The Canal Fill Ratio as a Factor Influencing the Aseptic Loosening of the Müller-Type Cemented Stem – Preliminary Report

The Müller type cemented hip prosthesis, also called self-locking prosthesis, is one of the most extensively copied and utilized hip prostheses. Considering the implantation of the cemented stem, the author originally suggested achieving a press fit between the stem and endostal cortex by implanting a prosthesis of the largest possible size. Analyzing our group of patients who undergo aseptic stem revision, we try to quantify the term „press fit“ by measuring the filling of the femoral canal by the metal stem, the so-called canal-fill ratio. Our preliminary results suggest that press-fit is achieved when the stem occupies more than 90% of the canal diameter in the anterior-posterior projection

Radiografska analiza odnosa lateralnog interkondilarnog grebena s Blumensaatovom linijom i tangentom stražnjeg femoralnog kortikalisa

The aim of this study is to determine the radiographic position of the lateral intercondylar ridge (LIR) and its relationship with the Blumensaat line (BL) and the tangent to the posterior cortex (PCT) of the distal femur. On 35 femur specimens, the LIR was labeled by using a 1 gauge wire. A true lateral view with the distal femur was taken. On the taken plain radiographs, we measured angles that close between BL and LIR, PCT and LIR. We also measured the ratio in which LIR crosses the BL. The mean angle between BL and LIR was 70,130 (SD 12,690), and the mean angle that BL closes with PCT was 143,610 (SD 7,910). The point where LIR intersects the BL divides it in a 1:6 ratio. Using these radiological measurements will allow surgeons to quickly estimate the position of the LIR and also allow quick and convenient preoperative planning, intraoperative tunnel placement as well as postoperative analysis.Cilj ove studije je odrediti radiografski položaj lateralnog interkondilarnog grebena (LIR) u odnosu na Blumensaatovu liniju (BL) i tangentu stražnjeg kortikalisa (PCT) femura. Na 35 preparata femura lateralni interkondilarni greben označili smo bakrenom žicom debljine 1 mm. Na pravim postraničnim radiografskim snimkama femura odredili smo kut koji zatvaraju BL i LIR, te LIR i PCT. Također smo izračunali omjer u kojem LIR dijeli BL. Prosječni kut koji zatvaraju BL i LIR iznosi 70,130 (SD 12,690), a prosječan kut između BL i PCT 143,610 (SD 7,910). Točka u kojoj LIR sječe BL dijeli liniju u omjeru 1:6. Predloženom radiografskom metodom moguće je pouzdano odrediti položaj LIR-a što će omogućiti lakše planiranje zahvata, lakše i točnije postavljenje femoralnog tunela kao i poslijeoperacijsku analizu

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

Treatment of Congenital Leg Length Discrepancies in Children Using an Ilizarov External Fixator: A Comparative Study

The purpose of this study was to evaluate the infl uence of intramedullary (IM) alignment used in combination with an Ilizarov external fi xation on the healing index (HI) and lengthening index (LI) in the treatment of congenital leg length discrepancies (LLD). This study included 35 patients aged from 3.5 to 19 (average age 10.73) who underwent the egalisation procedure using an Ilizarov external fi xator. We compared the duration of the external fi xator application, LLD, HI and LI between two groups of children: children in Group I underwent limb lengthening by the conventional llizarov technique using an Ilizarov external fi xator alone, and children in Group II underwent a combination of Ilizarov technique and intramedullary alignment with two Kirschner wires, introduced through two mini-incisions. We found signifi cant differences between the two groups of patients for duration of external fi xator application and HI. Patients with congenital LLD treated with combined method of treatment had benefi t from intramedullary alignment due to its better outcome

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)

THE ARTHROSCOPIC TREATMENT OF ANTERIOR ANKLE IMPINGEMENT IN ATHLETES

SAŽETAK Cilj: Svrha je ovog rada utvrditi uspješnost artroskopskog liječenja sindroma prednjeg sraza gornjega nožnog zgloba. Bolesnici i metode: Ukupan broj od 23 liječena bolesnika klasificiran je na osnovi prisutne artroze na radiološkim preoperacijskim snimkama. Simptomi 5 bolesnika u grupi stupnja O uzrokovani su samo mekotkivnim srazom, u grupi od 13 bolesnika stupnja I. simptomi su uzrokovani mekotkivnim i osteofitnim srazom, a u grupi od 5 bolesnika stupnja II. uza znakove sraza prisutno je i suženje zglobne pukotine. Standardnim operacijskim artroskopskim anteromedijalnim i anterolateralnim ulazima pristupali smo u zglob te provodili sinovijektomiju i abraziju osteofita. Rezultati liječenja obrađeni su praćenjem pet paramatera (bol, oticanje, pokretljivost, šepanje, aktivnost) i vrednovanih Ogilvie- Harrisovim bodovnim sustavom. Vrijeme praćenja bolesnika bilo je dvije godine. Rezultati: U svih pet parametara koji su se pratili, došlo je do statistički značajnog poboljšanja te time i uspješnog liječenja bolesnika. Zaključak: Artroskopsku resekciju nabujalog veziva te osteofita prednjeg ruba tibije i vrata talusa možemo smatrati uspješnim načinom liječenja sindroma prednjeg sraza gornjega nožnog zgloba.SUMMARY AIM: The purpose of our study was to evaluate the results of arthroscopic treatment of anterior ankle impingement. Patients and methods: By using preoperative radiographs, we grouped 23 patients according to the extent of their osteoarthritis. The symptoms of those with grade-0 (5- patients) could be attributed to anterior soft tissue impingement only, in those with grade-I (13 patients) to anterior soft tissue and osteophytic impingement and those with grade-II (5-patients) in narrowing of the joint cavity accompanied by osteophytic impingement. We used anteromedial and anterolateral portals for osteophytic debridment and partial synoviectomy. The results were evaluated recordnig five parameters (pain, swelling, stiffness, limping, activity) in the Ogilvie-Harris score system. Follow up period was 2 years. Results: The success of the patient treatment was confirmed with statistical significant improvement in all five parameters. Conclusion: Arthroscopic excision of soft tissue overgrowths and osteophytes is proved to be a succesive method of tretament of the anterior ankle impingement in athlete

Readiographic analysis of the Blumensaat’s line and the location of the lateral intercondylar ridge as contribution to the anatomic anterior cruciate ligament reconstruction

Cilj: Cilj rada bio je ispitati oblik Blumensaatove linije te utvrditi položaj lateralnog interkondilarnog grebena u odnosu na nju. Ispitanici i metode: U radu je korišteno 12 preparata femura sa Zavoda za anatomiju Medicinskog fakulteta u Rijeci. Na svakom preparatu tankom savitljivom žicom obilježen je lateralni interkondilarni greben. Učinjena je postranična rendgenska snimka femura uz potpuno preklapanje kondila. Na snimkama je analiziran oblik Blumensaatove linije, razlika u rendgenološkoj gustoći prikaza pojedinih dijelova te položaj lateralnog interkondilarnog grebena u odnosu na Blumensaatovu liniju. Rezultati: Na rendgenološkom prikazu Blumensaatova linija bila je ravna u 25 % preparata. U 75 % preparata stražnji dio linije bio je konveksan u smjeru prema distalno. S obzirom na radiografsku gustoću Blumensaatove linije mogla se podijeliti u tri dijela. Prednji i stražnji dio imali su gustoću intenziteta kortikalne kosti, dok je gustoća srednjeg dijela odgovarala intenzitetu spongiozne kosti. Lateralni interkondilarni greben spaja se s Blumensaatovom linijom u točki koja stražnji segment dijeli u omjeru 58 % : 42 %. Lateralni greben s Blumensaatovom linijom zatvara kut od 62.40 stupnjeva. Zaključak: Blumensaatova linija u 75 % analiziranih preparata nije ravna, već je u stražnjem dijelu zaobljena s konveksitetom usmjerenim prema distalno. Na profilnoj RTG snimci LIR koljena zatvara kut od 62.40 stupnjeva.Aim: The aim of this study was to analyze the shape of the Blumensaat\u27s line and the relationship with lateral intercondylar ridge on the lateral radiographic view. Patients and Methods: On twelve femoral specimens, the lateral intercondylar ridge were labeled with the thin wire. A full lateral view with the distal femur was taken. At the X-ray we analyzed the radiographic shape of the Blumensaat’s line and a possible difference of the radiographic density during its course. The angle between lateral intercondylar ridge and Blumensaat’s line was calculated as well. Results: The Blumensaat’s line was straight in 25% of specimens. In 75% the posterior part had convexity. Regarding the radiographic density the BL could be divided into three parts. The density of the anterior and posterior was similar as the cortical bone, while the middle part corresponds to the cancellous bone. The posterior part was the longest. The lateral intercondylar ridge and the Blumensaat’s line formed the angle of average 62,40 and intersect with the LIR at the point which divides the posterior part of the BL at the 58%:42% ratio. Conclusion: In 25% the Blumensaat’s line was straight. In 75% of the specimens the posterior convexity was observed. The lateral interc ondylar ridge and the Blumenssat’s line formed the angle of the 62,50. They intersected at the point which divides the posterior part in the 58:42 ratio

THE ARTHROSCOPIC TREATMENT OF ANTERIOR ANKLE IMPINGEMENT IN ATHLETES

SAŽETAK Cilj: Svrha je ovog rada utvrditi uspješnost artroskopskog liječenja sindroma prednjeg sraza gornjega nožnog zgloba. Bolesnici i metode: Ukupan broj od 23 liječena bolesnika klasificiran je na osnovi prisutne artroze na radiološkim preoperacijskim snimkama. Simptomi 5 bolesnika u grupi stupnja O uzrokovani su samo mekotkivnim srazom, u grupi od 13 bolesnika stupnja I. simptomi su uzrokovani mekotkivnim i osteofitnim srazom, a u grupi od 5 bolesnika stupnja II. uza znakove sraza prisutno je i suženje zglobne pukotine. Standardnim operacijskim artroskopskim anteromedijalnim i anterolateralnim ulazima pristupali smo u zglob te provodili sinovijektomiju i abraziju osteofita. Rezultati liječenja obrađeni su praćenjem pet paramatera (bol, oticanje, pokretljivost, šepanje, aktivnost) i vrednovanih Ogilvie- Harrisovim bodovnim sustavom. Vrijeme praćenja bolesnika bilo je dvije godine. Rezultati: U svih pet parametara koji su se pratili, došlo je do statistički značajnog poboljšanja te time i uspješnog liječenja bolesnika. Zaključak: Artroskopsku resekciju nabujalog veziva te osteofita prednjeg ruba tibije i vrata talusa možemo smatrati uspješnim načinom liječenja sindroma prednjeg sraza gornjega nožnog zgloba.SUMMARY AIM: The purpose of our study was to evaluate the results of arthroscopic treatment of anterior ankle impingement. Patients and methods: By using preoperative radiographs, we grouped 23 patients according to the extent of their osteoarthritis. The symptoms of those with grade-0 (5- patients) could be attributed to anterior soft tissue impingement only, in those with grade-I (13 patients) to anterior soft tissue and osteophytic impingement and those with grade-II (5-patients) in narrowing of the joint cavity accompanied by osteophytic impingement. We used anteromedial and anterolateral portals for osteophytic debridment and partial synoviectomy. The results were evaluated recordnig five parameters (pain, swelling, stiffness, limping, activity) in the Ogilvie-Harris score system. Follow up period was 2 years. Results: The success of the patient treatment was confirmed with statistical significant improvement in all five parameters. Conclusion: Arthroscopic excision of soft tissue overgrowths and osteophytes is proved to be a succesive method of tretament of the anterior ankle impingement in athlete