[Somatometric and impedance measurements of the lower extremities in orthopedics]. / Prínosy somatometrických a impedancných meraní dolných koncatín v ortopédii.

PURPOSE OF THE STUDY: The objective was to demonstrate the contribution of somatometry and vascular impedance measurement to the evaluation of somatic status and nutrition, particularly the state and function of the vascular system of lower extremities, in patients with arthropathy of the weight-bearing joints. MATERIAL: Impedance plethysmography and impedance phlebography appeared to be the best methods for assessment of vascular hemodynamics; pulse oxymetry, carried out on toes, was most convenient for measurement of haemoglobin saturation with oxygen (HbO2). The state of vessels was determined according to the CEAP classification. Somatometric methods included measurement of the circumference and volume of calves, and assessment of body height, at the anthropometric wall, and weight to calculate the body mass index (BMI). RESULTS: The lower extremities affected by arthropathy were compared with the unaffected ones by means of CEAP classes and related to the body mass values of patients. It was found that only 15 men and 26 women had normal body mass. The rest of the patients were overweight or obese (grade I and II). Only 14 men and 17 women were free of signs of vascular insufficiency, the others were classified in the range of C1 to C4 of the CEAP system. Impedance measurements showed lower mean values for affected extremities and for overweight or obese patients. A comparison of the parameters of arterial and venous hemodynamics between the affected and unaffected extremity by means of the paried t-test gave statistically significant results in patients with higher BMI grades and higher classes of vascular insufficiency, regardless of their gender. The results of HbO2 saturation measurement showed normal values in both men and women. DISCUSSION: To meet the requirements of orthopaedists, the Biophysical Laboratory carried out non-invasive measurements of somatometric parameters and vascular impedance values in patients with arthropathy of the weight-bearing joints of lower extremities. The results were similar to those of a large Framingham cohort study on knee arthropathy and obesity. The data derived from measurement of basic impedance, specific impedance and pulse-related impedance changes show that it is important to record and evaluate skin lesions and oedema because they are related to vascular disease. The finding that an increasing volume the calf was indirectly related to a decreasing basic impedance of calf vessels was confirmed by our results. This information is important for the evaluation of impedance measurement results in order to make diagnosis in individual patients. CONCLUSIONS: Our results showed that, in the group investigated, (i) there was a high proportion of overweight and obese patients; (ii) assessment by CEAP classification revealed higher grades of vascular insufficiency; (iii) affected extremities showed a significant decrease in arterial and venous haemodynamics, particularly in women with higher-grade vascular insufficiency; (iv) there was no difference in HbO2 saturation measured on toes.

[Giant cell tumor--osteoclastoma: part II]. / Obrovskobunkový nádor--osteoclastoma: II. cast'.

Authors present current views on the comprehensive diagnostics, treatment and prognosis of giant cell tumours. They include an exact algorithm of diagnostics necessary for a timely treatment. They describe an often unexpected behaviour of these tumours which is frequently active and aggressive, to a small extent these tumours show the tendency to become malignant. The treatment prefers curretage, antibiotic irrigation and filling in with bone cement. In case of recurrence and an extensive process, block resection and replacement by an individual implant, in hardly accessible locations (spine, sacrum, pelvis) or radiotherapy is recommended. The authors present in detail results of a 10-year systematic follow-up of 56 patients, of which 61.6% were in active stage, 36.8% in aggressive stage. The most frequently used method (in 73.2%) was curretage, irrigation and filling in with bone grafts, in 12.5% of cases block resection and replacement by bone grafts. Total results after all these types of operations evaluated in the interval of 3 years after the operation were very good, i.e. 85.7% remissions, there were 14.3% of recurrence. Of these setbacks 5.4% were in remission for more than 3 years and thus conduced to the increase of the number of remissions to 94.6% which can be evaluated as an excellent result. Local recurrence occurs in 10-15% with the application and 15-25% without the application of local adjuvant therapy. In the third stage in case of extensive destruction we perform resection en bloc, radiotherapy in hardly accessible locations (spine, sacrum, pelvis). In case of extensive destruction in the region of joints the method of choice is the application of both individual and total replacement.

[Arthroplasty according to colonna - 1999.]. / Colonnova artroplastika - 1999.

Authors evaluate results of arthroplasty according to Colonna.The surgery was performed at the Ist University department of orthopaedics in Bratislava in the period of 1955-1973. Of 97 patients (123 hips), 64 (79 hips) were followed up 5-25 years and 23 (31 hips) over 25 years. All patients at the last follow up for were assessed as having not satisfactory results, because of early pain at the operated side, limited movement of the hip joint and radiologically evident arthritic changes. Key words: Colonna, arthroplasty, DDH.

[Our Experience in the Revision Surgery of THR.]. / Nase skúsenosti s reimplantáciou TEP koxy.

The authors present their experience in the revision surgery of THR. Most often it was the case of aseptic loosening of the acetabulum, the femoral component or both components (67 %), lytic radioluscence or even lysis in the region of implants, fissures even fractures of the femur and septic loosening. They evaluate the results of revision surgeries of THR for a 5-year period in 106 patients after Merle dAubigne and Postel: excellent result was achieved in 33 %, good in 39 %, average in 19 % and a poor result in 9 %. The authors emphasize in case of primary surgery the importance of indication criteria, age of the patient, appropriate choice of the type of implant, evaluation of the immunological condition of the patient. In revision surgeries of aseptic loosening of the implant and bone defects of the medial acetabular wall efficient was mainly the application of bone grafts and cementless acetabular cup of the Harris-Galante, Zweymüller or Balgrist type. Periprothetic fractures of the femur should be treated by internal fixation and Wagner revision stem. In case of septic loosening the endoprosthesis was extracted or a two-phase revision surgery performed. Key word: THR revision surgery, aseptic loosening, bone defects, Wagner revision stem.

[Results of application of hydroxyapatite and hydroxyapatitecollagen.]. / Výsledky pouzitia hydroxyapatitu a hydroxyapatitkolagénu na výpln kostných defektov.

The authors present their experience of the application of hydroxyapatite and a composite-hydroxyapatitecollagen in 2 groups of patients. In the first group they evaluate the mediumterm results in 10 girls and 8 boys of average age of 12,5 years after the filling of bone defects in case of bone cysts, aneurysmatic cysts, fibrous cortical defect and eosinophilous granuloma. Hydroxyapatite was applied in the form of rolls, small bricks, strips. The first signs of healing were evident as early as after 4 months, after 36 months osteointegration was practically finished. In the second group of 1995-2000 period they applied hydroxyapatite in 15 patients of average age of 45 years. In this group they applied the mentioned biomaterial also in 6 patients with instabilities and primary and secondary (metastasis) bone tumours on the spine where they also achieved after a shorter follow-up of 6-8 months good osteoinductive and conductive qualities of the biomaterial. The authors point out the two biggest contributions in this respect: filling of bone cavities with an unusually big amount of hydroxyapatite (up to 70 g) and good, even though only short-term results after resection and filling of malignant bone tumours. Key words: hydroxyapatite, collagen, osteoinduction, osteoconduction, bone defects.

[Somatometric and Hemodynamic Measurements after the Total Replacement of Weight Bearing Joint in Preventive Administration of Low-molecular Heparines.]. / Somatometrické a hemodynamické merania po artroplastikách váhonosných klbov pri profylaktickom podaní NMH.

The authors present outcomes of simple somatometric and impedance measurements of the condition of venous hemodynamics after the total replacement of weight bearing joints with a simultaneous prophylactic application of low molecular heparines (LMH). Measurements in a group of 125 patients (86 females and 39 males) showed increase of circumferences up to symptoms of a swelling on proximal portions of the limb operated on in an early postoperative period; as a rule it reached its peak between 6th and 8th day with a subsequent subsidence in the next period, i. e. until the dismissal of the patient from the hospital. As compared to non-operated extremities the statistical evaluation of circumferences on proximal parts showed a high significance (p = 0,001). Dynamics of these changes reaching the maximum on 6th-8th postoperative day necessitated the adjustment of antithrombotic regimen of administration of low-molecular heparines in the form of therapeutic dosage in 3 of 39 males and 17 of 86 females. There were no clinical symptoms of either venous thrombosis or pulmonary embolization during the hospital treatment. Results of our clinical study document great significance of somatometric measurements of horizontal proportionality of the lower extremity in the post-operative period after total replacement of weight bearing joints for the adjustment of prophylactic administration of LMH and prevention of the incidence of thromboses of deep venous system. Key words: deep venous thrombosis, periodicity of the risk of venous thrombosis, prevention by lowmolecular heparines, somatometric measurements, venous stasis.

[Primary intraosseous liposarcoma - case report.]. / Primárny kostný liposarkóm - kazuistika.

Primary intraosseous liposarcoma belongs to exceptional tumors rarely found on the sceleton. There are only several tens of cases described in literature and they are published as case reports. Because there is not enough experience, especially with diagnostics of this illness, it happens that it is considered as malignant fibrous histiocytoma, malignant mesenchymoma or with secondary infiltration of liposarcoma of soft tissue into the bone. Authors tried (in correlation with the clinical outcome studies of macroscopic samples with detailed histologic examination) to overcome diagnostic uncertainities of this case. Key words: primary intraosseous liposarcoma, maligant bone tumors.

[Acetabular Replacements in THR in Dysplastic Osteoarthritis of the Hip.]. / Náhrady acetábula pri totálnych endoprotézach u dysplastických koxartróz.

The authors present different options of the surgical treatment of dysplastic osteoarthritis of the hip. For the acetabular replacement they use Harris-Galante, Zweymúller and Balgrist cementless cups. They evaluate results for a five-year postoperative period in 182 patients. On the basis of Merle d'Aubigne and Postel evaluation system the results were excellent in 79,6 % and very good in 12,1 %.The authors recorded only a relatively small percentage of complications (10,9 %) relating to the wound infect, loosening of the cup, trombophlebitis and palsy of n. peronaeus com. or n. femoralis. The authors emphasise the importance of CT examination of the hip joint in the preoperative preparation and of the knowlege of biomechanics of pelvis for the insertion of the cementless cup. The replacement of acetabulum in dysplastic osteoasthritis of the hip is an open issue - there exists no ideal cup for each case. Key words: dysplastic osteoarthritis of the hip, cementless cup, THR, acetabuloplasty.

[Osteoarthropathies and conditions after alloplasties of the knee joints from the aspect of antropometric examinations.]. / Osteoartropatie a stavy po aloplastikách kolenných klbov v obraze antropometrických vysetrení

The authors submit an analysis of the nutritional status assessed by anthropometric methods in a clinical group of 70 patients (mean age 58 years) where on account of the X-ray and the clinical finding of arthritis of the knees an alloplastic operation was performed. The results of the examination are compared with the analysis of the nutritional status of a group of 20 without X-ray and clinical signs of arthritis of the knee. The patients belonged to a similar age bracket. The authors used somatometric measurements of anthropometric parameters focused on assessment of the relative body weight. The results confirmed an age-dependent decline of height, known from epidemiological studies, the difference being statistically significant, p = 0.05 in the group of men in the Huporal group, as compared with men in the control group. A similar trend was found in median values of sitting height in both clinical groups and in the height of the trunk in men. Using linear regression, they revealed that the increase of Brock's index corresponded to the increase of pelvic circumference in women in different groups, while in men of all investigated groups this relationship is apparent in the abdominal circumference. Evaluation of the nutritional status by Broca's index revealed in the control group a 50 % incidence of clinical obesity, while in the clinical Huporal group it was 89 %, and in the clinical TEP group 87 % were in the group of overweight and obesity. Also tables of the nutritional status based on BMI confirm the marked predominance of overweight and obesity in patients of both clinical groups. Key words: osteoarthropathy of the lower extremities, alloplasty of the knee joints, anthropometric parameters, relative body weight.

[Results of surgical synovectomy of the knee joint in patients with rheumatoid arthritis.]. / Výsledky chirurgickej synovektómie kolena u pacientov s reumatoidnou artritídou.

The authors evaluate the results of synovectomy of the knee in 216 patients (83 men and 133 women) with rheumatic arthritis (RA); 35 patients with juvenile chronic arthritis (JCA) in the evaluated group account for 16,2%. On average 2.3 years have elapsed since the operation. They evaluate the peroperative macroscopic appearance of the synovial membrane, the damage of intraarticular structures, the effect of surgery on the range of movements. Comprehensive evaluation according to Aidem -Baker revealed very good results in 52.8%, good results in 36.1%, satisfactory results in 7.4% and poor results in 3.7%. Key words: surgical synovectomy, synovectomy of the knee, rheumatoid arthritis (RA), juvenile chronic arthritis (JCA).

[First results after implantation of an individual endoprosthesis of the coxa according to aldinger.]. / Prvé výsledky po implantácii individuálnej totálnej endoprotézy koxy podl'a Aldingera.

In the introduction of the paper the authors draw attention to the advantages of individually made total endoprostheses of the hip joint (TEP). They mention three reasons which made them implant individual TEP, as described by Aldinger, i. e. the highest percentage of dysplastic coxarthroses in their clinical material requiring an individual approach to the deformed proximal femur, failures of TEP according to Müller in dysplastic coxarthroses and finally complications when inserting some non-cemented TEP in the above indication. When evaluating the results of implantation of Aldinger's individual TEP in 50 young patients (mean age 40,5 years) after an interval of 4-30 months following operation the authors achieved in 96 % very good and good results. So far they did not record any complications after implantation of Aldinger's TEP. Key words: individual total endoprosthesis according to Aldinger, acetabulum - type Harris-Galante, acetabulum - type Zweymuller, dysplastic coxarthroses.

[Implantation of 110 total hip joint endoprosthesis using the Zweymüller method]. / Skúsenosti s implantáciou 110 totálnych endoprotéz bedrového klbu podl'a Zweymüllera.

The authors discuss in the submitted paper the advantages and disadvantages of cemented and non-cemented endoprostheses, type Zweymüller. They evaluate the medium-term results (one half to 5 years) after surgery in 92 patients from a total of 121 operations in 110 patients (11 bilateral). As to indications, the first place was held by so-called dysplastic coxarthroses, followed by post-traumatic coxarthroses and rheumatoid arthritis incl. the juvenile type. The results of these operations were after an average of 18.27 months following operation according to the DMS evaluation of Merle d'Aubigné and Postel excellent and good in 89%. The authors recorded a relatively small percentage of complications, associated in particular with the replacement of the acetabulum in three patients and the replacement of the femoral component in two patients.

[Salmon calcitonin nasal spray and calcium sandoz forte in the prevention and treatment of osteoporotic fractures in postmenopausal women (information on clinical trial).]. / Lososí Calcitonin - nosný spray a Calcium Sandoz forte v prevencii a liecbe osteoporotických fraktúr u postmenopauzálnych zien (informácia o klinickej studii).

At the First Orthopaedic Clinic in Bratislava, Hlboká 7, since August 24, 1992 a clinical trial is under way which is focused on the effectiveness of treatment with salmon Calcitonin (Miacalcic Sandoz) and calcium (Sandoz) in postmenopausal osteoporosis. On the above mentioned day Sandoz Co. supplied the Clinic with a densitometer Lunar DPX-L working on the principle of double X-ray absorptiometry. The preparation for this clinical trial started at the beginning of 1992. By the end of June in the trial 62 female patients were included. The authors plan to include another 36 patients were included. The authors plan to include another 36 patients by the end of the year, thus the total number should be 100. Key words: osteoporosis, bone densitometry.

[Indications for transposition of the greater trochanter.]. / Indikácie transpozície velkého trochanteru.

The greater trochanter participates by its anatomical structure mainly in the function of the coxa, lumbar spine and has an impact on standing and gait. In case of morphological deformities its static and biomechanical functions are inadequate. One of the possible ways of adjusting the anatomical shape of the greater trochanter, if deformed, is its isolated transposition in case of trochanter altus. This condition is encountered in congenital dislocation of the hip joint, relative prolongation is found also in necrosis of the head of the femur. The authors analyzed 31 patients (27 women and 4 men, 27 patients after LCC and three after Perthes' disease) where during the last five years transposition of the greater trochanter was performed. The result was very satisfactory in 48% of the patients, good in 39%, unchanged in 10% and poor in 3%. As transposition of the greater trochanter is performed on a pathological coxa, it would be an illusion to expect after this operation restitution ad integrum. The authors discuss advantages and disadvantages of this operation. Key words: greater trochanter, osteotomy, transposition.

[Mineralization of the Coxa (DPX) before Implantation of TEP.]. / Stav mineralizácie (DPX) koxy pred implantáciou TEP.

The authors point out that when TEP are planned more attention is paid to the type of prosthesis, its composition and technical parameters and less attention to the quality of osseous tissue which is the subject of the present work. The authors examined at the First Orthopaedic Clinic Medical Faculty Comenius University Bratislava by means of a densitometer LUNAR DPX L the neck of the femur in patients before implantation of a TEP. They examined 96 coxae in patients with an average age of 57 years. Primary coxarthrosis accounted for 48%, bionecrosis of the head for 21%, deforming coxarthrosis (condition following LCC) 12%, rheumatoid arthritis 9%, conditions after fractures of the neck of the femur 9%. In the first group the bone density - BMD per g/cm2 in the neck of the femur (K) was 0.996 (109%), of Ward's triangle (W) 0.902 (118%), of the trochanter (T) 0.748 (106%). Values in the other groups: Group 2: K = 0,823 (93 %), W = 0,702 (91 %), T = 0,587 (76 %). Group 3: K = 0,987 (107%), W = 0,814 (99%), T = 0,684 (89 %). Group 4: K = 0,740 (83 %), W = 0,586 (74 %), T = 0,479 (64 %). Group 5: K = 0,604 (66 %), W = 0,533 (68 %), T = 0,513(63%). The results indicate that in idiopathic coxarthrosis the density is normal or elevated, in deforming coxarthrosis the coxa is difficult to examine by means of our software. In rheumatoid arthritis bionecrosis and mainly after fractures is density reduced. Reduced bone density is associated with the firmness of the fixation of TEP. Key words: DEXA, DPX, bone density, total endoprosthesis.

[Advantages of digitalization and analysis of roentgenograms of bones by microcomputer.]. / Výhody digitalizácie a analýzy röntgenogramov kostí mikropocítacom.

The creation of an experimental group for digitalization of two-dimensional X-ray pictures of bones was the starting point for the application of selected procedures for their computer-assisted analysis. During processing of the picture first the primary digitalized picture was corrected (e. g. subtraction of the background, correction of the non-homogenity of the scanning element and light source) and subsequently the picture was prepared by spot or local transformations (e. g. semithresholding, equalization, Sobel's operator and subtraction of two differently prepared pictures) while preserving the geometry of the original objects on the picture. On treated pictures of bony structures then graphic procedures of identification of important spots, lines, angles and derived indices and of mutual relations of bones were verified. For creation of prerequisites of the long-term development of osseous changes, in particular in patients with non-cemented implants of the hip joints, possibilities of and quantitative requirements of filing of digitalized two-dimensional X-ray pictures of the bones in information media were tested as well as the possibility to transmit them in the local computer network. Finally the authors draw attention to the advantages of digitalization and analysis of two-dimensional X-ray pictures of bones by a microcomputer from the aspect of impact on information, economic aspects and in particular preserving of information in digital form. Key words: digitalization of X-ray pictures, digital processing of X-ray pictures, filing of X-ray pictures.

[Comparison of surgical and radioactive synovectomy in various disorders of the knee joint]. / Porovnanie chirurgickej a rádioaktívnej synovialektómie pri rôznych afekciách kolenného klbu.

The authors evaluate after an interval of 1-20 years the long-term results of surgical synovectomy in 454 patients and radioactive synoviorthesis in 528 patients performed at the First Orthopaedic Clinic, Medical Faculty, Comenius University and Faculty Hospital in Bratislava and at the Orthopaedic and Traumatological Clinic of the Medical Faculty in Martin in 1969-1991. The most frequent diagnosis in surgical synovectomy is rheumatic synovitis in radioactive synovectomy arthrotic synovitis (47.6% and 68.6%). The authors evaluate both methods of synovectomy according to Aidem-Baker and compare the results of the two methods. They found significantly more very good and good results after surgical synovectomy (54.8% and 33.5%) as compared with radioactive synoviorthesis (15.5% and 38.0%). Conversely they found significantly more satisfactory and poor results in radioactive synoviorthesis (29.1% and 17.4%) than after surgical synovectomy (8.8% and 2.9%) which comprise patients relatively satisfied with this procedure and who do not agree with other procedures.