Early results of revision acetabular cup using antiprotrusio reconstruction rings and allografts.

BACKGROUND: Hip arthroplasty is one of the most frequently performed orthopedic procedures with high scores of success while its most common complication is aseptic loosening of the acetabular component, which may result from host bone loss or even from pelvis discontinuity. The purpose of the study was to evaluate results in patients after revision acetabular arthroplasty with reconstruction rings and allografts. MATERIALS AND METHODS: Retrospective data was collected from 69 revisions of acetabular components, performed in a group of 69 treated patients (the mean age 65.1 years). Before surgery, the patients had bone defects of type IIb (n = 5), IIc (n = 20), IIIa (n = 27) or IIIb (n = 17), according to Paprosky et al. RESULTS: The mean followup period of the patients was 7.2 years (range 3-19 years). A Kaplan-Meier analysis showed that a 3- and 10 year survival rate was 92.8% and 84.8% respectively, using further revision for any reason of the acetabular device as an end point. Eight patients revealed implant related complications. Four patients presented with ring loosening, one with a loose acetabular polyethylene cup, two hips demonstrated recurrent dislocations and one patient was with deep infection. Regarding the remaining 61 patients without re-revision surgery, the mean Harris hip score improved from 30.5 to 73.8 points. CONCLUSION: A modified, antiprotrusion cage provides an acceptable survival rate and radiological results, but complications could still be expected. It seems that the observed massive bone loss with pelvic discontinuity and an insufficient fixation of the cage to the ischium may result in implant loosening. Stable fixation of the ischial ring flange with screws is an essential condition to expect a good outcome.

[Clinical and metallographic evaluation of the causes of mechanical loosening of revision baskets Recon Ring--description of 3 cases]. / Kliniczna i metalograficzna ocena przyczyn mechanicznego obluzowania koszy rewizyjnych Recon Ring--opis 3 przypadków.

Aim of this study is to assess the causes of mechanical loosening of revision Recon Ring baskets (Aesculap / BBrown, Germany). This analysis was done by assessing the circumstances of baskets loosening of revision in 3 patients. Intraoperative images and radiographs of patients with these clinical complications were analyzed, and removed damaged bins and bolts of revision metallographic expertise. It was found that the most likely cause mechanical damage to the implant was originally unstable or re-fixing their ischial part, causing movable canopy closer to the basket is balanced by the screws and in turn causing fracture or bending arms, and follow-up baskets of hip bone loss. Our observations suggest that the most important is proper attachment of acetabular basket, especially his arm sciatic.

[Hip revision arthroplasty in massive bone loss of acetabulum with the use of reinforcement ring]. / Zabiegi rewizyjne w duzych ubytkach panewki z zastosowaniem koszy wzmacniajacych.

The aim of the study was the assessment of results after acetabular revision arthtoplasty with the use of reinforcement ring ReconShell (BBrown - Aesculap) and homogenous bone grafts. There were 49 patients in the study (42 women and 7 men) in the age from 30 to 88 years. The follow-up period ranged from 4 to 48 months. Before operation the mean Harris hip score was 31.14 and at last follow-up 71.64 points. Aseptic loosening of reconstruction ring was found in 3 patients. During next revision good integration of bone grafts, that were implanted into acetabulum at previous operation was found. In one hip revision of loose polietylen cup was performed. Three patient had early dislocation of hip endoprothesis, that were treated successfully in abduction casts. Next 2 patients had re-revision performed for recurrent dislocations. One patient had implants removal for septic loosening. Prolonged wound healing was noticed in 5 patients. Two patients had temporary and one permanent common peroneal nerve palsy. Two patients had temporary femoral nerve palsy. The use of reconstruction rings in massive bone loss of the acetabulum after cup loosening gives satisfactory clinical results. After the procedure patients have stabile joint that allows for weight bearing. Despite relatively high number of complications (most of which are temporary) this procedure is worth recommending.

Evaluation of satisfaction with surgical treatment for musculoskeletal dysfunction in children with cerebral palsy.

BACKGROUND: The variety of symptoms in cerebral palsy (CP) points to the advisability of using the term 'cerebral palsies' to underline the complex nature of the associated musculoskeletal dysfunctions. The incidence of CP is estimated at 1 to 5 in 1000 live born infants. This makes CP one of the main causes of hospitalization in paediatric orthopaedic wards. The complicated nature of the musculoskeletal dysfunctions entails the necessity of employing multiple surgical procedures: starting from multilevel soft tissue operations, to multiple corrective osteotomies, to spinal surgery with implantation of baclofen pumps for subarachnoid administration. The aim of the study was to evaluate the level of satisfaction following surgery in CP children. MATERIAL AND METHODS: The study group was composed of 52 children (27 males and 25 females) surgically treated between 1988 and 2001. There were 18 children with hemiparesis, 19 with diparesis and 15 with tetraparesis. A subjective evaluation of the level of the satisfaction of the patient and the parent/guardian after the surgical treatment was carried out during a follow-up examination. RESULTS: Forty-three parents (82.6%) reported improvement after the surgery and declared that they would take the same decision again. Five parents reported no significant change in the quality of life of their children (9.6%), and two (3.8%) reported a deterioration. CONCLUSION: 1. Multilevel soft tissue release in children with CP significantly improved their quality of life and was associated with a high level of parents'/guardians' satisfaction.

Cementless hip joint alloplasty complicated by intraoperative fracture of the femoral bone.

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.

[Use of bulky, femoral head allografts in revision hip arthroplasty for acetabular component aseptic loosening]. / Zastosowanie allogennych, litych przeszczepów kostnych w zabiegach rekonstrukcyjnych po obluzowaniu aseptycznym panewki endoprotezy stawu biodrowego.

The aim of the study was to analyze results in patients treated with frozen, bulky femoral head allografts without reinforcement ring for significant bone lost after acetabular component aseptic loosening. Retrospective analysis was done on 19 patients in the average age of 58 years. There were 13 women in this group. Acetabular bone lost was classified as IIIa or IIIb according to Paprosky. For revision 10 cemented and 9 uncemented cups were used. Mean coverage of acetabular component by graft on antero-posterior radiographs was 52% (from 30% to 100%). The mean follow-up was 4.2 years. Seven of our patients required another revision for aseptic loosening of the cup. The remaining 12 patients had satisfactory clinical and radiological result. The function improved from 35 points before operation to 76 at last follow-up according to Harris grading system (minimum improvement was 20 points). Two of the patients had radiographic signs of osteolysis around implant, without symptoms of loosening. Coverage of acetabular cup by the graft was 65% in cases of loosening and 42% in those patient without loosening (p <0.01). There was no statistical relationship between age and frequency of loosening (p > 0.05). Bulky, femoral head allografts are passive scaffold and may lose the mechanical strength. In cases of big bone defects of supero-lateral part of acetabulum use of metal reinforcement rings should be considered.

[Derotational osteotomy of humerus in the treatment of children with persistent brachial plexus palsy]. / Osteotomia derotacyjna kosci ramiennej w leczeniu dzieci z przetrwalym okolporodowym porazeniem splotu ramiennego.

Patients with persistent brachial plexus palsy, advanced secondary deformity of gleno-humeral joint and rigid adduction and internal rotation contracture are candidates for external derotation osteotomy of the humerus. The aim of the study was to analyze the clinical results of patients treated with humeral derotational osteotomy. The analysis was performed on 9 patients in the average age of 12.5 years. Before surgery 4 of them had dislocation, 2 subluxation and 3 advanced deformity of gleno-humeral joint. After the operation active external rotation improved 46 degrees and passive 55 degrees. In all patients improvement of shoulder function of 5 points according to Mallet classification was noted. Active internal rotation decreased from 6 to 4 points according to our own classification, and passive internal rotation deteriorated from 6 to 5 points. Flexion and abduction in gleno-humeral joint as well as flexion contracture of the elbow has not changed significantly. The trumpet sign was present in any of our patients. The follow up ranged from 1 to 8 years. Our results confirms that external derotational osteotomy of the humerus significantly improves shoulder function in patients with persistent brachial plexus palsy. This is a valuable method of treatment in patients with advanced gleno-humeral dysplasia that are not candidates for soft tissue releases and muscle transfers.

[Elective total hip arthroplasty for patients 75 years of age and older]. / Alloplastyka calkowita stawu biodrowego w leczeniu choroby zwyrodnieniowej u osób po 75. roku zycia.

The increasing life expectancies among octogerians ang nanogerians cause increased need for total hip replacement in this age group. The aim of our study was to analyze final results after total hip arthroplasty in patients 75 years of age and older. Clinical and radiological retrospective study was performed on a group of 59 patients (72 hips) in the mean age of 78 years. Minimal follow-up was 3 years. According to Harris Hip Score hip function improved on an average of 47 points and at final follow-up was 86 points. Patients with medical diseases had poorer hip function improvement. Early dislocation was found in 3 patients with was treated conservatively with good result. Almost 1/4 of patients suffered medical postoperative complications: pneumonia (n = 1), urinary tract infection (n = 4), pulmonary embolism (n = 1), acute myocardial infarction (n = 1), postoperative confusion (n = 5) and mild intestinal occlusion (n = 1). Additionally, one patient died for pulmonary embolism. There were no radiological signs of aseptic loosening or need for revision operation. Three fourth of our patients had satisfactory results after total hip replacement, despite relatively high medical (24%) and local complication rate. Aseptic loosening is rear in this age group.

Patellar height after barrel-vault high tibial osteotomy.

The purpose of the study was to assess the influence of barrel-vault high tibial osteotomy on patellar position and to evaluate the reliability and interobserver variability of three patellar height ratios. The radiographs of 24 knees that had undergone barrel-vault height tibial osteotomy with available preoperative as well as postoperative radiographs of the last follow-up were enrolled in the study. The patellar position was evaluated with the use of the Insall-Salvati, Blackbourne-Peel and Caton-Linclau methods. The indices were calculated with the tibial slope angle measured by the Moore-Harvey method. The average patellar index in the Blackburne-Peel and Caton-Linclau measurements had a statistically significant tendency to increase after barrel-vault tibial osteotomy. The results of the Insall-Salvati assessment method showed no statistically significant differences. Intrasession ICCs (intraclass correlation coefficient) varied between 0.8 and 0.99. The kappa value for the inter-observer agreement of all three ratios determined varied between 0.48 for the Blackburne-Peel index and 0.5 for the Insall-Salvati and Caton-Linclau indices. The average tibial slope before the surgery was 11.8 degrees (+/- 3.6) and decreased to 6.6 degrees (+/- 4.3). No significant associations between the index change and tibial slope change were detected. The data suggest that since some of patellar height indices measure different anatomical relationships, comparable types of indices should be used in order to estimate the patellar height or patellar relation to the joint line.

[Treatment of physeal fractures in children]. / Leczenie zlaman kosci dlugich z jednoczesnym uszkodzeniem chrzastki wzrostowej u dzieci.

The aim of the study was to determine final clinical and radiological results of epiphyseal fractures treated in our hospital. Thirty-five patients were included in the study (6 girls and 29 boys) aged from 5 to 17 years (mean 12.1 years). Follow up ranged from 2 to 20 years. According to Salter and Harris classification system 15 patients had type I and 20 had type II fracture. According to the Neer-Horowitz classification system of the proximal end of humerus one patient had grade III and three had grade IV fracture. Physeal fractures included: proximal end of humerus (n = 4), distal end of radius (n = 16) (with coexistent distal end of ulna fractures in 6 cases), distal end of femur (n = 4), distal end of tibia (n = 3) and distal end fibula (n = 8). Six patients were treated with open reduction and K-wire fixation, three with skeletal traction and cast, one with closed reduction and K-wire fixation and twenty five with closed reduction and cast. Neurovascular deficit was noted in any of our patients at admission and after reduction. During follow-up we did not notice physeal arrest, changes in limbs axis or limb shortening in any of our patients. All our patients had good clinical results. In 2 cases in early postoperative follow-up limitation of shoulder abduction after physeal fracture of proximal humerus was observed. Restoration of proper anatomical conditions is conducive to restore function of growth plate. Kirschner wire fixation did not increase the risk of growth arrest. Physeal injuries at the end of growth did not cause limb axis changes.

[Anterior cruciate ligament reconstruction by autogenous bone-patellar tendon-bone graft: correlation between bone-tunnel position and clinical results]. / Rekonstrukcja wiezadla krzyzowego przedniego autogennym przeszczepem kostno-wiezadlowo-kostnym--ocena zaleznosci pomiedzy lokalizacja kanalów kostnych a wynikiem klinicznym.

The authors evaluate correlation between bone-tunnel position and clinical results of 50 patients, aged 18-47 years, after anterior cruciate ligament reconstruction by bone-patellar tendon-bone autograft with half-tunnel technique. The evaluation comprises the femoral tunnel placement at the lateral femoral condyle, the angle of the tibial tunnel to the medial joint line of the tibia and paraarticular location of the tibial tunnel width clinical outcome within one to five years prior to operation. Bone-tunnel placement was based on radiograms done in anteroposterior and lateral view. Clinical evaluation was based on the International Knee Documentation Committee (IKDC) scale. Statistical analysis was performed by using Fisher exact test, Mann-Whitney test and chi 2 test with Yates correction. The results show that placement the femoral tunnel anteriorly to the line which was perpendicular to the Blumensaat line where it starts to curve posteriorly and tibial tunnel angle of 75 degrees or more is associated with statistically significant worsened of clinical outcome. Malalignment of femoral tunnel placement characterised much larger effects of qualitative and quantitative changes.

[Operative treatment of Haglund's deformity]. / Operacyjne leczenie deformacji piety Haglunda.

The paper presents results of the operative treatment of 22 heel in 18 patients mostly young women from 13 to 31 years old (average 20.6) with Haglund's exostosis. Operative technique consisted in partial resection of the heel with removal of the Achilles bursa. The most valuable was radiological examination for the diagnosis and assessment operative results. The ultrasound examination was helpful of estimation of Achilles tendon and calcaneal bursa. Good results achieved in 16 patients (20 heel) with follow-up from 4 to 20 years (average 9.5). Unsatisfactory results in 2 patients was connected with inadequate bone resection.

[Percutaneous trigger finger release]. / Przezskórne uwolnienie sciegna w leczeniu palca przeskakujacego.

Results of percutaneous release of the trigger finger in 18 patients (5 males and 13 females), 23-67 years old are presented. All in all, 26 fingers were operated, 10 of them was the thumb. The distribution of fingers following Quinnel was: grade I--4; grade II--12; grade III--7 and grade IV--3. The follow-up period was 6 months. The patients were operated in the office under local anesthesia with the technique described by Eastwood. Two patients required reoperation due to early recurrence of triggering. No complications were noted. In 92% of fingers complete recovery was achieved. Slight limitation of flexion persisted in two thumbs. The pain was relieved and all patients were satisfied with the procedure. The method is effective, safe and easily accepted by the patients.