The revision of the hip surgery belongs to the major orthopaedic surgery and the purpose of our research is the presentation of our experience. During the period 2004–2008, revision in surgery of the hip was performed in 15 patients, while most of them were women with average 73 years. 190 subcapital fractures were revisioned in 7 patients, 277 pertrochanteric fractures in 3 patients, 75 total arthroplasties in 5 patients and all of them were bipolar arthroplasties and osteosynthesis with DSH plate. The average interval between the primary operation and revision arthroplasty was 28 months, revision of the acetabular was performed in 3, revision of the femoral in 1 and regarding to the other patients both types of revision were performed. According to Paprosky classification we noted lesions of type I and type II and in 13 cases operation was made in a time. Early complications appeared in 6 patients (mostly postoperative infections). For the stabilization of the acetabular we used supporting rings with bone grafts or press fit acetabulars without cement, while for the femoral, according to the injury extend and the bone quality, the stabilization of the stem was made with cement. The average follow-up time was 20 months, we re-examined 14/15 patients and chronic complications appeared in 2 patients. The final result was satisfactory, according to Harris-Hip score with the radiological evaluation. Conclusively, hip revisions are difficult and demanding operations, accompanied by serious complications. For their success good preoperative planning, experience and complete material-technical supporting are required with use, most of the times, of custom made prosthesis, supporting rings of the acetabular with bone graft.
Periprosthetic fractures represent a challenging problem in joint arthroplasty the incidence of which seems to be increasing due to the big number of the arthroplasties and the increasing average life expectancy. The purpose of this study is to present the methods of treatment, the problems that we have to solve intra-operatively and our long term results about the healing procedure and the fuctional restoration. Between 2000–2008 we operated 15 femoral peri-prosthetic fractures(1 re-fracture). 10 of them were after hip arthroplasties. The classification which used was Lewis-Rorabeck for the fractures after TKR and Vancouver for them after THA. Cause of fracture was fall and the time interval from the primary operation was 1–14 years. The majority of the patients were women(14), and the mean age 65 years. 13 of the 15 fractures were treated with ORIF and the remaining two need to be revised. During the follow up 2 of them died due to other pathological problems. The post op follow up ranged from 1–8(3.5)years. The postoperative evaluation was done according the Harris Hip Score and the Knee Society Clinical Rating System. The fractures healed after a mean time of 6 months. Two postoperative wound infections were registered to the revised fractures and their treatment were successful with surgical debridement. All the patients are in good health condition, moving with some kind of support and they are selfreserved. As a conclusion we believe that this kind of fractures demand the proper surgical planning, prediction of all possible complications and the cooperation of other specialties and physiotherapisties.
These fractures are usually caused from high energy road accidents and sports injuries and are accompanied by meniscal and collateral ruptures. Aim the study is to present the surgical treatment of these fractures in relation to quality and technique of the reduction and the evaluation of results with base clinical and radiological criteria. From 1996 until 2001. 30 patients with mean of age 48.5 years mainly men, we have treated with tibial plateau fractures, that main cause had the road accident. According to the classification of AO, were predominate of type A and associated injuries had 12 patients. The diagnosis became with simple radiographs, tomographies and in 5 with computed tomography. All patients were operated on average 5 days after the injury and were used in 16 with lag screw {8 with subcutaneous technique } and in 14 with buttress plate and screws In the 1/3 of patients were used bone grafts and in 12 were observed rupture of lateral meniscus. They were re-examined 27/30 patients 1–7 years after the injury and the result it was satisfactory in 24/27. A radiologic control revealed arthritic changes in 17 patients and painful only 5 of them. while all patients had been operated with subcutaneous technique of lag screws had excellent result.. 23 came back in their work while serious instability of the Knee was not observed. As shown in the bibliography in this fractures the quality of reduction and atraumatic technique in combination with stable fixation and early range of motion they constitute strategical goals of treatment that it ensures a good result. The arthritic changes are asymptomatic when do not exist serious{ cruciate -meniscal damage -} instability of the Knee.
