Minimally invasive techniques in total hip replacement--our clinical experience.

The article presents the general concept of minimally invasive surgery, including theoretical benefits and risks. The indications, contraindications, technical requirements and necessary precautions are discussed. An overview of different surgical approaches is presented together with a detailed description of the surgical technique of minimally invasive cementless total hip replacement that is used at the Department of Orthopedics and Traumatology of Locomotor System, Medical University of Warsaw. Techniques for enhancing the precision of placement of prosthetic elements and leg length equalization used in clinical practice are also presented.

Total hip arthroplasty for treatment of bone metastases.

Background. Bone metastases are observed in many patients with neoplastic disease. Frequently, the first sign of metastasis is a pathological fracture in weight bearing regions. The proximal end of the femur is the most common site of long bone involvement by metastatic disease and pathological fracture. Treatment of metastatic disease should be multidisciplinary: both oncologic and orthopedic. The target of operative procedure is a relief of pain and regaining the ability to walk. In case of changes in proximal end of the femur, the tumor resection and total hip arthroplasty is a procedure of choice.
Material and methods. In the Orthopedic Clinic in Warsaw, 27 patients with bone metastases in proximal end of the femur had total hip arthroplasty performed in the period of 1998-2002. In 16 cases it was possible to collect data about postoperative period - these patients were analyzed. In 14 patients postresective prostheses were used and in 2 procedures - standard prostheses.
Results and Conclusions. This type of treatment reduced pain, restored weight bearing ability of the limb and improved comfort of life. Subjective estimation of treated patients was good. Only in one case the clinical result was poor. Total hip arthroplasty is an efficacious palliative treatment in patients with metastases in proximal end of the femur. Final effect of therapy depends on individual precise preoperative planning and multidisciplinary specialist postoperative care.

[Carbon external fixator--CARBOELASTOFIX in treatment of tibia diaphysis fractures]. / Stabilizator weglowy CARBOELASTOFIX w leczeniu zlamaii trzonów kosci piszczelowych.

The authors presents the results of healing status of tibia diaphysis fractures treated with carbon-plate fixator on a group of 12 patients (9 men and 3 women with age between 27 and 89 years). Long-term mechanical investigations and studies at animals, performed at our Department have shown advantages of bone fixation performed with a new device for osteosynthesis, called by authors CARBOELASTOFIX. General principle of the method is the use of external fixation device, made of carbon-epoxide resin composite plates with variable flexibility, enabling hastened fracture healing. The research allowed also to work out the guidelines of indications for surgery, surgical technique and method of modifying flexibility of fixation consistently with fracture healing course. The mean time of observation (from the operation to the healing) was 23 weeks, having 10 good and 2 bad results.

[Comparison of the Ender's nailing and Dynamic Hip Screw (DHS) fixation in the treatment of trochanteric fractures in elderly patients]. / Porównanie rozleglosci zabiegu przy zastosowaniu pretów Endera i sruboplytki DHS w leczeniu zlamaan przezkretarzowych kosci udowej u osób w wieku podeszlym.

The aim of this study was an evaluation which operative method of treatment: stabilisation with the Dynamic Hip Screw or with Ender's nails is less invasive procedure in elderly patients with trochanteric fractures. 100 consecutive patients with trochanteric fracture were enrolled into the study, of which 53 patients (49 women, 4 men; mean age 89 years) were stabilised intramedullarily with the use of Ender's nails and 47 patients (26 women, 21 men; mean age 76 years) were treated operatively with the use of Dynamic Hip Screw. The factors compared the mean length of hospital stay, the mean duration of the surgery, post-operative blood loss, early local and general complication rate and mortality in both groups. We took into account their general health and coexisting illnesses according to the American Society of Anesthesiologists (ASA) classification, type of fracture according to AO and Evan's classifications and the surgeon's experience. The mean duration of the surgery was 27 minutes longer in the case of DHS stabilisation. The complication rate was higher and the mean length of postoperative hospital stay was longer after Ender nailing. The mean blood loss: the drop in Red Blood Cells (RBC), Haematocrit (Ht) and the Mean Haemoglobin Concentration (Hb) was also higher in patients treated with the use of Ender nails. The mean rate of blood units that had to be transfused postoperatively was also higher in "Ender" group. The difference was statistically significant, especially in the group of patients treated as emergency procedure at the day of admission (p < 0.05). The operative treatment of trochanteric fractures in elderly patients with the use of DHS device showed to be a less invasive procedure in comparison to Ender nailing. In conclusion, the indications for this method of trochanteric fractures' treatment should be expanded, especially in the case of unstable fractures.