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INTRODUCTION: Gonarthrosis is arthrosis of the knee joint, a chronic non-inflammatory disease manifested by progressive destruction of the intra-articular cartilage, accompanied by abnormal formation of the bones form the joint, changes in the synovial membrane and synovial fluid. Gonarthrosis is the most common type of arthrosis. Gonarthrosis can be treated conservatively and operatively. Among well-established surgical options for the treatment of medial gonarthrosis are high tibial osteotomy (HTO), unicompart-mental knee arthroplasty (UKA), and total knee arthroplasty (TKA). Proximal fibular osteotomy (PFO) or superior partial fibulectomy is a relatively recent procedure proposed to reduce knee pain in patients with medial compartment. AIM: Our study aims to demonstrate an alternative treatment for gonarthrosis with proximal fibular osteotomy and reduced knee pain in patients with medial compartment osteoarthritis of the knee. MATERIALS AND METHODS: At the Department of Orthopedics and Traumatology at J.Z.U "Borka Taleski" Prilep in the period from 2018 to 2021, 14 cases were treated, of which 11 were female and 3 were male. All patients were aged between 62 and 82 years with a mean age of 71.3 years. Patients had a severe degree of gonarthrosis (III/IV) according to Kellgren-Lawrence classification. Arthroscopy was performed in 2 patients. The fibula osteotomy was 7 cm away from the fibular head, with 1 cm resected bone fragment from the fibula. RESULTS: The average duration of the surgery was 30 minutes. Patients were followed up on the 7th day, first month, 3 months and 6 months after surgery. The final evaluation of function was done after 6 months by examining the active and passive movements of the knee joint. In all 14 patients we have excellent results with pain reduction, improvement of movement and quality of life. CONCLUSION: Proximal fibular osteotomy is an option for medial compartment osteoarthritis of the knee. Current literature is limited to small case series which report good outcomes in pain reduction, including the correction of varus deformity in medial gonarthrosis. Further studies are needed to determine the place of the PFO in the medial gonarthrosis management algorithm before it can be recommended for routine clinical use.
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Osteoartritis de la Rodilla , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Osteoartritis de la Rodilla/cirugía , Osteoartritis de la Rodilla/complicaciones , Peroné/cirugía , Calidad de Vida , Dolor/complicaciones , Dolor/cirugía , Osteotomía/efectos adversos , Osteotomía/métodos , Resultado del TratamientoRESUMEN
Porous metal augments have been used successfully for management of large acetabular defects during revision hip arthroplasty. This study analyzes and compares the clinical and radiographic outcomes of porous metal augments in cemented and uncemented acetabular revisions, all performed at the same institution. In the period 2015-2017, 36 patients with 37 large acetabular defects were treated with porous metal augments in cemented and uncemented acetabular revisions. Postoperatively, patients were monitored for two years on average period of 24-36 months. Acetabular augments were used when preoperative and intraoperative findings indicated the presence of large acetabular defects that can hinder the stability of the revision implants. We used lateral approach, 36 mm femoral head, and cementless or cemented acetabular cup depending on local bone quality. Postoperatively, all patients followed total hip arthroplasty precautions, with weight bearing as tolerated regimen with use of crutches during 6 weeks after surgery. The follow-up was radiological and clinical. We used HHS. At a mean follow-up of two years (range 24-36 months) one patient had reinfection and one patient had infection. None of the patients shown signs of aseptic augment or acetabular cup loosening. Porous metal augments show comparable excellent radiographic and clinical short-term outcomes, when combined with cemented or uncemented cups in revision hip arthroplasty. They allow good bone ingrowth, adequate implant contact and good stability. Complications were related to infection and not related to the augments itself.
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Acetábulo/anomalías , Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/instrumentación , Reoperación/métodos , Acetábulo/diagnóstico por imagen , Cuidados Posteriores , Anciano , Artroplastia de Reemplazo de Cadera/métodos , Cementos para Huesos/efectos adversos , Cementación/tendencias , Femenino , Prótesis de Cadera , Humanos , Masculino , Metales/efectos adversos , Persona de Mediana Edad , Porosidad , Complicaciones Posoperatorias/epidemiología , Diseño de Prótesis , Radiografía/métodos , Reoperación/instrumentación , Resultado del TratamientoRESUMEN
INTRODUCTION: In the past distal tibia fractures, including intraarticular fractures, frequently led to poor functional outcomes. The Ruedi-Allgower four steps open method, and later the Patterson and Sirkin recommendations for delayed operative treatment has made a drastic advancement in the treatment of these fractures. The two-stage minimally-invasive protocol using locking plate fixation proved a historical turning point, improving functional results to the highest levels compared to all other methods. AIM: To present the superior results of the two-stage minimally-invasive method using locking plate fixation, making this a historic step forward in treating distal tibia fractures. MATERIAL AND METHODS: A prospective longitudinal study, collecting data from Traumatology-Clinic in the 2014-2016 periods, available for nine-month follow-up. Twenty-three patients were finally included in the study. RESULTS: In analysing the data collected, we focused our attention on the final functional outcomes as indicated by dorsiflexion nine months after injury and also according to the AOFAS Ankle-Hindfoot Scale. Results were excellent with no or minimal consequences. Where complications were present, these were benign and did not require further surgery. CONCLUSION: We believe this modern method for the treatment of distal tibia fractures should be applied routinely and considered as the gold standard in this domain.
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INTRODUCTION: This study was conducted to analyze the reliability of clinical diagnosis in ACL tear injuries. MATERIAL AND METHODS: All patients attending our clinic with knee pain from 2009 to 2013 underwent systematic and thorough clinical assessment. From one hundred and three patients with knee problems in 73 were arhroscopicaly diagnosed ACL tears. All these patients underwent therapeutic arthroscopic knee surgery. The clinical diagnosis was confirmed during this procedure. The accuracy, sensitivity and specificity were calculated based on these arthroscopic findings. RESULTS: The accuracy of clinical diagnosis in our study was 82.5% for ACL tears. Our study revealed high sensitivity and specificity and almost high accuracy for ACL injuries of knee joint in comparison to arthroscopy. MRI is an appropriate screening tool for therapeutic arthroscopy, making diagnostic arthroscopy unnecessary in most patients. CONCLUSION: Magnetic resonance imaging is accurate and non invasive modality for the assessment of ligamentous injuries. It can be used as a first line investigation in patients with soft tissue trauma to knee.
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The aim of this study was to compare findings from clinical examinations, MRI scans and arthroscopy in ACL injury of the knee in order to assess the diagnostic significance of both examination findings. This study was conducted to manage the reliability of clinical diagnosis in ACL tear injuries. All patients attending our clinic with knee pain from 2009 to 2013 underwent systematic and thorough clinical assessment. Of 103 patients with knee problems arthroscopy ACL tears was diagnosed in 73. All these patients underwent therapeutic arthroscopic knee surgery. The clinical diagnosis was evaluated and confirmed during this procedure. The accuracy, sensitivity and specificity were calculated based on these arthroscopic findings. The MRI accuracy of clinical diagnosis in our study was 82.5% for ACL tears. Accuracy for two of three clinical examination tests of clinical diagnosis in our study was 96% and 94% for ACL tears. According to our obtained correlation between clinical examinations, MRI scan and arthroscopy for ACL injuries, we concluded that carefully performed clinical examination can give equal or better diagnosis of ACL injuries in comparison with MRI scan. Our study revealed MRI scan high sensitivity and specificity and not so high accuracy for ACL injuries of the knee joint in comparison with arthroscopy. MRI is an appropriate screening tool for therapeutic arthroscopy, making diagnostic arthroscopy unnecessary in most patients. According to our findings we can conclude that a positive anterior drawer test and a positive Lachman clinical examination test is more accurate for predicting, i.e. diagnosis of ACL tear. On the ither hand, MRI scan findings showed less accuracy for predicting, i.e. diagnosis of ACL tear. According to many studies of clinical examination tests compared (correlated) with arthroscopy, the accuracy of predicting ACL tears depends on the level of the skilled orthopaedic or trauma surgeon's hands. Based on these findings, we feel that MRI, except in certain circumstances, is an expensive and unnecessary diagnostic test in patients with suspected meniscal and ACL pathology.