In case when a cavity is detected in the place of a diagnosed osteomyelitis and when the location of the lesion is in the metaphyseal area, a revision can be done by an endoscopic method, using a standard arthroscopic device. This method was called as “medulloscopy”. In our paper we would like to introduce our first experiences with this method.

We performed six surgeries of a chronic tibia osteomyelitis by an endoscopic method (medulloscopy) between January 2012 and December 2014. In four surgeries we treated a proximal metaphyseal tibia osteomyelitis and in two surgeries a distal tibial metaphysis. The group of patients consisted of one female and five male of an average age 50.8 years, with ages ranging between 36 and 82 years.

Mean duration of local difficulties preoperatively caused by chronic osteomyelitis was 96 months (from 3 to 304 months). We followed the patients averaged 17.5 months (4–24 months). By April 2015 all six patients (100%) were without need of reoperation for relapse of chronic osteomyelitis.

In our opinion the medulloscopy belongs to the spectrum of procedures for the revision of the long bones metaphyses, especially the tibia. The balance sheet for the use of this surgical method must be reasonable in relation to the type of surgery, the limits of arthroscopic instruments and experience of the surgeon.

Osteomyelitis caused by resistant bacterial strains can be dealt with antimicrobial agents which have a different mode of action compared to antibiotics. A very promising appears to be antimicrobial peptides (AMPs). We found and verified in vitro experiments that one of the most effective and least toxic antimicrobial peptides are contained in the wild bee venom.

The aim of this study was to verify the efficacy of topically applied, synthetically prepared antimicrobial peptide (Hal 2/27) with carrier, originally isolated from the venom of the wild bee in experiments on laboratory rats.

It was used 18 rats, which were indicated osteomyelitis of the left femurs. After a week of six rats were injected calcium phosphate carrier with AMP Hal 2/27, six rats received only a carrier without AMP and six other rats remained without further intervention. After a week, rats were sacrificed and X-ray was performed in all rats limbs.

Rats who received carrier with AMP Hal 2/27 had less X-ray evidence of osteomyelitis of femurs compared to rats after administration of the carrier without AMP.

Topical application of a new synthetic antimicrobial peptides isolated from wild bee venom (Hal 2/27) using local carriers seems to be a promising way to treat and prevent infectious complications in orthopedics and traumatology.

Internal grant of University Hospital Motol, Advanced Therapies, NO: 9777 and Internal grant of University Hospital Motol, NO 6010

The infected total shoulder arthroplasty is not a frequent finding at the present time, the necessity of treating this complication may become more urgent with the continually increasing number of arthroplasty procedures performed.

From 1992 till the beginning of 2005, eleven patients were treated for infected total shoulder arthroplasty. An acute infection occurred in one patient (9 %), subacute in three (27 %) and late in seven patients (64 %). The average period between the primary operation and infection manifestation was 19.3 months.

The group of 181 patients operated on for shoulder replacement between 1992 and 2005 was evaluated, and a deep infection of total shoulder arthroplasty was found in 11 patients (2.2 %).

An antibiotic therapy alone was sufficient to eradicate the infeciton in only 20 % of the infected patients, but these showed good Constant scores (average, 42 points). Revision surgery, debridement and irrigation drainage had a low success rate (33 %) and good Constant scores (average, 45 points) in the cured patients. A two-stage exchange was 100 % successful but had a poor outcome, with an average Constant score of 26 points. However, a two-stage exchange involving a spacer had both 100 % success rate and a good outcome with an average Constant score of 49 points. On statistical evaluation using the unpaired t-test, there was a significant difference in the Constant scores (T 4.35 p=0.005) between the patients undergoing exchange arthroplasty with (n=40) and without (n=4) the spacer.

Poor function scores after resection arthroplasty are not surprising, because a sharp residual proximal humerus is likely to irritate soft tissues and, in addition, it is not possible to reconstruct a rotator cuff to match it.

Comparing the results of one-stage with two-stage reimplantation is a complex issue. Attention should be paid to a relationship between the methods routinely used to treat an infected total shoulder arthroplasty and those preferred by the given hospital for treatment of other joints. If the therapy is well established in that hospital and gives good long-term results, it is optimal to use it also for the treatment of infected total shoulder arthroplasty.

The method of treating infected total shoulder arthroplasty is not different from other big joint therapies. The use of a spacer will allow us to remodel soft tissues satisfactorily even after extensive debridement. The functional results of treatment involving a spacer are significantly better.

History of surgical wounds drainage is long-lasting. In our research we focused on the debated issue of safety and effectiveness of drainage.

In the period 2006–2008 we were examined 198 samples of patients after arthroplasty, or one-stage exchange for aseptic loosening and and 202 patients with infected artrhoplasty. For all patients was performed a prospective study of drain contamination using PCR methods.

Research has confirmed that the Redon drainage is a safe method that provides a clear benefit for the pacient. Based on the results of this study is recommended to keep drains 2 days after surgery.

Negative factor for the colonization of the drain are higher postoperative blood loss.

Continuous irrigation drainage can be clearly classified into standard operating procedures in the treatment of infectious diseases in the orthopedic. The use of irrigation drainage brings benefit over risk.

Prolonged irrigation drainage did not remove the contamination from the drains. Handling with irrigation drainage systems and dressing exchange did not a risk factor of contamination.

For infected knee joint is recommended to leave irrigation drainage about 100–112 hours, follow sucktional drainage and further 12 to 24 hours to remove the drains.

An important finding is the frequent presence of pathogenic fungi in the DNA material from arthroplasty area.

Introduction: At EFORT 2007 – Thomazeau, Duparc and Hertel excellently formulated principles that may help to decide which types of comminuted dislocated fractures should be resolved by osteosynthesis and which ones by arthroplasty – regarding blood supply of the humeral head. In following section Baker, Shahid, Biberthaler, Farron and Kääb presented results of treatment of complicated fractures by Philos plate. The fact that emerging from these presentations is that using of angular stable implants may lead in many cases to the failure of osteosynthesis, especially in osteoporotic humeral head and/or small size of head.

In their presented work authors summarize the results of using Philos plate in ultimate indications. These are – dislocated proximal humeral fractures with abruption of the head in anatomical neck, where head fragment is so much thin and eventually osteoporotic, that fixation of any osteosynthetic component would be technically impossible. These cases include even situations where head fragment is then splitted into two major fragments.

Method: In our Clinic we have used the Philos plate in 54 cases during last four years. 11 cases of it were indications for arthroplasty according to general principles. In four of 11 cases head was abrupted into two major fragments, and in four of 11 cases head was completely separated from soft tissues and deprived of blood supply. Despite of that, there was performed a reconstruction by Philos plate considering low age of patients/range of age 26 to 54 years/as an attempt for humeral head preservation. Procedure was performed entirely by most experienced surgeons.

Results: Evaluation was performed 1 to 2 years after osteosynthesis. In all eleven cases full healing was found. In 4 cases there is clear remodelling of the head without any collapse of it. Also function of operated shoulder articulations enables the return of extremity functioning. We monitored no significant pain of the joint in any patients.

Conclusion: Angular stable implant allows an attempt for salvage of anatomical head even in cases with head disruption and devitalized fragment.

Presentation supported by grants MSMT CR 57/226010NPV, GA CR 106/04/1118 and FT–TA3/131

Migration of the acetabular component may give rise to oval-shaped bone defects in the acetabulum. The oblong implant is designed to fill these defects and achieve a stable cementless anchorage with no significant bone loss. We prospectively reviewed 133 oblong long oblique revision components at a mean follow-up of 9.74 years (0.6 to 14). All had been used in revisions for defects of type IIB to IIIB according to Paprosky. Aseptic loosening was the reason for revision in 11 cases (8.3%) and deep infection in seven (5.3%). The probability of implant survival over a 12-year follow-up estimated by the Kaplan-Meier method gave a survival rate of 0.85% respectively 0.90% when deep infection was excluded as the endpoint.

Our study supports the use of these components in defects from IIB to IIIA. The main precondition for success is direct contact of more than half of the surface of the implant with the host acetabular bone.

The results of proximal humeral replacement following trauma are substantially worse than for osteoarthritis or rheumatoid arthritis. The stable reattachment of the lesser and greater tuberosity fragments to the rotator cuff and the restoration of shoulder biomechanics are difficult. In 1992 we developed a prosthesis designed to improve fixation of the tuberosity fragments in comminuted fractures of the proximal humerus. The implant enables fixation of the fragments to the shaft of the prosthesis and the diaphyseal fragment using screws, washers and a special toothed plate. Between 1992 and 2003 we used this technique in 50 of 76 patients referred to our institution for shoulder reconstruction after trauma. In the remaining 26, reconstruction with a prosthesis and nonabsorbable sutures was performed, as the tuberosity fragments were too small and too severely damaged to allow the use of screws and the toothed plate.

The Constant score two years post-operatively was a mean of 12 points better in the acute trauma group and 11 points better in the late post-traumatic group than in the classical suture group.

We recommend this technique in patients where the tuberosity fragments are large enough to allow fixation with screws, washers and a toothed plate.

We assessed the long-term results of 58 Souter-Strathclyde total elbow replacements in 49 patients with rheumatoid arthritis. The mean length of follow-up was 9.5 years (0.7 to 16.7). The mean pre-operative Mayo Elbow Performance Score was 30 (15 to 80) and at final follow-up was 82 (60 to 95). A total of 13 elbows (22.4%) were revised, ten (17.2%) for aseptic loosening, one (1.7%) for instability, one (1.7%) for secondary loosening after fracture, and one elbow (1.7%) was removed because of deep infection. The Kaplan-Meier survival rate was 70% and 53% at ten and 16 years, respectively. Failure of the ulnar component was found to be the main problem in relation to the loosening. Anterior transposition of the ulnar nerve had no influence on ulnar nerve paresthaesiae in these patients.

The weak points and complications of the classic spacers are eliminated by the construction of an articulated spacer. We did have very good results with the application of a classic spacer and considered the negative properties of the articulated spacer as a foreign matter in the wound. Gradually, the excellent literary results, standardization of the procedure, faster rehabilitation and a significant growth of comfort for the patient convinced us of the fact, that we chose the right way. Therefore we prepared and verified the new implant. In its construction we used the experience from the creation of classic spacers as well as the principle of a drained spacer allowing a drainage of the cavity of the femur. The implant is constructed as a module to be enwrapped by as large amount of the bone cement with an antibiotics as possible. The cup is flat with a diameter of 42 mm, with grooves allowing adhesion of as large a quantity of cement as possible with the articular area for the head of a diameter of 28 mm. For a better stability of the implant, it is constructed as antiluxation one. The implant stem consists of three parts so that a high modularity is secured upon low costs. The body of the stem has a single length and it is furnished in the axis with a drain enabling the use of a flush lavage. For a better modularity, it is possible to fit on the stem body three different lengths of the neck. In 2002 and 2004, the articulated spacer was used to treat 26 patients with a deep infection of a hip joint prosthesis. The treatment of the infection has been successful in all cases. The period of leaving the drained articulated spacer was 12,8 weeks. The result of the Harris hip score when after implantation it reaches on average 94.7 points. The contribution of this method is also supported by an even more average growth of the Harris hip score as opposed to the condition prior to operation, which was 37,5 points. The patients did not feel any pain in between the operations. The only restriction of the quality of life was brought by a recommended necessity of walking with crutches. The technique combines the advantages of a two-stage procedure with flexibility of the reimplanting term and the economic and social profits for the patient.

We report a case of sciatic nerve palsy following total hip replacement which has lead to a novel hypothesis to account for this complication.

The aim of this paper is to present a new solution in treating osteoarthritis after congenital dysplasia. In the First Orthopaedic Clinic in Prague, we have obtained, by using oval-shaped cups, excellent results in the treatment of acetabular deficiency occurring in THA loosening. These positive results have also encouraged us to use the implants in THA for secondary coxarthrosis.

In severe acetabular defects, an endoprothesis is very difficult to implant. A whole range of methods has been described for fixing the acetabular component. We prefer not to use cemented implants with middle-aged patients. Methods using bulk bone grafts are being scaled down. Cup implantation to the neoacetabulum is disadvantageous because forces inherent to the hip joint are considerably higher in the superior lateral position. Cotyloplasty and controlled fracture impair the medial wall with the enhanced risk of implant protrusion to the pelvis. The implementation of an oval cup eliminates the above-mentioned disadvantages.

During the period of 1994 to 1998, we applied the LOR cup in treating secondary coxarthrosis eight times in six women (mean age: 54 years). 83% had already been operated for congenital hip dislocation. The stage of the dysplasia was classified as Crowe II in two hip joints, Crowe III in four, and Crowe IV in two. An average of four screws were used for a 52x64 cup. Mean follow-up was 4.8 years.

The mean Harris hip score at follow-up was 92 points. There were no infections, luxations, implant migrations, or screw failures. The radiograph evaluations revealed just one case of a translucent line 1 mm wide in the b,c zone. Osteointegration was perfect with the other implants.

Using the oval-shaped cup does not usually require implementation of bulk bone grafts. Implant shape and the option of implementing an eccentric inlay enables preservation of the rotational centre, which is advantageous in terms of biomechanics. Implantation of the cup is easy and fast. Because of the good results, we suggest introducing the oval-shaped cup as a standard method of THA primo-implantation with patients who have acetabular dysplasia. The LOR cup was designed as a revision implant, but a disadvantage is the insufficient size scale and the 32 insert. For widespread application, it is therefore necessary to design a smaller size 28 inlay cup. We are currently developing our own acetabular component with a more suitable size scale and a plasma-sprayed hydroxyapatite ceramic coating.