Ανάλυση βάδισης σε ασθενείς με ολική αρθροπλαστική ισχίου επιφανείας και ολική αρθροπλαστική ισχίου με μεγάλη μηριαία κεφαλή

Previous studies report improved hip kinematics and functionality after resurfacing total hip replacement (THRS), when compared to standard total hip replacement (THR). Additionally, bone preserving procedures maintain the advantage of greater femoral bone stock for future revisions. However, such prostheses are restricted to younger and more active patients. On the other, hip kinematics with standard THR are optimized with the use of large diameter femoral heads (BFH-THR).The purpose of this study is to evaluate whether the improved functional outcome of THRS can be attributed to bone preservation or is just the result of the use of large femoral heads or patients’ selection.Thirty one patients, randomly selected for THRS and BFH-THR, were included in this study. Gait speed, postural balance, proprioception and overall performance were analyzed in clinical tests, at the first year follow up.Our results demonstrated a non-statistically significant improvement in gait analysis. Although postural balance and proprioception characteristics in the THRs group were better. If THRS devices provide identical or superior outcomes to traditional BFH-THR, physicians may prefer to perform the more bone preserving procedure. Further investigation should be focused on outcomes of THRS revisions in younger patients to confirm the advantage of bone preserving procedures.Παλαιότερες βιβλιογραφικές αναφορές αναδεικνύουν την καλύτερη κινηματική και λειτουργικότητα του ισχίου μετά από αρθροπλαστική επιφανείας σε σχέση με συμβατικές αρθροπλαστικές ισχίου. Επιπλέον οι επεμβάσεις αναθεώρησης στις αρθροπλαστικές αυτές είναι τεχνικά ευκολότερες με καλύτερα αποτελέσματα λόγω του οστικού εδάφους που προσφέρουν στην αναθεώρηση. Παρόλα αυτά τα πλεονεκτήματα οι αρθροπλαστικές επιφανείας έχουν ένδειξη σε νέους και δραστήριους ασθενείς. Επίσης η συμβατικές αρθροπλαστικές ισχίου μπορούν να επωφεληθούν των πλεονεκτημάτων των μεγάλων μηριαίων κεφαλών με μεταλλικές αρθρούμενες επιφάνειες. Ο σκοπός αυτής της μελέτης είναι να διαπιστωθεί κατά πόσο η καλύτερη λειτουργικότητα του ισχίου στις αρθροπλαστικές επιφανείας είναι αποτέλεσμα της οστικής διάσωσης ή οφείλεται στο μεγάλο μέγεθος της μηριαίας κεφαλής και στο μικρότερο της ηλικίας των ασθενών που υποβάλλονται σε αυτή. 31 ασθενείς τυχαιοποιήθηκαν και υποβλήθηκαν σε επεμβάσεις αρθροπλαστικής επιφανείας (THRS) και αρθροπλαστικής με στηλαιό και μεγάλη μηριαία κεφαλή (BFH-THR). Πραγματοποιήθηκε σε αυτούς μετεγχειρητικά ανάλυση βάδισης, ανάλυση ισορροπίας και ιδιοδεκτικότητας. Επίσης συμπληρώθηκαν και αναλύθηκαν κλινικά ερωτηματολόγια στον ένα χρόνο μετεγχειρητικά. Τα αποτελέσματα μας δεν εμφάνισαν καμία σημαντική στατιστική διαφορά στην ανάλυση βάδισης μεταξύ των δύο ομάδων παρόλο που παρατηρήθηκαν βελτιωμένα στοιχεία ισορροπίας και ιδιοδεκτικότητας για τις αρθροπλαστικές επιφανείας. Εφόσον οι αρθροπλαστικές επιφανείας εμφανίζουν παρόμοια ή και βελτιωμένα χαρακτηριστικά σε σχέση με την συμβατική αρθροπλαστική με στηλαιό και μεγάλη μηριαία κεφαλή, θα πρέπει να εκτιμάτε η επιλογή επέμβασης με χαρακτήρα οστικής διάσωσης. Περαιτέρω διερεύνηση θα πρέπει να επικεντρωθεί στα αποτελέσματα των αναθεωρήσεων των αρθροπλαστικών με οστική διάσωση σε νέους ασθενείς για την επιβεβαίωση της προσφοράς αυτών των επεμβάσεων

The use of core track endoscopy to document accurate decompression of the femoral head

The aim of this study is to evaluate the role of endoscopy as diagnostic and prognostic method for Ficat and Steinberg stage IIIA and IIIB lesions by assessing the efficacy, risks and complications of this method. In a prospective study from January 2008 until September 2013, nine patients ( 13 hips) were assessed. In nine hips the disease was stage II, in three hips stage III and in one hip stage IV. Evaluation included x-rays, magnetic resonance and bone scintigraphy. After femoral head decompression, the borders of the removed necrotic area were investigated under direct visualisation by means of endoscopy in order to assess the vitality status of the surrounding bone. Endoscopic evaluation was successful in nine hips. The visualisation of healthy bone borders after removing the necrotic bone was not possible in four cases. The preoperative MRI findings were in correlation to our endoscopic findings in five out of nine cases. There were no cases of cartilage perforation, femoral neck fracture and other intra and postoperative complications. Endoscopic evaluation of the removed necrotic bone can greatly improve the therapeutic effect by visualising the borders of the decompressed bone area and provide information regarding the necessity for bone graft and the type of graft required

Atlantoaxial rotational dislocation and associated multiple-level fractures to the spine

We present a case of a young woman with multilevel spinal injuries. The injury includes a rotational atlantoaxial dislocation associated with concomitant injury at C5 and at the sacrum. Rotational dislocation at C1-C2 level is not frequently encountered in young adults, and the presence of associated lesions to the spine makes this condition a challenging one. The medical record of a patient who sustained three spinal injuries at different levels of the spine was evaluated. The prevalence of this type of injury, the diagnosis, the clinical behavior, and the applied treatment are evaluated. The patient was treated non-operatively, and a satisfactory clinical outcome was recorded at the last follow-up visit. © Springer-Verlag 2011

Congenital variations of the upper cervical spine and their importance in preoperative diagnosis. A case report and a review of the literature

Several variations of the bony and vascular anatomy around the first and second cervical vertebrae have been reported. Failure to recognise these variations can complicate operations on the upper cervical spine. We present a patient with recent onset of cervical myelopathy due to stenosis at the C3-4 level. Preoperative evaluation identified Klippel-Feil syndrome with cervical fusion of C2-3, aplasia of posterior arch of C1, anomalous vertebral artery course and a "ponticulus posticus" of C2. The combination of these variations in a Klippel-Feil syndrome patient has never been reported. Thus, we recommend a thorough preoperative imaging evaluation, with CT scan and CT angiography or DSA, in addition to plain radiographs. This evaluation is imperative, before a cervical spine surgery, allowing a better understanding of the anatomy, in order to minimise the risks of misplacement of cervical instrumentation especially in such patients. © Springer-Verlag 2013

Open talar dislocations without associated fractures

Aim: Total dislocation of the talus first reported in 1680. It is a rare injury and without associated fractures is even rarer. Is generally considered to be one of the most disabling ankle injuries and occurs after high energy trauma. The primary goal of our study is the retrospective evaluation of complete talar extrusion without associated fractures and immediate reimplantation. Materials and methods: In the past nine years, nine patients with mean age 31.7 years were admitted to our center with a complete open talar extrusion. The dislocated talus was reduced and held in place with two Steinmann pins placed from the inferior aspect of the calcaneus, through the talus and into the inferior aspect of the tibia. An external fixator was used to stabilize the limb. The mean follow up time was 21.1 months. At the last follow up visit, six patients were evaluated both radiographically and functionally with the AOFAS score. Results: Six patients were free of complications and the mean AOFAS Ankle-Hindfoot Scale score at the time of the last follow up visit was 82.5. Two patients had an infection, one had avascular necrosis of the talus and one had signs of subtalar joint arthritis. Two patients had to undergo arthrodesis. Conclusions: It is important to attempt reimplantation of the talus since a good final outcome is to be expected. Even in the case of a catastrophic complication this technique will ensure adequate bone stock for additional surgical procedures. (C) 2013 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved