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.

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.

We present the results of treatment of complicated comminutive fractures and fracture dislocations of the proximal humerus at the First Orthopedic Clinic of Prague in the last ten years. We also compare the results using two different methods of treatment: shoulder arthroplasty and non-anatomical shoulder reconstruction.

Treatment of complicated fractures of the proximal humerus is difficult. The results are not always good because the moving apparatus of the shoulder is often destroyed. The common method of treatment is shoulder arthroplasty with reconstruction of the rotator cuff. In our clinic we use (especially in young patients) the so-called non-anatomical reconstruction of the shoulder that enables us to save the humeral head. This reconstruction is suitable when three-fourths of the joint surface is preserved with the technical possibility of further fixation to the distal fragment.

From 1990 to 1999 we operated on 42 acute fractures not suitable for anatomical reconstruction or conservative treatment. Shoulder arthroplasty was performed in 22 patients and non-anatomical reconstruction in 20 patients. It was possible to maintain partial blood supply of the humeral head in seven patients. Evaluation of functional results was made by the method according to Constant and radiographs were also evaluated. In non-anatomical reconstruction we paid particular attention to the observation of the onset of necro-biotic rebuilding of the humeral head.

In the 22 patients who underwent shoulder arthroplasty, we recorded results of three excellent, fourteen good, four satisfactory and one unsatisfactory. In patients who had non-anatomical shoulder reconstruction, the results were four excellent, eleven good, four satisfactory and one unsatisfactory. Out of this group there were three excellent and four good results in patients with a partially saved blood supply to the humeral head. There are signs of necro-biotic changes of the humeral head in four patients, but its presence clearly has no direct effect on the final shoulder function.

There are significantly worse results from arthroplasty in trauma cases than in other diagnoses such as osteoarthritis and rheumatoid arthritis. According to our own method, non-anatomical reconstruction of the shoulder has comparable results. In addition, this procedure enables saving the humeral head. There is also the advantage of no problems that are associated with arthroplasty (infection, migration of components, etc.). We have achieved remarkably good results in non-anatomical reconstruction with partial saving of the blood supply of the humeral head. The development of necro-biotic rebuilding of the head has no direct influence on the functionality of the shoulder.