[Arthroscopic Bankart Repair with Remplissage for Anterior Instability: Functional Outcomes, Risk of Failure]. / Artroskopická Bankartova operace se soucasnou remplissage: funkcní výsledky, riziko selhání.

PURPOSE OF THE STUDY This study aimed to evaluate the clinical outcomes and the rate of recurrence in patients who had undergone arthroscopic Bankart repair with remplissage for anterior instability of the glenohumeral joint. MATERIAL AND METHODS The study included 96 arthroscopic Bankart procedures with remplissage performed between 2013 and 2019 at our department in 93 patients (81 men and 12 women; with the mean age of 33 years). We gathered and analysed preoperative data, including a 3D-CT scan of the affected shoulder. Apart from stability, the functional results were assessed postoperatively using the WOSI, SSV, Rowe score, and by measuring the strength of shoulder girdle muscles. The non-parametric MannWhitney U-test was used to identify the predisposing factors for recurrence of glenohumeral instability. RESULTS The arthroscopic Bankart repair with remplissage was indicated in 74 shoulders for primary TUBS and in 22 shoulders as a revision procedure. The recurrent instability was observed in 13 of 96 operated shoulders (13.5%). Subjective instability (positive apprehension test in the extreme positions of the shoulder joint, in abduction and external rotation in particular) was reported by 10 patients (10/13; 77%), three patients experienced a redislocation of the glenohumeral joint in the postoperative follow-up (3/13 patients; 23%). The risk of recurrence of the glenohumeral instability was not correlated with either the number of previous stabilisation procedures, or any other preoperative or intraoperative parameters. Conversely, a new postoperative injury was a factor of key importance. The patients with recurrent instability (subjective instability or glenohumeral dislocation) achieved a significantly lower Rowe score, SSV, postoperative VAS, and worse overall satisfaction with the procedure compared to the group with no recurrent instability. The remplissage induced minor limitations of external rotation at 0° abduction and internal rotation at 90° abduction. After rehabilitation, the muscle strength of the operated shoulder in both groups was comparable to that of the untreated shoulder in all planes of the shoulder range of motion. DISCUSSION Our study confirms the clinical relevance of the addition of remplissage to the arthroscopic Bankart procedure for reducing the rate of recurrent glenohumeral instability in TUBS with a clinically significant Hill-Sachs lesion. Satisfaction with the surgical outcome is high; the functional outcomes are very good, including muscle strength. Surprisingly, though, the risk of recurrent instability does not correlate with the number of implants used in the stabilisation procedure. CONCLUSIONS Addition of remplissage to the arthroscopic Bankart stabilisation in patients with a clinically significant Hill-Sachs lesion shows a low risk of recurrence of glenohumeral instability after surgery compared to the conventional arthroscopic Bankart repair alone. The remplissage does cause minor restrictions in the glenohumeral joint external rotation, but it was not reflected in the satisfaction of patients or a lower clinical score of the shoulder joint. The preoperative assessment of the HillSachs lesion using the "glenoid track" on a 3D-CT scan helps improve the preoperative planning and prediction of outcomes of the stabilisation procedure. Key words: glenohumeral instability, Bankart defect, Hill-Sachs lesion, Bankart repair, remplissage, arthroscopy.

Soft tissue calcification treated with local and oral magnesium therapy.

Eighty patients with soft tissue calcification were treated: 24 suffered from myositis ossificans traumatica, 23 from calcific bursitis (Duplay's disease), six from osteoarthropathy of elbow joint after severe craniocerebral trauma, nine from calcification around the elbow joint after local trauma, 13 from calcification around the hip joint, and five from calcification in ligaments and tendons. Using a new method of treatment about 75% of patients were cured. Calcifications disappeared or diminished substantially. Very good functional improvement followed in affected joints. The treatment involved local application of MgSO4 under local anaesthesia into calcified areas for 2-20 weeks, together with peroral administration of Mg lactate for 4-6 months. There were no complications or side effects of this treatment.

Serum magnesium and calcium in patients with dorsalgias.

Serum magnesium and calcium was examined in 70 patients with chronic dorsalgias. Values of calcium were stabilized, but values of magnesium were unstable and exceeded the 2SD lines, being more often over than under these lines. Lability of serum magnesium levels is considered a secondary consequence, caused by the stress of pain. These symptoms may be alleviated by Mg administration, by local application of Mg through transdermic iontophoresis or sonophoresis, or by hydropathy of the paravertebral muscles.

[The importance of magnesium in orthopedics. VI. The importance of magnesium in the treatment of ectopic calcification and ossification]. / Význam magnézia v ortopedii. Cást VI. Význam magnézia v lécbe ektopickych kalcifikací a osifikací.

In a five-year investigation the authors demonstrate their results with Mg treatment in 54 patients with ectopic calcifications and ossifications. Based on the results of experimental work, where the inhibiting action of Mg ions on calcium phosphate precipitation was proved in vitro as well as in vivo, the authors treated by means of local MgSO4 injections and oral administration of Mg lactate 17 patients with ossifying myositis, 16 with calcareal bursitis, 4 patients with paraosteoarthropathy of the elbow after craniocerebral injuries, 6 calcifications of the hip joint after operations and 5 calcifications in the insertions of tendons and ligaments. In all instances diminution to complete disappearance of the calcificates and ossificates was observed. The authors achieved also very favourable functional results. In the majority of patients the mobility in adjacent joints was restored. Clinical experience indicates that Mg prevents the development or suppresses further growth of ectopic calcifications and ossifications. During the formation of the ossificate, which is still immature, Mg causes diminution and sometimes complete absorption of the immature bone.

[The significance of magnesium in orthopedics. V. Magnesium in osteoporosis]. / Význam magnézia v ortopedii. Cást V. Magnézium u osteoporóz.

The authors submit an investigation of 60 patients with senile, post-menopausal and drug-induced osteoporosis. Using the method of absorption spectrophotometry, they found a reduced level of Mg in red blood cells in 63.6% of senile, 66.7% postmenopausal and only in 22.2% drug-induced osteoporoses. Also the mean level of red cell magnesium was significantly lower in the group of senile (1.94 mmol) and postmenopausal (1.85 mmol) osteoporosis as compared with drug-induced osteoporosis (2.25 mmol). The authors revealed moreover that the level of red cell magnesium in the former two groups declines in proportion to the severity of osteoporosis and correlates thus with the clinical and X-ray finding. For treatment of osteoporisis the authors used magnesium lactate alone (in 37 patients) and combined with sodium fluoride (in 23 patients). In the majority of patients they had very favourable results. Based on laboratory and therapeutic results, consistent with data in the experimental literature, the authors assume that magnesium as a catalyst of bone metabolism and as one of the most important factors controlling the formation of bone matrix and its mineralization plays a significant role in the aetiopathogenesis of senile and postmenopausal osteoporosis. The authors assume that Mg deficiency which is increasing in recent years in soil as well as in foodstuffs and water may be the main cause of the increasing number of patients with osteoporosis in civilized countries. Magnesium should have its firm place not only in therapy but also in prevention of the majority of osteoporosis.

[Initial Experience with Morscher's Elongation Osteotomy in Coxa Brevis.]. / První zkusenosti s Morscherovou elongacní osteotomií u coxa brevis.

The authors present their initial experience with triple osteotomy of the proximal femur with elongation of the neck of the coxa brevis. The objective of elongation osteotomy is to achieve sufficiency of the abductors after reduction and distalization of the greater trochanter and to improve the biomechanics of the hip joint. The same indication applies to double intertrochanteric Wagner or Dungle osteotomy which achieves also similar results. At the Orthopaedic Clinic of the Medical Faculty, Palacký University Olomouc in the course of 13 months eight patients were operated. The authors describe briefly the surgical procedure, explain the necessity of a certain modification during the final stage of operation during adjustment and refixing of the reduced greater trochanter. They discuss the indication spectrum, explain why they do not use simple transposition of the greater trochanter and mention the possibility of subsequent osteotomy of the pelvis or plastic operation of the tectum in case of concomittant acetabular dysplasia. Key words: coxa brevis, triple osteotomy, elongation of the neck of the femur, reduction and distalization of the greater trochanter.

[Subcapital osteotomy of the femoral neck in the treatment of coxa vara in adolescence--long-term results]. / Subkapitální osteotomie krcku femoru v lécbe coxa vara dospívajících--dlouhodobé výsledky.

The authors present a group of 16 adolescents suffering from coxa vara treated in the years 1967-1987 for a severe slipped capital femoral epiphysis by subcapital osteotomy. The authors deal with the etiology, symptomatology and treatment with special regard to the severe slip. Spica cast was applied in most operations and no internal fixation was used. In the so far latest female patient the femoral head was fixed after osteotomy by Kirschner wires according to Dyas Aries. In the discussion the authors report considerably lower percentage of complications in the longterm examination, mainly as concenns the avascular necrosis of the femoral head in comparison with most works presented both in the Czechoslovak and foreign literature. These results are explained by a proper indication, prepping technique, adequate operative technique and a consistent adherence to longterm nonweight of the extremity operated on. Preventive epiphyseodesis on the intact hip joint has not been performed.

[Stereotactically aimed biopsy of vertebral body l2.]. / Stereotakticky cílená biopsie z obratlového tela L2.

The authors describe successful use of an whole-body stereotactic apparatus for collection of pathological tissue samples from the vertebral body L2. Key words: whole-body aiming apparatus, stereotactic biopsy, vertebral body.

[Early failure of the polyethylene liner in the ABG I total hip prosthesis]. / Predcasné selhání polyetylenové vlozky u TEP kycelního kloubu ABG I.

PURPOSE OF THE STUDY: The polyethylene liner has appeared to be a weak point in total hip arthroplasty. An early wear-through or a fracture of the polyethylene liner have been referred to as a catastrophic failure. The aim of the present study is to report our experience with this rare complication in ABG I hip prostheses. MATERIAL: Between September 1994 and January 2000 a total of 506 ABG I prostheses were implanted at our clinic. Due to wear-related complications, revision arthroplasty had to be performed in 90 hips in 23 male and 63 female patients by January 2002. Extensive titanium metallosis associated with polyethylene failure was found in 11 hips of 11 female patients. The remaining 56 hips of 52 female patients served as a control group. METHODS: The characteristics recorded in every patient's included age, type of patient, sex, height, weight, ESR, CRP, diagnosis, Harris hip score before revision, cup size, abduction angle of the cup, time between the primary and revision surgery and implant stability. Student's t-test, the Mann-Whitney U-test and Pearson's chi 2 test were used to evaluate the results. RESULTS: The complete failure of ABG I prostheses occurred in 2.17% of the replaced hips (11/506). A fracture or complete wear-through were the causes of failure in three (3/11, 27%) and eight (8/11, 73%) hips, respectively. The average cup size in hips without metallosis was 48.9 mm (range, 44-58; SD, 3.1) and that in hips with metallosis was 46.5 mm (range, 46-48; SD, 0.9). This difference was highly significant (t-test, p = 0.00002; U-test, p = 0.014). In the hips with metallosis, the average thickness of the polyethylene liner was 5.17 mm (range, 4.9-5.9; SD, 0.45) and the Harris hip scores before revision were significantly lower than in the hips without metallosis (59 versus 70.3 points; t-test, p = 0.023; U-test, p = 0.044). There were no other significant differences between the hips with early catastrophic failure of the polyethylene liner and those without it. DISCUSSION: Several studies have shown an indirect relationship between polyethylene thickness and its wear. Berry et al. reported catastrophic failure in hip prostheses with a polyethylene thickness of less than 5 mm; in our study, the three failed polyethylene liners were 5.9 mm in thickness. CONCLUSIONS: This is the first report on a wear-through of the polyethylene liner in ABG I cups. It is suggested that a thin polyethylene liner, design characteristics and probably also poor polyethylene quality are crucial factors responsible for rapid wear in ABG I cup. The highest risk is associated with the combination of a 46 mm cup and a 28 mm head. Patients who have prostheses of this size should be checked up more frequently.

[Is osteolysis associated with a stable total hip replacement asymptomatic?]. / Je osteolýza kolem stabilní TEP kycelního kloubu asymptomatická?

PURPOSE OF THE STUDY: It has been reported that periprosthetic osteolysis in a stable cementless total hip prosthesis is often free from symptoms. The aim of this study is to check this assumption and provide details on the clinical presentation of this troublesome and worrying complication of hip arthroplasty. MATERIAL: Between March 1999 and June 2002, 76 hips in 72 patients underwent revision arthroplasty for periprosthetic osteolysis associated with stable ABG I prostheses. This patient group included 53 females and 19 males. The average age at the time of revision was 49 years (range, 32 to 63). The average time between the primary and revision surgery was 54.6 months (range, 23 to 85). The average cup size was 49.7 mm (range, 44 to 60), the modular 28-mm CoCr head was used in 69 hips, 28-mm ceramic head in six hips, and 22-mm CoCr head in one patient. METHODS: The following characteristics were recorded: gender, age, type of patient, height, weight, symptoms, diagnosis, ERS, CRP, Harris hip score, cup size, abduction angle and extent of bony defects. The data of symptomatic and asymptomatic patients were compared by parametric or non-parametric tests. RESULTS: Before revision, 61 hips (80%) were symptomatic. The patients complained of pain or signs of instability or both, and these complaints were taken as indications for revision surgery. The remaining 15 hips (20%) were asymptomatic. The average period from the primary surgery to the appearance of the first symptoms was 43 months (range, 5 to 80). The average Harris hip score before revision was 68 points (range, 37 to 90) and 82 points (range, 10 to 98) in the symptomatic and asymptomatic patients, respectively (p = 0.002). There were no other significant differences between these patients. DISCUSSION: The results of our study are in agreement with the findings of Hozack et al., but not with those of Maloney et al. and others who have reported that the progression of osteolysis developing in association with hip arthroplasty can be without symptoms. CONCLUSIONS: Osteolysis developing around a stable cementless hip prosthesis is generally symptomatic, with pain being the most frequent symptom. Even without a periprosthetic fracture, osteolysis may seriously impair the function of a joint and comfort of the patient. Since symptomatic patients are likely to see their attending physicians, it is emphasized that attention should also be paid to asymptomatic patients who have prostheses with unsuitable designs or pairings.

[Biochemical findings in osteoporosis. II. The importance of zinc]. / Biochemické nálezy u osteoporóz. II. Význam zinku.

The authors examined 33 cases of senile, 18 cases of postmenopausal and 9 cases of medicamentous osteoporosis and assessed serum and red cell zinc content. The mean blood levels of zinc were highest in the group of medicamentous osteoporosis. In all three groups the zinc level was reduced more frequently in serum than in red cells.

[Biochemical findings in osteoporosis. I. The significance of magnesium]. / Biochemické nálezy u osteoporóz. I. Význam magnézia.

The authors examined in 60 patients with osteoporosis the serum and red cell magnesium and calcium content. Thirty-three patients suffered from senile osteoporosis, 18 patients from postmenopausal osteoporosis and nine had osteoporosis caused by corticoids. In the former two groups were signs of chronic magnesium deficiency, in the third groups there was a trend of low serum calcium levels. The results indicate the important role of magnesium in these disorders of bone metabolism.