Introduction

Dislocation of an uncemented total hip replacement (THR) can cause damage to the femoral hear, when it passes through the rim of metal acetabular shell. This can lead to metal transfer on the surface of the head or chipping of bulk head material. Although dislocation is one of most common complications in total hip arthroplasty (THA), little is known if causes any further damage to the articulating surface of ceramic heads in long term observations.

Introduction

Backside wear of polyethylene (PE) inlays in fixed-bearing total knee replacement (TKR) generates high number of wear debris, but is poorly studied in modern plants with improved locking mechanisms.

Approximately 40 to 50% of the civilized population may expect feet disorders, and in 90% localized in the forefoot. Hallux valgus (H.V.) deformity is not a single malformation, but a complex problem affecting the first ray of foot, frequently accompanied by deformities and symptoms of the lesser toes. Proximal osteotomy and soft tissue release of I metatarso-phalangeal joint (MTP) provides adequate correction of intermetatarsal angle and joint alignment.

Material and methods. 65 patients (59 women and 6 men) with 83 hallux valgus deformities treated by surgical corrections with cuneiform proximal osteotomy of the first metatarsal bone and soft tissue plasty of I MTP joint were evaluated. The average age of the patients was 52,8 years (±12,4) and the mean follow-up was 4,2 years (±1,0). Mann criteria were used to assess the radiological stage of the disease. Treatment results were assessed by means of two numerical scales: Mielke scale and AOFAS scale. On the basis of the sum of points obtained for each criteria, the treatment result was qualified as: excellent, good, fair or poor. In the radiological assessment the alteration of the valgus angle (HVA) and the intermetatarsal angle (IMA) of the hallux were evaluated.

Results. Exacerbation of hallux valgus deformity in radiological examination was moderate or severe in accordance to the Mann criteria. 21 feet accompanied by deformities of lesser toes had additionally surgical procedure for the treatment of them. According to Mielkie scale the mean score was 6,5pts. (±1,9), and the treatment result of 95% of patients was evaluated as excellent or good. The mean score in AOFAS scale was 91,2pts (±11,2) with percentage of 80,6% excellent and good results. Higher percentage of fair and poor results in AOFAS scale was due to restricted motion of first MTP joint in 8 patients, out of whom due to persistent pain ailments in 6. In case of 4 feet, cosmetic improvement was unsatisfactory, and 4 patients had problems with wearing commercial shoes. Average correction value of the hallux valgus angle was 21° (33,5° to 12,5°). Foot intermetatarsal angle correction was 9° (16,2° to 7,2°).

Conclusions. Proximal osteotomy of the first metatarsal bone with soft tissue release of I metatarso-phalangeal joint allows for good correction of the hallux valgus deformity with good functional results.

Search for optimal shape of hip implant have gone on from 70th’s. Different shapes of hip cups and methods of their implantation, which were created within those years, indicate, that long term results of cementless arthroplasty are still not satisfactory.

The clinical and radiological results of cementless hip arthroplasty, which were performed with two types of shape cups (threaded spherical and threaded conical), were analyzed after at least 7 years follow up. Analysis was based on results 106 of cementless hip arthroplasties among 141, which were done during 1993 – 1996. The study concerned 58 threaded spherical cups (group A) and 48 conical (group B). Application of cups was randomized with respect to both sex and etiology of hip dysfunction and their implantation conditioned to possession of this type of implant on this moment.

The mean age of 63 women and 35 men ( in 8 both side) in the moment of implantation were 48,9 years ( 10,6)and ranged from 28 to 76 years. Mean time of follow up was 8,2 years( 1,4) and ranged from 7 to 10 years.

Pre- and postoperative clinical evaluation of hip function was carried out by means of Harris Hip Scale. Radiological evaluation was based on measurements of angle of inclination, horizontal and vertical migration of cup and radiolucent lines in DeLee-Charnley zones. Those measurements of last x-ray examination were compared with those, which were done immediately after arthroplasty.

There were 80% of excellent and good results and 17% poor results in clinical evaluation of group A. In radiological evaluation of this group mean horizontal migration was 1mm, and vertical was 2,5mm. Clinical and radiological symptoms of cup loosening were confirmed in 10 hips. The revision procedures were performed in 9 hips. In group B excellent and good clinical results were in 98% and poor results only in 2 % of treated hips. Radiological evaluation also showed less migration of cups. Mean horizontal migration was 0,3mm, and vertical was 0,7mm. Clinical and radiological symptoms of loosening were in 1 hip, which were treated by revision procedure.

Conclusion of our study is statement, that application of cementless threaded conical cup in hip arthroplasty give better clinical and radiological midterm results, than apllication of cementless threaded spherical cups.

Aims: The aim of this study was to evaluate the application of collagen scaffold in the reconstruction of articular cartilage. Methods: 28 rabbits was used in the study. A defect penetrating into the subchondral bone was made. The animals were divided into 2 groups according to the procedure: group I consisted of rabbits with defects þlled with collagen scaffold, in group II the defects remained empty. The results were observed after 4 and 12 weeks macroscopically and microscopically (modif. OñDriscoll scale). Results: Total þlloing of the defect with regenerated tissue was revealed, with smooth surface and good integration with the surrounding cartilage in 1st group. In 2nd group the surface of the newly formed tissue was irregular, defect was partially þlled and incompletely integrated with cartilage. Hyaline-like cartilage dominated on microscopic examination of the 1st group the (2±0.8). In the 2nd group regenerating tissue was mostly þbrous (1.5±0.8). Signs of degeneration were more signiþcant in 2nd group (0.7±0.7) when compared to 1st group (1.6±0.8). However they deteriorated over time in both groups with loss of structural integrity and integration with sourounding cartilage. The main adventage of scaffold application was better þlling of cartilage defect (1.6±0.8 vs. 1±0.6). Possibly incorporation of chondrogenic cells into defect would improve cellular integrity and properties of regenerating tissue. Conclusion: This study showed better results of reconstruction of articular cartilage by means of biodegradable scaffold.