Bu çalışmada önceki kombine yüksek tibial osteotomi (KO) sonrası total diz artroplasti (TDA)'lerinin sonuçları eşleştirilmiş bir primer TDA kontrol grubununkiler ile karşılaştırıldı. Hastalar ve yöntemler: 01 Ağustos 2006-31 Aralık 2011 tarihleri arasında önceden KO geçiren 24 hastada (10 erkek, 14 kadın; ort. yaş 69.5 yıl; dağılım, 60-79 yıl) 24 ardışık çimentolu TDA uygulandı (çalışma grubu). Çalışma grubu aynı dönemde primer TDA uygulanan 24 hastalık bir kontrol grubu (10 erkek, 14 kadın; ort. yaş 69.9 yıl; dağılım, 63-79 yıl) ile karşılaştırıldı. Ameliyat öncesi ve sonrası Diz Derneği diz ve fonksiyon skoru ve hareket açıklığı belirlendi. Femorotibial açı, lateral subkondral plağa tanjan ve fibula başının üstü arasındaki mesafe, tibial kondilin transpozisyonu, patellar tendonun uzunluğu ve tibial eğim açısı ameliyat öncesinde ölçüldü. Son takipte, aynı parametreler hesaplandı ve lateral tibial kemik rezeksiyonunun miktarı belirlendi. Bulgular: Ortalama takip süresi çalışma grubunda 97 ay (dağılım, 61-124 ay) ve kontrol grubunda 97 ay (dağılım, 61-123 ay) idi. Her iki grubun TDA sağkalım oranı %100 idi. Son takipte, klinik ve radyolojik veriler açısından anlamlı farklılık yoktu. Fakat sadece rezeke edilen lateral kemik miktarı çalışma grubunda kontrol grubundan anlamlı olarak daha düşüktü. Sonuç: Planlanan düzeltmenin 10° veya daha yüksek olduğu, medial diz artrozlu genç ve aktif kişilerde TDA'nın sonuçlarını olumsuz etkilemediği görünen KO'yu önermeye devam ediyoruz. Anahtar sözcükler: Diz Derneği klinik skorlama sistemleri, eşleştirilmiş gruplar, primer total diz artroplastisi, kombine yüksek tibial osteotomi sonrası total diz artroplastisi.

Purpose The revision of any total knee replacement is carried out in a significant number of cases, due to the excessive internal rotation of the tibial component. The goal was to develop a personalized method, using only the geometric parameters of the tibia, without the femoral guidelines, to calculate the postoperative rotational position of tibial component malrotation within a tolerable error threshold in every case. Methods Preoperative CT scans of eighty-five osteoarthritic knees were examined by three independent medical doctors twice over 7 weeks. The geometric centre of the tibia was produced by the ellipse annotation drawn 8 mm below the tibial plateau, the sagittal and frontal axes of the ellipse were transposed to the slice of the tibial tuberosity. With the usage of several guide lines, a right triangle was drawn within which the personalized Berger angle was calculated. Results A very good intra-observer (0.89-0.925) and inter-observer (0.874) intra-class correlation coefficient (ICC) was achieved. Even if the average of the personalized Berger values were similar to the original 18° (18.32° in our case), only 70.6% of the patients are between the clinically tolerable thresholds (12.2° and 23.8°). Conclusion The method, measured on the preoperative CT scans, is capable of calculating the required correction during the planning of revision arthroplasties which are necessary due to the tibial component malrotation. The personalized Berger angle isn’t altered during arthroplasty, this way it determines which one of the anterior reference points of the tibia (medial 1/3 or the tip of the tibial tuberosity, medial border or 1/6 or 1/3 or the centre of the patellar tendon) can be used during the positioning of the tibial component. Level of evidence Level II, Diagnostic Study (Methodological Study).

Absztrakt: Bevezetés: A csípőarthroscopia mint minimálinvazív eljárás egyre nagyobb szerepet tölt be a csípőízületi megbetegedések diagnosztikájában és kezelésében. Vizsgálatunkban a csípőarthroscopiának az osztályunkon kialakult gyakorlatát és az ezzel kapcsolatos kezdeti tapasztalatainkat mutatjuk be. Célkitűzés: Célunk az volt, hogy osztályunk műtéti protokolljába illesszük a csípőarthroscopia eljárását, mert az irodalom áttekintése után, valamint külföldi tanulmányutak tapasztalatát átgondolva reális és sikeres technikának tartjuk ezt a beavatkozást. Módszer: Az osztályunkon 2017. 01. 01. és 2019. 04. 15. között történt 29 csípőarthroscopia eredményeit vizsgáltuk a pre- és posztoperatív, módosított Harris-csípőpontérték (modified Harris hip score – mHHS) összehasonlításával. A műtéteket 30 fokos optikával, jellemzően standard behatolási kapukból végeztük. A műtéti indikáció jellemzően a csípőütközési (hip impingement) szindróma volt. Eredmények: Izolált ’cam’ (bütyköstengely) típusú deformitást 3, izolált ’pincer’ (csipesz) típusú deformitást 9, kevert deformitást 13 esetben észleltünk. A 13 férfi és 16 nő átlagéletkora 44,1 év volt. Legfiatalabb betegünk 22, a legidősebb pedig 60 éves volt. A műtét után az mHHS szignifikáns javulását észleltük mind az F-, mind a Student-féle t-próba szerint. Következtetés: A csípőarthroscopia megfelelő alternatíva a csípő számos betegségének műtéti kezelésében. A ’learning curve’ (tanulási görbe) hosszabb ugyan, mint más ízületek tükrözése esetén, a beavatkozás megfelelő szakmai felépítésével azonban a szövődmények kockázata csökkenthető, ezáltal a csípőarthroscopia megoldás lehet a csípő számos megbetegedésének ellátásában. Orv Hetil. 2020; 161(9): 340–346.

Our goal is to draw attention to the inflammation of the iliopectineal bursa being a rare condition, which can cause lower limb swelling and anterior pain of the hip even years after total hip arthroplasty. A 67-year-old woman was admitted seven years after hip arthroplasty (cemented total endoprosthesis [TEP]) with swelling and feeling of excessive fullness of the lower extremity and with tolerable anterior hip pain. The physical examination and blood tests were non-specific for septic condition. Ultrasound showed a cystic mass in the inguinal region with a direct contact to the common femoral vein. Deep vein thrombosis was excluded. The single-photon emission computed tomography-computed tomography (SPECT-CT) was administered to decide the surgical plan, either making a bursa extirpation or making revision hip arthroplasty. The SPECT-CT excluded the possibility of aseptic loosening. Methylene blue was injected into the bursa intraoperatively which did not enter the strong pseudo-capsule of the joint and, therefore, we did not administer revision of the TEP, and the bursa was extirpated. Two weeks after the operation, the patient had no pain, was able to walk, and the swelling decreased. Four months after surgery, the pain and feeling of fullness disappeared, with minimal lower limb swelling. In conclusion, in case of increasing complaints of patients who left years behind without any problem following total hip arthroplasty, the pathogenic role of the iliopectineal bursa should be taken into account, after excluding more frequent causes such as aseptic loosening or periprosthetic joint infection. As long as we consider about a rare disease, we can find a solution to the patient’s complaint sooner.