Revision arthroplasty using a custom-made implant in the course of acetabular loosening of the J&J DePuy ASR replacement system - case report.

RATIONALE: Resurfacing arthroplasty using the J&J DePuy ASR system was withdrawn from surgical treatment due to the necessity of frequent revision procedures after its application. There have been many studies concerning treatment of acetabular bone loss using different operating techniques. However, we felt that data of custom - made implant usage in such cases is highly insufficient, and there is lack of evidence on its application in treatment of loosening of the previous implant. The aim of the study was to evaluate the effectiveness of surgical treatment with a custom-made implant in a patient with extensive acetabular bone loss after aseptic loosening of the acetabular component of the J&J DePuy ASR surface prosthesis in the early period of observation. PATIENT CONCERNS: A 74-year-old patient was taken to the Orthopaedic Trauma Emergency Room due to increasing pain in the right hip for about 3 months. Nine years earlier he underwent resurfacing arthroplasty of the right hip using the J&J DePuy ASR method. DIAGNOSES: The imaging diagnostics (X-ray, computed tomography, ultrasound) revealed the presence of a pseudotumor and lysis around the acetabular implant, which caused a fracture in the acetabulum. INTERVENTIONS: Revision arthroplasty of the right hip joint was performed with the removal of the ASR implant. During the procedure extensive bone defects were visualized, preventing the insertion of the revision acetabulum. After extensive plasticization of the defects with the use of allogeneic cancellous chips the "hanging hip" was left with the intention of making another attempt to insert the implant after the reconstitution of the acetabular bone. A computed tomography examination 2.5 years after the ASR removal revealed the lack of an adequate degree of bone remodeling for the planned implant. Arthroplasty using custom - made aMace Acetabular Revision System by Materialize was performed 3 years after the removal of ASR. OUTCOMES: Optimal implant adherence to the bone base and full osseointegration with the pelvic bone bearing has been achieved. Significant improvement in clinical parameters has been noted, with no complications in the postoperative period. LESSONS: The use of an individual custom-made implant in extensive acetabular bone loss after aseptic loosening of the acetabular component of the J&J DePuy ASR surface prosthesis in patients is an effective method of surgical treatment.

[Physiotherapy in metaphysial hip replacement with use J&J Proxima stem]. / Fizjoterapia w alloplastyce przynasadowej stawu biodrowego z uzyciem trzpienia J&J Proxima.

In last years on the whole world violently grows up the number of patients at which occurrence productive degenerative changes of osteoarticular system. Actually these diseases more and more concern the young persons, active professionally. This consequences of these changes lead to limiting the functional functions of pond, pain as well as they worsen the quality of life. Pain in degenerative joint disease of various aetiology can be combated with the new surgical techniques offered by contemporary orthopaedics. Hip alloplasty is the only effective treatment method facilitating the restoration of physical fitness, correct mobility and the eradication of chronic pain. After operating introduces the different methods of improving finally. This work presents physiotherapeutic procedures, commenced on admission to the orthopaedic ward, involved in hip joint alloplasty with the J&J Proxima stem. The disseminating of introduced model of improving as well as the initiation him to program of the treatment confirms the legitimacy of choice, and it influences on improvement of the state of health also and the patients' functional efficiency with degenerative disease of hip joint.

[Realloplasty of the acetabular component of the hip joint endoprosthesis without mechanical support systems]. / Realloplastyka komponentu panewkowego endoprotezy stawu biodrowego bez uzycia mechanicznych systemów wzmacniajacych.

This work presents the tactics of surgical procedures in 40 patients who underwent revision of the hip joint due to isolated loosening of the acetabular component of the endoprosthesis. The studied group were operated between 2004 to 2006 without the use of mechanical support systems. Realloplasty of the acetabular component involved the evaluation of: etiology of acetabular loosening, concomitant diseases in the operated patients, and the grade of acetabular defects according to Paprosky's classification. In this work we analyze the type of both the loosened acetabulum and that used in revision, and discuss complications. Finally, we present a clinical evaluation of the operated patients according to Harris scale before revision surgery and six and twelve months after, with good early results.

Heterotopic ossification in patients with hip osteoarthritis below forty years old after total hip replacement.

BACKGROUND: Even though heterotopic ossification (HO) is most often asymptomatic in patients after total hip replacement (THR), it remains a serious problem in orthopaedics as it is observed in nearly all operated patients. MATERIALS AND METHODS: The article presents a pre- and post-operative retrospective analysis of heterotopic ossification based on radiographic evidence. The study involved 77 patients below forty years old who underwent THR due to degenerative changes. Heterotopic ossification was evaluated using Brooker's basic four-grade scale. RESULTS: Heterotopic ossification was diagnosed more often in women. The study confirmed once again that non-steroidal anti-inflammatory drug (NSAID) prophylaxis reduces the risk of ossification. We propose that the hydroxyapatite coating of implants may also contribute to a higher incidence of heterotopic ossification in operated patients. CONCLUSIONS: A history of surgical procedures and a lack of NSAID prophylaxis contributed to heterotopic ossification in the region of the replaced hip joint in the study group.

Arthroscopy for anterolateral soft tissue impingement of the ankle joint.

BACKGROUND: Anterolateral soft tissue impingement of the ankle joint is a common consequence of ankle sprain due to excessive supination and adduction of the foot, injuries to the tibiofibular syndesmosis and lateral malleolus fractures. MATERIAL AND METHODS: Twenty-two arthroscopic procedures to treat anterolateral soft tissue impingement of the ankle joint were performed at the Independent Public Regional Hospital of Trauma Surgery in Piekary Slaskie between 2006 and 2007. The study group included male patients at the mean age of 34 (17 to 55) years. Medical histories revealed ankle sprain in 13 patients, lateral malleolus fracture in 7, and isolated tibiofibular syndesmotic disruption in 2. The mean time from the injury to the arthroscopic treatment was 5 years (range 2 to 8 years). All patients that underwent arthroscopy were evaluated according to the AOFAS score at baseline (before surgery), and at 3 and 12 months after the treatment. The procedure consisted in the removal of hypertrophic, inflamed and scarred soft tissue from the lateral recess. RESULTS: The mean preoperative AOFAS score was 75.4 points. Post-operatively, the AOFAS functional scores increased to 90.6 and 92 points in the third and twelfth month after the procedure respectively. One patient showed temporary neurapraxia of the dorsal intermediate nerve and the ramus cutaneus branch of the superficial peroneal nerve. CONCLUSION: These results show that arthroscopic treatment of anterolateral soft tissue impingement of the ankle joint produces satisfactory early outcomes.

[Fracture of the femur head--description of four cases]. / Zlamanie glowy kosci udowej--opis 4 przypadków.

Fracture of the femur head is most ofen caused by car accidents and a falls from a height. Treatment of these fractures is hard and is burden risk of aseptic necrosis of the femoral head and arthritis of the hip joint. In the paper are presented four cases of femur head fracture. Two of them were treated by surgical procedure, one using conservative therapy and one using total hip replacement for reason arthritis of the hip joint.

[The algorithm of physiotherapeutic procedures in patients after total cementless joint arthroplastics]. / Algorytm postepowania fizjoterapeutycznego u pacjentów po totalnej bezcementowej alloplastyce stawu skokowo-goleniowego.

The aim of this study is to present the physiotherapeutic procedure in patients after total cementless ankle atrhroplastics. It was introduced thus far methods and resources in the way of physics and kinesitherapy, how also methods in physical medicine, which there are introduced to numerous department of medicine also in orthopedics. From reason of small number of reports, the authors present in this work current dates of relate in physiotherapeutic procedure before and after cementless ankle arthroplasty, which profitably influence and show the characteristic improvement of local and general state in patient. In spite of existing limitations the introduced plan with patients after total cementless joint arthroplasty should facilitate taking of sure solutions and workings persons with this patients.