Association between Polymorphism eNOS4, tPA, Factor V Leiden, Prothrombin, and Methylenetetrahydrofolate Reductase and the Occurrence of Legg-Calvé-Perthes Disease.

BACKGROUND: Legg-Calvé-Perthes (LCPD) disease is a complex condition affecting the femoral head's epiphysis in children. It occurs with a prevalence ranging from 0.4 to 29.0 cases per 100,000 children under the age of 15. It involves various factors, including genes associated with coagulation and fibrinolysis, pro-inflammatory factors, and vasoactive substances. METHODS: We investigated the relationship between genetic mutations associated with coagulation and vascular disorders and the occurrence of LCPD in Polish patients. We performed a study involving 25 patients with LCPD and 100 healthy controls. All subjects were genotyped for eNOS4, Factor V Leiden, prothrombin, tPA25, and MTHFR polymorphism. RESULTS: The analysis revealed that the frequencies of eNOS4 genotypes were significantly different in LCPD patients than in the control group (p = 0.018). The frequencies of 4a allele were significantly higher in patients with LCPD than in the healthy population (26% vs. 9%, p = 0.0012). There were no significant differences in genotype and allele frequencies for Factor V Leiden, prothrombin tPA 25, and MTHFR gene polymorphisms between patients with LCPD and the controls. CONCLUSIONS: Genotype and allele frequencies of eNOS4 were significantly higher in patients with LCPD. These findings suggest a potential association between the eNOS gene polymorphism and an increased risk of developing LCPD.

Quantitative Description of Isomorphism in the Series of Simple Compounds.

The introduction of the notion of energy change resulting from the ion exchange in apatites leads to the question: how can some simple isomorphic series be described using the mentioned idea? We concentrated on the simple isomorphic series of compounds: apatite, bioapatite, calcite, aragonite, celestine, K-, Zn- and Cu-Tutton's salts. It was demonstrated in all the series, except Tutton's salts, that the change in energy and the change in the crystal cell volume are, in a simple way, dependent on the change in the ionic radii of the introduced ions. The linear relationships between the variations in energy and in the universal crystallographic dimension d were derived from the earlier equations and proven based on available data. In many cases, except the Tutton's salts, linear dependence was discovered between the change in energy and the sinus of universal angle Θ, corresponding to the change in momentum transfer. In the same cases, linear dependencies were observed between the energy changes and the changes in the volumes of crystallographic cells, and mutually between changes in the crystallographic cell volume V, crystallographic dimension d, and diffraction angle Θ.

Studies on Chemical Composition, Structure and Potential Applications of Keratoisis Corals.

The chemical composition and structure of bamboo octocoral Keratoisis spp. skeletons were investigated by using: Scanning Electron Microscopy SEM, Raman Microscopy, X-ray Diffraction XRD, Laser Ablation-Inductively Coupled Plasma LA-ICP, and amino acid analyzers. Elements discovered in the nodes (mainly organic parts of the skeleton) of bamboo corals showed a very interesting arrangement in the growth ring areas, most probably enabling the application of bamboo corals as palaeochronometers and palaeothermometers. LA-ICP results showed that these gorgonian corals had an unusually large content of bromine, larger than any other organism yet studied. The local concentration of bromine in the organic part of the growth rings of one of the studied corals grew up to 29,000 ppm of bromine. That is over 440 times more than is contained in marine water and 35 times more than Murex contains, the species which was used to make Tyrian purple in ancient times. The organic matter of corals is called gorgonin, the specific substance that both from the XRD and Raman studies seem to be very similar to the reptile and bird keratins and less similar to the mammalian keratins. The missing cross-linking by S-S bridges, absence of aromatic rings, and significant participation of ß-turn organization of peptides differs gorgonin from keratins. Perhaps, the gorgonin belongs to the affined but still different substances concerning reptile and bird keratin and in relation to the more advanced version-the mammalian one. Chemical components of bamboo corals seem to have great medical potential, with the internodes as material substituting the hard tissues and the nodes as the components of medicines.

Measurements of Energetic States Resulting from Ion Exchanges in the Isomorphic Crystals of Apatites and Bioapatites.

Developments in the field of nanostructures open new ways for designing and manufacturing innovative materials. Here, we focused on new original ways of calculating energy changes during the substitution of foreign ions into the structure of apatites and bioapatites. Using these tools, the energetic costs of ion exchanges were calculated for the exemplary cases known from the literature. It was established that the most costly were ion exchanges of some cations inside apatites and of anions, and the least costly exchanges in tetrad channel positions. Real energy expenses for bioapatites are much smaller in comparison to mineral apatites due to the limited involvement of magnesium and carbonates in the structure of hard tissues. They are of the order of several electron volts per ion. The rigorous dependences of the energy changes and crystallographic cell volumes on the ionic radii of introduced cations were proved. The differentiation of the positioning of foreign ions in locations of Ca(I) and Ca(II) could be calculated in the case of a Ca-Pb reaction in hydroxyapatite. The energetic effects of tooth aging were indicated. The ability of energy change calculation during the ion exchange for isomorphic substances widens the advantages resulting from X-ray diffraction measurements.

Hierarchy of Bioapatites.

Apatites are one of the most intensively studied materials for possible biomedical applications. New perspectives of possible application of apatites correspond with the development of nanomaterials and nanocompounds. Here, an effort to systematize different kinds of human bioapatites forming bones, dentin, and enamel was undertaken. The precursors of bioapatites and hydroxyapatite were also considered. The rigorous consideration of compositions and stoichiometry of bioapatites allowed us to establish an order in their mutual sequence. The chemical reactions describing potential transformations of biomaterials from octacalcium phosphate into hydroxyapatite via all intermediate stages were postulated. Regardless of whether the reactions occur in reality, all apatite biomaterials behave as if they participate in them. To conserve the charge, additional free charges were introduced, with an assumed meaning to be joined with the defects. The distribution of defects was coupled with the values of crystallographic parameters "a" and "c". The energetic balances of bioapatite transformations were calculated. The apatite biomaterials are surprisingly regular structures with non-integer stoichiometric coefficients. The results presented here will be helpful for the further design and development of nanomaterials.

Minimum 10 years clinical and radiological outcomes of acetabular revisions of total hip arthroplasties with tricalcium phosphate/hydroxyapatite bone graft substitute.

BACKGROUND: Aseptic loosening is the most frequent indication for revision of total hip arthroplasty. Revision arthroplasty of acetabular component is a challenge for every surgeon because they have to simultaneously deal with the reconstruction of bone defects, adequate implant geometry and stable fixation. Allografts are the most frequently used materials in reconstruction of bone loss during revision surgeries. Because of an increasing number of revision hip arthroplasties and poor availability of allografts, we decided to use bone graft substitutes in acetabular revisions. METHODS: Between September 2005 and January 2010, 44 revision arthroplasties in 43 patients were performed with the use of bone graft substitutes for acetabular defect reconstruction in revision of total hip arthroplasty. Acetabular bone defects were classified according to Paprosky. Seventeen hips were classified as IIA, 3 hips IIB, 3 hips IIC, 10 hips IIIA and 11 hips IIIB. Acetabular bone defects were reconstructed with tricalcium phosphate/hydroxyapatite bone graft substitute - BoneSave. Clinical and radiological examination was performed after 3 months, 1 year and then annually. Harris hip score was used for clinical evaluation. Survival analysis was performed with Kaplan-Meier method with aseptic loosening as the definition of endpoint. RESULTS: The average follow-up period is 12 (range from 10 to 15) years. During the follow-up, three patients died after 24 months because of causes not related to surgery. None of the patients was lost to follow-up. The evaluation of clinical results revealed an increase in pre-operative HHS from average 38.3 (range 25 to 55) points to average 86.3 (range 45 to 95) points at the most recent follow-up. Radiographic evaluation showed the migration of one revision cage 12 months after surgery. Revision arthroplasty performed after 14 months revealed the partial incorporation of bone graft substitute. There were not any cases of loosening of revision acetabular cup at the most recent follow up examination in the remaining 39 patients. Bone graft substitute was not absorbed in all of these patients. The survival after 10 years amounted to 97.56%. CONCLUSION: Bone graft substitute Bone Save may be suitable for acetabular revision surgery, however preoperative bone defect is critical for success and determining of a surgical technique, so this is multifactorial in this challenge surgery.

The effect of crystalloid infusion on body water content and intra-abdominal pressure in patients undergoing orthopedic surgery under spinal anesthesia.

BACKGROUND: Crystalloids are frequently used for the correction of spinal anesthesia-induced hypotension, intraoperative bleeding, or vaporisation from surgical wounds. OBJECTIVES: The aim of this study was to observe the effect of perioperative crystalloid infusion on intraabdominal pressure (IAP), volume excess (VE), total body water (TBW), and extracellular body water (ECW) in patients undergoing elective orthopedic surgery under spinal anesthesia. MATERIAL AND METHODS: Adult patients undergoing hip or knee replacement were studied. Changes in VE, TBW, ECW, and IAP were observed in patients who received restrictive fluid therapy (group R) and in patients who received liberal fluid therapy (group L). IAP was measured in the urinary bladder. All parameters were measured at 4 points in time: just before anesthesia (baseline value, A); just after surgery (B); 3 h after surgery (C); and on the morning of postoperative day 1 (D). Additionally, IAP was measured after anesthesia, just before surgery (A1). RESULTS: The mean baseline values of IAP, ECW, TBW, and VE were comparable between groups L and R. The induction of anesthesia reduced IAP in both groups (p < 0.001). IAP and VE increased in both groups after surgery. Significantly higher values of IAP, however, were noted in group L at time points B, C, and D. TBW and ECW increased after surgery in group L. In group R, ECW slightly increased only at time point C. IAP strongly correlated with ECW in group L (p < 0.001, r = 0.62). CONCLUSIONS: Spinal anesthesia reduces IAP. A perioperative increase in body water content and IAP mainly depends on the volume of the infused crystalloids.

Mosaicplasty for the treatment of osteochondritis dissecans following Legg-Calvé-Perthes disease: a case report and literature review.

Legg-Calvé-Perthes disease leads to hip joint deformity. Osteochondritis dissecans following Perthes disease (OCDP) is a less common entity. Treatment options of OCDP are limited. Osteochondral autologous transfer (OATS) is an established method of treatment of full thickness cartilage defects in different locations. This paper presents the case of a 42-year-old patient diagnosed with symptomatic OCDP and treated with lesion fixation using autologous osteochondral grafts via surgical hip dislocation. At the most recent follow-up, 5.5 years after the surgery, the patient did not complain of any pain during rest or activity. He had painless motion with persisting abduction and internal rotation reduction. Harris hip score (HHS) improved from preoperative 62 to 92 points at most recent follow-up. Treatment protocol was discussed in relation to the literature regarding this clinical topic.

Fixation of femoral head fractures with autologous osteochondral transfer (mosaicplasty).

Posterior fracture dislocation of the femoral head is a rare entity usually requiring open reduction and internal fixation. Results of different fixation methods have been reported, including countersinking screws, headless screws, and bioabsorbable implants. Osteochondral autologous transfer (mosaicplasty) is an established method of treatment of full thickness cartilage defects of the knee, ankle, and elbow. At our institution, posterior fracture-dislocations of the femoral head were treated with femoral head fragment fixation using osteochondral autografts through surgical hip dislocation. Osteochondral plugs were harvested from the non-weight-bearing area of the lateral femoral condyle of the knee and used for fixation of the reduced fragment. This article details the technique and its application.

A seven- to 14-year follow-up study of bipolar hip arthroplasty in the treatment of osteonecrosis of the femoral head.

INTRODUCTION: Bipolar hip arthroplasty (BHA) in the treatment of Ficat stage III osteonecrosis of the femoral head (ONFH) has theoretical advantages over total hip replacement (THR) in that it preserves the natural acetabulum and uses an implant that allows better stability and larger range of movement. The purpose of this study was to evaluate the clinical and radiological outcomes of BHA with uncemented ingrowth stems in the treatment of ONFH. MATERIAL AND METHODS: Thirty-nine hips in 34 patients (two women and 32 men) with a mean age at the time of surgery of 45.31 years (range 30-66 years) operated between 1998 and 2005 were examined in a retrospective evaluation. Mean follow-up was 9.5 years (range 3-14 years). Patients were evaluated with the Harris hip score (HHS). Kaplan-Meier survivorship was calculated to examine the revision rate. Radiographic analysis included evaluation of bipolar head migration, radiolucent lines around the stem and osteolysis in the acetabulum and the femur. RESULTS: Evaluation of clinical results revealed an increase in HHS from 28 points preoperatively to 88.6 points at the most recent follow-up. Radiographic evaluation showed bipolar head migration in 3 hips (7.7%). Survival rate of BHA, with revision THR defined as the endpoint, was 92.31% at ten years (CI 95%). All implanted uncemented stems were stable without any radiographic signs of loosening or osteolysis. CONCLUSIONS: The results of the present study show that implantation of BHA with uncemented ingrowth stem in Ficat stage III is still justified.

Prevalence of genetic risk factors related with thrombophilia and hypofibrinolysis in patients with osteonecrosis of the femoral head in Poland.

BACKGROUND: The etiology of osteonecrosis of femoral head (ONFH) has not been fully elucidated. Increased intravascular coagulation and/or hypofibrinolysis have been proposed as pathogenic mechanisms. Previous reports demonstrated significant association between incidence of ONFH and polymorphisms of genes related with thrombophilia especially in Caucasian subjects. The aim of our study was to evaluate the relationship between genetic mutations leading to coagulation disorders and ONFH in Polish patients. METHODS: We have investigated the frequencies of four markers among 68 unrelated individuals with clinically and radiographically documented ONFH and among 100 healthy unrelated blood donors in Eastern part of Poland. The three genes were involved in thrombophilia: factor V Leiden (G1691A), prothrombin (G20210A), Methylenetetrahydrofolate Reductase (MTHFR C677T) and one in hypofibrinolysis: Tissue Plasminogen Activator (PLAT TPA25 I/D). The samples were genotyped with polymerase chain reaction followed by restriction enzyme analysis for the restriction fragment length polymorphisms. The allele and genotype frequencies were analyzed in the relation to ONFH etiology (idiopathic and secondary), gender, age (patients younger or older than 50 years) and the number of affected joints (unilateral or bilateral ONFH). RESULTS: No significant difference in allele frequencies between patients and control groups were observed in genes involved in thrombophilia. We have found a statistically significant increased frequency of D allele of PLAT TPA 25 I/D polymorphism between the entire group of patients with ONFH and controls (p=0,026, OR=1,54, CI 0,99-2,4). D allele frequency was also significantly increased in patients with primary ONFH (p=0,009, OR=1,81 CI 1,1-3,01), in males (p= 0,013; OR 1,74; 95% CIs 1,08-2,78), patients older than 50 years (p= 0,018, OR= 2,04; 95% CIs 1,09-3,82) and in cases with bilateral ONFH (p= 0,01; OR= 1,92; 95% CIs 1,13-3,27) (Table 9). The differences in DD homozygous genotype frequency were statistically significant for patients with idiopathic ONFH compared with control group (p=0,023, OR=2,75, CI 0,99-7,9) and in cases of bilateral ONFH (p=0,034; OR 3,12; 95% CIs 1,06-9,18) (Table 10). The frequencies of ID heterozygous genotype were statistically significantly higher in entire group of patients with ONFH (p=0,004 OR 2,71; 95% CIs 1,32-5,57), idiopathic ONFH (p= 0,01; OR 2,91; 95% CIs 1,24-6,87), males (p=0,0007; OR 3,75; 95% CIs 1,67-8,42), patients older than 50 years (p=0,001; OR 6,89; 95% CIs 1,87-25,84) and in cases with bilateral ONFH (p=0,009; OR 3,19; 95% CIs 1,26-8,03). CONCLUSION: The results suggest that inherited hypofibrinolysis is a risk factor of idiopathic ONFH in Polish population.

Clinical and radiological outcomes of treatment of avascular necrosis of the femoral head using autologous osteochondral transfer (mosaicplasty): preliminary report.

PURPOSE: The purpose of this study was to evaluate clinical and radiological outcomes of autologous osteochondral transfer (OATS) for femoral head osteonecrosis. METHODS: Twenty-one hips in 20 patients (one woman and 19 men), average patients' age at the time of surgery of 35.4 (range 20-56) years, were treated with OATS for osteonecrosis of the femoral head (ONFH). Seven patients at pre-collapse ARCO stages IIA and IIB were treated with OATS alone. Thirteen patients with large pre-collapse ARCO IIC and post-collapse ARCO III and IV were treated with OATS and morselised bone allografts (OATS/allograft). Harris hip score (HHS) was used for clinical evaluation of outcomes; X-rays were performed to examine the evolution of the disease. Kaplan-Meier survival curves were used to determine the failure of the procedures with conversion to THR defined as endpoint. RESULTS: Follow-up of patients treated with OATS alone was 46.14 (range 18-75) months with HHS improvement from a preoperative mean of 42 to 87.85 points at the latest follow-up examination. Only one patient in this group needed a revision operation with THR. The survival for this group of patients was 85.71 % at four years. Follow-up of patients treated with AOTS/allograft was 32.7 (range 7-84) months with HHS improvement from a preoperative mean of 35.2 to 65.7 points at the latest follow-up examination. One patient died six months after the surgery. There were five conversions to THR because of femoral head collapse in this group of patients with survival of 61.54 % at three years. CONCLUSION: The use of osteochondral grafts offers the possibility of successful treatment for ONFH at small and medium pre-collapse stages. The outcomes of large pre-collapse and post-collapse stages were below our expectations. OATS is a time buying procedure for young patients as it may defer total hip replacement.

Endothelial nitric oxide synthase gene intron 4 polymorphism in non-traumatic osteonecrosis of the femoral head.

PURPOSE: Nitric oxide (NO) synthesised by endothelial NO synthase (eNOS) is a potent regulator of internal haemodynamics. A polymorphism in intron 4 of the eNOS is associated with different vascular disorders. We investigated the potential involvement of this polymorphism in idiopathic and secondary osteonecrosis of the femoral head (ONFH) in Polish patients. METHODS: We performed a study involving 68 patients with ONFH (45 idiopathic and 23 secondary) and 100 healthy controls. All subjects were genotyped for the eNOS4 polymorphism by the polymerase chain reaction followed by agarose gel electrophoresis. RESULTS: The analysis revealed that the frequencies of eNOS4 genotypes were significantly different in ONFH patients (both idiopathic and secondary) than in controls. The frequencies of the 4a allele were significantly higher in the total group of patients versus controls [22.79 vs 9%, p = 0.00039, odds ratio (OR) 2.98]. In subgroup analysis the 4a allele increased significantly in both idiopathic (20 vs 9%, p = 0.0074, OR = 2.52) and secondary (28.26 vs 9%, p = 0.00047, OR = 3.98) ONFH patients compared to control subjects. The frequency of the 4a/b genotype in the total group of patients (36.76 vs 16%, p = 0.0011, OR = 3.24) as well as patients with idiopathic (35.56 vs 16%, p = 0.0069, OR = 2.96) and secondary (39.13 vs 16 %, p = 0.0073, OR = 3.89) ONFH was higher than in the control group. CONCLUSIONS: There was a significantly higher frequency of eNOS 4a allele carriers among the total group of patients as well as in idiopathic and secondary ONFH. This suggests that the eNOS gene polymorphism may be associated with increased risk of ONFH.

Comparison of treatment results of acute and late injuries of the lisfranc joint.

OBJECTIVE: A retrospective comparison of treatment difficulties and treatment outcomes in Lisfranc joint injuries with late and early diagnosis. METHODS: The study group consisted of 10 patients diagnosed and treated properly within six months to 20 years of the accident causing the injury (mean six years). The control group consisted of the same number of randomly selected patients with a similar type of injury treated immediately after the accident. Mean follow-up was 13 years in the study group and eight years in the control group. The analysis evaluated the causes of the delay and the foot function at the time of follow up, measured using the AOFAS Midfoot Scale and the Lublin Foot Functional Score. The scores of the patients were analyzed using the non-parametric Mann-Whitney U test and the non-parametric Wilcoxon test. RESULTS: The control group had statistically significantly better scores on both scales. CONCLUSION: The main cause of treatment delay was misdiagnosis by the primary care physician. Level of Evidence III, Retrospective Comparative Study .

[Large diameter femoral heads in primary alumina/alumina and XSPE/alumina total hip arthroplasty. A follow-up study of 50 hips after average 40 months and review of literature]. / Pierwotna calkowita bezcementowa endoprotezoplastyka stawów biodrowych--ceramika/ceramika i ceramika/polietylen XSPE z uzyciem glów o duzej srednicy. Ocena 50 bioder po okresie srednio 40 miesiecy i przeglad pismiennictwa.

INTRODUCTION: The aim of the study was a preliminary report of the use of large diameter alumina femoral heads in total hip arthroplasty. MATERIAL AND METHODS: In the years 2005-2008 50 THRs were implanted in 48 patients with the use of 36 mm alumina femoral heads. 5 women and 43 men in the age from 35 to 75 years (average 61 years) were operated on. Primary osteoarthritis was the cause of 41 arthroplasties, and AVN of femoral head of 9 surgeries. 18 alumina/alumina and 32 polyethylene/alumina THRs were implanted. The prospective study consisted of clinical examination with Harris Hip Score and X-ray evaluation. AP and lateral view X-rays were evaluated. The incidence of radiolucent lines around acetabular cups were noted with DeLee and Charnley zones and around stems with Gruen's zones. RESULTS: The follow up is from 24 to 58 months (average 40 months). There was an increase in Harris Hip Score from average 37 points (from 25 to 49 points) before operation to average 94 points (from 90 to 100 points) after the surgery. The incidence of postoperative dislocation have not been noted. Long-term postoperative X-ray examination have showed proper geometry of endoprostheses without radiolucent lines. Neither visible wear of bearing surfaces nor breakage of alumina components have been noted. CONCLUSIONS: 1) The use of 36 mm femoral heads in total hip arthroplasty decrease the risk of postoperative dislocation. 2) Innovative biomaterials: alumina ceramics and cross-linked polyethylene give chance for decrease the incidence of osteolysis.

Anterior approach according to Ganz--surgical dislocation of hip joint.

The surgical technique of an anterior approach to the hip joint according to Ganz is described. The procedure preserves the deep branch of the medial circumflex artery, which, combined with greater trochanter osteotomy, allows for safe hip joint dislocation without a risk of avascular necrosis of the femoral head. This approach makes it possible to inspect the femoral head and the entire acetabulum. It is suitable for the treatment of early stages of coxarthrosis.

Operative technique and results of core decompression and filling with bone grafts in the treatment of osteonecrosis of femoral head.

BACKGROUND: The aim of this paper is to present the operative technique and results of core decompression and clearing of a necrotic zone in the femoral head followed by filling the defect with impacted autologous or synthetic bone grafts. This procedure allows for mechanical prevention of further collapse of the femoral head and loss of its spherical shape. It also creates conditions for the incorporation of the biological graft or synthetic bone. MATERIALS AND METHODS: A series of 63 patients (72 hips) were treated for aseptic osteonecrosis of the femoral head between 1996 and 2009. This group comprised 42 men and 21 women aged 19 to 60 years (average age: 35 years). Radiographic staging of necrosis was based on the ARCO (Association Research Circulation Osseous) classification. All patients were treated with core decompression followed by filling the bone defect with autologous or synthetic (Wright ProDense) bone grafts. RESULTS: Average follow-up was 5 years (from 1 to 12 years). After one year of follow-up, pain relief with preservation of a spherical femoral head was obtained in 45 hips (63%). Sixteen hips (22%) had significant limitation of the range of motion that, however, did not exceed preoperative values, with no significant pain during walking, and loss of the spherical shape of the femoral head on radiographs. CONCLUSIONS: Filling the defect with morsellized or synthetic bone grafts followed by graft impaction creates mechanical and biological conditions for graft incorporation. Where collapse has not occurred during the first six post-operative months, a good and lasting result can be expected.

[Early experiences in the use of Mayo stem in hip arthroplasty]. / Wczesne doswiadczenia w zastosowaniu trzpieni Mayo w protezoplastyce bioder.

The aim of this study was early clinical and radiological examination of patients after THR with Mayo stem. In the years 2004-2007 at Orthopaedic and Traumatology Department, Medical University in Lublin 38 Mayo stems were implanted in 35 patients. There were: 5 women and 30 men in the age from 27 to 67 years (average 51 years). The main cause of surgery was primary coxarthritis in 17 hips, AVN in 17, and DDH in 4. Follow-up is from 12 to 48 months (average 24.2 months). Preoperative Harris Hip Score varied from 32 to 45 pts. (average 38 pts.) and increased to 75-100 pts. (average 96 pts.) at longest postoperative follow up. There was one postoperative dislocation of THR 3 weeks after the surgery. There was one Mayo stem migration nine months after the surgery (15 mm) with radiolucent lines in all Gruen's zones. Conclusions. 1) Operative technique of Mayo stem is easy even with minimalny invasive technique. 2) The use of metal on metal bearing surfaces with short metaphyseal stem in THR gives possibility for good durable clinical result

[First experiences with total hip resurfacing arthroplasty]. / Pierwsze doswiadczenia w calkowitej protezoplastyce powierzchniowej stawów biodrowych.

MATERIAL: From may 2005 25 surface arthroplasties were made in 10 women and 15 men in the age from 23 to 64 years (average 43 years). The main reason for arthroplasty was idiopathic arthritis in 20 patients. 24 ReCap (Biomet) endoprosthesis were implanted. The dysplastic BHR (Smith & Nephew) acetabular component was implanted in one patient because of the deficit of dysplastic acetabulum. RESULTS: The follow up is from 10 to 20 months (average 11 months). Clinical results in Harris Hip Score is from 90 to 100 points (average 95.8 pts). The average acetabular cup's angle of inclination is 51.2 degrees (from 40 to 77 degrees), and average femoral heads angle is 140.3 degrees (from 131 to 148 degrees). There were not any significant intraoperative and early postoperative complications. CONCLUSIONS: Early clinical results and data from bibliography confirm the value of surface arthroplasty in the treatment of young and active patients. The procedure is technically demanding.