Iatrogenic Intraprosthetic Dislocation of Dual Mobility Cup. Case Study.

Intra-prosthetic dislocation of the dual-mobile acetabular cup is a rare complication. Most often, it is the result of wear of the polyethylene liner. It can also occur during a closed reduction of a dislocated dual-mobile cup. It is extremely important to recognize this complication immediately in order to avoid the consequences. This paper presents the first case of iatrogenic intraprosthetic dislocation at the Traumatology and Orthopaedics Department of the Military Medical Institute, our management of the case and suggestions for treating patients with a dislocation of the dual-mobile acetabular cup.

D-dimer Levels are not a Good Marker for Venous Thromboembolism in Patients Before and After Total Hip Replacement.

BACKGROUND: Total hip replacement activates the coagulation and fibrinolysis systems. The aim of this paper is to describe the concentrations of these proteins following elective total hip replacement. MATERIAL AND METHODS: This prospective laboratory study enrolled 30 patients (including 18 women) who had been qualified for primary total hip replacement due to idiopathic osteoarthritis. Mean age was 70 years (range: 45-86 years). All patients received venous thromboembolism (VTE) prophylaxis according to the current guidelines (enoxaparin 40 mg SC s.i.d. from the day of the procedure). An immunoenzymatic assay (ACL TOP 500 CTS analyser, Beckman Coulter, Brea, CA, USA) was used to determine D-dimer levels before the surgical procedure, 6 hours after the procedure, and on the 2nd, 4th, and 6th post-operative day. RESULTS: No patients showed signs and symptoms of VTE during the hospital stay. The mean D-dimer level before the procedure was 1 mg/ml, with a highest mean value of 11.8 mg/ml at 6 hours after the procedure; the levels would then decrease but would remain above the normal range for 6 days after surgery. Elevated baseline D-dimer levels (>0.5 mg/ml) were found in 80% of the study patients. CONCLUSIONS: 1. D-dimers act like acute phase proteins, with levels increasing several-fold following total hip repla-cement. 2. D-dimer levels cannot be used to diagnose venous thromboembolism even before the procedure and hospi-talisation in patients with idiopathic coxarthrosis and no clinical manifestations of thrombosis.

Unusual Location of Osteoid Osteoma in the Acromion.

We present the clinical case of a 14-year-old female patient complaining of omalgia. A focus of osteoid osteoma located in the acromion was diagnosed. The lesion was removed using the arthroscopic technique, and the symptoms subsided completely. We also present a review of published papers regarding unusual locations of osteoid osteoma.

Periprosthetic Metastatic Lesion in Stem Region after THA. Case Study.

The paper describes a periprosthetic metastatic lesion in the stem region which developed 4 years after cementless total hip arthroplasty in a 64-year-old female patient. The patient underwent primary THA due to osteoarthritis in 2010. In June 2014, she presented with increasing hip pain. Diagnostic imaging revealed a periprosthetic osteolytic lesion in the stem region. The patient was referred to the Orthopaedic Department for further evaluation with a suspicion of pyogenic osteomyelitis. An open surgical biopsy was performed. Histopathological examination indicated metastatic cancer originating from the lungs or thyroid. A PET-CT scan showed a metabolically active tumour in the parahilar area of the left lung with metastases to mediastinal and hilar lymph nodes, left adrenal gland, spleen and right proximal femur. In October 2014, a revision total hip arthroplasty with the use of a modular femoral resection stem was performed. Patient subsequently received oncologic treatment (chemotherapy and radiation therapy).

[Current concepts in surgical treatment of chronic ankle joint instability]. / Aktualne poglAdy na temat leczenia operacyjnego przewlekLej niestabilnoSci stawu skokowego.

Ankle sprain is one of the most common musculoskeletal injuries. Initial treatment of choice in acute injury is conservative and is obtained by immobilization. The goal of such treatment is to heal ruptured capsular-ligamentous complex. However, despite the conservative treatment some patients develop chronic ankle instability as a result of injury. In those cases, surgical anatomical and non-anatomical ligamentous reconstruction is advised. Aim of the study was evaluation of the results obtained with various surgical techniques in view of published data. According to most authors, in patients who experienced chronic ankle instability, surgical technique of anatomical repair is preferred. In cases when anatomical repair might not be undertaken due to technical capabilities, anatomical reconstruction using autoor allografts is advised.

[Dislocation after total hip arthroplasty--the problem is still present, reasons and treatments]. / Zwichniecia protez stawu biodrowego--problem nadal aktualny, przyczyny i metody leczenia.

Dislocation after total hip replacement remains a significant problem in orthopedic practice. Despite the use of more modem implants risk of instability is estimated at a few percent for primary treatment and for several procedures. The standard procedure in case of the first dislocation is reduction of the prosthesis in general anesthesia. Further investigation is individual, each case must be thoroughly examined for proper execution of the original surgery and the risk of the next dislocation. Regardless of the subsequent procedures performed a key role in the event of instability prosthesis plays properly conducted rehabilitation and patient education.

[Instability and other local complications after revision hip replacement in one patient--a case report]. / NiestabiInosc i inne miejscowe powiklania po realoplastyce stawu biodrowego--opis przypadku.

Arthroplasty of the hip is now considered as a safe procedure. The most frequent complications include such terms as pulmonary embolism, myocardial infarction and thrombosis locally at the lower extremities, wound infection, loosening of the implant, periprosthetic fracture, dislocation of the prosthesis or sciatic nerve injury. The work is described for patient operated at the Department of Orthopaedics WIM, in which within 3 years from revision surgery made of loosening of the implants there were multiple complications, including multiple prosthetic dislocations, periprosthetic fracture, nonunion and damage of the stabilizing plate. During this period, the present 73-year old woman were seven treatments, including three closed repositions dislocated prosthesis. Treatment was discontinued in February 2012 stating union at the pseudarthrosis.