The Content of the 14 Metals in Cancellous and Cortical Bone of the Hip Joint Affected by Osteoarthritis.

The aim of the study was to determine the content of particular elements Ca, Mg, P, Na, K, Zn, Cu, Fe, Mo, Cr, Ni, Ba, Sr, and Pb in the proximal femur bone tissue (cancellous and cortical bone) of 96 patients undergoing total hip replacement for osteoarthritis using ICP-AES and FAAS analytical techniques. The interdependencies among these elements and their correlations depended on factors including age, gender, place of residence, tobacco consumption, alcohol consumption, exposure to environmental pollution, physical activity, and type of degenerative change which were examined by statistical and chemometric methods. The factors that exerted the greatest influence on the elements in the femoral head and neck were tobacco smoking (higher Cr and Ni content in smokers), alcohol consumption (higher concentrations of Ni, Cu in people who consume alcohol), and gender (higher Cu, Zn, and Ni concentrations in men). The factors influencing Pb accumulation in bone tissue were tobacco, alcohol, gender, and age. In primary and secondary osteoarthritis of the hip, the content and interactions of elements are different (mainly those of Fe and Pb). There were no significant differences in the concentrations of elements in the femoral head and neck that could be attributed to residence or physical activity.

Effect of surgical treatment on lipid peroxidation parameters and antioxidant status in the serum of patients with peripheral arterial disease.

The various risk factors for peripheral arterial disease (PAD) are almost identical to those for atherosclerosis and include abnormal levels of lipids or lipoproteins. Lipid peroxidation parameters and total antioxidant capacity in the serum of male patients with PAD before surgery as well as 3-5 days and 7-10 days after surgery were measured. We also compared these parameters with those in a group of patients receiving simvastatin therapy. Concentrations of lipid hydroperoxides (LOOHs) and malondialdehyde, the total antioxidant capacity (assessed by ferric reducing antioxidant power assay), concentration of thiol (-SH) groups, and ceruloplasmin activity were determined spectrophotometrically in PAD patients treated surgically (Group I) or pharmacologically (Group II). The patients before surgical treatment had significantly higher concentrations of malondialdehyde but lower ceruloplasmin activity than those observed in Group II, treated with simvastatin. No significant differences before surgery in ferric reducing antioxidant power or thiol concentrations were found between the two groups. However, in Group I, both ferric reducing antioxidant power and thiol group concentrations decreased 3-5 days postoperatively, and ceruloplasmin activity increased 7-10 days after surgical treatment. The presented results demonstrate diverse oxidative stress responses to surgical treatment and confirm the beneficial effects of statin therapy in PAD.

[Total hip replacement after Legg-Calvé-Perthes disease]. / Totalna endoprotezoplastyka stawu biodrowego po chorobie Perthesa.

BACKGROUND: Total hip replacement (THR) is at present an accepted treatment in patients with severe osteoarthritis of the hip after Perthes disease. The aim of this paper is to evaluate the results of THR in patients suffering from secondary osteoarthritis, operated from 1990 to 2000 in the Orthopaedic and Traumatologic Department of Poznan University of Medical Sciences. MATERIAL: Material included 9 patients, 3 females and 6 males, on whom 9 THR were performed, lateral approach was used in all cases. At the time of operation, the age of patients ranged from 41 to 69 years (mean 56). Follow-up ranged from 11 to 21 years (mean 15 years). Cemented total hip arthroplasty was used during 3 of the THR, 6 of them were cementless. METHOD: The patients were clinically and radiologically evaluated preoperatively, postoperatively, and at final examination. The clinical state was evaluated with Harris hip score and WOMAC scale. We based our radiological examination on Hip Society system. RESULTS: The average preoperative Harris score for the group of patients was 34, WOMAC score 77. After an average of 15-years follow-up all hips were considered excellent, with average Harris score of 93, WOMAC Score of 6. All patients had increased function and decreased pain. The radiograms of all patients revealed that the acetabular and femoral components were correctly positioned with no radiographic evidence of loosening in the last examination. The inclination angle of the acetabular component was 22-45 degrees (mean: 33 degrees) and the acetabular opening angle was 0-15 degrees (mean: 3 degrees). The stem was neutral-oriented in all hips. No ectopic ossification concentrations were found. CONCLUSION: Clinical and radiological evaluation of our material showed that total hip replacement in the treatment of osteoarthritis secondary to Perthes disease allows regaining good lower limb function, which helps the patients staying less dependant on the surrounding environment. The results of THR are good regardless of the type of prosthesis and the type of fixation. Importantly, THR was carried out after a quite long time after Perthes disease in the childhood.

[Total hip replacement in psoriatic arthritis--raport of 4 cases]. / Endoprotezoplastyka w luszczycowym zapaleniu stawu biodrowego--opis 4 chorych.

BACKGROUND: It is unusual for the hips to be affected by psoriatic arthritis. But in that rare cases, totalhip replacement (THR) is at present an accepted treatment in patients with severe and painfull deformity. The aim of this paper is to evaluate the results of THR in patients suffering from psoriatic arthritis of the hip, operated from 2000 to 2008 in the Orthopaedic and Traumatologic Department of Poznan University of Medical Sciences. MATERIAL: Material included 4 patients, 2 females and 2 males, on whom 5 THRs were performed, lateral approach was used in all cases. At the time of operation, the age of patients ranged from 48 to 61 years (mean 53). Follow-up ranged from 2 to 10 years (mean 6 years). The operative treatment was a multistage process (during one operation only one joint was replaced). Cementeless total hip arthroplasty was used during all of the THRs. METHOD: The patients were clinically and radiologically evaluated preoperatively, postoperatively, and at final examination. The clinical state was evaluated with Harris hip score and WOMAC scale. We based our radiological examination on Hip Society system. RESULTS: The average preoperative Harris score for the group of patients was 31, WOMAC score 77. After an average of 6 years follow-up all hips were considered excellent, with average Harris score of 90, WOMAC Score of 5. All patients had increased function and decreased pain. The radiograms of all patients revealed that the acetabular and femoral components were correctly positioned with no radiographic evidence of loosening in the last examination. The inclination angle of the acetabular component was 30-48 (mean: 39 degrees) and the acetabular opening angle was 3-20 degrees (mean: 4 degrees). The stem was neutral-oriented in all hips. No ectopic ossification concentrations were found. CONCLUSION: The hip may be involved by the psoriatic arthritis. Clinical and radiological evaluation of our material showed that total hip replacement in the treatment of psoriatic arthritis allows regaining good lower limb function, which helps the patients staying less dependant on the surrounding environment. Ectopic ossification is not the clinical problem during THR in patients who suffer from psoriatic arthritis.

[Total hip replacement after slipped capital femoral epiphysis]. / Totalna endoprotezoplastyka stawu biodrowego po zluszczeniu glowy kosci udowej.

BACKGROUND: Total hip replacement (THR) is at present an accepted treatment in patients with severe osteoarthritis of the hip after slipped capital femoral epiphysis. The aim of this paper is to evaluate the results of THR in patients suffering from secondary osteoarthritis, operated from 1987 to 2004 in the Orthopaedic and Traumatologic Department of Poznan University of Medical Sciences. MATERIAL: Material included 16 patients, 9 females and 7 males, on whom 18 THR were performed, lateral approach was used in all cases. At the time of operation, the age of patients ranged from 32 to 70 years (mean 50). THR was carried out after 33 years afterwards slippage of capital femoral epiphysis. Follow-up ranged from 6 to 23 years (mean 11 years). The operative treatment was a multistage process (during one operation only one joint was replaced). Cemented total hip arthroplasty was used during 5 of the THR, 13 of them were cementless. METHOD: The patients were clinically and radiologically evaluated preoperatively, postoperatively, and at final examination. The clinical state was evaluated with Harris hip score and WOMAC scale. We based our radiological examination on Hip Society system. RESULTS: The average preoperative Harris score for the group of patients was 32, WOMAC score 74. After an average of 11-years follow-up all hips were considered excellent, with average Harris score of 91, WOMAC Score of 6. All patients had increased function and decreased pain. The radiograms of all patients revealed that the acetabular and femoral components were correctly positioned with no radiographic evidence of loosening in the last examination. The inclination angle of the acetabular component was 22-49 degrees (mean: 36 degrees) and the acetabular opening angle was 0-10 degrees (mean: 4 degrees). The stem was valgus-oriented in 1 hip, and neutral-oriented in 17 hips. No ectopic ossification concentrations were found. CONCLUSION: . Clinical and radiological evaluation of our material showed that total hip replacement in the treatment of osteoarthritis secondary to slipped capital femoral epiphysis allows regaining good lower limb function, which helps the patients staying less dependant on the surrounding environment. The results of THR are good regardless of the type of prosthesis and the type of fixation. Importantly, THR was carried out after a quite long time after slippage of capital femoral epiphysis.

[Long-term results after nonconstrained total knee arthroplasty]. / Totalna endoprotezoplastyka kondylarna stawu kolanowego--wyniki odlegle.

INTRODUCTION: The total knee replacement concerns patients with large functional impairments of this joint. The most common in use now is total nonconstrained knee prosthesis. MATERIALS AND METHODS: Twenty-five patients underwent total knee replacement between 1987-1997. For twelve patients the cause of treatment was RA, for thirteen it was the implication of idiopathic osteoarthritis of the knee. The mean age of the patient during the operation was 60 years (range 27 to 78 years). The mean follow-up of knee replacement was 13 years. We based our outcome evaluation on clinical (WOMAC, KSS) and radiological evaluation. RESULTS: The average preoperative KSS score for the group of patients was 40, WOMAC score--95. After an average of 13 years follow-up all knees were considered excellent, with average KSS score of 98, WOMAC score of 30. All patients had increased function and decreased pain. The radiograms of all patients revealed that the femoral and tibial components of the prosthesis were correctly positioned with no radiographic evidence of loosening in the last examination. CONCLUSION: Clinical and radiological evaluation of our material showed that total knee replacement allows regaining good lower limb function for the long time, which helps the patients staying less dependant on the surrounding environment. The above appears to occur regardless of the primary diagnosis which was the indication for operation.

Radiographic evaluation of the results of total hip arthroplasty with the cementless Zweymüller endoprosthesis.

BACKGROUND: Cementless endoprostheses include the Zweymüller endoprosthesis. Extensive clinical and radiological investigations were carried out in the Department of Orthopaedics and Traumatology of the University of Medical Sciences in Poznan in 180 patients who had received this endoprosthesis between 1995 and 2004. MATERIAL AND METHODS: The study group was composed of 180 patients (252 hips), out of whom 138 patients (193 hips) had been operated on due to primary (idiopathic) degenerative changes and 42 patients (59 hips) had needed treatment on account of degenerative changes secondary to developmental hip dysplasia and hip joint dislocation. The mean duration of post-operative follow-up was 6 years in patients with primary degenerative changes and 7 years in patients with secondary degenerative changes. The patients were also divided into two groups according to the length of post-operative follow-up. The first group, evaluated after a follow-up of more than 10 years, was composed of 31 hips, whereas the second group, with a follow-up of up to 10 years after the surgery, comprised of 221 hips. We evaluated anteroposterior hip joint radiographs taken before the surgery, during the follow-up and at the final examination and, additionally, axial hip radiographs taken on the first post-operative day and lateral radiographs of the femur and the hip joint taken at the final examination. The radiographic evaluation was carried out according to the recommendations of the Hip Society. RESULTS: There was no radiographic evidence of implant loosening among the 180 patients. In the group of post-dysplastic hips, the inclination angle of the acetabular component was 29-52 ° (mean: 40.2 °) and the acetabular opening angle was 0-21 ° (mean: 7.9 °). The stem was valgus-oriented in 9 hips, varus-oriented in 11 hips and neutral-oriented in 39 hips. In the group of patients with primary degenerative changes the inclination angle of the acetabular component was 29-65 ° (mean: 42.5 °) and the opening angle was 0-32 ° (mean: 8.9 °). The stem was valgus-oriented in 12 cases (6.3 %), varus-oriented in 43 cases (22.6%) and neutral-oriented in 138 cases (71%).There were no statistically significant differences between the group of patients treated due to idiopathic degenerative changes and those treated on account of post-dysplastic patients as well as between the groups divided according to the length of the follow-up as regards the position, the inclination and opening angle of the acetabular component, and the position of the stem. CONCLUSIONS: The Zweymüller Alloclassic endoprosthesis provides good stability of the acetabular component and the stem in the treatment of both primary and post-dysplastic degenerative changes. The Zweymüller stem provides good conditions for the integration of bone surface with the endoprosthesis, while the acetabular component facilitates the remodelling of the bone surrounding the implant.

[Total hip replacement in treatment of patients with deformity of the hip caused by ankylosing spondylitis]. / Totalna endoprotezoplastyka stawu biodrowego w przebiegu zesztywniajacego zapalenia stawów kregoslupa.

BACKGROUND: Total hip replacement (THR) is at present an accepted treatment in patients with severe deformity of the hip caused by advanced ankylosing spondylitis. The aim of this paper is to evaluate the results of THR in patients suffering from ankylosing spondylitis, operated from 1987 to 2007 at the Orthopaedic and Traumatologic Department of Poznan University of Medical Sciences. Material. Material included 26 patients, 2 females and 24 males, on whom 34 THR were performed, lateral approach was used in all cases. At the time of operation, the age of patients ranged from 27 to 77 years (mean 57). Follow-up ranged from 3 to 21 years (mean 10.5 years). The operative treatment was a multistage process (during one operation only one joint was replaced). Cemented totalhip arthroplasty was used during 16 of the THR, 17 of them were cementless and 1 as a hybrid. METHOD: The patients were clinically and radiologically evaluated preoperatively, postoperatively, and at final examination. The clinical state was evaluated with Harris hip score and WOMAC scale. We based our radiological examination on Hip Society system. RESULTS: The average preoperative Harris score for the group of patients was 27.3, WOMAC score 78.5. After an average of 10 years follow-up all hips and knees were considered excellent, with average Harris score of 91.4, WOMAC Score of 5.0. All patients had increased function and decreased pain. The radiograms of all patients revealed that the acetabular and femoral components were correctly positioned with no radiographic evidence of loosening in the last examination. No ectopic ossification concentrations were found. CONCLUSION: Clinical and radiological evaluation of our material showed that total hip replacement in the treatment of severe deformity of the hip caused by advanced ankylosing spondylitis allows regaining good lower limb function, which helps the patients staying less dependant on the surrounding environment. Ectopic ossification is not the clinical problem during THR in patients who suffer from spondylytis deformans.

[Clinical versus radiological mid-term results of total knee arthroplasty for degenerative arthritis of the knee]. / Zaleznosc wyników klinicznych totalnej kondylarnej alloplastyki stawu kolanowego w zmianach zwyrodnieniowych od wyników radiologicznych u chorych leczonych ta metoda w ocenie srednioterminowej.

Total knee arthroplasty (TKA) is widely accepted method for treatment of severe osteoarthritis. The aim of this paper was to retrospectively review patients operated in our institution with total condylar knee arthroplasty due to osteoarthritis and assess clinical and radiological results of this procedure. All patients treated with TKA between 1998 and 2001 were reviewed, those with diagnosis of rheumatoid arthritis were excluded from the study. One hundred and one TKA in 68 patients were studied. WOMAC protocol and KSS (Knee Society Score) were used to evaluate patients clinically, and KSS alone for radiological analysis. Bone-implant interface has been studied, position of the implants and mechanical axis of the limb both pre- and postoperatively. Excellent and good results were achieved in 89% of TKA. Subjective self-assessment was usually worse than objective one. Radiolucency was found in 16 cases (more often around tibial component than the femoral one), usually without clinical symptoms of the loosening. An accurate alignment within the range of 3 to 9 degrees valgus has been found in 68% of the knees. Subjective scores were worse than objective clinical assessment. The clinical score was higher than radiological one. The tendency to varus tibial implant fixation was observed. Suboptimal implantation has not led to implant loosening in mid-term results.

[Arthroplasty of both hips and knees]. / Obustronna totalna endoprotezoplastyka stawów biodrowych i kolanowych.

INTRODUCTION: The total joint replacement of the four great human articulations concerns patients with extreme functional impairment of the locomotor system (musculoskeletal system). Most frequently this regards patients with rheumatoid arthritis (RA) or the ones treated operatively in childhood for DDH (Developmental Dysplasia/Dislocation of the Hip) or patients with idiopathic arthritis of the hip and knee. MATERIALS AND METHODS: Eight patients underwent total join replacement of both hips and both knees (four-joint arthroplasty) between 1986 and 2006. For six patients the cause of treatment was RA, for one patient it was an implication of DDH and for the last one it was an implication of idiopathic osteoarthritis of hips and knees. The operative treatment was a multistage process (during one operation only one joint was replaced). The mean age of the patient at the time of the last procedure was 51 years (range 36 to 70 years). The mean follow-up, of four-joint replacement, was 6 years). The mean follow-up of four-joint replacement, was 6 years. We based our outcome evaluation on clinical (HHS, KSS, WOMAC) and radiological examination. RESULTS: The average preoperative Harris score for the group of patients was 35.3, WOMAC score--79.5, and Knee Society Score--38.1. After an average of 6 years follow-up all hips and knees were considered excellent, with average Harris score of 99.4, WOMAC Score of 4.5 and Knee Society Score of 98.3. All patients had increased function and decreased pain. The radiograms of all patients revealed that the acetabular and femoral components and the femoral and tibial ones were correctly positioned with no radiographic evidence of loosening in the last examination. CONCLUSION: Clinical and radiological evaluation of our material showed that total replacement of both hips and knees allows regaining good lower limb function, which helps the patients staying less dependant on the surrounding environment.

Short-term results of total hip replacement in patients under thirty years of age.

BACKGROUND: Total hip replacement is a commonly accepted treatment for disorders of the hip. The paper reviews the clinical and radiological outcomes of total hip arthroplasties performed in young patients. MATERIAL AND METHODS: Twenty-eight total hip arthroplasties were performed in twenty-one young patients between 1996 and 2005. The mean age of the patient at the time of the operation was 25.8 years (range 17 to 30 years). The mean follow-up was 6 years (range 3 to 12 years). RESULTS: The average preoperative Harris score for this group of patients was 35.82 (range 11.75 to 51.45). After 6 years of follow-up all hips were rated excellent, with an average Harris score of 99.13 (range 95.6 to 100). Radiographs revealed that the acetabular and femoral components were correctly positioned in all patients. CONCLUSIONS: 1. Total hip arthroplasty is an effective treatment in young patients who suffer from bilateral hip disease. 2. Using bone grafts around the acetabulum and inside the femoral canal is recommended especially in post-dysplastic hips and in rheumatoid patients.

Distant outcomes of the Chiari osteotomy 30 years follow up evaluation.

Background. The aim of my paper was to assess distant treatment results of patients who were treated because of hip displasia and the Chiari osteotomy was performed on those patients. Material and methods. I evaluated treatment outcomes of 27 patients who were treated at Poznan University of Medical Sciences, Clinic of Orthopedics, in 1965-1990. The Chiari osteotomy was performed on all patients for hip decenteration or hip subluxation after developmental displasia. 34 hips were evaluated (20 female and 7 male). The average age of patients was 13 years in the moment of the operation. The follow up examination was conducted 10-36 years after the Chiari osteotomy Results. After many years (30 years after the operation on the average), 37% of patients could fit into groups of very good and good results. I could assess the hips before the operation using only parameters marked on anteroposterior films. The radiographs of the hips showed displasia characterized by shallowness and steepness of the acetabulum, an increased apparent neck-corpus angle, low submersion of the femoral head in the acetabulum, and insufficient coverage of the femoral head by the acetabulum. On the radiographs taken one year after the operation I observed very good coverage of the femoral head proved by higher values (above quota) of the Wiberg angle, the Sharp angle, the Heyman and Herndon acetabulum-head indicator. I defined also a course of the osteotomy drafting an osteotomy angle, setting a degree of bone fragments displacement (medialisation), and a height of the osteotomy. Conclusions. 1. The Chiari osteotomy as a hip saving operation allows patients to function in satisfactory clinical conditions for many years. 2. When conducted correctly, the Chiari osteotomy considerably improves femoral head coverage not only in the frontal plane but also in the transverse plane. 3. Too wide osteotomy angle, more than 20 degrees , further than 50% displacement of a distal bone fragment and too low course of the osteotomy in relation to the apex of the femoral head extorted many a time by intraoperative situation, may favor worse patients clinical conditions some time later, considering acceleration of degenerative lesions confirmed before the operation.

Distal greater trochanteric transfer in the treatment of deformity of the proximal femur caused by avascular necrosis.

Background. Distal greater trochanteric transfer is one of the surgical methods used to correct proximal femoral deformity arising in the course of treatment for developmental dysplasia of the hip. Material and methods. We reviewed a series of 49 patients (55 hips) who had undergone distal greater trochanteric transfer at the mean age of 13.9 years due to deformity of the proximal femur after treatment for developmental dysplasia of the hip, in order to verify the value of the procedure. The mean follow-up was 15 years. Clinical and radiological assessment was supplemented with strain-gauging evaluation of the muscles involved. Results. Good results were achieved in those patients who had good range of movement or isolated restriction of abduction before the operation. After surgery, a 22% increase of abductor torque was found, the Trendelenburg sign disappeared in 30 individuals, and 15 patients regained normal gait. Conclusions. Distal greater trochanteric transfer improved hip joint biomechanics. Good abduction/adduction range of hip movement was essential for clinical improvement and increased muscle strength after surgery. Arthritic changes occurred primarily in those hip joints without clinical improvement. Distal transfer of the greater trochanter delayed osteoarthritis of the hip.

[Axial and derotational traction before surgery for slipped femoral capital epiphysis]. / Wyciag osiowy i derotacyjny przed leczeniem operacyjnym mlodzienczego zluszczenia glowy kosci udowej.

18 cases of slipped femoral capital epiphysis were prepared for surgery by axial and derotational traction lasting 1 to 5 (av. 2,9) weeks. In all cases significant pain relief was achieved, partially the range of passive motion in the hip was improved. No reduction of slipped epiphysis was recorded. Best results occurred in medium and severe (> 60 degrees) cases. The traction before surgery for slipped femoral epiphysis is considered to improve range of motion, bring good pain relief, but not reduce the slipped epiphysis.

[Long-term results of pinning for slipped capital femoral epiphysis]. / Odlegle wyniki leczenia mlodzienczego zluszczenia glowy kosci udowej stabilizacja szyjkowo-glowowa.

Clinical and radiological analysis of 39 hips in 32 patients treated with in situ pinning for light and non-severe (up to 78 degrees) slipped capital femoral epiphysis. The population of 21 boys and 11 girls aged 10-16 (av. 13.1) was observed in 4-27 (av. 21) years. The observation showed 18.8% very good, 18.8% good, 46.8% satisfactory, 12.5% bad results and 3.1% (1 patient) of unsuccessful treatment, according to Heyman & Herndon clinical evaluation scale. Radiological evaluation of secondary coxarthritis acc. to Boyer: 0 - 35.,8%, I - 23.1%, II - 33.4%, III - 7.7%. Slipped upper femoral epiphysis causes secondary coxarthritis. Kirschner wire pinning is good method for non-severe cases.

[The effect of absent ossific nucleus of the femoral head on results of surgical treatment for developmental dislocation of the hip]. / Wplyw braku jadra kostnienia glowy kosci udowej na radiogramach przedoperacyjnych na wyniki operacyjnego leczenia rozwojowego zwichniecia stawu biodrowego u dzieci do 24. miesiaca zycia.

We have studied retrospectively 33 hips in 26 children at an average of 9 years 5 months after simultaneous open reduction and Dega transiliac osteotomy for developmental dislocation of the hip (DDH). All children were younger than 2 years of life at the time of surgery. The hips were divided into two groups: with present and with absent ossific nucleus of the femoral head on preoperative radiographs. Clinical and radiographic results have been assessed in both groups. No statistically significant difference was found between the groups. We conclude, that absent ossific nucleus of the femoral head as a sole reason should not delay surgery for DDH.

Surgical treatment of dysplastic and isthmic spondylolisthesis.

Background. Dysplastic spondylolisthesis results from a congenital malformation of the vertebral processes, sometimes accompanied by spina bifida; its progression causes subluxation or dislocation in the intervertebral joints and an anterior repositioning of the entire vertebra. Isthmic spondylolisthesis, on the other hand, most often results from a spinal fissure. The body and part of the arch are dislocated, while the intervertebral joints are normal. Treatment is indicated when there is pain, neurological symptoms, or radiological signs of progression of the slippage. Material and methods. Twenty-five patients with spondylolisthesis (14 with dysplastic and 11 with isthmic) were treated surgically using in situ fusion, the Harrington method with posterolateral fusion, or transpedicular instrumentation with posterolateral fusion. Grade III or IV spondylolisthesis was reduced with traction screws. Decompression of the spinal canal and intervertebral foramina was performed in patients with neurological deficits. Results. Complete pain relief was achieved in 72% of the patients, partial in 24%, none in 4%. Neurological deficits subsided in the majority of patients. Complete recovery was achieved in 87.5% of the transpedicular patients, 72.7% of the in situ fusion patients, and 50% of the Harrington patients. Transient neurological complications occurred in 2 patients after complete reduction of the displacement, mechanical complications (hook dislocation, rod or screw failure) in 2 patients. Conclusions. Complete reduction of the slippage proved to be a riskier procedure than partial reduction.

[Evaluation of surgical correction of idiopathic scoliosis according to Scoliosis Research Society criteria]. / Ocena leczenia operacyjnego skolioz idiopatycznych w swietle klasyfikacji Scoliosis

Background. The aim of this study was a subjective evaluation of scoliosis surgery in cases of idiopathic scoliosis according to the criteria of the Scoliosis Research Society (SRS). Material and methods. Examinations based on the SRS protocol were performed for 135 patients surgically treated using Cotrel-Dubousset instrumentation with posterior spondylodesis. These were mainly patients with thoracic scoliosis, Cobb's angle 59.9+/-12.5 degrees . Results. Surgery led to correction of scoliosis to 34.6 degrees , i.e. 57.8% improvement, with a gradual decrease after compensation in the postoperative period. Posterior spondylodesis involved from 6 to 13 vertebrae. The summary outcome according to the SRS protocol was 3.79+/-0.44. The patients evaluated their level of activity the highest (4.09+/-0.9). Conclusions. Patients treated operatively with the CD technique achieve good overall outcome in terms of quality of life, as measured by the SRS questionnaire. The highest marks were given for activity, and the lowest for limited motion due to spondylodesis. The mean outcome is not significantly dependent either on the degree of scoliosis correction in the frontal plane or on the extent of the spondylodesis.

Influence of scoliosis corrrection in the thoracic spine on posture compensation in patients with King's type II scoliosis (Lenke's IB, IC).

Background. The aim of our study was to assess the course and outcome in scoliosis without spondylodesis in the lumbar spine after surgical correction performed in the thoracic segment with the C-D method in patients with King's type II scoliosis (Lenke's IB, IC). Material and methods. 42 patients with idiopathic scoliosis were operated in the thoracic spine. The Cobb's angle averaged 635 +/- 9.2 degrees , together with coexistent lumbar scoliosis of 50.1 +/- 13.2 degrees . The mean observation time after surgery with the C-D method was 4.3 +/- 1.8 years. Both curvatures of correction, thoracic kyphosis, and lumbar lordosis were evaluated, as well as the thoracic-lumbar angle and shape of the lumbar scoliosis in relation to the central vertical sacral line were analyzed. Results. C-D surgery corrected thoracic scoliosis up to 28.8 +/- 8.3 degrees (54.6% scoliosis correction). Secondary correction of lumbar scoliosis not treated with C-D instrumentation made it possible to obtain a Cobb's angle of 28.9 +/- 9.7 degrees (42.3% scoliosis). Selective instrumentation and spondylodesis of scoliosis in the thoracic spine coexisted with transient decompensation of the posture on the left after surgery in 7 patients. Subsequent postsurgical observation showed the percentage of scoliosis correction in the lumbar spine decreasing to 32.7% and then to 29%. The number of patients with posture decompensation decreased to 2 cases. Conclusions. Equilibrated correction of scoliosis at the thoracic level reaching 50-60% of initial value is correlated in postsurgical observation with a small percentage of secondary decompensation of posture. The number of patients with postoperative decompensation decreases with corrections in the lumbar spine not treated with instrumentation during scoliosis surgery.

The CD-Hopf method in the surgical treatment of idiopathic scoliosis of the thoracolumbar or lumbar spine.

Background. The aim of this paper is to assess the extent of correction of scoliosis after surgery from the anterior approach using the CD Hopf method. Material and methods. We analyzed 20 patients with idiopatic thoracolumbar or lumbar scoliosis (Cobb angle 53 +/- 8 degrees , lordosis angle 56.9 +/- 11.9 degrees , vertebral translation 5.5 +/- 0.9 cm). Results. After surgery with the CD Hopf method, the scoliosis angle was reduced to 21 +/- 8 degrees . The correction rate was 61.7 +/- 12.1 degrees , with spondylodesis limited to 4 vertebrae in 13 patients, and 3 vertebrae in 7 patients. The average lumbar lordosis after surgery was 50.8+/-7.9 degrees , and the average vertebral translation was 2.6 +/- 1.1 cm. In post-surgical follow-up examinations the scoliosis angle increased slightly, not exceeding 3 degrees . Conclusions. Surgical treatment of scoliosis using the CD Hopf technique through the anterior approach allows for major correction in the frontal plane, accompanied by moderate decrease of lumbar lordosis. This method also enables significant improvement of horizontalization of border scoliosis vertebrae despite the short extent of the instrumentation and spondylodesis.