[Mid-Term Results of Unicompartmental Knee Replacement Using Oxford Phase III System]. / Strednedobé výsledky unikompartmentální kolenní náhrady Oxford Phase III.

PURPOSE OF THE STUDY Partial knee replacement appears to be an appropriate surgical solution of unicompartmental knee joint osteoarthritis in correctly indicated cases. The purpose of our study was to evaluate the mid-term outcomes of unicondylar knee replacement using the Oxford Phase III system in the group of patients treated by the First Department of Orthopaedic Surgery, St. Anne s University Hospital Brno. MATERIAL AND METHODS The prospective study evaluated 47 patients (in 4 patients bilaterally) after the Oxford unicompartmental knee replacement performed between 2011 and 2016. The patients were evaluated using the Knee Society Score (KSS), Oxford Knee Score (OKS) and radiological examination performed at 7.3 years after surgery on average. All the patients were operated on by the same surgeon. RESULTS Based on the questionnaires and the clinical examination, the clinical and functional status was assessed, using the Knee Society Score (KSS). The mean preoperative KSS and FS values were 59.8 and 56.5, respectively. The postoperative KSS and FS values were 91.2 and 83.4. The mean preoperative value of the Oxford Knee Score (OKS) was 27.3. Postoperatively the values reached 40.7 on average. Based on the radiological examination, the lower limb correction of axis in the frontal plane was assessed. The mean axis correction was 3.1°. The mean tibial component slope measured on lateral radiograph was 82.7°. The basic analysis of X-rays did not reveal any component malposition. The implant survival rate was calculated using the Kaplan-Meier cumulative survival curve. In our group of patients, the mean survival rate of Oxford Phase III unicondylar knee replacement at 7.3 years postoperatively is 98.0%. DISCUSSION Many studies have reported excellent results of unicondylar knee replacement and a long survival rate of over 90%. Still debated, however, are the indication criteria and also the importance of the surgeon s experience and mastery of the surgical technique. CONCLUSIONS The results of the study confirm our excellent clinical experience and the survival rate of 98% at the mean follow up of 7.3 years after surgery shows great promise for quality long-term results. Overall, crucial for the success of UKR continues to be the compliance with the indication criteria for surgery. The choice of the type of implant and, last but not least, the correct surgical technique and postoperative rehabilitation programme are also important. Key words: unicompartmental knee replacement, Oxford Phase III, osteoarthritis of the knee.

[Tibiotalocalcaneal Arthrodesis: Comparison of Fixation Methods, Mid-Term Clinical Results]. / Tibiotalokalkaneální artrodéza: srovnání metod fixace, strednedobé klinické výsledky.

PURPOSE OF THE STUDY The authors focused on the topic of tibiotalocalcaneal arthrodesis. It is a surgical procedure used to manage severe comprehensive ankle and hindfoot pathology. The scope of surgery and the negative impact on the walking stereotype are offset by preserving a weight-bearing and pain-free limb. The purpose of the study was to evaluate the group of patients who had undergone surgery at the First Department of Orthopaedic Surgery, St. Anne s University Hospital Brno and to identify the most suitable fixation for arthrodesis. It also aimed to compare the outcomes achieved by the authors with those reported by other departments. MATERIAL AND METHODS The group included patients operated on at the authors department between 2011 and 2021. The surgery was indicated in patients with severe concomitant arthritis of the upper and lower ankle, complex hindfoot instability, Charcot arthropathy. Contraindications included acute infection, decompensated diabetes and heavy smoking. The study compares fixation using a lateral plate, a retrograde nail and a retrograde nail with fibula acting as biological plate. The patients were scored preoperatively and postoperatively using the AOFAS Ankle-Hindfoot Score. Statistical analysis of the results was also carried out. RESULTS The group included 23 patients, of whom a lateral plate was opted for in 7 patients, a retrograde nail in 8 patients and a retrograde nail with fibula used as a biological plate in 8 patients. The patients of the group were followed up for the period ranging from 0.5 to 9 years after surgery. Serious complications were observed by the authors in 6 patients of the group. The failure of osteosynthesis material was reported in 2 cases with lateral plating fixation. A stress fracture above the apex of the nail developed in 2 cases. A serious infection was observed by the authors in 1 patient. The method associated with the lowest incidence of complications was the fixation with a retrograde nail and fibula used as a biological plate. DISCUSSION The forms of fixation for tibiotalocalcaneal arthrodesis have recently advanced considerably, the methods of fixation for arthrodesis in particular. The modern implants enable to compress the individual structures, to provide stable fixation and potentially to avoid long-term plaster cast fixation. Nonetheless, these surgical procedures are associated with a high complication rate. Currently, there is no consensus in international studies on the optimal fixation for arthrodesis. Numerous papers describe complications including postoperative infections, failure of osteosynthesis material and fractures close to osteosynthesis material. The number and the type of complications observed by the authors in their group of patients were similar to those reported by other authors. CONCLUSIONS Tibiotalocalcaneal arthrodesis is a surgical procedure reserved exclusively for patients indicated based on strict criteria and should be performed by an experienced team able to cope with potential complications. In the followed-up group of patients, the optimal method of fixation for arthrodesis appeared to be the fixation with a retrograde nail and fibula used as a biological plate. Key words: tibiotalocalcaneal arthrodesis, retrograde nail, lateral ankle plate, ankle instability, ankle arthrosis, biological plate.

[Treatment of Giant Cell Tumor of Bone in the Distal Radius and Ulna]. / Lécba obrovskobunecného kostního nádoru distálního radia a ulny.

PURPOSE OF THE STUDY The preferred treatment of giant cell tumor of bone is curettage with the use of local adjuvant. If the tumor spreads beyond the bone into soft tissues, en bloc excision should be performed. Intralesional curettage allows joint preservation, but it is associated with a high recurrence rate. The purpose of the study was to identify the risk factors for local recurrence and to compare the functional outcomes after both types of surgical procedures. MATERIAL AND METHODS The group included 16 patients (5 women, 11 men) with giant cell tumor of bone in distal forearm treated at the First Department of Orthopedic Surgery, St. Anne s University Hospital Brno in 2005-2019. The mean age of patients was 38 years (22-53). The follow-up period was 6.75 years (2-15) on average. The most common location of the tumor was distal radius (14). In 6 patients denosumab treatment was indicated. Based on the obtained data, we compared the effects of gender, Campanacci grade, type of surgery and administration of denosumab on the risk of local recurrence. The functional outcomes were evaluated retrospectively based on the Musculoskeletal Tumor Society scoring system for upper limb salvage surgeries. RESULTS Resection and reconstruction using an osteocartilaginous allograft was performed in 9 patients. Seven patients were treated with tumor curettage with bone cement used to fill the cavity. The group of patients who underwent curettage showed a significantly higher mean MSTS score 89% compared to the group of patients with resection with the mean MSTS score 66% (P < 0.05). Local tumor recurrence was reported in 3 patients (18.75%). No statistically significant difference was found in gender, tumor grade, radicality of surgery or administration of targeted therapy with respect to the incidence of local recurrence. Altogether 6 complications (37.5%) were observed in the group. DISCUSSION The treatment of a giant cell tumor of bone aims to completely remove the tumor and to preserve the best possible function of the limb. The complications in distal forearm involve particularly an increase incidence of local recurrence and painful or limited range of motion of the wrist. Whereas curettage with the use of local adjuvant is burdened with a higher recurrence rate, resection with allograft reconstruction of bone defect is usually associated with poorer functional outcomes. CONCLUSIONS Tumor curettage using local adjuvant is preferred in a well-circumscribed tumor and offers an excellent functional outcome. En bloc tumor resection and reconstruction using an osteocartilaginous allograft is a suitable treatment option for a locally advanced tumor with a low risk of local recurrence. Key words: giant cell tumor of bone, distal radius, distal ulna, curettage, osteocartilaginous allograft.

[Long-Term Results of Total Knee Replacement Using P.F.C. Sigma System with an All-Polyethylene Tibial Component]. / Dlouhodobé výsledky totální náhrady kolenního kloubu P.F.C. Sigma s celopolyetylenovou tibiální komponentou.

PURPOSE OF THE STUDY Use of an all-polyethylene (all-poly, AP) tibial component in primary total knee arthroplasty is still an attractive option considering the durability of replacement, the elimination of backside wear and the lower cost compared to modular metalbacked tibia. The purpose of the study was to evaluate the long-term results of the total knee replacement using the P.F.C. Sigma system with a monoblock all-polyethylene tibial component implanted at the 1st Orthopedic Department of the St. Anne's University Hospital and Masaryk University Brno in the period 1999-2010. MATERIAL AND METHODS In the monitored period, 911 total knee replacements using P.F.C. Sigma with an all-polyethylene tibial component were performed. This cohort of patients was evaluated at least 10 years after the primary replacement surgery. Altogether 323 knee replacements in 289 patients were evaluated. The clinical outcomes were assessed according to the Knee Society Clinical Rating System (KSS) and the Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. The replacement survival was evaluated using the Kaplan-Meier survival analysis. RESULTS In the evaluated group, the average KS was 82.6 points and the average functional score was 74.7 points. Excellent results were recorded in 213 cases, good results in 78 and satisfactory in 23 replacements. Poor clinical results were reported in 9 patients. The average range of motion was 105.8°. In 5 knees (1.5%) revision surgery was performed for infection complications, 3 cases were complicated due to periprosthetic fractures, 4 replacements were revised due to anterior knee pain and 8 knees showed a limited range of motion. Only 1 replacement was revised for aseptic loosening, with no need for reimplantation of the component. The survivorship of the implant was 98.5 % at the follow-up of 12.8 years, including the reasons of reimplantation. DISCUSSION Total knee replacement with an all-polyethylene tibial component is not so popular as the metal-backed modular implants. The all-polyethylene tibial component has certain advantages: lower unit costs, no backside wear, no liner dislocation, possibility of conservative bone resection. On the other hand, this type of implant is not modular and augmentations or longer stems cannot be used. Even though this type of endoprosthesis is recommended exclusively for elderly patients with a lower level of activity, the current mid- and long-term results show that indications for all-poly implants are much broader. CONCLUSIONS The total knee replacement with an all-polyethylene tibial component shows very good long-term clinical outcomes with an excellent survival rate. The all-poly design is cost-effective and may be used not only in elderly patients. Key words: total knee replacement, all-polyethylene tibial component, long-term results.

Acute pain: a multifaceted challenge - the role of nimesulide.

BACKGROUND: This article summarizes the outcome from an international consensus meeting, which took place in Vienna on 4 November 2014. SCOPE: The aim of the meeting was to provide the state of the art on the pathophysiology and treatment of acute pain with special emphasis on nimesulide, a non-steroidal anti-inflammatory drug (NSAID) indicated for the treatment of acute pain and primary dysmenorrhea. Besides the data on the mechanisms of acute inflammatory pain and on the efficacy and safety of nimesulide in patients affected by different forms of acute pain, the clinical experience of attending experts was discussed based on selected case reports. RESULTS: The members of this consensus group recognized that nimesulide is a NSAID highly effective in the treatment of several painful situations with an acute inflammatory component including primary dysmenorrhea. Although safety concerns regarding nimesulide have emerged in recent years, both robust new epidemiological data and clinical experience confirm a positive benefit/risk profile of nimesulide in the treatment of several forms of acute pain. CONCLUSIONS: The members of this international consensus group concluded that nimesulide, when used appropriately, remains a particularly valuable and safe option for the treatment of several conditions characterized by the presence of acute inflammatory pain because of the rapid onset of the analgesic action, and the positive evidence-based benefit/risk profile.

[Distal femoral periprosthetic fractures: classification and therapy]. / Periprotetická zlomenina distálního femuru--klasifikace a terapie.

PURPOSE OF THE STUDY: Periprosthetic fracture is one of the most serious complication of total knee arthroplasty. In our retrospective clinical study we designed our classification with rules for treatment of those fractures. MATERIAL AND METHODS: During the last thirty years we treated 53 distal femoral periprosthetic fractures in our orthopaedic department. In our clinical study we reviewed our group of distal femoral periprosthetic fractures with on the basis of X-ray findings, the treatment method used and treatment outcomes. RESULTS: According to our findings we divided distal femoral periprosthetic fractures into six groups: Type I Nondisplaced fractures, 5.7%; treatment failure rate, 33%. Type II a Fractures with lateral comminution (the most often type of fractures), 37.7%; treatment failure rate, 20%. Type II b Fractures with medial comminution, 7.5%; treatment failure rate, 60%. Type II c Fractures above TKA (the second most often type), 34%; treatment failure rate, 18%. Type II d Comminuted fractures, 5.7%; treatment failure rate, 18%. Type IIIFractures with loosening of TKA, 9.4%; treatment failure rate, 20%. For the treatment of fractures we used various methods according to the type of fracture: Plate osteosynthesis in 32 cases, with failure in seven. Three failures in IIa group due to incorrect osteosynthesis with condylar plate, treated by reosteosteosynthesis with same implant. One in IIb group treated primarily with cement plomb, after second failure treated with revision total knee arthroplasty. Two failures in IIc group, treated by reosteosynthesis with spongioplasty using the same implant. One failure in III group solved with revision TKA. Intramedullary nail in nine cases , with failure in two. One failure in IIb group treated by reosteosynthesis with condylar plate and cement plombage. One in IIc group due to infection, solved with extraction of material and second stage revision TKA. Conservative treatment in three cases,with failure in two. One in I group treated with condylar plate. One in IId group solved with revision TKA. Miniosteosynthesis in three cases, with failure in two.One failure in IIa group treated with condylar plate, one in IIb group treated with intramedullary nail and additional hydroxyapatite plombage. Revision total knee arthroplasty in five cases with no failure. Extraction of TKA, external fixation, and arthrodesis in 1 case with no failure. DISCUSSION: The rules for treatment of distal femoral periprosthetic fractures are not definite yet. For fractures above TKA is recommended nail osteosynthesis; for fractures at the level of femoral component is preferable to use osteosynthetic material, condylar plate or LCP. Bone grafts, bone cement, and artificial bone are used to augment osteosynthesis in comminuted fractures. Fractures at the site of loosening are indicated for revision TKA. CONCLUSIONS: According to our results: Type I: Conservative treatment possible. Osteosynthesis with condylar plate is recommended. Type IIa: Indication for condylar plate osteosynthesis. Type IIb: The most problematic group. Osteosynthesis with condylar plate with augmentation or condylar plate placed from medial side. Type IIc: Plate osteosynthesis possible, intramedullary nail is recommended. Type IId: Osteosynthesis with augmentation is possible in some cases; revision TKA is recommended. Type III: Indication for revision TKA.