[Effectiveness of continuous passive motion after total knee replacement]. / Efektywnosc ciaglego biernego ruchu po zabiegu pierwotnej endoprotezoplastyki stawu kolanowego.

Continuous passive motion (CPM) is frequently used method in the early post-operative rehabilitation in patients after knee surgery. Aim of this study was to evaluate the effectiveness of CPM after primary total knee arthroplasty. Efficacy was assesed in terms of clinical score and functional recovery. 93 patients (101 knee joints) undergoing total knee replacement were assigned into two groups. The experimental group received continuous passive motion and active exercises. A control group received conventional physical therapy only. CPM was initiated in the first day after surgery, for 120 minutes, starting with 0-40 degrees range of motion, increased as tolerated (mean 10 degrees per day) and maintained during the hospital stay. Outcome measures were those included in Knee Society Score (KSS). Functional recovery was evaluated using WOMAC. All subjects were evaluated once before the surgery and on 10th day postoperatively. Mean clinical score (KSS) at the day 10 was 70 +/- 15 points in the experimental group and 74 +/- 12 in a control group. There were no statistical difference between the two groups for any outcome measures. CPM group mean range of motion was 83 degrees +/- 14 degrees and a group without CPM 77 degrees +/- 21 degrees. KSS functional score was 66 +/- 9 points in the experimental group compared to 62 +/- 7 points in a control group. Subjective estimation of pain level, joint stiffness and function showed no statistical difference between the two groups regarding total and subscale scores. Mean total score was 24 +/- 19 points in the CPM group and 22 +/- 17 in a group without CPM. These findings show that CPM had no significant advantage in terms of improving clinical measurements. However, there was beneficial effect on subjective assessment of pain level, joint stiffness and functional ability.

[Clinical versus radiological mid-term results of total knee arthroplasty for degenerative arthritis of the knee]. / Zaleznosc wyników klinicznych totalnej kondylarnej alloplastyki stawu kolanowego w zmianach zwyrodnieniowych od wyników radiologicznych u chorych leczonych ta metoda w ocenie srednioterminowej.

Total knee arthroplasty (TKA) is widely accepted method for treatment of severe osteoarthritis. The aim of this paper was to retrospectively review patients operated in our institution with total condylar knee arthroplasty due to osteoarthritis and assess clinical and radiological results of this procedure. All patients treated with TKA between 1998 and 2001 were reviewed, those with diagnosis of rheumatoid arthritis were excluded from the study. One hundred and one TKA in 68 patients were studied. WOMAC protocol and KSS (Knee Society Score) were used to evaluate patients clinically, and KSS alone for radiological analysis. Bone-implant interface has been studied, position of the implants and mechanical axis of the limb both pre- and postoperatively. Excellent and good results were achieved in 89% of TKA. Subjective self-assessment was usually worse than objective one. Radiolucency was found in 16 cases (more often around tibial component than the femoral one), usually without clinical symptoms of the loosening. An accurate alignment within the range of 3 to 9 degrees valgus has been found in 68% of the knees. Subjective scores were worse than objective clinical assessment. The clinical score was higher than radiological one. The tendency to varus tibial implant fixation was observed. Suboptimal implantation has not led to implant loosening in mid-term results.

Short-term results of total hip replacement in patients under thirty years of age.

BACKGROUND: Total hip replacement is a commonly accepted treatment for disorders of the hip. The paper reviews the clinical and radiological outcomes of total hip arthroplasties performed in young patients. MATERIAL AND METHODS: Twenty-eight total hip arthroplasties were performed in twenty-one young patients between 1996 and 2005. The mean age of the patient at the time of the operation was 25.8 years (range 17 to 30 years). The mean follow-up was 6 years (range 3 to 12 years). RESULTS: The average preoperative Harris score for this group of patients was 35.82 (range 11.75 to 51.45). After 6 years of follow-up all hips were rated excellent, with an average Harris score of 99.13 (range 95.6 to 100). Radiographs revealed that the acetabular and femoral components were correctly positioned in all patients. CONCLUSIONS: 1. Total hip arthroplasty is an effective treatment in young patients who suffer from bilateral hip disease. 2. Using bone grafts around the acetabulum and inside the femoral canal is recommended especially in post-dysplastic hips and in rheumatoid patients.

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.

Simultaneous open reduction and Dega transiliac osteotomy for developmental dislocation of the hip in children under 24 months of age.

The authors studied retrospectively 33 hips in 26 children at an average of 9 years 5 months after simultaneous open reduction and Dega transiliac osteotomy for developmental dislocation of the hip (DDH). All children were younger than 2 years of life at surgery. At the latest follow-up 89% of the clinical results and 72% of the radiographic results were rated excellent or good, despite a 45% rate of avascular necrosis observed before surgery. The authors attempted to identify factors influencing the final result. Given the low complication rate (3%) and low reoperation rate (3%), the authors conclude that the reviewed surgical protocol is safe and efficient in the treatment of DDH in young children.

[The effect of absent ossific nucleus of the femoral head on results of surgical treatment for developmental dislocation of the hip]. / Wplyw braku jadra kostnienia glowy kosci udowej na radiogramach przedoperacyjnych na wyniki operacyjnego leczenia rozwojowego zwichniecia stawu biodrowego u dzieci do 24. miesiaca zycia.

We have studied retrospectively 33 hips in 26 children at an average of 9 years 5 months after simultaneous open reduction and Dega transiliac osteotomy for developmental dislocation of the hip (DDH). All children were younger than 2 years of life at the time of surgery. The hips were divided into two groups: with present and with absent ossific nucleus of the femoral head on preoperative radiographs. Clinical and radiographic results have been assessed in both groups. No statistically significant difference was found between the groups. We conclude, that absent ossific nucleus of the femoral head as a sole reason should not delay surgery for DDH.

[Graft remodeling following Hertel ACL reconstruction in MR imaging]. / Przebudowa przeszczepu po rekonstrukcji wiezadla krzyzowego przedniego metoda Hertla w obrazie tomografii rezonansu magnetycznego.

MRI and clinical assessment of 21 patients operated on with Hertel method due to knee instability has been presented. Position of the graft in reference to the Blumensaat line has been evaluated in MRI with the use of 3 point scale after mean follow-up of 9-months. Four points scale has been used to grade signal intensity as indicator of graft remodeling. Lysholm scale served for clinical assessment. Mean grade for graft position was 2.3 and for signal intensity 2.7. Better remodeling of the graft correlated positively with its better positioning, but clinical assessment correlated poorly with signal intensity and localization of the graft. Incorrect positioning of the graft hinders its remodeling--ligamentization of the tendon.

[Surgical treatment of advanced congenital scoliosis with the C-D method]. / Leczenie operacyjne zaawansowanych skolioz wrodzonych metoda C-D.

The paper presents the results of surgical treatment of 15 cases of congenital scolisios with CD instrumentation. Progression of the deformity was most often seen in cases with combined deformities (according to the McMaster classification). Indications for surgical treatment were progression of the curvature and trunk and thorax deformity progression, particularly during the growth spurt. The age at the time of surgery ranged from 10.3 to 16 years (average: 13.8 years). Follow-up period ranged from 2 to 8 years (average: 4 years). Intraoperative deformity correction ranged from 0 to 60% (average 32%). Loss of correction during follow up ranged from 0 to 3%. The overall silhouette improvement was a result of correction of the spine curvature, correction of thoracic hyperkiphosis and a decrease of trunk decompensation. The only complications noted were 3 cases of transient neurological symptoms from the lower extremities. Preoperative MRI allows detection of congenital deformities of the spinal canal, a contraindication for surgical correction of the deformity with spinal implants.