Optimization of Revision Hip Arthroplasty Workflow by Means of Detailed Pre-Surgical Planning Using Computed Tomography Data, Open-Source Software and Three-Dimensional-Printed Models.

BACKGROUND: In revision hip arthroplasty (RHA), establishing the center of rotation (COR) can be technically challenging due to the acetabular bone destruction that is usually present, particularly in severe cases such as Paprosky type II and III defects. The aim of this study was to demonstrate the use of open-source medical image reconstruction software and low-cost 3D anatomical models in pre-surgical planning of RHA. METHODS: A total of 10 patients, underwent RHA and were included in the study. Computed tomography (CT) scans were performed for all cases, before surgery and approximately 1 week after the procedure. The reconstruction of CT data, 3D virtual planning of the COR and positioning of acetabular cups, including their inclination and anteversion angles, was carried out using the free open source software platform 3D Slicer. In addition, anatomical models of the pelvis were built on a desktop 3D printer from polylactic acid (PLA). Preoperative and postoperative reconstructed imaging data were compared for each patient, and the position of the acetabular cups as well as the COR were evaluated for each case. RESULTS: Analysis of the pre- and post-op center of rotation position data indicated statistically insignificant differences for the location of the COR on the X-axis (1.5 mm, t = 0.5741, p = 0.5868) with a fairly strong correlation of the results (r = -0.672, p = 0.0982), whilst for the location of the COR in the Y and Z-axes, there was statistical dependence (Y axis, 4.7 mm, t = 3.168 and p = 0.0194; Z axis, 1.9 mm, t = 1.887 and p = 0.1081). A strong correlation for both axes was also observed (Y and Z) (Y-axis, r = 0.9438 and p = 0.0014; Z-axis, r = 0.8829 and p = 0.0084). Analysis of inclination angle values showed a statistically insignificant difference between mean values (3.9 degrees, t = 1.111, p = 0.3092) and a moderate correlation was found between mean values (r = -0.4042, p = 0.3685). Analysis of the anteversion angle showed a statistically insignificant difference between mean values (1.9 degrees, t = 0.8671, p = 0.4192), while a moderate correlation between mean values was found (r = -0.4782, p = 0.2777). CONCLUSIONS: Three-dimensional reconstruction software, together with low-cost anatomical models, are very effective tools for pre-surgical planning, which have great potential use in orthopedic surgery, particularly RHA. In up and in- and up and out-type defects, it is essential to establish a new COR and to identify three support points within the revision acetabulum in order to correctly position acetabular cups.

Assessment of fibrillin-2 and elastin gene polymorphisms in patients with a traumatic Achilles tendon rupture: Is Achilles tendon rupture a genetic disease?

OBJECTIVE: The study aimed to investigate the polymorphism of fibrillin-2 (FBN2) and elastin genes in patients with Achilles tendon rupture and to compare the results with a control group of participants who did not experience such an injury. METHODS: In this prospective study, 106 consecutive patients in whom traumatic Achilles tendon rupture was diagnosed and treated were included. The control group consisted of randomly selected 92 athletes (10 women and 82 men) 85 of whom had practiced sports in the past, aged 40-76 years, who during their sports career did not experience Achilles tendon ruptures. Material for genetic tests was obtained by the swab from the oral cavity epithelium of all the study population. RESULTS: 102 (96%) of patients with traumatic Achilles tendon ruptures were people with polymorphism B or heterozygotes for the elastin gene. 97 (92%) of patients with traumatic Achilles tendon ruptures were people with polymorphism B and heterozygotes for the FBN2 gene. Patients with homozygote A of the elastin gene and homozygote A of the FBN2 gene demonstrated a considerably lower incidence rate of sport-related Achilles tendon rupture. The type of sport that led to the Achilles tendon rupture and the amount of experience practicing it, as well as BMI and drug usage, did not contribute to a higher rate of incidence of any additional musculoskeletal problems or a longer time to return to their pre-injury sports activity. Polymorphisms of the fibrillin 2 (P=.0001) and elastin (P=.0009) genes impact the occurrence of traumatic injury to the Achilles tendon. However, it does not affect the length of full recovery time (P =.2251). CONCLUSION: Minimally invasive and, above all, safe collection of genetic material from the epithelium of the oral cavity in order to assess the polymorphic state of the FBN and elastin genes may allow the identification of a group of players at risk of Achilles tendon rupture resulting in long-term injury, which will significantly affect their sports career in the future. LEVEL OF EVIDENCE: Level II, Prognostic Study.

Methods of Tibiofibular Syndesmosis Fixation.

The tibiofibular syndesmosis is a ligamentous structure connecting the distal ends of the tibia and fibula. This article presents and compares the available methods of treatment of syndesmosis injuries. Current publications from the online database PubMed and relevant available books are analysed and compared with AO Surgery guidelines. Metal and bioabsorbable syndesmotic screws and the suture button technique, including all possible modifications of these approaches, are compared. The focus is on the technical aspects of the procedures, functional outcomes and complications of these procedures. According to the literature, the best long-term functional outcomes are obtained with the dynamic fixation method involving the suture button. This fixation technique is closest to a physiological connection, there is no need to subsequently remove the implant and return to work is faster. Given all this, the popularity of this fixation technique can be expected to increase dynamically.

Talus Fracture Accompanied by Irreducible Dislocation of Talar Trochlea - Treatment Strategy.

A talus fracture accompanied by trochlear dislocation is an ever-present therapeutic problem as it requires immediate surgery since any delay may result in necrosis of soft tissues and the talus, which, consequently, leads to permanent disability. Of crucial importance in the treatment of such injury is accurate analysis of fracture morphology, immediate institution of treatment and minimally invasive surgery allowing early movement of the affected limb. We operated on a male patient after a high-energy injury using a low-invasive method we had modified, which allowed for early kinesiotherapy. The functional outcome of the procedure was very good.