The purpose of this study was to evaluate retrospectively the results of urgent lumbar surgery performed due to severe neurologic deficit.

Eight patients underwent urgent lumbar surgery: 7 patients underwent surgery less than 12 hours from the onset of the symptoms. One patient was operated on less than 24 hours from symptoms initiation.

6 Pts. had Cauda Equina Syndrome, 2 pts. had radicular deficiency presented with drop foot.

All patients underwent lumbar decompression.

The patients were followed up for at least 2 years. Mean follow up was 3 years and 8 months.

5 of the 6 that had Cauda Equina Syn (CER). had complete neurological recovery. One patient had no improvement. The cause of the CER was undifferentiated carcinoma.

The two patients operated on because of drop foot had no improvement.

Our results confirmed the good outcome of early intervention in patients having CER due to disc herniation No improvement was seen following surgery due to nerve root paresis.

Purpose: Numerous implants used in repairing a trochanteric fracture of the hip are currently available. The purpose of this prospective study was to determine the complications and results of the percutaneous compression plate (PCCP), a relatively new device versus the conventional dynamic hip screw (DHS).

Materials and Methods: Between 2001–2003, 110 consecutive patients with trochanteric fractures were treated in our department. Fifty-five fractures were stabilized using the PCCP and 55 fractures were treated with the DHS. Results were analyzed according to fracture pattern, type of implant, quality of fracture reduction and position of implant. Function was assessed on the basis of pain, walking aids and walking capability.

Results: Forty-seven (85%) of 55 hips treated with PCCP healed without additional treatment and complications. Forty-three (78%) treated with DHS healed without additional treatment and complications. Complications among 8 patients (15%) of the PCCP group were: deep vein thrombosis, cardiac complication, chest infection and pressure sores. Complications among 12 patients (22%) of the DHS group were: implant failure (7%), deep wound infection, deep vein thrombosis and pressure sores.

Conclusions: Use of the PCCP implant provides similar and occasionally better results compared to those obtained with the conventional DHS device. The most outstanding advantage of the PCCP device was no implant failure or implant cut out.

Purpose: Total knee arthroplasty has been established as a reliable treatment modality for advanced gonarthrosis. Satisfactory outcome depends on restoration of the neutral alignment of the leg. Our study evaluates whether computer-assisted navigated knee arthroplasty achieves a more accurate knee alignment.

Materials and Methods: In a prospective study two groups of 24 patients undergoing TKA had operations using either a computer-assisted navigation system or a conventional technique. Limb alignment and component orientation were determined on post-operative coronal and lateral X-rays.

Results: In our study the post operative axis of the thumb was significantly better in the computer-assisted group (94%, within ±3^° varus/valgus) compared with the conventional group (82%, within ±3° varus/valgus). A significantly better orientation of the femoral and the tibial components was achieved in the computed-assisted navigated group.

Conclusions: Computer-assisted navigated TKA gives better correction of leg alignment and components orientation as we saw in the computer-assisted navigated group. Potential benefits in the long-term outcome and functional improvement require further investigation.

Purpose: Conducting a prospective study comparing the short-term results of minimally invasive total knee replacement surgery using a conventional prosthesis (i.e. not specifically designed for minimally invasive surgery – MIS, AGC Biomet) with knee arthroplasties performed via a transvastus approach.

Operative Technique: MIS knee arthroplasty is performed via a medial parapatellar skin incision from the supero-medial pole of the patella to the tibial tuberosity. The major difference is the lack of quadriceps muscle dissection and the lack of patellar inversion. The instruments fit into the incision, though some of the pins have to be inserted percutaneously. In order to reduce patello-femoral pressure and pain, an osteophytectomy is performed followed by sawing a slice of the patella and denervation using a diathermy. The wound is closed with intra-dermal sutures and a drain is not used.

Materials and Methods: Forty-five consecutive knee replacements were randomized into either a conventional trans-vastus approach (22 patients) or a minimally invasive procedure (23 patients). The patients were assessed using an HSS knee score, a VAS score and knee range of motion every day during hospitalization was recorded separately. Blood consumption and length of hospitalization were recorded as well. The patients were followed for a minimum of 3 months. Radiographic evaluation included prosthesis alignment in the AP and lateral views.

Results: Pre-op age, sex, VAS score and HSS were similar in both groups. Initial limb alignment averaged 9 degrees of varus in both groups. Pre-op range of motion was similar in both groups -5 degrees of extension and 90 degrees of flexion. Operative time was similar in both groups. Length of hospital stay was similar in both groups. Blood usage was diminished in the MIS group by an average of 0.8 units.

At the 2-weeeks and 6-weeks time-point the range of motion in the MIS group was better both in flexion and in extension by an average of 20 degrees, than in the conventional surgery group. This difference was nullified at the 3 months time-point. Radiographic alignment was similar in both groups. The limb alignment post-op averaged 3 degrees of varus.

Conclusions: MIS knee arthroplasty appears to yield similar results to conventional arthroplasty regarding prosthesis alignment and hospitalization.

Forty-two revision knee replacements were performed in our department between 1992–2000. We report our experience in 18 cases of stiff knees with a range of motion from −5° – 75° (average 50°) where an oblique incision through the quadriceps tendon combined with medial capsular incision (the “wandering resident” incision) was used for exposure. This exposure allowed us to expose the stiff knee with no hazard of avulsion of the patellar tendon and with easy removal of the old prosthesis and implantation of the new one. In 5 of these cases, this exposure was used twice in two stage revisions of a septic prosthesis.

Post-operative rehabilitation was slower, a knee brace was used in extension for 6 weeks and daily physiotherapy and CPM from 0°–70° only. Full range of motion was started after 6 weeks. Follow-up in 1–8 years (average 3.5 years).

All patients had good clinical results with range of motion from 0°–110° (average 86°). One patient had a lag of 10° in active extension. The knee score of the American Knee Society ranged from 35–52 (average 40) and improved to 72–89 (average 84).

In 3 cases, we used a non-constrained prosthesis (PCL) sacrificing condylar prosthesis), in 11 cases a constrained prosthesis (CCK type) and in 4 cases a rotating hinge prosthesis.