[Show abstract][Hide abstract] ABSTRACT: Background:
Periprosthetic fracture of the femur is a common complication of total hip replacement surgery. There are several risk factors, including the female gender, an uncemented implant, the use of a straight or revision stem and secondary osteoarthritis. The aim of the study was a radiological evaluation of treatment of periprosthetic femoral fractures Material and methods. The study group consisted of patients who underwent hip replacement surgery at the Department of Orthopaedics and Traumatology, Medical University of Silesia, between 2002 and 2006. Radiologic evaluation of outcomes was based on the scheme developed by HIP Society, SICOT, AAOS and, additionally, on Beals and Tower's classification.
The incidence of pathological findings, such as lucent zones along the stem-bone interface, crack of the cement and focal osteolysis of the greater trochanter and around the cement, did not exceed 10%. Lucent zones were most frequently seen in radiographs of cemented prostheses in Gruen's zones 2, 3 , 4 and 5. Cortical hypertrophy was seen medially in Gruen's zones 4, 5 and 6. Adams` arc osteolysis was found in 15.5% of patients with intraoperative fractures and almost 40% of patients with late fractures. Heterotopic ossification was noted only in 7 patients.
1. Radiological evaluation of treatment of periprosthetic femoral fractures after hip replacement surgery is one of the most difficult parts of patient status assessment in post-surgical patients. 2. The most common pathological radiographic findings were stem subsidence and the presence of osteolytic foci around Adams` arc. 3. The occurrence of a periprosthetic fracture did not significantly affect Beals and Tower scores.
[Show abstract][Hide abstract] ABSTRACT: Osteoporosis and its consequence of low trauma fracture represent a major health burden in aging population, because it results in increased morbidity, mortality and high health care costs. The number of hip fractures worldwide will approximately double by the year 2025 and more than triple by 2050. The aim of the study was to assess the incidence and trends of osteoporotic hip fracture in women and men aged over 50 years in polish population.
Hospital records in population of 32,100 men and 39,984 women between January 1st, 2002 and December 31, 2010 with ICD-10 codes S72,0, S72,1 and S72,2 (femoral neck, intertrochanteric, subtrochanteric, inter and subtrochanteric fracture) were included in analysis.
The study revealed 937 low energy hip fractures (240 in men 697 and in women). Systematic increase in rate over the study period, with the 44% in last year compared to 2002 year can be noticed. The increase was lowest in female (20.7%) than in male population (57.6%), and similarly was lowest in urban (27%) than in rural (67.7%) inhabitants.
Concluding, the incidence of osteoporotic hip fracture in Polish men and women aged over 50 years is low, but the epidemiological picture is likely to change due to apparent aging of the population. Increasing trend of hip fracture incidence together with changes in age structure will result in an increased need for specialized care including several medical branches (GP, orthopedics, geriatrics, rehabilitation). Levels of evidence - IV.
[Show abstract][Hide abstract] ABSTRACT: Background.Avascular necrosis of the femoral head continues to represent a major challenge for the orthopaedist and trauma surgeon. A fully effective method of treatment is yet to be introduced. After femoral head collapse, only total hip replacement can help the patient. Our study aims to assess the effects of treatment of avascular necrosis of the femoral head with extra corporeal focused shockwave therapy.Material and methods. A prospective study was carried out in patients with avascular necrosis of the femoral head, ARCO stage I-III, diagnosed by MRI imaging. Shock waves are applied under x-ray guidance. Four points are marked on the skin above the lesion. Each spot receives a dose of 1500 pulses at an energy flux density of 0.4 mJ/mm2 and a frequency of 4 Hz. Each patient undergoes 5 therapy sessions. A posturometric and stabilometric assessment is carried out before and after the therapy. Other examinations include a tensometric evaluation of the strength of the treated limb, and an assessment of pain intensity (VAS scale)and hip function (Harris hip score). Follow-up visits are scheduled at 6 weeks and 3, 6 and 12 months post-treatment.Results. Nine patients were treated with shockwave therapy at the Department of Orthopaedics and Musculoskeletal Traumatology, Medical Faculty, Medical University of Silesia, between 5 May 2011 and 1 June 2012. The patients demonstrated pain reduction and improved mobility of the treated joint (VAS score decreasing from 6.75 +/- 0.71 to 2.5 +/- 1.7; Harris hip score increasing from 55.21 +/- 15.45 to 89.21 +/- 8.26). Tensometric platform testing carried out after the treatment revealed a statistically significant difference between mean velocity of the centre of pressure (CoP) movement when walking with eyes open and closed (p<0.05) and mean CoP movement along the x (walking with eyes closed) and y (free standing with eyes closed) axes.Conclusions. 1. Extracorporeal focused shockwave therapy resulted in considerable improvement in the patients' quality of life at 6 weeks' follow-up. 2. At 6 months some patients reported intensified pain and worse hip function.
[Show abstract][Hide abstract] ABSTRACT: Background. Focused shockwaves have been successfully used in orthopaedics and physiotherapy for over twenty years. The aim of this study was to evaluate the usefulness of focused shockwaves in treating patients with osteonecrosis of the femoral head (OFH), as well as their effectiveness as a therapy for tennis elbow and symptomatic heel spurs. Material and methods. The study has covered to date 6 patients with osteonecrosis of the femoral head (OFH) (stages I, II and III on the ARCO scale), 10 patients with tennis elbow (TE) and 6 patients with symptomatic heel spurs (HS). The patients were treated using focused shockwaves. Results. After treatment ended, pain intensity was noted to be statistically significantly lower in all groups of patients. In the OFH patients functional improvement could also be observed, as well as increased strength of wrist flexors and extensors and of finger flexors in the TE patients. The OFH and HS patients obtained better results in tests carried out on the tensometric platform. Conclusion. Focused shockwave is an effective and safe physical modality for treating early stages of osteonecrosis of the femoral head, tennis elbow and symptomatic calcaneal spurs; its main advantage is good analgesic effect right after treatment. However, the delayed effects of the therapy need to be investigated to confirm its effectiveness.
No preview · Article · Jun 2012 · Fizjoterapia Polska
[Show abstract][Hide abstract] ABSTRACT: Background:
Intraoperative periprosthetic femoral fracture (IPFF) is one of the most frequent complication of total hip arthroplasty (THA). This complication is a very important factor affecting rehabilitation, hospitalization time and cost of treatment. It may occur during the intramedullary reaming, removal or fixation of the stem The aim of the study was to identify risk factors of IPFF, in order to devise strategies that would minimize incidence of this complication in the future.
The study group consisted of patients who underwent hip surgery at the Department of Orthopaedics and Traumatology, Medical University of Silesia in Katowice between January 2002 and December 2006. We included cases of primary total hip replacement (both cemented and uncemented), hemiarthroplasties, revision THAs with exchange of at least one of the elements and the Girdlestone procedures.
The IPFF was diagnosed in 105 cases (101 patients), out of 1188 surgeries. We found the following risk factors for the primary THA: female gender, younger age, uncemented implant, the use of straight or revision stem, secondary osteoarthritis. For revision surgery there were: left hip surgery and implantation of revision stem.
We hope that identification of risk factors for the intraoperative periprosthetic femoral fracture would allow orthopaedic surgeons to select the group of patients with high risk of fracture and to devise strategies that would minimize incidence of this complication in the future.
No preview · Article · Jan 2012 · Chirurgia narzadow ruchu i ortopedia polska
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to assess fracture status in men by quantitative ultrasound measurements at the calcaneus. The diagnostic accuracy of quantitative ultrasound measurements was evaluated at baseline and follow-up.
We observed 165 men (baseline age ± SD, 59.84 ± 10.6 years) recruited from an outpatient osteoporosis clinic. The mean follow-up duration was approximately 101.3 ± 35 months. There was no difference in either age or body mass index at baseline between the patients with a fracture history (n = 30) and the others (n = 135). The following fractures were identified at baseline: ankle, 15; wrist, 10; rib, 9; foot, 5; and hip, 1. The speed of sound (meters per second), broadband ultrasound attenuation (decibels per megahertz), and stiffness index (percent) were measured with a quantitative ultrasound device. The date of fracture occurrence at follow-up was defined as the final point.
In the patients with a fracture history, the ultrasound variables were significantly lower than those in the rest of the group (P < .05). During the follow-up period, fractures occurred in 21 patients (wrist, 11; ankle, 5; rib, 3; hip, 1; and humerus, 1), and the ultrasound outcomes were nonsignificantly lower in the fractured men. The risk of fracture was estimated by the Cox regression analysis. A prior fracture was the only factor that significantly (4 times) increased the risk of a subsequent fracture (hazard ratio, 4.21; 95% confidence interval, 1.81-9.86; P < .001).
Calcaneus ultrasound measurements can distinguish between patients with fractures and those without. In follow-up, ultrasound measurements did not indicate an increased fracture risk; a prior osteoporotic fracture was the major prognostic factor.
No preview · Article · Jul 2011 · Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine
[Show abstract][Hide abstract] ABSTRACT: Ewing sarcoma is a malignant, small round cell bone tumor, presenting predominantly in children and adolescents. Ewing sarcoma may develop in every bone; diaphyses of long bones, ribs and flat bones are the main locations. Local and systemic clinical symptoms are nonspecific - pain, swelling, fever or ill-being. The aim of the study was to assess the role of radiography, computed tomography and magnetic resonance imaging in the analysis of bone lesions in children and young adults with Ewing sarcoma.
Twenty-seven patients, aged between 1 year and 10 months, and 17 years and 2 months, with histologically verified Ewing sarcoma of the bone, referred to the Radiological Department of University Hospital No 6., John Paul II Upper Silesian Centre for Child Health Katowice, in the period from 1996 to 2007, were included in the study.Plain radiography was performed in every child, CT in 20 and MRI in 12 individuals. Tumour location, extension of the tumour, soft tissue mass, and periosteal reaction were taken into consideration in the evaluation of the lesion. In some cases, pathological features of the MRI and CT were compared. The prevalence of some radiological features was compared to the literature data.
THE MOST COMMON SITE OF TUMOR WAS: ribs (6 children), femoral bone (6 children), pelvis (4 children) and tibia (3 children). In 2 children, a primary tumor was diagnosed in the spine (multifocal in 1 child). X-rays revealed: periosteal reaction in 17 children (63%), soft tissue involvement in 19 children (70%), permeative component in 16 children (59%), and sclerotic component in 5 children (19%). In 10 children (37%), periosteal reaction was not detected. The examination revealed: soft tissue calcifications in 7 cases (26%), a well-delineated focus of destruction within bones in 3 children (11%), cortical thickening in 4 children (15%), cortical destruction in 4 children (15%), saucerisation in 3 children (11%), bone expansion in 3 children (11%), pathological fracture in 2 children (7%), cystic component in 1 child (4%), and vertebra plana in 1 child (4%).Reaction of tumors after i.v. contrast administration, shown on CT, was visible in 16 children - it was useful for a better description of the tumor and extension of the mass within the soft tissue. All MRI examinations (12 children) showed a heterogenous mass with ill-defined borders and a violated cortex. Low signal intensity of the tumor in a T1-weighted image and high signal intensity in a T2-weighted image was shown as well. Heterogenous enhancement of signal intensity on T1-weighted images could be observed after i.v. contrast administration. MRI EXAMINATIONS SHOWED: tumor in an adjacent soft tissue in 11 children, and involvement of the epiphyseal plate or of the joint cavity in 6 children.
X-ray and MRI are essential in diagnostics. CT examination is more useful to estimate periosteal reactions and destruction of bone and marrow cavity, especially in flat bones. However, to recognise a malignancy, it is necessary to perform a histopathological examination. In doubtful cases, the examination has to be verified as well.
Full-text · Article · Mar 2010 · Polish Journal of Radiology