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Giant cell tumour (GCT) is a rare, benign tumour, but it has a locally aggressive nature and a high rate of recurrence. A wide en-bloc resection of the distal part of the ulna, with or without stabilisation of the ulnar stump, is the recommended treatment option. Functional results after that kind of surgery are mostly satisfying but, in some cases, it can result in wrist instability, causing pain and weakness of grip strength. That is why when it comes to young people, with high functional demands, we prefer reconstruction of distal ulna and distal radioulnar joint after an en-bloc resection of the distal ulna. The distal ulna is reconstructed with an autologous free fibular graft and the distal radioulnar joint is stabilised with an autologous palmaris longus tendon graft. We present our operative technique and good functional results of three young patients treated with this procedure. Our results confirm the hypothesis that the reconstruction of the distal ulna and the distal radioulnar joint leads to a satisfactory functional result in young and active patients with higher functional demands.

The aim of our study was to compare acetabular cartilage affected by primary and DDH-induced secondary osteoarthritis (OA) using T2 mapping, which gives us information about cartilage water and collagen content, and the orientation of collagen fibrils. Samples of the osteochondral unit were obtained intraoperatively during total hip arthroplasty from the acetabulum of 15 patients with primary OA (pOA-Ac) and 15 patients with DDH-induced secondary OA (sOA-Ac). The samples were then scanned on a 7 Tesla micro-magnetic resonance imaging (micro-MRI) machine and the T2 values of all samples were calculated. The results were compared using a t-test. The average T2 values for the sOAAc and pOA-Ac groups were 57.28±31.87 ms and 37.54±11.17 ms, respectively. The calculated p-value was 0.019, making results statistically significant at p

Patella alta is a common condition in ambulatory patients with cerebral palsy, especially those with crouch gait. The treatment of symptomatic patella alta in such patients is complex and conservative methods seldom provide satisfactory results. Thus, patellar tendon advancement surgery is often required and can be, if necessary, combined with other surgical procedures. Here, we report a case of combining both conservative method and surgical procedure in a 26-year-old female patient with cerebral palsy and bilateral patella alta. One month prior to surgical intervention we administered a botulinum toxin type A (BTX-A) in the ipsilateral quadriceps. Reduced muscle spasticity of the knee extensor mechanism facilitated the patellar tendon shortening procedure and yielded excellent postoperative results. After a six-month postoperative rehabilitation course, the patient had no pain and the knee range of motion improved from 5-50° preoperatively to 0-140° postoperatively in both knees. To our knowledge, we are the first to report a use of preoperative BTX-A in the treatment of patella alta in a patient with cerebral palsy. The efficacy and safety of this treatment modality may give encouragement to a wider use of preoperative BTX-A in order to facilitate surgical intervention and postoperative rehabilitation in cases of muscle spasticity.

The purpose of this study was to evaluate the 4-year survivorship of total knee arthroplasty (TKA) of a single manufacturer and determine whether failure rates differ between the cruciate-retaining (CR) and the posterior-stabilised (PS) type of implant. In addition, possible causes of revision were analysed as well. A retrospective analysis of 580 TKAs, with either the CR or the PS type of the Biotech Future Knee endoprosthesis (BIOTECH GmbH, Garbsen-Berenbostel, Germany) was performed. The 4-year survivorship for revision of any cause in all cases was 89.14%, with aseptic loosening being the most common cause of revision (53.9%). Regarding the type of implant model, the revision rate was higher in the PS group compared to the CR group (13.7% to 8.0%, respectively, p=0.027). The Cox regression models suggested that the type of prosthesis was a significant predictor of the need for revision (HR, 0.442; 95% CI, 0.234-0.833). In conclusion, our study has shown higher revision rates with the PS implant type when compared to the CR implant type with a higher rate of aseptic loosening in the PS group. Further studies are needed to determine the cause of these results and to investigate whether the problem is specific to the implant.

Total hip arthroplasty (THA) is one of the most successful surgeries. Cemented, uncemented and hybrid methods of implant fixation can be used with different chances for implant survival. There is no consensus on the best fixation method. The aim of the study was to compare the groups of uncemented and hybrid implants according to survival, revision risk and revision cause. Until October 2015, a total of 199 THA uncemented and hybrid (uncemented acetabulum, cemented femur) implants implanted during the 1995-2003 period that had revision or last x-ray taken at least seven years after the initial operation were included in the study. Revision rate, risk factors, revision cause and revised components were investigated. A significant difference was found in the revision rate, i.e., 48 (27.9%) in uncemented group versus 13 (48.1%) in hybrid group (p=0.032). The relative risk for revision was significantly higher (RR=1.72; 95% CI: 1.09-2.73; p=0.019) in hybrids, most often due to loosening (p=0.004). The linear wear of polyethylene was the main cause of revision in uncemented THA (p

Total hip arthroplasty implies proper orientation of both acetabular and femoral components with a range of 25-40° of combined anteversion. The aim of the study was to examine resistance to periprosthetic fracture of the axially loaded cross section rectangular femoral stem (Zweymüller) with respect to different degrees of anteversion, implanted in the artificial bone model, in laboratory conditions. Femoral bone models with implanted femoral stems were divided into 3 groups depending on the degree of stem anteversion (A, control group 13-17°; B, stem retroverted 0°-4°; and C, stem anteverted 26-30°). The amount of axial load leading to periprosthetic fracture (PPFx) of the artificial bone model was determined experimentally for each construct. The results showed that the load at which the PPFx occurred significantly increased with the increase of the endoprosthesis anteversion angle. In our clinical practice, we are often unable to place the acetabular component in an ideal grade of anteversion for intraoperatively determined reasons. The results of this experimental study suggested that increasing rectangular femoral (Zweymüller) stem anteversion lowered the risk of PPFx. This study was limited by experimental design (laboratory conditions, artificial bone) and should be clinically verified.

Osteoid osteoma (OO) is the most common benign osteogenic bone tumor that predominantly affects young adults. OO is commonly localized in long bones, and therefore, it is rarely considered in differential diagnosis of chronic shoulder pain. We report a case of a 22-year-old male athlete, without history of previous trauma, who presented to our Department with chronic shoulder pain, which escalated during the night and responded to nonsteroidal anti-inflammatory drug treatment. Considering these typical symptoms, diagnostic pathway was immediately directed towards OO, with magnetic resonance and computed tomography confirming the diagnosis of OO of the coracoid process (CP). Since neurovascular structures are in the proximity of CP, and this very delicate area does not support radiofrequency ablation, we decided to perform an open procedure with drilling of the lesion and excochleation. The pain withdrew immediately after the procedure, and on six-month follow up the patient remained pain free. In the treatment of OO of the CP, we recommend open surgical procedure with tumor ablation by drilling instead of CP resection, presenting a safe, simple and low-cost method that simultaneously completely destroys the lesion and preserves the anatomical and functional role of CP.