[Total hip arthroplasty in post-dysplastic hip arthritis. Can type and position of the acetabular component influence longevity of the prosthesis?]. / Totální endoprotéza kycelního kloubu u postdysplastické koxartrózy: Má typ jamky a její umístení vliv na zivotnost endoprotézy?

PURPOSE OF THE STUDY: The aim of the study was a retrospective evaluation of our patients with post-dysplastic hips treated by cemented or non-cemented total hip arthroplasty (THA) in order to ascertain which type and position of the acetabular component was most effective. MATERIAL: In the years 1999-2002, 111 THA procedures were performed in 93 patients, 76 women and 17 men, with post-dysplastic hip arthritis. The average age of the patients at the time of implantation was 52.6 years. On the basis of pre-operative radiographic findings, the patients' conditions were evaluated using the Hartofilakidis classification into three disease categories: dysplasia, low dislocation and high dislocation, and the patients were placed in two groups. Group 1 included 78 patients, and group 2 comprised 26 patients. None of our patients was classified as having high dislocation. Thirty-nine of these patients had previously undergone surgery for dysplastic hips. METHODS: A total of 104 THAs were evaluated, because radiographic data was incomplete in seven cases. In addition to X-ray findings, the prosthesis type (cemented, hybrid, non-cemented), post-operative complications and signs of loosening were included in the evaluation. Clinical outcomes were assessed by the Harris score. The follow-up terminating on 31st December 2005 was 67 months on the average. RESULTS: In group 1 patients, the average Harris score increased from 38.6 to 80.3 points and in group 2 patients from 35.5 to 84.9 points, mostly with excellent and good results. In 72.1 % of the hips, a press-fit acetabular component was implanted. In 55.8 % of the cases, the acetabular component was implanted off the anatomical center of rotation, into the high hip center, with the range from 9 to 20 mm and an average of 15 mm. The average limb lengthening was 2.5 cm, ranging from 1.0 to 3.5 cm. CONCLUSIONS: Our results show that it is more effective to use non-cemented THA for post-dysplastic hips. The implantation of a noncemented acetabular component into the high center provides better covering of the cup with solid bone, without the necessity of cotyloplasty or structural graft use. Also, it does not markedly affect hip function or patients' subjective feelings.

[Management of pseudoarthrosis of the navicular bone of the wrist using the Synthes 3.0 screw]. / Osetrení pakloubu clunkové kosti zápestí sroubem Synthes 3,0.

The authors compare their results of the management of the pseudoarthrosis of the navicular bone of the wrist with those reported in the literature. The study group included 21 patients and the Synthes 3.0 mm was applied. The authors concentrate on both technical and biological aspects of the therapy, mainly on an appropriate choice of the procedure, quality of the management of the surfaces of the pseudoarthrosis and significance of correct introduction of the device. The rate of the healed pseudoarthroses reached 85.7% in their patient trial group. They conclude that the main prerequisites for a successful outcome are the biological status of the pseudoarthrosis and a thorough management of the pseudoarthrosis surfaces, rather than a type of the implant.