Bone mineral density changes after total knee arthroplasty: one-year follow-up.

The study involved analysis of differences in bone mineral density (BMD) in the region of knee arthroplasty in 106 female patients. BMD was assessed using dual-energy X-ray absorptiometry in a follow-up time schedule: before surgery and 2 weeks postoperatively (baseline), 5, 12, 24, and 48 weeks after knee joint arthroplasty. Four assessment regions A, B, C, and D were determined in immediate proximity to the arthroplasty site. A year after surgery, a decrease in BMD was observed in all determined regions-(9.9%, 13.8%, 9.9%, and 7.6% respectively) in comparison with the baseline value. The most significant BMD decrease was observed in the period between 5 and 12 weeks after the knee joint arthroplasty. In our opinion, the decrease in BMD at the knee joint arthroplasty site is a result of the postoperative increased bone resorption and decreased patient motor activity.

[Revision hip arthroplasty management tactics--own experience]. / Taktyka postepowania w endoprotezoplastyce rewizyjnej stawu biodrowego--doswiadczenia wlasne.

INTRODUCTION: Aseptic loosening of hip prosthesis is one of the most serious complications after primary joint arthroplasty. Due to the aging of societies, lengthening of the average life span and increasing number of primary arthroplasty procedures, it can be assumed that the number of revision procedures will be continuously increasing by the year. THE AIM OF THE STUDY: presentation of own experience in operative management tactics and early results of treatment after the revision hip arthroplasty. MATERIALS AND THE METHOD: The analysis included 182 patients at the average age of 68, who underwent the revision hip arthroplasty procedure. The procedures of this type were performed most often after cement arthroplasty performed using the Weller's method (45%). The average observation period was 2.3 years. A clinical evaluation of the patients was performed using the Harris scale. A preoperative radiological evaluation was performed using Paprosky classification (for an acetabulum) and Mallory classification (for a femoral bone shaft). Bone defects were evaluated using AAOS classification. A postoperative radiological evaluation was performed on the basis of: radiolucent lines of the acetabulum area in DeLee-Charnley zones and in the area of the endoprosthesis stem in Gruen zones, acetabulum migration and settling of the endoprosthesis stem. RESULTS: During the 2-year observation there were 88.5% of good results reported. According to the Harris scale an improvement was achieved from the average of 46 points before the operation to 85 points after the procedure. 11.5% of bad radiological and functional results were reported including: 11 cases (6.0%) with bad radiological results, and 10 cases (5.5%) with bad clinical results. CONCLUSIONS: Revision hip arthroplasty procedures require individual planning, selection of implants and additional implants. Intraoperative evaluation is required due to lack of an objective image analysis of prosthesis element loosening and a level of bone stock damage determining the scope of the procedure, selection of implants and number of allogenic grafts. Our management tactics is an effective method of aseptic loosening of acetabulum and stem treatment after primary hip arthroplasty.

Use of densitometric examination after cemented total knee arthroplasty.

Background. Dual energy X-ray absorptiometry (DXA, DEXA) is one of many ways of measuring bone mineral density (BMD). Considering the fact that it is possible using DXA analysis to distinguish metal elements from bone, this method seems to be optimal in the assessment of bone mineral density in the area of an inserted implant. The aim of our study was to examine the usefulness of DXA examination of the knee joint area after cement arthroplasty. Material and methods. A BMD analysis of four areas surrounding the knee prosthesis was performed using the author's own method. Results. After a series of densitometry analyses, the coefficient of variation (CV) and the least significant difference (LSD) were determined. Conclusions. DXA analysis of the knee joint after arthroplasty using the method described here shows high repeatability. Periodic DXA analysis of the vicinity of the knee prosthesis may be useful in assessing the dynamics of change occurring around the implant.

Local experience with total hip replacement in dysplastic coxarthrosis.

Background. The goal of our study was to assess the efficacy of total hip replacement in the treatment of dysplastic arthrosis of the hip. Material and methods. Between November 2001 and June 2003 we performed total hip replacement in 40 patients (46 hips). Arthritic deformations were classified according to Crowe's classification scheme and operated using a variety of techniques and prostheses. Outpatient examinations were performed every 6 weeks. Rehabilitation began 24 hours after surgery. Results. The average time of hospitalization was 14 days. According to Harris's scale, the average result was 35.4 before operation, 59.8 immediately after surgery, and 79.16 at 18 months post-operatively. The average difference between lower limbs was 3 cm before surgery and 1 cm post-operatively. The average range of flexion in the hip preoperatively was 36 degrees , 85 degrees post-operatively. All the patients suffered pain in the dysplastic hip before surgery; 4.4% patients still felt pain 12 months after surgery. In 2 cases there was loosening of the acetabular component of the prosthesis, which required revision surgery. In 3 cases there was dislocation of prosthesis. In 2 cases the implant was infected. In 1 case there was paresis of the femoral nerve. Thromboembolism occurred in 3 cases. Conclusions. In Crowe's first and second degree dysplastic arthrosis of the hip, a good outcome is obtained with standard stem prosthesis. A CDH stem should be used in stenosis of the intramedullary canal. Patients with dysplastic hips have better quality of life after total hip replacement.

[The influence of body injuries on bone union of femoral shaft fractures treated by different operative methods]. / Wplyw dodatkowych obrazen ciala na gojenie sie zlaman trzonu kosci udowej leczonych róznymi metodami operacyjnymi.

Femoral shaft fracture is very often main musculo-skeletal injury in polytrauma patient. We analysed bone union of femoral shaft fractures treated by different operative open methods--AO plate osteosynthesis, Zespol method and open intramedullary nailing and by closed intramedullary nailing, in patients with concomitant body injuries. We compared patients operated by open methods without complications with the group demanding fracture reoperation. We found out no statistical correlation between the frequency of local complications demanding reoperation and the presence of associated injuries p = 0.209 or their severity expressed in ISS p = 0.202. The highest ISS 29.5 points occurred in the group operated on by closed intramedullary nailing. Lack of complications in this group gives evidence of efficiency of this method of treatment.

Current methods for monitoring the treatment of osteoporosis: increased bone mineral density or reduced fracture risk?

Bone fractures are the most serious complication of osteoporosis. Fractures occurring in vertebrae or the proximal epiphysis of the femur directly increase the risk of mortality. As a result of the aging of our society and the prolonged average life expectancy, it is becoming increasingly important to develop diagnostic methods that will enable the early and accurate diagnosis of osteoporosis, and testing methods to measure the factors that are decisive for the mechanical endurance of bones. The most important diagnostic test, despite certain defects and the danger of a false result, is still the densitometric measurement of bone tissue using the DEXA method. By contrast, the monitoring of treatment based on the testing of bone tissue density remains a dubious method. The new definition of osteoporosis introduced in 2001 has concentrated our attention on reducing the risk of fracture. Thanks to large, randomized epidemiological studies, we can identify those drugs which reduce the risk of first and subsequent osteoporotic bone fractures. Alendronian, rizedronian, and parathormon have been demonstrated to have effects that reduce the risk of fractures, both in vertebrae and in the proximal epiphysis of the femur. The overarching goal of our treatment is still avoiding osteoporotic fractures, and not merely trying to improve the results of densitometric tests.

Treatment of trochanteric fractures of the femur: DHS or Gamma nail? - own experience.

Background. The aim of proximal femur fractures treatment, which mostly concerns geriatric population, is quick restore the patient's health status to the level from before accident. Surgical treatment with stable fracture reduction is the procedure of choice. It is achieved mostly with DHS screws or the Gamma nail. Material and methods. Our paper presents results of treatment with the Gamma nail of 206 patients with proximal femur fractures, author's own experience with indications of good points and faults of methods, possible difficulties and complications. Results and Conclusions. In most of our patients the result obtained was good or satisfying, what let us recommend alternative use of DHS system and Gamma nail in most tochanteric fractures of the hip, with special attention to Gamma nail in treatment of unstable fractures or complications of others methods of stabilisation.

Clinical anatomy in the vicinity of the hip joint in magnetic resonance imaging.

Background. MRIs were obtained from 24 patients with suspicion of small pelvis pathology, with no indication of hip joint pathology.
Results and Conclusions. Based on the normal descriptive and topographical anatomy of the hip joint and its vicinity, the authors identified on the MRIs the main bony, muscular, vascular and nervous structures comprising and surrounding the hip joint. A clinical division of the muscles surrounding the hip joints is proposed.

Differences in lower limb bone mineral density in children with anisomelia.

Background. Lower limb discrepancy (anisomelia) can be caused by many different factors leading to shortening (90% of cases) or lengthening of a limb (10% cases). This article present the results of densitometric tests performed on patients treated for lower limb discrepancy in the Department of Orthopedic of the Silesian Academy of Medicine in the years 1997-1998.
Material and methods. Our research involved 57 patients, 31 girls and 26 boys. The Ilizarov technique was used to lengthen 33 femurs and 24 tibias. The average discrepancy was 45 mm (48 mm in the femurs and 42 mm in the tibias), and the patients average age was 13,8 years (range 7-26). The test were performed with a DPX apparatus by the Lumar Corporation. The bone mineral density (BMD) was measured in the area of the shortened limb segment and compared to the results of the analogous measurement of the opposite limb. The height of the measurement frame was 50 mm, and the width was equal to the width of the bone. The measurement field was located in each case at a distance of 3-4 cm (on the respective bone) from the line of the knee joint, in order to eliminate additional density caused by growth cartilage and the imposition of the patella. The repeatability of the tests was assured by a support maintaining constant internal limb rotation of 400.
Results. A difference in BMD between the shorter limb and the opposite limb was found in 47 children (82,5%). The average was 16,5%, whereas it was higher in the shorter femurs (19,1%, range 4,5 - 68,5%) than in the tibia (14%, 5,2 - 59,8%). A greater degree of demineralization was found in the girls (23,5%) than in the boys (20%). No correlation was found between the etiology of the shortening and the degree of calcification.
Conclusions. The results of these tests may have great significance in the case of densitometric monitoring of regenerated bone being formed in the course of lower limb by the Ilizarow method.