The mini exposure in THR is currently a very trendy issue in reconstructive surgery.

Purpose: We present our initial experience with the posterior mini exposure.

Materials and method 32 patients from February to August 2004 have been submitted to mini THR.

23 patients were female and 9 were male, with mean age 64 years (34 – 72 years).

The exposure was posterior; the incision length was at a mean of 8 cm (7 – 10 cm). In 30 cases we used the SYNERGY THR, in 1 case the ZIMMER and in 1 case the DURALOC-SUMIT (DePuy) THR. All cases were without cement.

Special retractors for mini procedures were used in 26 out of the 32 operations, whereas classic retractors were used in the rest.

Results: We observed a substantial reduction in morbidity with less postoperative blood loss in the drains (a mean of 200 cc), fewer analgesics were used than usual and mobilization of the patients was faster.

All the patients were mobilized by the 2nd postoperative day and released from the hospital by the 4–6th day postoperative day. Radiologically there was no case of components malpositioning.

Conclusion: The mini posterior exposure THR is feasible for the experienced hip surgeon; it has many advantages while none of the technical problems and disadvantages of the minimal two incision exposure.

The upper and lower thirds of the tibia are areas of peculiar anatomy and pose a lot of problems in their treatment.

Purpose We present a method of hybrid external fixation used in a wide variety of these fractures.

Material and method: Between 2000 and 2004, 29 patients with fractures of the tibia (16 fractures of the lower third and 13 fractures of the upper third) were treated with hybrid external fixation ORTHOFIX. Most of the fractures involved the adjacent joints, 12 fractures of the tibial condyles and 9 pilon fractures. Among the patients, 5 had septic non-union 2 of who were submitted to bone transport with the attachment of a lengthening system. All patients were called for monthly follow up till union.

Results: In all cases except one (septic non-union – bone transport of the lower third) there was successful union by 3 to 7 months postoperatively. There was no malalignment, no deep infection or other major complication.

Conclusion: The rational use of the hybrid external fixation offers a valuable solution in the treatment of the complex fractures in the upper and lower third of the tibia.

Purpose: The 7–10 years follow-up of a series of 165 consecutive hybrid total hip arthroplasties performed by the same team of surgeons and with the same technique is presented.

Materials and method: Underreaming and pressfitting of the cup was performed in all cases. Screws were used supplementary in 8 of the cases. For the fixation of the stem second generation cement technique was performed in 77 hips and the third generation technique in 88.

Results: After a mean follow-up of 8 years (range 7 to 10 years) the average Harris hip score increased from 36 points (range 7 to 63 points) preoperatively to 93,5 points (range, 75 to 100 points). Revision was performed in one patient, no radiographic loosening or osteolysis and no infections.

Conclusion: The medium to term results are very encouraging and seem extremely promising for the long term (at least a decade).

Purpose: To study the pattern of neurological lesions and the frequency they occur in patients with cervical injuries. The relationship of these lesions with certain types of injuries and the cause of omjury.

Patients and methods: Between 1970–2001, 665 patients suffering a cervical injury were studied in our Department. There were 192 male and 73 female patients aged 42,3 years on average. Two hundred sixty-five of these cases (38,5%) were presented with neurological symptoms.The mean time of hospitalization was 43,45 days. The patients were classified according to the type and the level of injury. ASIA‘s functional classification was used (35,1% were ASIA A, 13,96% ASIA B, 10,57% ASIA C and 40,37% ASIA D). 194 were followed up for a mean period of 7 years. Conservative treatment was applied to 183 (69%) patients while 82 patients (31%) were treated operatively with anterior cervical fusion, posterior cervical fusion, or combined anterior and posterior fusion. Postoperatively, most of the patients with incomplete neurological lesion, were improved.

Conclusions: An analysis of our cases showed the following: a) There is a relationship between the type of neurological signs and the type of osseous or ligamentous injuries. b) There is relationship between type of osseous or ligamentous injury and severity of neurological lesion.. c) Burst fractures are the most severe fractures, followed by bilateral dislocations and tear-drop fractures. d) There is a relationship between mechanism of injury and severity of neurological lesion

Over the period 1990–2002, 12 patients, 3 male and 9 female, mean age 65 years (58–74), have been treated for deep infection after total knee arthroplasty (TKA). Two patients diagnosed with early and ten with late infection. Diagnosis was clinical, radiological (X-rays, 3 phase bone scan with Tc99m), laboratory (WBC, ESR, CRP) and from knee aspiration cultures. Of the inflammations, three were low grade.

Eight patients had resurfacing total knee replacement, while four hinged type (Endomodel). Five of the initial arthroplasties were referred cases.

Two phase revision was performed to all patients.

Initially there was removal of the prothesis and extensive surgical debridement. Staphylococcus Aureus was cultured from seven arthroplasties, Staphylococcus Epidermidis from three and Pseudomonas Aeruginosa from two.

After the prothesis removal, PMMA spacer with antibiotic was placed, in eleven cases molded to the shape of a TKA which permitted knee motion. A 6–8 week period of IV antibiotic therapy followed, which was based on intraoperative cultures and microbial sensitivity. Finally arthrodesis was performed in two knees, while in the other ten a new cemented TKA was place. All the patients received postsurgery antibiotics for 3–6 months.

No recurrences of infection were note over a follow-up period of 8 months to 10 years, one revision was performed for a fractured femoral stem.

In conclusion, two phase revision arthroplasty is proved to be an invaluable method in the treatment of deep infection after total knee arthroplasty.