Cementless femoral neck endoprosthesis SPIRON in men in aspects of clinical status and quality of life in an average 7-year follow-up.

BACKGROUND: We report the clinical evaluation, quality of life and pain assessment in patients who had a femoral neck SPIRON endoprosthesis. METHODS: The study group consisted of 27 men in whom 35 femoral neck endoprosthesis were implanted (8 on the left side, 12 on the right side and 7 bilateral) due to idiopathic osteoarthritis of the hip (20 patients) or avascular femoral osteonecrosis (7 patients) in a mean 7-year follow-up. RESULTS: The median pre-operative Harris Hip score (HHS) was 35.5 and post-operative 98.5 (p < 0.001). The median WOMAC HIP score was pre-operatively 57 and post-operatively 0 (p < 0.001). The median SF-12 score was pre-operatively 4 and post-operatively 33 (p < 0.001). The median pain assessment in VAS scale was 7 pre-operatively and 0 post-operatively (p < 0.001). CONCLUSIONS: The results of all examined patients have changed significantly in every category showing that SPIRON endoprosthesis improved their quality of life and statistically reduced pain ailments. Moreover we have proved that higher BMI (> 30) is associated with worse operation outcomes.

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.

Effect of Total Ankle Arthroplasty and Ankle Arthrodesis for Ankle Osteoarthritis: A Comparative Study.

BACKGROUND Surgical methods in treatment of joint osteoarthritis (OA) aim at meeting the increasing expectations of people with active lifestyles. Ankle joint arthroplasty has been performed increasingly more often as an alternative to arthrodesis. The aim of this study was to compare arthrodesis and arthroplasty in the treatment of ankle osteoarthritis. MATERIAL AND METHODS The study involved 56 patients (45 males and 11 females) aged 21-72 years (mean 51) presenting with end-stage ankle OA: 29 patients (52%) underwent arthroplasty (Group A) and 27 patients (48%) underwent arthrodesis (Group B). Patients underwent surgery between 2004 and 2016 at a single clinical center. The observation period ranged from 6 to 150 months (mean 55 months). To assess the results of surgical treatment, quality of life (Health Assessment Questionnaire-HAQ, 12-Item Short-Form Survey-SF-12) and functional (American Orthopedic Foot & Ankle-AOFAS, Kofoed, Takakura) scores were used. For pain assessment, Visual Analog Scale was used (VAS). RESULTS After the surgery, group A and B had a statistically significant improvement in the joint function and pain relief according to AOFAS (A: 32.6 to 68.2; B: 27.4 to 61.3), Kofoed (A: 31.8 to 68; B: 25.9 to 60.3), Takakura (A: 30.6 to 62.9; B: 25.4 to 49.3), and VAS scores (A: 7.28 to 4.14; B: 7.33 to 3.78) compared with preoperative scores. After the surgery, quality of life scores improved in both groups, for HAQ (A: 0.91 to 0.53; B: 1.34 to 0.56) and for SF-12 (A: 26.6 to 36.8; B: 25.6 to 38.0). CONCLUSIONS The comparison of total ankle arthroplasty and ankle arthrodesis in treatment of end-stage ankle osteoarthritis did not reveal any significant differences.

Hip resurfacing arthroplasty in treatment of avascular necrosis of the femoral head.

BACKGROUND: Hip resurfacing is a conservative type of total hip arthroplasty but its use is controversial, especially in patients with osteonecrosis. The aim of this study was analysis of the clinical and radiographic outcomes of hip resurfacing in patients with osteonecrosis. MATERIAL/METHODS: Between 2007 and 2008, 30 hip resurfacing arthroplasties were performed due to osteoarthritis secondary to avascular necrosis of femoral head staged as Ficat III and IV. Patients were qualified to resurfacing arthroplasty when the extent of avascular necrosis using Kerboul's method was <200° and the angle between avascular necrosis and head-neck junction was >20°. All patients were evaluated clinically and radiologically before and 60 months after the operation. RESULTS: The mean Harris Hip Score (HHS) score increased from 47.8 to 94.25 (p<0.05). Physical activity level (University of California, Los Angeles activity score--UCLA activity score) improved from 3.7 to 7.55 (p<0.05). No implant migration was observed. CONCLUSIONS: Management of osteonecrosis of the hip with resurfacing arthroplasty seems to be effective in strictly-selected patients.

[Physiotherapy in metaphysial hip replacement with use J&J Proxima stem]. / Fizjoterapia w alloplastyce przynasadowej stawu biodrowego z uzyciem trzpienia J&J Proxima.

In last years on the whole world violently grows up the number of patients at which occurrence productive degenerative changes of osteoarticular system. Actually these diseases more and more concern the young persons, active professionally. This consequences of these changes lead to limiting the functional functions of pond, pain as well as they worsen the quality of life. Pain in degenerative joint disease of various aetiology can be combated with the new surgical techniques offered by contemporary orthopaedics. Hip alloplasty is the only effective treatment method facilitating the restoration of physical fitness, correct mobility and the eradication of chronic pain. After operating introduces the different methods of improving finally. This work presents physiotherapeutic procedures, commenced on admission to the orthopaedic ward, involved in hip joint alloplasty with the J&J Proxima stem. The disseminating of introduced model of improving as well as the initiation him to program of the treatment confirms the legitimacy of choice, and it influences on improvement of the state of health also and the patients' functional efficiency with degenerative disease of hip joint.

[Realloplasty of the acetabular component of the hip joint endoprosthesis without mechanical support systems]. / Realloplastyka komponentu panewkowego endoprotezy stawu biodrowego bez uzycia mechanicznych systemów wzmacniajacych.

This work presents the tactics of surgical procedures in 40 patients who underwent revision of the hip joint due to isolated loosening of the acetabular component of the endoprosthesis. The studied group were operated between 2004 to 2006 without the use of mechanical support systems. Realloplasty of the acetabular component involved the evaluation of: etiology of acetabular loosening, concomitant diseases in the operated patients, and the grade of acetabular defects according to Paprosky's classification. In this work we analyze the type of both the loosened acetabulum and that used in revision, and discuss complications. Finally, we present a clinical evaluation of the operated patients according to Harris scale before revision surgery and six and twelve months after, with good early results.

Heterotopic ossification in patients with hip osteoarthritis below forty years old after total hip replacement.

BACKGROUND: Even though heterotopic ossification (HO) is most often asymptomatic in patients after total hip replacement (THR), it remains a serious problem in orthopaedics as it is observed in nearly all operated patients. MATERIALS AND METHODS: The article presents a pre- and post-operative retrospective analysis of heterotopic ossification based on radiographic evidence. The study involved 77 patients below forty years old who underwent THR due to degenerative changes. Heterotopic ossification was evaluated using Brooker's basic four-grade scale. RESULTS: Heterotopic ossification was diagnosed more often in women. The study confirmed once again that non-steroidal anti-inflammatory drug (NSAID) prophylaxis reduces the risk of ossification. We propose that the hydroxyapatite coating of implants may also contribute to a higher incidence of heterotopic ossification in operated patients. CONCLUSIONS: A history of surgical procedures and a lack of NSAID prophylaxis contributed to heterotopic ossification in the region of the replaced hip joint in the study group.

Arthroscopy for anterolateral soft tissue impingement of the ankle joint.

BACKGROUND: Anterolateral soft tissue impingement of the ankle joint is a common consequence of ankle sprain due to excessive supination and adduction of the foot, injuries to the tibiofibular syndesmosis and lateral malleolus fractures. MATERIAL AND METHODS: Twenty-two arthroscopic procedures to treat anterolateral soft tissue impingement of the ankle joint were performed at the Independent Public Regional Hospital of Trauma Surgery in Piekary Slaskie between 2006 and 2007. The study group included male patients at the mean age of 34 (17 to 55) years. Medical histories revealed ankle sprain in 13 patients, lateral malleolus fracture in 7, and isolated tibiofibular syndesmotic disruption in 2. The mean time from the injury to the arthroscopic treatment was 5 years (range 2 to 8 years). All patients that underwent arthroscopy were evaluated according to the AOFAS score at baseline (before surgery), and at 3 and 12 months after the treatment. The procedure consisted in the removal of hypertrophic, inflamed and scarred soft tissue from the lateral recess. RESULTS: The mean preoperative AOFAS score was 75.4 points. Post-operatively, the AOFAS functional scores increased to 90.6 and 92 points in the third and twelfth month after the procedure respectively. One patient showed temporary neurapraxia of the dorsal intermediate nerve and the ramus cutaneus branch of the superficial peroneal nerve. CONCLUSION: These results show that arthroscopic treatment of anterolateral soft tissue impingement of the ankle joint produces satisfactory early outcomes.

[Mediastinal involvement in the course of proliferative diseases in children in the materials of one institution]. / Zmiany w sródpiersiu w przebiegu chorób rozrostowych u dzieci w materiale jednego osrodka.

UNLABELLED: The mediastinum region may be the primary or secondary localization of neoplasms. The aim of our study was the assessment of clinical symptoms, histopathology and outcome of mediastinal tumours in children. MATERIALS AND METHODS: A group of 27 children, chosen from the group of 128 patients with malignancies, which were treated in the years 2000-2004 in the Oncology and Haematology Unit of the Paediatric Department in Katowice, has been studied. In this group there were 14 boys and 13 girls at the age between 2 and 12 years. We analysed the clinical symptoms prior to the diagnosis and the duration of these symptoms, histologic type of tumours and results of treatment. RESULTS: The primary localization in the mediastinum was diagnosed in 23 patients (85,2%) among them 15 (55,5%) of these children have been diagnosed as having Hodgkin's disease, and in 8 (29,6%) non Hodgkin's lymphoproliferative disease. Four of the children (14,8%) had mediastinal secondary localization of solid tumours (2 - neuroblastoma, 1 - carcinoma suprarenalis, 1 - carcinoma epitheliale of unknown origin). The most frequent symptoms were: fever (70,3%), weakness (66,6%), cough (55,5%), madiastinalpain (33,3%). The duration of these symptoms prior to the diagnosis was between 5 days and 182 clays. CONCLUSIONS: 1. In the group of neoplasms localized in the mediastinum, lymphoproliferative diseases are the most frequently diagnosed disorders. 2. In case of fever of unclear etiology and persistent cough, it is necessary to exclude mediastinal malignancy. 3. There is a need to improve the system of oncological education for medical students and doctors.

[Causes of chronic renal failure and clinical status of patients during initiation of hemodialysis therapy in upper Silesian region]. / Przyczyny przewleklej niewydolnosci nerek i stan kliniczny chorych w chwili rozpoczecia hemodializoterapii na obszarze Górnego Slaska.

UNLABELLED: The aim of this study was to evaluate the causes of chronic renal failure and clinical status of patients during the onset of hemodialysis therapy in Upper Silesian region. Medical documentation and questionnaires of 175 patients initiating hemodialysis therapy from November 1999 to October 2000 were analyzed. Concentrations of creatinine, calcium, phosphorus in serum, hemoglobin in blood, concomitance of hypertension, frequency of uremic symptoms, HBV and HCV infections, and occurrence of mature arterio-venous fistula before the first hemodialysis were assessed. The main causes of end stage kidney disease were: chronic glomerulonephritis (29%), diabetic nephropathy (27%), polycystic kidney disease (15%), interstitial (11%) and hypertensive (9%) nephropathy. The first contact with nephrologist for 30% of patients was the admission for the initiation of renal replacement therapy. 33% of patients were treated due to chronic renal failure shorter than 1 year. Only 53% of patients had matured arterio-venous fistula during the first hemodialysis session. Anemia, hyperphosphatemia (>1.7 mmol/l) and arterial hypertension were found in 87%, 49.5% and 82% of patients starting hemodialysis therapy, respectively. The main symptoms of chronic uremia were weakness, pruritus, swelling, nausea and insomnia. CONCLUSIONS: Most of patients with chronic renal failure is referred to the nephrologists at the advanced stage of the disease. It is especially true for patients with diabetic nephropathy.