The purpose of this study was to compare the clinical and radiological findings in patients with avascular necrosis of the femoral head after management with vascularized fibular graft (VFG) compared to porous tantalum implant.

The study included 60 hips in 50 patients, who were followed prospectively for 2–4 years. 28 patients (30 hips) were treated with VFG and 22 patients (30 hips) were treated with a porous tantalum implant. The two patient groups were matched for age, gender, etiology, pre-operative stage and Harris Hip Score (HHS). Of the VFG group, 14 hips were stage II and 16 were stage III, while of the tantalum group, 1 hip was stage I, 11 hips were stage II and 18 hips were stage III, according to Steinberg classification system. Mean operative time was 3 hours for VFG and 30 min for porous tantalum.

At final follow-up, there was no significant statistical difference in the radiological stage (p=0.246), and radiological progression of the disease (p=0.329) was observed between these two groups. Using HHS, the mean clinical results improved in the VFG group from 61 points preoperatively to 90 points at final follow-up, while in tantalum group HHS improved from 63 to 81 points (p=0.022). Three hips from each group underwent total hip arthroplasty.

The results of the present study suggest that although the management of AVN with VFG appears to show better results compared to the use of porous tantalum using clinical evaluation Methods: (eg HHS), further controlled studies with larger patient groups and longer follow-up are required.

Aim: To describe a new technique, the Ç Ioannina method È, which aims to improve the precision of targeting the lesion of the femoral head, thus increasing the survival of the femoral head in patients with osteonecrosis treated with a free vascularized þbular graft. Material: Twenty-seven patients (30 hips) with femoral head osteonecrosis were treated with this technique in our Orthopaedic Department during the last four years.

With use of CAD-CAM the lesion is located and a custom-made metallic aiming device is manufactured. This aiming device is then used to place the graft in its optimal position in the center of the lesion. This group was compared with 20 patients with conventional targeting. Results: Outcome was evaluated both clinically and radiologically. The short-term results showed precision of targeting in 89% of the patients, compared to 55% with the conventional method. X-ray exposure and operative time were also signiþcantly reduced.

Conclusions: This technique is the result of more than 12 years of experience in the treatment of osteonecrosis with transfer of free vascularized þbular graft. It was designed and developed by the þrst of the authors and expresses the contemporary trend for precision in location and description of the lesion. It decreases X-ray exposure, minimizes operative time and optimizes the placement of the graft.

Aim: To present our experience concerning late infections in operated scoliosis. Methods: 118 patients were treated surgically using multiple hook and screw instrumentation systems over the last 10 years. 103 patients had idiopathic (mean age 22.1) and 15 had neuromuscular scoliosis (mean age 12.2 years). All patients were instrumented posteriorly. Bovine xenografts were used were used in all cases where fusion was the goal. Additional anterior fusion was necessary in 8 patients. To date 10 patients (7 idiopathic and 3 neuromuscular) presented late deep wound postoperative infections. None of these patients had signs of generalized septic condition. The latent period of the infection varied from 1 to 5 years. Two patients presented rod failure. Initial pus cultures were negative in 5 patients. A common þnding was pus lining on the instrumentation surface with increased concentration under the cross-links. All patients had at least one loose cross-link nut. Local corrosion of the hardware and metal inþltration of the surrounding tissues was also present. The instrumentation was removed in all cases. All patients but one had satisfactory bony fusion. A variety of pathogens were cultured from intra-operative specimens (5 CNS, 2 A. baumannii, 1 peptostreptococcus, 2 St. epidermidis). A continuous irrigation system was used for 5 days in all patients, combined with antibiotics IV for 7 days and po for 45 days. Results: Protocol treatment was successful in all patients. No recurrence of the infection was observed after the removal of the instrumentation. Conclusions: The exact etiology of those infections seems to be an interesting subject for investigation. The extended surface and bulky nature of the construct are a probable predisposing factor, as is instrumentation failure and loosening. No bone involvement was noticed. Removal of instrumentation appears to be effective treatment.

Introduction: In cases of severe, rigid scoliotic curves, anterior or posterior fusion alone is inadequate and surgical treatment with a combined anterior and posterior) approach is required. The purpose of this study is to evaluate the effectiveness and the complications of these lengthy procedures.

Material and Methods: Between 1993 and 2002, 125 patients with scoliosis were surgically treated in our department. A total of 18 patients with scoliosis were treated with a combined anterior and posterior approach. The mean age of these patients was 19.6 years (range 5.5 – 60 years). Fourteen patients were subjected to a single-stage procedure, while 4 patients underwent a staged procedure. Thirteen patients underwent anterior release and posterior nstrumentation, while 5 patients underwent both anterior and posterior instrumentation. Additional thoracoplasty was performed in 3 cases. The mean duration of the operation was 12.1 hours (range 4.5 – 14 hours). All patients were monitored postoperatively in the Intensive Care Unit. The mean duration of follow-up was 4.5 years (0.6 – 9 years).

Results: Anterior release and posterior instrumentation achieved a mean 30% correction of curves that were corrected by only 15% with traction preoperatively. Combined anterior and posterior nstrumentation achieved a mean 44% correction of curves that were corrected by only 22% with traction preoperatively. One patient presented residual pneumothorax that was treated with chest tube. One patient with neuromuscular scoliosis presented wound dehiscence and early infection, which led to removal of the posterior instrumentation.

Conclusions: A combined anterior and posterior procedure is indicated in patients with severe, rigid curves. It achieves greater correction, and prevents the crankshaft phenomenon in immature patients. We recommend the single-stage procedure (if patient general condition permits), because: 1) total anesthesia time is reduced, 2) total intraoperative blood loss is reduced, 3) hospital stay is reduced, and 4) greater curve correction is achieved. Severe complications include respiratory dysfunction and diffuse intravascular coagulation in multiply transfused patients, especially with use of an intraoperative autotransfusion device.