Specific approach to total hip arthroplasty in patients with childhood hip disorders sequelae.

Hip arthroplasty in patients with a history of paediatric hip disorders presents a significant challenge for orthopaedic surgeons. These patients are typically younger and have greater functional demands. Therefore, achieving optimal biomechanical conditions is crucial, involving placement of the acetabulum at the ideal centre of rotation and securing a stable femoral component with good offset to preserve abductor muscle function and restore leg length.

Measurement of safe acetabular medial wall defect size in revision hip arthroplasty with a porous cup.

Introduction: The majority of acetabular revisions can be performed with an uncemented, porous acetabular component with or without bone grafting. These are contained acetabular defects, with an intact acetabular rim (Paprosky type I and II). As defects of the medial wall of the acetabulum are a challenge situation revision surgery, we performed this biomechanical study on a pig pelvis model with contained acetabular defects to determine the size of medial wall defect at which the acetabular cup will have sufficient primary stability.

Revision of Acetabular Component with a Debonded Porous Coating in an Elderly Patient.

Debonding of the porous coating from the acetabular component of a total hip endoprosthesis is a rare complication. Revision total hip arthroplasty for an unstable acetabular component with a debonded porous coating strongly fixed to the bone can be challenging, especially in elderly patients of poor overall health. In such patients, revision procedures should be as simple and safe as possible.

Influence of Fondaparinux Versus Nadroparin Calcium Thromboprophylaxis on Clinical Parameters Following Total Knee Arthroplasty.

Fondaparinux has been shown to be as effective as low molecular weight heparin in orthopedic surgery, with no cases of heparin induced thrombocytopenia proven until today. The main goal of this prospective randomized controlled trial was to define whether thromboprophylaxis in patients with primary osteoarthritis of the knee undergoing total knee arthroplasty (TKA) influences clinical parameters in the same manner in patients receiving fondaparinux as in those receiving nadroparin during the first 7 postoperative days. Sixty patients with primary knee osteoarthritis underwent unilateral TKA performed by the same surgeon and were randomized into two groups of 30 patients receiving either fondaparinux or nadroparin thromboprophylaxis.

[POSSIBILITIES AND LIMITATIONS OF SEXUAL ACTIVITY FOLLOWING TOTAL HIP REPLACEMENT].

Total hip replacement in patients with osteoarthritis significantly reduces pain and enhances the quality of life (QoL). Sexual activity is an important component of QoL about which doctors rarely discuss with patients even though it is a matter of concern to many patients. In fact, patients who have previously had impaired sexual function due to preoperative hip pain and/or stiffness find that after surgery their hips are pain free and have better motion.

USEFUL TECHNIQUE FOR ALLOGRAFT BONE HARVEST.

Although regarded as a gold standard, harvesting of autologous bone graft is associated with donor site morbidity and a number of complications. An alternative is allograft with limited availability as the main shortcoming. Femoral heads as allografts are now routinely obtained during total hip arthroplasty.

Elevated CRP level could herald less efficient autologous conditioned serum (ACS) treatment.

Autologous conditioned serum (ACS) is a biologically based local treatment aiming to influence the cytokine imbalance and is used in a variety of orthopedic diseases and conditions. The ACS contains elevated levels of various anti-inflammatory cytokines, such as IL-1 RA (receptor antagonist), IL-4 and IL-10 and several growth factors. It contains a combination of cytokines and growth factors, and their specific contribution to clinical effects have yet to be determined.

Ulnar Shortening Osteotomy After Distal Radius Fracture Malunion: Review of Literature.

Malunion of distal radius fracture is often complicated with shortening of the radius with disturbed radio- ulnar variance, frequently associated with lesions of triangular fibrocartilage complex and instability of the distal radioulnar joint. Positive ulnar variance may result in wrist pain located in ulnar part of the joint, limited ulnar deviation and forearm rotation with development of degenerative changes due to the overloading that occurs between the ulnar head and corresponding carpus. Ulnar shortening osteotomy (USO) is the standard procedure for correcting positive ulnar variance.

Halogravity traction in the preoperative treatment of scoliosis in twins with Marfan syndrome.

We report on the influence of the duration of halogravity traction for achieving curve correction in monozygotic twins with Marfan syndrome who underwent posterior spinal fusion. Review of the medical charts and standard radiograph analysis of twin girls treated at our department was performed. Halogravity traction with a four-pin skull construct was applied for 3 weeks in twin A and for 2 weeks in twin B with a maximum of 20% body weight used.

Dislocated trial femoral head during total hip arthroplasty: review of the literature and the new algorithm for treatment.

Dislocation of the trial femoral head is a rare and unpleasant event that can compromise the success of the total hip arthroplasty. A 62-year-old Caucasian woman with osteoarthritis was admitted to our Department and underwent an elective total hip arthroplasty. While performing the dislocation manoeuver the trial femoral head dissociated from the taper in the superior and anterior direction in the soft tissue and could not be retrieved immediately.

Antibiotics in frozen bone grafts can cause allergic reactions in recipient patients.

Antibiotic prophylaxis is a routine procedure during total hip arthroplasty (THA), and the vast majority of cadavers within the multitissue procurement receive one or more antibiotics. Upon harvesting, bone grafts are stored in the bone banks on the temperature as low as -80°C for up to 5 years. It is shown in the literature that the antibiotics remain active and viable in the bone grafts even after being exposed to extremely low temperatures in the prolonged periods.

Patient satisfaction after revision hip arthroplasty or resection hip arthroplasty due to periprosthetic infection.

In this retrospective study we have analysed 10-year period results of all type periprosthetic hip joint infection treatments at our Department. Data for 73 patients were analysed and functional status for 41 patients evaluated. A smaller proportion of patients (45%) with resection arthroplasty as the definitive solution were satisfied.

A simple new technique for the removal of fractured femoral stems: a case report.

Introduction: The removal of broken femoral stems has become a major issue in revision surgery, and is a technically difficult and time-consuming procedure.

Case Presentation: We present a case of a fracture of a cementless long femoral stem in a 65-year-old, white Caucasian man. The distal part was removed with a special longitudinal osteotomy through the anterior cortex extending distally for 10 cm.

Failure of bulk bone grafts after total hip arthroplasty for hip dysplasia.

Introduction: Bulk bone grafts are used in total hip arthroplasty (THA) when adequate acetabular cup coverage cannot be achieved. Data from literature show mainly good short-term and mid-term results with contradictory long-term results. The aim of this study was to investigate acetabular cup stability and graft integrity after dysplastic adult hip reconstruction with total hip endoprosthesis and bulk bone graft for acetabular deficiency.

Cefazolin should be administered maximum 30 min before incision in total knee arthroplasty when tourniquet is used.

Periprosthetic infection is regarded as one of the most feared complications following total knee arthroplasty, developing in 0.4-2% of patients. Staphylococcus aureus and Staphylococcus epidermidis are credited for more than half of all infections.

Treatment of postoperative pain after total hip arthroplasty: comparison between metamizol and paracetamol as adjunctive to opioid analgesics-prospective, double-blind, randomised study.

Introduction: Metamizole use has been limited because of its risk of agranulocytosis. However, more recent literature seems to support its safety. This prospective, randomised, double-blind study was conducted to compare the analgesic effects of intravenous metamizole or intravenous paracetamol in combination with morphine PCA during the first 24 h following total hip arthroplasty.

Pre-operative autologous blood donation versus no blood donation in total knee arthroplasty: a prospective randomised trial.

Purpose: During total knee arthroplasty (TKA) blood loss can be significant and in spite of all techniques for reducing blood loss there is still a significant possibility for blood transfusions. For blood loss management during TKA, pre-operative autologous blood donation (PABD) is still a standard of care. In this prospective randomised study we have evaluated the efficacy of PABD in patients undergoing TKA to answer the question whether there is any need for autologous blood donations during TKA and, if yes, for which group of patients.

Bifid median nerve in a patient with carpal tunnel syndrome--correlation of clinical, diagnostic and intraoperative findings: case report and review of the literature.

A young patient with symptoms of median nerve compression in carpal tunnel without known risk factors is presented. Ultrasonography and magnetic resonance imaging confirmed an anatomical variation of the median nerve in carpal tunnel, described in the literature as bifid median nerve. The knowledge of the existence ofbifid median nerve is important in planning surgical decompression of median nerve to avoid nerve injury or potential relapse if decompression of both branches has not been done.