[Short-term Outcomes of Touch® Prosthesis for Thumb Carpometacarpal Joint]. / Krátkodobé výsledky s totální endoprotézou korenového kloubu palce Touch®.

PURPOSE OF THE STUDY Rhizarthrosis, a degenerative condition of the carpometacarpal joint of the thumb, affects mainly women. Surgical treatment is indicated once the non-operative treatment fails. Thumb carpometacarpal joint total arthroplasty constitutes one of the surgical treatment options. This study aims to evaluate the short-term functional and radiological outcomes of Touch® prosthesis with a minimum follow-up period, namely two years after surgery. MATERIAL AND METHODS The study presents the outcomes of a group of 56 endoprostheses implanted in 48 patients. The dual mobility Touch® prosthesis is evaluated. The group consisted of 41 women and 7 men, with the median age of the patients being 62 years. The patients were indicated for surgery after the non-operative treatment had failed. All of them suffered from stage II - IV osteoarthritis according to the Eaton-Littler classification. The range of motion - the opposition was assessed using the Kapandji score. The function and the pain were evaluated with the DASH questionnaire preoperatively and at 3 months, 6 months, 1 year and 2 years postoperatively. RESULTS After 24 months, 91.1% (51 patients) were satisfied with the surgical outcome. Altogether 8.9% of patients (5 patients) experienced postoperative exercise-induced pain, limitation of movement of the CMC joint or hand weakness. No dislocation or endoprosthetic loosening occurred in the evaluated group. Primary wound healing was reported in all patients and no superficial or deep infection was observed. The mean DASH score was 65.3 points preoperatively; at the 2-year follow-up, the mean score decreased to 10.8 points. The pain assessed in question 24 of the DASH questionnaire decreased from the mean value of 4.45 points to 1.2 points. After two years, the range of motion of all patients was X/X according to Kapandji. DISCUSSION There are plenty of surgical techniques to manage rhizarthrosis. All types of surgery have their pros and cons. Most endoprostheses used nowadays show good short-term, mid-term, and some of them even long-term outcomes in terms of survival. The Touch® prosthesis, characterized by dual mobility, is the 3rd generation thumb CMC prosthesis and in our study achives comparable short-term outcomes to those reported by international literature. The use of the dual mobility design appears to be effective in reducing the dislocation rate. CONCLUSIONS The Touch® thumb CMC prosthesis achieves very good short-term functional and radiological outcomes. We can recommend the prosthesis provided the patients are followed-up for more than two years after surgery. Key words: rhizarthrosis, osteoarthritis, endoprosthesis of the carpometacarpal joint, dual mobility, Touch®.

[Short-Term Results of the Carpometacarpal Joint Arthroplasty Using the Ivory® Prosthesis]. / Krátkodobé výsledky náhrady korenového kloubu palce ruky Ivory®.

PURPOSE OF THE STUDY Trapeziometacarpal osteoarthritis affects primarily postmenopausal middle-aged and older women. Total joint replacement is one of the surgical treatment options for symptomatic advanced degenerative changes of the carpometacarpal joint. This study aims to evaluate the short-term functional and radiological results of the Ivory ® prosthesis with the minimum followup period of three years after the surgery. MATERIAL AND METHODS Presented are the results of 48 total trapeziometacarpal joint replacements in the group of 40 patients composed of 36 women and 4 men. The age of patients ranges from 41 to 75 years (median 56 years), with the ratio between the dominant and non-dominant upper extremity 23:25. The follow-up period ranged from 36 to 63 months (median 52 months). The surgery was indicated in patients with symptomatic trapeziometacarpal arthrosis of stage II, III and early stage IV according to Eaton-Glickel once the conservative therapy had failed. In all the patients, the evaluation of the function and pain of the operated joint by DASH score, the range of motion -thumb opposition by Kapandji score were carried out at regular intervals pre- and postoperatively, the radiological evaluation of the stage of degenerative joint condition was done preoperatively, whereas the position of the implant and the lengthening of the first column of the finger were assessed postoperatively. RESULTS Subjectively, the patients were satisfied with the result of the surgery. After the joint replacement, in 65% of cases the patients reported full satisfaction with no difficulties present, in 31% of cases the patients suffered from pain during loading, in 4% of cases the patients reported also occasional pain at rest. Postoperatively, the total DASH score values decreased from the mean preoperative value of 52.79 to 10.4 points at a three-year follow-up. The average value of pain dropped from 3.46 to 1.44 points 3 years after the surgery. The average range of motion - thumb opposition by Kapandji score increased from 8.57/10 to 9.85/10 one year after the surgery. The difference between the values of average increase in length of the first column of the finger was 0.14 mm in favour of the sub-group of symptomatic cases. In the evaluated group, the need for revision was determined in 4 implants. In 1case for aseptic loosening of the cup and three times for dislocation. After 36 months, 47 of 48 implants were in situ, the overall three-year survival was achieved in 97.9%. The most frequent postoperative complication was the occurrence of De Quervain s tenosynovitis (10%). DISCUSSION Currently, most of the newer types of modular uncemented hydroxyapatite-coated total "ball and socket" joint replacements present acceptable medium-term, and in some cases even long-term, results regarding the survival. The most pressing issue continues to be the survival of implants, particularly the failure of the trapezial component and the associated risk of revision surgery. Good postoperative results can be achieved by accurate indication, carefully applied cup implant and good postoperative cooperation of patients. The complementary study did not confirm that the lengthening of the thumb causes the postoperative development of De Quervain s tenosynovitis. CONCLUSIONS The uncemented first carpometacarpal joint total replacement using the Ivory ® prosthesis brings about very good shortterm functional and radiological results, with no occurrence of early aseptic loosening of the implant. Key words:rhizarthrosis, arthroplasty, carpometacarpal joint prosthesis, uncemented.

[Analysis of Costs Associated with Revision Total Knee Arthroplasty]. / Analýza nákladu spojených s reoperacemi TEP kolena.

PURPOSE OF THE STUDY No study has so far been published in the Czech Republic that would try to at least estimate the costs associated with revision total knee arthroplasties (TKA). The purpose of our study was to determine the total costs of primary and revision TKA for aseptic and septic failure and to determine the structure of costs, all with respect to a single workplace in the Czech Republic. MATERIAL AND METHODS The group included a total of 43 patients aged 55 to 82 years, of whom 23 (53.5%) with primary TKA implantation, 10 (23.3%) patients with revision surgery for aseptic failure, and 10 patients for septic failure of TKA. The costs of TKA were calculated retrospectively, factoring in all the items of reported care sent to the health insurance company system. The resulting costs reflected the appropriate payments in CZK based on the point value in the year concerned. RESULTS The average costs of uncomplicated primary TKA implantation amounted to CZK 136,279; the surgical treatment of aseptic failure of TKA was CZK 189,634; and the surgical treatment of septic failure of TKA was CZK 296,189. In all the evaluated cases, the highest cost item was the material of the implant (43.5 to 54.2% of the total costs), followed by the bed costs (19.8 to 21.6%), and the third highest cost item being the performance of surgery (13.6 to 16.5%). The costs of the physician's services represented 12.8 to 14.7% of the total costs and 23.6 to 33.8% of the costs of the implants. The costs associated with the treatment of infection by multiple-stage reimplantation were 5.4 times higher than when DAIR (revision surgery with debridement, irrigation, original implant retention) was used. The average costs of inpatient rehabilitation accounted for CZK 23,046 and the insurance company reimbursed on average CZK 33,544 for a 4-week therapeutic spa treatment. DISCUSSION The finding that the revision TKA is several times more expensive than the primary TKA and that the multiple-stage total knee reimplantation is the most expensive corresponds with the literature. In the Czech Republic, the dominant cost item is the cost of the implant, namely in the total costs of both the primary and revision TKA, with the revision implants in our study being on average 2.1 times more expensive than the implants used for primary implantation. Besides, the costs of implants also considerably differ across countries. The costs of the physician's services ranked 4th in the list of cost items, which does not correspond with the data reported in Western Europe or the US. Conversely, the least difference was observed in the costs of preoperative preparation and auxiliary examinations. CONCLUSIONS We have concluded in our study that the average costs of the total knee replacement for aseptic failure were 1.9 times higher than the costs of primary surgery. The average costs of treatment for septic failure (two-stage procedure) were 2.7 times higher compared to primary surgery. In case of aseptic failure, the costs of total knee reimplantation were 2.7 times higher compared to the replacement of only polyethylene liner in case of instability and osteosynthesis in case of periprosthetic fracture, with components retention. The costs of septic failure therapy were 5.4 times higher in multiple-stage reimplantation compared to revision surgery with debridement, irrigation and original implant retention. Key words: total knee arthroplasty; total knee replacement; revision total knee arthroplasty; aseptic failure; septic failure; cost analysis.

[Occurrence and Progression of Early Radiolucent Lines around Total Knee Arthroplasty]. / Výskyt a progrese casných radiolucentních linií kolem TEP kolenního kloubu.

PURPOSE OF THE STUDY Radiolucent (RL) lines may appear around the total knee arthroplasty (TKA); they occur much more frequently under the tibial component than under the femoral one. The RL lines are gaps between the TKA and the cement, or between the cement and the bone bed. They are clearly visible immediately after the surgery or may appear later. They constitute pathology of the interface and are subject to research mainly due to their potential association with aseptic loosening. The aim of this study was to assess how often they are clearly visible on the first postoperative radiograph in everyday clinical practice, how they develop during the following two years, and to compare the results with the available professional literature. Another aim was to assess the relation between RL lines and the alignment of components, the patient's habitus and clinical outcomes of the surgery. MATERIAL AND METHODS The group included 62 patients with a total number of 69 TKA implants, of which 28 were men (45.2%) and 34 women (54.8%) aged 46 to 79 years of age. The occurrence of RL lines was monitored on the first postoperative radiograph and subsequently at a one-year interval during the following 2 years. The location of RL lines and the placement of components were assessed radiographically in terms of the concept by Meneghini et al. The evaluation of surgical outcomes was done using the Knee Society Score (KSS), and the habitus was assessed with the BMI index. Subjective evaluation of the surgical outcome was done using the 4-point satisfaction scale. RESULTS The first postoperative radiographs showed a RL line at 9 (0.8%) locations in 9 (13.0%) TKAs. The control radiographs made 1 year after the surgery showed a RL line at 42 (3.8%) locations in 29 (42.0%) TKAs. During the last check conducted 2 years after the surgery, a RL line was detected at 60 (5.4%) locations in 33 (47.8%) TKAs. Throughout the follow-up period, progression of the existing RL line occurred at 6 locations in 6 (8.7%) TKAs. On the very contrary, the RL line disappeared at 8 locations in 6 (8.7%) TKAs. An association was found between the RL line occurrence and postoperative limb axis (a higher risk was posed by the varus deformity). Moreover, the frequency of RL lines increased with the growing BMI value. No relation was found between the KSS and satisfaction with the surgery and the occurrence of RL lines. DISCUSSION AND CONCLUSIONS The occurrence of RL lines corresponds roughly with the frequency stated in literature. Some lines show progression, other disappear. So far, we have been unable to distinguish the predictively significant RL lines from the insignificant ones. Important will undoubtedly also be the size of surface of RL lines and their cause. More frequent RL lines were observed in the postoperative varus deformity of TKA and with the growing BMI value. The RL lines under the anterior part of the femoral component showed a tendency to progress. In order to avoid them we recommend modifying the cementing technique. Clinically significant is the fact that the RL lines occurrence correlates neither with subjective nor with clinical outcomes of the surgery. Key words: total knee arthroplasty; total knee replacement; radiolucent lines; progression; alignment; Knee Society Score; BMI.

[Percutaneous release in the treatment of trigger digits]. / Perkutánní fenestrace pri postizení lupavým prstem.

PURPOSE OF THE STUDY: To evaluate, in a retrospective study, the surgical outcomes of percutaneous A1 pulley release in the treatment of trigger digits. MATERIAL: The group evaluated comprised 100 digits in 88 patients. There were 65 women and 23 men. Ten patients had surgery on two digits and one patient on three digits. The patients' average age at the time of surgery was 57.9 years. This procedure was performed on 55 thumbs and 45 fingers (4 index fingers, 19 middle fingers, 19 ring fingers, and 3 little fingers). METHODS: A bent hypodermic needle is used to release the A1 pulley, whose localization is determined as suggested by Froimson. The procedure is performed under local anaesthesia without tourniquet use. Pulley release is done with the needle tip. The finger/thumb is kept in hyperextension of the metacarpophalangeal joint to avoid injury to the nerve and vascular plexus. The extent of tendon release is checked by active motion of the treated digit that should move freely without snapping or locking. Subsequently, a compression bandage is applied for two days, with the digit being exercised immediately after surgery. RESULTS: Of the 100 digits treated, 95 procedures led to complete relief of symptoms and restoration of a full range of motion. Five digits underwent repeat surgery (three percutaneous and two open release procedures). No complaints were reported for 79.7 % and 91.1 % of the treated digits at 2 weeks and 2 months after surgery, respectively. Better results were recorded for the treatment of thumbs. Complications included early trigger finger recurrence in two cases, late recurrence was not recorded. A restricted range of motion after surgery required repeat surgery in three cases. No serious complications such as injury to the tendon, bowstring effect, nerve damage or wound infection were recorded. DISCUSSION: The results of surgery, both percutaneous and open release, in our patient group are comparable with those reported in the literature. In contrast to some authors, we carry out release on all digits. If indicated, we perform percutaneous release also at reoperations. CONCLUSIONS: Percutaneous release has been adopted as a standard method at our department. Because of its minimal invasiveness, it reduces the risk of complications associated with open procedures. It can be carried out at an outpatient department, is less painful and allows the patient to return to daily activities and work in a shorter time.