Custom hip arthroplasty

     Total hip replacement is rapidly growing procedure because of  pain relief ,restoring range of motion  and patient`s satisfaction. Primary go is to restore individual geometry of patient`s hip joint, long term components survival and most important- improving patient`s quality of life.  In past decades this surgery has several limitations as patient`s age, bone morphology ( incl. anatomical deformities) ,previous surgeries ,etc.  Recently , with the development of modern implants ( cups and stems) these limitations are past. Young patients indicated for THA are always great challenge , because their functional requirements , life expectancy ,anatomical variations (  due to congenital or acquired disorders) , greater mobility and higher risk of aseptic loosening.  Standart  cementless  stems have some unsolved issues as fixed  intra / extramedular  dimentions, proximal stress shielding, impingement, etc. They are based on 2D-planning and often have mismatch between acetabular and femoral center of rotation.  Custom femoral  stems are based on specific 3D- scan of the hip joint, which presents  individual  shape of  acetabulum and especially femoral canal. This allows  optimal bone support for the stem, preserving bone substance , excellent  contact bone-stem and most important- restores center of rotation.  For the period 2010-2014  we  operated  16 patients , 8 were  with Osteoarthrosis (OA); 4-with Avascular necrosis (AVN) ; 2 with dysplastic hips (DDH) and two with posttraumatic osteoarthrosis . Follow up is 6-42 months.  We perform THA with modified  posterior surgical approach with minimal femoral reaming, due to individual femoral rasp with the same size  as the customized  femoral stem. During  the follow up period we found no complications,Harris Hip Score was 97 pts.  and  85%  of  the patients had regular physical exercises for 3 weeks

Arthroscopic treatment of massive rotator cuff tears involving subscapularis

Introduction. Massive rotator cuff tears represent a major challenge in shoulder surgery. Contemporary arthroscopic techniques allow for repair in majority of cases. In the setting of a massive rotator cuff tear, engagement of subscapularis plays a significant role in function deterioration and is a risk factor for pseudoparalysis. Materials and methods. We present our experience and clinical results with arthroscopic repair of massive rotator cuff tears engaging subscapularis in 32 patients, followed for 12,5 months. Results. Complete repair was performed in 25 (78.1%) and partial repair in 7 (21,9%) of the cases with significant improvement in active forward flexion and good to excellent functional result in 68,8%, according to Constant score. Acute pseudoparalysis was successfully reversed in 8 out of 9 cases (88,8%). Transient neurologic complication was observed in 1 case (3%). Conclusion. Subscapularis plays an important role in massive rotator cuff tears and should always be repaired. Arthroscopic repair of massive rotator cuff tears engaging subscapularis is safe and efficient with good clinical results during one year follow up. While complete repair of all torn tendons with secure reattachment to the tuberosities is the preferred surgical treatment, repair of subscapularis and lower portion of infraspinatus is crucial for normal rotator cuff function. Careful patient selection and individually tailored surgery is important for successful treatment

Revision total hip replacement using long curved fully hydroxyapatite-coated modular stems with distal interlocking

Successful femoral reconstruction in revision total hip replacement needs to address variable metadiaphyseal bone defects and still represents a controversial issue. We present our clinical experience with the use of two types of long revision, curved, fully hydroxyapatite (HA)-coated titanium femoral stems with distal interlocking. A group of 20 patients has been followed up clinically and radiographically for a period of 12.1 months (3-30 months). Indications included aseptic and septic loosening as well as adverse local tissue reactions (ALTR) to metal debris. The major complications in our series included postoperative instability and intraoperative periprosthetic femoral fracture. Revision curved modular fully HA-coated stems with distal interlocking provide for good primary stem stability and successful secondary osteointegration in revision total hip arthroplasty (THA) for both aseptic and septic loosening in the setting of femoral bone defects. Longer follow-up in a larger cohort of patients is needed to confirm the good and very good short-term results and assess femoral bone remodeling

DUAL MOBILITY CUPS REDUCE DISLOCATION RATE IN TOTAL HIP ARTHROPLASTY FOR DISPLACED FEMORAL NECK FRACTURES

PURPOSE: To assess the dislocation rate after total hip arthroplasty with dual mobility cup (DMC) for displaced femoral neck fractures and to compare the results with that of conventional total hip arthroplasty (THA) and bipolar hemiarthroplasty (BHA) in the same clinical setting at our institution. MATERIALS AND METHODS: 49 cases (47 patients) treated with total hip arthroplasty with DMC, 38 cases (38 patients) with BHA and 29 patients (29 cases) operated on with conventional THA were retrospectively reviewed. RESULTS: In the DMC total hip arthroplasty group, there were no dislocations (0%). %). One dislocation (3,1%) occurred in the BHA group, and 3 dislocations occurred (11,1%) in the THA group. ). There was a statistically significant difference in favour of DMC group compared to THA group regarding dislocation rate (p=0,05). Dislocation rate did not differ significantly between DMC and BHA groups. There was no significant difference in mortality, complications and re-operation rate between groups. CONCLUSION: Dual mobility cups significantly reduce dislocation rate in total hip arthroplasty performed for displaced femoral neck fractures compared to conventional total hip arthroplasty while similar advantage over bipolar hemiarthroplasty could not be demonstrated in the current study

Foreign Investment, Regulatory Arbitrage, and the Risk of U.S. Banking Organizations

This study investigates the implications of cross-country differences in banking regulation and supervision for the international subsidiary locations and risk of U.S. bank holding companies (BHCs). We find that U.S. BHCs are more likely to operate subsidiaries in countries with weaker regulation and supervision and that such location decisions are associated with elevated BHC risk and higher contribution to systemic risk. The quality of BHCs' internal controls and risk management play an important role in these location choices and risk outcomes. Overall, our study suggests that U.S. banking organizations engage in cross-country regulatory arbitrage with potentially adverse consequences