RESUMEN
PURPOSE OF THE STUDY Patellar surface replacement during total knee arthroplasty is still a matter of discussion among orthopedic surgeons. The purpose of this study was to examine possible benefits of patellar surface replacement in selected patients with symptomatic degenerative valgus deformity. We have not found any studies in the literature that compare the results of patella management solely for valgus or varus knee deformity nor those that compare both. MATERIAL AND METHODS Patients were randomly assigned to a group that would receive patellar surface replacement during total knee arthroplasty and a group of patients in whom total knee arthroplasty was performed without patellar surface replacement. 60 patients were included in the study. Total knee arthroplasty with patellar resurfacing (TKAPR) was performed in 30, and without PR (TKA) in 30 of them. Results were prospectively gathered and compared at regular intervals. RESULTS There were no significant differences between groups for examined parameters except for Oxford Knee Score at 6 months which was in favor of patellar resurfacing group. DISCUSSION The decision whether to replace the patella or not is currently exclusively a matter of surgeon's choice. Establishing selection criteria for patients that would benefit from patella resurfacing could, therefore, be very useful for both patients and orthopaedic surgeons performing total knee replacement. CONCLUSIONS Although evidence in our study could not strongly suggest performing patella resurfacing in patients with valgus deformity, the results were slightly better in the patella resurfacing group and this trend could increase if larger series of patients would be employed. A longer follow-up period would be required for clear-cut decisions and more prospective studies are warranted. Key words: knee, arthroplasty, patella, replacement, valgus, deformity.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/métodos , Genu Valgum/cirugía , Rótula/cirugía , Toma de Decisiones Clínicas , Femenino , Humanos , Masculino , Resultado del TratamientoRESUMEN
INTRODUCTION: The aim of the study was to determine the validity of acetabular component position of the noncemented total hip endoprosthesis after Chiari pelvic osteotomy. MATERIAL AND METHODS: The study involved 75 patients operated on at the Institute of Orthopedic Surgery "Banjica" in the period from 1990-2009. The first group consisted of 39 patients (46 hips) who underwent Chiari pelvic osteotomy and also later the implantation of a noncemented total hip endoprosthesis. A control group consisted of 36 patients (47 hips) who underwent total hip arthroplasty due to degenerative hip dysplasia. RESULTS: In the previously operated patients the centre of rotation of the hip was on the average placed more proximally, while in the control group of patients the position of the acetabular component was closer to the anatomical one. In the group of patients after Chiari osteotomy the mean acetabular cup abduction angle rated 41.8°±9.8°, while in the control group this value was on the average higher (45.4°±8.6°). DISCUSSION: There was a significant difference between the studied groups in relation to the distance between the acetabular component of endoprosthesis and the acetabular teardrop (t=-2.763; p=0.007). No statistically significant difference was determined in the mean value of the angle of acetabular abduction component of endoprosthesis between the studied groups of patients (t=1.878; p=0.064). CONCLUSIONS: Acetabular component position of the total hip endoprosthesis was not compromised by anatomic changes of the acetabulum caused by Chiari pelvic osteotomy.
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Acetábulo/anatomía & histología , Acetábulo/diagnóstico por imagen , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Cadera/normas , Análisis de Falla de Equipo , Adolescente , Adulto , Trasplante Óseo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/cirugía , Osteotomía/métodos , Postura , Radiografía , Reoperación , Resultado del Tratamiento , Adulto JovenRESUMEN
UNLABELLED: Fractures of the femoral neck are the most common with the older population, and in this population are dominantly made by the forces of low strength intensity. AIM: To show early complications ensued during the first 6 weeks after the surgical treatment of the older patients with fractures of the femoral neck. MATERIALS AND METHOD: 315 hospitalised patients are included within the retrospective analysis who are operated because of the fracture of the femoral neck in KBC Bezanijska Kosa in Belgrade, in the period 2007-2010. RESULTS: Early complications noted during the first 6 weeks after the surgery were: death of the patient 17 (5.3%), dislocation of the endoprosthesis 12 (3.8%), wound infection 8 (2.5%), pulmonary embolism 1 (0.3%), deep-vein thrombosis 6 (1.9%), lesion n. peroneusa 4 (1.2%), paraplegia 1 (0.3%), decubital wounds of sacral region 15 (4.8%). CONCLUSION: Aloplastic surgery of dislocated fractures of the femoral neck with the older population enables relatively fast mobilisation of the patients, early rehabilitation of the patients with acceptable number of the early complications.
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Fracturas del Cuello Femoral/cirugía , Complicaciones Posoperatorias , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera , Femenino , Fijación Interna de Fracturas , Humanos , MasculinoRESUMEN
Minimally invasive hip surgery techniques have been proposed as an alternative to conventional soft tissue exposure total hip arthroplasty. Purposed advantages of the technique included less blood loss, faster recovery, shoter stay in hospital and better cosmetical result. During the years good results have been presented by many authors, and serious complications have been found only in a few articles. But, some papers reported a catastrofic complications of the MIS procedures. Our intention is to present complication which had occured in our experience with MIS total hip replacement. Retrospective study involved 215 patients (230 hips). All patients, of mean age 55.7 years, obtained fiber metal midcoated or fiber metal taper femoral stem and identical fiber metal coated acetabular shell with polyethylene or ceramic insert. The goal of the study was to evaluate intraoperative and early postoperative complications: bone fractures and/or implant, blood loss, dislocations, prolonged bleeding, loss of component position in 6 week postop. period, infections, and thromboembolism. The complications we had may occure with any type of operating technique. The purpose of the study was not either to condone or condemn MIS techniques but to shaw the complications that had occurred in our experience.
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Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Cadera/efectos adversos , Femenino , Prótesis de Cadera , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversosRESUMEN
This paper investigates the properties of geopolymer obtained by alkali-activation of fly ash (FA), i.e. the influence of characteristics of the representative group of FA (class F) from Serbia, as well as that of the nature and concentration of various activators on mechanical and microstructural properties of geopolymers. Aqueous solutions of Ca(OH)(2), NaOH, NaOH+Na(2)CO(3), KOH and sodium silicate (water glass) of various concentrations were used as alkali activators. It was established that the nature and concentration of the activator was the most dominant parameter in the alkali-activation process. In respect of physical characteristics of FA, the key parameter was fineness. The geopolymer based on FA with the highest content of fine particles (<43 microm), showed the highest compressive strength in all cases. Regardless of FA characteristics, nature and concentration of the activator, the alkali-activation products were mainly amorphous. The formation of crystalline phases (zeolites) occurred in some cases, depending on the reaction conditions. The highest compressive strength was obtained using sodium silicate. Together with the increase of sodium silicate SiO(2)/Na(2)O mass ratio, the atomic Si/Al ratio in the reaction products was also increased. Under the experimental conditions of this investigation, high strength was directly related to the high Si/Al ratio.
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Álcalis/química , Carbono/química , Material Particulado/química , Polímeros/química , Ceniza del Carbón , Fuerza Compresiva , Fenómenos Mecánicos , Silicatos , ZeolitasRESUMEN
The authors are describing currently important problem--developmental dislocation of the hip. Guidelines for the treatment have been given according to literature date and upon their own experience. Therapeutic suggestions for the first twelve months of life are based on the ultrasound typing--it is advised to perform nonoperative treatment (abduction devices, "over head" traction, Pavlik harnesses). During the second year of life a pause in the treatment should be adviced in order to avoid postreduction avascular hip necrosis as a very important complication. After that period surgical treatment has to be done (open reduction, pelvic and femoral osteotomies). Special suggestions have been given for the treatment of consecutive leg length inequality and the deformities caused by postreduction avascular hip necrosis.
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Luxación Congénita de la Cadera/terapia , Preescolar , Luxación Congénita de la Cadera/diagnóstico , Humanos , Lactante , Recién NacidoRESUMEN
"Minimaly-invasive" total joint arthroplasty have been widely introduced to the orthopaedic community several years ago. The concept has received a great attention and has been greeted variably with enthusiasm, concern, and skepticism. Numerous meetings, scientific exibits, symposia and congreses has been taking place all around the world. Whether this represents the future of orthopaedic surgery or just a fad, the term "minimaly-invasive" or "minimaly-incision" are yet to be clear and establish. Our intention is to present 72 of first 100 cases of total hip arthroplasty performed by "minimaly-incision" surgery. In our opinion first results are positve and we intend to continue with this kind of surgery.
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Artroplastia de Reemplazo de Cadera/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodosRESUMEN
Fasciocutaneous lobe on AIP ( a. interossea posterior) is characterized by thin skin, good texture and satisfactory pedicle lenght, which enables the repair of numerous hand defects. It can be either loose or reversed on the pedicle. We present here 2 neglected cases of thumb injury in which there was a need to compensate the full thickness of the skin. We believe that thumb defects can be repaired with both functionally and esthetically good effects using AIP lobe.