Revision arthroplasty using a custom-made implant in the course of acetabular loosening of the J&J DePuy ASR replacement system - case report.

RATIONALE: Resurfacing arthroplasty using the J&J DePuy ASR system was withdrawn from surgical treatment due to the necessity of frequent revision procedures after its application. There have been many studies concerning treatment of acetabular bone loss using different operating techniques. However, we felt that data of custom - made implant usage in such cases is highly insufficient, and there is lack of evidence on its application in treatment of loosening of the previous implant. The aim of the study was to evaluate the effectiveness of surgical treatment with a custom-made implant in a patient with extensive acetabular bone loss after aseptic loosening of the acetabular component of the J&J DePuy ASR surface prosthesis in the early period of observation. PATIENT CONCERNS: A 74-year-old patient was taken to the Orthopaedic Trauma Emergency Room due to increasing pain in the right hip for about 3 months. Nine years earlier he underwent resurfacing arthroplasty of the right hip using the J&J DePuy ASR method. DIAGNOSES: The imaging diagnostics (X-ray, computed tomography, ultrasound) revealed the presence of a pseudotumor and lysis around the acetabular implant, which caused a fracture in the acetabulum. INTERVENTIONS: Revision arthroplasty of the right hip joint was performed with the removal of the ASR implant. During the procedure extensive bone defects were visualized, preventing the insertion of the revision acetabulum. After extensive plasticization of the defects with the use of allogeneic cancellous chips the "hanging hip" was left with the intention of making another attempt to insert the implant after the reconstitution of the acetabular bone. A computed tomography examination 2.5 years after the ASR removal revealed the lack of an adequate degree of bone remodeling for the planned implant. Arthroplasty using custom - made aMace Acetabular Revision System by Materialize was performed 3 years after the removal of ASR. OUTCOMES: Optimal implant adherence to the bone base and full osseointegration with the pelvic bone bearing has been achieved. Significant improvement in clinical parameters has been noted, with no complications in the postoperative period. LESSONS: The use of an individual custom-made implant in extensive acetabular bone loss after aseptic loosening of the acetabular component of the J&J DePuy ASR surface prosthesis in patients is an effective method of surgical treatment.

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.

[Early clinical and radiological results following cervical disc arthroplasty]. / Wczesne wyniki kliniczne i radiologiczne protezoplastyki krazka miedzykregowego w odcinku szyjnym.

The aim of this study was to assess early results of anterior cervical decompression and arthroplasty for cervical disc disease. The results of operations of 32 patients (43 instrumented levels) were examined to assess clinical outcome, the restoration of disc height, postoperative lordosis, mobility of instrumented segment and complication rate. Clinical outcome evaluated with VAS score improved from 7.5 preoperatively to 2.7 post operation. There was improvement in disc height measured by Tureyen method of 48%, 5 degree restoration of lordosis per segment and average 5 degree mobility of operated segment. In two cases spontaneous fusion occurred. There were no loosening of prosthesis observed. Overall the study shows that early results of arthroplasty are clinically efficient and safe as fusion. Assessment of biomechanical advantages of arthroplasty demands further observation to compare if long-term results are superior to fusion.

[Assessment of radiological results of anterior cervical discectomy with different fusion cages]. / Ocena radiologicznych wyników leczenia operacyjnego dyskopatii szyjnej z zastosowaniem róznych typów wszczepów miedzytrzonowych.

The purpouse of this study was to compare results of anterior cervical decompression and fusion for cervical disc disease with 2 different interbody devices: titanium cylinder-design cage and carbon box-design cage. The results of operations of 46 patients (60 instrumented levels) divided in to groups according to implant type were examined to asses the restoration of disc height, clinical outcome, bony fusion and complication rate. In the cylinder-design cage group average postoperative restoration of disc height was 72% but with narrowing rate of 26% in follow up. In the carbon box group postoperative disc height restoration was 51% with narrowing in follow up to 6%. Clinical outcome was comparable in both groups and loss of disc height in cylinder-design cage group had no effect on clinical outcome. There were 2 cases of pseudoarthrosis in cylinder cage group. Overall the study shows better radiological outcome of carbon box-design cages in comparison to cylinder design cages with no influence on clinical effect.