Measuring Improvement Following Total Hip and Knee Arthroplasty Using the SF-36 Health Survey

The aim of this study was to evaluate the impact of total hip or knee arthroplasty upon quality of life in elderly patients. The study was carried out at the Clinic for Orthopaedic Surgery Lovran on 74 total hip arthroplasty and 70 total knee arthroplasty patients. All patients had completed theMedical Outcomes Study 36-Item Short Form in the week having preceded their surgery and then again postoperatively, 2 years after. The data obtained were statistically processed at the level of physical function, role limitations due to physical problems, role limitations due to emotional problems, social function, mental health, energy or vitality, pain and general health perception, and change in health. The primary total hip arthroplasty patients showed significant improvement at all levels measured. Similarly, the primary total knee arthroplasty patients expressed significant improvement according to all the parameters but the mental health assessment. Comparison of outcomes between the two assessment groups of patients resulted in slightly superior quality of life outcomes in total hip arthroplasty patients. It can be concluded that total hip or knee arthroplasty significantly enhances the health related quality of life in elderly patients

Bilateral Congenital Dislocation of the Knee with Ipsilateral Developmental Dysplasia of the Hip – Report of Three Patients

Congenital dislocation of the knee (CDK) is a very rare condition. Here we report our strategy and results in treatment of three children with CDK. All three patients were treated with conservative method, and only one had underwent a surgical procedure on one knee. Of the remaining, we recorded a good outcome with conservative treatment in three knees, while two had poorer outcome as a result of musculoskeletal anomalies. We also present here a unique case of a child born without cruciate ligaments and patellas on both sides. We performed the operative procedure by Z-plasty of the extensor apparatus on one left knee according to Niebauer and King on one child. The clinical result of this procedure was very good. Five years after the operation we decided to perform an MRI examination to assess the postoperative status of the operated knee, especially the position and the shape of left patella. We found the asymmetry and high position of the operated patella resulting in patella alta. Compared to the initial clinical presentation, we consider all patients to have good clinical presentation nowdays

Hemiarthroplasty is an Effective Surgical Method to Manage Unstable Trochanteric Fractures in Elderly People

Trochanteric femoral fractures are a major problem in the elderly because of higher bone fragility due to osteoporosis. Numerous chronic illnesses, which usually affect the elderly, aggravate and complicate their surgical treatment. Trochanteric femoral fractures results in high morbidity and mortality in elderly patients. The aim of our study is to evaluate the effectiveness of hemiarthroplasty in the treatment of unstable trochanteric femoral fractures in elderly patients. Between 2000 and 2005, 50 patients with unstable trochanteric femoral fractures (41 women) aged 75 to 92 years (mean 86 years) underwent cemented hemiarthroplasty. The surgical procedure was performed within first 48 hours after the fracture (out of which 14 in the first 12 hours, 27 in the first 24 hours and 9 in the first 48 hours), with minimal blood loss. Hemiarthroplasty was indicated in patients where stability was important to allow early mobilization. In forty patients (80%) early ambulation with full weight bearing was achieved during the short period of hospitalization (9–14 days). Given that the affected population is predominantly the elderly, who are less mobile and demanding and thus put less strain on the endoprosthesis, we believe that this kind of treatment is the treatment of choice for unstable trochanteric femoral fractures in these patients. This assumption is corroborated by the fact that we did not have any endoprosthesis luxation, apparent acetabular protrusion or instability during the mean follow up period of 15 months (range 12–18 months)

Computer assisted total knee arthroplasty

Artroza koljena je najčešća degenerativna bolest zglobova čija se incidencija povećava starenjem populacije. U uznapredovaloj fazi bolesti liječenje artroze koljena obuhvaća ugradnju totalne endoproteze koljena. Dugotrajnost preživljenja totalne endoproteze koljena ovisi o ispravnoj pozicioniranosti komponenata endoproteze u sve tri ravnine, odnosno o rekonstrukciji biomehaničkih odnosa donjeg ekstremiteta. Pogreške u kirurškoj tehnici najčešći su razlog nepreciznosti ugradnje komponenti totalne endoproteze koljena. Razvojem instrumentarija poboljšavaju se rezultati ugradnje endoproteze koljena, a značajan napredak postiže se uvođenjem računalne navigacije u kirurgiju koljena 1997. godine. Virtualnim povezivanjem anatomskih struktura, prvenstveno koštane anatomije pacijenta, s računalnom slikom istoga, koristeći podatke slikovnih pretraga ili anatomske intraoperativne podatke, svaka je kirurška akcija prikazana na ekranu u realnom vremenu na računalno oblikovanom modelu. Virtualna trodimenzionalna reprodukcija koljena uz pomoć računala omogućava preciznije reseciranje zglobnih površina i ugradnju komponenti endoproteze koljena. Precizna pozicioniranost dijelova endoproteze i rekonstrukcija biomehaničkih odnosa omogućava brži oporavak, agresivniju fizioterapiju, a i sam vijek endoproteze je produljen, čime se smanjuju troškovi zdravstvenog sustava i povećava zadovoljstvo pacijenta.Knee osteoarthritis is the most common degenerative joint disease, whose incidence increases as populations age. In advanced stages, knee osteoarthritis disease treatment considers the implantation of a total knee endoprosthesis. Longterm survival of total knee endoprosthesis depends on the correct positioning of prosthesis components in all three planes, with respect to the reconstruction of the biomechanical relations of the lower extremities. Mistakes in surgical technique are the most common reason for inaccurate implantation of the total knee endoprosthesis components. The development of instruments for total knee arthroplasty enhanced the results of total knee arthroplasty and significant progress was achieved with the introduction of the computer navigation system in knee surgery in 1997. Virtual linking of anatomical structures, primarily the bone anatomy of the patient, with computer images of the same, using image search data or intraoperative anatomic data, each surgical action is displayed on the monitor in real time on a computer-shaped model. Virtual three-dimensional reproductions of the knee using a computer system enable accurate resection of the articular surface and precise implantation of total knee endoprosthesis components. The precise positioning of total knee endoprosthesis components and the reconstruction of the biomechanical relations allow faster recovery, aggressive physiotherapy, and longer survival of endoprosthesis which reduce the cost of the health system and increase patient satisfaction

Malignant fibrous histiocytoma of the femur - case report

U članku prikazujemo 33-godišnjeg pacijenta oboljelog od malignog fibroznoga histiocitoma lijevog femura. Bolesnik je primljen u našu ustanovu radi patološkog prijeloma proksimalnoga dijela lijevog femura. Nakon hospitalizacije učinjena je biopsija tumorozne tvorbe, te je dobivena dijagnoza malignog fibroznoga histiocitoma. Pacijent je upućen na kemoterapiju, te se po provedenom liječenju ponovno hospitalizira u našoj ustanovi. Tada se učini ekstirpacija tumora in toto, uz rekonstrukciju alogenim presadkom proksimalnoga femura i ugradnjom totalne revizijske endoproteze lijevoga kuka. Postoperacijski tijek protekao je uredno, a pacijent se vertikalizirao uz pomoć dvije dolaktične štake. Godinu dana po operativnom zahvatu prisutan je uredan položaj ugrađenog transplantata i ndoproteze, nema znakova recidiva, a pacijent samostalno obavlja svakodnevne životne aktivnosti.In this article we present the case of a 33-year-old patient with malignant fibrous histiocytoma of the left femur. The patient was admitted in our hospital due to pathological fracture of the left proximal femur. Upon admission, tumor biopsy was performed and malignant fibrous histiocytoma was confirmed. Chemotherapy and radiotherapy were performed prior to the second admission to our hospital. We performed extirpation of the tumor in toto and reconstruction with homotransplantat for proximal femur and implantation of total revision endoprothesis for the left hip. The postoperative course was without complications and the patient started walking with 2 crouches after surgery. A year after surgery there is an adequate postion of homotransplantat and endoprosthesis, there are no signs of relapse and the patient continues with normal daily activities

OBESITY INDICATORS AND ATHLETIC PERFORMANCE IN 11-15 YEAR-OLD CHILDREN

Poveæana tjelesna masa djece se često u literaturi povezuje sa smanjenim sposobnostima vezanima uz sportsku izvedbu. Zbog smanjenih motoričkih sposobnosti takva djeca često izbjegavaju sudjelovanje u sportskim aktivnostima što dovodi do zatvorenog kruga tj. do daljnjeg povećanja tjelesne mase. Cilj ovog rada bio je utvrditi koje motoričke sposobnosti su pod najvećim utjecajem povećane tjelesne mase, te da li postoje razlike prema spolu. Uzorak se sastojao od 224 djece koji su bili polaznici 5, 6, 7 i 8-og razreda osnovne škole (prosječna dob 13,07±1,24). Prije početka istraživanja, detaljna objašnjenja postupka ispitivanja te obrazac za suglasnost roditelja poslana su roditeljima djece. Protokol testiranja je obuhvaćao mjerenje morfoloških karakteristika (visina, težina, postotak masti) i različitih motoričkih sposobnosti (brzina, snaga, vrijeme reakcije, ravnoteža mjereni na Kistler Quattro jump force platformi, ravnotežnim platformama i Newtest Powertimer PC sustavu). Za svako dijete je izračunat indeks tjelesne mase i postotak masti, te je pojedinačno svaki ispitanik uvršten u pojedinu skupinu prema stupnju uhranjenosti (nedovoljno uhranjeni, normalno uhranjeni, poveæane tjelesne mase i pretili). U tu svrhu su se koristili grafikoni rasta za dob i spol. ANOVA/MANOVA statistička analiza je ukazala na znaèajan pad sposobnosti s porastom stupnja uhranjenosti u svim motoričkim testovima osim testovima ravnoteže kod dječaka. Nasuprot tome, neočekivano, sposobnosti djevojaka većeg indeksa tjelesne mase se nisu značajno razlikovale od onih nižeg indeksa. Jedini statistički značajno lošiji rezultat deblje djevojke su postigle na testu repetitivnih pokreta donjih ekstremiteta. U zaključku, sportski programi koji se nude u školama morali bi sadržavati i aktivnosti u kojima se dječaci povećane tjelesne mase neće osjećati nedovoljno sposobnima, a možda čak i neke sportove u kojima je bitna ravnoteža kao pokazatelj koji je najmanje pod utjecajem tjelesne mase kao npr. skateboard i sl.An increased body mass in children is usually associated with a decrease in athletic performance. Because of the poorer performance, children tend to avoid the participation in sport activities. This leads to the vicious circle resulting in further increase in body weight. The aim of this study was to identify the motor abilities which are most affected by the body mass increase and to investigate the possible differences in the influence of body mass index on motor abilities with regard to sex. The sample comprised 224 children attending 5th, 6th , 7th and 8th grade of the elementary school (mean age 13,07±1,24). Prior to testing, the detailed explanations of the testing procedure as well as the parental consent form were distributed to the parents. The children underwent testing procedure encompassing measurements of morphological characteristics (height, weight, body fat percentage) and motor abilities (various tests for speed, power, reaction time and balance performed on Kistler Quattro jump force platform, balance boards or Newtest Powertimer PC system). For each child the body fat percentage and body mass index were calculated. Each subject was checked on percentile growth chart for children and classified into one of four categories: underweight, normal weight, overweight or obese. The ANOVA/MANOVA analysis showed, in boys, a significant decrease in all tested motor abilities with the increase of body weight except for the balance board performance. On the contrary, the athletic performance in girls was not significantly influenced by the increase of body mass index. The only test in which the decrease in performance in girls was noted was the test measuring the frequency of lower legs repetitive movements. In conclusion, as the overweight boys of that age do not perform in sport activities as good as their leaner counterparts do, we think that a special attention should be paid to the selection of the sport activities offered for boys in school sport clubs. We have seen here that the balance is still well preserved, regardless of the body mass, so it might be a good choice to offer skateboard classes or similar activities