Aims

The standard of surgical treatment for lower limb neoplasms had been characterized by highly interventional techniques, leading to severe kinetic impairment of the patients and incidences of phantom pain. Rotationplasty had arisen as a potent limb salvage treatment option for young cancer patients with lower limb bone tumours, but its impact on the gait through comparative studies still remains unclear several years after the introduction of the procedure. The aim of this study is to assess the effect of rotationplasty on gait parameters measured by gait analysis compared to healthy individuals.

To compare the effects of botulinum toxin injection with and without electromyographic (EMG) assistance for the treatment of spastic muscles.

In a prospective comparative study, botulinum toxin was injected intramuscularly into 17 patients with spasticity due to CNS damage (CP, SCI, head injury, stroke). All patients were evaluated using the modified Ashworth scale and the score was 2–4. In 9/17 patients, group A (53%), the injection was given with EMG assistance, while in 8/17 patients, group B (47%), without, always from the same injectionist. The follow-up period ranged from 4 to 24 months.

Average spasticity decreased in all injected muscles and new scores were 1–2 grades less according the modified Ashworth scale. No complications or side effects were noted. The average reduction of spasticity reached 1.66 (SD 0.5) in group A and 1.25 (SD 0.46) in group B. The average reduction of spasticity was statistically more pronounced in group A (p< 0.001).

The effectiveness of botulinum toxin injection for the treatment of muscle spasticity in patients with CNS damage increases when used with EMG assistance and this is attributed to the appropriateness of points for injection.

To compare usual practices against published guidelines of Perioperative Antimicrobial Prophylaxis (AP), which is an established method to reduce the risk of postoperative infection in TJR.

We prospectively evaluated AP in 616 patients, who underwent TJR of the hip and the knee in an ongoing cohort study. Teicoplanin was administered once perioperatively (10mg/kg iv) in one group A (n=278), while in the other group B (n=338) AP was administered according to the usual practice (various antibiotic combinations, including hemisynthetic penicillins/penicillinase inhibitors, cephalosporins, aminoglycosides and quinolones for 2–10 days). An evaluation form and personal examination were used for data collection and monitoring. Patients were followed up for 2 years minimum.

The two groups did not statistically differ (p> 0.05) regarding overall postoperative infections. Superficial soft tissue infection developed in 9/616 pts. 1/278 in group A (0.4%) vs 8/338 in group B (2.4%) (p< 0.05). Deep SSI was rarely seen, 4/616 pts (0.6%). 2/278 in group A (0.7%) vs 2/338 in group B (0.6%) (p=NS). Mean duration of AP was significant higher in group B [6(IQR: 5–8.25)], p< 0.001 Mann-Whitney test. Only in group B, MRSA-MRCNS postoperative infections did appear. The duration (days) of glycopeptide antibiotic usage, therapeutic (group B) or prophylactic (group A), was comparable in both groups (p> 0.05).

Glycopeptide antibiotic prophylaxis for TJR leads to less postoperative infections compared to other antibiotic prophylaxis, but similar duration of overall glycopeptide usage (prophylactic and therapeutic) in both groups.

Background: Perioperative Antimicrobial Prophylaxis (AP) is an established method to reduce the risk of intraoperative infection in TJR. Usual practices are not always compatible with published guidelines leading to excess morbidity, antibiotic overuse and emergence of resistance.

Methods: We prospectively evaluated AP in 616 patients, who underwent TJR of the hip and the knee in an ongoing cohort study. Teicoplanin was administered once perioperatively (10mg/kg iv) in one group A (n=278), while in the other group B (n=338) AP was administered according to the usual practice (various antibiotic combinations, including hemisynthetic penicillins/penicillinase inhibitors, cephalosporins, aminoglycosides and quinolones for 2–10 days). An evaluation form and personal examination were used for data collection and monitoring. Patients were followed up for 2 years minimum.

Results: The two groups did not statistically differ (p> 0.05) regarding overall postoperative infections. Superficial soft tissue infection developed in 9/616 pts. 1/278 in group A (0.4%) vs 8/338 in group B(2.4%) (p< 0.05). Deep SSI was rarely seen, 4/616 pts (0.6%). 2/278 in group A (0.7%) vs 2/338 in group B (0.6%) (p=NS). Mean duration of AP was significant higher in group B [6(IQR:5–8.25)], p< 0.001 Mann-Whitney test. Only in group B, MRSA-MRCNS postoperative infections did appear. The duration (days) of glycopeptide antibiotic usage, prophylactic (group A) or therapeutic (group B), was comparable in both groups (p> 0.05).

Conclusions: Glycopeptide antibiotic prophylaxis for TJR leads to less postoperative infections compared to other antibiotic prophylaxis, but similar duration of overall glycopeptide usage (prophylactic or therapeutic) in both groups.

Aim: To compare the effects of botulinum toxin injection with and without electromyographic (EMG) assistance for the treatment of spastic muscles.

Methods: In a prospective comparative study, botulinum toxin was injected intramuscularly into 17 patients with spasticity due to CNS damage (CP, SCI, head injury, stroke). All patients were evaluated using the modified Ashworth scale and the score was 2–4. In 9/17 patients, group A (53%), the injection was given with EMG assistance, while in 8/17 patients, group B (47%), without, always from the same injectionist. The follow-up period ranged from 4 to 24 months.

Results: Average spasticity decreased in all injected muscles and new scores were 1–2 grades less according the modified Ashworth scale. No complications or side effects were noted. The average reduction of spasticity reached 1.66 (SD 0.5) in group A and 1.25 (SD 0.46) in group B. The average reduction of spasticity was statistically more pronounced in group A (p< 0.001).

Conclusions: The effectiveness of botulinum toxin injection for the treatment of muscle spasticity in patients with CNS damage increases when used with EMG assistance and this is attributed to the appropriateness of points for injection.

During the last decade intramedullary nailing of the humerus became a more popular operation. Modern nails are successfully used in treatment of fractures involving proximal, distal and middle shaft humerus, as well as pseudarthrosis and pathological fractures. Minimal invasive insertion lessens the complications from neurovascular and soft tissue damage without significant delay in healing period in comparison with compression plates. Aim of our study is to present our experience and the clinical outcomes of this method.

Material and Methods: Between 1998 and 2006 50 patients (52 Fractured Hunerus) were treated in our department. The mean average age was 35 y.o. (18–55 y.o.) and the operation time was 2.5 days after the injury. All fractures were acute (Unstable, comminuted, in both limps or polytrauma patients). In 25 cases we used the unreamed Synthes nail (22 Cases Antegrade insertion and 13 Cases retrograde insertion). In 27 cases we used the T2 or Polarus reamed nail (23 cases Antegrade insertion and 4 cases retrograde insertion). The mean duration of the surgery was 1.3 h.

Results: The healing time was 12.5 weeks (8–16) and no preudarthrosis occurred. There were 4 radial nerve palsies (2 primary – 2 after operation) that were neuroapraxia and resolved in almost 6 weeks. One antegrade nail (Polarus-reamed) was malpositioned and applicated again and in 2 retrograde nails the posterior cortex of the fossa was fractured (in one case we changed fixation method-plates). No infection occurred. In some patients full abduction, elevation and external rotation achieved in 6 weeks and in some others after 3 months.

Conclusions: Intramedullary nailing of the humerus is a very good solution of fracture treatment, especially in multiple trauma patients. In good hands offers good fracture alignment and adequate stability. Postoperative rehabilitation period is short, uneventful healing is common and almost excellent results always appear.

Background: Mobile-bearing knee designs represent an alternative to conventional fixed-bearing TKA designs. We present the results of a prospective, long-term clinical follow-up study of the Rotaglide (Corin UK) rotating – translating platform total knee design.

Methods: Between October 1990 and December 1998, 326 primary consecutive knee replacements were performed in 260 patients (223 women and 37 men). The average age of the patients at the time of the index procedure was 66.84 years (range 20–82 years). Osteoarthritis was the etiologic factor in 297 knees (91.10%) and rheumatoid arthritis in 25 knees (7.66%). Twenty knees (6.13%) had previous operations (including 16 osteotomies). Both femoral and tibial components were cemented in all knees and the patellae were resurfaced in 199 knees (61.04%). The polyethylene (GUR 1050) mobile inlay was at that time sterilized by Gamma irradiation (2.5 Mrad), packed and stored in air permeable ‘paper bag’. Patients were evaluated at three and six months post operatively and yearly thereafter with use of the KSS. In addition, a radiographic analysis of the tibial, femoral, and patellar components was carried out at each interval and at the last assessment. Twenty four knees (7.36%) were excluded from the study out of which ten knees (3.07%) of eight patients who had died and fourteen knees (4.29%) of ten patients who were lost to follow up. Thus 302 knees (92.64%) were assessed clinically and radiologically in 242 patients. Average follow-up 12.13 years (range 9 to 17).

Results: Pre-operative KSS Knee score 30 (range, 22 to 56) and KSS function score 39 (range, 32 to 58) improved to 88 (range, 62 to 96) and 85 (range, 56–95) respectively. Knee alignment was achieved in 279 out of 302 knees (92.38%). Knee stability was achieved in 292 knees (96.68%). Knee flexion was improved from an average of 92 degrees pre-op to an average of 113 degrees post-operatively. Zonal radiographic analysis revealed fourteen (4.63%) instances of radiolucent lines, ten of which measured < 1 mm in width. None of these lines were deemed to be progressive. Four of the remaining knees with a radiolucent line > 2 mm followed-up carefully and three of them eventually were revised. There were twenty four (7.36%) failures that resulted in revision surgery. In seventeen (5.21%) of them the findings were those of worn out or broken polyethylene with no sings of metal wear or component loosening and therefore only polyethylene exchange was carried out. The other seven knees (2.15%) were totally revised. Kaplan-Meier survivorship using revision of polyethylene mechanical failure as the end point was 94.76%. Overall survivorship of the implant at seventeen years was 92.64%.

Conclusions: This mobile-bearing, total knee prosthesis was associated with a good survival rate and demonstrated clinical efficacy during the 9 to 17 years follow-up interval.

Purpose : The purpose of our study is to present, our long term experience of a total knee joint arthroplasty using a mobile bearing polyethylene platform.

Material and Method : From 1990 to 1998 we operated 324 knees in 259 patients. During the last follow-up 301 knees were assessed in 241 patients.

7 patients died (9 knees) and 11 patients did not attend.

The postoperative follow-up time ranged from 4–12 years (average 8,5 yrs).

207 patients were women (265 knees) and 34 were men (36 knees) aged from 20 to 82 years (average 67,2yrs) at the time of operation.

275 patients suffered from osteoarthritis, 23 from rheumatoid arthritis and 3 from avascular necrosis.

Results : The preoperative and postoperative evaluation was done according to the British Orthopaedic Association Knee Assessment Chart. The knee pain was improved in all of our patients. The knee flexion was improved from an average of 87° pre-op to an average of 113° post-op.

The pre-op valgus deformity was corrected in 24 from 26 knees and the varus was corrected in 157 from 172 knees.

Postoperative alignment was achieved in 286 knees (94,65%).

Radioluscent line was observed in 14 knees (in 6 knees < 1mm and in 8 knees 1–2mm of thickness).

There were 7 complications of the prosthesis needing re-operation.

In 6 cases wear and breakage of the polyethylene and in 1 dislocation of the meniscus was confirmed.

Conclusion : The Rotaglide T.K.R is a reliable solution with satisfactory long-term results. The prosthesis design allows correction of a small rotational malalignment of the femoro–tibial axis. In our patients we did not observe any component loosening and there was no need for re-operation and metal component replacement.

We recommend the use of Rotaglide total knee replacement in more active and biologically young patients when needed.

The choice of the surgical exposure in total hip arthroplasties for osteoarthritis is a significant parameter for a successful outcome.

The aim of this study is to evaluate complications or/and advantages related to the most often used approaches for total hip arthroplasties: the direct lateral or transgluteal (Hardinge) and the posterior (Moore) one.

During the period 1997–2000, 50 patients with lateral approach and 50 patients with posterior approach were randomly selected from a pool of 394 total hip arthroplasties (382 patients). Patients with surgery of the contralateral hip were excluded. The mean age of the patients was 72 years (62–84 years) and the indication was degenerative osteoarthritis. The operating time and the postoperative, early and late, complications were studied. The average follow-up was 18 months (12–24 months) and included clinical and radiographic control.

The mean operating time was 76 min. (63–91 min.) and 92 min. (83–110 min.) for lateral and posterior approach, respectively. Complications (early and late) associated with transgluteal approach were 16 patients with positive trendelenburg sign, which disappeared within one year post op, 8 with sympathetic knee effusion which subsided within 6 weeks, 2 with ectopic periarticular ossification and 1 with severe thigh pain. In total hip arthroplasties with posterior approaches, 4 cases were complicated with ectopic ossification, 3 with sympathetic knee effusion which subsided within 4 weeks, 2 with posterior dislocation which needed revision surgery and 2 with peroneal nerve paresis which recovered within 6 months. Except for the trendelenburg sign (p< 0.001), all the other complications did not differ statistically significantly (p> 0.05).

In conclusion, the posterior approach seems to be related with more severe postoperative complications compared to the transgluteal approach. The gluteus medius’ loss of strength (responsible for limping in equal legs’ length), could be treated with prompt strengthening of the muscle within the first postoperative year.