Influence of the acetabular cup position on hip load during arthroplasty in hip dysplasia

Abstract Placement of the acetabular cup during total hip arthroplasty is of great importance because usually every deviation from the ideal centre of rotation negatively influences endoprosthesis survival, polyethylene wear and hip load. Here we present hip load change in respect to various acetabular cup positions in female patients who underwent total hip replacement surgery due to hip dysplasia. The calculation suggests that, in the majority of cases, for every millimeter of lateral displacement of the acetabular cup (relative to the ideal centre of rotation) an increase of 0.7% in hip load should be expected and for every millimeter of proximal displacement an increase of 0.1% in hip load should be expected (or decreased if displacement is medial or distal). Also, for every millimeter of neck length increase, 1% decrease is expected and for every millimeter of lateral offset, 0.8% decrease is expected. Altogether, hip load decreases when the cup is placed more medially or distally and when the femoral neck is longer or lateral offset is used. Résumé Le positionnement de la cupule acétabulaire durant la réalisation d'une prothèse totale de hanche est très important car une déviation de la position idéale du centre de rotation peut influer de façon négative sur la survie, sur l'usure et sur les vecteurs de forces au niveau de la hanche. Nous présentons une étude qui permet de visualiser les vecteurs de forces en fonction des différentes positions de la cupule chez des patients de sexe féminin qui ont bénéficié d'une prothèse totale de hanche mise en place pour dysplasie. Les calculs permettent de penser que dans la majorité des cas chaque millimètre de latéralisation de la cupule augmente de 0,7% la charge au niveau de la hanche et que chaque déplacement proximal l'augmente de 0,1%. Ainsi chaque augmentation millimétrique de la longueur du col peut entraîner une diminution de 1% des forces, de même en ce qui concerne chaque millimètre d'offset latéral qui permet d'obtenir une diminution de 0,8%. En conclusion, les charges diminuent au niveau de la hanche quand la cupule est placée de façon plus médiane ou distale et quand les longueurs du col fémoral ou de l'offset son utilisées

Orthopedic and cutaneous reactions to nickel after total hip replacement

Implant degradation products have shown signs of a cutaneous allergic response after implantation of a metal orthopedic replacement, loosening and failure of the joints as well as skin rashes, general fatigue, pain, and impaired wounds and bone healing. The prevalence of contact skin sensitivity in patients with a joint replacement device is higher than that in the general population. This delayed hypersensitivity to metallic orthopedic implants is more clearly defined and is a contributing factor to implant failure. Nickel was associated with hypersensitivity responses as the first cause in metallic orthopedic implants as early as 1966 by Foussereau and Laugieru and is a commonly used metal in alloys because it grants necessary strength and durability to the implant. Herein we report on delayed hypersensitivity to nickel sulfate in a patient with pain, fatigue, and contact allergic dermatitis in both inguinal regions, with instability of the left acetabular part and with five hip replacements from 1987 to 2013. The findings of this report support that primary sensitization to a metal due to an implant itself might develop. Proper investigation in patients with history or prior hypersensitivity reactions to metals and test evaluation before orthopedic device implantation is needed.  before orthopedic device implantation is needed. </p

Nova metoda liječenja patele alte kod bolesnice s cerebralnom paralizom: prikaz slučaja s pregledom literature

Patella alta is a common condition in ambulatory patients with cerebral palsy, especially those with crouch gait. The treatment of symptomatic patella alta in such patients is complex and conservative methods seldom provide satisfactory results. Thus, patellar tendon advancement surgery is often required and can be, if necessary, combined with other surgical procedures. Here, we report a case of combining both conservative method and surgical procedure in a 26-year-old female patient with cerebral palsy and bilateral patella alta. One month prior to surgical intervention we administered a botulinum toxin type A (BTX-A) in the ipsilateral quadriceps. Reduced muscle spasticity of the knee extensor mechanism facilitated the patellar tendon shortening procedure and yielded excellent postoperative results. After a six-month postoperative rehabilitation course, the patient had no pain and the knee range of motion improved from 5-50° preoperatively to 0-140° postoperatively in both knees. To our knowledge, we are the first to report a use of preoperative BTX-A in the treatment of patella alta in a patient with cerebral palsy. The efficacy and safety of this treatment modality may give encouragement to a wider use of preoperative BTX-A in order to facilitate surgical intervention and postoperative rehabilitation in cases of muscle spasticity.Patela alta relativno je često stanje u ambulatornih bolesnika s cerebralnom paralizom, osobito onih koji se prezentiraju čučećim hodom. Liječenje simptomatske patele alte u takvih je bolesnika složeno i konzervativne metode liječenja rijetko daju zadovoljavajuće rezultate. Stoga je u većini slučajeva indicirano operacijsko liječenje u smislu izolirane distalizacije patele ili udružene s drugim kirurškim zahvatima. U ovom radu prikazan je slučaj udružene primjene konzervativne metode liječenja i kirurškog zahvata kod 26-godišnje bolesnice s cerebralnom paralizom i obostranom patelom altom. Mjesec dana prije kirurške intervencije apliciran je botulinum toksin tip A (BTX-A) u ipsilateralni mišić kvadricepsa. Posljedično smanjena spastičnost mišića ekstenzora koljena olakšala je postupak skraćivanja ligamenta patele i omogućila je sigurniju rehabilitaciju. Šest mjeseci nakon operacije pojedinog koljena bolesnica se nije žalila na bolove, a opseg pokreta oba koljena poboljšan je s 5-50° prije operacije na 0-140° poslije operacije. Ovim radom prvi smo izvjestili o uporabi prijeoperacijskog BTX-A u liječenju patele alte kod bolesnika sa cerebralnom paralizom. Dokaz o učinkovitosti i sigurnosti ove metode liječenja mogao bi potaknuti širu prijeoperacijsku primjenu BTX-A kako bi se, u slučajevima povišenog tonusa mišića, olakšala kirurška intervencija i unaprijedila poslijeoperacijska rehabilitacija

Bifocal Stress Fracture of Pubic Rami after Contralateral Total Hip Arthroplasty and Longstanding Ipsilateral Hip Fusion

In this case report we present a patient with bifocal pubic rami stress fractures after contralateral total hip arthroplasty for congenital hip dysplasia and longstanding ipsilateral hip fusion. Treatment protocol for patients with various degrees of hip arthritis on one side and contralateral longstanding hip fusion are proposed based on the literature and our and previously published cases

Prvih 100 godina nastave ortopedije na Medicinskom fakultetu Sveučilišta u Zagrebu

In Croatia, hospitals where patients with diseases of the locomotor system were cared for date from more than 100 years ago. However, we consider the beginning of orthopaedics in Croatia to be the year 1908 when Božidar Špišić (1879 - 1957) founded the first Orthopaedic Institute in Zagreb. In 1917, the School of Medicine, University of Zagreb was founded, and when the first students were in their fifth year of studies, the Department of Orthopaedic Surgery was established on December 15, 1922, and Božidar Špišić became an Assistant Professor. From that date until today, Orthopaedics has been an independent department within the School of Medicine. The Department of Orthopaedic Surgery was primarily established for the education of medical students. Another important activity of the Department was the training of orthopaedic surgeons and specialists in overlapping fields with orthopaedics. In 1973, the department made a program of postgraduate studies in orthopaedics. The department also participated in postgraduate studies of other professions overlapping with orthopaedics and held numerous post-graduate courses and continuous medical education for doctors. Also, the department organised both domestic and international meetings, symposia, and congresses. Within the scientific post-graduate and doctoral studies, the Department of Orthopaedic Surgery members are lecturers in many courses. This article presents the work and development of the Department of Orthopaedic Surgery in the first 100 years of orthopaedics education at the School of Medicine, University of Zagreb and clinical work as a part of the University Hospital Centre Zagreb. It is a presentation of time periods under nine heads of the department, starting from Professor Božidar Špišić all to the current head Professor Domagoj Delimar.Premda su i ranije u Hrvatskoj postojale bolnice u kojima su se zbrinjavali bolesnici s bolestima i ozljedama lokomotornog sustava, organiziranim početkom rada ortopedije u Hrvatskoj smatra se 1908. godina kada je Božidar Špišić (1879. - 1957.) u Zagrebu osnovao prvi Ortopedski zavod na slavenskom jugu. 1917. godine utemeljen je Medicinski fakultet Sveučilišta u Zagrebu, i kada prvi studenti dolaze na petu godinu studija medicine, utemeljuje se i Katedra za ortopediju, a dr. Božidar Špišić postaje docent 15. 12. 1922. godine. Od tog datuma pa sve do danas ortopedija je samostalan predmet i Katedra u okviru Medicinskog fakulteta. Katedra za ortopediju prvenstveno je osnovana za edukaciju studenata medicine, dok je slijedeća značajna djelatnost Katedre za ortopediju bila i ostala izobrazba specijalista ortopeda i specijalista struka koje se preklapaju s ortopedijom. 1973. godine Katedra za ortopediju započela je provoditi plan i program postdiplomskog studija iz ortopedije, a održava i mnogobrojne postdiplomske tečajeve te tečajeve trajnog usavršavanja liječnika. Također, Katedra organizira domaće i međunarodne sastanke, simpozije i kongrese. Na znanstvenom postdiplomskom i doktorskom studiju članovi Katedre za ortopediju voditelji su mnogih kolegija. Prikaz rada i razvoja Katredre za ortopediju u proteklih 100 godina djelovanja u okviru Medicinskog fakulteta Sveučilišta u Zagrebu i Klinike za ortopediju Kliničkog bolničkog centra Zagreb podijeljen je na više vremenskih odsječaka, počevši od prvog pročelnika profesora Božidara Špišića sve do današnjeg, devetog pročelnika Katedre za ortopediju i predstojnika Klinike za ortopediju Kliničkog bolničkog centra Zagreb profesora Domagoja Delimara

Groin Pain

Entezitis tetiva aduktora longusa i/ili trbušnih mišića definiramo kao sindrom bolne prepone. Jedan od čestih uzroka nastanka sindroma bolne prepone jest slabost trbušne stijenke. Za nj danas postoji uvriježeni naziv sportska hernija. Sindrom bolne prepone najčešće se pojavljuje u nogometaša (u Hrvatskoj 6,24%). Inicijalno se pojavljuju mukle boli u području preponske regije kao rezultat opterećenja tokom sportske aktivnosti. U kliničkom pregledu osobito je važan aduktorski test. Liječenje sindroma bolne prepone je složeno, kao i uzroci nastanka sindroma. U početku treba smanjiti intenzitet treninga ili potpuno prestati sa sportskom aktivnošću. Primjenjuju se nesteroidni protuupalni lijekovi i miorelaksansi. Provode se vježbe istezanja i jačanja aduktora, trbušne muskulature, iliopsoasa, kvadricepsa te mišića stražnje lože natkoljenice. Ako konzervativno liječenje ne dovodi do poboljšanja, potrebno je kirurško liječenje.Groin pain is defined as tendon enthesitis of adductor longus muscle and/or abdominal muscles that may lead to degenerative arthropathy of pubic symphisis in an advanced stage. Pubic region is a point where kinematic forces cross. The balance between the adductor and abdominal muscles is of great importance, as well as the elasticity of pubic symphisis which enables movement of up to 2 mm and rotation of up to 3 degrees. The weakness of the abdominal muscle wall, known as the sportsman\u27s hernia, is the most common cause of painful groin. Groin pain is the most common in soccer players (6.24% in Croatia). Most authors believe that the main cause of groin pain is the adductor muscle overload. When active, sportsmen start to feel a dull pain in the groin region. The adductor test is of great importance for physical examination; the patient should be lying supine with his hips abducted and flexed at 80 degrees. The test is positive if the patient, while attempting to pull his/her legs against pressing in the opposite direction, feels a sharp pain in the groins. The treatment of groin pain is complex and individual, as its causes may vary from patient to patient. Gradual physical therapy combined with pharmacotherapy should be effective in most cases. The latter includes nonsteroid anti-inflammatory drugs and muscle relaxants. A physical therapy programme usually involves stretching and strengthening of adductor muscles, abdominal wall muscles, iliopsoas muscle, quadriceps, and hamstrings. In case that physical therapy and pharmacotherapy fail, surgery is needed, depending on the cause

Veća učestalost revizijskih zahvata i aseptičkog razlabavljenja totalnih endoproteza koljena sa stražnjom stabilizacijom u usporedbi s totalnom endoprotezom koljena s očuvanim stražnjim križnim ligamentom istog tipa endoproteze – retrospektivna studija jednog centra na 580 koljena

The purpose of this study was to evaluate the 4-year survivorship of total knee arthroplasty (TKA) of a single manufacturer and determine whether failure rates differ between the cruciate-retaining (CR) and the posterior-stabilised (PS) type of implant. In addition, possible causes of revision were analysed as well. A retrospective analysis of 580 TKAs, with either the CR or the PS type of the Biotech Future Knee endoprosthesis (BIOTECH GmbH, Garbsen-Berenbostel, Germany) was performed. The 4-year survivorship for revision of any cause in all cases was 89.14%, with aseptic loosening being the most common cause of revision (53.9%). Regarding the type of implant model, the revision rate was higher in the PS group compared to the CR group (13.7% to 8.0%, respectively, p=0.027). The Cox regression models suggested that the type of prosthesis was a significant predictor of the need for revision (HR, 0.442; 95% CI, 0.234-0.833). In conclusion, our study has shown higher revision rates with the PS implant type when compared to the CR implant type with a higher rate of aseptic loosening in the PS group. Further studies are needed to determine the cause of these results and to investigate whether the problem is specific to the implant.Primarne endoproteze koljena razlikuju se u dizajnu s obzirom je li stražnja ukrižena sveza održana (CR) ili žrtvovana (PS). Cilj istraživanja bio je ispitati 4-godišnje preživljenje totalne endoproteze koljena jednog proizvođača te utvrditi postoje li razlike s obzirom na CR ili PS dizajn endoproteze. Također, analizirani su mogući uzroci revizijskih zahvata. Retrospektivno je analizirano 580 koljenskih (PS i CR) endoproteza Biotech Future Knee (BIOTECH GmbH, Garbsen-Berenbostel, Germany). Ukupno 4-godišnje preživljenje ispitivanih endoproteza je 89.14%, a kao najčešći uzrok revizijskog zahvata zabilježeno je aseptičko razlabavljenje endoproteze (53.9%). S obzirom na dizajn endoproteze, postotak revizijskih zahvata je bio viši u PS nego u CR grupi(13.7% i 8.0%, p=0.027). Coxov regresijski model upućuje na dizajn endoproteze kao značajan prediktor potrebe za revizijskim zahvatom (HR, 0.442; 95% CI, 0.234-0.833). U zaključku, ovo istraživanje utvrdilo je viši postotak revizijskih zahvata kod PS dizajna u usporedbi s CR dizajnom endoproteze. Potrebne su dodatne studije kako bi se utvrdilo je li opažena razlika specifična za dizajn endoproteze ili ispitivani implantat

Ulnar shortening osteotomy after distal radius fracture malunion: review of literature

Malunion of distal radius fracture is often complicated with shortening of the radius with disturbed radio- ulnar variance, frequently associated with lesions of triangular fibrocartilage complex and instability of the distal radioulnar joint. Positive ulnar variance may result in wrist pain located in ulnar part of the joint, limited ulnar deviation and forearm rotation with development of degenerative changes due to the overloading that occurs between the ulnar head and corresponding carpus. Ulnar shortening osteotomy (USO) is the standard procedure for correcting positive ulnar variance. Goal of this procedure is to minimize the symptoms by restoring the neutral radio - ulnar variance. In this paper we present a variety of surgical techniques available for ulnar shorthening osteotomy, their advantages and drawbacks. Methods of ulnar shortening osteotomies are divided into intraarticular and extraarticular. Intraarticular method of ulnar shortening can be performed arthroscopically or through open approach. Extraarticular methods include subcapital osteotomy and osteotomy of ulnar diaphysis, which depending on shape can be transverse, oblique, and step cut. All of those osteotomies can be performed along wrist arthroscopy in order to dispose and treat possibly existing triangular fibrocartilage complex injuries. At the end we described surgical procedures that can be done in case of ulnar shorthening osteotomy failure