Total hip arthroplasty using cementless avantage cup in patients with risk of hip prosthesis instability.

BACKGROUND: The aim of the study was to assess total hip arthroplasty procedures using the cementless Avantage cup in women with additional risk factors for postoperative hip instability. MATERIAL AND METHODS: A total of 280 cementless Avantage and Avantage Reload cups were implanted in 260 women aged between 29 and 79 years (60.9 years on average) in the years 2004-2010. In 217 women, there was at least one additional risk factor for prosthesis dislocation. The survival of the cup was assessed by using the necessity of cup replacement as an endpoint of the study. The statistical analyses used the Fisher test to assess the difference in the necessity of revision surgery between the Avantage and Avantage Reload cups, and the Kaplan Meier method was used to evaluate the effective functioning time of the prosthesis. Additionally, tests were conducted on the surface layer of 2 not used and 4 removed cups. RESULTS: 239 patients (259 arthroplasties) were subjected to the final examination. The follow-up period ranged from 2.7 to 9.7 years, 7.0 years on average. None of the patients demonstrated postoperative prosthesis instability. Aseptic loosening was observed in 19 cups in 18 women (7.3%). Intra-prosthetic dislocation occurred 4 times, and in two cases it was combined with loosening of the cup. Revision surgery was required more often in patients with the Avantage cup (9.5%, 17 out of 179) in comparison to the Avantage Reload (2.5%, 2 out of 80). However, the observed differences did not reach the level of statistical significance. The cumulative survival rate of the Avantage cup was 0.94 at 5 years and 0.86 at 8 years. CONCLUSIONS: 1. Avantage cups reduce the risk of postoperative hip instability. 2. Patients with cementless Avantage cups should be closely monitored for signs of aseptic loosening.

Mortality as an indicator of treatment quality after pertrochanteric fractures in the elderly.

BACKGROUND: Fractures in people over the age of 65, especially pertrochanteric fractures of the femur, present a growing medical problem. Surgical treatment of such fractures should be performed in the shortest possible time after the accident. Efforts were made to answer the question what contributes to the reduction in mortality after pertrochanteric fractures. MATERIAL/METHODS: This work presents a comparative analysis of two populations treated surgically due to pertrochanteric fractures at the District Hospital of Orthopedic and Trauma Surgery in Piekary Slaskie during years 1988-1992 and 2005-2008. Patient mortality was used as an indicator of treatment quality. In the first group of 118 patients hospitalized in years 1988-1992, there were 48 deaths reported during 12 months after the surgery. In the second studied population of 244 patients (operated in years 2005-2008), 54 deaths were noted in the 12-month period after the surgery. There was a reduction in mortality from 40.6% to 22.3% over those 15 years. CONCLUSIONS: Introducing mortality as an indicator in the comprehensive assessment of treatment quality will intensify its monitoring in both the hospital as well as the out-of-hospital period of care. It will also reveal the individuality and social importance of geriatric fractures.

Total hip arthroplasty with shortening subtrochanteric Z osteotomy in the treatment of developmental dysplasia with high hip dislocation.

BACKGROUND: The work presents the results of total hip arthroplasty in the treatment of arthrosis secondary to for developmental dysplasia with high hip dislocation or corollary to previous surgery of dysplastic high riding hips. In all patients the cup was placed in its anatomical position. In order to avoid excessive lengthening of the operated limb and the associated complications, the femoral shaft was shortened by subtrochanteric Z osteotomy. The osteotomy site was stabilised with a cementless CDH stem. MATERIAL AND METHOD: The technique was used in 10 women at an average age of 53. 4 years between 2006 and 2011. Five patients were operated on due to the degenerative changes secondary to developmental dysplasia with high dislocation of hip joint. The remaining patients had undergone surgery before. Angular osteotomy of the proximal femur was performed in four patients and total hip arthroplasty with high placement of the acetabular component in one. The average preoperative Harris Hip Score was 43.7. Preoperative shortening of the limb ranged from 4 to 10 cm, with an average of 6. 1 cm. RESULTS: The patients were followed up for a mean of 28. 3 months. No postoperative nerve damage has been observed. The operated limb was lengthened in all patients (range: 2.5 to 5 cm, mean: 3.4 cm). Radiographic union at the osteotomy site was obtained after an average of 4.5 months. All patients reported complete or near-complete pain relief and improved function of the operated limb. By the last follow-up visit, the Harris Hip Score had increased to 86 points on average. CONCLUSIONS: Subtrochanteric osteotomy of the femur reduces the risk of postoperative complications associated with excessive limb lengthening and facilitates access to the acetabulum. Total hip arthroplasty with shortening subtrochanteric Z-type osteotomy is a safe method in the treatment of degenerative changes secondary to developmental dysplasia with high hip dislocation.

[Realloplasty of the acetabular component of the hip joint endoprosthesis without mechanical support systems]. / Realloplastyka komponentu panewkowego endoprotezy stawu biodrowego bez uzycia mechanicznych systemów wzmacniajacych.

This work presents the tactics of surgical procedures in 40 patients who underwent revision of the hip joint due to isolated loosening of the acetabular component of the endoprosthesis. The studied group were operated between 2004 to 2006 without the use of mechanical support systems. Realloplasty of the acetabular component involved the evaluation of: etiology of acetabular loosening, concomitant diseases in the operated patients, and the grade of acetabular defects according to Paprosky's classification. In this work we analyze the type of both the loosened acetabulum and that used in revision, and discuss complications. Finally, we present a clinical evaluation of the operated patients according to Harris scale before revision surgery and six and twelve months after, with good early results.

Psychological and psychiatric factors related to health-related quality of life after total hip replacement - preliminary report.

UNLABELLED: Total hip replacement is one of the most successful orthopaedic interventions in improving considerably the patients' performance, nevertheless some patients demonstrate declined functional ability following an operation. Such condition is not a consequence of medical illness or the surgery itself but might rather be associated with mental status. The authors conduct an investigation concerning the relation between some psychological and psychiatric factors and their influence on health-related quality of life in patients after total hip replacement. METHODS: Into the study group we included 102 subjects undergoing total hip replacement (59 female, 43 male). In all subjects we measured depression (Beck Depression Inventory - BDI), anxiety (State and Trait Anxiety Inventory - STAI), sense of coherence (SOC-29), personality traits (Eysenck Personality Inventory - EPI) and health related quality of life (SF-36). RESULTS: The postoperative values of the PCS and the MCS for the whole group of patients correlated negatively with the SOC values (p=0.04 and p=0.03 respectively). Neuroticism (EPI) and anxiety as a trait (STAI) were also associated with postoperative performance, both in mental (p=0.03 and p=0.008 respectively) and physical (p=0.005 and p=0.04 respectively terms). CONCLUSION: Total hip replacement improves significantly the patient's health-related quality of life at 6months after surgery, what is influenced by sense of coherence, neuroticism and anxiety as a trait. Above mentioned factors should be taken into account when rehabilitation and social readaptation processes are planned.

Anxiety and depression and their influence on the quality of life after total hip replacement: preliminary report.

Objective. The study investigated health-related quality of life in relation to mental status (anxiety and depression) and demographic factors in patients before and after total hip replacement due to osteoarthrosis. Methods. The SF-36, HADS, socio-demographic data questionnaire was delivered to a group of 184 subjects (108 females, 76 males) at the mean age at the time of surgery of 59 years. Questionnaires were delivered to the subjects 2 weeks before the surgery and 6 months after the operation (by mail). Results. Patients after hip replacement showed significant improvement in health-related quality of life in most domains of SF-36 score and summary scale of PCS (Physical Component Summary Scale) and MCS (Mental Component Summary Scale). They also showed improvement in mental status. Elderly patients were more likely to show worse score in MCS and PCS before and after surgery. BMI (body mass index) was correlated only with preoperative PCS. Mental status was associated with postoperative PCS and MCS. Patients who were satisfied with the results of the surgery showed higher PCS and MCS score. Conclusion. Hip replacement surgery brings significant improvement to the quality of life. Age and mental status of those patients influence markedly their postoperative performance.

[The association of quality of life with mental status and sociodemographic data in patients after total hip replacement]. / Wplyw czynników psychicznych i socjodemograficznych na jakosc zycia chorych poddanych zabiegowi endoprotezoplastyki stawu biodrowego.

AIM: The aim of this study was to assess the mental status and sociodemographic data and their influence on the quality of life in patients after total hip replacement. METHODS: SF-36, Soc-29, HADS, MPI, sociodemographic questionnaire were given to a cohort of 48 subjects who participated in this study (28 female, 20 male), with age range of 54-70 (mean 56). Questionnaires were administered to subjects two weeks before surgery and three months after surgery. RESULTS: Patients after total hip replacement showed significant improvement in health-related quality of life in the summary scale of PCS and MCS and HADS-D and HADS-A. There were no significant differences in SOC and MPI. The postoperative values of the PCS and the MCS for the whole group of patients correlated positively with the SOC values. Neuroticism (MPI) was also associated with the postoperative functioning in the mental and physical dimensions. Older patients had more likely to have worse score in MCS and PCS before and after surgery. CONCLUSIONS: Total hip replacement significantly improves patient health and well-being at three months after surgery. Sense of coherence, neurotism and old age influence quality of life.

[Avantage double mobility press--fit cup in total hip arthroplasty]. / System avantage--panewka z podwójnym ruchem w alloplastyce stawu biodrowego.

The Avantage double mobility press-fit cup was devised by Dr. Bousquet in the 70's to bring reasonable response to a problem of recurrent dislocation after total hip arthroplasty. The cup is attached to the femoral head by a bipolar polyethylene liner. The polyethylene liner moves freely inside a shiny--polished metal cup. The angular range of motion before impingement is increased by the mobility of the liner. The double connection (cup-liner, liner-head) reduces the stress on the metal cup and improve the stability of the prosthesis. The solution has proved to be efficient in reducing dislocation risk and maintains at the same time the appropriate range of motion. Between January 2004 and November 2005, 113 hip arthroplasties in 108 women with use of the double mobility cup were performed. The cemented version of the Avantage cup was inserted in 15 patients (mean age--76.9 years). Uncemented, HA coated implant was used in 98 patients (with mean age of 55 years). The mean follow-up was 20.4 months. No one patient was lost to follow-up. No postoperative dislocation was observed during follow-up. There was no unwanted leg lengthening greater than 1 cm. The Avantage cup may be indicated in any primary total hip arthroplasty especially in those with increased risk of postoperative dislocations. This cup enables a correct balance of the hip without a need of the unwanted lengthening of the leg.

Comparative study of the Ender method and Dynamic Hip Screw stabilization in the treatment of intertrochanteric fractures of the femur.

Background. The aim of this retrospective study was to compare the results of two fixation devices (Ender rods in 118 patients and dynamic hip screw in 98 patients) for treatment of intertrochateric fractures of the hip. Material and methods. The two treatment groups were similar with respect to important preoperative variables such as age, coexisting disseases, bone quality and incidence of stable and unstable fractures. The following outcomes were assessed: quality of reduction, length of hospital stay, early mortality, reoperations, persistent pain at a knee or hip, decrease in range of motion of the knee and leg shortening. Results and conclusions. The subgroup analysis showed higher incidence of complications in patients with unstable type of fracture treated with Ender nailing. These complications included mainly valgus angulation and malrotation of the fracture, need for a secondary procedure due to loss of stabilization and knee pain. Intramedullary stabilization with Ender rods is not recommended in treatment of unstable intertrochanteric fractures of the femur.

Arthroscopy in the treatment of injuries and knee disorders in children and adolescents.

Background. In children and young adolescents, like in adults the knee joint is the most exposed joint to the injuries and pathologies of various ethiology. Injuries of the knee joint in children and young adolescents have their own specificity and they are characterized by some differences. Therefore the diagnostics and management are difficult even for the experienced surgeons. Material and methods. The study is a retrospective analysis of 1552 arthroscopies of the knee joint in children and young adolescents performed in the years 1986-2001. These arthroscopies accounted for 14,4% of all 10770 arthroscopies. Conclusions. Arthroscopy is a decisive diagnostic examination in many cases of diseases of unknown ethiology. Particularly in acute injuries it allows for choosing a further method of treatment. In these conditions also operative arthroscopy is performed. The arthroscopy in children is restricted not by the size of the joint which is very elastic but by the surgeons experience.