Marek Drobniewski

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.

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.

Evaluation of Outcomes of Total Knee Replacement with and without a Navigation System

BACKGROUND The aim of this study was to compare the results of TKA performed with the use of a navigation system vs. conventional knee arthroplasty and to evaluate the effectiveness of navigation system support in TKA. MATERIAL AND METHODS We evaluated patients undergoing TKA for osteoarthritis in the years 2011-2013. Columbus prostheses were implanted in 84 knees. Group 1 included patients in whom TKA was performed with the use of the OrthoPilot Navigation System, and Group 2 was a control group of patientsundergoing conventional TKA. Group 1 ultimately comprised 30 patientsat a mean age of 71.8 years, while Group 2 consisted of 30 patients at a mean age of 73.5 years. Radiographic parameters were evaluated according to the mechanical axis of the leg. Clinical evaluation relied on the VAS and KSSscores. RESULTS Mean operation time was 94 minutes in Group 1.It was shorter in Group 2, with a mean of 75 minutes. Postoperative VAS scores did not differ betweenthe groups. Significant improvement was noted between pre- and postoperative in KSS scores in both groups. The control group showed more valgus mechanical axis deviation than varus deviation. CONCLUSIONS In experienced hands, navigated surgery time may be similar to that of conventional TKA and give superior results, both clinical and radiographic.

Fracture of the Femoral Stem as a Rare Complication of Total Hip Arthroplasty. Cases Report

The aim of this paper is to present the femoral stem fracture as a rare complication of total hip arthroplasty and describe further management in such cases. We present 5 cases of stem fracture in the Mittelmeier prosthe-sis which occurred from 8 to 29 years after the primary procedure. In three cases, the primary hip arthroplasty was performed due to dysplastic coxarthrosis. The remaining two patients had idiopathic and post-traumatic coxarthrosis. The four female patients underwent revision hip arthroplasty with stem replacement. One patient refused surgical treatment and has been followed up at the outpatient clinic. Annual clinical and radiological examination is an approved method for detecting late complications Hip arthroplasty should be performed at specialised centres where relevant prostheses and instruments are used. A transfemoral approach and the use of revision stems anchored in the femoral shaft is a method of choice for revision procedures performed due to stem fractures.

Hip joint arthroplasty in pubic symphysis separation in the course of congenital bladder exstrophy - study of two cases

Congenital bladder exstrophy is a severe congenital malformation identified in one out of 30,000-50,000 live newborns and seen more often in girls. Some patients develop osteoarthritis of the hip joints which requires total hip arthroplasty. Reports of such cases are very rare in the world literature, which prompted us to present two cases treated at our Department and analyse their early outcomes. Our experience so far has been rather modest but the results encourage considering total hip arthroplasty in the treatment of hip osteoarthritis in future patients with pubic symphysis separation in the course of congenital bladder exstrophy.

NERVE ENDINGS AND VASCULAR SUPPLY IN SEMITENDINOSUS TENDON OF CEREBRAL PALSY CHILDREN

ABSTRACT Objective: To evaluate the distribution of SP (substance P) and S-100 peptide immunoreactivity, as well as the vascular supply of tissues commonly used as grafts for anterior cruciate ligament (ACL) reconstruction. A second aim was to compare the above mentioned distribution in the semitendinosus muscle tendons of cerebral palsy (CP) patients with the semitendinosus muscle tendons and patellar tendons of patients without CP. Methods: The first group consisted of 14 children with cerebral palsy with a mean age of 11.7 years old. At the time of hamstring lengthening operation, a sample of semitendinosus muscle was taken for analysis. The second group comprised 20 patients treated for isolated ACL rupture of the knee (mean age 32 years old). Group three comprised ten patients in the mean age of 14.3 years old treated for recurrent lateral patellar dislocation, and from whom a sample of patellar tendon was obtained. Results: No statistically significant differences were demonstrated with regard to the amount of immunopositive nerve fibers expressing SP or S-100 in all 3 groups of patients. A significant difference was noted in the number of blood vessels between the adult and child semitendinosus muscles, but not between the semitendinosus muscles and patellar tendon of children. Conclusion: The number of nociceptors as well as proprioceptive fibers is similar in patients with CP and patients from a neurologically healthy population. Level of Evidence IV, Cases Series.

Computed tomography in evaluation of revision hip arthroplasty outcomes.

Background. This study aimed to assess contact between Recon Shell reinforcement cages used in revision hip arthroplasty and the bony base. Radiographic examinations were performed with the use of multi-energy computed tomography. Material and methods. We tentatively assess the fixation of Burch-Schneider reinforcement cages (Recon Shell made by Aesculap company) implanted in 10 patients, using two methods of evaluation. An analysis of dual energy CT scans enabled us to assess contact between the reinforcement cages and the bony base. Results. The two methods of evaluation produced different results. The evaluation method based on the division of the acetabular component into a weight-bearing zone and a non-weight-bearing zone (accounting for screw fixation) showed lack of support in the weight-bearing zone in 6 out of 10 cases and direct contact with the implant bed in only one case. The assessment of contact at anchorage holes of reinforcement cages fixed at primary procedures revealed no such support in only one case and the presence of direct contact in 5 cases. There was no correlation between the radiological outcomes and clinical results based on the Harris Hip Score. Conclusions. 1. Multi-energy computed tomography (MARS) is useful in evaluating results of revision hip allo-plasty. 2. The introduction of new imaging techniques for the evaluation of revision procedures demonstrates a need for new, unified methods of outcome assessment adjusted to the characteristics of a particular procedure.

Metallographic evaluation of hip joint implants wear and electrochemical implants potential

We performed metallographic evaluations of implants, removed during revision hip arthroplasty. The implants were evaluated for electrochemical potentials and the presence of wear products on the implants surface. A total of 50 patients (50 hips) underwent revision hip arthroplasty during the years 2007-2009 for aseptic loosening. The mean follow-up from primary hip replacement to revision was 10.1 years (from six months to 17 years). All hip joint implants removed during the revision arthroplasty were submitted to metallographic analysis and all heads were submitted to analysis under a scanning microscope. All polyethylene (PE) cups and inserts showed numerous features of wear (friction wear, plastic deformation and creeping, fatigue wear and degradation), six PE cups were broken. In six ceramic cups, only friction wear features were found; one of them was mechanically broken. In all heads articulating on PE not one had any mechanical damage. Heads of ceramic implants in ceramic-ceramic articulation undergo abrasive wear. None of the studied stems (cemented or uncemented) revealed any features of wear. Areas of titanium crystals (formed by electrolytic sedimentation of metals) were macroscopically identified on the sliding surface of six heads that was confirmed by chemical composition and scanning microscope. In the course of prosthesis use, wear products are produced and transferred onto the sliding surfaces of implant heads and cups via ways other than purely mechanical contact. It has been confirmed that metals used for implant construction, make galvanic cells with different electrochemical potentials.