Mobility of the lumbo-pelvic-hip complex (spinopelvic mobility) and sagittal spinal alignment - implications for surgeons performing hip arthroplasty.

INTRODUCTION: The optimal positioning of the hip prosthesis components is influenced by the mobility and balance of the spine. The present study classifies patients with pathology of the spino-pelvic-hip complex, showing possible methods of preventing hip dislocations after arthroplasty. HYPOTHESIS: Hip-Spine Classification helps arthroplasty surgeons to implant components in more patient-specific position. MATERIALS AND METHODS: The group of 100 patients treated with total hip arthroplasty. Antero-posterior (AP) X-rays of the pelvis in a standing position, lateral spine (standing and sitting) and AP of the pelvis (supine after the procedure) were analyzed. We analyzed a change in sacral tilt value when changing from standing to sitting (∆SS), Pelvic Incidence (PI), Lumbar Lordosis (LL) Mismatch, sagittal lumbar pelvic balance (standing position). Patients were classified according to the Hip-Spine Classification. Postoperatively, the inclination and anteversion of the implanted acetabular component were measured. RESULTS: In our study 1 A was diagnosed in 61% of all cases, 1B in 18%, 2 A in 16%, 2B in 5%. 50 out of 61 (82%) in group 1 A were placed within the Levinnek "safe zone". In 1B, 2 A, 2B, the position of the acetabular component was influenced by both the spinopelvic mobility and sagittal spinal balance. The mean inclination was 43.35° and the anteversion was 17.4°. CONCLUSIONS: Categorizing patients according to Hip-Spine Classification one can identify possible consequences the patients at risk. Pathology of the spino-pelvic-hipcomplex can lead to destabilization or dislocation of hip after surgery even though implanted according to Lewinnek's indications. Our findings suggest that Lewinnek safe zone should be abandoned in favor of the concept of functional safe zones.

An Analysis of the Preoperative Factors, Spinopelvic Mobility and Sagittal Spinal Alignment in Pre-THA Patients.

Hip arthroplasty is a very effective medical procedure. The optimal positioning of the components and the functioning of the endoprosthesis are influenced, among other things, by the mobility and balance of the spine. The aim of the study was to analyze the factors influencing the mobility of the lumbar-pelvic-iliac complex (spinopelvic mobility) together with the assessment of sagittal spinal alignment in patients prior to THA (total hip arthroplasty). Patients who underwent hip replacement surgery due to advanced osteoarthritis of the hip were enrolled in the study (n = 103). The sociodemographic characteristics, BMI, radiological advancement of the degenerative disease, quality of life, and range of joint mobility were completed using a proprietary questionnaire, the EQ-5D-5L questionnaire, and a clinical examination. X-ray images were analyzed: AP of the pelvis standing up, lateral of the spine standing and sitting. Key parameters were measured as ∆SS-change in sacrum angle value when changing from standing to sitting position and pelvic incidence (PI)-lumbar lordosis (LL) mismatch-sagittal lumbar pelvic balance measured in standing position. The patients were assigned to the appropriate groups according to the Hip-Spine Classification: normal group: 1A (n = 65; 63.1%), abnormal groups: 1B (n = 17; 16.5%), 2A (n = 16; 15.5%), 2B (n = 5; 4.9%). A correlation was shown between the abnormal groups and the individual components of PROMs in the scope of the self-service and normal activities categories (EQ-5D and EQ-VAS). However, the strength of the relationship turned out to be moderate, and the remaining components of the survey were statistically insignificant. The remaining factors analyzed, i.e., age, BMI, the range of hip motion, the presence of contracture in the joint in a clinical examination, and the radiological advancement of osteoarthritis on the Tonnis scale, do not predict abnormal relationships between the spine and the pelvis in our patients waiting for THA. Therefore, further investigations are needed to evaluate the correlation between preoperative factors and the lumbar-pelvic-iliac complex in patients prior to planned hip arthroplasty.

Is the Synovium the First Responder to Posttraumatic Knee Joint Stress? The Molecular Pathogenesis of Traumatic Cartilage Degeneration.

OBJECTIVE: The aim of this study was to evaluate if a similar catabolic and inflammatory gene pattern exists between the synovium, hyaline cartilage, and blood of patients with the knee joint tissues and if one precedes the other. DESIGN: A total of fifty-eight patients (34 females and 24 males) with a mean age of 44.7 years (range, 18-75) underwent elective knee arthroscopy due to previously diagnosed pathology. Full blood samples were collected preoperatively from synovium and cartilage samples intraoperatively. Real time PCR with spectrophotometric analysis was performed. Following genes taking part in ECM (extracellular matrix) remodeling were selected for analysis: MMP-1, MMP-2, MMP-8, MMP-9, MMP-13, MMP-14, ADAMTS-4 (Agg1) and ADAMTS-5 (Agg2) proteases, TIMP-1, and TIMP-2 - their inhibitors - and IL-1 and TNF-α cytokines. RESULTS: Analysis revealed a strong and significant correlation between gene expression in synovial and systemic blood cells (p <0.05 for all studied genes) with ADAMTS-4, ADAMTS-5, IL-1, TNF-α and TIMP-2 expression most positively correlated with an R>0.8 for each. An analysis between chondrocytes and systemic blood gene expression shown no significant correlation for all genes. Bivariate correlation of International Cartilage Repair Society grading and genes expression revealed significant associations with synovial MMP-1, MMP-2, MMP-8, MMP-9, IL-1, TNF-α and TIMP-2. CONCLUSION: We suggest that the synovial tissue is the first responder for knee joint stress factors in correlation with the response of blood cells. The chondrocyte's genetic response must be further investigated to elucidate the genetic program of synovial joints, as an organ, during OA development and progression.

More than 20 years of experience with Dega transiliac osteotomy in the treatment of dislocated hip joints in children with cerebral palsy.

Cerebral palsy in children, which is the result of a nonprogressing damage to the central nervous system, causes motor and posture disorders that change with age. The level of child activity correlates with the hip dislocation risk. It most often affects nonwalking patients and those with tetraparesis or oblique pelvis. The aim of the study was to assess the effectiveness and clinical value of Dega pelvic osteotomy with accompanying directional femoral bone osteotomy after minimum of 20 years from surgery of patients with cerebral palsy. The conducted research was retrospective and concerned the children operated at our Hospital. The assessment was carried out in 346 children with spastic hip during the years 1993-2000. The inclusion criteria were applied: unilateral dislocation of the hip, the observation period of at least 20 years, pelvic osteotomy by Dega method and combined with varus derotation femur osteotomy. The analysis involved fifteen patients. The follow-up period was minimum 20 years (20-27 years). The average migration percentage decreased from 88% down to 25%, and an improved range of mobility was observed in the operated joint after surgery. However, the range of mobility was again significantly reduced during the last control examination after a minimum of 20 years. In all hips, the degenerative joint disease was present. Pelvic transiliac osteotomy, according to Dega, with VDRO, ensures very effective correction of the deficit in femoral head coverage by the acetabulum in the upper, lateral and posterior parts. However, it does not prevent the development of the early degenerative disease of the joint.

Early Results of Total Cementless Hip Joint Arthroplasty with a Conical Screw Cup.

BACKGROUND: With the development of hip arthroplasty, there are increasingly more indications for effective use of this surgical method. Endoprostheses are now being more and more commonly used in difficult cases of secondary coxarthrosis and in increasingly younger patients. The aim of this study is to present the early results of hip joint arthroplasty with the Zweymüller conical screw cup. MATERIALS AND METHODS: The study enrolled 117 patients (64 women and 53 men) who underwent a total of 123 hip joint arthroplasties with the Zweymüller conical screw cup. The mean age of the patients at surgery was 60.8 years (range: 26-81 years). The mean follow-up period was 7.7 years (range: 5-12.6 years). RESULTS: Pre-operative Merle d'Aubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement was 6.3 points. The outcomes were classified as excellent in 42 cases (34.15%), good in 56 cases (45.53%), satisfactory in 14 (11.38%) and poor in 11 cases. Poor results were always associated with implant loosening. Heterotopic ossification was noted in 8 cases (6.5%). According to the Kaplan-Meier estimator, 5-year survival probability was 91.1% for the whole implant and 94.3% for the stem alone. CONCLUSIONS: 1. Our follow-up data (from a mean follow-up period of more than 7 years) indicate that the Zwey-müller conical screw cup affords excellent clinical and functional results in patients operated on for advanced hip osteoarthritis. 2. In patients correctly qualified for this procedure, with good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. As only medium-term follow-up data are available, there may be more cases of loosening over time, indicating a need of regular long-term follow-up.

Early Results of Cementless Hip Joint Arthroplasty with the Straight Zweymller Stem.

BACKGROUND: Total cementless hip joint arthroplasty is a method commonly used in the treatment of advanced hip osteoarthritis. The aim of this paper is to present the early results of hip joint arthroplasty with the straight Zweymller stem. MATERIALS AND METHODS: The study enrolled 117 patients (64 women and 53 men) who underwent a total of 123 hip joint arthroplasties with the straight Zweymller stem. The mean age of the patients at surgery was 60.8 years (range: 26-81 years). The mean follow-up period was 7.7 years (range: 5-12.6 years). RESULTS: Pre-operative Merle dAubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement was 6.3 points. The outcomes were classified as excellent in 42 cases (34.15%), good in 56 cases (45.53%), satisfactory in 14 (11.38%) and poor in 11 cases. Poor results were always associated with implant loosening. Heterotopic ossification was noted in 8 cases (6.5%). According to the Kaplan-Meier estimator, 5-year survival probability was 91.1% for the whole implant and 95.1% for the stem alone. CONCLUSIONS: 1. Our follow-up data (from a mean follow-up period of more than 7 years) indicate that the straight Zweymller stem affords excellent clinical and functional results in patients operated on for advanced hip osteoarthritis. 2. In patients correctly qualified for this procedure, with good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. As only medium-term follow-up data are available, there may be more cases of loosening (mainly of the acetabular cup) over time, indicating a need of regular long-term follow-up.

Analysis of the Results of Hip Arthroplasty with the Use of Khanuja Group 6 stems.

BACKGROUND: Total cementless hip joint arthroplasty is universally recognized as a method of treatment of ad-vanced hip osteoarthritis. Multifaceted research by a wide group of implant specialists has led to the development of special implants that fulfill their purpose even in the most severe deformities of the hip joint. The aim of the study is to present and analyse the results of hip joint arthroplasty with the Antega anatomical stem. MATERIALS AND METHODS: The study enrolled 533 patients (342 women and 191 men) who underwent a total of 595 hip joint arthroplasties with the Antega anatomical stem. The mean age of the patients at surgery was 56.2 years (range: 20-87 years). The mean follow-up period was 7.3 years (range: 5-15.5 years). RESULTS: Pre-operative Merle d'Aubigne-Postel scores (modified by Charnley) were poor in all patients. Mean post-operative improvement was 6.1 points. The outcomes were classified as excellent in 419 cases (70.4%), good in 102 cases (17.1%), satisfactory in 39 (6.6%) and poor in 34 cases. Poor results were usually associated with loosening of one of the prosthetic components. Heterotopic ossification was noted in 37 cases (6.2%). According to the Kaplan-Meier estimator, 10 years' survival probability was 89.9% for the whole implant and 96.1% for the stem alone. CONCLUSIONS: 1. Our follow-up data (from a mean follow-up period of more than 10 years) indicate that the Antega anatomical stem affords excellent clinical and functional results. 2. With good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. Modification of the Antega stem implantation technique significantly reduces the risk of so-called unexplained thigh pain, which sometimes occurs following hip replacement surgery. 4. As only medium-term follow-up data are available, there may be more cases of loosening (mainly of the acetabular cup) over time, requiring regular long-term follow-up.

Future of total hip arthroplasty with the Metha short stem in modern surgeries.

The aim of the study was to analyse the results of uncemented total hip replacement, using the Metha (metaphyseal) stem. A total of 158 patients (70 females and 88 males) were qualified to the study and submitted to total hip arthroplasty (183 procedures altogether), using the Metha stem. The mean age of the patients on the day of surgery was 51.7 years (the range from 17 to 69 years). The mean follow up period was 9.2 years (the range from 5 to 13.5 years). Preoperative assessments gave poor scores, according to the Merle d'Aubigne and Postel classification, modified by Charnley. The average improvement after surgery, according to the used scale, was 6.9 points. A very good outcome was recorded in 154 cases (84.2%), a good outcome was achieved in 20 cases (10.9%) and a poor outcome was confirmed in 9 cases, while no satisfactory case was observed. Poor outcomes were associated with implant loosening. Extraskeletal ossification was noted in 10 cases (5.5%). According to the Kaplan-Meier estimator, the 10-year survival was 93.2% and 97.3% for the whole implant and the stem alone, respectively. 1. Our follow-up period of more than 9 years on the average, indicates that Metha stems produce excellent clinical and functional results in operated young patients with advanced degenerative changes of the hip joint. 2. Assuming a proper qualification for the procedure, the absence of complications and a correct surgical technique, which is slightly more difficult, when compared to standard stem implantation, the risk of aseptic loosening is fairly negligible.

Early Results of Total Cementless Hip Joint Arthroplasty with the Anatomical Stem.

BACKGROUND: The aim of this study is to present the early results of hip joint arthroplasty with the EXCEPTION anatomical stem (BIOMET). MATERIALS AND METHODS: The study enrolled 173 patients (110 women and 63 men) who underwent a total of 190 hip joint arthroplasties with the EXCEPTION anatomical stem. The mean age of the patients at surgery was 58.2 years (range: 28-82 years). The mean follow-up period was 7.3 years (range: 5-10.1 years). RESULTS: Pre-operative Merle d'Aubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement was 6.7 points. The outcomes were classified as excellent in 131 cases, good in 39, satisfactory in 13 and poor in 7 cases. Poor results were always associated with implant loosening. Heterotopic ossification was noted in 14 cases (7.4%). According to the Kaplan-Meier estimator, 5 years' survival probability was 96.31% for the whole implant and 99.47% for the stem alone. CONCLUSIONS: 1. Our follow-up data (from a mean follow-up period of more than 7 years) indicate that the EXCEPTION anatomical stem affords excellent clinical and functional results. 2. With good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. Due to the relatively short duration of follow-up, there may be more cases of loosening (mainly of the acetabular cup) over time, requiring regular long-term follow-up.

An assessment of the return to professional activity of patients aged ≤30 years after hip replacement surgery.

OBJECTIVES: The study evaluated the professional activity of patients after a total cementless hip replacement surgery performed at the age of ≤30 years. MATERIAL AND METHODS: The study group comprised 87 patients, with 95 total cementless hip replacements. The mean age was 25.7 years. The youngest patient was 17 years old, and the oldest 30 years old. The mean length of observation was 20.1 years, ranging 5-33 years. All patients underwent clinical and radiological evaluations before the surgery, and again in the third, sixth and twelfth months after the surgery. Further follow-up visits were performed every year. The tests were scored according to the Merle d'Aubigné and Postel (MAP) classification, as recommended by the Polish Society of Orthopaedics and Traumatology. Postoperative radiographs were used to assess the position of the endoprosthesis, and the degree of implant healing in the bone tissue. The data was subjected to statistical analysis. RESULTS: Of the surveyed group, 67 patients were professionally active before the surgery: 34 were white-collar workers, 29 manual workers, and 4 students or school pupils. The remaining 20 had not worked for many years, and were receiving sickness or disability benefits. An excellent result, according to the Kellgren-Lawrence classification, was noted in 22 cases, a good result in 42 cases, and a satisfactory result in 6 cases. In 25 cases, a poor result was observed. All of the patients professionally active before the surgery returned to work following the procedure. A further analysis found that 15 previously-unemployed patients commenced employment following the procedure. The mean length of the sick leave was 196.2 days, and rehabilitation payments were granted in 5 cases. CONCLUSIONS: Total cementless hip replacement is a valuable method of treating osteoarthritis in young patients. All of the patients who worked before the surgery returned to work in the same position and on the same employment conditions. Most of the previously-unemployed patients commenced employment following the procedure. Int J Occup Med Environ Health. 2021;34(6):747-54.

Influence of Vibroacoustic Therapy on Local Status and Rehabilitation of Post-TKR and Post-THR patients.

BACKGROUND: Rehabilitation following major joint replacement surgery is an extremely important part of complementary treatment after the surgical procedure. To obtain the best final treatment outcome possible, apart from improvements in surgical technique, new methods of rehabilitation are still being sought and implemented to increase its effectiveness, safety and patient comfort. One such technique is vibroacoustic therapy, a method of treatment based on the direct transmission of audible sound vibrations through a sound transmitter to the patient's body. The present study assessed the effectiveness of vibroacoustic therapy in early postoperative rehabilitation of post-TKR and post-THR patients. MATERIAL AND METHODS: The study involved 60 post-TKR and post-THR patients divided into two groups depending on the type of surgery. Each group was further divided into an experimental group treated with the VITAFON-2 apparatus and a control group treated with a placebo apparatus; all patients also underwent routine kinesiotherapy that is offered at the hospital. Vibroa-coustic treatment was carried out and evaluated during the first 4 days following surgery. Symptom intensity, range of motion of the operated joints, oedema in the operated limb and haematoma absorption were assessed. RESULTS: Postoperative vibroacoustic therapy performed during the first 4 post-operative days reduced pain more significantly than kinesiotherapy alone. It also clinically improved the absorption of post-traumatic haematomas in post-TKR patients insignificantly better than kinesiotherapy. In post-THR patients who had undergone an anterolateral approach procedure, phoning (vibroacoustic stimulation) significantly sped up the rate of recovery of normal internal rotation angles in the operated joints. CONCLUSIONS: 1. Vibroacoustic therapy applied topically in post-TKR patients exerts a significant positive effect on reducing pain intensity. 2. Topical vibroacoustic therapy does not significantly reduce the oedema around the operated hip and knee joints or increase their range of motion. 3. Vibroacoustic therapy accelerates the absorption of postoperative subcutaneous haematomas in a clinically visible manner.

The return to professional activity patients treated surgically due to advanced gonarthrosis.

OBJECTIVES: The goal of this work is to analyze the issue of return to professional activity by working-age patients who have been treated surgically with total knee arthroplasty (TKA) due to gonarthrosis. MATERIAL AND METHODS: Overall, 88 working-age patients were examined, with a total of 91 TKA procedures performed due to advanced gonarthrosis. The average age of the patients was 54.2 years for women and 58.1 years for men. A modified Knee Society Score scale was used to compile the results of the clinical trial. The Kellgren-Lawrence classification was used to assess preoperative radiographs. Postoperative radiographs evaluated the position of the endoprosthesis of both the femoral and tibial components in the anteriorposterior and lateral upright projections. The obtained results were subjected to statistical analysis. RESULTS: In the preoperative assessment, both the clinical and radiological results obtained were unfavorable in all cases. Throughout the observation period of approximately over 3.8 years, a very good result was noted in 65 cases (71.4%), a good result in 20 cases (22%), and a satisfactory result in 6 cases. There were no bad results. The average improvement on the Visual Analogue Scale was 6.5 pts. The radiological assessment did not reveal any radiological symptoms of the aseptic loosening of the endoprosthesis, simultaneously concluding that each time the endoprosthesis components were properly seated. Only 53 (58.3%) of the examined patients were professionally active before the surgery. After completing the treatment, 46 (50.5%) of all patients returned to work, in favor of intellectual workers. The average duration of sick leave was 136.2 days, and rehabilitation allowance was granted in 19 cases. CONCLUSIONS: Firstly, in working-age patients, TKA is a valuable method for surgical treatment of advanced gonarthrosis of varying etiology. Secondly, most of the patients who worked before the surgery returned to performing work in the position held and on the same full-time equivalent basis. Int J Occup Med Environ Health. 2021;34(5):617-28.

The Influence of Hippotherapy on the Body Posture in a Sitting Position among Children with Cerebral Palsy.

The purpose of this study was to assess the influence of hippotherapy (therapy with horses) on posture and body function among children with cerebral palsy. A case-control study included forty-five children aged 6-12 years, classified as Gross Motor Function Classification System (GMFCS) level I or II, with spastic diplegia or hemiplegia. The participants were randomly divided into three groups: study I (n = 15), study II (n = 15) and control (n = 15). The children from the study groups attended 30min hippotherapy sessions for 12 consecutive weeks, twice (study group I) or once (study group II) a week. The Sitting Assessment Scale (SAS) was used. A comparison of SAS showed an improvement in almost all the assessed categories among the children who participated in hippotherapy. In study group I, statistically significant differences were noted in the assessment of head position control, arm function (in both cases, p = 0.012) and trunk control (p = 0.005) and in study group II in the assessment of trunk control (p = 0.028). Hippotherapy has a positive influence on the body posture and function of individual body parts in a sitting position among children with cerebral palsy.

Outcomes of Cementless Total Hip Arthroplasty with Anatomical AURA II Stem.

BACKGROUND: The aim of the paper is to describe the outcomes of hip arthroplasty with the anatomical AURA II stem (BIOMET). MATERIAL AND METHODS: The study enrolled 189 patients (105 women and 84 men) who underwent a total of 213 hip arthroplasty procedures with the anatomical AURA II stem. Mean age of the patients at surgery was 61.7 years (range: 21 to 76 years) and mean follow-up period was 131.9 months (11 years). RESULTS: Pre-operative Merle d'Aubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement in the scores was 6.8 points. Excellent results were obtained in 123 cases, good in 22, fair in 24 and poor in 44 cases. The poor results were always associated with acetabular cup loosening. A total of 13 (6.1%), patients developed heterotopic ossification. According to the Kaplan-Meier estimator, 10 years' survival probability was 76.19% for the whole endoprosthesis and 100% for the stem alone. CONCLUSIONS: 1. Our follow-up data from a mean of 11 years show that the use of the anatomical AURA II stem results in a considerable reduction in hip pain and produces good and lasting clinical outcomes. 2. With good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal.

Contribution of Bone Tissue to Regulation of Calcium and Phosphate Metabolism. Role of FGF23 and Klotho Protein.

Bone tissue actively contributes to the regulation of systemic homoeostasis, and particularly the maintenance of calcium-phosphate balance. The parathyroid hormone-vitamin D feedback axis is balanced by the recently discovered bone-FGF23-kidney hormonal axis. An active complex consisting of FGF23, a receptor and Klotho protein blocks phosphate reabsorption in the proximal tubules, increasing urine phosphate levels and decreasing blood phosphate levels. Mutations of the gene mediating FGF23 transcription lead to a number of diseases, examples including autosomal dominant hypophosphataemic rickets. Klotho protein is a cofactor for FGF23 displaying cardio-, vaso- and nephroprotective activity. It increases calcium reabsorption in the kidneys and inhibits phosphate reabsorption. It also exerts antioxidative and anti-insulin effects and inhibits tissue calcification and apoptosis. As an inhibitor of bone resorption, osteoprotegerin becomes an important contributor to bone remodelling, while RANK/RANKL signalling inhibition is used in the treatment of postmenopausal osteoporosis. Osteocalcin plays an important role in energy metabolism in the human body. Sclerostin exerts a strong catabolic effect on bone tissue. Newly identified contributors to the regulation of calcium and phosphate homoeostasis suggest that bone tissue plays a complex role in the systemic metabolism.

The Jumper's Knee - a New Look at Non-surgical Treatment. Pilot Study.

BACKGROUND: There are many opinions and views regarding the methods of treatment of patellar ligament enthesopathy. No gold standard of treatment exists. This paper presents our approach involving conservative treatment and an appropriate rehabilitation regime. Our aim was to assess the effectiveness of a combination of various conservative treatment techniques and the time needed to return to sport. MATERIAL AND METHODS: The study enrolled 14 patients treated in 2019 and 2020. Knee joint evaluation was based on clinical and radiological examination (sonography and MR). All patients were treated conservatively according to a specially prepared treatment protocol. Patients were evaluated at two-week intervals until the symptoms subsided completely. The KOOS, Kujala and SF36 questionnaires were used to evaluate the results. RESULTS: All of the patients returned to painless physical activity within 3-4 weeks from the start of treatment. In the group of professional athletes, 100% returned to sport. The return to sport took slightly longer for pa-tients with bilateral (5-6 weeks) in comparison to unilateral jumper's knee (3-4 weeks). The longest period of return to sport, in a patient who had severe pain at rest before starting treatment, was 7 weeks. Statistically significant improvement was noted in all of the questionnaires used and in all subdomains at 6 months after the beginning of the treatment. CONCLUSIONS: 1. The conservative approach proposed by us generated promising results in the treatment of the jumper's knee. 2. A 100% rate of return to sport was recorded among our patients.

Prognosis for Peripheral Nerve Injuries after Hip Joint Arthroplasty.

BACKGROUND: Peripheral nerve damage is a rare complication of hip replacement surgery that severely impairs the therapeutic outcome. The aim of the present study was to determine the time needed for nerve recovery and re-storation of activity following iatrogenic damage during a primary or revision hip arthroplasty from an anterolateral approach and its relationship with the severity of damage. MATERIALS AND METHODS: A prospectively collected database of 1107 patients treated with primary arthroplasty and 303 patients following revision arthroplasty (mean age 63 years, range 53 to 72 years) was analysed. This included 15 cases of palsy of the peroneal branch of the sciatic nerve and 7 of the femoral nerve. The mean follow-up was 3.6 years (minimum two years). RESULTS: The following risk factors were identified: dysplastic osteoarthritis, limb elongation, revision arthroplasty, female sex and post-traumatic osteoarthritis. All five patients demonstrating light palsy (Lovett score 3-5), and 9 out of the 17 with severe palsy (Lovett score 0-2) achieved full recovery. Of all patients, 63.6% regained nerve function after 4 weeks to 24 months (mean 17 months), with nine demonstrating complete recovery and five partial. Also, 66.6% patients regained femoral nerve function and 61.5%, sciatic nerve function. CONCLUSION: 1. The femoral nerve and the peroneal branch of the sciatic nerve demonstrate a similar pattern of functional recovery following damage. 2. All patients recovered from light palsy, and almost 2/3 of cases of severe palsy demonstrated partial or complete recovery. 3. Female sex is a significant risk factor.

Analysis of Outcomes of Total Cementless Hip Joint Arthroplasty in the Treatment of Advanced Hip Osteoarthritis Following Childhood Perthes' Disease.

BACKGROUND: The aim of this study is to analyse the outcomes of total cementless hip joint arthroplasty in the treatment of advanced hip osteoarthritis following Perthes' disease in childhood. MATERIAL AND METHODS: The study enrolled 56 patients (15 women and 41 men) who underwent a total of 61 hip joint arthroplasties for coxarthrosis following Perthes' disease. The mean age of the patients at surgery was 46.7 years (range 21-67 years). The mean follow-up period was 13.7 years. RESULTS: Pre-operative Merle d'Aubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement was 6.7 points. The outcomes were classified as excellent in 25 cases, good in 16, satisfactory in 16 and poor in 9 cases. Poor results were always related to loosening of the acetabular cup. Heterotopic ossification was noted in 7 cases. According to the Kaplan-Meier estimator, 10 years' survival probability was 85.24% for the whole implant and 100% for the stem. CONCLUSIONS: 1. Total cementless hip joint arthroplasty is an effective method in the treatment of advanced hip osteoarthritis following Perthes' disease in childhood. 2. With good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. Due to the patients' young age, there may be more cases of loosening over time, requiring regular long-term follow-up.

Retraction Note: An evaluation of the potential consequences of drilling titanium and tantalum implants during surgery - a pilot study.

The authors have retracted this article [1] because it constitutes redundant publication [2].

Feet Deformity and Gait Disturbance in a Patient with Pachydermoperiostosis (PDP). Case Study.

Pachydermoperiostosis is a rare condition representing a primary form of hypertrophic osteoarthropathy. It presents in different stages. Patients often overlook early symptoms, because they are benign. The most common manifestations are clubbing of the fingers and toes, skin thickening with characteristic folds on the face and head and widening of joints accompanied by radiological changes. Surgical treatment is not often needed, and, consequently, there are no strict guidelines on surgical management, which is mainly based on case report ana-lysis. This paper presents a case of surgical management of pachydermoperiostosis.