Introduction: One of the most challenging problems in total hip arthroplasty (THA) is implantation of the prothesis in the dysplastic hip. The purpose of the study is to evaluate the long-term results of uncemented total hip) in patients below 50 years of age.

Material and Methods: In the last twenty years, 862 primary uncemented hip endoprosthesis were implanted in our Institution. This surgery was performed in 459 patients. From this group 220 hips in 177 patients (167 women and 10 men), who had dysplastic coxarthrosis, were included in our study. The left hip was operated in 66 and the right one in 68 patients. Bilateral surgery was performed in 43 patients. The means age at the time of hip surgery was 38,3 years (range from 18 to 49 years). The mean follow-up was 9,3 years ( range from 2 years to 18,6 years). In 167 (75,8%) patients the operative treatment of DDH was performed during the childhood. Only 39 (17,7%) patients were treated in the childhood conservatively. All patients were evaluated clinically and radiological. For clinical evaluation the classification system proposed by Merle d’Aubigne and Postel with Charnley modification was used. For radiological evaluation of the steam implantation the classification system proposed by De Lee and Charnley was used and for the cup implantation the system by Gruen and Moreland. The femoral head displacement prior to THA surgery was classified according to Crowe at all. classification.

Results: Based on above mentioned criteria in 26 hips (11,8%) the final result was graded as very good, in 61 cases (27,7%) as good, in 94 hips (42,7%) as satisfactory and in the remaining 39 cases (17,8%) the final result was poor. We observed a very strong correlation between clinical and radiological results. According to Crowe and all. classification, in class I we noted 19 (61,3%) very good , 11 (35,5%) good, 1 (3,2%) satisfactory results. In class II % (6,6%) very good, 25 (32,9%) good, 39 (51,3%) satisfactory results. In class III only in 2 cases the final result was graded as very good, and good in 23 hips (25,8%). In class IV there was no very good result, and we observed 19 (21,4%) poor results. In analyzed group in 37 (16,8%) patients the revision hip surgery was necessary because of aseptic prosthesis loosening.

Discussion and Conclusion: The treatment of dysplastic coxarthrosis by means of THA is difficult. The high level of experience is necessary to perform this type of surgery. This type of THA should be done only in special orthopaedic centers. Starting the surgery one has to think about complications.

Introduction: One of the most important factors, to improve the primary prosthesis stability is the bearing surface between the femoral head and the cup. The connection metal-metal and ceramic-ceramic seems to be one of the best to reduce the loosening rate. The purpose of the study is to evaluate the long-term results of uncemented total hip replacement using the ceramic Mittelmeier enoprosthesis (ceramic cup – ceramic head).

Material and Methods: In the last twenty years, 258 primary ceramic, Mittelmeier type hip endoprosthesis were implanted in our Institution. This surgery was performed in 222 patients (116 women and 106 men), at the average age at the surgery of 45,6 years (range from 18 years to 70 years). In 36 patients the surgery was performed on both hips. The means follow-up was 10,2 years ( range from 4 years to 18,6 years). The most frequent indication for surgery was: in 105 cases idiopathic, in 81 dyspalstic and in 25 posttraumatic coxarthrosis. All patients were evaluated clinically and radiological. For clinical evaluation the classification system proposed by Merle d’Aubigne and Postel with Charnley modification was used. For radiological evaluation the classification system proposed by De Lee and Charnley ( steam) and system by Gruen and Moreland (cup) was used.

Results: Based on above mentioned criteria in 87 hips (33,7%) the final result was graded as very good, in 96 cases (37,3%) as good, in 47 hips (18,2%) as satisfactory and in the remaining 28 cases (10,9%) the final result was poor. The very good and good results were noted in patients older than 50 years with idiopathic coxarthrosis. The poor results were observed in young patients with dysplastic coxarthrosis, especially in cases with poor developed hip joint after the previous hip surgery in the childhood, because of DDH (type III and IV according to Crowe at all. classification system). Only 13 hips (5%) required revision procedures. In 2 cases (0,8%) revision was directed only to the cup, in 6 hips (2,3%) to the steam and in 5 cases (1,9%) it was necessary to exchange both elements.

Conclusion: The long term results and our experience with ceramic uncemented hip endoprosthesis type Mittelmeier are promising. This type of hip prosthesis should be indicated in young patients with idiopathic or posttraumatic coxarthrosis. This indication could give long lasting good clinical and functional results.

Introduction: Late diagnosed developmental dysplasia of the hip joint (DDH) is now a very rare case in an orthopaedic practice. It is mostly because of early ultrasound screenings of baby’s hips. Two ultrasound techniques are most popular and widely used in the world – the Graf’s technique in Europe and Harcke’s in the USA. The purpose of this study was to establish a value of Harcke’s technique which is not very popular in Europe.

Material and Methods: During the last 10 years, 25 000 ultrasound hip examinations of newborns hips because of early DDH screening were performed in our Clinic. In every child both hips were examined using two techniques (Graf’s and Harcke’s). The mean age during the first hip ultrasound examination was 5 weeks (from 10 days to 8 weeks). The Siemens SL1 equipment with linear transducer of 7.5 MHz was used for examination. The position of the hip during examination followed all requirements indicated by Graf or Harcke. All ultrasound examination were performed and analyzed by two orthopaedic surgeons.

Results: In this study the DDH was diagnosed in 5,6% of all examined hips. Most common type of dysplastic hip was type II according to Graf’s classification, or laxity with stress according to Harcke’s classification. The cases with decentration (subluxation or dislocation) were diagnosed in 2% of all dysplastic hips. In Graf’s technique there were some differences in measuring the beta or alfa angles between examiners, however, this did not influenced the type of hip dysplasia. Harcke’s method was easy to perform because the measuring of the angles was not necessary. The time which was required for examination of a child’s hips did not extend 2 minutes.

Conclusions: Both methods are very useful in early diagnosis of DDH and could be used for general hip screening for newborn hips. Harcke’s method gives a better visualization of the hip in two planes and gives dynamic pictures.

Aims: The purpose of this study was to evaluate the late results after total hip arthroplasty in young patients with dysplastic coxarthrosis. Methods: In our Institution between the years 1985 Ð 2001, 949 total hip arthroplasties (THA) were performed because of severe hip arthrosis. From this group, 186 patients (231 hips) were diagnosed as dysplastic coxarthrosis and this group (176 female and 10 male) was selected for further evaluations. The average age at the time of surgery was 38,1 years (from 18 to 52 years). In the early childhood 141 patients (75,8%) were surgically treated because of hips dysplasia, non-surgical treatment was applied in 33 patients (17,7%) and no treatment at all in 12 cases. The uncemented THA was performed in 208 hips (90%) before the age of 50 years. We used the Crowe classiþcation to group dysplastic hips before the surgery. To the Crowe class 1 were classiþed 57 hips (24,7%), to class 2 Ð 78 hips (33,8%), class 3 included 69 hips (29,9%) and class 4 Ð 27 hips (11,6%). The clinical outcome was rated according to the Harris hip-scoring system. Radiological appearance based on de Lee and Gruen classiþcation and overall placement of prosthesis. Results: In our material we noted excellent results in 103 hips, good in 64, fair in 45 and poor results in 19 hips. Poor results were mostly connected to aseptic loosening of the prosthesis. The clinical results were slightly better than radiological. Conclusions: Treatment of dysplastic coxarthrosis is difþcult and connected with high rate of complication and technical problems during the surgery. The most common complications occurred in hips class 3 and 4 according to Crowe classiþcation. In 8% of all treated hips, revision THA was necessary because of different type of complications.

Introduction: The knee arthritis is a very common seen chronic disease in an orthopaedic practice. It is mostly seen in patients after 6 decade of life and connected with a severe knee pain. In most of the cases the surgical intervention is indicated because of unicondylar arthritis changes. Because of the costs of the hemiarthroplasty we choose a high tibial osteotomy for tibial axis correction to prevent further gonarthrosis.

The aim of this study was to evaluate the late results after high tibial osteotomy in patients with unicondylar gonarthrosis.

Material and Methods: In our Institution during last 20 years 94 high tibial osteotomy were performed because of unicondylar, medial gonarthrosis. The mean age of the patient at the time of surgery was 56 years (from 19 to 72 years). The mean follow-up was 16 years. Only patients with arthritic changes on the medial compartment of the knee with a “good” lateral part of the knee were scheduled for this type of surgery. In every case the dome type of osteotomy was performed followed by 1cm resection of fibula. After surgery the limb was stabilized with plate in 16 cases, K-wires in 4 cases, Ilizarov frame in 43 cases, orthofix device in 8 cases and other type of external fixator in remaining 23 cases. In patients where external fixator was used the full weight bearing was recommended as soon as patient tolerated the pain. The external fixator was removed after an average period of 6 weeks when bone callus was diagnosed. To assess of the clinical results based on HSS score and radiological results were evaluated using the modified Dihlmann classification.

Results: In 88,8% of all cases the final result was graded as excellent and good, in 1,9% the final results was satisfactory and in 7.8% the final results was poor. From analyzed patients 46% was scheduled for TKR at an average time of 12 years after initial surgical procedure. In 28% after average 16 years after high tibial osteotomy the good shape of the knee joint was observed with good clinical function and radiographic appearance. Pain was reduced in 82% of all cases, increased range of the knee motion was observed in 65% and improved walking ability in 64% of all cases. The poor results were connected with not adequate patients selection for this type of surgery (patients after 7 decade of life) and with advanced arthritic knee changes before the surgery.

Conclusions : The high tibial osteotomy is a good method for preventing gonarthrosis. When early performed gives good long-lasting result. In our opinion is recommended for unicondylar gonarthrosis as an alternative to the knee hemiarthroplasty.