[Evaluation of screening for developmental dysplasia of the hip in the Liberec region in 1984-2005]. / Souborné zhodnocení screeningu vývojové dysplazie kycelního kloubu v regionu Liberec za období 1984-2005.

PURPOSE OF THE STUDY: To analyze our results of screening for developmental dysplasia of the hip (DDH) in the Liberec region between 1984 and 2005 MATERIAL AND METHODS: The study comprised 30,010 infants screened for DDH without any primary selection between 1984 and 2005.The infants were clinically examined on the basis of a three-step screening system (newborn, at 6 weeks and between 3 and 4 months of age) and by an imaging method. In the period from 1984 to 1991, this was plain radiography of the hip at 3 months of age, and a total of 12,944 infants were assessed. Between 1992 to 2005 ultrasonography (USG) was used at 6 weeks (or earlier when clinical signs were present) and again at 3 to 4 months of age, and a total of 17,066 infants were evaluated. In 16,678 of these infants, the sonogram obtained at 6 weeks was evaluated in detail by the Graf method. The presence of the epiphyseal nucleus of the proximal femur was assessed at 3 months, and from 2000 at 4 months of age. Attention was paid to the occurrence of DDH in general and findings of dislocation, both subluxation and luxation, of the hip, the proportion of right-side, left-side and bilateral findings, gender differences, the presence or absence of ossification of the femoral epiphyseal nucleus in infants between 3 and 4 months of age and, in the 1992-2005 period, the stratification of Graf types at 6 weeks. A question of whether the child's months of birth might have any relation to a possibility of DDH occurrence was also raised. RESULTS: Between 1984 and 1991, DDH was recorded in 10.4% of the infants, usually in a light form responding well to conservative treatment; subluxation was found in 1.99% and luxation in 0.6%. Between 1992 and 2005, DDH (mostly light forms) was recorded in 5.2%, subluxation in 0.5% and luxation in 0.2% of the infants. Right-side, left-side and bilateral findings were seen in 29%, 46% and 25% of the infants, respectively, and there were distinct differences between the genders. In an evaluated group of 453 infants with either subluxation or luxation, 86% of girls and 14% of boys were affected. The month of birth had no effect on DDH occurrence. Of the 9878 infants examined at 3 months, ossification of the femoral epiphyseal nucleus was found only in 37%, and of the 7188 infants examined at 4 months this was recorded in 64%. In a total of 33,356 hips (16,678 infants) evaluated at 6 weeks on the Graf scale, the following Graf types were recorded: Ia, 21%; Ib, 58%; IIa, 20%; IIc, 1%; D/IIIa, 0.19%; and IIIb/IV, 0.08%. DISCUSSION: The occurrence of DDH (formerly congenital dysplasia of the hip), including all forms/grades, is reported to be 3% to 5% in Central Europe. Our recent results obtained by the USG method are in agreement with this, as are our findings of its more frequent occurrence in girls (boys to girls, 1 to 6) and on the left side. Several reasons--medical, statistical or even sociodemographic--can be considered to explain the discrepancies in DDH detection rates obtained with radiography and ultrasonography, i.e., 10.5% vs 5.3%. For instance, the USG detection of DDH at 6 weeks of age initiates early treatment preventing progression of hip dysplasia. Better facilities available for home neonatal care and increased interest in general baby wellness may also play a role. CONCLUSIONS: Screening for developmental dysplasia of the hip is fully justified, because DDH prevalence is still high (500 subluxations and 200 luxations per 100,000 population). However, attention should also be paid to reducing factors and conditions that may adversely affect hip development from the baby's prenatal period to spontaneous walking.

[Use of a silicone metatarsophalangeal joint endoprosthesis in hallux rigidus over a 15-year period]. / Patnáct let pouzívání silikonové endoprotézy I. metatarzofalangeálního skloubení pri diagnóze hallux rigidus.

PURPOSE OF THE STUDY: The aim of this retrospective study was to evaluate the results of a Swanson type, two stem, flexible silicone prosthesis used for first metatarsophalangeal joint replacement in hallux rigidus. MATERIAL AND METHODS: Between June 1987 and December 2001, we implanted this prosthesis in 145 first toes of 128 patients. This group comprised 83 women (96 replacements) and 45 men (49 replacements); the average age of the group was 49.5 (range, 17 to 82) years. Check-ups carried out in 2002 included clinical and X-ray examination and a questionnaire. Eighty-nine patients presented themselves (63 women and 26 men) and eight patients responded to the questionnaire only. A total of 97 patients (with 108 replacements) were checked up at an average follow-up of 4.75 years (range, 7 months to 15 years). In the questionnaire, we sought information on the patient's satisfaction with the arthroplasty and pain in the joint at rest and when walking in shoes or barefooted. On clinical examination, we assessed the range of motion in the first metatarsophalangeal joint and covering skin status. In X-ray films, we measured the toe axis, replacement status and position, and recorded the presence of bone proliferation. RESULTS: Of the 97 patients, 38 (43 replacements) were free from any pain; of the remaining 59 patients (65 replacements), 22 experienced pain of varying intensity at rest, 56 (60 replacements) had pain when walking in shoes and 44 (46 replacements) experienced pain when walking barefooted. Satisfaction with the surgical outcome was reported by 85 patients (with 94 operations), which is nearly 79%. Clinical examination showed that, post-operatively, flexion and extension were on average 11 degrees (range, 0 to 30 degrees) and 19 degrees (5 to 50 degrees), respectively. Post-operative infection was recorded in two cases and a pressure sore in the scar in six cases. Only one case required repeat surgery. X-ray examination revealed hallux valgus in 23 cases, failed replacement in six, and osteolytic areas in the vicinities of the distal and the proximal stem were found in 14 and 3 cases, respectively. Calcifications around the implant were recorded in 15 cases and osteophytes were present on the lateral sides of the proximal big toe phalanx and the resected head of the first metatarsal in 65 cases. DISCUSSION: Several methods have been available for treatment of hallux rigidus. Resection arthroplasty is used most frequently, with interposition arthroplasty second in rank. The osteotomy of either the first metatarsal or the proximal phalanx is preferred in younger patients. Cheilectomy, i.e., removal of dorsal osteophytes involving excision of about 25% of the dorsal part of the head of the first metatarsal, is also a common method, as well as its combination with different types of osteotomy. Total replacement of the first metatarsophalangeal joint is less frequent because neither metal nor hemiphalangeal implants had good outcomes. Flexible silicone two-stem prostheses have been appreciated by the patients but clinical results have been inconsistent; because of frequent failure they have not often been used. The subjective evaluation by our patients was in agreement with assessments reported by other authors; however, our results of clinical examination determining the range of motion were better. Although the average range of motion was not very high (30 degrees), the proportion of our patients in whom the minimal motion was less than 15 degrees was only 11% and this value was markedly lower than reported by other authors. Also our radiographs showed failed implants less frequently than reported in the literature. CONCLUSIONS: Based on favorable subjective assessments by the patients and a low number of failed implants, this technique can be regarded as an appropriate therapy for middle-aged patients with a diagnosis of hallux rigidus, even though it may not permit a large range of motion in the joint affected.