An evaluation of subtalar titanium screw arthroereisis for the treatment of symptomatic paediatric flatfeet - early results.

BACKGROUND: Idiopathic flexible flatfoot is a common condition in children which typically improves with age and remains asymptomatic. However, the condition can sometimes be more severe, and cause mechanical impairment or pain. The aim of the study was to perform a prospective clinical, radiological, podoscopic and pedobarographic assessment (static and dynamic) of subtalar titanium screw arthroereisis for the treatment of symptomatic, idiopathic, flexible flatfeet. METHODS: A prospective, consecutive, non-controlled, cohort, clinical follow-up study was performed. In total, 30 patients (41 feet), mean age 10 (6 to 16 years), were evaluated. Clinical and standing radiological assessments, static and dynamic pedobarography, as well as podoscopy, were performed before surgery and at final follow-up. RESULTS: Treatment was associated with significant improvements in heel valgus angle, radiographic parameters (lateral and dorso-planar talo-first metatarsal angle, calcaneal inclination angle, talar declination angle, longitudinal arch angle) and podoscopic parameters (Clark's angle, Staheli's arch index and Chippaux-Smirak index). Significant increases were noted for lateral loading, forefoot contact phase and double support / swing phase, and reduced medial loading (dynamic pedobarography), as well as lateral midfoot area and loading, but decreased were observed for medial forefoot loading (static pedobarography). Four patients reported persistent pain in the sinus tarsi region (six feet), and in one case, the implant was replaced for a larger one due to undercorrection. No overcorrections or infection complications were noted in the study group. CONCLUSIONS: Subtalar arthroereisis is a minimally-invasive and effective surgical method for treating symptomatic, idiopathic, flexible flatfeet; it has an acceptable complication rate with good early clinical results. LEVEL OF EVIDENCE: II b.

Clinical and radiological evaluation of radial neck factures in children and adolescents treated by percutaneous leverage reduction with Kirschner wire stabilization.

PURPOSE: The aim of the study was to evaluate the clinical and radiological results of surgical treatment of radial neck fractures in children and adolescents by percutaneous leverage with Kirschner wire stabilization. METHODS: A retrospective clinical and radiographical evaluation was performed on a cohort of 61 patients (mean age 9.7 years; range 3 to 15) with isolated, unilateral radial neck fractures treated between 2009 and 2019. The mean duration of follow-up was 4.2 years (range 2 to 9 years). All fractures were types III and IV according to Judet's classification. RESULTS: After mean follow-up, the radiographic results according to Metaizeau were rated as excellent in 70.5% of respondents, good in 27.9%, satisfactory in 1.6%. According to Mayo Elbow Performance Score, 95.1% of respondents obtained a very good result, 3.3% good, and 1.6% satisfactory. The mean radial neck-shaft angle changed from a mean 51.5° before operation to 3.8° postoperatively (p<0.001). The mean translation was 3.1mm before surgery and 0.5mm postoperatively (p<0.001). No limb axis deviation, elbow joint instability, and infection of the implant insertion site were observed. No statistically significant differences were noted between girls and boys (p>0.05). CONCLUSIONS: Our findings indicate that percutaneous leverage with Kirschner wire stabilization is an effective and safe method for treating isolated radial neck fractures, characterized by a low risk of iatrogenic complications.

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.

Clinical and radiological evaluation of surgical treatment of medial epicondyle fractures of humerus in children. A two-centre study.

The present study analyses the outcome of open reduction and internal fixation (ORIF) of humerus medial epicondyle fracture with the use of Kirschner (K) wires, and determine the effect of elbow dislocation. The study included 112 patients operated on in 2005-2016. Of these, 81presented with an isolated medial epicondyle fracture (mean age 11.6 years), and 31 with an elbow dislocation (mean age 11.9 years). Out of 112 patients tested, 98 achieved an excellent treatment result, ten good and a mean Mayo Elbow Performance Score (MEPS); no significant differences were observed between dislocated and non-dislocated elbow groups. Those with an isolated medial epicondyle fracture demonstrated a mean flexion of 140.7° and extension deficit of 3.0°, while those with an elbow dislocation displayed a mean flexion of 134.5° and extension deficit 6.1°. The dislocation group demonstrated significantly greater extension and flexion deficits (p = 0.019, p < 0.001, respectively). One patient required revision surgery due to nonunion. Ulnar nerve function was normal in 110 patients: in the other two, it resolved spontaneously in one, and the nerve was transposed in the other. Medial elbow instability was found in seven patients: two with elbow dislocation and five without. ORIF with K wires is a safe procedure for treating medial epicondyle humeral fractures that yields good or very good results. Similar outcomes are observed between patients with and without dislocation according to MEPS; however, flexion and extension are more limited in the former group.

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.

Time efficiency of direct anterior hip arthroplasty compared to postero-lateral approach in elderly patients.

INTRODUCTION: Primary arthroplasty of the hip joint is currently one of the most commonly performed procedures in orthopedics. In Poland we are observing significant changes in the age structure. With the prolonged life more and more elderly patients require musculoskeletal surgery to maintain comfortable and painless mobility. Reducing the duration of the procedure reduces the costs of anesthesiology, surgical and instrument teams, as well as the operating room technical team. The aim of the study was to compare the time required to perform hip joint arthroplasty by the direct anterior approach (DAA) with the postero-lateral approach (PLA) in our hospital. MATERIAL AND METHODS: A retrospective analysis of 559 total and bipolar cemented and cementless hip replacement procedures based on two operative approaches - the minimally invasive DAA over the course of 2 years, and the standard PLA over the course of 3 years - was performed. RESULTS: Statistically significant differences were observed between the approaches used for cementless total arthroplasty with regard to the mean treatment times: 51.9 min for the 272 DAA cases, and 78.3 min for the 190 PLA cases (p < 0.0001). For the cementless hemi-arthroplasty procedure, the mean treatment times were 46.9 min in 36 patients for DAA, and 48.2 min for 61 patients for PLA (p = 0.57). CONCLUSIONS: Minimally invasive DAA significantly shortens the time of the procedure in elderly patients compared to PLA. Further study is needed to analyze other aspects of those two approaches.

Efficacy of intravenous tranexamic acid administration in revision hip arthroplasty.

BACKGROUND: This study aimed to evaluate the efficiency of constant dose intravenous administration of tranexamic acid (TXA) in reducing postoperative blood loss, hemoglobin (Hb) concentration, and the number of transfusions in revision hip arthroplasty (RHA). METHODS: The study included 145 consecutive patients who had undergone RHA: a TXA group (75 patients) who received two doses of TXA (1.0 g 15 min before skin incision and 1.0 g during wound closure) and a no-TXA group (70 patients). Percentage blood loss and quantitative blood loss were calculated. RESULTS: The percentage blood loss (23.82 ± 10.6% vs. 39.17 ± 15.1%; P < 0.001), Hb drop (2.9 ± 1.14 g/dL vs. 4.22 ± 1.4 g/dL; P < 0.001), and total blood loss (1030 ± 477 mL vs. 1736 ± 761 mL; P < 0.001) were significantly lower in the TXA group than in the no-TXA group on postoperative day 1. Percentage blood loss (37.5 ± 10.4% vs. 43.1 ± 12.5%; P < 0.01), Hb drop (4.64 ± 1.5 g/dL vs. 5.22 ± 1.6 g/dL; P < 0.01) and total blood loss (1639 ± 543 mL vs. 1908 ± 681 mL; P = 0.02) were significantly lower in the TXA group than in the no-TXA group on the 5th postoperative day. The blood transfusion requirements were lower in the TXA group than those in the no-TXA group (30.7% vs. 71.4% of patients; P < 0.001), with a lower transfusion per patient ratio of 0.55 in the TXA group and 1.4 in the no-TXA group. No postoperative complications were associated with TXA administration, including deep-vein thrombosis and pulmonary embolism. CONCLUSION: Administration of TXA is an effective method to reduce perioperative blood loss, Hb drop and the number of transfusions in RHA.

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.

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].

Success Rates of Revision Knee Arthroplasty for Periprosthetic Joint Infection in Rheumatoid and Non-Rheumatoid Arthritis Patients.

This study evaluated the success and failure rates as well as the final results following 2-stage revision total knee arthroplasty (TKA) for periprosthetic joint infection (PJI). Particular emphasis was placed on comparing patients with rheumatoid arthritis (RA) and non-RA patients. A total of 140 knees that required 2-stage revision for PJI after TKA were analyzed. Mean patient age at first revision TKA was 67.9 years (range, 43 to 89 years), and mean time from second-stage revision to final follow-up was 53.3 months (range, 26 to 127 months). Thirty-eight of the 140 knees (27.1%) demonstrated recurrence of infection after first 2-stage revision. Of these, 8 required another 2-stage revision, 25 required knee arthrodesis, and 2 required amputation; 3 patients refused further treatment or were lost to follow-up. There was no recurrence of infection. No statistically significant differences were observed between the RA and non-RA groups in terms of success or failure rate (P=.6) according to Diaz-Ledezma and Knee Society Scores (P=.3). These findings indicate reinfection rates and final results were similar in RA and non-RA patients following revision TKA for PJI. [Orthopedics. 2019; 42(5):e472-e476.].

Supervised physiotherapy leads to a better return to physical activity after anterior cruciate ligament reconstruction.

BACKGROUND: The main goal of rehabilitation after anterior cruciate ligament reconstruction (ACLR) is to return to functional and sports activity at a preinjury level. The aim of this study was to assess the influence of supervised (SU) versus non-supervised (NS) rehabilitation protocols after ACLR on the return to sports activity and quality of life of amateur athletes. METHODS: The study included a total of 50 patients after ACLR, with 25 in the SU group and 25 in the NS group. No significant differences were observed between the two groups with regard to age, sex, or BMI. Two different ACLR techniques were used: hamstring graft and bone patellar tendon bone. The patients were examined preoperatively and 12 months postoperatively. Outcomes were evaluated utilizing the Kujala Scale, Tegner Scale, the Knee injury and Osteoarthritis Outcome Score (KOOS), the Functional Movement Screen (FMS), and range of motion. Patients from the SU group participated in rehabilitation sessions with a physiotherapist with an average of 48 meetings. Those in the NS attended six meetings with the physiotherapist. RESULTS: At final follow-up, patients from both groups demonstrated a higher level of functional and sports activity and had a better quality of life 12 months after ACLR. Patients from the supervised group returned to a significantly higher level of sports activity (Tegner Scale: SU=6, NS=5, P=0.003) and reported significantly better quality of life 12 months after ACLR (KOOS QOL: SU=90, NS=74; P<0.001). CONCLUSIONS: Supervised, controlled physiotherapy results in higher activity levels and better quality of life in amateur athletes 12 months after ACLR.

The Influence of Implant Position on Final Clinical Outcome and Gait Analysis after Total Knee Arthroplasty.

The aim of the study was to evaluate the impact of implant component alignment on objective and subjective outcomes after total knee arthroplasty (TKA). The rotation of the femoral component and its influence on the final results were also examined. After exclusion, the study examined 102 patients (mean age, 66.28 years; range, 51-79 years) who had undergone unilateral TKA. All of the operative procedures were performed by one surgeon with one type of implant. One year after the operation, improvements in Knee Society's Knee Scoring System, functional score, Western Ontario and McMaster Universities Osteoarthritis Index, and Visual Analog Scale were observed; however, none showed a significant correlation with any of the parameters analyzed by X-ray or computed tomography (CT) (α, ß, γ, δ angles and posterior condylar angle [PCA]). Significant improvements were found for the vast majority of the parameters used for gate analysis at the final follow-up. Significant correlations were found between PCA angle and differences in stance phase, swing phase of the operated limb, and step width (all p = 0.03). No other significant relationships were found between gait parameters and indicators measured by X-ray and CT. None of the analyzed radiographic parameters, including rotation of the femoral component, correlated with final clinical results. Neither femoral internal rotation of 3° to 6°, nor rotation of 0° ± 3° or 0° ± 6° influenced the outcome. One year after TKA, a significant improvement was observed in both functional and gait parameters.

The Anterolateral Ligament of the Knee: A Proposed Classification System.

The anterolateral ligament (ALL) is a potential stabilizer of the knee and cooperates with the anterior cruciate ligament (ACL). It originates on the lateral epicondyle of the femur, to which it is mainly posterior and proximal; insertion is posterior to Gerdy's tubercle. Its anatomical characteristics vary. Recent publications have focused on morphological variations concerning mainly the femoral and tibial attachments, and on morphometric measurements. Histological and cystochemical examinations have also been performed. Classical anatomical dissection was performed on 111 lower limbs (25 isolated and 86 paired) fixed in 10% formalin. The knee region was dissected using traditional techniques and the morphological features of the ALL were assessed: morphometric measurements and the types of ALL. The ALL was present in 70 individuals (37 woman and 33 men). In 30 cases, it was absent symmetrically, and in 11, it was present on just one side (P = 0.0011). The ALL was morphologically very variable. In type I (the most common form - 64.3%), a single band traveled parallel to the fibular collateral ligament (FCL); in type II the band crossed it. In type III, the origin was located on the lateral epicondyle of the femur and also on the lateral-posterior surface of the joint capsule, and the insertion was in the deep fascia of the leg: this type could be called a capsule. Type IV was characterized by a double ALL, type IIb by ligaments that bifurcated, and type V by the ALL starting directly from the FCL rather than the femoral epicondyle. The ALL is characterized by high morphological variability, both in its femoral and in its tibial attachments and in its course. Clin. Anat. 31:966-973, 2018. © 2018 Wiley Periodicals, Inc.

Unrecoverable bi-products of drilling titanium alloy and tantalum metal implants: a pilot study.

BACKGROUND: Trabecular metal implants with a porous architecture that allows for the incorporation of bone into the implant during healing are gaining popularity in alloplastic revision procedures. The bi-products of drilling titanium alloy (Ti) and tantalum (Ta) implants have not been previously assessed. METHODS: Four holes were drilled in each of 2 spatially porous trabecular implants, one Ta and the other Ti alloy (Ti-6Al-7Nb), for this pilot in vitro study. The particles were flushed out with a continuous flow of saline. The particles' weight and the volume were then measured using a Radwag XA 110/2X (USA) laboratory balance. The total volume of the obtained metal fines was measured by titration using a 10 mm3 measurement system. RESULTS: A cobalt carbide bit was used since the holes could not be made with a standard bone drill. Each Ti and Ta implant lost 1.26 g and 2.48 g of mass, respectively. The volume of free particles recovered after each stage was 280 mm3 and 149 mm3, respectively. Approximately 0.6% of the total implant mass was not recovered after drilling (roughly 2% of the mass of the particles created by drilling), despite the use of 5 µm filters. CONCLUSIONS: It is technically difficult to drill holes in Ti and Ta implants using standard surgical tools. The drilling process creates a considerable amount of metal particles, which cannot be recovered despite intensive flushing. This may have an adverse influence on the bio-functionality (survival) of the endoprosthesis and present deleterious systemic consequences.

Hip osteonecroses treated with calcium sulfate-calcium phosphate bone graft substitute have different results according to the cause of osteonecrosis: alcohol abuse or corticosteroid-induced.

INTRODUCTION: The aim of the study was to assess the factors influencing the final results of treatment of the femoral head osteonecrosis (ONFH) with core decompression and bone substitute grafting. The special interest was focused on comparison between alcohol- and steroid-induced ONFHs. MATERIAL AND METHODS: In this prospective study, a total of 53 patients (58 hips) in the mean age of 35.5 years were included: 29 had a history of alcohol use (32 hips) and 24 of steroid use (26 hips). The mean follow-up was 4.2 years (minimum 3 years). RESULTS: At last follow-up, significant improvements were noted in the Harris Hip Score (HHS) (mean 44.0 vs 55.9 points, p < 0.00002) and VAS scores (mean 7.0 vs 5.8 points, p < 0.0002) for the whole ONFH cohort, comparing to pre-operative status. The degree of improvement did not differ between Ficat and Arlet grade II and grade III (mean 14.9 vs 6.2 points, respectively, p = 0.1). No change was found between the final and initial results in this group in the steroid group (HHS mean 42.2 vs 45.5 points, p = 0.5 and VAS mean 6.8 vs 6.5 points, p = 0.5), but the improvement was noted in the alcohol group (HHS mean 45.5 vs 64.4 points, p < 0.0001; VAS mean 7.1 vs 5.2 points, p < 0.0001) comparing to pre-operative status. CONCLUSIONS: Presented treatment of ONFH significantly improves hip function, offers pain reduction, and gives similar functional improvement for hips scoring grade II and III on the Ficat and Arlet scale. A good response to operative treatment is seen in patients with alcohol-induced ONFH, but not in those with steroid-induced ONFH.

Comparison of hamstring and patellar tendon grafts in anterior cruciate ligament reconstruction: A prospective randomized study.

Objective This prospective randomized study was performed to compare the outcomes of two operative methods of anterior cruciate ligament (ACL) reconstruction based on either bone-patellar tendon-bone (BTB) grafts or hamstring tendon (HT) grafts. Methods Among 100 patients, 96 completed the full follow-up period and were included in the final analysis (48 in the BTB group and 48 in the HT group). The patients were evaluated preoperatively and 1, 3, 6, and 12 months after ACL reconstruction. The Kujala score, Tegner score, and Knee injury and Osteoarthritis Outcome Score (KOOS) were among the parameters used to evaluate the patients. Results Both groups were comparable in terms of sex, age, and body mass index. None of the analyzed scores were significantly different between the BTB and HT groups at either the initial or last visit. Both groups demonstrated improvement at the 12-year follow-up according to the Kujala score and most categories of the KOOS. The Tegner activity level score showed significant improvement in the HT but not BTB group. Conclusion Patients undergoing ACL reconstruction with BTB and HT grafts show comparable improvement in functional results after 1 year of rehabilitation.

Treatment of Femoroacetabular Impingement with a Mini-open Direct Anterior Approach.

BACKGROUND: The opinion about best methods of femoroacetabular impingement (FAI) treatment are not consistent. Operative treatment of this condition may be arthroscopic, but open procedures with osteotomy of the greater trochanter and hip dislocation has been used. The present study evaluates the benefits of the mini-open direct anterior approach (DAA) in treating patients with FAI, with is a procedure available for most orthopedic surgeons. MATERIALS AND METHODS: 39 patients treated for FAI (25 men and 14 women) at an average age of 29.3 years (range 18-46 years) were reviewed in this retrospective study. The mean followup was 45 months, (range 24-55 months). The hip impingement test was positive in all patients. The diagnosis of FAI was confirmed on anteroposterior and lateral hip view radiographs. All patients were operated with mini-open DAA. The outcomes were assessed with the Harris Hip Score, Short-Form 36 Health Survey and VAS score. Preoperative osteoarthritis was assessed according to Tönnis score. RESULTS: At the final followup, improvement was noted compared to preoperative status in Harris Hip Score (P < 0.00001), visual analog scale score (P < 0.001), and Short-Form-36 score (P < 0.001). Nineteen patients returned to their previous sports activities. No major complications occurred. One patient developed heterotopic ossification and three patients developed temporary postoperative meralgia paresthetica. Five patients from the treatment group required total hip arthroplasty for severe osteoarthritis. CONCLUSIONS: Mini-open DAA is a safe and effective procedure for the treatment of FAI that gives good relief of symptoms and allows a successful return to preoperative activity levels. Further research with a longer followup period is needed to evaluate the influence of surgery on natural history of FAI.

Return to Work after Surgical Treatment of Coxarthrosis by Total Cementless Hip Arthroplasty.

BACKGROUND: Total hip arthroplasty is currently commonly used in surgical treatment of advanced hip osteoarthritis of various aetiologies. Studies show that the number of these procedures has been growing every year, which is associated with global population ageing. The aim of the study was to assess return to work in patients after surgical treatment by arthroplasty due to hip osteoarthritis. MATERIAL AND METHODS: The study assessed 114 patients of productive age who underwent surgery due to advanced hip osteoarthritis. The mean age was 49.9 years in women and 52.2 years in men. All patients included in this retrospective study underwent clinical and radiographic assessment prior to arthroplasty and at the last out-patient follow-up visit. The patients' occupational status and the time of return to work after surgery were also assessed. The results of this clinical study were analysed according to the Merle d'Aubigne-Postel classification (modified by Charnley). Preoperative radiographs were assessed according to the Kellgren-Lawrence classification. The radiographs served to assess the position of the endoprosthesis, including both the acetabular component and the stem. The results were statistically analysed. RESULTS: Pre-operative assessment classified all cases as poor both clinically and radiographically. The post-operative outcomes were excellent in 71 cases (61.7%), good in 37 cases (32.2%) and fair in 7 cases. No case was classified as poor. The mean improvement was 6.6 points and reached the level of statistical significance. Radiographic evaluation did not reveal evidence of aseptic implant loosening and confirmed a normal seat of endoprosthetic components within the Lewinnek safe zone in each case. Only 75 (65.8%) of the study participants worked before the procedure. After the treatment was completed, 67 (58.8%) study patients took up employment. The mean duration of sick leave was 138.6 days and 21 patients were receiving rehabilitation benefits. CONCLUSIONS: 1. Total hip arthroplasty is a valuable method of surgical treatment of advanced coxarthrosis of various aetiologies in patients of productive age. 2. Most patients who worked before the surgery return to work in the same position and work time. 3. Only dysplastic coxarthro-ses have an unfavourable prognosis with respect to starting or resuming work after surgery.

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

BACKGROUND: The aim of the study was to evaluate the potential consequences of drilling titanium alloy (Ti) and tantalum (Ta) implants. METHODS: During an in vitro study, four holes were made in each of two spatially porous trabecular implants: one Ta and the other Ti alloy (Ti-6Al-7Nb). The weight and the volume of particles produced during the drilling were then measured using a Radwag XA 110/2X (USA) laboratory balance. RESULTS: The loss of mass of the Ti and Ta implants was respectively 1.26 g and 2.48 g, and the volume of free particles was respectively 280 mm3 and 149 mm3. The particles were recovered after each stage. Despite the use of 5 µm filters, around 0.6% of the total implant mass from both implants was not recovered after drilling (roughly 2% of the mass of the particles created). CONCLUSION: It is technically difficult to make holes in Ti and Ta implants using standard surgical tools, and the process creates a significant amount of metal particles which cannot be removed, despite intensive flushing. This may have a potentially adverse influence on the survival of the implant and result in negative systemic consequences.