Comparison of the cellular composition of two different chondrocyte-seeded biomaterials and the results of their transplantation in humans.

Our study compares the histological and immunohistochemical cellular composition of two different chondrocyte-seeded biomaterials and the results of their transplantation. Our study cohort included 21 patients, comprising 19 men and two women with a mean age of 32 years, who were affected by single chondral lesions of the femoral condyles. These patients were enrolled in our study and treated with arthroscopic implantation of the tissue Hyalograft C and/or Brno culture. Brno culture bioengineered with a fibrin-based scaffold contains round cells showing features of differentiated chondrocytes expressing S-100 protein and α-smooth muscle actin. In contrast, in the case of Hyalograft C, the scaffold was made up of a fibrillar network composed of biomaterial fibres of the esters of hyaluronic acid and cells resembling fibroblasts and myofibroblasts and expressing only α-smooth muscle actin. The average size of the defects was 2.5 cm2. Patients were evaluated using the standardized guidelines of the International Knee Documentation Committee. During the comparison of bioptic samples obtained from both patient cohorts, we did not observe any important differences in the histological makeup of the newly formed cartilage. The histological analysis of these two groups of homogeneous patients shows that this bioengineered approach, under proper indications, may offer favourable and stable clinical results over time, in spite of the different matrix and cellular composition of the two transplants used.

[Ipsilateral traumatic dislocation of hip and knee joints. Case report]. / Ipsilaterální traumatická luxace kycelního a kolenního kloubu - kazuistika.

Traumatic obturator dislocation of the hip without fracture associated with antero-lateral knee dislocation is considered to be an extreme injury. Such a case, which has never been treated in our department, is reported here. The patient was a 40-year-old man who suffered his injury in a motorcycle accident. He had ipsilateral traumatic obturator hip dislocation and anterior knee dislocation.Within two hours of injury dislocation reduction was carried out under general anaesthesia, the anterior cruciate ligament was reconstructed using BTB allograft and a CT scan was obtained. In this type of trauma CT-angiography is always indicated to detect any possible threat to limb vitality. The functional results were excellent and were directly dependent on the correct use of arthroscopy. At 3 years post-operatively, his hip and knee joints were examined. The Harris hip score was 98 points and the International Knee Documentation Score (IKDC) was also excellent. There was no neurological deficit, although this type of trauma is usually associated with neurological complications. At the time of examination the patient was symptom free.

[Total hip replacement from a MIS-AL approach (comparison with a standard anterolateral approach)]. / Totální endoprotéza kycelního kloubu z MIS-AL prístupu - porovnání se standardním anterolaterálním prístupem.

PURPOSE OF THE STUDY: Minimally invasive surgery (MIS) techniques have recently become a powerful and effective marketing instruments that are often perceived by the patient as the criterion of the surgeon's and institution's standard. In addition to studies reporting the benefits of minimally invasive procedures, some authors have recently found no such benefits or even pointed out some disadvantages. In this paper we present our own view of this issue. Our definition of minimally invasive surgery: a minimally invasive procedure is such that an optimally placed incision using anatomical intervals without damage to muscle insertions allows us to gain a good view of the operating field and to safely perform the planned surgery. Because of this optimal approach it is possible to make skin incisions shorter. MATERIAL: Between April 21, 2005, and December 28, 2006, the first 40 MIS hip procedures were performed at the Department of Orthopaedic Surgery of the ILF Bulovka. Forty patients who, in the same period, were operated on from an anterolateral standard approach and who met the same indication criteria, including age, comprised a control group. In both groups all routinely used types of implants were included. METHODS: For objective assessment of potential differences between surgical outcomes of the two techniques, the following para- meters were recorded: operating time, peri-operative blood loss, pre- and post-operative Hb levels, Hb level on the first post- operative morning, amount of blood drained away with a Redon drain, number of anodyne applications (indirect evaluation of post-operative pain) and length of hospital stay. The parameters were compared for the cemented and the uncemented implants separately. The results were evaluated using the paired t-test, with the significance level set at a value of p<0.05. RESULTS: A comparison of the MIS-AL results with those of the standard total hip replacement procedure did not show any significant differences, not even during further follow-up; by the end of 2008 no implant failure or necessity of revision arthro- plasty was reported. DISCUSSION: So far the only indisputable fact is that all the benefits of minimally invasive techniques described until now are merely related to time, as they facilitate a faster rate of soft tissue repair; therefore, these techniques only shorten recovery and thus speed up return of the operated hip to full function. CONCLUSIONS: Based on comparison of the standard anterolateral and minimally invasive techniques it can be concluded that the MIS- AL approach is effective even without the use of special instrumentation. However, the results of this study failed to give unambiguous support to its advantage over the classical technique.

[Treatment of deep cartilage defects of the knee with autologous chondrocyte transplantation on a hyaluronic Acid ester scaffolds (Hyalograft C)]. / Osetrení hlubokých defektu chrupavky kolena transplantací autologních chondrocytu fixovaných na nosici z esteru kyseliny hyaluronové (Hyalograft C).

PURPOSE OF THE STUDY: The treatment of chondral defects by transplantation of autologous chondrocytes has recently shown further development. Various biomaterials are used as carriers facilitating attachment and even distribution of chondrocytes in the defect. Since 2003 Hyalograft C, hyaluronan-based scaffolds, has been used, in a clinical study, for implantation of autologous chondrocytes in the treatment of deep chondral lesions of the knee at our department. MATERIAL: Eight patients (7 men and 1 woman; average age, 31 years) followed up for at least 9 months were evaluated. The lesions with an average size of 3.9 cm2 were localized on femoral condyles. METHODS: The outcome of surgery was evaluated on the basis of the IKDC Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS) and Lysholm knee score. The patients underwent MR examination preoperatively and at 3, 6 and 12 months after surgery. The newly-formed cartilage was assessed by International Cartilage Repair Society (ICRS) visual scores at second-look arthroscopy carried out at 9 to 12 months following transplantation. Consistency of the new cartilage developing in the defect and that of healthy cartilage around the defect was compared by means of a special indentation probe in three patients. A biopsy sample was collected from the grafted site for histological, histochemical and immunohistochemical examination. RESULTS: All patients reported improvement in knee function on average at 10 months after surgery. The average IKDC subjective score increased from 46 points preoperatively to 74 points postoperatively. The KOOS evaluation showed pain relief and improved function. In quality of life evaluation the average score of 35 points before surgery increased to 70 points after it. The average Lysholm knee score was 61 points before and 83 points after surgery. MR findings correlated well with arthroscopic findings. Second-look arthroscopy showed a normal appearance of the newly-formed cartilage in six, and an abnormal appearance in two patients. The average ICRS visual score was 9.4 points. No graft failure was recorded. The newly-produced tissue had the histological characteristics of a mixed hyaline and fibrous cartilage in seven patients, and of hyaline-like cartilage in one patient. DISCUSSION: The ICRS visual repair assessment of the newly-formed tissue showed that our results were better than the one-year outcomes reported by Bartlett et al. (11 patients after transplantation of a collagen bilayer seeded with chondrocytes), but worse than the results of an Italian multi-center study (55 patients with Hyalograft C-based grafts followed up on average for 14 months). At almost one year, implantation of on a Hyalograft C resulted in the production of mixed cartilage incorporated well in the subchondral bone. Only one patient had mature hyaline cartilage. One year is too short to allow for complete remodeling of the newly formed cartilage into a mature hyaline cartilage. This is in agreement with other studies suggesting that the new cartilage continues to mature and remodel for a time longer than one year. CONCLUSIONS: Based on our results we suggest that the use of Hyalograft C is a safe and effective option for treatment of deep chondral defects of the knee; it is particularly useful in patients in whom the primary defect treatment has failed. The application of Haylograft C is relatively quick and easy; this is convenient when surgery involves more than one procedure (ligament reconstruction, osteotomy). However, a definite evaluation of this method will be possible only after long-term results are available. Key words: deep cartilage defects, chondral defects, cartilage repair, autologous chondrocyte transplantation, hyaluronan- based scaffold, Hyalograft C, cartilage repair assessment, ICRS.

Desmin-positive and alpha-smooth muscle actin positive chondrocytes in human defective articular cartilage--preliminary report.

We studied the results of immunostaining for S-100 protein, alpha-smooth muscle actin, muscle specific actin and desmin in articular cartilage specimens obtained during an arthroscopy from eight patients with different degrees of osteoarthritis of the knee joint. In all cases, most of the cartilage cells were strongly positive for S-100 protein. Actin positive chondrocytes were present in four samples showing repair cartilage changes with occurrence of fibrocartilage tissue. Moreover, in one case, we observed typical desmin-positive chondrocytes in the layer of cartilage filling the defect of the articular cartilage surface. The expression of desmin can be regarded as a reaction to trauma or the indication of an inherent abnormality. The chondrocytes probably switched on smooth muscle features during the healing process, because desmin is to a great extent a typical muscle cell marker. This fact could probably support our previous supposition that cartilage cells expressing muscle markers could be designated as myochondroblasts and myochondrocytes analogously to the terminology of myofibroblasts. It is possible that during the healing of the cartilage defects, such a transformation of the immunophenotype of the cartilage cells is quite frequent, but it could also be only transient nature only.

[Distal shortening osteotomy of the metatarsals using the Weil technique: surgical treatment of metatarsalgia and dislocation of the metatarsophalangeal joint]. / Weilova distální zkracovací osteotomie metatarzu: chirurgické lécení metatarzalgie a dislokace v metatarzofalangeálních kloubech.

PURPOSE: Weil technique of the distal shortening osteotomy of metatarsal is a relatively new method of the surgical treatment of metatarsalgia and dislocation of metatarsophalangeal (MTP) joints. A retrospective study evaluates the first experience in Weil osteotomy at the authors' department. MATERIAL: Between May 1999 and the end of 2000 twelve patients (14 feet) were operated on in which the Weil technique of the osteotomy was performed on 28 metatarsals. Indication for the surgery was chronic metatarsalgia with dislocation of the MTP joint, with excessive length of one or more lesser metatarsals, with insufficiency of the first ray after the surgery of hallux valgus and metatarsalgia after the resection of the head of II metatarsal. All patients were women, average age of 57 years (range, 50-68 years) at the time of operation. The average follow-up is 9 months (range, 6-24 months). Dislocated prior to operation were 9 MTP joints, in 2 cases a deformity of 2nd digit of the digitus supraductus type was operated on. METHODS: The patients evaluated subjectively the functional and cosmetic outcomes of the surgery. Clinical evaluation related to recurrence or transfer of difficulties to the head of the neighbouring metatarsal, range of motion of the MTP joint, function and grip of the digit. Radiograph was used for the evaluation of the metatarsal index, post-operative shortening of II metatarsal, reduction of dislocation in the MTP joint and healing of osteotomy. RESULTS: Satisfied with the functionla and cosmetic results of the operation were 83% patients (10 of 12). Recurrence of metatarsalgia was not found in any patient, transfermetatarsalgia in one patient. Reduction of the range of motion in the MTP joint (plantar flexion) by more than 50% was recorded in 43% operated on metatarsals and in all metatarsals after the reduction of the dislocation. Acceptable function and strength of the digit evaluated by the ability to press by the digit a sheet of paper against the floor was preserved in most of the operated on metatarsals--86% (24 of 28). Average shortening of II metatarsal was 5.6 mm. All dislocated MTP joints were reduced postoperatively. Dislocation recurred in 2 cases. Avascular necrosis of the head of II metatarsal after the reduction of the dislocation was encountered in one case. DISCUSSION: The small number of recurrences and transfermetatarsalgia proves that Weil osteotomy allowing a controlled shortening of metatarsal with a fixation is a reliable method in the solution of metatarsalgia. The operation directly on the joint allows reduction of the dislocation of the MTP joint. Shortening of metatarsal facilitates reduction and reduces axial pressure in the MTP joint. Recurrence of dislocation is reported between 15% and 22%. After a more difficult reduction and danger of redislocation some authors recommend a temporary transfixation of the MTP joint by K-wire. The disadvantage of the operation is a frequent temporary limitation of the range of motion in the MTP joint which is caused by the opening of the articular capsule and its subsequent contraction. No author reports any problems with the healing of the osteotomy. The results in our group of patients are comparable with the results published by other authors. CONCLUSION: Weil osteotomy allows a planned controlled shortening of metatarsal with a stable fixation. Osteotomy heals well. Osteotomy is intraarticular which on one side provides the possibility to correct dislocation in the MTP joint, however, on the other hand it poses a risk of the limitation of the range of motion of this joint. The main contribution the authors see in the new possibility of surgical treatment of more severe matatarsalgia and deformities of the forefoot with the preservation of joints.

[Artroskopická náhrada predního zkrízeného vazu volným stepem z ligamentum patellae transtibiální technikou.]. / Arthroscopic Transtibial ACL Reconstruction with the Free Graft from the Patellar Ligament.

Surgical techniques of replacement of the anterior cruciate ligament were further developed in recent years. In the submitted paper the authors describe arthroscopic replacement of the anterior cruciate ligament by transtibial technique of a single incision with an incomplete femoral canal. The objective of the work is to test, based on the authors' own shortterm experience, the reliability and contribution of this technique and possibly correct it with regard to the assembled results and experience. Main emphasis was laid on evaluation of the range of mobility, stability and X-ray evaluation of the localization of the femoral and tibial canal and the femoral interference screw. During evaluation the recommendations of IKDC were respected. For evaluation of the anterior translation of the tibia (Lachman's test) an arthrometer KT 1000 was used. For X-ray evaluation of the site of the intraarticular orifice of the tibial and femoral canal the authors used Harrier's method and for evaluation of impingement of the graft on the ceiling of the intercondylar space Howell's method. A total of 32 patients were checked, all operated by this technique in 1994. The mean age of the patients at the time of operation was 24 years (16-40). The mean follow up period after surgery is 9 months (6-18 months). In all a graft from the patellar ligament was used, fixed to the femur by an interference screw, to the tibia by an interference screw in 26 patients. In 6 patients the graft was fixed by a hook. 94% of the patients evaluated the function of the operated knee as normal or almost normal. In 28 patients extension and in 30 flexion was without restriction. Two of the four patients with restricted extension, pain and oedema were subjected to repeated arthroscopy with the diagnosis "cyclops" syndrome. When evaluating the anterior translation of the tibia by an arthrometer KT 1000 (134 N, by maximal manual force) in 24 patients the difference was less than 3 mm, in 7 it was 3-5 mm and in one more than 5 mm. The pivot shift test was positive (1+) only in one patient. The required intraarticular orifice of the tibial canal (into section B according to Harner) was achieved in 87.5% patients and optimal centering of the femoral canal (into section D according to Harner) in 56% patients. In the remainder the femoral canal was in a slightly more ventral position (it reached as far as section C, on average by 2 mm). Slight impingement according to Howell was found in 4 patients. In 28 patients the femoral interference screw was inserted parallely, in three patients the divergence was 10-20 degrees and in one 35 degrees . The described technique reduces the risk of impingement of the graft on the ceiling of the intercondylar space. Correct orientation of the femoral canal and faultless insertion of the femoral interference screw calls for adequate experience. For orientation and drilling of the femoral canal optimal flexion is 80 degrees . The greatest surgical trauma is taking the graft from the patellar ligament. The method promotes more rapid rehabilitation. Key words: anterior cruciate ligament, arthroscopic replacement, transtibial technique.

[Indications for and contribution of diagnostic arthroscopy of the knee joint]. / Indikace a prínos diagnostické artroskopie kolenního kloubu.

The paper deals with indications and diagnostic possibilities of arthroscopy of the knee joint. The first part is devoted to the application of arthroscopy in the diagnosis of acute knee injuries. The Gillquists scheme of diagnostic procedure is outlined. Acute arthroscopy is indicate in acute blockade and in hemarthros. Arthroscopy has made the highest contribution in the diagnosis and treatment of damaged meniscus. High attention is devoted to chondropathy of patella and femoropatellar joint. Possibilities of arthroscopy in the evaluation of femoropatellar congruence are described. Less frequent causes of pains in anterior parts of the knee joint are mentioned (overuse sy, patellofemoral impingement sy, etc.). Arthroscopy is a method of choice in the identification and therapy of synovial plicae. In suspected disease of synovial lining the possibility of aimed biopsy is the main advantage. Other indications are as follows: dissecting osteochondrosis, intrajoint bodies of various etiologies, gonarthrosis. Arthroscopy enables a better planning of some operation interventions and to determine further prognosis. In the conclusion the authors draw attention to the contribution of diagnostic arthroscopy of knee joint in younger children, where a clinical examination and, particularly, its evaluation may be difficult.

[Arthroscopic reconstruction of the anterior cruciate ligament using the transtibial technique and a graft from the patellar ligament--results after 5-6 years]. / Artroskopická rekonstrukce predního zkrízeného vazu transtibiální technikou stepem z lig. patellae--výsledky po 5 az 6 letech.

PURPOSE OF THE STUDY: Arthroscopic reconstruction of the anterior cruciate ligament (ACL) by transtibial technique with free graft from the patellar tendon fixed by interference screws is a commonly used procedure. The aim of this study is to evaluate the results 5 to 6 years after the surgery. MATERIAL: Fifty-two of 79 patients operated on in 1995 were checked in the period of 2000-2001. The average age of patients at the time of surgery was 26 years (range, 15-20 years), there were more men (62%), prevailing were injuries resulting from sports activities (92%). METHOD: We have used evaluation according to IKDC. We focused on the problems at the site from which the graft was harvested, on the difficulties in the kneeling position and walking on knees. Evaluation of the activity was based on the Tegner score. On radiographs we assessed the length of the patellar tendon, dilatation of the tibial canal and the incidence and degree of osteoarthritis. RESULTS: General evaluation according to IKDC was normal or nearly normal in 79% of patients. The difference of the anterior displacement of tibia between the operated on and non-operated on knee measured by arthrometer (KT 1000, 89N) was < 3 mm in 58% of patients and < or = mm in 95% of patients. Significant difficulties on the operated on side in the kneeling position and walking on knees were reported by 3 patients, slight difficulties were reported by 28 patients. Twenty patients reported slight difficulties also on the non-operated on side. Prior to the injury the average level of activity after Tegner was 7.9 (range, 6-10), prior to the operation 2.7 (range, 0-6) and at the time of check examination 7.0 (range, 4-10). The same level of activity as before the injury was reported by 61.5% of patients. Shortening of the patellar tendon on the operated on side > 5% (6 mm) was found out in 1 patient, shortening of < or = 5% (2-3 mm) in 30 patients. Tibial canal on the lateral projection 1 cm beneath the joint line was wider than 10 mm (dilated) in 6 patients. On the operated on knee osteoarthritis was found of the medial compartment of degree B and C in 42% of patients and on the non-operated knee in 19% patients. Aggravation of osteoarhritis of the medial compartment by one degree occurred after 5 to 6 years after the surgery in 4 out of 20 patients. All of them underwent meniscectomy. Eighty-six per cent (19 of 22) of patients with osteoarthritis of the medial compartment underwent medial meniscectomy. DISCUSSION: General results according to IKDC are compared with results published by Aglietti, Jomha and Patel. Dilatation of the tibial canal was found out in 6 patients and it was associated with the graft-tunnel mismatch. The relationship between meniscectomy and arthritis is well-know. In 31% of patients after medial meniscectomy there was found out narrowing of the joint line to 2-4 mm (degree C). In case of partial medial meniscectomy the posterior horn, i.e. the most important part of the meniscus, was in most cases removed. Worsening of the arthritis after resection of the minor radial lesions of the lateral meniscus or after leaving incomplete lesions of the posterior horn of the lateral meniscus untreated has not been observed. CONCLUSION: The surgery allows to improve the stability and extent of activity in most of the patients. The most frequent problem consists in the difficulties at the site of graft harvesting which may contribute to the decrease of subjective satisfaction. The relation between shortening of the patellar tendon and patellar difficulties was not proved. In the patients after medial meniscectomy osteoarthritis progresses even after ACL reconstruction.

[Initial experience with implantation of the cemented Beznoska/S.V.L. total knee joint endoprosthesis]. / První zkusenosti s implantací cementované totální endoprotézy kolenního kloubu typu Beznoska/S. V. L.

PURPOSE OF THE STUDY: The authors present the results of their first trial of a new, Beznoska/S. V. L. type, knee prosthesis in order to introduce it to a broad orthopedic public. MATERIAL: Clinical and radiological evaluation was carried out on 34 knee prostheses implanted in 31 patients between September 1997 and October 1999. The average patient age at the time of surgery was 71.3 years and the average interval between surgery and assessment was 22.4 months (range 6 to 31 months). All patients underwent implantation due to primary or secondary gonarthosis. A brief description of the implant and the instrumentation and used surgical technique is provided. METHODS: Clinical outcomes were evaluated according to the "Knee-Society Clinical Rating System" by John N. Insall. The system classifies both knee joint parameters and knee function. X-ray films were assessed on the basis of the "Knee-Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System" by Frederic C. Ewald. In standardized X-ray projections, this allowed us to evaluate the implant position as well as radiolucent lines. RESULTS: On stability evaluation, we found anteroposterior instability up to 5 mm in 85% of the implants and mediolateral instability up to 9 degrees in 97% of them. A maximum flexion of 90 degrees to 120 degrees was achieved in 91% of the implants. The final outcome in terms of knee score was on average 80.3 points (range, 40 to 97 points), which was a very good result. Evaluation by function score showed that only 17% of the patients were not able to walk farther than 500 meters. Although 82% of them had to hold on a railing when going upstairs, all were able of stair ascent and descent; 13% had to use a walking stick permanently. The average function score was 68.4 points (range, 30 to 100), which was a good outcome. Radiograms in anteroposterior projection, assessed according to Ewald, showed the average femoral flexion angle (alpha) to be 95.2 degrees, the average tibial angle (beta) to be 89 degrees and the total valgus angle (omega) to be 3.2 degrees. In lateral projection, the femoral flexion angle (gamma) was on average 2.5 degrees and the average tibial angle (delta) was 86.7 degrees. An optimal position of the patella was achieved in 27 implants. Five radiolucent lines, up to 1 mm, were found in zone 1 of the femoral component and further lines were observed in zones 1, 2 and 4 of the tibial component. DISCUSSION: When assessing the results by the knee and function scores, it had to be taken into consideration that the average age of the patients was 71.3 years. At this age, walking without a stick, or stair ascent or descent without the use of a railing can hardly be expected. The average result of 68.4 points achieved can, therefore, be considered a very satisfactory outcome. The values shown by X-ray examination were close to the normal condition. The patients were also asked for their subjective opinion of the effect of arthroplasty; 97% of them regarded the effect as good or very good, only one patient reported no benefit. CONCLUSIONS: The results of the first trial of the use of a cemented prosthesis, type Beznoska/S. V. L., in total knee arthroplasty are presented, together with practical recommendations. Although the patient sample was small and the follow-up period short, the results are promising and suggest excellent prospects for this implant.

[Arthroscopic subacromial decompression.]. / Artroskopická subakromiální dekomprese.

Arthroscopic subacromial decompression is a generally recognized method of the treatment of the primary impingement sydrome and is one of the basic arthroscopic methods. The data in literature present 73-94 % of good and very good results. From May 1993 till June 1996 we treated at our clinic 40 patients with arthroscopic subacromial decompression of which 38 patients were followed up. The average period of follow-up is 3 years (2-5 years). All patients had clinical symptoms of impingement syndrome prior to operation. The patients who were indicated to resection of the lateral part of the clavicula and suture of the rotator cuff were not incorporated in the group. For the evaluation we used UCLA score after Ellman, the subjective satisfaction of patients was evaluated in detail. In 79 % the results after UCLA were good and very good (satisfactory). The most marked improvement was achieved in the evaluation of pain. 84 % of patients evaluated subjectively the result of the operation as good and very good. Worse evaluation on average was provided by patients who suffered the injury of the shoulder joint, patients already disabled before the surgery and women. The causes of unsatisfactory results in our group were the following: insuficient resection of acromion in 2 patients, persisting pain of acromioclavicular joint in 2 patients, non-diagnosed complete rupture of the rotator cuff in 1 patient, secondary impingement syndrome in 1 patient, CB syndrome in 1 patient and unclear cause of persisting complaints in 1 patient. Unsatisfactory results are caused by technical errors during the surgery and incorrect indications. The results can be improved by a careful clinical examination (acromioclavicular joint, stability, elimination of a secondary impingement), preliminary planning of the extent of resection of acromion according to radiographs (Y-projection, projections after Rockwood) and a correct evaluation of arthroscopic findings (lesion of labrum, SLAP, lesion of the rotator cuff). Key words: impingement syndrome, subacromial decompression, arthroscopy.

[The Zweymuller endoprosthesis in hip joint revision surgery]. / Endoprotéza typu Zweymüller v revizní chirurgii kycelního kloubu.

PURPOSE OF THE STUDY: The aim of the study is the verification of the applicability of the Zweymüller system of total hip replacement in dependence on the size of defects of acetabulum and femur and evaluation of early results in patients operated on in 1998 and 1999. MATERIAL: In 1998 and 1999 we reimplanted 125 total hip replacements. In 60 revision surgeries we used at least one component of Zweymüller Bicon Plus system. We prospectively followed defects of acetabulum and femur in DGOT classification. The size of the stem was planned, final indication of the cup was determined peroperatively. METHODS: During the implantation of the cup we tried to achieve primary stability of the implant. The cup was implanted in uni- and bisegmental defects. In total we implanted 50 Bicon cups, in 24 hip joints we applied morselized allograft in the defect. In tri-segmental defects we used twice the Burch Schneider cage and in 4 hip joints a bone allo-graft with a cemented cup in combination with SL-Plus stem. In one female patients after the implantation of Bicon cup in type 7 defect there occurred an early failure. When removing bone cement we preferred fenestration of the cortical bone of the femoral shaft. In 30 hips SL-Plus stem was used and in 13 hip joints SLR-Plus was applied. We checked 50 hip joints operated on by the method after Harris and by radiographs in two projections. RESULTS: Fifteen patients are without pain, 14 patients take analgesics. The final result is excellent in 24% of patients, good result in 32%, satisfactory in 24% and poor in 20% of patients followed up. By comparison with HHS value prior to the surgery HHS got worse in two patients who are not satisfied with the result of the operation. Average score prior to surgery was 47.4 points (range, 23-82.6). Five times we encountered a radioluscent line of acetabular component in zone III. Radiograph signs of loosening of the cup or stem were not found in any of the hip joints. CONCLUSION: Zweymüller system is applicable in revision surgeries of both cemented and cementless hip joint replacements. The cup may be applied in uni-segmental and bi-segmental acetabular defects under the condition of achievement of primary stability. Applied morselized bone allografts have a good potential for osteointegration and remodeling. The rectangular stem is suitable for the treatment of defects extending as far as 5 cm below the level of lesser trochanter. Bone cement was extracted from fenestration, transfemoral approach was not required in any of the patients. Even with the use of SLR (revision) stem we did not transfer fixation of the femoral component to the lower half of femur.

[Physical medicine and sports]. / Manuální medicína a sport.

In the treatment of sportsmen where one of the essential requirements is a rapid and accurate diagnosis with effective therapy which reduces the period of rest and immobilization, knowledge from the sphere of manual medicine is a great asset. In addition to manipulation procedures proper which call for accurately defined conditions and practice, it is possible to apply a wide range of reflex methods and mobilization to achieve favourable therapeutic results in predominantly functional disorders of the locomotor apparatus. These efforts have their limitations and possibilities and in some instances it is necessary to seek in addition to impaired function also more serious diseases or damage caused by repeated microtraumas.