[National Register of Joint Replacement Reflecting the Treatment of Developmental Dysplasia of the Hip in Newborns]. / Národní registr endoprotéz kycelního kloubu jako zrcadlo lécby vývojové dysplazie kycle u novorozencu.

PURPOSE OF THE STUDY In the Czech Republic a systematic neonatal hip screening has been performed for many decades. Its aim is to prevent, by means of early treatment of hip dysplasia in the newborn period, the development of hip deformities leading to the onset of degenerative hip changes during the adulthood. The study aims to prove the effects of paediatric hip care based on the data analysis of the Czech National Register of Joint Replacement. MATERIAL AND METHODS The National Register of Joint Replacement comprises information on implantation of hip arthroplasties performed over the period of last 15 years, while the screening has been carried out for almost 60 years. An analysis of the patients' data from the register was conducted; the data was sorted by the diagnosis leading to surgery in individual age categories and individual years. The obtained data was correlated with the systems of newborn hip screening at the time when the treated generations of patients were born. RESULTS According to the National Register of Joint Replacement, in the period 2003-2017 a total of 174,515 primary hip joint replacements were performed, 345 total hip arthroplasties (0.19 %) were implanted for complete hip dislocation in dysplasia, 14,139 replacements (8.10%) were performed for postdysplastic hip degeneration. By comparing the periods 2005-2007 and 2015-2017 a decrease almost to a half of the number of implanted endoprostheses for hip dislocation was identified. Moreover, only 8 of 345 dislocated hips in the Register were managed by joint replacement in patients who were born during the systematic screening period. The percentage of endoprostheses implanted for postdysplastic degeneration decreased respectively; in 2005-2007 period 2,692 of 28,525 hip endoprotheses (9.44%) were implanted, whereas in 2015-2017 period 3,285 of 46,228 hips (7.11%) were operated on. This decline is statistically significant (p < 0.001, OR 1.34). DISCUSSION The efficiency and success rate of sonography resulted in Central Europe in such a rapid expansion of neonatal ultrasound hip screening that no comparative studies were carried out to confirm this concept (as is currently requested by evidencebased-medicine). This has later become the source of misunderstanding and subject to criticism primarily in the overseas literature. Those who focus on ultrasound screening feel that conducting prospective randomised studies on (non)treatment in ultrasound detected pathologies is ethically unacceptable today. When seeking another way of confirming the efficiency of universal screening, a detailed analysis of data from the hip joint replacement registry has proven successful. CONCLUSIONS A low number of arthroplasties implanted for hip dislocation in the Czech population is recorded in the National Register of Joint Replacement. This confirms the success of the existing system of neonatal hip screening; the results show that the treatment of hip dislocation in children is successful. The ongoing decline in the share of patients in the population treated by total hip replacement in postdysplastic degeneration has been confirmed. Data evolution will be subject to further research in the upcoming decades, with a positive effect of ultrasound monitoring of treatment to be foreseen. Key words: developmental dysplasia of the hip, screening, register of joint replacements.

[Infectious complications of surgically treated musculoskeletal injuries: review of risk factors and etiological agents in years 2000-2005]. / Infekcní komplikace operacní lécby poranení pohybového aparátu: prehled rizikových faktoru a eiologických agens za roky 2000-2005.

PURPOSE: Infection is considered one of the most serious complications of the surgical treatment of musculoskeletal injuries. The aim of the study was to evaluate known risk factors and etiological agents of infectious complications in patients surgically treated for musculoskeletal injuries within 6 years. METHODS: In a group of 5 234 patients followed in 2000-2005 the early or delayed infectious complication developed in 65 patients (26 women, 39 men, age 22-83 years). In every patient with infectious complication the important risk factors related to personal history, type of the injury, surgery and other treatment were recorded and microbiological culture results were collected. RESULTS: In 60 patients (92.3%) at least one of the following risk factors was registered: diabetes mellitus, age above 75 years, abuse of alcohol and drugs, distant infectious focus or severe skin disease at the time of surgery, polytrauma requiring long-termed stay in intensive care unit, extensive soft tissue injury associated with closed or opened fracture. In 27 patients (41.5%) grampositive cocci and in 17 patients (26.2%) gramnegative bacteria were isolated, in 12 patients (18.5%) mixed bacterial flora was identified and 9 patients (13.8%) had negative cultures. The most severe findings from microbiological view occurred in patients with extensive soft tissue injury associated with fracture, diabetes or long-termed stay in intensive care unit. CONCLUSION: The infectious complications after the surgical treatment of musculoskeletal injuries occurred predominantly in patients with risk factors. The extensive soft tissue injury associated with fracture, diabetes and long-termed stay of the polytrauma patient in intensive care unit were identified as the most frequent risk factors. The patients of these risk groups also presented with the most serious microbiological findings.

[Valgus Osteotomy in the Treatment of the Ischemic Necrosis of Femoral Head in Children: Part II - Clinical Evaluation of the Group.]. / Valgizující osteotomie pri lécení následku ischemické postdysplastické nekrózy hlavice kosti stehenní u detí- II. cást: klinické hodnocení souboru.

The authors present long-term results of the surgical treatment of ischemic necrosis of proximal femur resulting from the treatment of the developmental dysplasia. They used their own technique of intertrochanteric valgus osteotomy in 77 hip joints. The surgical technique was published in the first part of the work. It consists in valgus osteotomy which lengthens femoral neck and, consequently also the whole limb. At the same time a fusion of the physis of the greater trochanter was performed and the pathological antetorsion of the femoral neck corrected. Osteotomy was fixed with a special valgus angled blade plate. In cases where dysplastic acetabulum persists the authors supplement the operation with the shelf operation after Bosworth. All patients operated on for the ischemic necrosis of femoral head were originally treated conservatively. Of the operated on group of 77 hip joints, 69 hip joints were classified in type III after Bucholz-Ogden and 8 hip joints in type II (type II B after Thomas et al.). Valgus operation was performed in children at the age of 3 to 15 years. The patients were further followed up on average 15,4 years, the average age upon the termination of the follow-up was 24,7 years. Eight patients of the group underwent a revision surgery by the same technique for inadequate primary correction or for the loss of correction in the course of the further growth of the hip joint. In 4 patients the authors equalized the length of both limbs by shortening the contralateral femur, in 3 patients additional fusion of the physis of the greater trochanter was performed. In case of dysplastic acetabulum the shelf arthroplasty after Bosworth proved to be very suitable. On the basis of their experience and clinical results the authors recommend to perform the surgery at the age between 7 and 10 years as in earlier operations there may occur a loss of correction during the following period and in children operated on later the adaptation of the operated on hip joint decreases. A prerequisite of a good long-term result is a precise preoperative planning of the operation and its exact technical performance. Key words: developmental dysplasia of the hip joint, ischemic necrosis, valgus intertrochanteric osteotomy of femur.