Chirurgia narzadow ruchu i ortopedia polska最新文献

Background: Total hip replacement (THR) is at present an accepted treatment in patients with severe deformity of the hip and acetabular protrusion. The aim of this paper is to evaluate the results of THR in patients suffering from acetabular protrusion, operated from 1991 to 2006 in the Orthopaedic and Traumatologic Department of Poznan University of Medical Sciences.

Material: Material included 36 patients, 34 females and 2 males, on whom 51 THR were performed, lateral approach was used in all cases. At the time of operation, the age of patients ranged from 41 to 78 years (mean 63). Follow-up ranged from 4 to 19 years (mean 9.9 years). The operative treatment was a multistage process (during one operation only one joint was replaced). Cemented total hip arthroplasty was used during 28 of the THR, 22 of them were cementless and 1 as a hybrid.

Method: The patients were clinically and radiologically evaluated preoperatively, postoperatively, and at final examination. The clinical state was evaluated with Harris hip score and WOMAC scale. We based our radiological examination on Hip Society system.

Results: The average preoperative Harris score for the group of patients was 29, WOMAC score 77. After an average of 9 years follow-up all hips were considered excellent, with average Harris score of 90, WOMAC Score of 6. All patients had increased function and decreased pain. The radiograms of all patients revealed that the acetabular and femoral components were correctly positioned with no radiographic evidence of loosening in the last examination. The inclination angle of the acetabular component was 30-55 degrees (mean: 40 degrees) and the acetabular opening angle was 2-15 (mean: 4 degrees). The stem was valgus-oriented in 8 hips, varus-oriented in 13 hips and neutral-oriented in 30 hips. No ectopic ossification concentrations were found.

Conclusion: Clinical and radiological evaluation of our material showed that total hip replacement in the treatment of severe deformity of the hip caused by osteoarthritis with acetabular protrusion allows regaining good lower limb function, which helps the patients staying less dependant on the surrounding environment. The results of THR are good regardless of the type of prosthesis and the type of fixation. Ectopic ossification is not the clinical problem during THR in patients who suffer from acetabular protrusion. We found a significant acetabular remodeling with the decreasing of the protrusion after THR.

The aim of the study was to analyze results in patients treated with frozen, bulky femoral head allografts without reinforcement ring for significant bone lost after acetabular component aseptic loosening. Retrospective analysis was done on 19 patients in the average age of 58 years. There were 13 women in this group. Acetabular bone lost was classified as IIIa or IIIb according to Paprosky. For revision 10 cemented and 9 uncemented cups were used. Mean coverage of acetabular component by graft on antero-posterior radiographs was 52% (from 30% to 100%). The mean follow-up was 4.2 years. Seven of our patients required another revision for aseptic loosening of the cup. The remaining 12 patients had satisfactory clinical and radiological result. The function improved from 35 points before operation to 76 at last follow-up according to Harris grading system (minimum improvement was 20 points). Two of the patients had radiographic signs of osteolysis around implant, without symptoms of loosening. Coverage of acetabular cup by the graft was 65% in cases of loosening and 42% in those patient without loosening (p <0.01). There was no statistical relationship between age and frequency of loosening (p > 0.05). Bulky, femoral head allografts are passive scaffold and may lose the mechanical strength. In cases of big bone defects of supero-lateral part of acetabulum use of metal reinforcement rings should be considered.

The purpose of the study was to analyze the value of clinical and radiological measurements of femoral anteversion. There were 49 patients (39 girls, 10 boys) with the mean age of 9.1 years (range from 4 to 15 years) at last follow-up. Among 98 analyzed hips 59 had IIb hip dysplasia according to Graf at childhood. Clinically femoral anteversion angle was measured using the trochanteric prominence angle test. On radiographs femoral anteversion angle was measured according to Strzyzewski method. Femoral anteversion wasn't significantly increased in joints type IIb. The correlation of clinical and radiographic determination of femoral anteversion was good (r=71) and it is recommended for routine examination. Hip rotation in flexion (r=59) better correlated with radiographic anteversion than in extension (r=46) and their combination increased correlation (r=62). Clinical examination in hips flexed 90 degrees allows for better assessment of femoral anteversion than examination done in hip extension.

Ultrasonography has had relatively long history (approximately 20 years) in the diagnosing carpal tunnel syndrome, but as late as in last decade has gained greater popularity and has been applied in the clinic. Numerous studies revealed that the most accurate parameter indicating the compression of the median nerve in the carpal tunnel is the cross sectional area of the nerve at the inlet level. However, contrary to the nerve conduction studies, sonographic measurements are characterised by wide range of normal, physiological (a mean of 4.8 to 9.7 mm2), pathological, indicating compression of the nerve values (a mean of 10.7 to 16.8 mm2) and cut-off coefficients between normal state and pathology (a mean of 6.5 to 14 mm2). Sensitivity and specificity of the method, calculated for different cut-off values is estimated of 60-90%, hence, is around 10% lower than the same parameters of electrophysiological tests. Difficulties in standardisation of cross-sectional nerve area (considered a classical parameter) motivated investigators to searching other indicators of the nerve compression, e.g. "wrist-forearm" ratio, which is a quotient of the cross sectional area of the median nerve at the carpal tunnel inlet and 12-15 proximally at the forearm level. Some studies showed greater accuracy of this ratio, allowing to obtain the sensitivity and specificity of more than 95%. After review of the studies, authors critically conclude that actual state of art does not justify considering ultrasonography a valuable additional test in diagnosing carpal tunnel syndrome and for routine use this technique in typical cases. Ultrasonography may be useful in patients with doubtful clinical picture, as a screening test, as well as in suspicion of intra-tunnel pathology. However, in atypical clinical situation, nerve conduction studies provide significantly more information on the function of the median nerve, presence of more than one compression sites or other pathology.

The study defines the idea behind the research project which analyzes the swing-through gait from the biomechanical and kinesiological perspective. In the preliminary phase, the authors performed a synthetic analysis of the state of knowledge, created a description of the general kinematic structure of the swing-through gait as a form of locomotion with the use of crutches, proposed definitions. The problem was described with the use of time characteristics of vertical and horizontal anterior-posterior as well as lateral components of ground reaction forces, measured from under the supporting limb and the crutches. Presenting the idea behind the research project, the authors defined in detail the purpose of the study, the assumptions, research methodology--including a description of methods used and the measurement channels which consisted of: 2 AMTI force platforms integrated into a measurement walkway, a set of 6 optoelectronic cameras of the BTS System as well as a multichannel kinesiologic electromyography performed with the use of the NORAXON System. All phases of the research were characterized, presenting the research protocol in its entirety. The research will be conducted in the Laboratory of the Department of Biomechanics of USPS in Poznan, which possesses the ISO 9001:2008 quality management system certificate.

Introduction: Back pain caused by metastases and infections are rare and are called "red flags". The aim of this study conducted for physiotherapy needs was to answer questions asked during taking a subjective examination among patients with serious spine pathology.

Material and methods: Examinations conducted according to McKenzie method were compared. 17 patients were evaluated. In I group were 7 persons with metastasis, in II group 10 patients with infection of the spine.

Results: Results were statistically evaluated by Chi-square test. Exact Fisher test for small groups was used. The most characteristic for patients with metastasis were: constant pain, increasing of pain during movement, decreasing during lying, and poor health and weight loosing. For infection typical signs was fever accompanying pain.

Conclusions: (1) Clinical examination plays key role in diagnostic. (2) Own surveys confirmed that McKenzie subjective examination enables physiotherapists to avoid traps in diagnosis of red flags. (3) Constant pain, weight loosening are characteristic for metastasis, and for infection constant pain and fever.

Arthritis of the thumb carpometacarpal joint is a fairly common disorder of unclear etiology, affecting mostly women in the postmenopausal age. The results of the operative treatment of 21 patients, 20 women and 1 men in a mean age of 59 years with the disorder classified in 3rd and 4th grade in Eaton-Littler scale are presented. Operation consisted in resection of the trapezium followed by thumb metacarpal suspension arthroplasty with flexor carpi radialis tendon, using a slip of the palmaris longus tendon. At a mean follow-up of 14 months, patients achieved significant reduction of the pain at the movement of the thumb (VAS from a mean of 8.1 to 2.9), improvement in thumb's opposition (Kapandji test from 7.6 to 9.5), power of the hand increased form 42 to the 68% of the other side and function of the hand in DASH score improved form 58 to 12 points. Pinch strength did not improved after surgery. The results show effectiveness of the modified technique in the treatment of thumb carpometacarpal arthritis.

In our article we introduce a proposal of intercondylar tibial eminence fracture in children management. When dealing with II and III type fracture according to Mes and McKeever classification, we would like to suggest artroscopic fracture fixation with the help of a tension band wiring technique using single bundle reconstruction set of anterior cruciate ligament.The method mentioned above was presented on two cases managed in our ward. Stable fixation of this type fracture allows for quick mobilization and physiotherapy of a patient. It appears to be the key element to full recovery in articular surface fracture.

Background: Bone deficiency can present a surgical challenge during revision total hip and knee arthroplasty. The amount of bone grafts available for surgical purposes is insufficient. Synthetic bone substitutes can eliminate the risk of infection transmission. The purpose of the present study was to evaluate the clinical and radiographic outcomes of revision hip and knee arthroplasty with use of an impaction bone-grafting with HA+beta-TCP in reconstruction of bone defects.

Materials and methods: 20 total hip revision (THR) and 10 total knee revision (TKR) were performed in 30 patients where impaction bone-grafting technique with HA+beta-TCP was used. Clinical, radiographic and CT results were assessed. Mean follow-up was 21 (11-48) months for THR and 22 (10-46) months.

Results: Loosening was seen in 2 cups. In one case the reoperation was performed. In the second due to massive bone loss the prosthesis was removed. No another acetabular and stem components required revision surgery. There were no knee implant migration or loosening observed. The mean total HSS score was 45.3 preoperatively and 71.5 postoperatively. The mean CRS score was 35.7 preoperatively and 73.4 postoperatively.

Conclusions: The use of HA+beta-TCP with bone grafts impaction is a good method of bone defect reconstruction and can provide good short-term clinical results in revision hip and knee arthroplasty.

Objectives: To asses a survival-time of the cemented hip prostheses and to find factors causing its loosening.

Materials and methods: 211 patients (282 hip prostheses) were analyzed, of the 1693 patients (2096 hip prostheses) treated between 1970-2000. The follow-up ranged from 7 to 34 years (mean: 12.2 ++/- 5.4 years). The age of the patients at the operation procedure ranged from 25 to 74 years (mean 52 +/- 12 years). Only aseptic prosthesis loosening were considered and Kaplan-Meyer method was used for the prosthesis survivorship assessment.

Results: Of the 282 prostheses, implant exchange was performed in 39 cases, where in 15 cases only cup was revised, in 5 cases the stem exclusively, and in 19 patients the whole implant was exchanged. Only 1.1% of implants were exchanged during first 5 years after surgery but from the 6th year the percentage of loosening increased several percents each year. Respectively 88.6, 70 and 65% survivorship of prosthesis was found after 10, 15, 20 years of follow-up. In the group of bilateral prosthesis implantation, the first implanted prosthesis was more susceptible for loosening. Seven cases of aseptic loosening (5.4%) of the 129 prostheses implanted between 1974 and 1995, occurred within 7 years after initial surgery where only one prosthesis (0.7%) was revised of the 152 implanted between 1996-2000 in the same time of follow-up. The age, growth, weight, BMI and sex did not influence the risk of implant loosening.

Conclusion: The mean survivorship of the hip prosthesis is 65% in 20- years follow up. When a proper initial fixation of the cemented hip prosthesis is performed, the risk of implant loosening increases gradually especially from the 6th year after surgery. The modern implants are less susceptible for loosening.