Treatment of Massive Giant Cell Tumor of Bone of the Proximal Radius. Case Study.

This paper presents a case of a massive giant cell tumor of bone (GCTB), Campanacci and Enneking type III, in an atypical location at the proximal end of the radius. In type I and II cases, surgical treatment is the treat-ment of choice: curettage of the lesion, replacement of bone defects with bone grafts or cement. Advanced type III changes frequently require segmental resection and joint reconstruction. In our patient, a segmental resection of the proximal third of the radius and infiltrated surrounding soft tissues was performed without reconstruction of the radius. A good clinical outcome without a relapse has been noted at one year post surgery.

Arthroscopic verification of objectivity of the orthopaedic examination and magnetic resonance imaging in intra-articular knee injury. Retrospective study.

INTRODUCTION: Arthroscopy of the knee joint is regarded as the most objective diagnostic method in intra-articular knee joint lesions. AIM: The purpose of this study was to assess the objectivity and diagnostic value of orthopaedic examination (OE) and magnetic resonance imaging (MRI) in reference to the arthroscopic result. MATERIAL AND METHODS: In a group of 113 patients treated by arthroscopic surgery for post-traumatic knee pathology between 2008 and 2010 in our department, accuracy of clinical and MRI findings that preceded surgery were studied retrospectively using a statistical method. Sensitivity, specificity, accuracy and predictive negative and positive values were the subject of analysis. RESULTS: In the presented trial, sensitivity values of the orthopaedic examination for injuries of the anterior cruciate ligament (ACL), meniscus medialis (MM), meniscus lateralis (ML) and chondral injuries (ChI) were 86%, 65%, 38% and 51%, respectively. Specificity values were 90%, 65%, 100% and 100%, respectively. The MR sensitivity and specificity values were 80%, 88%, 44% and 32%, and 86%, 64%, 93% and 97%, respectively. CONCLUSIONS: Assessment of intra-articular knee joint lesions is a difficult diagnostic problem. In making a decision about arthroscopy of the knee joint, an appropriate sequence of examinations should be carried out: OE, MRI and arthroscopy. The improvement in the effectiveness of the orthopaedic examination and MRI can limit the too high frequency of diagnostic arthroscopies, which generates the risk of operation treatment and costs.

Total knee arthroplasty with application of anatomic endoprosthesis journey. Clinical and radiological assessment in a 2-year follow-up.

BACKGROUND: Growing expectations regarding TKA inspire the researchers to look for a perfect endoprosthesis. One of the new-generation prostheses is Journey BCS (Smith&Nephew), introduced in 2004, which, according to its inventors, completely restores anatomy and kinematics of the knee. The aim of this study was to evaluate TKA with Journey endoprosthesis in a two-year follow-up. MATERIAL/METHODS: The study was a prospective analysis. It included 61 patients aged 52-87 years, with primary OA and axial deformity under 15°, and without a significant instability in the frontal plain. A total of 61 TKAs were assessed with the use of WOMAC OI, KSS clinical and radiological scales. The group was evaluated after 6, 12, 24 weeks, 1 and 2 years postoperatively. RESULTS: At the end point of observation, 97% of the patients obtained good and very good clinical and radiological results. Mean knee flexion in the study group increased until 24 week and reached 121.8°. These results are comparable with the results described in the literature, but do not differ significantly from the outcomes of conventional endoprostheses. CONCLUSIONS: In the presented material, TKA with the application of anatomic endoprosthesis Journey allowed to obtain in the majority of patients very good and good early clinical and radiological results.

[Joint arthroplasty in patients on long-term renal dialysis. Qualification, risks and benefits]. / Endoprotezoplastyka stawów u pacjentów przewlekle dializowanych. Kwalifikacja, czynniki ryzyka i korzysci.

UNLABELLED: The aim of this study is to evaluate the qualifications, risks and benefits associated with the arthroplasty of the: hip, knee and elbow in patients on long term renal dialysis. MATERIAL AND METHODS: The study was retrospective and 11 patients were included who underwent 10 hip replacements, 4 knee and one elbow joint. RESULTS: In seven cases the outcome was excellent, six good and two satisfactory. CONCLUSIONS: Classification of patients with end-stage renal disease to joint arthroplasty is a difficult problem and requires an interdisciplinary experience in conducting intra and postoperative period which allows to avoid many complications. The benefits of improving the quality of life exceeds the operative risk and cost of treatment. Obtained good clinical results encourage to extend indications for surgical treatment.

Total hip arthroplasty with bone grafts for protrusio acetabuli.

BACKGROUND: This retrospective cohort study analyses the long-term outcomes of total hip arthroplasty (THA) in arthritis patients with various forms of acetabular protrusion. MATERIAL: We analyse 135 consecutive cemented total hip arthroplasties in 127 patients. Mean age of the patients was 55.2 years (range: 30-72 years). The study group consisted of 119 women and 16 men who were followed up for a mean of 12.7 years. Mean preoperative function was poor, with a Harris score of 28.0 points. METHODS: Clinical evaluation utilized the Harris hip score, and radiographic assessment relied on the criteria of the Joint Committee of the Hip Society, AAOS and SICOT. RESULTS: Clinical outcomes of the study group were as follows: excellent in 35 (25.9%), good in 78 (57.8%), fair in 17 (12.6%), and poor in 5 (3.7%). The mean postoperative Harris score was 86.6 points. The radiographic outcomes were excellent in 47 (34.8%), good in 60 (44.5%), fair in 18 (13.3%), and poor in 10 hips (7.4%). Loosening of both components was observed in 6 hips and of the acetabular component in 4 hips. Complications other than aseptic loosening were observed in 25 (18.5%) hips. CONCLUSIONS: Implant survival following THA in arthritis with acetabular protrusion depends mainly on proper bone stock reconstruction. 80-85% patients after THA with acetabular bone stock reconstruction achieved very good and good results following an average of 12 years of follow-up. Patients with autogenic bone grafts achieved better outcomes. There was no substantial effect of aetiology, type of endoprosthesis, grade of acetabulum migration on the final outcome.

Subvastus and medial parapatellar approaches in TKA: comparison of functional results.

The purpose of this study was to compare the clinical results of total knee arthroplasty (TKA) in the early and late postoperative period using subvastus and medial parapatellar approach. A prospective randomized controlled study was conducted in a group of 169 patients (180 TKAs) with 2-year follow-up. Patients were divided into a study group (97 TKAs) with a subvastus approach and a control group (83 TKAs) with a parapatellar approach. Assessment of the results of both operating approaches was based on functional, clinical Knee Society Score, and pain (visual analog scale). Patients in the subvastus group achieved full active extension, better range of motion, and better Knee Society Score results at 12 days, 6 weeks, and 12 weeks earlier than patients in the medial parapatellar group. They also had less pain at 12 days. No statistically significant differences existed between assessed end points in both groups at 24- and 52-weeks, and 24-months postoperatively. The subvastus approach has given patients better early clinical results; however, at longer follow-up, both groups had similar outcomes. The potential benefits of the subvastus approach are: protection of the extensor mechanism from damage, less risk of damaging the blood supply to the patella, earlier clinical recovery, and less pain in the early postoperative period. The subvastus approach is an alternative to the standard medial parapatellar approach in TKA. It can be used with equally good results, especially taking into consideration positive clinical aspects in the early postoperative period.

[Treatment of open femur fracture with critical bone loss of femoral shaft in politrauma patient--case report]. / Zaopatrzenie otwartego wieloodlamowego zlamania trzonu kosci udowej z krytycznym ubytkiem kosci w urazie wielomiejscowym--opis przypadku.

UNLABELLED: The authors describe the case of a 21 year old patient who suffered an politrauma injury in a traffic accident (motorcyclist). OBJECTIVES: Presentation of possiblities of treatment femur bone fracture with critical bone loss using intramedullary nail. METHODS: Patients's Injury included: fractures of the femur, temporal bone, and ulna. The patient's Severity Score (ISS) was 24. The dominant trauma fracture was open, comminuted fracture of femur shaft (AO 32-C2, Anderson-Gustilo IIIa) with bone loss stated as critical (loss of femoral shaft over 10 cm, including the loss of more than 50% of the circumference was about 8 cm length, and the loss of the full circumference of more than two branches of the missing bone). Osteosynthesisnad bone length reconstruction of the femur was with use of intramedullary locking nail. RESULTS: Full reconstruction was regenerated after 12 months. Although there was extensive injury no local and general complications appeared. CONCLUSION: Early definitive fracture stabilization and secondary dynamisation possible to obtain the bone regeneration at the defect site.