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.

A very rare case of the accessory palmaris longus muscle and clinical significance.

The palmaris longus muscle is located in the forearm region. It morphological variability was noted during standard anatomical dissection of the upper limb. The muscle was characterized by a normal course, i.e. originating from the medial humeral epicondyle and inserting to the palmaris aponeurosis, but a small additional tendon attached to the flexor retinaculum was observed in its distal part. An accessory palmaris longus muscle was also observed nearby. Interestingly, this accessory muscle was reversed, and the first part was not muscular, but tendinous, represented by two tendons originating from the common muscular mass attached to the medial epicondyle of the humerus; these later connected together, creating one muscle belly distally attached to the flexor retinaculum. This additional structure was innervated by a neural branch from the median nerve and the ulnar artery was responsible for blood supply. The course of the median nerve is also clinically important, because before entering the carpal tunnel, it was located directly under the accessory palmaris longus muscle. In turn, the ulnar artery passed through a special hole created by the flexor digiti minimi brevis and flexor retinaculum, before passing under the palmaris brevis muscle.

Congenital, Acquired, and Trauma-Related Risk Factors for Thoracic Outlet Syndrome-Review of the Literature.

Thoracic outlet syndrome is a group of disorders that affect the upper extremity and neck, resulting in compression of the neurovascular bundle that exits the thoracic outlet. Depending on the type of compressed structure, the arterial, venous, and neurogenic forms of TOS are distinguished. In some populations, e.g., in certain groups of athletes, some sources report incidence rates as high as about 80 cases per 1000 people, while in the general population, it is equal to 2-4 per 1000. Although the pathogenesis of this condition appears relatively simple, there are a very large number of overlapping risk factors that drive such a high incidence in certain risk groups. Undoubtedly, a thorough knowledge of them and their etiology is essential to estimate the risk of TOS or make a quick and accurate diagnosis.

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.

Functional assessment and evaluation of health problems with the cervical spine among dental assistants and hygienists.

Purpose: The aim of the study was to evaluate the mobility of the cervical spine, pain and function according to Neck Disability Index (NDI) scores among dental assistants and hygienists. Comparison between dental professionals and a control group was also performed. Methods: In the study, 338 dental assistants and hygienists with a mean age of 35.8 were evaluated. Of these, 195 were measured with the CROM 3 device, and 143 with a classic tape measure, for the range of motion of their cervical spine. A non-dental professional group consisting of 60 women (whose work was not related to repetitive movements of cervical spine) was also tested, 30 with the CROM 3 device, and 30 with a classic tape measure. The dental and control groups were also surveyed with the NDI questionnaire and Visual Analogue Scale (VAS). Results: Dental assistants and hygienists had significantly reduced functional ROM in all directions in comparison to the control group. Among the 338 volunteers form the study group the VAS pain score was higher than in the control group. NDI scores were also worse in the study group, compared to the control group. Functional results in all subgroups of the NDI questionnaire were better in the control group. Among dental workers the cervical spine typically demonstrated significantly greater mobility in right-rotation, resulting from the position occupied at the unit at which they work. Conclusions: Our findings confirm a decrease in the mobility of the cervical spine, lower functional scores involving various everyday activities and greater intensity of pain among dental assistants and hygienists in comparison to participants whose work does not involve cervical spine overuse.

Coexistence of rare varieties of palmaris profundus and flexor superficialis muscle.

The superficial layer of the anterior compartment of the forearm is characterized by different morphological variations. During standard anatomical dissection, two morphological variations in the superficial compartment of the forearm were observed. The first one was the palmaris profundus, which originated from the radius and distally fused with the tendon to 3rd digit (from the flexor digitorum superficialis muscle) inserted on the medial phalanx of the third digit. The second variation was a distinct superficial flexor of the 4th digit represented by one muscle belly with originated from a common mass from the medial humeral epicondyle, passes through the carpal tunnel, and is inserted into the medial phalanx of the fourth digit. The flexor digitorum superficialis muscle was located deeply to it and it was divided only into three tendons (to 2nd, 3rd, and 5th digits). Tendons connected to the 2nd and 3rd digits were crossed with each other at the level of carpal tunnel. From the humeroulnar head of the flexor digitorum superficialis muscle, an additional muscle belly was arising and its tendon was fused with the superficial flexor of the fourth digit. Knowledge about morphological variations in this region is clinically important because of the direct correlation with the median nerve, and the possibility to cause carpal tunnel syndrome.

An assessment of the dietary habits among road cyclists competing in amateur races.

From year to year, practicing various sports by amateur athletes is becoming more and more popular. One of such sports is road cycling. To achieve very good sports performance athletes should pay attention not only to physical activity but also to proper nutrition and hydration of the body. The aim of the study was to assess amateur cyclists' dietary habits, especially nutrition and hydration, including assessment of the regularity of eating meals, type of consuming products and fluid intake preferences. The study recruited 41 men aged 23-75 years (43.76 ± 13.25) participating in amateur race road cycling. To obtain information about nutrition and hydration, an original questionnaire was used. Out of all participants, 65.9% declared that they pay attention to their diet, and as many as 75.6% indicated that they eat meals regularly. The vast majority (43.9%) of the cyclists declared consuming four meals a day. Most of the cyclists consumed meat products several times a week-73.2% and dairy products-43.9%. The participants most often chose only one portion of fruit (41.5%) and vegetables (31.7%) during the day. The vast majority of cyclists consumed 3 L of fluids on a training day-51.2%. It turned out that all of the athletes hydrated during training: before it was 68.3% and after training-92.7%. We conclude that the amateur cyclists pay a lot of attention to their nutrition and hydration. During the day, most athletes eat an appropriate amount of meals on a regular basis and drink the right amount of fluids. However, eating of dairy, fruits and vegetables, or hydrating before exercising is insufficient.

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.

How to Differentiate Pronator Syndrome from Carpal Tunnel Syndrome: A Comprehensive Clinical Comparison.

The diagnostic process that allows pronator syndrome to be differentiated reliably from carpal tunnel syndrome remains a challenge for clinicians, as evidenced by the most common cause of pronator syndrome misdiagnosis: carpal tunnel syndrome. Pronator syndrome can be caused by compression of the median nerve as it passes through the anatomical structures of the forearm, while carpal tunnel syndrome refers to one particular topographic area within which compression occurs, the carpal tunnel. The present narrative review is a complex clinical comparison of the two syndromes with their anatomical backgrounds involving topographical relationships, morphology, clinical picture, differential diagnosis, and therapeutic options. It discusses the most frequently used diagnostic techniques and their correct interpretations. Its main goal is to provide an up-to-date picture of the current understanding of the disease processes and their etiologies, to establish an appropriate diagnosis, and introduce relevant treatment benefiting the patient.

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.

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.

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.

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.

Hip joint arthroscopy in professionally active patients with osteoarthritis.

OBJECTIVES: The primary endpoints of the study were to assess the effectiveness of hip joint arthroscopy in the treatment of femoroacetabular impingement (FAI) in patients with joint gap stenosis and to determine if and how quickly patients were able to return to work and physical activity. MATERIAL AND METHODS: The prospective study of patients undergoing hip joint arthroscopy due to pain in FAI has been conducted. They were divided into 2 groups depending on the degree of the radiological examination. The criterion was the width of the joint gap. The study group involved 47 patients with hip joint gap of 2-3 mm, identified by means of the standardized X-ray examination. The control group consisted of 45 patients with hip joint gap > 3 mm. The post-operative follow-up period of the patients lasted at least 2 years. In addition, the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) questionnaire together with Harris Hip Score (HHS) were applied. The patients were also evaluated for the post-operative time period enabling return to work. RESULTS: All the patients after hip joint arthroscopy returned to normal physical activity within 12 weeks after operation, enabling their return to work. However, it should be noted that during the post-operative follow-up, pain sensations either recurred or did not regress in 37 patients in the study group and 12 patients in the control group after treatment. The nearly equal results of the WOMAC questionnaire and HHS before operation significantly vary between both groups in the last follow up. In the study group they did not change expressively. CONCLUSIONS: Despite the little invasiveness, hip joint arthroscopy in patients with joint gap stenosis brings about the far from satisfactory results. This procedure is not worth considering. Despite unsatisfactory pain relief, patients decided to returned to work, due to their occupational position and for fear of losing the job due to long absenteeism. Int J Occup Med Environ Health. 2019;32(1):115-120.

Fracture of the Femoral Stem as a Rare Complication of Total Hip Arthroplasty. Cases Report.

The aim of this paper is to present the femoral stem fracture as a rare complication of total hip arthroplasty and describe further management in such cases. We present 5 cases of stem fracture in the Mittelmeier prosthe-sis which occurred from 8 to 29 years after the primary procedure. In three cases, the primary hip arthroplasty was performed due to dysplastic coxarthrosis. The remaining two patients had idiopathic and post-traumatic coxarthrosis. The four female patients underwent revision hip arthroplasty with stem replacement. One patient refused surgical treatment and has been followed up at the outpatient clinic. Annual clinical and radiological examination is an approved method for detecting late complications Hip arthroplasty should be performed at specialised centres where relevant prostheses and instruments are used. A transfemoral approach and the use of revision stems anchored in the femoral shaft is a method of choice for revision procedures performed due to stem fractures.