The purpose of this study was to compare the clinical results of total knee arthroplasty (TKA) in the early and late postoperative period using subvastus and medial parapatellar approach. A prospective randomized controlled study was conducted in a group of 169 patients (180 TKAs) with 2-year follow-up. Patients were divided into a study group (97 TKAs) with a subvastus approach and a control group (83 TKAs) with a parapatellar approach. Assessment of the results of both operating approaches was based on functional, clinical Knee Society Score, and pain (visual analog scale). Patients in the subvastus group achieved full active extension, better range of motion, and better Knee Society Score results at 12 days, 6 weeks, and 12 weeks earlier than patients in the medial parapatellar group. They also had less pain at 12 days. No statistically significant differences existed between assessed end points in both groups at 24- and 52-weeks, and 24-months postoperatively. The subvastus approach has given patients better early clinical results; however, at longer follow-up, both groups had similar outcomes. The potential benefits of the subvastus approach are: protection of the extensor mechanism from damage, less risk of damaging the blood supply to the patella, earlier clinical recovery, and less pain in the early postoperative period. The subvastus approach is an alternative to the standard medial parapatellar approach in TKA. It can be used with equally good results, especially taking into consideration positive clinical aspects in the early postoperative period.

Implant survival following THA in arthritis with acetabular protrusion depends mainly on proper bone stock reconstruction. 80-85% patients after THA with acetabular bone stock reconstruction achieved very good and good results following an average of 12 years of follow-up. Patients with autogenic bone grafts achieved better outcomes. There was no substantial effect of aetiology, type of endoprosthesis, grade of acetabulum migration on the final outcome.

Ultrasound examinations are recognised as being safe. The greatest epidemiological threat during the performance of examination is the transfer of pathogenic and opportunistic microorganisms between patients and from personnel to patients. Colonization of the skin with opportunistic bacteria of immunocompromised and high risk patients may lead to infection following an ultrasound scan. Aim: To identify and evaluate the strains of bacteria occurring on ultrasound equipment subjected to unexpected control performed by a local infectious diseases control team. We assumed that transducers, gel holders and gel bottles can be contaminated with normal human skin microflora. The remaining tested parts of the ultrasound equipment could possibly be contaminated with normal human skin microflora and other pathogens. Material and methods: The swabs were taken from ultrasound scanners located in various hospital settings, from out-patient based radiology scanning rooms to operating theatre, and cultured. Results: Among all isolated 23% strains were classified as environmental microflora; 8% as strains related to patient's skin contamination; and 13 % strains constituted pathogenic Gram-negative rods.. The remaining strains were classified as opportunistic flora 38%. High prevalence of opportunistic bacteria cultured in our study lead to the modification of the ultrasound cleaning procedures in both institutions and recommendation of the use of antibacterial wipes to clean all parts of ultrasound equipment in contact with patients' skin and examiners. Conclusions: Contamination not only affects parts of diagnostic equipment placed in direct contact with the patient, but also, those surfaces that only medical personnel have had contact with.

PurposeMalrotation of the femoral component after primary total knee arthroplasty (TKA) is one of the most important problems leading to painful TKA requiring revision surgery. MethodsA comprehensive systematic review of the literature was performed to present current evidence on how to optimally place the femoral component in TKA. Several landmarks and techniques for intraoperative determination of femoral component placement and examination of their reliability were analyzed. Results2806 articles were identified and 21 met the inclusion criteria. As there is no unquestioned gold standard, numerous approaches are possible which come along with specific advantages and disadvantages. In addition, imaging modalities and measurements regarding postoperative femoral component rotation were also investigated. Femoral component rotation measurements on three‐dimensional (3D) reconstructed computerised tomography (CT) images displayed intraclass correlation coefficients (ICC) above 0.85, significantly better than those performed in radiographics or two‐dimensional (2D) CT images. Thus, 3D CT images to accurately evaluate the femoral prosthetic component rotation are recommended, especially in unsatisfied patients after TKA. ConclusionThe EKA Femoral Rotation Focus Group has not identified a single best reference method to determine femoral component rotation, but surgeons mostly prefer the measured resection technique using at least two landmarks for cross‐checking the rotation. Level of evidenceIII.

IntroductionArthroscopy of the knee joint is regarded as the most objective diagnostic method in intra-articular knee joint lesions.AimThe purpose of this study was to assess the objectivity and diagnostic value of orthopaedic examination (OE) and magnetic resonance imaging (MRI) in reference to the arthroscopic result.Material and methodsIn a group of 113 patients treated by arthroscopic surgery for post-traumatic knee pathology between 2008 and 2010 in our department, accuracy of clinical and MRI findings that preceded surgery were studied retrospectively using a statistical method. Sensitivity, specificity, accuracy and predictive negative and positive values were the subject of analysis.ResultsIn the presented trial, sensitivity values of the orthopaedic examination for injuries of the anterior cruciate ligament (ACL), meniscus medialis (MM), meniscus lateralis (ML) and chondral injuries (ChI) were 86%, 65%, 38% and 51%, respectively. Specificity values were 90%, 65%, 100% and 100%, respectively. The MR sensitivity and specificity values were 80%, 88%, 44% and 32%, and 86%, 64%, 93% and 97%, respectively.ConclusionsAssessment of intra-articular knee joint lesions is a difficult diagnostic problem. In making a decision about arthroscopy of the knee joint, an appropriate sequence of examinations should be carried out: OE, MRI and arthroscopy. The improvement in the effectiveness of the orthopaedic examination and MRI can limit the too high frequency of diagnostic arthroscopies, which generates the risk of operation treatment and costs.