ABSTRACT
The authors present their experience in the revision surgery of THR. Most often it was the case of aseptic loosening of the acetabulum, the femoral component or both components (67 %), lytic radioluscence or even lysis in the region of implants, fissures even fractures of the femur and septic loosening. They evaluate the results of revision surgeries of THR for a 5-year period in 106 patients after Merle dAubigne and Postel: excellent result was achieved in 33 %, good in 39 %, average in 19 % and a poor result in 9 %. The authors emphasize in case of primary surgery the importance of indication criteria, age of the patient, appropriate choice of the type of implant, evaluation of the immunological condition of the patient. In revision surgeries of aseptic loosening of the implant and bone defects of the medial acetabular wall efficient was mainly the application of bone grafts and cementless acetabular cup of the Harris-Galante, Zweymüller or Balgrist type. Periprothetic fractures of the femur should be treated by internal fixation and Wagner revision stem. In case of septic loosening the endoprosthesis was extracted or a two-phase revision surgery performed. Key word: THR revision surgery, aseptic loosening, bone defects, Wagner revision stem.
ABSTRACT
The authors describe the diagnostic and therapeutic procedure in diseases of the shoulder joint with regard to arthroscopic possibilities, assembled over a five-year period. Surgery of the shoulder joint accounts at the Clinic for 4 % of all surgical operations. This number comprises 46 arthroscopies of the shoulder, i. e. 21 % of all surgical operations of the shoulder joint. The autors describe the procedure during arthroscopy of the shoulder. The rations of arthroscopic diagnoses were folows: PHS of adhesion 11 %, instability 13 %, synovitis 11 %, arthritis, "mouse" 9 %, tendopathy of the rotator cuff, bursitis 20 %, tendinosis calcarea 9 %, rupture of the rotator cuff 20 % acromioclavicular arthritis 9 %. In half these patients an open operation followed: treatment of instability 26 %, operation sec. Neer 26 %, suture of rotator cuffs + operation sec. Neer 39 %, extirpation of calcificate 9 %. The arthroscopic procedure was: lavage 13 %, extirpation of "mouse" 4 %, smoothing of cartilage, forage 4 %, synovectomy - shaving 17 %, intraarticular elimination of adhesions 13 %, subacromial elimination of adhesions 13 %, subacromial decompression - shaving 27 %, extirpation of calcificate 9 %. Satisfactory results after Neer's open surgery, as well as after arthroscopic decompression were recorded in 84 % of patients. After Neer's open plastic operation satisfactory results are obtained after 3-6 months, after arthroscopic decompression already after 1.5 to 2 months. The authors consider arthroscopy a good diagnostic and therapeutic procedure in the framework of surgery of the shoulder joint. The advantage of arthroscopy is the shortening of the rehabilitation stage to half as compared with an open operation. Key words: arthroscopy of the shoulder, indications.
