Megaendoprosthesis in the treatment of bone tumors in the knee and hip region

Background/Aim. For almost two decades extremity amputation has not been the only viable option for patients with from bone cancer in the region of the hip and knee. Remarkable advances in implant technology, surgical reconstructive technique and adoption of new chemotherapy protocols provide a new option for surgeons who diagnose and treat bone tumors. Megaendoprosthesis has become widely accepted alternative in limb salvage surgery of the extremities. The aim of this study was to present an outcome of the treatment of bone tumors in the knee and hip region by the use of custom made megaendoprothesis. Methods. In the period 2006-2008 we adopted new clinical practice protocols for preoperative management in candidates for tumor megaprostheses of the hip and knee including: surgical tumor staging, histopathological verification, determinants of anatomical-mechanical defect, status of soft tissues, CT evaluation of the referent measures of pelvis, femur and tibia necessary for creation of custom made endoprosthesis and surgery plan, as well as modern, less invasive surgical approach. The patients were monitored during ≥ 24 months after the surgery for detecting possible complications. Results. All procedures were performed without complications during and immediately after the surgery. During the follow-up period not less than 24 months we failed to record any significant complications. Conclusion. Custom made megaendoprosthesis are the method of choice in the treatment of bone tumors in the region of the hip and knee at the Orthopedics and Traumatology Clinic, Military Medical Academy, Belgrade. The greatest challenge - ensuring longevity of a prosthesis can be achieved not only by prevention of common complications of arthroplasty procedures but, certainly, with the introduction of new methods for preoperative planning - computer-assisted technique of measuring referent sizes and software solutions for the selection and design of custom-made components of an endoprosthesis

Prednosti i rizici bilateralnih artroplastika kolena u jednom aktu

Introduction: Gonarthrosis in a certain number of cases requires surgical treatment – knee arthroplasty. Bilateral gonarthrosis is a common finding. Patients with bilateral gonarthrosis can be operated in one procedure, during one course of a hospital stay, which may have significant advantages over delayed procedure. Bilateral knee arthroplasty in one procedure is routinely performed in some orthopedic centers, and in other, due to potentially higher risks of this approach, patients are operated in two surgical procedures with various time intervals between two arthroplasties. The aim of the study is to determine the advantages and risks of bilateral knee arthroplasty in one procedure in relation to bilateral total knee arthroplasty in two procedures. The aim was to determine the benefits and risks of bilateral knee arthroplasty in one act in relation to bilateral total knee arthroplasty in two acts. Methods: Retrospective study, in the first group, 256 patients of both gender, who had bilateral total knee arthroplasty in one act in the Department of Orthopaedic Surgery and Traumatology, Military Medical Academy in Belgrade from 01. january 2004. to 31. december 2011. year, in the second group were 165 patients who had bilateral total knee arthroplasty in two acts in the same department and in the same period. In all cases, an identical surgical approach and technique was used, with the standard antibiotic prophylaxis and thromboprophylaxis with low-molecular weight heparins. We assessed the risk of postoperative mortality, complications, functional outcome, the need for transfusions, and length of hospital stay. Results: This analysis shows that in the examined groups of patients, SBTKA and BTKA in two acts, who had no significant differences in the presence of preoperative comorbidity and age, there were no statistically significant differences in postoperative 30-day mortality, postoperative complications, infections and revision surgery. When it comes to the assessment of the functional outcome and length of hospital stay SBTKA shows significantly better results compared to BTKA in two acts. 7 Conclusion: Results of this study show that SBTKA even in patients with recorded preoperative comorbidities can be safe and successful procedure with acceptable low incidence of postoperative complications

Femoroacetabular impingement after the femoral neck fracture healed in a nonanatomical position

Introduction. Femoroacetabular impingement is the result of the pathological conditions in the osseous acetabulum and/or the proximal femur. One of its causes is a non-anatomically healed femoral neck fracture. Case report. A male, aged 51, with a subcapital left femoral neck fracture was treated conservatively. The fracture healed 9 months later and although the patient was walking on crutches he suffered from pain in the left groin. The X-ray images showed the valgus and the retroposition of the left femoral head. The patient was operated on and intraoperatively the thickness and a bone prominence in the anterosuperior femoral neck area in the line of the previous fracture were found, which was pressing and spreading beneath the acetabular labrum, thus squeezing the acetabular cartilage. The labrum lesion which was found was the result of the mechanical pressure of the existing femoral neck deformity during the hip movements. Irretrievably damaged part of the labrum was resected and the anterosuperior femoral headneck osteochondroplasty was done. One year after the surgery, the patient had no pain, he walked without limping, the impingement test was negative, the radiological parameters were adjusted and there were no signs of the avascular necrosis of the femoral head. Conclusion. The femoral neck fracture should be treated adequately with the full anatomical position and the proper internal fixation. If the deformity occurs as the result of a treatment, it should be removed as soon as possible to prevent the osteoarthritis of the hip