L. Zhang, R. Alkentar, S. Manó, J. Szabó, T. Mankovits, Z. Csernátony
PURPOSE OF THE STUDY Different techniques have been reported to reconstruct the defi cient acetabulum during total hip arthroplasty (THA). The purpose of this study was to compare the biomechanical features of the bulk bone graft (BBG) technique (Harris acetabular plasty) and the Roof Step Cut (RSC) technique using fi nite element analysis. MATERIAL AND METHODS Based on a female patient's dysplastic hip CT scan, 3D models were assembled according to the two techniques. For the Harris technique, an irregular BBG was sculpted from a solid sphere, while for the RSC technique, the graft was sculpted into a step-cut shape with a similar size. Each graft was fi xed with two compression screws at two different angles (0° and 45°). Four fi nite element models were used to compare the von Mises stress distribution and total deformation of the grafts and the screws. The pressure and sliding distances of the contacts between the bone graft, metal cup and acetabular host bone were also analyzed. RESULTS For both of the bone grafts and the screws, compared to the Harris models, the maximum stress of the RSC models was signifi cantly lower (16.56 MPa, 25.50 MPa vs 97.13 MPa, 112.72 MPa) and the total deformation was signifi cantly smaller (0.0096 mm, 0.0089 mm vs 0.022 mm, 0.018 mm). 45° inserted screws generated higher stress at the end of the screws and on the outside of the bone graft. In case of 0° inserted screws, the maximum value was mainly located in the middle of the screws, inside the screw channel as well as at the contact area between the graft and the host bone. At all analyzed contacts, the RSC technique shows signifi cantly lower pressure and sliding distances, irrelevant to the screw's insertion angle. In comparison, the model of BBG with 45° screws showed a signifi cant sliding effect and higher contact pressure. CONCLUSIONS Compared with the BBG technique, the step-shaped graft of the RSC technique could signifi cantly reduce the maximum stress and deformation of the graft and the screws, and decrease the pressure and sliding distance between the bone graft, metal cup and the acetabular host bone. The angle of screw placement affects the location of stress and deformation. Key words: developmental dysplasia of the hip, total hip arthroplasty, acetabular reconstruction, bone graft, fi nite element analysis.
{"title":"Biomechanical Comparison of the Roof Step Cut Technique with the Bulk Bone Graft Technique During Total Hip Arthroplasty for Hip Dysplasia: a Finite Element Analysis.","authors":"L. Zhang, R. Alkentar, S. Manó, J. Szabó, T. Mankovits, Z. Csernátony","doi":"10.55095/achot2023/036","DOIUrl":"https://doi.org/10.55095/achot2023/036","url":null,"abstract":"PURPOSE OF THE STUDY Different techniques have been reported to reconstruct the defi cient acetabulum during total hip arthroplasty (THA). The purpose of this study was to compare the biomechanical features of the bulk bone graft (BBG) technique (Harris acetabular plasty) and the Roof Step Cut (RSC) technique using fi nite element analysis. MATERIAL AND METHODS Based on a female patient's dysplastic hip CT scan, 3D models were assembled according to the two techniques. For the Harris technique, an irregular BBG was sculpted from a solid sphere, while for the RSC technique, the graft was sculpted into a step-cut shape with a similar size. Each graft was fi xed with two compression screws at two different angles (0° and 45°). Four fi nite element models were used to compare the von Mises stress distribution and total deformation of the grafts and the screws. The pressure and sliding distances of the contacts between the bone graft, metal cup and acetabular host bone were also analyzed. RESULTS For both of the bone grafts and the screws, compared to the Harris models, the maximum stress of the RSC models was signifi cantly lower (16.56 MPa, 25.50 MPa vs 97.13 MPa, 112.72 MPa) and the total deformation was signifi cantly smaller (0.0096 mm, 0.0089 mm vs 0.022 mm, 0.018 mm). 45° inserted screws generated higher stress at the end of the screws and on the outside of the bone graft. In case of 0° inserted screws, the maximum value was mainly located in the middle of the screws, inside the screw channel as well as at the contact area between the graft and the host bone. At all analyzed contacts, the RSC technique shows signifi cantly lower pressure and sliding distances, irrelevant to the screw's insertion angle. In comparison, the model of BBG with 45° screws showed a signifi cant sliding effect and higher contact pressure. CONCLUSIONS Compared with the BBG technique, the step-shaped graft of the RSC technique could signifi cantly reduce the maximum stress and deformation of the graft and the screws, and decrease the pressure and sliding distance between the bone graft, metal cup and the acetabular host bone. The angle of screw placement affects the location of stress and deformation. Key words: developmental dysplasia of the hip, total hip arthroplasty, acetabular reconstruction, bone graft, fi nite element analysis.","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139279758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Vinter, P. Dráč, M. Dobiáš, M. Ošťádal, I. Čižmář, I. Olecká
PURPOSE OF THE STUDY The study aimed to propose an optimal based fl ap creation with the view to ensure long-term survival of the interposition arthroplasty. MATERIAL AND METHODS A total of 28 dorsal wrist capsules were collected from 16 cadavers (with age range at death 18 to 80 years, with no visible wrist pathology). Altogether 112 histological specimens were obtained from these 28 samples. Post-hoc Dunn's tests were used to analyse the percentage of vascularisation of individual sides of the dorsal capsule (circumference and area) at the 0.05 level of signifi cance. Spearmann's correlation analysis was used to assess the effect of age on vascularization of the dorsal wrist capsule. In cadavers in whom both capsules were collected, the limbs were compared. For the sake of comparison, the Wilcoxon matched pairs test was used. RESULTS Regarding statistical signifi cance, the largest share of the total circumference and area of the measured vessels of the dorsal capsule is constituted by the distal side (35.2% of the circumference and 30.9% of the area). The blood supply of the dorsal capsule received on the ulnar side is the lowest (12.9% of the circumference and 17.6% of the area). There was no signifi cant effect of age on vascularization of the dorsal wrist capsule confi rmed. Also, the comparison of vascularization of both limbs from a single cadaver did not yield any statistically signifi cant results. DISCUSSION Proximal row carpectomy is a long-established surgical technique used to manage the degenerative changes in the wrist. Our results showed the best vascularization on the distal and radial sides of the dorsal wrist capsule. In this light, the distally-based fl ap or the fl ap described by Berger, which respects the clinically important ligaments, appear to be the least invasive and help maintain the future stability of the wrist. CONCLUSIONS In clinical practice, we advise that a radially-based fl ap according to Berger is created and the distal side of the dorsal capsule, the most vascularized portion based on our results, is preserved as much as possible. The fl ap created in this manner also preserves the important carpal ligaments and appears to the authors of this study to be the most benefi cial, also with respect to the presence of the largest arteries, contrary to the distal side. Another option is to use a distally-based fl ap for interposition arthroplasty. Key words: interposition arthroplasty, proximal row carpectomy, vascularization, degenerative changes, wrist.
{"title":"[Technique Optimization of Interposition Arthroplasty During Proximal Row Carpectomy with Regard to the Vascularity of the Capsule in Carpal Joint: Cadaverous Study].","authors":"L. Vinter, P. Dráč, M. Dobiáš, M. Ošťádal, I. Čižmář, I. Olecká","doi":"10.55095/achot2023/040","DOIUrl":"https://doi.org/10.55095/achot2023/040","url":null,"abstract":"PURPOSE OF THE STUDY The study aimed to propose an optimal based fl ap creation with the view to ensure long-term survival of the interposition arthroplasty. MATERIAL AND METHODS A total of 28 dorsal wrist capsules were collected from 16 cadavers (with age range at death 18 to 80 years, with no visible wrist pathology). Altogether 112 histological specimens were obtained from these 28 samples. Post-hoc Dunn's tests were used to analyse the percentage of vascularisation of individual sides of the dorsal capsule (circumference and area) at the 0.05 level of signifi cance. Spearmann's correlation analysis was used to assess the effect of age on vascularization of the dorsal wrist capsule. In cadavers in whom both capsules were collected, the limbs were compared. For the sake of comparison, the Wilcoxon matched pairs test was used. RESULTS Regarding statistical signifi cance, the largest share of the total circumference and area of the measured vessels of the dorsal capsule is constituted by the distal side (35.2% of the circumference and 30.9% of the area). The blood supply of the dorsal capsule received on the ulnar side is the lowest (12.9% of the circumference and 17.6% of the area). There was no signifi cant effect of age on vascularization of the dorsal wrist capsule confi rmed. Also, the comparison of vascularization of both limbs from a single cadaver did not yield any statistically signifi cant results. DISCUSSION Proximal row carpectomy is a long-established surgical technique used to manage the degenerative changes in the wrist. Our results showed the best vascularization on the distal and radial sides of the dorsal wrist capsule. In this light, the distally-based fl ap or the fl ap described by Berger, which respects the clinically important ligaments, appear to be the least invasive and help maintain the future stability of the wrist. CONCLUSIONS In clinical practice, we advise that a radially-based fl ap according to Berger is created and the distal side of the dorsal capsule, the most vascularized portion based on our results, is preserved as much as possible. The fl ap created in this manner also preserves the important carpal ligaments and appears to the authors of this study to be the most benefi cial, also with respect to the presence of the largest arteries, contrary to the distal side. Another option is to use a distally-based fl ap for interposition arthroplasty. Key words: interposition arthroplasty, proximal row carpectomy, vascularization, degenerative changes, wrist.","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139279761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Wolf, D. Millenaar, P. Winter, F. Mahfoud, S. Landgraeber
PURPOSE OF THE STUDY A global bibliometric comparison of the level of scientific interest and output in the two research areas hip and knee arthroscopy (H-ASC and K-ASC) was carried out. In addition, the different degrees of publication activity in the countries and institutes performing this research were investigated. MATERIAL AND METHODS Publications from 1945-2020 listed in the Web of Science Core Collection were included in the study. Using the web application Science Performance Evaluation (SciPE), quantitative and qualitative aspects were evaluated. Subsequently, the date of publication, author information, and other metadata were analysed. RESULTS Since 1945, 3,924 studies have been published on K-ASC and 2,163 on H-ASC. The majority of the publications which have appeared since 2016 dealt with the topic of H-ASC (H-ASC: 241.2 publications/year; K-ASC: 217.4 publications/year). The USA published the most on both topics (H-ASC: 1,123 publications; K-ASC: 1,078 publications). More countries and institutes participated in K-ASC (3,008 institutes, 82 countries) than in H-ASC (103 institutes, 57 countries). The ten institutes with the most publications accounted for 36.71% and 12.34% of all publications on H-ASC and K-ASC, respectively. H-ASC received 78.12% of its funding from private sponsors while K-ASC was supported mainly by governmental/nonprofit sponsors (70.92%). CONCLUSIONS This study provides the first scientific comparison between H-ASC and K-ASC. Measured by qualitative and quantitative aspects, K-ASC was the most flourishing research area overall. In the last ten to five years, interest has shifted towards HASC with an increasing number of publications and a higher rate of citations. Key words: knee arthroscopy, hip arthroscopy, bibliometric comparison.
研究目的:对髋关节和膝关节镜(H-ASC和K-ASC)两个研究领域的科学兴趣水平和产出进行了全球文献计量学比较。此外，还调查了进行这项研究的国家和研究所的不同程度的出版活动。材料和方法本研究纳入了Web of Science核心馆藏中1945-2020年的出版物。利用web应用科学绩效评估(SciPE)，从定量和定性两个方面进行了评价。随后，对出版日期、作者信息和其他元数据进行分析。结果自1945年以来，共发表了3,924篇关于K-ASC的研究和2,163篇关于H-ASC的研究。自2016年以来出现的大多数出版物都涉及H-ASC的主题(H-ASC: 241.2出版物/年;K-ASC: 217.4出版物/年)。美国在这两个主题上发表的文章最多(H-ASC: 1123篇;K-ASC: 1,078出版物)。K-ASC(82个国家，3008个研究所)比H-ASC(57个国家，103个研究所)参加的国家和研究所更多。发表论文最多的10个研究所分别占H-ASC和K-ASC总发表论文的36.71%和12.34%。H-ASC的资金来自私人赞助商的78.12%，而K-ASC的资金主要来自政府/非营利赞助商(70.92%)。结论本研究首次对H-ASC和K-ASC进行了科学比较。从定性和定量两个方面来看，K-ASC是总体上研究最活跃的领域。在过去的十到五年中，随着出版物数量的增加和引用率的提高，人们的兴趣转向了HASC。关键词:膝关节镜，髋关节镜，文献计量学比较。
{"title":"Comprehensive Analysis of Scientific Output in Hip and Knee Arthroscopy.","authors":"M. Wolf, D. Millenaar, P. Winter, F. Mahfoud, S. Landgraeber","doi":"10.55095/achot2023/028","DOIUrl":"https://doi.org/10.55095/achot2023/028","url":null,"abstract":"PURPOSE OF THE STUDY A global bibliometric comparison of the level of scientific interest and output in the two research areas hip and knee arthroscopy (H-ASC and K-ASC) was carried out. In addition, the different degrees of publication activity in the countries and institutes performing this research were investigated. MATERIAL AND METHODS Publications from 1945-2020 listed in the Web of Science Core Collection were included in the study. Using the web application Science Performance Evaluation (SciPE), quantitative and qualitative aspects were evaluated. Subsequently, the date of publication, author information, and other metadata were analysed. RESULTS Since 1945, 3,924 studies have been published on K-ASC and 2,163 on H-ASC. The majority of the publications which have appeared since 2016 dealt with the topic of H-ASC (H-ASC: 241.2 publications/year; K-ASC: 217.4 publications/year). The USA published the most on both topics (H-ASC: 1,123 publications; K-ASC: 1,078 publications). More countries and institutes participated in K-ASC (3,008 institutes, 82 countries) than in H-ASC (103 institutes, 57 countries). The ten institutes with the most publications accounted for 36.71% and 12.34% of all publications on H-ASC and K-ASC, respectively. H-ASC received 78.12% of its funding from private sponsors while K-ASC was supported mainly by governmental/nonprofit sponsors (70.92%). CONCLUSIONS This study provides the first scientific comparison between H-ASC and K-ASC. Measured by qualitative and quantitative aspects, K-ASC was the most flourishing research area overall. In the last ten to five years, interest has shifted towards HASC with an increasing number of publications and a higher rate of citations. Key words: knee arthroscopy, hip arthroscopy, bibliometric comparison.","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44139076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PURPOSE OF THE STUDY The current study aimed to investigate the intra- and inter-observer reliability of the Ellman classification system in partialthickness rotator cuff tears through magnetic resonance imaging (MRI) scans instead of arthroscopic views. MATERIAL AND METHODS Pre-operative MRI scans of 45 patients, with confirmed partial-thickness rotator cuff rupture in previous arthroscopic surgeries (performed by the senior author), were obtained from Picture Archiving and Communication Systems records. The observers (n=8) were asked to categorize MRI scans according to Ellman's classification of location and grade. There were four orthopedic surgeons less experienced in rotator cuff operations in the first group and four more experienced orthopedic surgeons in the second group. They were asked to re-evaluate the MRI scans six weeks later, without access to their previous answers. Reliability evaluation was performed within and among the groups. It was also evaluated if the surgeon's experience increased the reliability of the classification. Fleiss kappa coefficient was used for the inter-observer reliability and Cohen kappa coefficient for the intra-observer reliability, and post hoc analysis was performed. RESULTS When all observers were examined in the inter-observer evaluation, it was seen that there was moderate agreement in the first location evaluation (κ=0.414); however, there was fair agreement in all other evaluations in both groups (κ=0.339- 0.383-0.337, respectively). When all observers were examined in the mean intra-observer evaluation, it was seen that there was substantial agreement in both evaluations (κ=0.795-0.721, respectively). DISCUSSION A classification system must be valid, reliable, and reproducible. It should establish a standard terminology for both surgeons and researchers. The correct identification of the tear configuration is crucial for selecting the correct repair technique. In our study, in which we evaluated the Ellman classification, which is frequently used in arthroscopic diagnosis, we investigated its intra-observer and inter-observer reliability on MRI scans. Although the mean intra-observer evaluation results were substantial agreement (κ=0.795-0.721, respectively), inter-observer evaluation results were fair agreement (κ=0.339- 0.383-0.337, respectively) except for the first location evaluation (κ=0.414). CONCLUSIONS Although intra-observer reliability was satisfactory, the Ellman system used in the classification of partial-thickness rotator cuff tears was not found to be useful by using only MRI views because of fair inter-observer reliability except for the first location evaluation, which was moderate agreement. Key words: partial, rotator cuff, tear, Ellman classification, reliability, validity.
{"title":"Reliability of Ellman Classification System in Partial Thickness Rotator Cuff Tears on Magnetic Resonance Views.","authors":"G. İlyas, O. Gokalp","doi":"10.55095/achot2023/031","DOIUrl":"https://doi.org/10.55095/achot2023/031","url":null,"abstract":"PURPOSE OF THE STUDY The current study aimed to investigate the intra- and inter-observer reliability of the Ellman classification system in partialthickness rotator cuff tears through magnetic resonance imaging (MRI) scans instead of arthroscopic views. MATERIAL AND METHODS Pre-operative MRI scans of 45 patients, with confirmed partial-thickness rotator cuff rupture in previous arthroscopic surgeries (performed by the senior author), were obtained from Picture Archiving and Communication Systems records. The observers (n=8) were asked to categorize MRI scans according to Ellman's classification of location and grade. There were four orthopedic surgeons less experienced in rotator cuff operations in the first group and four more experienced orthopedic surgeons in the second group. They were asked to re-evaluate the MRI scans six weeks later, without access to their previous answers. Reliability evaluation was performed within and among the groups. It was also evaluated if the surgeon's experience increased the reliability of the classification. Fleiss kappa coefficient was used for the inter-observer reliability and Cohen kappa coefficient for the intra-observer reliability, and post hoc analysis was performed. RESULTS When all observers were examined in the inter-observer evaluation, it was seen that there was moderate agreement in the first location evaluation (κ=0.414); however, there was fair agreement in all other evaluations in both groups (κ=0.339- 0.383-0.337, respectively). When all observers were examined in the mean intra-observer evaluation, it was seen that there was substantial agreement in both evaluations (κ=0.795-0.721, respectively). DISCUSSION A classification system must be valid, reliable, and reproducible. It should establish a standard terminology for both surgeons and researchers. The correct identification of the tear configuration is crucial for selecting the correct repair technique. In our study, in which we evaluated the Ellman classification, which is frequently used in arthroscopic diagnosis, we investigated its intra-observer and inter-observer reliability on MRI scans. Although the mean intra-observer evaluation results were substantial agreement (κ=0.795-0.721, respectively), inter-observer evaluation results were fair agreement (κ=0.339- 0.383-0.337, respectively) except for the first location evaluation (κ=0.414). CONCLUSIONS Although intra-observer reliability was satisfactory, the Ellman system used in the classification of partial-thickness rotator cuff tears was not found to be useful by using only MRI views because of fair inter-observer reliability except for the first location evaluation, which was moderate agreement. Key words: partial, rotator cuff, tear, Ellman classification, reliability, validity.","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42842398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PURPOSE OF THE STUDY Dislocation is one of the most common early complications of total hip arthroplasty (THA). In this manuscript, 20 years of experience with the management of this complication are presented, particularly in relation to the type of instability. MATERIAL AND METHODS In the period between January 1999 and December 2020, at least one dislocation occurred in 157 of 8 286 (1.9%) THA patients, of which 117 dislocations (1.6%) in primary and 40 (3.4%) in revision THAs. Almost all patients were operated on from the anterolateral approach during the follow-up period. The type of dislocation was evaluated using the modified Dorr classification. In the first dislocations, conservative approach was usually opted for, except for cases with a clear malposition, irreducible or unstable hips after the reduction. The minimum follow-up period was 18 months (18-240). The success rate of the chosen treatment approach was assessed by means of standard statistical methods. RESULTS The total dislocation rate in the follow-up period was 1.6% for primary THAs and 3.4% for revision THAs. The dislocation rate was slightly higher between 1999 and 2009 compared to the following decade (2.1% versus 1.3% for primary THAs; p=0.009). The most common type of dislocation was the positional dislocation (62%), followed by dislocations due to a combination of causes (17%) and component malposition (11%). Treatment of dislocation was successful in a total of 130 patients (130/157; 83%). Even though a stable hip was achieved in 21 patients (13%), the functional outcome was unsatisfactory, and in 6 patients (4%) we failed to achieve a stable hip. In the positional type of dislocation, the success rate of closed reduction following the first-time dislocation was 86.4% and a similar success rate was reported for reoperations in the first-time dislocations due to the malpositioned components (85.7%). In the second-time dislocation, the surgical therapy was significantly more reliable compared to closed reduction regardless of the type of dislocation (78.6% versus 46%). The treatment of dislocations following primary THAs showed comparable outcomes to those of the treatment of dislocations following revision THAs. Overall, the worst outcomes were achieved in patients with a combined type of dislocation. In total, the THA had to be removed in 11.5% of hips (18/157). The probability of final THA removal increased with the increasing order of dislocation. DISCUSSION In our group of patients, the dislocation rate in THA was comparable or lower than the published data. With the use of preventive measures, i.e. dual mobility cup or larger head diameters in high-risk patients, we managed to reduce the dislocation rate over time. The positional type of dislocation prevails in our group of patients just as in the previously published series, followed by instability from malposition of components. The modified Dorr classification is used to guide the treatment since it allows us no
{"title":"[How Does Affect the Type of Instability after Total Hip Arthroplasty the Outcomes? Our Experience between 1999 and 2020].","authors":"J. Spicka, J. Gallo, K. Langová","doi":"10.55095/achot2023/029","DOIUrl":"https://doi.org/10.55095/achot2023/029","url":null,"abstract":"PURPOSE OF THE STUDY Dislocation is one of the most common early complications of total hip arthroplasty (THA). In this manuscript, 20 years of experience with the management of this complication are presented, particularly in relation to the type of instability. MATERIAL AND METHODS In the period between January 1999 and December 2020, at least one dislocation occurred in 157 of 8 286 (1.9%) THA patients, of which 117 dislocations (1.6%) in primary and 40 (3.4%) in revision THAs. Almost all patients were operated on from the anterolateral approach during the follow-up period. The type of dislocation was evaluated using the modified Dorr classification. In the first dislocations, conservative approach was usually opted for, except for cases with a clear malposition, irreducible or unstable hips after the reduction. The minimum follow-up period was 18 months (18-240). The success rate of the chosen treatment approach was assessed by means of standard statistical methods. RESULTS The total dislocation rate in the follow-up period was 1.6% for primary THAs and 3.4% for revision THAs. The dislocation rate was slightly higher between 1999 and 2009 compared to the following decade (2.1% versus 1.3% for primary THAs; p=0.009). The most common type of dislocation was the positional dislocation (62%), followed by dislocations due to a combination of causes (17%) and component malposition (11%). Treatment of dislocation was successful in a total of 130 patients (130/157; 83%). Even though a stable hip was achieved in 21 patients (13%), the functional outcome was unsatisfactory, and in 6 patients (4%) we failed to achieve a stable hip. In the positional type of dislocation, the success rate of closed reduction following the first-time dislocation was 86.4% and a similar success rate was reported for reoperations in the first-time dislocations due to the malpositioned components (85.7%). In the second-time dislocation, the surgical therapy was significantly more reliable compared to closed reduction regardless of the type of dislocation (78.6% versus 46%). The treatment of dislocations following primary THAs showed comparable outcomes to those of the treatment of dislocations following revision THAs. Overall, the worst outcomes were achieved in patients with a combined type of dislocation. In total, the THA had to be removed in 11.5% of hips (18/157). The probability of final THA removal increased with the increasing order of dislocation. DISCUSSION In our group of patients, the dislocation rate in THA was comparable or lower than the published data. With the use of preventive measures, i.e. dual mobility cup or larger head diameters in high-risk patients, we managed to reduce the dislocation rate over time. The positional type of dislocation prevails in our group of patients just as in the previously published series, followed by instability from malposition of components. The modified Dorr classification is used to guide the treatment since it allows us no","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45453141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute traumatic intervertebral disc herniation of the thoracic spine is a rather rare injury with only a few reported cases to date. In this manuscript, we present a case of a 58-year-old male patient who sustained a car accident-related high-energy trauma, resulting in a disc herniation of the thoracic spine. Furthermore, we also discuss the possible implications of late diagnosis of such condition. The patient was initially referred from the Emergency Department as a case of head contusion with a left upper limb paresis. Due to only minimal bony trauma visible on the initial spine CT scan, the neurological deficit was attributed to the cranial trauma. The diagnosis of a traumatic disc herniation was therefore established only after the rapid onset of paraparesis, which gradually progressed into paraplegia, and a following spine MRI scan. Despite the subsequent urgent spinal decompression, the neurological functions of the lower limbs were not restored. This manuscript addresses the indications for performing MRI scans in polytrauma patients with a CT-verified spine trauma. Although it may be complicated to perform routine MRI scans in all such patients in daily practice, it can certainly help diagnose such injuries earlier and thus prevent potential permanent neurological damage to the patients. Key word: spine injury, traumatic disc herniation, thoracic spine, spine surgery.
{"title":"[Acute Traumatic Intervertebral Disc Herniation].","authors":"J. Soukup, J. Cerny, T. Novotný","doi":"10.55095/achot2023/034","DOIUrl":"https://doi.org/10.55095/achot2023/034","url":null,"abstract":"Acute traumatic intervertebral disc herniation of the thoracic spine is a rather rare injury with only a few reported cases to date. In this manuscript, we present a case of a 58-year-old male patient who sustained a car accident-related high-energy trauma, resulting in a disc herniation of the thoracic spine. Furthermore, we also discuss the possible implications of late diagnosis of such condition. The patient was initially referred from the Emergency Department as a case of head contusion with a left upper limb paresis. Due to only minimal bony trauma visible on the initial spine CT scan, the neurological deficit was attributed to the cranial trauma. The diagnosis of a traumatic disc herniation was therefore established only after the rapid onset of paraparesis, which gradually progressed into paraplegia, and a following spine MRI scan. Despite the subsequent urgent spinal decompression, the neurological functions of the lower limbs were not restored. This manuscript addresses the indications for performing MRI scans in polytrauma patients with a CT-verified spine trauma. Although it may be complicated to perform routine MRI scans in all such patients in daily practice, it can certainly help diagnose such injuries earlier and thus prevent potential permanent neurological damage to the patients. Key word: spine injury, traumatic disc herniation, thoracic spine, spine surgery.","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44383921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PURPOSE OF THE STUDY Articular cartilage injury is a common disease in daily life, with a high incidence. The aim of this study was to investigate the effect and mechanism of miRNA-140-3p in bone mesenchymal stem cells (BMSCs)-derived exosomes under hypoxia on inflammatory articular chondrocytes. MATERIAL AND METHODS To simulate the pathological status of arthritis, rat chondrocytes were used to establish the osteoarthritis (OA) model by IL-1β (10 μg/ml) as a modulating in vitro, and exosomes were isolated by differential ultra-high speed centrifugation. The cell counting kit-8, wound healing and flow cytometry assays were utilized to assess proliferation, migration and apoptosis of chondrocytes, respectively. Lipogenic and chondrogenic differentiation of chondrocytes were detected by oil red O staining and toluidine blue staining individually. The expressions of miR-140-3p and chondrocyte-specific gene mRNA were investigated using qRT-PCR. Western blot was applied to assess chondrocyte associated proteins and BMSC-Exo surface protein markers, and immunohistochemistry was adopted to detect the staining of collagen I and II. RESULTS Under scanning electronic microscope, the shape of exosomes was almost round. Exosome treatment prominently impaired the inhibition of chondrocytes' proliferative and migrative ability by IL-1β. It was found hypoxia had a more marked impact on proliferation, expression of collagen II and apoptosis in OA chondrocytes than normoxia, as well as a stronger effect on weakening adipose differentiation and enhancing chondrogenic differentiation in inflammatory chondrocytes. Furthermore, incubation with BMSC-Exo overexpressing miR-140-3p can remarkably increase the survival rate and migration in inflammatory chondrocytes. In addition, overexpression of miR-140-3p was found to enhance the chondrogenic differentiation of inflammatory chondrocytes. Furthermore, we found that the healing effect of exosomes on inflammatory chondrocytes under hypoxic conditions was produced by a rise in miR-140-3p expression within them and that hypoxia-mediated upregulation of miR-140-3p expression occurred through HIF-1α. CONCLUSIONS Under hypoxia, BMSC-Exo enhanced the chondrogenic phenotype, increased the viability of inflammatory chondrocytes. The overexpression of miR-140-3p in BMSC-Exo is beneficial to protect joints and delaying the pathogenesis in OA. Key words: HIF-1α, apoptosis, lipogenic differentiation, chondrogenic differentiation.
{"title":"The Anti-Inflammatory Effect of miR-140-3p in BMSCs-Exosomes on Osteoarthritis.","authors":"Y. Hu, H. X. Liu, D. Xu, X. Xue, X. Xu","doi":"10.55095/achot2023/032","DOIUrl":"https://doi.org/10.55095/achot2023/032","url":null,"abstract":"PURPOSE OF THE STUDY Articular cartilage injury is a common disease in daily life, with a high incidence. The aim of this study was to investigate the effect and mechanism of miRNA-140-3p in bone mesenchymal stem cells (BMSCs)-derived exosomes under hypoxia on inflammatory articular chondrocytes. MATERIAL AND METHODS To simulate the pathological status of arthritis, rat chondrocytes were used to establish the osteoarthritis (OA) model by IL-1β (10 μg/ml) as a modulating in vitro, and exosomes were isolated by differential ultra-high speed centrifugation. The cell counting kit-8, wound healing and flow cytometry assays were utilized to assess proliferation, migration and apoptosis of chondrocytes, respectively. Lipogenic and chondrogenic differentiation of chondrocytes were detected by oil red O staining and toluidine blue staining individually. The expressions of miR-140-3p and chondrocyte-specific gene mRNA were investigated using qRT-PCR. Western blot was applied to assess chondrocyte associated proteins and BMSC-Exo surface protein markers, and immunohistochemistry was adopted to detect the staining of collagen I and II. RESULTS Under scanning electronic microscope, the shape of exosomes was almost round. Exosome treatment prominently impaired the inhibition of chondrocytes' proliferative and migrative ability by IL-1β. It was found hypoxia had a more marked impact on proliferation, expression of collagen II and apoptosis in OA chondrocytes than normoxia, as well as a stronger effect on weakening adipose differentiation and enhancing chondrogenic differentiation in inflammatory chondrocytes. Furthermore, incubation with BMSC-Exo overexpressing miR-140-3p can remarkably increase the survival rate and migration in inflammatory chondrocytes. In addition, overexpression of miR-140-3p was found to enhance the chondrogenic differentiation of inflammatory chondrocytes. Furthermore, we found that the healing effect of exosomes on inflammatory chondrocytes under hypoxic conditions was produced by a rise in miR-140-3p expression within them and that hypoxia-mediated upregulation of miR-140-3p expression occurred through HIF-1α. CONCLUSIONS Under hypoxia, BMSC-Exo enhanced the chondrogenic phenotype, increased the viability of inflammatory chondrocytes. The overexpression of miR-140-3p in BMSC-Exo is beneficial to protect joints and delaying the pathogenesis in OA. Key words: HIF-1α, apoptosis, lipogenic differentiation, chondrogenic differentiation.","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42915470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The spleen is one of the most commonly injured organ in blunt traumas to the chest and abdomen. Splenic injury can be a serious complication of fracture of the left 9th to 11th rib. The authors present a case report of a 65-year-old male patient with a blunt trauma to the left chest and abdomen, diagnosed with multiple left rib fractures, left hemothorax and splenic injury with a small subcapsular hematoma with no signs of active splenic bleeding. Due to hemodynamic instability and a large volume of blood loss via the chest drain, the patient was indicated for emergency left thoracotomy. A perforation in the lower lobe of the left lung caused by rib fractures was found, which was treated with sutures. Furthermore, the diaphragm was examined, two ruptures were identified from which blood was coming out, and thus a phrenotomy was performed. The bleeding central splenic rupture came as a big surprise. A spleen preserving surgery was impossible, therefore a splenectomy had to be performed, followed by chest wall stabilization with splints. Transthoracic approach to manage the splenic injury through phrenotomy should not be used as a standard. In a selected group of patients with concomitant chest and upper abdominal organ injuries, the use of this surgical approach appears to be highly beneficial. Key words: splenic injury, splenectomy, thoracotomy, rib fractures, diaphragmatic rupture.
{"title":"[Splenectomy via the Transdiaphragmatic Approach].","authors":"J. Chudáček, D. Klos, M. Gregořík","doi":"10.55095/achot2023/035","DOIUrl":"https://doi.org/10.55095/achot2023/035","url":null,"abstract":"The spleen is one of the most commonly injured organ in blunt traumas to the chest and abdomen. Splenic injury can be a serious complication of fracture of the left 9th to 11th rib. The authors present a case report of a 65-year-old male patient with a blunt trauma to the left chest and abdomen, diagnosed with multiple left rib fractures, left hemothorax and splenic injury with a small subcapsular hematoma with no signs of active splenic bleeding. Due to hemodynamic instability and a large volume of blood loss via the chest drain, the patient was indicated for emergency left thoracotomy. A perforation in the lower lobe of the left lung caused by rib fractures was found, which was treated with sutures. Furthermore, the diaphragm was examined, two ruptures were identified from which blood was coming out, and thus a phrenotomy was performed. The bleeding central splenic rupture came as a big surprise. A spleen preserving surgery was impossible, therefore a splenectomy had to be performed, followed by chest wall stabilization with splints. Transthoracic approach to manage the splenic injury through phrenotomy should not be used as a standard. In a selected group of patients with concomitant chest and upper abdominal organ injuries, the use of this surgical approach appears to be highly beneficial. Key words: splenic injury, splenectomy, thoracotomy, rib fractures, diaphragmatic rupture.","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47685669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Popelka, V. Barták, M. Mazura, J. Klouda, I. Landor, R. Hromádka
PURPOSE OF THE STUDY Total arthroplasty of the first metatarsophalangeal joint is one of the surgical treatment options for patients with advanced hallux rigidus. This study evaluates the pressure changes in the propulsion phase of the gait cycle using dynamic pedobarography after the total arthroplasty of the first metatarsophalangeal joint by Medin PH-Flex and their comparison with the control groups of patients with hallux rigidus and with asymptomatic patients. MATERIAL AND METHODS Dynamic pedobarograph was used to evaluate 15 first MTP joint replacements by Medin PH-Flex implants in 12 female patients, the average time since joint replacement was 3.5 years (1.5 to 5.5 years). The control group consisted of 13 forefeet in 12 patients with hallux rigidus of Grade 3 and Grade 4 according to the Coughlin classification and 17 healthy patients with no clear foot deformity, i.e. of a total of 34 forefeet. A zone for each metatarsal (M1-M5) and the big toe area (T1) were defined with the use of an integrated software. The difference between the pressure under the big toe area and the first metatarsal bone - hallux stiffness (T1-M1) and the forefoot balance parameter, i.e. the difference between the pressures under the medial and lateral half of the forefoot ((M1+M2)-(M3+M4+M5)), was obtained. The parameters were evaluated for each group during the propulsion phase of the gait, i.e. from 55% to 100% of the stance phase and from 75% to 100% of the stance phase, i.e. that part of propulsion when the greatest pressure is exerted on the big toe. RESULTS For the HS parameter (T1-M1) in 55% to 100% of the stance phase, the median value was -0.66 ± 1.22 (-1.90 to 1.45) in the control group, -0.85 ± 1.94 (-1.40 to 3.80) in patients with hallux rigidus, and -0.10 ± 1.48 (-1.30 to 2.40) in patients after the first MTP joint replacement. The median forefoot balance parameter from 55% of the stance phase was -3.48 ± 2.45 (-6.90 to 0.68) in healthy patients and -4.43 ± 2.72 (-6.98 to 0.23) in hallux rigidus patients. In patients after the joint replacement, the value was -3.00 ± 2.46 (-6.20 to 0.40). The data were statistically analysed by the Dunnett's and Tukey's multiple comparison tests. The hallux stiffness parameter showed a significant improvement after the joint replacement compared to patients with hallux rigidus (p<0.0001). No statistical significance was confirmed when comparing the joint replacement cases and the healthy patients from the control group (p=0.0007 and p=0.0010, respectively). As concerns the forefoot balance parameter, a significant difference was reported in patients with joint replacement compared to healthy patients from the control group and patients with hallux rigidus (p <0.0001). DISCUSSION The published pedobarographic studies differ in terms of the methodology used, the patient population and the parameters examined. The pedobarographic studies after the replacement of the first MTP joint or after its arthrodesis present incon
{"title":"[Total Replacement of the First Metatarsophalangeal Joint by Medin PH-Flex and Its Effect on Forefoot Biomechanics in the Propulsion Phase of the Gait Cycle].","authors":"S. Popelka, V. Barták, M. Mazura, J. Klouda, I. Landor, R. Hromádka","doi":"10.55095/achot2023/030","DOIUrl":"https://doi.org/10.55095/achot2023/030","url":null,"abstract":"PURPOSE OF THE STUDY Total arthroplasty of the first metatarsophalangeal joint is one of the surgical treatment options for patients with advanced hallux rigidus. This study evaluates the pressure changes in the propulsion phase of the gait cycle using dynamic pedobarography after the total arthroplasty of the first metatarsophalangeal joint by Medin PH-Flex and their comparison with the control groups of patients with hallux rigidus and with asymptomatic patients. MATERIAL AND METHODS Dynamic pedobarograph was used to evaluate 15 first MTP joint replacements by Medin PH-Flex implants in 12 female patients, the average time since joint replacement was 3.5 years (1.5 to 5.5 years). The control group consisted of 13 forefeet in 12 patients with hallux rigidus of Grade 3 and Grade 4 according to the Coughlin classification and 17 healthy patients with no clear foot deformity, i.e. of a total of 34 forefeet. A zone for each metatarsal (M1-M5) and the big toe area (T1) were defined with the use of an integrated software. The difference between the pressure under the big toe area and the first metatarsal bone - hallux stiffness (T1-M1) and the forefoot balance parameter, i.e. the difference between the pressures under the medial and lateral half of the forefoot ((M1+M2)-(M3+M4+M5)), was obtained. The parameters were evaluated for each group during the propulsion phase of the gait, i.e. from 55% to 100% of the stance phase and from 75% to 100% of the stance phase, i.e. that part of propulsion when the greatest pressure is exerted on the big toe. RESULTS For the HS parameter (T1-M1) in 55% to 100% of the stance phase, the median value was -0.66 ± 1.22 (-1.90 to 1.45) in the control group, -0.85 ± 1.94 (-1.40 to 3.80) in patients with hallux rigidus, and -0.10 ± 1.48 (-1.30 to 2.40) in patients after the first MTP joint replacement. The median forefoot balance parameter from 55% of the stance phase was -3.48 ± 2.45 (-6.90 to 0.68) in healthy patients and -4.43 ± 2.72 (-6.98 to 0.23) in hallux rigidus patients. In patients after the joint replacement, the value was -3.00 ± 2.46 (-6.20 to 0.40). The data were statistically analysed by the Dunnett's and Tukey's multiple comparison tests. The hallux stiffness parameter showed a significant improvement after the joint replacement compared to patients with hallux rigidus (p<0.0001). No statistical significance was confirmed when comparing the joint replacement cases and the healthy patients from the control group (p=0.0007 and p=0.0010, respectively). As concerns the forefoot balance parameter, a significant difference was reported in patients with joint replacement compared to healthy patients from the control group and patients with hallux rigidus (p <0.0001). DISCUSSION The published pedobarographic studies differ in terms of the methodology used, the patient population and the parameters examined. The pedobarographic studies after the replacement of the first MTP joint or after its arthrodesis present incon","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42085697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PURPOSE OF THE STUDY Rhizarthrosis, a degenerative condition of the carpometacarpal joint of the thumb, affects mainly women. Surgical treatment is indicated once the non-operative treatment fails. Thumb carpometacarpal joint total arthroplasty constitutes one of the surgical treatment options. This study aims to evaluate the short-term functional and radiological outcomes of Touch® prosthesis with a minimum follow-up period, namely two years after surgery. MATERIAL AND METHODS The study presents the outcomes of a group of 56 endoprostheses implanted in 48 patients. The dual mobility Touch® prosthesis is evaluated. The group consisted of 41 women and 7 men, with the median age of the patients being 62 years. The patients were indicated for surgery after the non-operative treatment had failed. All of them suffered from stage II - IV osteoarthritis according to the Eaton-Littler classification. The range of motion - the opposition was assessed using the Kapandji score. The function and the pain were evaluated with the DASH questionnaire preoperatively and at 3 months, 6 months, 1 year and 2 years postoperatively. RESULTS After 24 months, 91.1% (51 patients) were satisfied with the surgical outcome. Altogether 8.9% of patients (5 patients) experienced postoperative exercise-induced pain, limitation of movement of the CMC joint or hand weakness. No dislocation or endoprosthetic loosening occurred in the evaluated group. Primary wound healing was reported in all patients and no superficial or deep infection was observed. The mean DASH score was 65.3 points preoperatively; at the 2-year follow-up, the mean score decreased to 10.8 points. The pain assessed in question 24 of the DASH questionnaire decreased from the mean value of 4.45 points to 1.2 points. After two years, the range of motion of all patients was X/X according to Kapandji. DISCUSSION There are plenty of surgical techniques to manage rhizarthrosis. All types of surgery have their pros and cons. Most endoprostheses used nowadays show good short-term, mid-term, and some of them even long-term outcomes in terms of survival. The Touch® prosthesis, characterized by dual mobility, is the 3rd generation thumb CMC prosthesis and in our study achives comparable short-term outcomes to those reported by international literature. The use of the dual mobility design appears to be effective in reducing the dislocation rate. CONCLUSIONS The Touch® thumb CMC prosthesis achieves very good short-term functional and radiological outcomes. We can recommend the prosthesis provided the patients are followed-up for more than two years after surgery. Key words: rhizarthrosis, osteoarthritis, endoprosthesis of the carpometacarpal joint, dual mobility, Touch®.
{"title":"[Short-term Outcomes of Touch® Prosthesis for Thumb Carpometacarpal Joint].","authors":"D. Filus, R. Pavličný","doi":"10.55095/achot2023/033","DOIUrl":"https://doi.org/10.55095/achot2023/033","url":null,"abstract":"PURPOSE OF THE STUDY Rhizarthrosis, a degenerative condition of the carpometacarpal joint of the thumb, affects mainly women. Surgical treatment is indicated once the non-operative treatment fails. Thumb carpometacarpal joint total arthroplasty constitutes one of the surgical treatment options. This study aims to evaluate the short-term functional and radiological outcomes of Touch® prosthesis with a minimum follow-up period, namely two years after surgery. MATERIAL AND METHODS The study presents the outcomes of a group of 56 endoprostheses implanted in 48 patients. The dual mobility Touch® prosthesis is evaluated. The group consisted of 41 women and 7 men, with the median age of the patients being 62 years. The patients were indicated for surgery after the non-operative treatment had failed. All of them suffered from stage II - IV osteoarthritis according to the Eaton-Littler classification. The range of motion - the opposition was assessed using the Kapandji score. The function and the pain were evaluated with the DASH questionnaire preoperatively and at 3 months, 6 months, 1 year and 2 years postoperatively. RESULTS After 24 months, 91.1% (51 patients) were satisfied with the surgical outcome. Altogether 8.9% of patients (5 patients) experienced postoperative exercise-induced pain, limitation of movement of the CMC joint or hand weakness. No dislocation or endoprosthetic loosening occurred in the evaluated group. Primary wound healing was reported in all patients and no superficial or deep infection was observed. The mean DASH score was 65.3 points preoperatively; at the 2-year follow-up, the mean score decreased to 10.8 points. The pain assessed in question 24 of the DASH questionnaire decreased from the mean value of 4.45 points to 1.2 points. After two years, the range of motion of all patients was X/X according to Kapandji. DISCUSSION There are plenty of surgical techniques to manage rhizarthrosis. All types of surgery have their pros and cons. Most endoprostheses used nowadays show good short-term, mid-term, and some of them even long-term outcomes in terms of survival. The Touch® prosthesis, characterized by dual mobility, is the 3rd generation thumb CMC prosthesis and in our study achives comparable short-term outcomes to those reported by international literature. The use of the dual mobility design appears to be effective in reducing the dislocation rate. CONCLUSIONS The Touch® thumb CMC prosthesis achieves very good short-term functional and radiological outcomes. We can recommend the prosthesis provided the patients are followed-up for more than two years after surgery. Key words: rhizarthrosis, osteoarthritis, endoprosthesis of the carpometacarpal joint, dual mobility, Touch®.","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49403787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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