Non-bacterial Thrombotic Endocarditis (NBTE) in the Absence of Malignancy or Lupus Anticoagulant/Antiphospholipid Antibodies: A Case Report.

Non-bacterial thrombotic endocarditis (NBTE) is a very rare condition characterized by sterile thrombi formation on cardiac valves and is often associated with hypercoagulation states, such as malignancy and autoimmune disorders. We present the case of a 74-year-old patient admitted to the intensive care unit with acute respiratory failure, who had a history of COVID-19 infection five months prior to admission, despite having received certified vaccination. The patient developed NBTE involving the mitral valve, alongside acute respiratory distress syndrome (ARDS). In spite of the exclusion of cancer and systemic connective tissue disorders, the patient's condition rapidly deteriorated, leading to treatment-resistant multi-organ failure and demise, despite aggressive management, including anticoagulation therapy, mechanical ventilation, and renal replacement therapy. This case underscores the need for further research into the mechanisms underlying NBTE in the absence of traditional risk factors. Additionally, it highlights the importance of long-term anticoagulant therapy in NBTE management to mitigate the risk of embolic complications. Our case contributes to the growing body of literature identifying a subset of NBTE cancer-free patients with distinct characteristics, including those associated with current or past COVID-19 infection.

Medium-term outcome of cementless, mobile-bearing, unicompartmental knee arthroplasty.

BACKGROUND: Cemented, mobile-bearing unicondylar knee arthroplasty (UKA) yields good functional results. However, radiolucent lines (RLL) are not uncommon, even in asymptomatic patients, and it has been debated whether these "physiological" RLLs are indicative of loosening. Cementless UKA may lead to fewer RLLs compared with cemented devices. The present study was designed to document mid-term outcome with an emphasis on clinical outcomes. METHODS: We included 153 knees of 150 consecutive patients in a retrospective study. All patients had received a cementless medial mobile-bearing UKA. Patients were evaluated with use of the Knee Society Score (KSS), which was obtained at baseline and at final follow-up. The WOMAC, Oxford Knee Score (OKS) and Forgotten Joint Scores (FJS-12) were administered at the final follow-up. Anteroposterior (AP) and lateral radiographs were taken at final follow-up. RESULTS: At a mean follow-up of 5 years (range, 3-7 years), implant survival was 97.1% (95% confidence interval, 91.1-99.1%). Excellent postoperative KSS, WOMAC, OKS and FJS scores were obtained. Postoperative radiography was available for 78 knees. RLL was observed in 10.3% of the cases, but no cases with complete RLLs were seen. CONCLUSIONS: Favourable results were found for cementless, mobile-bearing UKA, with no aseptic loosening at an average follow-up of 5 years. Cementless UKA fixation may lead to a clinically "forgotten joint" and may decrease the rate of RLLs.

Midterm Results of Cementless Total Knee Arthroplasty: A Retrospective Case Series.

BACKGROUND: There is an ongoing debate about whether to use cementless or cemented fixation for Total Knee Arthroplasty (TKA). OBJECTIVE: The study aimed to assess midterm survivorship of the Vanguard cementless system, and to demonstrate the utility of the Bone Hardness Test (BHT) for the selection of cementless fixation TKA. METHODS: From September 2009 through November 2014, 123 total knee arthroplasties were completed, with cementless Vanguard Cruciate Retaining TKA in 110 knees (102 patients) and cemented Vanguard in 13 cases (12 patients). Implant fixation was based on intraoperative assessment of posterior cruciate ligament stability, bone quality, and BHT. All patients with a cementless Vanguard implant were eligible for this retrospective study. Preoperative and postoperative Knee Society Score and Western Ontario and McMaster Universities Osteoarthritis Index were obtained. Standardized standing anteroposterior and lateral radiographs were taken. RESULTS: Three patients (4 TKAs) were lost to follow-up. The mean follow-up time was 5.5 ± 1.4 years. All scores significantly improved postoperatively. No radiographic failures were observed. Five-year implant survival, with revision of any component for any reason as an endpoint, was 97.2% (95% confidence interval, 91.7 - 99.1%). Five-year survival with revision for aseptic loosening was 100%. Only one knee required revision due to an isolated unrelated bearing exchange, and two additional knees required secondary resurfacing of the patella for retropatellar pain. CONCLUSION: Good midterm results were obtained with the cementless Vanguard Cruciate Retaining TKA for the treatment of osteoarthritis. The Bone Hardness Test appears to be an effective way to determine the selection of cementless TKA.

Midterm Results of Cementless and Cemented Unicondylar Knee Arthroplasty with Mobile Meniscal Bearing: A Prospective Cohort Study.

BACKGROUND: Cemented unicompartmental knee arthroplasty (UKA) yields good clinical outcome but common revision reasons are loosening and pain. Cementless UKA may reduce the revision rate. OBJECTIVE: The current study was designed to assess clinical and radiographic outcome of cemented and cementless UKA, using bone quality as determined by the Bone Hardness Test (BHT) as selection criterion for cementless implantation. METHODS: In this prospective comparative cohort study we analyzed 50 cementless and 29 Oxford consecutive UKA cases. Patients with sufficient bone quality were eligible for cementless UKA. Bone quality was assessed with the BHT, which consisted of exercising pressure with the thumb on the bone surface created after resection of the tibia. RESULTS: The average surgical times were 62.5 ± 12.6 and 78 ± 16 minutes in the cementless and the cemented group, respectively (p < 0.01). The average thickness of the polyethylene insert was 4.3 ± 1.2 (range, 3 - 9) and 3.7 ± 0.8 (range, 3 - 6) mm, respectively (p = 0.02). Both types of implants yielded excellent clinical and functional results. At an average follow-up time of seven years, we found non-significant differences between clinical results of cementless versus cemented implants. CONCLUSION: Shorter surgical time makes cementless implantation more attractive to surgeons when considering UKA options for their patients. The average thickness of the polyethylene insert in cementless group was 0.6 mm thinner than in the cemented group. The BHT is a simple and useful test to assess whether patients are eligible for cementless UKA.

Hip-specific quality of life survey for patients with hip osteoarthritis - development and preliminary validity assessment.

BACKGROUND: Many various surveys are used to assess quality of life of patients with hip osteoarthritis, but none of them evaluates quality of life dependent on a single joint in bilateral disease. Aim. Development and preliminary validation of hip-specific quality of life survey (HSS) of patients with hip osteoarthritis. MATERIAL AND METHODS: A group of experts developed the final version of HSS questionnaire in 4 stages. Statistical analysis was conducted on 181 preoperative and postoperative HSS questionnaires completed by patients undergoing hip replacement surgery due to hip osteoarthritis. Discrimination index for each item, questionnaire internal consistency, proportion and dispersion of unanswered items, questionnaire filling time, ceiling effect and floor effect values as well as correlation between each item and subscale score were subject to statistical analysis. RESULTS: Final version of the questionnaire is characterized by good discriminant power (CR >3 for each item except for one). Cronbach alpha coefficient for each subscale of preoperative as well as postoperative questionnaire reached a value over 0.8 and point value for each item correlated significantly with the sum of points in each HSS subscale. CONCLUSIONS: No floor effect was observed in any of the cases, while ceiling effect was demonstrated in 1.1% of preoperative HSS questionnaires.

Patient-related outcome questionnaires in the assessment of the results of total hip replacement.

A variety of patient-related outcome questionnaires have been used for the assessment of results of total hip replacement. Generic core scales (SF-12, SF-36) and disease-specific scales like: Harris Hip Score, Western Ontario and McMaster University Osteoarthritis Index, Hip dysfunction and Osteoarthritis Outcome Score, Oxford Hip Score, American Academy of Orthopedic Surgeons hip and knee Questionnaire, Lower Extremity Functional Scale are used most frequently. Even though all of them were assessed in terms of construct and content validity, reproducibility and sensitivity, there are still some problems related to bias when total hip replacement evaluation is performed in the presence of comorbidities, contralateral hip disease and ceiling effect influencing the final score. As a result, there is a need for development of a new PRO questionnaire in order to improve total hip replacement assessment, enable early detection of postoperative complications or to evaluate the results of surgery in both hips separately. It is crucial that such measuring device has to be deprived of the influence of irrelevant factors on the final score.

Influence of age on the outcome of rehabilitation after total hip replacement.

BACKGROUND: This publication compares the results of physiotherapy after total hip replacement in two groups, each consisting of 50 subjects, differing in age by 10 years. MATERIAL AND METHODS: A group of 100 patients after total hip replacement was divided into two subgroups consisting of 50 subjects each, with mean age difference of 10 years. The first group included patients aged 47-60 years, the other 61-69 years. Patients were assessed at 6 weeks and reevaluated at 10 weeks after surgery during a 4-week in-hospital rehabilitation program. The study was based on a questionnaire, physical examination, 6-minute walking test and a test on stabilometric platform. RESULTS: In the younger group we observed easier and faster resolution of pain in the operated joint. In group II, which included patients aged 61 to 69 years, improvement in hip joint mobility was less pronounced than in the younger group. Six-minute walking test showed less improvement in walking distance in group II than group I. Among group II patients we noted less pronounced increase in weight bearing on the operated limb (by 2%, while 4% improvement was noted in group I), while final degree of weight-bearing was greater in group II than in group I and amounted to 48%. CONCLUSIONS: Younger patients recover faster, hip pain subsides easier, hip function returns more readily and to a greater extent. During a 4-week course of in-hospital rehabilitation older patients may regain hip function in a manner that brings them closer to the younger group.

Impact of athletic activity on the stability of the lower limb joint prosthesis.

This publication analyses the impact of athletic activity on the stability of lower leg implant. Analysis of literature does not allow for a clear answer whether such activity is an independent predictor of early loosening. Number of publications warning patients against excessive sports activities, equals the number of reassuring reports.

[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.

[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.

[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.

[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.

[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.

Efficient X-ray generation of Sm2+ in nanocrystalline BaFCl/Sm3+: a photoluminescent X-ray storage phosphor.

Efficient X-ray generation of relatively stable Sm2+ centers is observed in nanocrystalline Sm3+-activated BaFCl, as prepared by a one-step wet chemical reaction. The conversion efficiency is approximately 50,000 times higher than that in microcrystalline BaFCl/Sm3+ prepared at 900 degrees C. The Sm2+ centers, and hence the radiation dose, can be directly monitored by the narrow photoexcited 5DJ-7FJ f-f luminescence lines. The relatively high efficiency of Sm2+ generation appears to be directly linked to the particle size.