Marcin Sibiński

An Isolated Medial Patellofemoral Ligament Reconstruction with Patellar Tendon Autograft

The aim of the study was to evaluate the results of the medial patellofemoral ligament reconstruction with a medial strip of patellar tendon autograft after a minimum 2-year followup. Ten patients (10 knees) were operated on by one surgeon, according to the modified technique, described by Camanho, without any bone plug at free graft end. The mean age of the patients was 27.2 years (ranging from 18 to 42 years). The mean follow-up period was 3 years and 7 months. All patients were reviewed prospectively. At the last follow-up visit, all the patients demonstrated a significant improvement in terms of patellofemoral joint stability, all aspects of the KOOS questionnaire, and Kujala et al.s score (59.7 points preoperatively and 84.4 points at the last followup). No patient revealed recurrent dislocation. The SF-36 score revealed a significant improvement in bodily pain, general health, physical role functioning, social role functioning, and physical functioning domains. The described MPFL reconstruction with the use of the medial 1/3rd of patella tendon is an effective procedure that gives satisfactorily patellofemoral joint functions, improves the quality of life, and provides much pain relief. It is relatively simple, surgically not extensive, and economically cost-effective procedure.

Secondary gleno-humeral joint dysplasia in children with persistent obstetric brachial plexus palsy

The study aimed to evaluate the degree of gleno-humeral joint deformation in children with persistent obstetric brachial plexus palsy and its effect on limb function. Computer tomography was performed in 24 children in the mean age of 6.1 years. There were eight boys and 16 girls. Gleno-scapular angle, congruency of gleno-humeral joint and joint deformity according to Waters at all. criteria were measured. The mean functional score according to the Mallet classification system was 12.3 points. The joint was stabile in nine, subluxed in seven and dislocated in nine cases. Gleno-scapular angle in affected joints was 23.3° and in non-affected 4.5°. The glenoid was statistically more retroverted in older children. With more severe posterior incongruence there was statistically greater limitation of passive external rotation, active internal rotation and a poorer functional result according to Mallet. Abnormalities were found also in the humeral head, being deformed and smaller compared to the non-affected side in all cases. Glenoid retroversion, posterior subluxation/dislocation of humeral head and smaller humeral head size are the abnormalities, most often identified in CT examinations. Shoulder function and in particular, passive, external rotation are closely associated with the degree of deformity of the glenoid, as well as with the extent of posterior humeral head dislocation.

Periprosthetic bone remodeling around short stem.

Total hip arthroplasty (THA) has become standard treatment for advanced degenerative changes of the hip. A few studies have reported promising clinical outcomes with the Metha stem fixated by metaphyseal anchoring. This study evaluated early bone remodeling around the Metha stem during 12 months of follow-up. The study population included 36 patients (18 women and 18 men) with a mean age of 50.4 years who underwent THA between 2009 and 2011 for advanced degenerative changes of the hip with the Metha stem. Patients were evaluated on the day of surgery, 10 days postoperatively, and then at 3, 6, and 12 months postoperatively. Evaluation included Harris Hip Score and dual-energy x-ray absorptiometry (DEXA) scanning in 7 Gruen zones. At 12 months postoperatively, Harris Hip Score increased significantly by 38 points. A significant change in bone mineral density (BMD) was found immediately after surgery; this change was most pronounced in Gruen zone 3 (+36%), followed by Gruen zones 2 and 5. The smallest postoperative BMD increase was observed in Gruen zone 7 (+3.66%). In contrast, at 3 months postoperatively, a trend toward decreased BMD was observed in all Gruen zones. At 6 months postoperatively, mean BMD decreased in all Gruen zones except for Gruen zone 6. At 12 months postoperatively, mean BMD increased in Gruen zones 2 through 6, with the highest value (30%) observed in Gruen zone 3; in Gruen zones 1 and 2, mean BMD decreased. Short-term assessment of periprosthetic bone remodeling after uncemented Metha stem implantation revealed different host-bone responses. Apparently, the Metha stem can reduce BMD loss in the proximal femur. DEXA is a precise method for assessing BMD changes around implanted Metha stem.

Morphological and Radiological Study of Ossified Superior Transverse Scapular Ligament as Potential Risk Factor of Suprascapular Nerve Entrapment

The suprascapular notch is covered superiorly by the superior transverse scapular ligament. This region is the most common place of suprascapular nerve entrapment formation. The study was performed on 812 specimens: 86 dry scapulae, 104 formalin-fixed cadaveric shoulders, and 622 computer topography scans of scapulae. In the cases with completely ossified superior transverse scapular ligament, the following measurements were performed: proximal and distal width of the bony bridge, middle transverse and vertical diameter of the suprascapular foramen, and area of the suprascapular foramen. An ossified superior transverse scapular ligament was observed more often in men and in the right scapula. The mean age of the subjects with a completely ossified superior transverse scapular ligament was found to be similar than in those without ossification. The ossified band-shaped type of superior transverse scapular ligament was more common than the fan-shaped type and reduced the space below the ligament to a significantly greater degree. The ossified band-shaped type should be taken into consideration as a potential risk factor in the formation of suprascapular nerve entrapment. It could explain the comparable frequency of neuropathy in various populations throughout the world despite the significant differences between them in occurrence of ossified superior transverse scapular ligament.

One-stage total knee arthroplasty with pre-existing fracture deformity: post-fracture total knee arthroplasty.

The aim of the study was to assess the results of treating knee osteoarthrosis with total knee arthroplasty (TKA) after previous tibia and/or femur fractures resulting in axial limb deformities. Thirty-six knees (34 patients) were operated on. At the most recent follow-up, 4.8 years after surgery, all but one patient demonstrated an improvement in both clinical and functional KSS. This male patient required revision after 2 years. Improved range of motion was generally noted, especially extension, however, two patients with both tibia and femur fractures had worse results. TKA is an effective method of treatment for patients with arthrosis after a previous femur or tibia fractures. When deformity is severe semi-constrained or constrained, implants with extensions may be necessary.

Quality of life and functional disability in skeletally mature patients with myelomeningocele-related spinal deformity.

The purpose of the study was to assess the quality of life, physical function, self-motivation, and self-perception of skeletally mature patients with spina bifida and scoliosis. This is a prospective study on 19 skeletally mature patients with a mean age of 21.4 years. Several questionnaires were used for the study: Activities Scale for Kids, Quality of Life in Spina Bifida Questionnaire, The Health Self-Determinism Index for Children, Harter’s Self-Perception Profile for Adolescents, and the Spina Bifida Spine Questionnaire. This study found no association between spinal deformity or other features related to spina bifida and self-perception, motivation, and overall physical function. More severe scoliosis affects quality of life and is related to the degree of pelvic obliquity and the age of the patients. Individuals with motor-level dysfunction below L3 had significantly better overall physical function compared with those with a higher level of lesions. This was the only factor found to affect physical function. Our findings suggest that most limitations in patients with spina bifida are not related to the degree of scoliosis but to other associated disabilities.

Lateral growth disturbances of the capital femoral epiphysis after nonoperative treatment of late developmental dislocation of the hip : Thirty-five cases followed to skeletal maturity

Abstract: The purpose of this study was to evaluate the effect of type 2 growth disturbances in the developing hip and compare it with other treated hips without evidence of growth arrest. Radiographic data of 117 children (155 hips) with late developmental dislocation of the hip treated by closed reduction at an average age of 14.9 months and followed to skeletal maturity were retrospectively reviewed. Depending on the presence of lateral growth disturbances, our patients were divided into 2 groups similar with regard to age and treatment methods. Lateral physeal arrest was evident at an average age of 8.9 years in 23% of these hips. Seventy-six percent of these hips with type 2 avascular necrosis were classified as Severin classes 1 and 2. One quarter of them had no deformity of femoral head, 8 had deformity of 2 mm or less, and 18 more than 2 mm. There was no statistical difference in satisfactory and unsatisfactory results or most parameters describing the acetabulum between the 2 groups. Lateral tilting of the proximal femoral epiphysis in most cases does not affect final radiologic results. It is a mild form of avascular necrosis and indications for secondary operative procedures are mostly related to natural history of the disease rather than to lateral physeal arrest.

The use of calcium carbonate beads containing gentamicin in the second stage septic revision of total knee arthroplasty reduces reinfection rate

BACKGROUND The aim of the study was to analyze effectiveness and safety of packing the medullary canal of the tibia and femur with Herafill (Heraeus Medical GmbH, Wehrheim, Germany), a void filler and antibiotic carrier, during second stage revision total knee arthroplasty (TKA) for periprosthetic joint infection (PJI). METHODS Two groups were formed of 28 consecutive patients during second stage revision TKA, comparable for gender and age. The study group received Herafill, while the control group did not. The average follow-up was 52 months (minimum 36 months). RESULTS No reinfections were observed in the study group, while five were seen in the control group. No other differences were observed between the study and control groups, including mean clinical KSS (Knee Society score) (67.4 and 68.4 points, respectively) and functional score (72.5 and 70.5 points respectively). No side effects related to the use of Herafill beads were noted. CONCLUSIONS Herafill packed into the tibial and femoral intramedullary canal during second stage of septic revision TKA is a reliable bone substitute, may reduce recurrence of infection and incorporates well with host bone. However, results after PJI treatment are less than optimal measured by KSSs as compared to patients who do not require revision.

Early results of revision acetabular cup using antiprotrusio reconstruction rings and allografts

Background: Hip arthroplasty is one of the most frequently performed orthopedic procedures with high scores of success while its most common complication is aseptic loosening of the acetabular component, which may result from host bone loss or even from pelvis discontinuity. The purpose of the study was to evaluate results in patients after revision acetabular arthroplasty with reconstruction rings and allografts. Materials and Methods: Retrospective data was collected from 69 revisions of acetabular components, performed in a group of 69 treated patients (the mean age 65.1 years). Before surgery, the patients had bone defects of type IIb (n = 5), IIc (n = 20), IIIa (n = 27) or IIIb (n = 17), according to Paprosky et al. Results: The mean followup period of the patients was 7.2 years (range 3-19 years). A Kaplan–Meier analysis showed that a 3- and 10 year survival rate was 92.8% and 84.8% respectively, using further revision for any reason of the acetabular device as an end point. Eight patients revealed implant related complications. Four patients presented with ring loosening, one with a loose acetabular polyethylene cup, two hips demonstrated recurrent dislocations and one patient was with deep infection. Regarding the remaining 61 patients without re-revision surgery, the mean Harris hip score improved from 30.5 to 73.8 points. Conclusion: A modified, antiprotrusion cage provides an acceptable survival rate and radiological results, but complications could still be expected. It seems that the observed massive bone loss with pelvic discontinuity and an insufficient fixation of the cage to the ischium may result in implant loosening. Stable fixation of the ischial ring flange with screws is an essential condition to expect a good outcome.

Cementless total hip arthroplasty with BiCONTACT stem - go od results at long term of follow -up.

BACKGROUND The aim of our study was an evaluation of long-term clinical and radiological results of arthroplasty with BiCONTACT stem. MATERIAL AND METHODS We qualified 115 patients (125 hips) to the retrospective analysis with a minimum 10-year follow-up period. The mean age of patients on the day of surgery varied was 50.7 years. The follow-up period lasted from 126 to 199 months (mean 14 years). RESULTS Harris hip score increased from 47.1 before operations to 85.3 at the last follow-up. Excellent results were recorded in 81 (64.8%) cases, good results in 23 (18.4%) and satisfactory results in 10 (8%) cases, while failure was noted in 11 cases. In 2 cases, aseptic stem loosening was identified, in 8 cup and in 2 cases both: cup and stem loosening. The BiCONTACT stem survival, assessed with the Kaplan-Meier estimator was 97.6%, while that of the both: cup and stem amounted to 91.2%, having taken into account acetabulum or stem loosening as end-point, regardless of cause. CONCLUSIONS 1. In an average 14-year observations, application of a BiCONTACT stem gives good clinical results. 2. With no incidental complications and proper operative technique, the risk of aseptic loosening is really scarce.