[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.

[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.

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.

[Long-range outcome in idiopathic scoliosis correction with Cotrel-Dubousset instrumentation]. / Odlegle wyniki leczenia operacyjnego skolioz idiopatycznych metoda Cotrela-Dubousseta.

Background. The purpose of this study is to evaluate outcome in idiopathic scoliosis treated surgically with Cotrel-Dubousset instrumentation. Material and methods. We analyzed the results of surgical treatment of 147 patients with idiopathic scoliosis classified according to King. The mean age of the patients at surgery was 15 years (range 12-25 years), and the mean follow-up was 6.3 years (range 3-12 years). Full-length standing preoperative, postoperative and last follow-up radiographs were studied. Radiographic analysis included the Cobb angle, Risser stage, apical vertebral rotation according to Perdriolle, radiological compensation, T2-T12 kyphosis and L1-S1 lordosis. Results. The greatest scoliosis correction was found in the frontal plane (60% in King IV), much lower in the sagittal. The mean loss of correction was 6.5% thoracic and 10.4% lumbar. In lordoscoliosis, postoperative kyphosis was below the normal range. Apical vertebral derotation ranged from 1 to 5 degrees. Derotation in the thoracic curve correlated with increased rotation in the lumbar curve. Decompensation to the left occurred postoperatively in the majority of patients. At last follow-up, the number of decompensated patients and mean decompensation was smaller. No back pain was found in the majority of patients (78.5%), and they judged the final result of treatment to be excellent (77.5%) or good (20.4%). Complications occurred in 10 patients (6.8%), early infection in 2 cases and late in 3. Conclusions. The greatest correction of scoliosis was found in the frontal plane, less in the sagittal. Small correction of the apical vertebral rotation of the main curve correlated with increased rotation in the secondary curve. The final follow-up decompensation was less than postoperatively.