively and 83 points (range 70-98) at follow-up. In the KOOS scores the improvement was seen in all scales. The SF-36 score revealed improvement in bodily pain, general health, mental health and physical functioning domains. CONCLUSIONS: The preliminary results indicate that the medial patellofemoral ligament reconstruction by using a medial strip of the patellar ligament autograft should be considered as effective as other surgeries with different sources of the graft. Restriction of the extent of the procedure to soft tissues without the involvement of the tubercle bony attachment and without drilling holes in the patella and the femur, as well as decreasing the number of implants to only one screw anchor, might lead to reduction of postoperative complications, with no negative effect on clinical results.
Subject(s)
Bone-Patellar Tendon-Bone Grafting/methods , Medial Collateral Ligament, Knee/surgery , Patellar Dislocation/surgery , Patient Satisfaction , Range of Motion, Articular , Adult , Female , Follow-Up Studies , Humans , Male , Medial Collateral Ligament, Knee/physiopathology , Orthopedic Procedures/methods , Outcome Assessment, Health Care , Patellar Dislocation/physiopathology , Poland , Recovery of Function , Treatment Outcome , Young AdultABSTRACT
AIM OF THE STUDY: The aim of the study is to assess the early results of primary total knee arthroplasty with reconstruction of medial tibial condyle with autogenous bone grafting in elderly patients. MATERIALS AND METHODS: The study was conducted on patients treated with primary total knee arthroplasty. Eight subjects (eight knees) aged 63-82 (mean, 73) with mean varus alignment 18 degress (range, 10-30 degrees) required restoration of medial tibial condyle. Autogenous bone grafting from resected joint ends was used and stabilized with cancellous screws. Patients were surveyed pre- and postoperatively with questionnaires, such as: Knee Injury and Osteoarthritis Outcome Study (KOOS) and SF-36 Health Survey, version 2. Incorporation of the bone graft were evaluated in radiographs. Subsequent folow-up assessments were performed 3, 6 and 12 months after surgery. RESULTS: Postoperatively, mean range of motion in the knee joint improved from 99 to 124 degrees and pain relief was observed. The largest improvement in KOOS and SF-36 scores was seen for activities of daily living, pain, quality of life and physical functioning, bodily pain domains, respectively. The analysis of radiographs showed incorporation of the bone grafts with no lysis. There was no evidence of graft collapse or tibial component loosening. CONCLUSIONS: Autogenous bone grafting is valuable material to fill defects in the proximal tibial plateau. Volume of resected grafts and incorporation time are limitations for this technique. On the basis of our observations, we presume that this method is effective in elderly patients.
Subject(s)
Arthroplasty, Replacement, Knee/methods , Bone Transplantation/methods , Knee Joint/surgery , Osteoarthritis, Knee/surgery , Tibia/transplantation , Aged , Aged, 80 and over , Bone Transplantation/diagnostic imaging , Female , Follow-Up Studies , Humans , Knee Joint/diagnostic imaging , Male , Middle Aged , Osteoarthritis, Knee/diagnostic imaging , Patient Satisfaction , Radiography , Surveys and Questionnaires , Transplantation, Autologous , Treatment OutcomeABSTRACT
UNLABELLED: Anterior cruciate ligament (ACL) injuries are becoming increasingly prevalent in children and adolescents. In those who had undergone ligament injuries progressive meniscal damage is frequently observed. This, in turn, can lead to osteoarthritis in older age. The aim of the study was to assess the prevalence of ACL injury and/or other intraarticular lesions in patients with active growth plate. MATERIALS AND METHODS: 59 patients (30 girls and 29 boys) with an average age of 15.5 years (range 7-16 years) were included in the study. Thirty-nine injuries occurred during sports activities. Average time between knee trauma and surgery was 7,3 months (range 1 week-3 years). The relationships between meniscal and ligament injuries were analyzed by means of logistic regression. RESULTS: Of all 50 patients had meniscal tears (36 localized in the medial side) and 35 ACL tears. Both type of injuries occurred together in 26 patients. Three patients had undergone additional cartilage injury. We observed that in patients with ACL injury medial meniscus tear was found with higher frequency (20 knees, 57%) than lateral one (6 knees, 17%). Although meniscal tear was slightly higher distributed in boys (27/29) than in girls (23/30), sex appeared not to be the risk factor to knee injury. CONCLUSIONS: Anterior cruciate injuries are common in adolescents and have similar character to those observed in adults. Higher incidence of medial meniscus tear may be related to chronic anterolateral knee instability caused by delay in surgical treatment.
