Assessment of the Length of the Pedicle of the Anterolateral Thigh Flap.

Purpose To estimate the length of the pedicle of the anterolateral thigh flap (ALT) and to assess how this length corresponds with the distances between the anatomical landmarks. Methods The study group consisted of patients who underwent computed tomography angiograms ranging minimally from the anterior superior iliac spine (ASIS) superiorly and tibia inferiorly. In the study we included 44 patients. In the axial window we identified single scans with (1) ASIS, (2) the apex of the greater trochanter, (3) the origin of the descending branch of the lateral femoral circumflex artery (LFCA), (4) the superolateral corner of the patella, (5) knee joint gap. Knowing the slice thickness in every patient and the difference in scan number we measured (A)-the distance between the scan (1) and the scan (4). This distance (A) represented the length of the line connecting ASIS and the superolateral corner of the patella (AP line). Next, we identified (6) the midpoint of the distance (A). Next we measured (B)-the distance between the scan (2) and the scan (5) and (C)-the distance between the scan (3) and the midpoint of the AP line (6). Results Mean distances between the scans were: (A) 45.34 cm (SD=4.14), (B) 43.12 cm (SD=4.08), (C) 11.69 cm (SD=1.62). There was low positive correlation between the distance (A) and the distance (C) (rs=0.43) and moderate positive correlation between the distance (B) and the distance (C) (rs=0.53). Conclusion Our study suggests that the mean estimated length of the ALT flap pedicle is 11.69 cm and that it positively correlates with the length of the femur and the length of the AP line.

Standards of perioperative management in total knee and hip arthroplasty procedures. A survey-based study. Part I: Preoperative management.

INTRODUCTION: Recent years have seen an increasing number of elective total knee (TKA) and hip arthroplasty (THA) procedures. Since a wide variety of methods and procedures are used in perioperative management, a survey-based study was carried out to identify the patterns of practice in Polish hospitals. MATERIAL AND METHODS: With the help of the LimeSurvey application, questionnaires for anaesthesio-logists and orthopaedists were prepared to gain insight into the preparation of patients for TKA and THA procedures and perioperative care. Questionnaires included both single and multiple-choice questions concerning among other things type of laboratory tests, additional examinations and consultations performed on a routine basis before elective TKA and THA procedures. RESULTS: A total of 162 medical centres took part in the study. Questionnaire responses were obtained from 93 (57%) orthopaedics teams and 112 (69%) anaesthesiology teams. A mean (standard deviation, SD) of 7.2 (3.5) laboratory tests are routinely ordered before surgery. For example, 47% of orthopaedists and 20% of anaesthesiologists order urinalysis, while 53% of orthopaedists and 26% of anaesthesiologists order a CRP test. Seventy-nine per cent of orthopaedists refer patients for at least one specialist consultation before the procedure. Dental consultation is requested by 40%, gynaecological consultation by 27%. Patient preoperative education is provided by 85% of orthopaedists and preoperative rehabilitation is prescribed by 46% of them. A total of 56% surveyed anaesthesiologists perform pre-anaesthetic evaluation upon patients' hospital admission. CONCLUSIONS: The study found that the number of examinations and specialist consultations conducted in Polish hospitals exceeded the scope of recommendations of scientific societies. Furthermore, the authors identified a need to standardise perioperative management in the form of Polish guidelines or recommendations, with the intention to improve patient safety and optimize health care expenses.

Spinal Involvement in Patients with Chronic Non-Bacterial Osteomyelitis (CNO): An Analysis of Distinctive Imaging Features.

Spinal involvement by chronic non-bacterial osteomyelitis (CNO) has been increasingly reported in recent years, often being presented as a diagnostic dilemma requiring differential diagnosis with bacterial spondylodiscitis and/or neoplasia. This study was aimed at identifying the imaging features of CNO facilitating its differentiation from other spinal diseases. Two radiologists assessed the imaging studies of 45 patients (16 male and 29 female, aged from 6 to 75 years, 15 children) with CNO collected from 5 referential centers. Spinal lesions were found in 17 patients (2 children and 15 adults), most often in the thoracic spine. In children, the lesions involved short segments with a destruction of vertebral bodies. In adults, the main findings were prominent bone marrow edema and osteosclerosis, endplate irregularities, and ankylosing lesions extending over long segments; paraspinal inflammation was mild and abscesses were not observed. In both children and adults, the involvement of posterior elements (costovertebral and facet joints) emerged as an important discriminator between CNO and neoplasia/other inflammatory conditions. In conclusion, a careful inspection of imaging studies may help to reduce the number of biopsies performed in the diagnostic process of CNO.

Corrective Osteotomies in Severe Non-Idiopathic Lower Limb Alignment Disorders in the Aspect of Future Joint Endoprosthesis-A Perspective Study.

The aim of this study was to retrospectively evaluate the effectiveness of corrective osteotomies in lower limb axis disorders at different levels of non-idiopathic (post traumatic, developmental, post-septic) etiology. A total of 50 patients were divided into three groups: A-thigh segment alignment disorder (24 patients); B-tibia segment alignment disorder (18 patients); C-thigh and tibia segment alignment disorder (8 patients). Radiological evaluation of digital lower limb postural X-ray was performed laterally and for AP, and included mLPFA, mLDFA, MAD, CORA coronal and sagittal plane parameters for the femur segment and mMPTA, mLDTA, MAD, CORA coronal and sagittal plane for the tibia segment. Clinical assessment was based on the LLFI. The mean follow-up was 55.8 months (12-86). Improvements in the radiological parameters and statistical significance were achieved for all measurements in all groups (p < 0.05). The most common plane of deformation was the coronal plane (varus/valgus), followed by the transverse (rotational) and sagittal planes (procurvatum/recurvatum). In this study, we examined 29 post-traumatic deformities and 21 other etiologies. Improvements in the LLFI score performance after corrective osteotomies were observed in all three groups. Corrective osteotomies are a safe and useful but challenging method of preserving joints in cases of post-traumatic, developmental or post-septic lower limb alignment disorders.

Intraarticular Implantation of Autologous Chondrocytes Placed on Collagen or Polyethersulfone Scaffolds: An Experimental Study in Rabbits.

Hyaline cartilage has very limited repair capability and cannot be rebuilt predictably using conventional treatments. This study presents Autologous Chondrocyte Implantation (ACI) on two different scaffolds for the treatment of lesions in hyaline cartilage in rabbits. The first one is a commercially available scaffold (Chondro-Gide) made of collagen type I/III and the second one is a polyethersulfone (PES) synthetic membrane, manufactured by phase inversion. The revolutionary idea in the present study is the fact that we used PES membranes, which have unique features and benefits that are desirable for the 3D cultivation of chondrocytes. Sixty-four White New Zealand rabbits were used in this research. Defects penetrating into the subchondral bone were filled with or without the placement of chondrocytes on collagen or PES membranes after two weeks of culture. The expression of the gene encoding type II procollagen, a molecular marker of chondrocytes, was evaluated. Elemental analysis was performed to estimate the weight of tissue grown on the PES membrane. The reparative tissue was analyzed macroscopically and histologically after surgery at 12, 25, and 52 weeks. RT-PCR analysis of the mRNA isolated from cells detached from the polysulphonic membrane revealed the expression of type II procollagen. The elementary analysis of polysulphonic membrane slices after 2 weeks of culture with chondrocytes revealed a concentration of 0.23 mg of tissue on one part of the membrane. Macroscopic and microscopic evaluation indicated that the quality of regenerated tissue was similar after the transplantation of cells placed on polysulphonic or collagen membranes. The established method for the culture and transplantation of chondrocytes placed on polysulphonic membranes resulted in the growth of the regenerated tissue, revealing the morphology of hyaline-like cartilage to be of similar quality to collagen membranes.

Radiologic Predictors for Clinical Improvement in PAO-A Perspective Study.

The aim of this study was to evaluate the results of surgical treatment of developmental dysplasia of the hip (DDH) with periacetabular osteotomy (PAO) and determine the values of radiological parameters that would allow us to obtain an optimal clinical result. Radiological evaluation included determining the center-edge angle (CEA), medialization, distalization, femoral head coverage (FHC), and ilioischial angle as measured on a standardized AP radiograph of the hip joints. Clinical evaluation was based on the HHS, WOMAC, Merle d'Aubigne-Postel scales and Hip Lag Sign. The results of PAO presented decreased medialization (mean 3.4 mm), distalization (mean 3.5 mm), and ilioischial angle (mean 2.7°); improvement in femoral head bone cover; an increased CEA (mean 16.3°) and FHC (mean 15.2%); clinically increased HHS (mean 22 points) and M. Postel-d'Aubigne (mean 3.5 points) scores; and a decrease in WOMAC (mean 24%). HLS improved in 67% of patients after surgery. Qualification of patients with DDH for PAO should be based on the following values of three parameters: CEA < 26°, FHC < 75%, and ilioischial angle >85.9°. To achieve better clinical results, it is necessary to increase the average CEA value by 11° and the average FHC by 11% and reduce the average ilioischial angle by 3°.

Femoroacetabular impingement in the unpinned contralateral hip in patients with primary unilateral slipped capital femoral epiphysis: preliminary radiographic outcomes.

The study evaluated femoroacetabular impingement (FAI) in the unpinned contralateral hip in patients with unilateral slipped capital femoral epiphysis (SCFE) and verified initial age, posterior sloping angle (PSA) and center-edge angle (CEA) as predictors of FAI in the contralateral hip. 152 patients with unilateral SCFE with a mean index age of 13.2 years (8.2-17.2 years) were enrolled retrospectively into the study. Mean follow-up was 8 years (3-14 years). PSA and CEA were measured on initial radiographs of the unaffected hip. Alpha-angle and CEA were measured on radiographs taken at the last follow-up to identify FAI. Four groups of patients were distinguished: (1) no FAI (10 patients, 17.54%); (2) CAM-type FAI (41 patients, 71.9%); (3) pincer-type FAI (3 patients, 5.26%) and (4) mixed-type FAI (13 patients, 22.8%). The mean PSA was 12.1°, 12°, 16.8°, 11.9° for groups 1, 2, 3 and 4, respectively, with no significant difference ( P = 0.65). The mean initial CEA for groups 1, 2, 3 and 4 was 34.4°, 35.5°, 42° and 42° respectively, with significant differences between groups 1 versus 4 ( P = 0.034) and 2 versus 4 ( P = 0.009). Conclusions are as follows: 1. Radiographic features of FAI were present in 85.1% of unpinned contralateral hips in patients with unilateral SCFE. 2. 71.9% of unpinned contralateral hips developed CAM deformity. 3. CEA can be used in predicting pincer-type FAI in the contralateral hip in unilateral SCFE. 4. PSA and age revealed negligible value in predicting FAI.

Can we still use X-rays to predict contralateral slip in primary unilateral slipped capital femoral epiphysis?

The objective of this study was to assess subsequent contralateral slip (SCS) in the unaffected hip in patients with primary unilateral slipped capital femoral epiphysis (SCFE) using three radiographic parameters: posterior sloping angle (PSA), center-edge angle (CEA) and triradiate cartilage (TC) appearance. A total of 152 patients admitted to two pediatric units between 2001 and 2015 were divided into three groups: A - underwent prophylactic fixation of the unaffected hip at the time of index surgery- high clinical risk of SCS; B - no clinical risk factors but SCS occurred; C - no issues regarding the contralateral hip during follow-up. The mean PSA for groups A, B and C were 22°(6-49), 17°(9-24) and 13°(0-27), respectively. PSA was significantly higher in Group A than in Group C ( P < 0.0001). The differences in PSA between groups A and B, but also B and C were insignificant ( P = 0.12 and p=0.21, respectively). The mean CEA in groups A, B and C was 33(25-43), 35(26-42) and 37(17-53), respectively. CEA did not differ significantly between groups A, B and C ( P = 0.25). Assessment of TC did not differ significantly between the groups ( P = 0.66). Observation of TC in groups B and C combined revealed that the cartilage was open in 65% of 77 patients and 14% of them developed SCS; whereas among the 35% of patients with ossified TC only 7% developed SCS (OR=2.0). PSA and CEA alone have no predictive value in determining the risk of contralateral slip. The absence of TC results in a two-fold decrease in the likelihood of developing an SCS. The decision of prophylactic surgical treatment of the contralateral hip in primary unilateral SCFE should not be based solely on radiographic findings.

Minimally Invasive Radiographic Evaluation of the Dysplastic Hip Joint Configuration in Terms of Surgical Treatment with Hip Preservation by PAO.

Introduction: Residual developmental dysplasia of hip (RDDH) is a factor of early osteoarthritis of the hip. The main problems are pain and instability of the hip joint due to inadequate coverage of the femoral head by the acetabulum. The purpose of this study was to radiologically evaluate RDDH after Bernese periacetabular osteotomy (PAO) and to compare RDDH to healthy hips. Materials and Methods: The radiological parameters of RDDH treated by PAO were retrospectively evaluated. Digital AP pelvic radiographs were taken, including parameters of central edge angle and femoral head coverage, medialization, distalization, and ilio-ischial angle. Clinical assessment is based on the VAS scale. The study group consisted of patients with RDDH, and the control group consisted of patients without RDDH. Results: After PAO radiological parameters decreased: medialization by 2.68 mm, distalization by 3.65 mm, and ilio-ischial angle by 2.62°. However, there was an increase in the parameters: CEA by 17.61° and FHC by 16.46%. There was a mean 3 point decrease in pain on the VAS scale. There was also a statistically significant radiological difference in the structure of dysplastic hip joints before surgery and healthy hip joints of the control group. Conclusions: Radiological studies confirmed the effectiveness of the PAO method in the treatment of RDDH. Based on all radiological parameters, differences between healthy and dysplastic hip joints were demonstrated. We believe that a thorough understanding of the values of radiological parameters used to describe dysplastic hip joints will allow us to improve the imaging diagnosis of this condition.

Hip dysplasia in adolescence: osteotomy in childhood improves the results of periacetabular osteotomy in adolescents and young adults : a prospective study.

AIMS: Developmental dysplasia of the hip (DDH) describes a pathological relationship between the femoral head and acetabulum. Periacetabular osteotomy (PAO) may be used to treat this condition. The aim of this study was to evaluate the results of PAO in adolescents and adults with persistent DDH. METHODS: Patients were divided into four groups: A, adolescents who had not undergone surgery for DDH in childhood (25 hips); B, adolescents who had undergone surgery for DDH in childhood (20 hips); C, adults with DDH who had not undergone previous surgery (80 hips); and D, a control group of patients with healthy hips (70 hips). The radiological evaluation of digital anteroposterior views of hips included the Wiberg angle (centre-edge angle (CEA)), femoral head cover (FHC), medialization, distalization, and the ilioischial angle. Clinical assessment involved the Harris Hip Score (HHS) and gluteal muscle performance assessment. RESULTS: Significant improvements in radiological parameters were achieved in all measurements in all groups (p < 0.05). The greatest improvement was in CEA (mean of 19° (17.2° to 22.3°) in Group B), medialization (mean of 3 mm (0.9 to 5.2) in Group C), distalization (mean of 6 mm (3.5 to 8.2) in Group B), FHC (mean of 17% (12.7% to 21.2%) in Group B), and ilioischial angle (mean of 5° (2.3° to 8.1°) in Group B). There were significant improvements in the mean HHS and gluteal muscle performance scores postoperatively in all three groups. CONCLUSION: The greatest correction of radiological parameters and clinical outcomes was found in patients who had undergone hip surgery in childhood. Although the surgical treatment of DDH in childhood makes subsequent hip surgery more difficult due to scarring, adhesions, and altered anatomy, it requires less correction of the deformity and has a beneficial effect on the outcome of PAO in adolescence and early adulthood. Cite this article: Bone Joint J 2022;104-B(7):775-780.

Regeneration of Articular Cartilage Using Membranes of Polyester Scaffolds in a Rabbit Model.

One promising method for cartilage regeneration involves combining known methods, such as the microfracture technique with biomaterials, e.g., scaffolds (membranes). The most important feature of such implants is their appropriate rate of biodegradation, without the production of toxic metabolites. This study presents work on two different membranes made of polyester (L-lactide-co-ε-caprolactone-PLCA) named "PVP and "Z". The difference between them was the use of different pore precursors-polyvinylpyrrolidone in the "PVP" scaffold and gelatin in the "Z" scaffold. These were implemented in the articular cartilage defects of rabbit knee joints (defects were created for the purpose of the study). After 8, 16, and 24 weeks of observation, and the subsequent termination of the animals, histopathology and gel permeation chromatography (GPC) examinations were performed. Statistical analysis proved that the membranes support the regeneration process. GPC testing proved that the biodegradation process is progressing exponentially, causing the membranes to degrade at the appropriate time. The surgical technique we used meets all the requirements without causing the membrane to migrate after implantation. The "PVP" membrane is better due to the fact that after 24 weeks of observation there was a statistical trend for higher histological ratings. It is also better because it is easier to implant due to its lower fragility then membrane "Z". We conclude that the selected membranes seem to support the regeneration of articular cartilage in the rabbit model.

Satisfactory clinical and radiologic outcomes with a new shorter and modular stem for end-stage hip osteoarthritis: an international prospective multicentre pilot study.

INTRODUCTION: This multicenter prospective cohort study aimed to assess the safety and clinical and radiologic performance of the CLS® BreviusTM Stem with Kinectiv® Technology. MATERIAL AND METHODS: A total of 222 consecutive subjects, recruited in five different centers, qualifying for primary total hip arthroplasty (THA), were enrolled in the study. All the subjects received the CLS® BreviusTM Stem with Kinectiv® Technology. All the enrolled study subjects underwent pre-operative clinical and radiographic evaluation. Additionally, all subjects underwent post-operative clinical, functional and radiographic evaluations at 6 months and 1, 2, 3, and 5 years. These evaluations included implant survival, pain and functional performance (Harris Hip Score [HHS], University of California, Los Angeles [UCLA] Activity Score, Oxford Hip Score), subject quality-of-life (EQ-5D), radiographic parameters, complications, and concentration of metal ions (aluminum and titanium) in blood. RESULTS: No revisions were performed during the follow-up period. Of the 222 patients, only 76 completed the 5-year follow-up. Only 7 and 5 patients had aluminum and titanium 5-year evaluations, respectively. All the clinical parameters showed an overall improvement in the overtime measured with ANOVA for repeated measures; furthermore, the clinical scores showed a statistically significant improvement at 5 years with respect to pre-operative value (p < 0.001). Aluminum and titanium showed no variation for repeated measures at different time points (p > 0.05). A total of six complications were reported, of which only two were hip-related. CONCLUSIONS: The function of the CLS® BreviusTM Stem with Kinectiv® Technology indicated that subject well-being significantly increased following THA regardless of age, gender, BMI, previous surgery, primary diagnosis, and lifestyle.

Assessment of the endoprosthesis offset in a dysplastic coxarthrosis.

Incorrectly developed acetabulum and subluxated hip joint may cause many problems for proper implantation of endoprosthesis. The aim of this work is to assess the radiological results of offset restoration and selection of endoprosthesis implant in a dysplastic hip joint. The study group consisted of patients who had a surgery in the period between 2016 and 2018. All of them had a cementless total hip endoprosthesis. The group consisted of 91 patients (96 hip joints), with an average age of 42 years (31-47 years). 55 left and 41 right hip joints. 70 females and 21 males. The control group consisted of patients who were not diagnosed with hip joint dysplasia. The control group consisted of 70 patients (70 hip joints), with an average age of 35 years (19-55 years). 53 females and 17 males. The radiographic assessment included the measuring of medialization and distalization which describe the offset of hip joint. The joint decentration was classified according to Crowe. Based on radiographic measurements we have achieved statistically significant (p<0.05) changes in medialization and distalization parameters. We have not noticed a statistically significant difference for medialization parameter (p=0.8259) after a surgery when compared to the control group. For all patients we have achieved a restoration of correct offset in the horizontal plane. The main idea behind endoprosthesis in a dysplastic coxarthosis is the implantation of endoprosthesis cup in an anatomically correct location. Small screw- in cup and conical stem offer great possibility of restoring correct offset of a dysplastic hip joint.

Guidelines of prevention, recognition and treatment of osteoporotic bone fractures.

Population aging makes osteoporotic fractures (OP) an increasingly serious healthcare problem. It is estimated that there are approximately 2,200,000 people with an osteoporotic fracture in Poland, and according to the NFZ (National Health Found) report 126,100 new fractures were registered in 2018, including 34,700 fractures of the proximal femur (PFF). Surgical treatment of OP fractures is difficult due to local conditions and the general health condition of the patients. Reduced bone strength makes it difficult to achieve permanent bone fixation and union.The current "Guidelines for the prevention, diagnosis and treatment of osteoporotic bone fractures" is an update of the 2017 version (previous versions: 2007, 2012) taking into account the progress made in this area of knowledge and practice. The latest principles of conduct have been created on the basis of contemporary world standards and publications. The recommended methods of treating fractures will be discussed: of the PFF, distal end of the radius, proximal end of the humerus and the spine. Particular attention has been paid to the management of patients with PFF, because the average age - 80 years causes that an average of 29.4% of patients in Poland die within a year after the fracture (data from the National Health Fund). After sustaining a fracture, the risk of a consecutive one increases 210 times, so the surgeon is required not only to treat the fracture, but also to implement fracture prophylaxis. The study will also present the principles of diagnosis and treatment of osteoporosis.The presented guidelines were adopted in August 2022 as an official document of the National Consultant in the field of Orthopedics and Traumatology of the bone and joints system and the President of the Polish Society of Orthopedics and Traumatology. The leading author was Prof. dr hab. med. Edward Czerwiski.

Comparison of Intramedullary Magnetic Nail, Monolateral External Distractor, and Spatial External Fixator in Femur Lengthening in Adolescents with Congenital Diseases.

The aim of this study is to evaluate the course of the treatment and clinical and functional outcomes of femur lengthening in adolescents with congenital disorders by the application of different surgical methods. This retrospective study comprised 35 patients (39 procedures). A total of 11 patients underwent femur lengthening with the use of the intramedullary magnetic nail (IMN) Precise 2 (NuVasive, San Diego, CA, USA), 7 patients (11 procedures) with the use of the monolateral external distractor Modular Rail System (MRS) (Smith and Nephew, Memphis, TN, USA), and 17 with the use of the computer-assisted external fixator Taylor Spatial Frame (TSF) (Smith and Nephew, Memphis, TN, USA). The inclusion criteria were as follows: (1) congenital femoral length deficiency without any axial deformities and (2), independently of the finally applied treatment, the technical possibility of use of each of the analyzed methods. The distraction index did not differ significantly between the groups (p = 0.89). The median lengthening index was the lowest in the IMN group (24.3 d/cm; IQR 21.8-33.1) and statistically different in comparison to the MRS (44.2 d/cm; IQR 42-50.9; p < 0.001) and the TSF groups (48.4 d/cm; IQR 38.6-63.5; p < 0.001). Similarly, the consolidation index in the IMN group (12.9 d/cm; IQR 10.7-21.3) was statistically lower than that in the MRS (32.9 d/cm; IQR 30.2-37.6; p < 0.001) and the TSF (36.9 d/cm; IQR 26.6-51.5; p < 0.001) groups. This study indicates that IMN is a more valuable method of treatment for femoral length discrepancy without axial deformity than MRS and TSF in complication rate and indexes of lengthening and consolidation.

Gorham-Stout disease involving ipsilateral clavicle and scapula in a child - a case report focusing on imaging and histopathological features of this extremely rare condition.

Gorham-Stout disease (GSD) is a very rare entity of unknown etiology, characterized by excessive intra-osseous proliferation of blood or lymphatic vessels, resulting in progressive resorption of bone matrix and destruction of bone. To date we have found only seven published cases concerning fully confirmed GSD of the shoulder girdle bones in children. Our case concerns an 8-year-old boy with involvement of the left clavicle and scapula. The knowledge of imaging and histopathological features is crucial for establishing the diagnosis of GSD, therefore the exchange of experiences in this field is essential for improving the care of affected patients.

Pelvic incidence and pelvic tilt can be calculated using either the femoral heads or acetabular domes in patients with hip osteoarthritis.

AIMS: The aim of the study was to compare two methods of calculating pelvic incidence (PI) and pelvic tilt (PT), either by using the femoral heads or acetabular domes to determine the bicoxofemoral axis, in patients with unilateral or bilateral primary hip osteoarthritis (OA). METHODS: PI and PT were measured on standing lateral radiographs of the spine in two groups: 50 patients with unilateral (Group I) and 50 patients with bilateral hip OA (Group II), using the femoral heads or acetabular domes to define the bicoxofemoral axis. Agreement between the methods was determined by intraclass correlation coefficient (ICC) and the standard error of measurement (SEm). The intraobserver reproducibility and interobserver reliability of the two methods were analyzed on 31 radiographs in both groups to calculate ICC and SEm. RESULTS: In both groups, excellent agreement between the two methods was obtained, with ICC of 0.99 and SEm 0.3° for Group I, and ICC 0.99 and SEm 0.4° for Group II. The intraobserver reproducibility was excellent for both methods in both groups, with an ICC of at least 0.97 and SEm not exceeding 0.8°. The study also revealed excellent interobserver reliability for both methods in both groups, with ICC 0.99 and SEm 0.5° or less. CONCLUSION: Either the femoral heads or acetabular domes can be used to define the bicoxofemoral axis on the lateral standing radiographs of the spine for measuring PI and PT in patients with idiopathic unilateral or bilateral hip OA. Cite this article: Bone Joint J 2021;103-B(8):1345-1350.

The Effect of the COVID-19 Pandemic on Total Hip and Knee Arthroplasty Surgical Volume in 2020 in Poland.

The aim of this study was to analyse the effect of the first year of the COVID-19 pandemic on total hip arthroplasty (THA) and total knee arthroplasty (TKA) surgical volume in Poland. A retrospective analysis of data concerning THA and TKA collected by the National Health Fund in Poland in 2019 and in 2020 has been conducted. The number of primary hip or knee arthroplasties in 2020 was around 71% and 67% of the number registered in 2019, respectively. There was also a decline in the volume of revision arthroplasties observed, with 65% and 63% of THA and TKA revisions performed in 2019. The most significant decrease was observed in April and May, and during the second wave of the pandemic in November 2020, with a decline of 87%, 55% and 56%, respectively. The results of this study show the significant impacts that the COVID-19 pandemic had on the volume of elective hip and knee arthroplasties in Poland in 2020. In comparison with 2019, a decrease of around 30% for primary and of 40% for revision arthroplasties was observed. The most significant decline was observed in April and May 2020, and during the second wave of the COVID-19 pandemic in Poland in November 2020.

Parasitosis of the vertebral canal mimicking lumbar intervertebral disc herniation: a case report.

STUDY DESIGN: Case report. BACKGROUND: It is a case of dracunculiasis of the spine mimicking lumbar intervertebral disc herniation. CASE PRESENTATION: A 57 year-old Caucasian male was admitted to the hospital because of the left L5 radiculopathy lasting for 2 months. The pain in the left lower limb was associated with muscle weakness on dorsal flexion of the foot, paresthesia of the dorsal aspect of the foot and tingling in the big toe. Neurological examination revealed: muscle weakness on dorsal flexion of the foot, impaired light touch and pin prick test on the dorsal aspect of the foot and positive Lasègue's sign. Magnetic resonance imaging (MRI) examination revealed L4-L5 intervertebral disc herniation with sequester compressing the left L5 nerve root. The open L4-L5 left side discectomy was performed. During the sequester evacuation 3 pieces of nematodes were removed and preserved in 10% of formaldehyde solution. After the surgery the patient was pain free with normal neurological examination. The diagnosis of dracunculiasis was based on the morphology of the nematode and on exclusion of the other parasites. DM infestation could not be confirmed with molecular testing that was impaired by the formaldehyde. CONCLUSIONS: Parasite infestation should be considered even in cases with obvious MRI of lumbar intervertebral disc herniation. If a nematode was found accidentally during any surgery it should be preserved in a 0.9% saline, not in formaldehyde, not to disturb the molecular tests.

Analysis of Radiographic Parameters of Sagittal Spinopelvic Alignment: Polish Nomenclature and Clinical Implications.

Over the last 30 years, many authors have suggested that the shape of the human spine in the sagittal plane is helpful in understanding its physiology and pathology. This paper presents the current views and Polish no-men-clature used for the assessment of the morphology and position of the pelvis in the sagittal plane. The va-lues of particular radiographic parameters are presented for healthy individuals and for patients with selected spinal pathologies. Moreover, the paper discusses the practical application of the radiographic parameters that describe the shape and position of the pelvis in the sagittal plane.