Procs III 2011.indb - Journal of Bone & Joint Surgery, British Volume ...

More documents

Recommendations

Info

348 HELLENIC ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY signifi cantly improved their range of joint movement and were relieved from pain. Surgical excision seems to provide a superior quality of life in these patients, as they have a high risk for major complications due to their poor level of mobility. 054 THE 22-TO 34YEARS OUTCOME OF CHARNLEY LOW FRICTION ARTHROPLASTY IN YOUNG PATIENTS WITH OSTEOARTHRITIS G. Georgiades, G. Babis, G. Kourlaba, G. Hartofilakidis 1st Department of Orthopaedics, University of Athens Medical School We reported on the outcome of 84 Charnley low friction arthroplasties performed by one of us (GH), the period 1973 to1984, in 69 patients, less than fi fty-fi ve years old, with osteoarthritis mainly due to congenital hip disease. The patients were followed prospectively; clinically using the Merle D’Aubigné and Postel scoring system, as modifi ed by Charnley and also radiographically. At the time of the latest follow-up, thirty-seven hips had failed (44%). In thirty-two hips, twenty-eight acetabular and thirty femoral components were revised because of aseptic loosening (six of the femoral components were broken). Three hips were infected and converted to resection arthroplasty. In two more hips a periprosthetic femur fracture occurred three and ten years postoperatively and were treated with internal fi xation. After a minimum of twenty-two years from the index operation, 37 original acetabular components and 36 original femoral components were in place for an average of 29 years. The probability of survival for both components with failure for any reason as the end point was 0.51 (95% confi dence interval, 0.39 to 0.62) at twenty-fi ve years when 35 hips were at risk. These long term results can be used as a benchmark of endurance of current total hip arthroplasties performed in young patients, with OA mainly due to congenital hip disease. 055 HYBRID STEM FIXATION IN REVISION HIP ARTHROPLASTY A. Tsamatropoulos, C.Vassos, E. Karavas, G. Epaggelis, D. Chalatsis, K. Sarafis 1st Orthopaedic Department, General Hospital of Asclepeion Voulas This study reports the results of hybrid stem fi xation in diffi cult revision hip arthroplasties where proximal femoral bone stock loss was severe. Twenty-six revision arthroplasties (21 women and 5 men, aged from 58 to 86 years), were performed between 1998 and 2008. The indication for surgery was aseptic loosening. In all cases, stabilization of the stem presented problems because of severe proximal femoral bone stock loss (due to extensive periprosthetic osteolytic defects), or because of iatrogenic defects or surgical procedures (attempts to remove the stem and cement with fenestration or extended osteotomy). The average follow-up was 48 months (range 16 to 120). Primary stability is necessary for the successful defi - nite fi xation of a cementless implant by bone. When this was not possible (because of proximal cortical insuffi - ciency), we used a modular distally cemented long stem, bypassing the area of bone defect for at least 6-7 cm. Proximally bone defects were grafted and osteotomy was closed with cerclage wires. Four stems (15%) had an asymptomatic subsidence (3 stems subsided less than 3-4 mm and 1 stem about 15mm). No stem was revised to date. Major complications did not occur. The mean Harris hip score improved from 32 points preoperatively to 82.3 points (at the most recent evaluation). Hybrid fi xation offers the advantage of initial and secure stability of the cemented stem on the short term, until stabilization of the entire implant by bone occurs. Thus early subsidence and loosening is avoided and on the long term benefi ts of the cementless fi xation are attained. Our results support the method of hybrid fi xation in patients with severe femoral bone loss (and consequently problematic stabilization), when primary stability is needed. 056 TOTAL HIP REPLACEMENT IN PATIENTS WITH FEMORAL DYSPLASIA USING STRAIGTH CONICAL WAGNER-TYPE STEMS R.A. Giannakos, K. Bargiotas, L. Papatheodorou, S. Varitimidis, T. Karachalios, K.N. Malizos University of Thessalia, Department of Orthopaedics The evaluation of the middle term behaviour of the Wagner-type stems in dysplastic femurs and the presentation of the technical and surgical differences with the implantation of a Wagner stem. Between 1997 and 2008 we implanted 64 Wagner stems in 58 patients. Average age at the time of implantation was 64 years. 52 patients was operated because of DDH, and 12 had had previous osteotomy. All patients were prospectively evaluated radiographically and clinically at annual intervals. Functional outcome was assessed with Harris Hip Score and Oxford Score. Mean follow-up of these series was 4 years (11-1)One stem was revised because of fracture of the lesser trochander and two more patients were re-operated for open reduction. With the re-operation as end-point and 95% Confi dence Interval survivorship rate was 98, 5%. There were no progressive radiolucent lines. Stem migration was at an average 2mm (1-6) during the fi rst two years and remained stable thereafter.There was no deep infection in these series. After the second year a dense zone is evident in all Gruen zones at the implant –bone interface with a width of 2-3 mm. Dysplasia of the proximal femur may pose signifi cant technical problems during THA due to the distortion of the geometry and the narrowing of the femoral canal. The sort, conical Wagner type stems can offer a very good alternative is such patients. They allow control of the anteversion and they are able get a good press-fi t despite the metaphyseal/diaphyseal mismatch and the femoral bowing. Wagner type stems are a reliable alternative when performing THA in patients with dysplastic femurs. 057 THE USE OF A CALCIUM HYDROXYAPATITE ANTIBIOTIC CARRIER (PEROSSAL*) AS A SPACER IN TWO-STAGE REVISION INFECTED ARTHROPLASTY A. Drakou, G. I. Karaliotas, V. Sakellariou, H. Tsibidakis, P. Pantos, A. Papadopoulos 1st Department of Orthopaedics, Athens University Medical School, ATTIKON University Hospital, Athens, Greece, 4th Department of Internal Medicine, Athens University Medical School, ATTIKON University Hospital, Athens, Greece Two-stage revision procedure is the gold standard in management of periprosthetic infections. Cement spacers have long been used to preserve the space created during resection procedure and to release antiobiotics within the created dead space. However, the problems related to cement as an antibiotic carrier are well recognised (thermal necrosis, random porosity, unspecifi ed antibiotic delivery rate). To present the concept of using PerOssal as a canal fi lling spacer and local antibiotic delivery system in twostage revisions of hip and knee infected arthroplasty. 8 patients (6 females, 2 males) with infected arthroplasty (4 TKRs, 4 THRs) were managed with two-stage revision procedures during the years 2006-2008 (minimum FU: 12 months). Our protocol consisted of: a) Preoperative determination of the causative organism b) Radical debridement surgery and cement spacer with PerOssal implantation c) Appropriate IV antibiotic therapy for 6 weeks, postoperative clinical evaluation and monitoring of infl ammation markers d) After a six-week antibiotic free interval and infl ammation markers normalization second stage surgery took place: Medullary canal reaming, intraoperative cultures, thorough wound irrigation and prostheses implantation e) Postoperative antibiotic therapy until culture results; IV antibiotic treatment for 6 more weeks if they were positive. f) FU evaluation at 3, 6, 12, and 24 months. We had 7 cases with eradication of infection, 2 with delayed wound closure, and 1 late recurrence of disease. We think that PerOssal can offer a very useful additional and genuine support in managing infected joint arthroplasties with so far good clinical results. 058. COMPRESS ® PROSTHESIS IN REVISION OF A DISTAL FEMORAL RECONSTRUCTION I. Panastasiou, M. Ioannou, G. Farfalli, P. Boland, C. Morris, J. Healey Department of Surgery, Memorial Sloan –Kettering Cancer Center, Orthopaedic Department, General Hospital of Kimi, Greece We present the results of 15 patients revised with a Compress ® prosthesis secondary to failure of other distal femur reconstruction. One prosthesis had to be removed because of deep infection. Three patients needed a second surgery due to a vertical crack proximal to the anchor plug at the level of a cortical bone defect. At last follow-up, radiologic evaluation of the entire series showed a mean bone growth ratio higher than did preoperative radiographs. All patients had mainly good or excellent MSTS functional results. Distal femoral prosthetic replacement with a Compress ® implant in severe cases of bone loosening and instability provides a reliable reconstruction alternative that promotes bone formation. Patients with cortical defects proximal to the anchor plug should be protected with extracortical supports. 059 TOTAL HIP ARTHROPLASTY WITH MODULAR NECKS AND BIG FEMORAL HEADS. EARLY CLINICAL AND RADIOLOGICAL FINDINGS C.S. Georgiou, P.D. Megas, E.G.Theodorou, C.G. Provatidis Orthopaedics Department, Medical School, University of Patras, National Technical University of Athens, School of Mechanical Engineering Total Hip Arthroplasty (THA) is one of the most important procedures in the fi elds of Reconstructive Orthopaedics. This study aims to present the preliminary results of the clinical and radiological evaluation of patients who have undergone THA with metal bearings, modular necks and big femoral heads and to correlate them with the results of the Finite Element Analysis. In the period from 1/1/2006 until today 90 patients (33 men and 57 women) with mean age 62,4 years have undergone primary THA. The patients were clinically and radiographically evaluated preoperatively, as well as postoperatively, in regular time intervals (1st, 3rd, 6th, 12th month and every year afterwards). The clinical assessment was based on two scales, Harris Hip Score (HHS) and Merle d’ Aubigne (MDA) score, whereas the radiographic on Engh criteria. The mean follow up was 16 months. The mean preoperative HHS and MDA score were 45 and 10,3 respectively, whereas 89 and 16,74 at the last evaluation. The mean Engh score was 16,12. No incidence of dislocation, infection and cup or stem adverse effect occurred. We demonstrate extensively, with respect to the used combination of neck and femoral head, the radiographic fi ndings in the zones of Grün and Charnley, in the areas of the tip of the stem and the calcar, as well as the resulting clinical manifestations. The early clinical and radiological data are in line with the increase in the stresses and strains on the upper part of the femur, which are revealed through the Finite Element Analysis. J BONE JOINT SURG [BR] 2011; 93-B:SUPP III
060 COMBINING BIGGER FEMORAL HEADS WITH MODULAR NECKS IN TOTAL HIP ARTHROPLASTY. A FINITE ELEMENT ANALYSIS E.G. Theodorou, C.G. Provatidis, C.S. Georgiou, P.D. Megas National Technical University of Athens, School of Mechanical Engineering, Orthopaedics Department University of Patras Total hip arthroplasty is nowadays a common treatment for a large number of pathological cases regarding the hip joint and is considered as the most successful orthopedic operation. With the mean age of patients constantly decreasing and the more intense way of life, the need for versatile implant designs has arisen. Currently modular hip implant systems are used extensively in order to compensate for diffi cult occasions, where offset and version correction are required. In addition to this femoral heads of bigger diameter have been introduced to deal with issues such as dislocation and impingement, although their infl uence on the mechanical behavior on the bone – implant assembly is not widely documented. Towards this direction a fi nite element model was generated. Computed tomographies of a cadaveric femur were used as raw data and processed, a Profemur-E system with variable heads was digitized, thus leading to a complete assembly consisting of the femur, the stem, the necks and the femoral heads in the commercial CAD software Solidworks. For typical loading scenarios – the stance phase of the gait cycle – the fi nite element analysis was performed in ANSYS Workbench. The results showed that the implementation of BFH and the neck version produced an increase in strains and stresses with respect to a normal head of 28mm and a straight neck in areas of clinical interest such as the calcar, the greater trochanter area and the stem tip region, considered responsible for thigh pain. 061 REVISION TOTAL HIP REPLACEMENT. PROBLEMS – COMPLICATIONS K. Papageorgiou, P. tilaveridis, A. Hatizioannidis, I. Papageorgiou, S. Christodoulou, S. Gerakas General Hospital Drama, Orthopaedic Department 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 classifi cation 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 fi t 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 fi nal result was satisfactory, according to Harris-Hip score with the radiological evaluation. Conclusively, hip revisions are diffi cult 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. J BONE JOINT SURG [BR] 2011; 93-B:SUPP III HELLENIC ASSOCIATION OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 349 062 COMPRESSION NEUROPATHIES OF THE ELBOW- SIMULTANEOUS EXISTENCE OF PRONATOR AND CUBITAL TUNNEL SYNDROME V. N. Psychoyios, I. Kormpakis, P. Intzirtzis, S. Thoma, I. Stathakopoulos 5th Orthopaedic Department, Hand & Upper Extremity Unit, Asklipeion Hospital of Voula, Athens Simultaneous compression of the median and ulnar nerve at the elbow is rather uncommon. The aim of this study was to describe 10 such cases which have been treated in our unit. The patients presented with a combination of ulnar neuritis symptoms at the elbow with a pronator syndrome. Five patients were female and 5 male with an average age of 33 years. All patients were manual workers. Regarding the cubital tunnel syndrome, all patients complained for hypesthesia in the ulnar nerve’s distribution in the hand and 6 for additional night pain in the medial aspect of the elbow. Regarding the pronator syndrome, the patients complained for mild tenderness or pain at the proximal forearm as well as hypesthesia or paresthesias at the digits. Nerve conduction studies were positive only for the ulnar nerve compression neuropathy. Six patients were treated by decompressing both nerves at the same time through the same medial incision, creating large medial fl aps. The ulnar nerve underwent a simple decompression. In one case that the symptoms were initailly attributed to ulnar nerve, a second operation for medial nerve decompression was required. In all patients symptoms subsided following surgical decompression. Four patients developed an ugly scar and 2 a hematoma. All returned to their previous occupation. Clinical tests and nerve conduction studies were performed postoperatively to evaluate the results; all of them turned out negative for ulnar and median nerve compression neuropathy. Simultaneous compression of the median and ulnar nerve at the elbow is rather rare. Careful evaluation of the patient’s symptoms as well as thorough clinical examination are the keystones for the correct diagnosis. Although decompression can be performed through the same medial incision, extensive dissection may be required. 063 FRACTURES OF THE RADIAL HEAD AND DISRUPTION OF THE INTEROSSEOUS COMPLEX. IS THE RECONSTRUCTION POSSIBLE? E. Apergis, G. Papadimitriou, A. Palamidi, I. Paraskeuopoulos, E. Tsialogiannis, T. Papagiavis Red Cross Hospital of Athens In Essex-Lopresti injuries, the prevailing concept, according to which the stability of the forearm can be restored after fi xation of the fracture or replacement of the radial head by a metallic implant, is disputable. The aim of this study is to evaluate the midterm results in 12 patients with an Essex-Lopresti injury who were treated operatively. We studied 12 patients, with comminuted fracture of the radial head, either isolated (4 patients) or with injury of the ipsilateral (4 patients) or the contralateral (4 patients) arm. Initially, 10 patients were treated with excision of the radial head whereas 2 underwent internal fi xation of the radial head and pinning of the DRUJ. Eventually, everyone developed a subluxation of DRUJ and had to be treated for an established Essex-Lopresti injury, 1-7 months after the initial injury. Six patients were treated with equalization of the radioulnar length (ulnar shortening osteotomy with or without a distractor-external fi xator) and restoration of the TFC, while six patients underwent replacement of the radial head with a titanium implant, equalization of the radioulnar length and restoration of the TFC. The results were evaluated after a mean follow-up of 4 years (1-12 years), based on radiological and clinical criteria. The six patients in whom the titanium radial head implant was used presented with good results, even though two of them reported forearm pain during activity. On the contrary, in the rest of the patients the radioulnar incongruity reappeared in varying degrees. However the poor radiological result was not consistent to the clinical one. We conclude that in cases of complete rupture of the interosseous membrane, internal fi xation or replacement of the radial head with a metallic implant will not probably provide us with a good long-term functional result. 064 OPEN SURGICAL TREATMENT OF THE STIFF ELBOW IN PATIENTS WITH NEUROMUSCULAR DISEASE V. N. Psychoyios, I. Kormpakis, S. Thoma, P. Intzirtzis, E. Zampiakis 5th Orthopaedic Department, Hand Unit, Asklipeion Hospital of Voula, Athens Elbow contracture is a well recognised sequel of neuromuscular disorders and can be a rather debilitating condition. Non operative treatment, such as physiotherapy and splinting, results in an improved range of motion, but since musculoskeletal pathology in neuromuscular diseases is progressive, an open surgical release of the elbow is often required. Therefore, the purpose of the present study was to assess the results of surgical treatment of elbow stiffness in patients suffering from neuromuscular disorders. Between January 2000 and October 2008, 11 patients with neuromuscular diseases underwent surgical treatment of elbow contracture. The mean age of the patients was 21 years. Eight patients had cerebral palsy, 2 arthrogryposis and 1 brachial plexus palsy. Preoperatively the lag of elbow fl exion and extension was 45° and 38° respectively. In 6 patients releases were performed through a lateral approach, while 3 required an additional medial incision. In 2 patients the pathology was addressed through a posterior approach. The mean follow up was 26 months. Postoperatively one patient developed skin necrosis which was treated conservatively. Furthermore, another patient developed transient ulnar neuritis, and fi nally one more presented with medial collateral ligament insuffi ciency. All patients had an improved functional arc of motion. Namely, the lag of elbow fl exion and extension was reduced to 22° and 10° respectively. At the fi nal follow up the patients maintained 90% of the range of motion that was achieved immediately postoperatively. Open release of the elbow contracture in neuromuscular diseases yield satisfactory results. Therefore, it can be expected that patients will obtain a functional range of motion. 065 CHRONIC RUPTURES OF THE INSERTION OF THE BICEPS TENDON V. N. Psychoyios, P. Intzirtzis, S. Thoma, V. Bavellas, K. Dakis 5th Orthopaedic Department, Hand Unit, Asklipeion Hospital of Voula, Athens Chronic distal biceps tendon rupture is a relatively uncommon situation with diffi culties in treatment. Surgical treatment with allograft has been described in the literature with varying results. The purpose of this study was to describe 9 cases of chronic distal biceps tendon rupture which have been treated in our unit with local soft tissue as a graft. All patients were male with an average age of 54 years. The mean interval between tendon rupture and reconstruction was 11 months. In all patients a fl ap from lacertus fi brosus was used in continuation with the remnants of the tendon. The fl ap was entubulated and advanced to the bicipital tuberocity. The biceps was released and mobilized as necessary. In addition, 3 patients underwent a fractional lengthening of the muscle. All procedures were performed through a single anterior approach. Anchors and anchor sutures were used to stabilize the tendon to the tuberocity. The mean follow up was 3 years. No complications were encountered except for a superfi cial infection which resolved with oral antibiotics. All patients returned to their previous occupation. Furthermore, they all achieved 5/5 muscle strength regarding fl exion and supination on manual testing. According to the
Page 1 and 2: Hellenic Association Of Orthopaedic
Page 3 and 4: initially developed. Two typical sc
Page 5 and 6: 024 ARTHROSCOPIC REPAIR OF ACETABUL
Page 7 and 8: 036 ENDOSCOPIC VERSUS OPEN CARPAL T
Page 9: 048 PERIPROSTHETIC FEMORAL FRACTURE
Page 13 and 14: 072 THE USE OF VAC SYSTEM IN ORTHOP
Page 15 and 16: 084 THE ROTAGLIDE MOBILE BEARING TO
Page 17 and 18: We found that FGF23 and FGFR1c mRNA
Page 19 and 20: arthroscopic treatment. Additionall
Page 21 and 22: 118 EARLY RESULTS OF THE PONSETI ME
Page 23 and 24: 006 IN VITRO 2D AND 3D BONE INDUCTI
Page 25 and 26: 017 AUTOLOGOUS CHONDROCYTE IMPLANTA
Page 27 and 28: 131 ANTEGRADE INTRAMEDULLARY NAILIN
Page 29 and 30: the presence of multi-level degener
Page 31 and 32: Of those 7 presented with a benign
Page 33 and 34: ones the following day. After the p
Page 35: medial border of the patella, where

Procs III 2011.indb - Journal of Bone & Joint Surgery, British Volume ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?