Tibiotalocalcaneal Arthrodesis in Osteoarthritis Deformation of Ankle and Subtalar Joint: Evaluation of Treatment Results.

Tibiotalocalcaneal arthrodesis (TTCA) is an increasingly used method of stiffening the ankle and subtalar joints in advanced degenerative deformities. The study group consisted of 19 men who were subjected to intramedullary and intraosseous arthrodesis using an intramedullary nail. The average age of patients was 46 (range 19-68) years. The main indication for surgical treatment was post-traumatic arthrosis 11 (58%). In the studied group, clinical condition was assessed using the American Orthopedic Foot and Ankle Score (AOFAS) classification, quality of life using the SF-12 scale, and assessment of pain intensity using the visual-analog scale (VAS) scale. The above parameters were evaluated before surgery (under 2 years), intermediate (from 2 to 5 years), and late (over 5 years) postoperative period. The clinical condition on the AOFAS scale improved from an average of 20.6 points before tibiotalocalcaneal arthrodesis to 63.5 after the procedure. The result was statistically significant (p < .0001). Analyzing the results using the SF-12 scale, a statistically significant increase was found. In the physical sphere of Physical Health Component Score-12 (p = .0004) and in the mental sphere of Mental Health Component Score-12 (p = .030). The intensity of pain assessed in the VAS scale, decreased in all three periods-p < .05. The strongest analgesic effect was observed in the early postoperative follow-up period. Tibiotalocalcaneal arthrodesis using an intramedullary nail causes a significant improvement in the clinical condition according to the AOFAS classification, enabling most patients to move independently, a significant improvement quality of life assessed in the SF-12 scale and a significant reduction of pain ailments assessed in the VAS scale, especially in the early postoperative period.

Total hip arthroplasty with shortening subtrochanteric Z osteotomy in the treatment of developmental dysplasia with high hip dislocation.

BACKGROUND: The work presents the results of total hip arthroplasty in the treatment of arthrosis secondary to for developmental dysplasia with high hip dislocation or corollary to previous surgery of dysplastic high riding hips. In all patients the cup was placed in its anatomical position. In order to avoid excessive lengthening of the operated limb and the associated complications, the femoral shaft was shortened by subtrochanteric Z osteotomy. The osteotomy site was stabilised with a cementless CDH stem. MATERIAL AND METHOD: The technique was used in 10 women at an average age of 53. 4 years between 2006 and 2011. Five patients were operated on due to the degenerative changes secondary to developmental dysplasia with high dislocation of hip joint. The remaining patients had undergone surgery before. Angular osteotomy of the proximal femur was performed in four patients and total hip arthroplasty with high placement of the acetabular component in one. The average preoperative Harris Hip Score was 43.7. Preoperative shortening of the limb ranged from 4 to 10 cm, with an average of 6. 1 cm. RESULTS: The patients were followed up for a mean of 28. 3 months. No postoperative nerve damage has been observed. The operated limb was lengthened in all patients (range: 2.5 to 5 cm, mean: 3.4 cm). Radiographic union at the osteotomy site was obtained after an average of 4.5 months. All patients reported complete or near-complete pain relief and improved function of the operated limb. By the last follow-up visit, the Harris Hip Score had increased to 86 points on average. CONCLUSIONS: Subtrochanteric osteotomy of the femur reduces the risk of postoperative complications associated with excessive limb lengthening and facilitates access to the acetabulum. Total hip arthroplasty with shortening subtrochanteric Z-type osteotomy is a safe method in the treatment of degenerative changes secondary to developmental dysplasia with high hip dislocation.

[Avantage double mobility press--fit cup in total hip arthroplasty]. / System avantage--panewka z podwójnym ruchem w alloplastyce stawu biodrowego.

The Avantage double mobility press-fit cup was devised by Dr. Bousquet in the 70's to bring reasonable response to a problem of recurrent dislocation after total hip arthroplasty. The cup is attached to the femoral head by a bipolar polyethylene liner. The polyethylene liner moves freely inside a shiny--polished metal cup. The angular range of motion before impingement is increased by the mobility of the liner. The double connection (cup-liner, liner-head) reduces the stress on the metal cup and improve the stability of the prosthesis. The solution has proved to be efficient in reducing dislocation risk and maintains at the same time the appropriate range of motion. Between January 2004 and November 2005, 113 hip arthroplasties in 108 women with use of the double mobility cup were performed. The cemented version of the Avantage cup was inserted in 15 patients (mean age--76.9 years). Uncemented, HA coated implant was used in 98 patients (with mean age of 55 years). The mean follow-up was 20.4 months. No one patient was lost to follow-up. No postoperative dislocation was observed during follow-up. There was no unwanted leg lengthening greater than 1 cm. The Avantage cup may be indicated in any primary total hip arthroplasty especially in those with increased risk of postoperative dislocations. This cup enables a correct balance of the hip without a need of the unwanted lengthening of the leg.