PURPOSE OF THE STUDYThe study aims to evaluate the long-term results of computer-navigated total knee arthroplasties performed by less experienced surgeon performing a small number of procedures per year. MATERIAL AND METHODSIn the prospective randomised study functional and radiological results, rate of revision and probability of clinical and radiological survival were compared in 30 computer-navigated (in 28 patients: 19 women, 9 men, with the mean age of 66.9 years) and 31 conventionally implanted (in 30 patients: 27 women, 3 men, with the mean age of 66.5 years) cemented total knee replacements without patellar resurfacing. The group was composed of patients who underwent surgery performed by the same surgeon who at the time of enrolment of patient in the study had no previous experience with the total knee replacement surgery and performed up to 30 such procedures annually. The mean follow-up of patients was 11 years. RESULTSNo statistically significant differences were detected regarding the mean age, sex, body mass index and etiology of osteoarthritis of the operated knee. The mean duration of computer-navigated surgeries (101±14.1; 80-140 min) was considerably longer than the duration of conventional joint replacements (94±8.2; 80-100 min; p = 0.01). When evaluating the radiological results, a statistically significant difference was found between the groups only with respect to the mean value of dorsal inclination of the tibial component (88.2˚±2.1 vs 86.2˚±3, p = 0.02). The mean values of other monitored angles did not show any significant differences. The number of correct implants (with a deviation of 3 degrees from the target values) was statistically significantly higher in the group of computer-navigated joint replacement surgeries in all the monitored parameters

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PURPOSE OF THE STUDYThe aim of the study was to evaluate the clinical and radiographic results of total hip arthroplasty (THA) with the Metha short hip stem and their comparison with the outcomes of THA using a conventional cementless stem. MATERIAL AnD METHODSA total of 30 Metha stems and 30 standard Biocontact stems implanted in the period from 2007 to 2012 were evaluated. The Metha patient group comprised 22 women and six men, with the mean age of 58.9±SD 8.7 years (43-75), mean height of 164.2±6.3 cm (156-178), mean body mass of 68.2±12 (48-91) and mean BMI of 25±3.9 (19-32). The Biocontact group included 19 women and 11 men, with the mean age of 63.6±10.8 years (45-77), mean height of 166.6±6.6 cm (152-175), mean body mass of 77.6±13.1 (46-104) and mean BMI of 27. 6±4.3 (20-37).The evaluation was based on plain X-ray findings and clinical status assessed using the Harris hip score and 10-point visual analogue scale (vAS) for pain before surgery and at final follow-up. RESULTSIn the Metha group the mean pre-and post-operative Harris hip scores were 41.7±9.9 (28-57) and 94.4±5.1 (82-100), respectively. In the Biocontact group the values were 41.5±11.9 (32-64) and 89.3±11.2 (57-100), respectively. The mean vAS for low back and thigh pain improved from the pre-operative value of 7.41±2.1 (4-9) to 0.56±1.0 (0-3) in the Metha group and from 7.29±2.2 (4-9) to 1.64±1.8 (0-5) in the Biocontact group.The post-operative results in both rating systems were significantly better (p<0.05) in the Metha than the Biocontact group patients. All stems showed radiographic evidence of good osteointegration. Stem subsidence and calcar atrophy were recorded in one patient of the Metha group. In the Biocontact group stem subsidence was found in two patients and signs of stress shielding in 14 patients. DISCUSSIOnShort hip stems have been introduced in THA implantation with the aim to restore physiological biomechanics as much as possible and to ensure good long-term functioning of the joint replacement as well as to save the proximal femoral bone tissue for potential THA re-implantation. Our results of short hip stem implantation presented in this study are compared with the results of relevant recently published literature. COnCLUSIOnSShort hip stems show adequate osteointegration without need for diaphyseal fixation and allow for more natural weightbearing distribution in the proximal femur. The short-and mid-term clinical results are better than with the use of conventional cementless stems. They can be recommended as an optimal choice for use in younger patients with good bone quality who are expected to require THA re-implantation.

PURPOSE OF THE STUDYThe aim of the study was to evaluate the incidence of osteopenia and osteoporosis in the patients elected to cementless total hip replacement. MATERIAL AnD METHODSThe group evaluated comprised 100 patients with primary or secondary forms of coxarthrosis who underwent cementless total hip arthroplasty (THA). The results of densitometric examination of the lumbar spine and proximal femur were analysed. Based on the lowest T-score value, the patients were divided into three groups, i.e., first, normal bone density; second, osteopenia; third, osteoporosis. Clinical examination included patient medical history, Harris hip scores and visual analogue scale assessment for pain intensity; the Kellgren-Lawrence clasification was used to measure the grade of hip osteoarthritis; blood tests were made to assess the levels of total calcium, ionised calcium, phosphorus, vitamin D and the markers of bone resorption and formation. RESULTSOsteoporosis was found in 32 and osteopenia in 21 patients; 47 patients had normal bone density. Osteoporosis was detected in the lumbar spine of 21 patients, in the proximal femur of nine patients and at both sites in two patients. In 13 patients this diagnosis was made for the first time. The patients with osteoporosis had a significantly lower body mass index. There were no differences in the other characteristics, i.e., age, functional, radiological and laboratory findings, among the groups; all three showed the mean vitamin D concentration below the lowest level of its physiological range. Insufficient vitamin D levels were found in 54 women and 18 men. Of all patients, only 13 women and four men took vitamin D supplements. DISCUSSIOnOsteoarthritis and osteoporosis are the most frequent complex musculoskeletal diseases. Several studies have suggested that these disorders are mutually exclusive. This assumption has been based on the absence of radiographic evidence of osteoarthritis seen in many elderly patients with femoral neck fractures. Our relatively frequent findings of osteopenia and osteoporosis in this study show that patients with osteoarthritis may not be protected from the development of generalised osteoporosis. Our results are compared with the relevant literature data and potential effects of osteoporosis and vitamin D deficiency on total hip arthroplasty are discussed. COnCLUSIOnSHip osteoarthritis does not reduce the risk of generalised osteoporosis. We found a relative high incidence of osteopenia and osteoporosis as well as vitamin D deficiency in patient with advanced form of hip osteoarthritis.

Subtalárna luxácia nohy zahŕňa luxáciu v talokalkaneárnom a súčasne v talonavikulárnom kĺbe. Talokrurálny a kalkaneokuboidálny kĺb ostávajú neporušené. Správne označenie by teda malo znieť talo-navikulo-kalkaneárna luxácia.Ide o zriedkavé poranenie, ktoré predstavuje asi 1-2 % všetkých traumatických luxácii (7,17). Ako prví ju v literatúre popísali Judey a Dufaurest v roku 1811 (10). Podľa polohy nohy voči členkovej kosti rozoznávame mediálnu, laterálnu, zadnú a prednú subtalárnu luxáciu nohy.Cieľom práce je, na základe retrospektívnej analýzy, prezentovať vlastné skúsenosti s liečbou subtalárnej luxácie nohy. SÚBOR PACIENTOV A METODIKAV priebehu rokov 1999 až 2011 sme na Klinike ortopédie a traumatológie pohybového ústrojenstva UPJŠ LF v Košiciach ošetrili 6 pacientov so subtalárnou luxáciou nohy, čo predstavovalo 0,4 % všetkých traumatických luxácii. V práci sme retrospektívne hodnotili kli-