The Importance of Patellar Resurfacing in Total Knee Arthroplasty for Symptomatic Valgus Degenerative Deformity.

PURPOSE OF THE STUDY Patellar surface replacement during total knee arthroplasty is still a matter of discussion among orthopedic surgeons. The purpose of this study was to examine possible benefits of patellar surface replacement in selected patients with symptomatic degenerative valgus deformity. We have not found any studies in the literature that compare the results of patella management solely for valgus or varus knee deformity nor those that compare both. MATERIAL AND METHODS Patients were randomly assigned to a group that would receive patellar surface replacement during total knee arthroplasty and a group of patients in whom total knee arthroplasty was performed without patellar surface replacement. 60 patients were included in the study. Total knee arthroplasty with patellar resurfacing (TKAPR) was performed in 30, and without PR (TKA) in 30 of them. Results were prospectively gathered and compared at regular intervals. RESULTS There were no significant differences between groups for examined parameters except for Oxford Knee Score at 6 months which was in favor of patellar resurfacing group. DISCUSSION The decision whether to replace the patella or not is currently exclusively a matter of surgeon's choice. Establishing selection criteria for patients that would benefit from patella resurfacing could, therefore, be very useful for both patients and orthopaedic surgeons performing total knee replacement. CONCLUSIONS Although evidence in our study could not strongly suggest performing patella resurfacing in patients with valgus deformity, the results were slightly better in the patella resurfacing group and this trend could increase if larger series of patients would be employed. A longer follow-up period would be required for clear-cut decisions and more prospective studies are warranted. Key words: knee, arthroplasty, patella, replacement, valgus, deformity.

[Unstable fractures of the pelvis treated by Ilizarov external fixation device].

We reviewed seven patients with an unstable fracture of the pelvic ring who had been treated with a Ilizarov external fixation device after a mean follow-up of 5.5 years. There were four "open-book" injuries (type B according to Tile) and three rotationally and vertically unstable injuries (type C according to Tile). In all patients union of fracture site had been achieved after a mean period of 65 days in patients with type B injuries and 98 days in patients with type C injuries. In the four patients with an "open-book" injury the symphyseal diastasis was partially reduced from 46 mm to 13 24mm to 13mm. The radiological result was excellent in one patient, good in one and poor in two patients. The functional outcome was rated as excellent in three patients and good in one patient. In patients with type C injury vertical displacement was partially reduced from 21mm to 12mm. The patients in this group had excellent, good and poor radiological result, respectively. The functional outcome was excellent in two cases and good in one case. General surgical complications were not seen. Infection at the pin sites was seen in six patients. In our study unsatisfactory or poor functional result was not registrated due to construction characteristics of Ilizarov device. Because of this characteristics there were no residual vertical displacement more then 8 mm.

[Diagnosis and treatment of Paget disease of the spinal vertebrae].

Paget disease, localized only on thoracic spine is extremly rare. It is a huge diagnostic problem and an equally big therapy challenge. Course of this disease is slow, it chronically worsens, thus demanding differentiation of various conditions, along with orthopaedic, neurological, radiographic and endocrine evaluation. Paget disease is followed by back pain, progressive weakening of legs and sphincter functions, due to pathological spine fractures and spinal stenosis. The treatment is surgical, in form of decompression and applying biphosphonates. Three patients are presented, all with worsening back pain which lasted several months. Hyperthonia and hyperreflexion of lower extremities were developed significantly. Over the course of time, neurological deficite got worse, almost to the point of spastic parapalegia. All of the patients were male, 50 to 68 years old. They had higher values of alcaline phosphatase and serum calcium than usual. In all cases, bone scintigraphy was positive where the lesion of thoracic spine existed. Biopsy suggested hyperparathyroidism, but, as it turned out, wrongly. After surgical treatment, neurological improvement was noticed on all three patients. In case of two, recidives occurred after three and five years respectively, so surgical reinterventions were made. These recidives are consequences of Paget disease progression. Aside from surgical treatment, they were treated by encrinologist. Remission of the disease lasted for seven and twelve years, respectively. Third patient had his condition recognized almost two years after first reception, and, due to big changes on vertebral body and paraplegia, posterior and anterior decompression of spinal canal and stabilization were done simultaneously. Biopsy confirmed Paget disease. During the postoperative course, nearly complete neurological improvement occured almost instantly. Only moments after hospital release, twenty four days after the operation, patient got sick in the hall. Unfortunately, he passed away due to massive lung embolism, even though he recieved adequate thromboembolic prophylaxion. Monoostotic form of Paget disease localized on vertebral body must be taken and considered seriously, especially when the patients suffer from progressive evolution of neurological deficite, followed by adequate biochemical blood and urine analysis, as well as radiographic signs of pathological fracture or invasive vertebral process. Surgical treatment can lead to significant improvement of clinical findings, but due to recidive, biphosphonate treatment is recommended.

[Congenital club foot].

Congenital club foot is the most frequent foot deformity. It occurs in 1% of newborns, two times more frequently in boys, with family inheritance. Patoanatomicaly, entity consists of bone deformities, articular malpositions and soft tissues retraction. All these produce adduction of the forefoot and varus and equinovarus of the hindfoot. Lateral side of the foot is convex and medial side is concave. Forefoot is in adduction and plantar flexion in relation to the hindfoot. The heel is rotated medialy which induces varus and eqinus of the foot. The aim of the treatment is to establish anatomically normal foot, painless, with moderate movements, which is suitable for normal shoes. At the beginning treatment is nonsurgical. If nonsurgical treatment fails further step should be surgical treatment. The success of treatment of congenital clubfoot depends on the time of diagnosis and treatment beginning.