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ABSTRACT: The introduction of sonography to the evalution of the hip joint, allowed for the non-invasive examination in preterm neonates and thus assessment of the development their hip joints. MATERIAL AND METHODS. The examined group consisted of 143 preterm neonates with the body weight by delivery lower then 2000 grams (286 hip joints) and the control group of 31 children from term delveries forming the control group. The sonographic examination was conducted stricktly according to the rules presented by Graf. First examination was performed averagely in the 3rd week of life, second avg. in the 14th, third in avg. the 23rd, fourth avg inthe 33r week of life. Wyniki. In the first examination, done in the 3rd week of life it was noticed that highest rate of the hips Ia appeared in the group I (newborns with the lowest bogy weight), and together with the increase in body weight the incidence of such hips decreased, when the incidence of type IIa hips increased at the same time. At the final examination no statistically significant differences were found between the hip joints and no dysplastic hips were found. Wnioski. According to our results, we found that preterm delivery is not a risk factor for the developmetal hip dysplasia.
Chirurgia narzadow ruchu i ortopedia polska 02/2005; 70(4):301-5.
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ABSTRACT: Background. Both conservative and surgical treatment are applied in the treatment of developmental hip dislocation in the second year of life. Our study to evaluated the results of surgical treatment at this age using open reduction combined with transiliac osteotomy and translation of the distal insertion of the iliopsoas muscle. Material and methods. The analyzed group consisted of 21 hip joints. The mean follow-up was 6 years (2-11 years). The age of the patients at surgery was 13 -24 months, average 18 months. Results. According to Severin's classification scheme 71% of the patients had excellent results and 29% good. However, when the analyzed joints were evaluated according to our classification scheme, the results were significantly worse: 29% excellent, 48% good, 23% satisfactory. The difference between the results was caused by parameters not included in Severin's classification: neck-shaft angle and neck centering angl. The true antetorsion angle was decreased in the final examination in comparison to preoperative results. The mean head-metaphyseal index of Kruczyński averaged 120.61% of normal in the whole group, and values higher than 120% were found in 13 cases (62%). Conclusions. The described method of treatment provided stable reduction with good coverage of the femoral head by the acetabular roof in more than 90% of cases. The problem of increased neck-shaft angle and neck centering angle occurring in 25% of cases remains unsolved. The antetorsion angle is still high in some cases at follow-up.
Ortopedia, traumatologia, rehabilitacja 03/2004; 6(1):34-43.
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ABSTRACT: The present study describes and analyzes current methods of evaluation of the morphology of the dysplastic hip found in the literature. The authors own method of evaluation is presented, which is based only on measurable parameters, and provides an objective and comparable definition of all the elements of which the joint is composed. The classification presented here enables the complete description of the morphology of the hip joint: the acetabulum, the proximal femur, the congruity of the joint, and the shape of the femoral head. It is based on measurable parameters, related to normal values, and allows for the comparison of any group of patients. It can be used for evaluation after both conservative and surgical treatment. The classification scheme can be extended by adding other joint parameters.
Ortopedia, traumatologia, rehabilitacja 03/2004; 6(1):75-81.
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ABSTRACT: Total hip replacement became a method of choice in treatment of the severe osteoarthritis. Despite the progress in constructing the implants and also the surgical technique, the number of complications rises together with the number of arthroplasties performed. The periprosthetic osteolysis and its consequence--the loosening is the one of the greatest problems of today's joint replacement. It creates the main obstacle for the long-term efficiency of the total hip arthroplasty. It was proved by the numerous research, wear debris of the implant induce the chronic periprosthetic inflammatory process. Many studies emphasize the influence of the proinflammatory cytokines on the bone metabolism. The aim of the study was the evaluation of the inflammatory process in patients with the severe osteoarthritis before the surgery and in subsequent periods after total hip replacements and also in patients with the aseptic loosening of the endoprosthesis, by the monitoring the levels of IL-6 in serum of the peripheral blood. The results suggest, that in patients following THA with the elevated level of IL-6, the inflammatory process was present. This inflammation may lead in future to the aseptic loosening of the implant.
Chirurgia narzadow ruchu i ortopedia polska 02/2004; 69(2):121-4.
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ABSTRACT: Background. Disorders in development of the hip in the uterus are caused mainly by mechanical factors. Their influence has been established on the basis of the results of examinations of newborns from singleton pregancies. Malposition of the fetus and the lack of space in the uterus are present in higher frequency in twin pregnancies. Thus, it is probable, that twin pregnacy may be a risk factor in developmental dysplasia of the hip.
Material and methods. We examined clinically and ultrasonographically 308 hip joints of 154 newborn twins and compare the values of the alpha related to different position in uterus, birthweight, gender, length of gestation and mode of delivery. The only pathological position of the fetus in the uterus is the tranverse one.
Results and Conclusions. The results of ultrasound examinations reveal that in the cramped space inside the uterus in twin pregnancies hip joints develop in different conditions than in singleton pregnancies and the twin pregnancy cannot be regarded as a risk factor which may cause developmental dysplasia of the hip.
Ortopedia, traumatologia, rehabilitacja 12/2003; 5(6):712-6.
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ABSTRACT: Background. Recent studies on the developmental dysplasia of the hip emphasize the role of the last trimester of pregnancy in the origin of the pathology. The aim of the study was to evaluate the development of the hip joints of preterm neonates born with different weight and in different periods of pregnancy.
Material and metods. 286 hip joints of preterm neonates born between 24 and 37 week of pregnancy and 62 ones of newborns from term deliveries were analysed. The evaluated newborns were divided into 3 groups of preterm ones: with the weight at birth below 1000 g (23 children), between 1000 and 1500 g (40 children), between 1500 and 2000 g (80 children) and a control group- 31 children from term deliveries with normal weight. In every case 4 single sonographic examinations were performed using the method presented by Graf. First, before the 6 week of age (mean 3 weeks), next after the 3rd month af age (mean 14 weeks), next after 5th month of age (mean 23 weeks) and the last one after the 7th month. The evaluation of the remodeling of the hips was based on the observation of changes in a and ss angles.
Results. It was found that the lower was the newborn's weight at birth the higher was the b angle. The similar tendency was noticed for the ss angle but was observed only in the group of preterm neonates. When the evaluation was based on the postconceptional age at the examination, it was found that the values of both angles worsened together with age, reaching the worst values between 37th and 42th week of postconceptional age. It proves the theory, that in the last trimester of the pregnancy, the acatabulum becomes more shallow and vertical together with the worsening of the cartilaginous femoral head coverage with time.
Conclusion. The presented results show that the worst anatomical parameters of the hip joint can be found at physiological term of delivery.
Ortopedia, traumatologia, rehabilitacja 12/2003; 5(6):703-11.
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ABSTRACT: This paper describes the radiological status on the start of walking in 31 hip joints in 24 children, in which the treatment of the developmental dysplasia with dislocation of the hip began in the first 2 weeks. Before the beginning of the treatment, ultrasonographic assessment revealed type D in 22% hips, type III in 55% and type IV in 23%. The radiographic evaluation was based on 6 parameters, which values were compared to the normal ones for the age group. It was estimated that only 32% hips had a correct radiological status, the other hips revealed smaller or greater dysplasia.
Chirurgia narzadow ruchu i ortopedia polska 02/2003; 68(5):303-5.
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ABSTRACT: Aseptic loosening of the prosthesis is caused by the mechanical instability of it's components or it depends on direct tissue reaction--foreign body reaction to implant's wear debris. Former studies showed a significant role of macrophages in the process of the chronic inflammation leading to the aseptic loosening. There are few studies concerning the early reaction against the implant and concerning in this process the role of neutrophils--the cells which form the primary defence of the body and are activated during contact with the foreign body. The examined group consisted of 33 patients aged 59-79 with implanted cemented hip or knee endoprosthesis due to the primary osteoarthritis. The count of granulocytes, production of the nitric oxide and hydrogen peroxide with Pick's and Market's method was evaluated in samples collected before the surgery, 2 months and 3 years after the operation. 3 years postoperatively 8 patients reported pain of the operated joint and in two cases aseptic loosening was recognized. In this group the level of production of the nitric oxide and hydrogen peroxide by the neutrophils 2 months postoperatively was significantly higher in comparisons to the levels in the patients without pain and the control group. In patients without pain the production of nitric oxide and the hydrogen peroxide did not change significantly after the surgery. The presented results suggest the neutrophil's activation by the cytokines, which appear as a result of a local response to a foreign body, may be a factor initiating a chronic inflammation around the implant leading to the aseptic loosening.
Chirurgia narzadow ruchu i ortopedia polska 02/2002; 67(1):11-8.
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ABSTRACT: Aseptic loosening is a result of the chronic inflammatory reaction in periprosthetic tissues. Its intensity depends on the implants construction material and reactivity of the host's tissues. The aim of the study was the evaluation of the acute phase proteins in various periods following total hip replacement and comparison between acute phase response observed in patients with well-functioning implants and with aseptic loosening.
The study group consisted of 97 patients following THR due to the hip osteoarthritis. Patients of Group I were evaluated before the surgery and 6 months after primary THR. Group II consisted of patients 3-4 years after primary THR. Group consisted of patients with aseptic loosening. Patients of all groups were divided according to the implant type (cemente/uncemented).
Concentrations of evaluated acute phase proteins: C-reactive protein (CRP), transferrin (Tf) and alpha-glycoprotein were assessed using immunoelectrophoresis.
In vast majority of patients (71-95%) following THR had present w3 variant of AGP which should be negative in physiological conditions. The average concentrations of AGP and AGP-RC were higher in patients following cemented THR.
Implantation of the endoprosthesis raises a chronic inflammatory reaction expressed by changes in the profiles of acute phase proteins. This process is more visible in patients following cemented THR. The profiles of the acute phase proteins in patients with aseptic loosening were not different than those observed in patients with well-functioning implants, what makes them useless as a diagnostic tool for loosening. This lack of differences may be caused by adaptation of the generalised response to long lasting process of aseptic loosening
Chirurgia narzadow ruchu i ortopedia polska 72(5):305-9.
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ABSTRACT: The acute phase proteins are commonly known universal markers of the inflammatory process. The aim of the study was the evaluation of the acute phase response in the first 6 months THR. The secondary aim was to check if the type of hip replacement affects the acute phase response.
The study group consisted of 40 patients who underwent THA using uncemented (20) and cemented (20) endoprostheses. The concentrations of C-reactive protein, alpha-glycoprotein, and alpha-1-antichymotripsin, and microheterogeneity of AGP were evaluated.
The blood levels of the acute phase proteins CRP, AGP, ACT rose significantly at 2 and 14 days after the surgery to return to preoperative values at 6 months after the surgery. The V3 variant of microheterogeneity of AGP, absent under normal conditions, and representative of acute inflammation, was found in a few patients preoperatively. In postoperative evaluations, it was found in the vast majority of the patients.
The analysis of the profiles of the glycosylation of AGP shows that the presence of the acute inflammatory response immediately following total hip replacement, which later changes into persistent chronic inflammation, is more pronounced in patients receiving cemented endoprosthesis.
Ortopedia, traumatologia, rehabilitacja 11(4):324-32.
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ABSTRACT: Hallux valgus and hallux rigidus are common foot deformities. One of possible procedures is Keller's surgery. The purpose of this study is to evaluate the use of pedobarography for postoperative evaluation of the foot. Group. We examined 54 patients aged 48 to 82 (average 60.4) after surgical treatment of Hallux valgus (78 feet) or Hallux Rigidus (15 feet). Methods. Retrospective pedobarographic evaluation 1 to 11 years after surgery was performed using PEL-38 system. Clinical results. All patients had markedly increased pressure under the 2nd and 3rd metatarsal heads comparing to other forefoot regions. Only 17% of feet had distal dynamic transverse arch during stance phase of gait. There was severe impairment of function of the great toe in entire group. In 82.7% of feet there was no ground contact of the great toe in dynamic evaluation of the stance phase. Conclusion. Pedobarographic examination has good value in postoperative functional assessment of the foot. It's a valuable addition to physical and radiological examination.
Chirurgia narzadow ruchu i ortopedia polska 74(4):224-7.
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ABSTRACT: The influence of physical activity on the survival of total hip replacement remains not fully recognized. It is unclear which activities are beneficient for patients following THR.
The study was conducted on group of 87 patients (94 hips) following uncemented THR with ABGII/Trident and 45 patients (51 hips) following hip resurfacing. The follow-up period was 6-30 months for THR group and 6-42 months for resurfacing group.
The patients answered a questionnaire based on WOMAC and SF-36 score, UCLA activity scale with additional questions concerning patients physical activity, working and place of living.
In WOMAC, physical domains of SF-36 and UCLA activity score patients following hip resurfacing showed better results. The most preferred activity in both groups was exercise walking and biking. The last one was particularly preferred by patients living in rural areas.
The vast majority of patients restricted their activity to disciplines with a safe range of hip weight bearing.
Chirurgia narzadow ruchu i ortopedia polska 74(6):348-52.
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ABSTRACT: For many years early treatment of degenerative joint disease in hip joint included only conservative procedures or extraarticular surgery eg. pertrochanteric osteotomy, acetabular roof reconstruction. Discovery of femoro-acetabular impingement mechanism opened space for new advanced operative techniques. For the last few years these techniques are mastered using arthroscopic approach as well as open joint surgery. In this paper we are describing technique with osteotomy of the greater trochanter and joint luxation for open treatment of femoro-acetabular impingement.
Chirurgia narzadow ruchu i ortopedia polska 75(3):164-7.
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ABSTRACT: The Ganz periacetabular osteotomy (PAO) is currently the most popular hip-sparing procedure in adults with acetabular dysplasia. If this procedure fails and a total hip arthroplasty is necessary, spatial reorientation of the acetabulum alters the conditions of implanting the acetabular component of the prosthesis. In our study, we present two cases of total hip arthroplasty in patients who had undergone PAO.
Ortopedia, traumatologia, rehabilitacja. 12(6):561-9.
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ABSTRACT: In the past, the procedure for rehabilitation after hip surgery, related to the long immobilization of the operated joint, was often delayed and limited in time. Today's surgical procedures and rehabilitation allows for a quicker return to full physical fitness. Postoperative physiotherapy is mainly focused on regaining full joint function (range of motion--ROM, strength, stability). The rehabilitation program must be a dynamic process, dosed up to the possibility of the patient, depending on the type of procedure performed. Rehabilitation must take into account not only the type of procedure performed intraarticular, but also surgical approach. Rehabilitation after surgery requiring dislocation of the hip by osteotomy with simultaneous artrotomii trochanter must take into account the time required for the stable union. Range of motion exercises begin in the first days after surgery using a continous passive movement (CPM) and passive exercises, and later a stationary bicycle. Menaging patients after treatment of CAM type femoroacetabular impingement is dependent on the degree of bone resection performed within the femur. In the treatment of Pincer-type f emoroacetabular impingement, as well as injuries of the hip labrum rehabilitation proceedings must take into account the location and the area of pathology. Rehabilitation after surgery for articular cartilage (chondroplasty or osteoplasty) in the first period is mainly focused on the avoidance of intraarticular conflicts in the reconstruction of the full ROM.
Chirurgia narzadow ruchu i ortopedia polska 75(4):225-30.
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ABSTRACT: There is an increasing number of hip joint arthroplasty procedures all over the world which are followed by revision surgery. The cases of severe bone loss and periprosthetic fractures revision of a stem can constitue a serious challenge even for an experienced orthopedic surgeon.
In the research material there are 18 patients 6-50 months after the stem of the hip prosthesis revision with Stryker Restoration modular stem.
Clinical evaluation according to HHS protocol, the quality of life measured with SF-36 form, and physical activity evaluated using UCLA score. The methods are also AP and X-Ray of both hips and lateral X-ray of revised hip with osteolysis around stem, stem subsidence, and difference in leg length evaluation, as well as the comparison of hip offsets.
Mean HHS score was 78.6 pts, mean SF-36 based quality of life 50.5 pts, and the mean UCLA 4.72. Radiolucent zones around the stem were observed in several cases which were correlated with the stem subsidence.
The clinical results in this study are similar to those from the literature, and slightly lower than of the patients after primary hip arthroplasty, particularly in function measuring subscales. The quality of life scores of our patients was significantly lower than reported by other authors in cases of hip revision arthroplasty. There was no case of aseptic loosening. Further observation of the patients considering osteolysis and its relation to stem subsidence is needed.
Chirurgia narzadow ruchu i ortopedia polska 76(5):286-90.
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ABSTRACT: Metal-on-metal bearings characterize lower wear than metal-poly, lower fracture risk than ceramics and they allow for the manufacturing of large diameter heads. The metal ion release from the bearings is the the major concern of these articulations.
The study group consisted of 16 patients who underwent hip resurfacing with Durom implant and had minimum 1 year follow-up period. Blood from the patients was collected 4 times: before the surgery, 2, 6 and 12 months postoperatively.
Clinical examination was done according to HHS, Radiographic image was used to measure the cup inclination, evaluation of chromium and cobalt ion blood levels was performed using graphite furnace atomic absorbtion spectrometry (GFAAS).
The levels of cobalt and chromium increased postoperatively significantly to decrease slightly at 6 months. At 1 year cobalt levels increased to the similar level like at at 2 months. The chromium level decresed to the values as low as preoperatively. The mean cup inclination angle measured on X-rays was 48 degrees(range 39 degrees - 56 degrees). The mean HHS result was 89.86 (range 64.43 to 98.73). The mean activity level measured with UCLA scale was 6 (range 3-9).
The metal ion blond levels increase sigficantly in the period 2-6 months following hip replacement with large diameter metal-on-metal articulation. In further examinations at 1 year post-op ion levels decrease.
Chirurgia narzadow ruchu i ortopedia polska 76(6):332-5.
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ABSTRACT: Modem indications for use of cemented or uncemented implants in revision hip arthroplasty are comparable. The use of bone cement provides predictable short term results, but the lack of osteointegration deteriorates its long term durability. Uncemented implants undergo osteointegration, but reduced contact with host bone may cause early loosening. Modular porous tantalum implants are highly osteointegrative, and the availability of bone stock augments increases the versatility of this system.
The study group consisted of 20 patients (21 hips) who underwent a revision hip arthroplasty using Trabecular Metal acetabular revision system. The follow-up period was between 7 and 31 months (average 20 months). All patients were evaluated with HHS and conventional radiography.
The mean HHS increased form40.45 (range 18.74-56.65) preoperatively to 78.8 (56.5-96) at the last follow-up. No mechanical failures, nor septic complications were noted.
Chirurgia narzadow ruchu i ortopedia polska 76(4):197-200.
