The role of adipocytokines in the pathogenesis of knee joint osteoarthritis.

Osteoarthritis (OA) is one of the most common causes of musculoskeletal disability in the world. Traditionally, it has been thought that obesity contributes to the development and progression of OA by increased mechanical load of the joint structures. Nevertheless, studies have shown that adipose tissue-derived cytokines (adipocytokines) are a possible link between obesity and OA. Furthermore, according to recent findings, not only articular cartilage may be the main target of these cytokines but also the synovial membrane, subchondral bone and infrapatellar fat pad may be encompassed in the process of degradation. This review presents the most recent reports on the contribution of adipocytokines to the knee joint cartilage degradation, osteophyte formation, infrapatellar fat pad alterations and synovitis.

[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.

[Possibilities of leg length equalization in total hip replacement]. / Mozliwosci egalizacji konczyn dolnych w endoprotezoplastyce stawu biodrowego.

Leg length discrepancy is a common and not appreciated complication after THR. Unequal leg length may cause earlier implant wear, patient's dissatisfaction, impair patient's function or even some legal consequences for the surgeon. To achieve the final equal leg length after surgery one must comply with some rules: proper patient's examination, informing patient about possible leg length discrepancy, proper length measurement- both clinical and radiological after antero-posterior pelvis x-ray; proper radiological length measurements especially when some hip contractures are observed, appropriate implant selection, proper prosthesis templating. The intraoperative leg length measurement with some surgical or radiological devices is essential for leg equalization. Special operative techniques are necessary for leg lengthening or shortening without hip instability. Final leg length measurement after surgery is necessary to determine a rehabilitation program.

[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.

[Synovial chondromatosis and tuberculosis of the hip coexistence]. / Chondromatoza stawu biodrowego wspólistniejaca z zapaleniem gruzliczym.

This article describes a rare case of primary synovial chondromatosis of the hip associated with active tuberculosis of the hip. Twenty four years old patient underwent total hip replacement at our institution. No reactivation of the infection was detected in the four-years follow-up. Clinical and radiological evaluation of our material showed that joint space widening may be the first sign in synovial chondromatosis of the hip. Importantly, if the tuberculosis infection is suspected we have to take the material for bacteriological investigation, regardless of others, obvious diagnosis.

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.

[Long follow-up radiological assessment of the cemented hip prosthesis]. / Odlegla ocena radiologiczna endoprotezoplastyki cementowej stawu biodrowego.

MATERIALS AND METHODS: The postoperative and last follow-up radiograms: 7 to 25 years after surgery (mean: 10.4 +/- 3.9) were evaluated in 123 patients (167 hips). The radiological evaluation was performed according to Hip Society recommendations. The position of the cup and the stem, polyethylene wear, the migration of the cup or stem, radiolucent lines and ectopic ossification were evaluated. RESULTS: At last follow-up in 17 hips a prior revision was performed and further radiological assessment revealed 16 cases of prosthesis loosening. The retrospective analysis of the postoperative radiograms of 33 hips with loosening revealed radiolucent lines around the cup in de-Lee zones I, II, III respectively in 5, 2, 5 hips where in patients without loosening radiolucent lines were found in respectively 11, 4, 17 hips. The correlation between the cup or stem positioning and the rate of loosening was not significant. Fracture of the cup cement was found in 5 hips and radiolucent line around the cup cement in I, II and III zone of deLee was found respectively in 70, 26, 52 hips at last follow-up. No polyethylene wear was found in 77 hips when mean wear of 2.9 mm was found in the rest. The radiolucent line was most often detected in Gruen zones 3, 9 and 10. The ectopic ossification was found in 67% hips at last follow-up. CONCLUSIONS: The radiolucent line around the cup is more often detected on postoperative radiograms in patients with early cup loosening but this correlation is not so clear in stem loosning. The increased osteolysis around the implant as well as ectopic ossifications are found in long follow-up of the cemented hip prosthesis.

[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.

[The retrospective analysis of good and poor results of the intertrochanteric osteotomy for hip osteoarthritis]. / Retrospektywna analiza dobrych i zlych wyników leczenia zmian zwyrodnieniowych stawu biodrowego osteotomia miedzykretarzowa.

OBJECTIVES: To predict the final result of intertrochanteric osteotomy. MATERIALS AND METHODS: 56 hips in 53 patients after intertrochanteric osteotomy without any change in neck-shaft angle were enrolled into the analysis. 26 hips with a good result of intertrochanteric osteotomy were included into A group and 26 hips with a poor result were included into B group. The follow up was 5 to 11 years. Such preoperative parameters as: age and body weight of patients, severity of arthritis, sphericity of the head, joint space width, center-edge angle, pain severity, walking capacity, range of motion- were analyzed in both groups of patients. Survival of the hips was estimated with a Kaplan-Meyer survival curve. RESULTS: At last follow up 27 hips (26 patients) were converted into hip prosthesis. The mean operative age of the patients in group A was 37.8 years and in group B 43.4 years. The severity of hip arthritis was similar in both groups of patients. Regular spherical head was found in 10 hips of group A and in 12 of B group. The center-edge angle was 15 degrees in group A and 18 degrees in group B. The joint space width was 2.6 mm in group A, and 2.5 mm in B group. Walking capacity, pain severity, range of motion of the affected hip was very similar in both groups of patients. Patients of group B had hip prosthesis already implanted 2.8 years after osteotomy. CONCLUSIONS: No statistically significant difference was found between analyzed preoperative parameters in patients with good and poor results of intertrochanteric osteotomy. The final result of intertrochanteric osteotomy is not predictable.

[Total hip replacement for acetabular protrusion in patients with osteoarthritis]. / Totalna endoprotezoplastyka stawu biodrowego w chorobie zwyrodnieniowej z panewka protruzyjna.

BACKGROUND: Total hip replacement (THR) is at present an accepted treatment in patients with severe deformity of the hip and acetabular protrusion. The aim of this paper is to evaluate the results of THR in patients suffering from acetabular protrusion, operated from 1991 to 2006 in the Orthopaedic and Traumatologic Department of Poznan University of Medical Sciences. MATERIAL: Material included 36 patients, 34 females and 2 males, on whom 51 THR were performed, lateral approach was used in all cases. At the time of operation, the age of patients ranged from 41 to 78 years (mean 63). Follow-up ranged from 4 to 19 years (mean 9.9 years). The operative treatment was a multistage process (during one operation only one joint was replaced). Cemented total hip arthroplasty was used during 28 of the THR, 22 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 29, WOMAC score 77. After an average of 9 years follow-up all hips were considered excellent, with average Harris score of 90, 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 30-55 degrees (mean: 40 degrees) and the acetabular opening angle was 2-15 (mean: 4 degrees). The stem was valgus-oriented in 8 hips, varus-oriented in 13 hips and neutral-oriented in 30 hips. 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 osteoarthritis with acetabular protrusion 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. Ectopic ossification is not the clinical problem during THR in patients who suffer from acetabular protrusion. We found a significant acetabular remodeling with the decreasing of the protrusion after THR.

[Survivorship of the cemented hip prosthesis]. / Ocena przezywalnosci cementowej endoprotezy stawu biodrowego.

OBJECTIVES: To asses a survival-time of the cemented hip prostheses and to find factors causing its loosening. MATERIALS AND METHODS: 211 patients (282 hip prostheses) were analyzed, of the 1693 patients (2096 hip prostheses) treated between 1970-2000. The follow-up ranged from 7 to 34 years (mean: 12.2 ++/- 5.4 years). The age of the patients at the operation procedure ranged from 25 to 74 years (mean 52 +/- 12 years). Only aseptic prosthesis loosening were considered and Kaplan-Meyer method was used for the prosthesis survivorship assessment. RESULTS: Of the 282 prostheses, implant exchange was performed in 39 cases, where in 15 cases only cup was revised, in 5 cases the stem exclusively, and in 19 patients the whole implant was exchanged. Only 1.1% of implants were exchanged during first 5 years after surgery but from the 6th year the percentage of loosening increased several percents each year. Respectively 88.6, 70 and 65% survivorship of prosthesis was found after 10, 15, 20 years of follow-up. In the group of bilateral prosthesis implantation, the first implanted prosthesis was more susceptible for loosening. Seven cases of aseptic loosening (5.4%) of the 129 prostheses implanted between 1974 and 1995, occurred within 7 years after initial surgery where only one prosthesis (0.7%) was revised of the 152 implanted between 1996-2000 in the same time of follow-up. The age, growth, weight, BMI and sex did not influence the risk of implant loosening. CONCLUSION: The mean survivorship of the hip prosthesis is 65% in 20- years follow up. When a proper initial fixation of the cemented hip prosthesis is performed, the risk of implant loosening increases gradually especially from the 6th year after surgery. The modern implants are less susceptible for loosening.

Expression of osteoblast marker genes in rat calvarial osteoblast-like cells, and effects of the endocrine disrupters diphenylolpropane, benzophenone-3, resveratrol and silymarin.

Compelling evidence indicates that some endocrine disrupters (EDs), acting as selective estrogen-receptor modulators, interfere with osteoblast differentiation and function. Hence, we investigated whether four EDs [bisphenol-A (BSP), benzophenone-3 (BP3), resveratrol and silymarin] affect differentiation and growth of rat calvarial osteoblast-like (ROB) cells in primary in vitro culture. ROB cells were cultured for up 30 days in a medium supplemented with fetal calf serum (FCS), and conventional RT-PCR detected the expression of collagen-1alpha and osteonectin mRNAs through the entire culture period. Real time-PCR demonstrated that at days 2 and 7 of culture the expressions of collagen-1alpha and osteonectin were very low, and underwent a 192- and a 334-fold increase, respectively, at day 21 of culture. In contrast, osteocalcin expression remained unchanged from days 2 to 21 of culture. EIA showed that ROB cells secreted sizeable amounts of osteocalcin and osteopontin between days 13 and 15 of culture. EDs were added at day 13 of culture at concentrations ranging from 10(-10) to 10(-6) M, being the culture medium deprived of FCS, and their effects were tested 48 h later. None of EDs was found to affect osteocalcin and osteopontin secretion from ROB cells, suggesting that their effects were tested at a relatively earlier stage of culture, when ROB cell differentiation into osteoblats is not fully accomplished, and/or the presence of estrogens contained in FCS is needed for EDs to exert their osteoblast-differentiation modulating action. BSP and BP3, but not resveratrol and silymarin, decreased proliferative activity of cultured ROB cells, a cytotoxic effect conceivably independent of their estrogen-receptor modulating activity.

Estradiol and resveratrol stimulating effect on osteocalcin, but not osteonectin and collagen-1alpha gene expression in primary culture of rat calvarial osteoblast-like cells.

Evidence is available that some endocrine disruptors, acting as selective estrogen receptor modulators (SERMs), interfere with osteoblast differentiation and function. Therefore, we investigated whether 17beta-estradiol, bisphenol-A (BSP), silymarin, genistein, resveratrol, procymidone, linurone and benzophenone-3 (BP3) modulate differentiation of rat calvarial osteoblast-like (ROB) cells in primary in vitro culture. Disruptors were added at day 18 of culture and cells were harvested 48 h later. Real time-PCR revealed that estradiol and resveratrol enhanced osteocalcin mRNA expression in ROB cells, while other disruptors were ineffective. The expression of osteonectin and collagen-1alpha was not affected by any disruptor. Estradiol, resveratrol, genistein and BSP stimulated the proliferative activity of ROB cells. In contrast, procymidone and linurone inhibited the proliferative activity, and silymarin and BP3 were ineffective. The conclusion is drawn that i) only resveratrol is able, like estradiol, to stimulate the specialized functions of ROB cells, and ii) the proliferative activity of ROB cells is more sensitive to endocrine disruptors, some of which could probably act via a mechanism independent of their SERM activity.

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.

Simultaneous open reduction and Dega transiliac osteotomy for developmental dislocation of the hip in children under 24 months of age.

The authors 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 surgery. At the latest follow-up 89% of the clinical results and 72% of the radiographic results were rated excellent or good, despite a 45% rate of avascular necrosis observed before surgery. The authors attempted to identify factors influencing the final result. Given the low complication rate (3%) and low reoperation rate (3%), the authors conclude that the reviewed surgical protocol is safe and efficient in the treatment of DDH in young children.

[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.

[Surgical treatment of degenerative lumbar spondylolisthesis]. / Operacyjne leczenie kregozmyków zwyrodnieniowych w odcinku ledzwiowym kregoslupa.

BACKGROUND AND PURPOSE: Degenerative lumbar spondylolisthesis occurs most often at the L4-L5 level and is characterized by anterior displacement of L4 vertebra on L5 vertebra. The aim of the study is to present both the decompression of nerve elements of the vertebral canal and the method of spine internal stabilization in patients with degenerative lumbar spondylolisthesis. MATERIAL AND METHODS: Clinical analysis comprises 11 patients treated surgically because of the degenerative spondylolisthesis. Intervertebral dislocation of more than 20% included 4 patients where the vertebral column stabilization was achieved by transpedicular stabilization as well as intervertebral and posterolateral spinal fusion (group I). In spondylolisthesis of less than 20% (4 patients) spondylodesis with intervertebral cages and posterolateral osseous grafts were carried out (group II). In the remaining 3 cases spondylolisthesis was smaller than 20% with denivelation of the intervertebral space (group III). There were nervous structures deliberated and spondylodesis was unnecessary. RESULTS: Low back pain and sciatic neuralgia were relieved in 9 (82%) patients. Neurological deficits were subsided completely in 7 (78%) cases. CONCLUSIONS: The evaluation of the degree of vertebral displacement, height of the intervertebral space and assessment of vertebral column stability allowed to determine the strategy of surgery in patients with degenerative lumbar spondylolisthesis.