Total hip replacement in young patients with use of MAYO prosthesis--early result of treatment]

Authors presented the results of the treatment of osteoarthritis of the hip with MAYO endoprosthesis. The paper is focused on young adults. 34 operations in the 2000-2006 were performed. Cementless MAYO stems were used. 32 patients (24 females and 8 males) were evaluated. The age of patients was 20-54 years (average 32,7 years). The main cause of the hip osteoarthritis was DDH (50%). Among others we identified posttraumatic deformities (14.7%), avascular necrosis of the head, multiepiphyseal dysplasia and the other (35.3%). Cementless press-fit Trilogy cup (Zimmer) was applied in 94.1% and cementless threaded acetabular cup in 5.9% patients. Results were analyzed according to clinical Hip Harris score and radiological assessment. After 7 years follow up good and very good outcomes were found in the majority of patients. Mayo stem causes minor damage of intertrochanteric region during procedure and has minimal effect on medullary cavity. It is an advantage in a case of the migration of endoprosthesis. It preserves the bone stock and allows Total Hip Replacement with cementless stem. Obtained results confirm the value of implantation of this kind of endoprosthesis in the case of young adults. Longer follow up period and bigger group of patients are required to confirm our observations.     

Postinfectious coxarthrosis and its surgical treatment

Results of the observation of 27 patients with postinfection coxarthrosis have shown expedience of using alloplasty of the hip joint with a demineralized osteocartilaginous transplants instead of operations of endoprosthesis in young patients. An original technique of alloplasty of the hip joint is proposed.     

Treatment of acetabular fractures

Experience in the treatment of 60 patients is generalized. Operative interventions are recommended for improving the outcomes of treatment in marked incongruence of the articular surfaces. Open reduction and osteosynthesis of the fragments is advisable in the first 21 days after the trauma. In neglected fractures of bones forming the acetabulum, the operation is performed with consideration for the condition of both components of the hip joint. The authors believe the following operations to be most indicated in this case: modeling resection of the hip joint, total endoprosthesis, arthrodesis. The late-term results were studied in 50 patients, among whom 31 were treated by surgery and 19 by nonoperative methods. The results were excellent in 6, good in 18, and satisfactory in 15 patients.     

Endoprosthesis in patients with dysplastic coxarthrosis or in those who suffered Perthes' disease in childhood

Endoprosthesis of the hip joint was performed in 48 patients with coxarthrosis aged 40-50 years, which had occurred after the Perthes's disease. The non-cement fixing of the Ver Sys endoprosthesis was applied, osteotomy and bringing down of the greater trochanter were done in 33% of observations simultaneously or 3-6 months before doing the endoprosthesis.     

Operative treatment of femoral neck fractures in elderly patients

Experience of the hip joint endoprosthesis for the femur colli fracture in 186 elderly patients is presented. The hip joint endoprosthesis expediency and its advantages in comparison with the femur osteosynthesis were substantiated.     

Myoplasty in total prosthesis of the hip joint

When the hip joint is replaced by an artificial one, not infrequently a cavity is formed round the neck of the endoprosthesis which is impossible to be covered with local tissues. It is possible to eliminate such a cavity and prevent the formation of a hematoma by myoplasty. Taking into consideration the peculiarities of vascularization and topography of the muscles situated near the hip joint, several versions of myoplasty of the cavity have been worked out which are used in accordance with its size and localization in relation to the neck of endoprosthesis. Evacuation of the hematoma took place in 3 cases of the total number of 97 operations employing myoplasty, while it was performed in 13 cases of 190 operations without myoplasty. Therefore myoplasty involving musculus gluteus minimus, musculus gluteus medius, musculus rectus femoris and musculus vastus externus, with regard to the size and the localization of the cavity is reliable means of preventing hematoma in case of cavity formation near the neck of the endoprosthesis after the implantation of an artificial hip joint.     

Results of total endoprosthetic treatment of dysplasia coxarthrosis with additional autologous acetabuloplasty of the roof of the acetabulum

With reference to the different operative treatments of dysplasia coxarthroses with a total hip endoprosthesis, 43 operations on the hip joint performed from 1975 to 1979 with a filling up to the acetabular roof defect with an autogenous bone graft had a clinical and roentgenological follow-up. The results were evaluated by means of a standardised procedure, and it was demonstrated with the help of clear successes that also anatomopathologically complicated cases can be provided with a suitable total endoprosthesis.     

Ist der dorsale Zugang mit einer erhöhten Luxationsrate nach Hüfttotalendoprothese behaftet?

The use of the dorsal approach to the hip joint for insertion of an endoprosthesis is associated with a dislocation rate of 1-7%, which is higher than comparable operations using an anterolateral approach. In recent years an enhanced dorsal capsular reconstruction technique has been recommended with increasing frequency. This has reduced the likelihood of dislocation to 0-3%. Controlled studies comparing the dorsal approaches with and without soft tissue reconstruction have documented significantly better results after soft tissue reconstruction, with a probability of 0-3% for dislocation. In order to understand the dorsal instability of the hip joint following implantation of an endoprosthesis, we describe the pathophysiology and the possible reasons for dislocation. Many factors, such as cup position, length of the neck of the femoral implant, diameter of the implant head, the condition of the dorsal soft tissues and the patient's general condition, influence the outcome of the operation and the frequency of dislocation. Possible ways for preventing posterior dislocation are described with reference to both surgical technique and patient selection. The current range of surgical treatment options for recurrent dislocation are presented: modular cups, dual-head cups, constrained cups, high offset femoral neck and soft tissue interventions.     

Gastroduodenal ulcers in the practice of joint endoprosthesis

The gastroduodenal ulcer rate and the gastrointestinal hemorrhage occurrence probability after total endoprosthesis of the hip and knee joint were studied. Of 526 patients in 4 (0.7%) after the total joint endoprosthesis operation the gastroduodenal ulcer had occurred, demanding the urgent treatment measures conduction. It is mandatory to conduct an adequate prophylactic measures to the patients, suffering pronounced gastropathy, according to anamnestic data available.     

Therapeutic concepts in infected hip prosthesis

In the period from January 1980 to December 1987, 62 patients with infected hip joint arthroplasties were treated. The duration of observation was on average 37 months (minimum 12 months, maximum 91 months). The choice of treatment modality depended on the type of infection, the state of anchorage of the endoprosthesis, the general condition of the patient, the type of bacterium and the state of the tissue surrounding the implant. 42 arthroplasties (67%) healed primarily. The remaining 20 were subject to 46 further operations (2.3 relapse operations/patient). 14 subsequently healed (23%) and six cases remained definitively infected.     

Rowing with an endoprosthesis of the hip (author's transl)

After inserting an endoprosthesis of the hip sports activities are mandatory to restore and maintain joint function. Rowing is compared with other disciplines as a most suitable sport. It entails all the advantages which are beneficial to patients with a hip endoprosthesis and should be generally adopted as an appropriate rehabilitation measure.     

Criteria of assessment of restriction of vital activity of patients after total endoprosthesis of the hip joint

Total endoprosthesis of the hip joint is an effective method of rehabilitation of patients with a severe pathology of the hip joint. But the lack of exact criteria of assessment of restriction of vital activity of patients after total endoprosthesis results in leveling the effects of medical rehabilitation due to the existing stereotype solution of the MSE bureau and so the majority of patients (90%) after operation get invalidization of the I and II groups for a long time without sufficient causes. Results of complex clinico-rentgenological, biomechanical, electrophysiological examinations and expert assessment of 450 patients after implantation of various domestic and foreign endoprostheses allowed the elaboration of differentiated criteria for the examination of restricted viral activity depending on the nosological form of the disease, degree of the disturbance of the statico-dynamic function, prognosis, complications, character and conditions of work.     

Comparative evaluation of surgical approaches in operative treatment of patients with the fracture of proximal end of the femur

Metalloosteosynthesis of neck and trochantarian region of the femur, endoprosthesis of the hip joint were performed in the treatment of the femur proximal end fractures. Significant frequency of early and late complications in patients, operated on using posterior approach, is caused by its traumaticity due to transsection of the muscles expanse, creation in them hematomas, significant quantity of the wound exudate. The perspectives of application of anterolateral approach in performing operations for fracture of the femur proximal end are proved.     

Specific features of hemodialysis patients and recipients of allogenic kidney determining requirements for the operation of endoprosthesis of the hip joint

The authors consider specific general status of 23 patients aged from 26 through 63 years who underwent operations of total endoprosthesis of the hip joint for aseptic necrosis of the femoral bone head (18 cases) and pathological fracture of the femur neck (5 cases). Out of 23 patients 11 were given dialysis treatment and 12 underwent allotransplantation of the kidney. A technique of complex preoperative management is described that allowed avoidance of general peri- and postoperative complications.     

Lower limb salvage surgery: modular endoprosthesis in bone tumour treatment

We retrospectively analysed 90 patients who underwent "en bloc" resection and modular endoprosthesis reconstruction in the lower limbs between 1987-2003. After proximal femur resection, reconstruction was performed with a modular endoprosthesis by Howmedica (KFTR, designed by Kotz) and modular revision endoprosthesis by W. Link or Lima-Lto (Revision system, designed by Wagner). The knee joint was reconstructed with a modular endoprosthesis (Howmedica, KFTR designed by Kotz) after distal femur or proximal tibia resection. Malignant bone tumours were present in 58 patients (64.5%), benign tumours in 16 (17.8%), metastases in 8 (8.9%), tumour-like lesions in 4 (4.4 %) and non-tumour-related destruction of the femur in 4 patients (4.4%). High-grade tumours were found in the majority of malignant bone tumours (70.7%). Treatment complications, which occurred in 26 patients, were: local recurrence of the tumour, deep infection, acetabular destruction following hemiarthroplasty, recurrent dislocations of endoprosthesis, periprosthetic fracture and hardware problems. In total, 23 patients (25.6%) died due to tumours. Endoprostheses should be considered as a treatment of choice for bone tumours in the hip and knee joint region. Advances in limb salvage surgery are, and will long continue to be, a great challenge for orthopaedic oncologists of the 21st century.     

Mechanisms of the optimization of oxygen metabolism under the effects of mafusol and mildronate during emergency implantation of hip prosthesis

The results of using antihypoxants Mafusol and Mildronate in the course of emergency endoprosthesis of the hip joint were analyzed in 41 patients at the age of (80.5 +/- 5.6) years with fractures of the proximal part of the femoral bone. The authors noted optimization of the organism oxygen budget under the influence of the drugs, its physiological mechanisms being deciphered. The protective properties of these drugs manifested themselves in lower consumption of oxygen by the tissues with greater possibilities of its release by oxyhemoglobin as well as in the lessening of intrapulmonary shunting and prevention of the development of metabolic acidosis.     

Rehabilitation of orthopedic patients after hip replacement

A comparative analysis of the treatment of 120 patients after endoprosthesis for degenerative-destructive diseases of the hip joint was carried on. All the patients were divided into two groups: the main group included 74 patients who underwent a full course of rehabilitation, the control group consisted of 46 patients without rehabilitation. The results of a comparative assessment of the static-dynamic function in the two groups of patients after operation of endoprosthesis have shown the inclusion of an obligatory program of rehabilitation to be expedient for the restorative treatment in addition to the operation of endoprosthesis.     

Revisionseingriffe nach Azetabulumfraktur

Complications and protracted courses are not uncommon following acetabular fractures. The aim of osteosynthesis should always be anatomical reconstruction with a step-free restoration of joint areas. If steps remain or osteosynthesis is insufficient, early revision is recommended to achieve optimal results. In the case of posttraumatic arthrosis, endoprosthesis can often not be avoided. A stable cup position is important in younger patients, since a change of endoprosthetic components is to be expected. For older patients primary hip prosthesis can be considered in the case of single-column fractures. In the case of two-column fractures, consolidation of the cup fundament should first be awaited; otherwise, anchorage of the endoprosthetic components cannot be achieved. Endoprosthesis after previous osteosynthesis is comparable with results seen in endoprosthetic revision surgery. Post-traumatic endoprosthesis has worse results than primary endoprosthesis in cases of osteoarthritis. Nevertheless, patients benefit from the better functionality compared to a Girdlestone situation or even a hip joint arthrodesis. The management of post-traumatic coxarthrosis is a challenge even in experienced hands and requires individual planning.     

The transtrochanteric anterior rotational osteotomy of Sugioka. Early and late results in idiopathic aseptic femoral head necrosis

The early and late results of 39 transtrochanteric anterior rotational osteotomies of Sugioka, performed since 1975 in idiopathic aseptic necroses of the femoral head, are presented; 23 results are excellent and good. The rates of postoperative complications and reoperations are high, more than 40% each. Reoperations in smaller necrotic areas are far less frequent. There is no deterioration of the result when the hip joint is replaced by an endoprosthesis after Sugioka osteotomy. Insufficiency of the gluteus muscles is more frequent, but, on the other hand, range of motion of the hip joint increases after total hip replacement. Based on the results, we feel that there are fewer indications for this operation. The procedure is indicated for young patients with good function of the hip joint and sectors of necrosis up to 90 degrees, especially when there is not other way to remove the area of necrosis from the weight-bearing zone of the femoral head.     

Purse-String Capsule Repair to Reduce Proximal Femoral Arthroplasty Dislocation for Tumor—A Novel Technique With Results

Hip joint dislocation is the most common complication after proximal femoral arthroplasty with a large endoprosthesis. Average dislocation rates are around 15%. In an attempt to decrease dislocations after proximal femoral arthroplasty for tumor resections, we devised a novel closure of the hip capsule. This technique uses a 3-mm cottony Dacron suture placed about the hip capsule in a circumferential, purse-string manner. Thirty-nine patients received hip hemiarthroplasty with purse-string capsular closure. Seven patients were lost to follow-up, leaving 36 patients available for analysis. One patient dislocated (2.8%). We believe this technique is useful in preventing dislocation in patients undergoing proximal femoral arthroplasty for oncologic disease.