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Sąnarinių paviršių atnaujinimo operacijos atliekamos esant artrozės pažeistam klubo sąnariui. Ši artroplastikos procedūra skiriasi nuo įprastinio klubo sąnario proteza­vimo, nes išsaugoma sąnario kaulinė struktūra ir anato­mija: paliekamas šlaunikaulio kaklas, pritaikomi kompo­nentai pagal įgimtus sąnario paviršiaus diametrus, todėl nepakinta kojos ilgis ir biomechanika. Manoma, jog taip geriau atkuriama sąnario funkcija, lyginant su įprastiniu endoprotezavimu. Pacientai greitai grįžta į aktyvią veiklą, net profesionalųjį sportą. Ši pažangi operacija netapo pir­maeiliu klubo sąnario artrozės chirurginio gydymo būdu dėl ribotų indikacijų, išskirtinų komplikacijų ir poopera­cinių rezultatų. Dėl operacijos technikos ir protezo savy­bių operacija gali komplikuotis šlaunikaulio kaklo lūžiu ar aplinkinių audinių pseudotumoru, kuris formuojasi dėl aplinkinių minkštųjų audinių reakcijos į metalo jonus, susidarančius trinantis metaliniams komponentų pavir­šiams. Šios komplikacijos dažnesnės vyresnio amžiaus pacientams, ypač moterims. Paviršių atnaujinimo ope­racija indikuotina tik jauniems, aktyviems vyrams, kurių gera kaulo kokybė. Ši operacija turi konkrečią šiandieni­nio chirurginio klubo sąnario artrozės gydymo poziciją.

Tyrimo tikslas. Įvertinti, kaip kito pacientų kelio sąnario funkcija po endoprotezavimo operacijos, praėjus vieneriems ir septyneriems metams, lyginant su priešoperaciniais duomenimis, kokie veiksniai tam turėjo įtakos. Metodai. Į prospektyvųjį tyrimą įtraukėme 120 kelio sąnario osteoartritu sergančių pacientų, hospitalizuotų kelio sąnario endoprotezavimui (KSE). Po septynerių metų tyrime liko dalyvauti 56 pacientai. Parametrai, kuriuos vertinome: paciento duomenys, Kelio sąnario draugijos anketa (Knee Society Score, KSS), judesių amplitudė (JA), mechaninės kojos ašies (MKA) nuokrypis, Yesavage’o geriatrinės depresijos skalė (GDS), simptominė stuburo patologija. Rezultatai. Palyginome priešoperacinius su pooperaciniais vienerių metų rezultatais nustatėme, kad funkcinė kelio sąnario būklė reikšmingai pagerėjo, tačiau, praėjus septyneriems metams, kai kurie rodikliai nežymiai sumažėjo. Reikšmingą įtaką blogesniems pooperaciniams rezultatams turėjo stuburo patologija ir blogesnis GDS rezultatas. Išvados. Šio tyrimo rezultatai rodo, kad po vienerių metų kelio sąnario funkcija reikšmingai pagerėja ir išlieka geresnė po septynerių metų po KSE nei prieš operaciją. Taip pat svarbu siekti sumažinti pacientų depresijos simptomus, gydyti stuburo patologijas, nes šie veiksniai turėjo įtakos pooperacinei kelio funkcijai.

Introduction: Elderly patients with displaced femoral neck fractures (FNF) are usually operated with arthroplasty but with various combinations of implants and approaches. Thus, the optimal treatment is still controversial. We aimed to compare the results between the cemented bipolar hemiarthroplasty (HA) and total hip arthroplasty (THA) patients operated for FNF regarding revision rate at 1 year postoperatively. Methods: The data were derived from the Lithuanian Arthroplasty Register. We included patients operated with cemented bipolar HA and compared them to the most frequently used cemented THA with 28-mm head during 2011–2016. For survival analysis, we used both revision for all reasons and for dislocations as an endpoint. Cox proportional hazards models were used to analyse the influence of covariates (age groups, gender, surgical approaches and arthroplasty groups). Results: There were 1177 bipolar HA and 514 THA included in our study. 26 (2.2%) revisions had occurred among the bipolar HAs as compared to 25 (4.9%) among the THAs 1 year after surgery. The main reason for revision was dislocation. The unadjusted cumulative revision rate for any reason at 1 year after surgery was 2.4% for the bipolar HA group and 5.1% for the THA group ( p = 0.0054). Cox regression analysis showed that the use of bipolar HA, anterolateral approach and younger age groups had lower risk of revision for all reasons. Conclusion: Bipolar HA and anterolateral approach had a significantly lower overall 1-year risk of revision in femoral neck fracture patients as compared to THA with 28-mm femoral heads.

This study investigated bone regeneration in the femoral neck canal of osteoporotic rats using a novel animal model. A calcium sulphate (CS)/hydroxyapatite (HA) carrier was used to deliver a bisphosphonate, zoledronic acid (ZA), locally, with or without added recombinant human bone morphogenic protein-2 (rhBMP-2). Twenty-eight-week-old ovariectomized Sprague-Dawley rats were used. A 1 mm diameter and 8 mm long defect was created in the femoral neck by drilling from the lateral cortex in the axis of the femoral neck, leaving the surrounding cortex intact. Three treatment groups and one control group were used: (1) CS/HA alone, (2) CS/HA + ZA (10 μg) (3) CS/HA + ZA (10 μg) + rhBMP-2 (4 μg), and (4) empty defect (control). The bone formation was assessed at 4 weeks post surgery using in vivo micro computed tomography (micro-CT). At 8 weeks post surgery, the animals were sacrificed, and both defect and contralateral femurs were subjected to micro-CT, mechanical testing, and histology. Micro-CT results showed that the combination of CS/HA with ZA or ZA + rhBMP-2 increased the bone formation in the defect when compared to the other groups and to the contralateral hips. Evidence of new dense bone formation in CS/HA + ZA and CS/HA + ZA + rhBMP-2 groups was seen histologically. Mechanical testing results showed no differences in the load to fracture between the treatments in either of the treated or contralateral legs. The CS/HA biomaterial can be used as a carrier for ZA and rhBMP-2 to regenerate bone in the femoral neck canal of osteoporotic rats.

BACKGROUND The aim of this study was to evaluate the reconstruction of a torn anterior cruciate ligament (ACL) with 10 mm diameter BPTB (bone-patellar tendon-bone) autograft versus 8 mm HT (hamstring tendon) autografts, to compare the ability to restore pre-injury sports activities and reduce revision risk after these procedures. MATERIAL AND METHODS A prospective clinical review was performed to compare results of patients who underwent primary anatomical ACLR with 10 mm BPTB autografts with patients who underwent 8 mm diameter HT autografts, between January 2011 and January 2014. RESULTS There were 183 patients evaluated: the 8 mm HT group showed statistically significant higher knee laxity values compared to the 10 mm BPTB group (p=0.042), and significant difference were detected in subjective International Knee Documentation Committee (IKDC) evaluation scores; the average subjective IKDC evaluations after two-year follow-up in the HT group was 88.45±2.8 versus 89.24±2.5 in BPTB group (p=0.047). In the evaluation of the IKDC objective protocol, results were excellent and good in 83 patients (94.3%) after BPTB and in 78 patients (82%) after HT ACLR (p

Recently, there has been increasing interest in the use of dual mobility systems in the treatment of hip instability. The aim of this study was to investigate the re-revision rate of dual mobility cup compared to different surgical concepts when used for first-time hip revisions due to recurrent dislocations. The data were derived from the Lithuanian Arthroplasty Register. For survival analysis, we used both re-revision for all reasons and for dislocations as an end-point. Cox proportional hazards models were used to analyze the influence of various covariates (age, gender, and implant concept). A total of 1388 revisions were recorded from 2011 to 2015, of which 362 were performed due to recurrent dislocation. Of the revisions, 247 were performed using dual mobility cups, while 115 were performed using a variety of other surgical constructs including constrained acetabular cups, conventional cups, femoral head exchanges, stem exchanges or anti-luxation rings. There were 27 re-revisions of which 15 were for additional dislocations. There were only 2% re-revisions due to dislocation with dual mobility vs 9% when using other surgical constructs. Cox regression adjusting for age and gender showed that in the short-term, dual mobility cup had a lower risk of revision due to dislocation as well as for all reasons compared to the other surgical constructs. In revision of total hip arthroplasties for dislocation, significantly lower short-term re-revision rate was observed for patients revised with dual mobility cup.

Purpose: Characterized cartilage lesions have a distinct impact on postoperative clinical outcome, which is still being evaluated. The purpose of this study was to assess the postoperative clinical outcome of autologous matrix-induced chondrogenesis (AMIC) for characterized cartilage lesions. Methods: Fifteen patients with articular cartilage (AC) defects of the knee were included in the study. AC defects were characterized intraoperatively by International Cartilage Repair Society score. Grade III–IV AC lesions were treated with AMIC; grade I–II lesions were left untreated. Patients were divided into subgroups and clinically evaluated by subjective autologous matrix-induced chondrogenesis (IKDC) and Tegner scores at median follow-up of 4.5 years. Results: Twenty-eight AC defects were diagnosed (1.9/patient). Multiple subgroup had larger diagnosed (7 ± 2.3 cm 2 , p = 0.022) and untreated (3.1 ± 2.3 cm 2 , p = 0.012) lesion areas than the single subgroup. Partly treated subgroup had larger untreated defect areas (3.6±2.3 cm 2 , p = 0.025) than the Treated subgroup. Average subjective IKDC values of total group and individual subgroups improved significantly at follow-up. More patients restored their previous activity levels ( p = 0.026) and had higher incremental subjective IKDC scores ( p = 0.014) in the single subgroup than the multiple subgroup. Diagnosed defect size negatively correlated to subjective IKDC incremental ( r = −0.624, p = 0.023) and postoperative scores ( r = −0.545, p = 0.054) in total group. Conclusions: AMIC can have a clinically relevant outcome for patients with single or multiple knee AC lesions; however, clinical outcome is superior in patients with a single defect per knee. Patients with single defects returned to previous physical activity levels significantly faster than patients with multiple defects. Diagnosed AC defect areas negatively correlate to clinical improvement at follow-up.

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The study was performed at the Department of Orthopaedics and Traumatology of the Kauno Klinikos Hospital of Lithuanian University of Health Sciences. Background. Intravascular fluids are empirically administered to prevent hypotension induced by spinal anaesthesia. Ultrasound measurements of the inferior vena cava (IVC) and the IVC collapsibility index (IVC-CI) is a non-invasive method to evaluate the intravascular volume status. The aim of the study was to identify the prognostic value of the IVC collapsibility index in spontaneously breathing patients to predict severe intraoperative hypotension. Materials and methods. Sixty patients undergoing elective knee arthroplasty under spinal anaesthesia were included in the prospective study. The diameters of IVCex, IVCin, and IVC-CI were measured before and 15 min after spinal anaesthesia when administration of 500 ml of normal saline using infusion pump was finished. The haemodynamic parameters (heart rate, systolic, diastolic, and mean blood pressures, breathing rate) were collected. Results. Severe arterial hypotension was noticed in 18.3% of the patients. No statistically significant differences were detected between changes in IVCex, IVCin, and IVC-CI comparing hypotensive and non-hypotensive patients at the baseline and after the interventions (p > 0.005). According to receiver operating characteristic (ROC) analysis, IVC-CI is not effective in the prediction of severe hypotension during spinal anaesthesia in spontaneously breathing patients: the area under the ROC curve for IVC-CI was 0.05. Conclusions. IVC-CI is not an effective predictor of severe hypotension after induction of spinal anaesthesia followed by normal saline administration in spontaneously breathing patients undergoing elective knee arthroplasty. More trials, including different patient subgroups, will be needed.

BACKGROUND The aim of this study was to determine whether graft size is associated with recurrent instability and insufficient functional outcomes after ACL reconstruction. MATERIAL AND METHODS We analyzed 214 consecutive patients with a completed follow-up of 12 months: 55 (25.7%) women and 159 (74.3%) men. Patients were divided into 3 groups according to the diameter of the middle of the hamstring graft. Follow-up examinations were performed pre-surgery and 3, 6, and 12-months postoperatively, and laxity assessments were performed using GNRB®. Differential laxity measured at 134N (Δ134=heathy vs. operated side). A "residual laxity" of the ACLR was defined as Δ134N>3 mm. RESULTS The results of the General Linear Model (Repeated Measures) showed that there was a significant main effect of time factor (F=379.759, p

Background and objective: Hypotension and bradycardia are the most common hemodynamic disorders and side effects of spinal anesthesia (SA) on the cardiovascular system. SA-induced sympathetic denervation causes peripheral vasodilatation and redistribution of central blood volume that may lead to decreased venous return to the heart. The aim of the study was to evaluate the changes of inferior vena cava collapsibility index (IVC-CI) during SA in spontaneously breathing patients during elective knee joint replacement surgery to prognose manifestation of intraoperative hypotension and bradycardia. Materials and methods: 60 patients (American Society of Anesthesiologists (ASA) physical status I or II, no clinically significant cardiovascular pathology) of both sexes undergoing elective knee joint replacement surgery under SA were included in the prospective study. Inspiratory and expiratory inferior vena cava (IVCin, IVCex) diameters were measured using an ultrasound device in supine position before and immediately after SA, then 15 min, 30 min, and 45 min after SA was performed. The heart rate, along with systolic, diastolic, and mean arterial blood pressures were collected. The parameters were measured at the baseline and at the next four time points. Results: There were no significant changes in IVCin, IVCex, and IVC-CI compared to baseline and other time point measurements in hypotensive versus nonhypotensive and bradycardic versus nonbradycardic patients (p &gt, 0.05). Changes in IVC diameter do not prognose hypotension and/or bradycardia during SA: the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for IVC-CI at all measuring points was &lt, 0.7, p &gt, 0.05. Conclusions: Reduction in IVC diameters and increase in IVC-CI do not predict hypotension and bradycardia during SA in spontaneously breathing patients undergoing elective knee joint replacement surgery.

Malalignment of the components affects long term total knee arthroplasty (TKA) survival. One of the options for achieving better TKA alignment may be a detailed preoperative radiological assessment. The aim of the study – to investigate the femoral valgus angle variations and affecting factors in patients with knee osteoarthritis (OA). Material and methods: We prospectively investigated severe OA patients, admitted for elective TKA. The standardized radiological assessment was performed – long standing hip-knee- ankle radiographs and the measurements were taken. We evaluated the relationship between the patients’, radiological parameters and femoral valgus angle. Results: 110 patients were included in the study and the mean measured femoral valgus angle was 6,7±1,3° and ranged from 4° to 10°. It was not significantly different between genders or varus/ valgus knee deformation. There was a significant relation between femoral valgus angle and neck-shaft, femoral bowing angles. Femoral valgus angle significantly increased with larger femoral bowing and smaller neck-shaft angles. Conclusions: Lithuanian patients with knee OA scheduled for TKA had a mean femoral valgus angle of 6,7±1,3° which ranged from 4° to 10°. Femoral neck-shaft and bowing angles significantly affects the femoral valgus angle.

Introduction: Patients with hip fractures are usually treated operatively in Western Europe. However, in Mid-Asia different indications are used to decide whether this patient is suitable for operative treatment and those are related to specific traditions and rules in hospital. Thus, traditions and surgeon/patient fears seem to affect treatment choices in hip fractures and subsequent outcomes. The aim of our study was to investigate patients with hip fractures and compare outcome at 1-year follow-up in the operated and nonoperated patient groups. Methods: All patients over 50 years old who sustained a hip fracture, between January 2014 and December 2014, were included. Patients were assessed preoperatively and at 1-year follow-up, using questionnaires from National Swedish Hip Fracture Register and quality of life (Euroqol EQ-5D). Results: Out of 398 included patients, 299 were operated on and 99 were not. 344 patients remained for our analysis before the end of 1-year follow-up. 51 patients (65%) deceased in the nonoperated group as compared to 55 (21%) in the operated group, pConclusions: We conclude that nonoperative treatment of hip fracture patients is associated with higher mortality and worse functional outcome as compared to those who were treated operatively. We therefore advocate operative treatment of the hip fracture in the vast majority of cases.

The purpose of the study was to investigate how the use of dual-mobility cups (DMCs) affected the risk of revision due to dislocation as well as overall risk of revision compared with a conventional total hip arthroplasty (THA) system in the short term. A total of 12,657 primary THAs were registered from the start of 2011 to the end of 2014. 620 THAs were with DMCs. For comparison, we included all registered THAs with Exeter cup and a cemented Exeter stem combined with 28-mm femoral head. Patients were followed up with respect to revision and/or death until 1 January 2016. For survival analysis, we used revision as an endpoint. Cox proportional hazards models were used to analyse the influence of various covariates (age, gender, surgical approach, THA model and pre-operative diagnosis). Of the 620 dual-mobility THAs and 2170 Exeter THAs, 100 had been revised. The overall unadjusted cumulative revision rate (CRR) for any reason of revision at five years after surgery was 3.9% in the dual-mobility group and 5.2% in the Exeter group. Cox regression analysis, adjusting for age, gender, THA type, surgical approach and pre-operative diagnosis, showed that the risk of revision was less in patients operated with DMCs and in patients having their operation for osteoarthritis. The DM implant had a lower short-term complication rate than a conventional well defined THA. Low dislocation rate suggests that it is a good choice for high risk patients.

Aim: The aim of this study was to audit hip fracture patients' care in Lithuania and compare it to Sweden's, identifying the differences in Lithuania, changes required for further care improvement, for a country where no integrated care pathways had been introduced. Methods: We investigated 64 hip fracture patients treated in Lithuania and 90 hip fracture patients treated in Sweden for a period of one year according our ''fast track'' protocol. Information about medical interventions, mean time period from admission to surgery, length of stay in the orthopedic department, incidence of pressure ulcers and information about discharge location was collected and com- pared in both institutions. Results: No oxygen therapy, infusion therapy, blood sampling and ECG were con- ducted in Lithuania during patients' transportation to the institution, but that was not the case in Sweden. Contrary to Lithuania, patients at Lund University Hospital do not attend the Acute & Emergency room and Swedish patients are supposed to be operated on within 24 h. Time to surgery in Lithuania was more than twice as long, but a rather similar in-hospital stay was observed. However, most patients in Lith- uania are discharged to a rehabilitation clinic for 18 days. Conclusion: Audit results of hip fracture care in Lithuania compared to Sweden showed potentially some benefits using the hip fracture care pathway, which was particularly associated with shorter time to surgery, thus reducing the risk of com- plications in this vulnerable group of old patients. Making comparisons like this in other countries may be useful, but must be taken in context along with the local cul- ture and health care system.

Summary Aim The purpose of this study was to perform an audit of patients with hip fractures treated in the Kaunas Medical University Hospital, Lithuania over a one year period, and to analyze outcomes after 4months. Methods Hip fracture patients, who were treated in Kaunas Medical University Hospital, were included in the audit. All data were recorded according to the Swedish Hip Fracture Register forms. Four months after the fracture, these forms and a standardized questionnaire, the Hip Disability and Osteoarthritis Outcome Score, were used to evaluate functional results for patients included in the study. Results A total of 64 patients with a mean age of 75years were consecutively included. At the 4month follow up, the patients were using more walking aids ( p =0.016) and had poorer mobility ( p =0.0018) compared to their prefracture status. Patients who were living alone ( p =0.03) and had a greater ASA grade ( p =0.01), were more likely to express hip joint symptoms. Older age was associated with greater pain ( p =0.04) and worse mobility ( p =0.02). Conclusion Through the introduction of prospective audit of patients with femoral neck fracture in Lithuania, we identified that high ASA grade and old age are significantly affecting outcomes for these patients.

Background: the main goal of the study was to investigate the prevalence of the articular cartilage defects (ACD) in the patellofemoral (PF) region of the knee joint based on the anatomical shapes of patella and its impact on the level of physical activity in the population needing arthroscopic procedures for all types of pathologies in the knee. Methods: The articular cartilage status of the PF region was obtained from 1098 arthroscopic procedures of the knee joint. The ACD were correlated to Wiberg’s shape of the patella and classified according to the degree, size and depth of the ACD in the PF region using the ICRS (International Cartilage Repair Society) system: group I consisting of patients with Wiberg type I shape (W1), group II—patients with Wiberg type II shape (W2) and group III—patients with Wiberg type III shape (W3). The Tegner physical activity scale was used to evaluate the physical activity of the patients. Results: The mean of ACD size (PF region) in the W3 group was 3.10 ± 0.99 cm2, which was a statistically significantly larger area in comparison with the W1 (1.90 ± 0.63 cm2; p < 0.0000) and W2 (1.95 ± 0.71 cm2; p < 0.0000). The patients from the W3 group (mean 3.10 ± 0.99) were less physically active (

Total knee replacement in severe osteoarthritis usually requires extensive soft tissue releases often associated with considerable bleeding. In a prospective, randomised trial we compared postoperative conventional suction drainage versus four hour clamping drainage in 60 patients undergoing total knee arthroplasty for severe osteoarthritis. We compared blood loss, number of transfusions, postoperative complications and knee function and found significantly less postoperative blood loss through the drains (p

We investigated intracapsular pressure and elasticity of the hip joint capsule in osteoarthritis. HOOS hip score, sonography of the hip joint, and radiographic assessment of osteoarthritis were performed in 31 patients before total hip arthroplasty. The intracapsular hydrostatic pressure was measured perioperatively, and 0.9% saline solution was then injected in the hip joint, 1 mL at a time, with continuous pressure recording up to 300 mm Hg. The mean radiographic grade of severity of osteoarthritis was 8 (SD, 2.4). The mean hydrostatic intracapsular pressure in 45 degrees of flexion was 2.2 mm Hg (SD, 10.0); in extension, 15.8 mm Hg (SD, 33.0); in inward rotation, 13.7 mm Hg (SD, 26.0); and in outward rotation, 12.1 mm Hg (SD, 24.3). Severe osteoarthritis was associated with lower intracapsular pressure and lower elasticity of the joint capsule.

Hip replacement as a routine procedure was introduced in Lithuania in 1991. At Klaipeda Hospital, one of the 2 hospitals at which this was begun, the arthroplasties were followed prospectively from the start. This study concerns the 10-year results from a country with no previous experience of hip replacement. The results are compared with those from a hospital with considerable experience of total hip replacement.We compared the revision rate for the first 658 primary ScanHip arthroplasties inserted at Klaipeda to that for the first 939 ScanHip primary arthroplasties inserted at Lund University Hospital, Sweden. Only patients with osteoarthritis were included, and the endpoint was revision for aseptic loosening with exchange of one or both components.We found that patients operated at Klaipeda Hospital had a significantly higher risk of revision (12%) than those operated in Lund (6%).Although we could not identify any specific reason for the Swedish results being better than the Lithuanian results, it is probable that previous surgical inexperience of hip replacement in Lithuania played a role. We believe that the findings will stimulate surgeons in Lithuania to analyze their failures and improve the results.

The aim of this study was to investigate if preoperative measurements of the femoral valgus angle (FVA) affected the mechanical alignment, individual component positions and clinical outcome in total knee arthroplasty (TKA). 120 patients were randomized into two groups. In one group (control), a fixed FVA for the intramedullary femoral guide was set at 7°, whereas in the other group (measured) FVA was measured preoperatively on long hip–knee–ankle radiographs, and the angle for the distal femoral cut was set accordingly. Preoperatively and 1 year after TKA, range of motion (ROM) and Knee Society Score (KSS) were assessed. Postoperatively, the coronal alignments of the components and the mechanical alignment were measured comparing the rate of outliers which deviated more than 3° from the neutral mechanical axis. 104 patients remained for the radiological analysis (52 in each group). There were no significant differences either in the mean preoperative or postoperative mechanical alignment, or femoral or tibial component alignment; also, there were no differences in the number of postoperative mechanical axis or tibial component alignment outliers. However, the number of femoral component alignment outliers was significantly higher in the control group. 97 patients were available for clinical outcome analysis. Preoperatively, the groups did not differ significantly with respect to KSS or ROM. The postoperative ROM and KSS functional subscale scores were similar between the groups. However, there was slightly but significantly better postoperative KSS objective subscale score in the measured group. Preoperative FVA measurement and following femoral distal cut adjustments did not affect overall leg alignment postoperatively, while positioning of femoral component was improved together with minor improvements in objective KSS subscale scores.

Hip dislocation after arthroplasty for femoral neck fractures (FNF) remains a serious complication. The aim of our study was to investigate FNF patients treated with THA, with a special focus of comparing the effect of surgical approach and femoral head size on the risk of revision for dislocation. Data were derived from the Lithuanian Arthroplasty Register, and we calculated the cumulative revision rates after surgery. For survival analysis, we used revision due to dislocation as an end-point. Cox proportional hazards models were used to analyse the influence of various covariates (age, gender, femoral head size, surgical approach). A total of 8,813 primary THAs were registered from 1 January 2011 to 31 December 2013, of which 1,412 were due to FNF: 899 involved 28-mm femoral heads and the remaining 513 received 32-mm heads. The posterior approach was used in 1,156 cases and the anterolateral approach in 256.. At the end of the follow-up period, 74 hips had been revised for recurrent dislocation. Cox regression adjusting for age, gender and head size showed that the posterior approach had 2.3-times [95% confidence interval (CI): 1.0–5.0, p = 0.04] greater risk of revision for dislocation We conclude that in order to reduce the early dislocation rate in FNF patients treated with THA, it is more effective to use the anterolateral approach than it is to select a femoral head size of 32 mm instead of 28 mm.

Hip fractures constitute a serious and common health problem from both individual and public health perspectives. Unified data collection and comparison between countries is recognised as an effective tool for care improvements. However, the variation in patients' demography, treatment methods and other local cultural aspects in different countries should be considered. The aim of our study was to compare femoral neck fracture patients treated in Kaunas and Lund, concerning functional outcome and quality of life. We investigated 99 patients treated by arthroplasty in Kaunas Clinics and 117 patients in Lund University Hospital. Patients were investigated according to the National Swedish Hip Fracture Register model and were followed up for a period of four months after the injury. The patient's place of residence, mobility, complaints of pain and additional hospital stay were recorded. The EQ-5D questionnaire was used to evaluate quality of life. Patients in Kaunas were significantly younger, had lower ASA grade and were more mobile before trauma and at four moths follow-up. However, when comparing quality of life at four months follow-up between the institutions, Lund patients reported significantly better self care, felt less pain and discomfort, and had less symptoms of anxiety and depression. The difference observed in quality of life rating between institutions might be related to local cultures of the countries and should be considered when comparing the data.

The aim of this study was to determine the causes and pattern of hemodynamic changes during hepatic resection, performed without vascular exclusion technique, and to select the most appropriate methods for monitoring patient's condition during the surgery.This prospective study included 55 ASA class I-III patients who had undergone hepatic resection surgery at the Clinic of Surgery, Hospital of the Lithuanian University of Health Sciences (former Kaunas University of Medicine) in 2003-2008. Additional monitoring of central hemodynamic parameters, arterial blood pressure, central venous pressure, and pressure in the inferior vena cava using invasive methods was performed.During the surgery, hypotension episodes (n=186) occurred in 53 out of 55 patients with a mean of 3.4 (SD, 2.0) episodes per patient. Changes (n=262) in femoral vein pressure were observed in 54 out of the 55 patients with a mean of 4.8 (SD, 3.2) episodes per patient. During the hypotension episode, significant changes in the mean arterial blood pressure, femoral vein pressure, cardiac output, cardiac index, systemic vascular resistance index, and central venous pressure were documented. There was a significant positive correlation between blood loss and number of changes in femoral vein pressure (r=0.5; P0.001). Blood loss of more than 450 mL was observed in 69.0% of patients with increasing and 38.2% of patients with decreasing central venous pressure (P0.01). Less than half (41.6%) of patients in the group of negative change in femoral vein pressure and 88.0% in the group of positive change in femoral vein pressure lost more than 450 mL of blood (P0.001).The most common hemodynamic changes during hepatic surgery include hypotension, decreased cardiac output and cardiac index, and elevated pressure in the inferior vena cava. More common cause of hypotension was clamping of the inferior vena cava, and less common was blood loss. Blood loss was related to the number of clamps of the inferior vena cava and increasing pressure in the superior vena cava. A cause of hypotension during hepatic resection may be determined by pressure monitoring in the superior and inferior vena cava.

Tyrimo tikslas. Nustatyti kepenų rezekcinių operacijų metu vykstančių hemodinaminių pokyčių priežastis bei jų pobūdį, kai nenaudojamos kepenų kraujotakos sustabdymo metodikos, bei parinkti labiausiai tinkamus paciento stebėsenos metodus. Metodai. Į prospektyvųjį tyrimą įtraukti 55 pacientai, kuriems 2003–2008 m. Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikose (tuometinėse KMUK) Chirurgijos klinikoje buvo atliktos kepenų rezekcinės operacijos. Papildomai buvo stebimi pacientų centrinės hemodinamikos rodmenys, arterinis kraujo spaudimas, centrinis veninis spaudimas ir slėgis apatinėje tuščiojoje venoje invaziniais metodais. Rezultatai. 53 pacientams operacijos metu konstatuoti hipotenzijos epizodai (iš viso 186) – 3,4 (2,0) vienam pacientui. Slėgio šlaunies venoje pokyčiai, nustatyti 54 pacientams (iš viso 262) – 4,8 (3,2) vienam pacientui. Hipotenzijos epizodo metu reikšmingai kito, atsižvelgiant į pradines reikšmes, slėgis šlaunies venoje, širdies minutinis tūris, širdies indeksas, sisteminis periferinių kraujagyslių priešinimosi indeksas, centrinis veninis slėgis. Netekto kraujo kiekis ir slėgio šlaunies venoje pokyčių skaičius tarpusavyje koreliavo teigiamai reikšmingai (r=0,5, p&lt, 0,001). Daugiau kaip 450 ml kraujo neteko 69,0 proc., jei centrinis veninis spaudimas didėjo, 38,3 proc., jei jis mažėjo (p&lt, 0,01). Daugiau kaip 450 ml kraujo neteko 41,6 proc. neigiamo slėgio šlaunies venoje pokyčio grupėje, 88,0 proc. – teigiamo pokyčio grupėje (p&lt, 0,001). Išvados. Kepenų operacijų metu dažniausiai stebimi hemodinaminiai pokyčiai yra hipotenzija, širdies indekso sumažėjimas ir slėgio apatinėje tuščiojoje venoje padidėjimas. Hipotenzijos priežastis dažniau yra apatinės tuščiosios venos perspaudimas, rečiau – kraujo netekimas. Kraujo netekimas susijęs su apatinės tuščiosios venos perspaudimų skaičiumi ir su didėjančiu slėgiu viršutinėje tuščiojoje venoje. Hipotenzijos priežastį kepenų rezekcinių operacijų metu galima nustatyti stebint slėgius viršutinėje bei apatinėje tuščiojoje venoje.

Background While a relation between pain and intracapsular pressure in the hip joint has previously been reported by some of the present authors, a newly published study including patients with severe osteoarthritis was not able to confirm this finding. This stimulated us to investigate the role of short rotators in relation to intracapsular pressure and pain in osteoarthritic hips. Methods We measured the intracapsular hydrostatic pressure peroperatively in 25 total hip arthroplasty patients with severe osteoarthritis in various positions of the hip joint before and after short rotator release, and correlated these pressures to pain. Results Release of the short rotators did not change the intracapsular pressure in any position except in 45° flexion, in which the pressure increased (p = 0.002). We found no correlation between intracapsular pressure and pain before or after short rotator release. Conclusion We could not show that the rotators directly affected the pressure nor could we find a relation between pressure and pain.

The results of minimally invasive techniques used for total knee replacement are controversial. Despite reported advantages such as faster recovery, there are some concerns regarding component positioning. We compared mini-midvastus versus medial parapatellar arthrotomy with respect to component position and functional results. We included 70 osteoarthritis total knee replacement patients in our study. Patients were randomised for the approach. We recorded Knee Society scores before and after the surgery and radiological component position. Patients were followed up to 12 weeks after the surgery. We found that the mini-midvastus approach was associated with better Knee Society scores six weeks after surgery; after 12 weeks the difference was not statistically significant. We found no difference related to the approach in radiological component position. The mini-midvastus approach is associated with faster recovery and reproduces the same accuracy in component positioning as the medial parapatellar approach.

Objective. To compare implant survival rates after total hip arthroplasty with Exeter matte or polished stems and to determine the relationship of synovitis/joint effusion to signs of implant loosening and stem type. Material and methods. The first part of the study included retrospective revision rate analysis of 118 primary hip replacements performed during 1991–1995. Two different designs of Exeter stems were used: matte surface stems during 1991–1995 (matte surface group – 47 cases), and polished stems during 1992–1995 (polished stem group – 71 cases). During the second part of the study, 24 patients (11 in polished stem group and 13 in matte stem group) were prospectively examined with radiography and sonography. Sonography was performed in order to evaluate capsular distension, i.e. the distance between prosthetic femoral neck and anterior capsule. Capsular distension depends on synovitis and/or synovia in prosthetic hip. The relationship between capsular distension, stem type, and radiographic signs of loosening was assessed. Results. For the first part of our study, total implant survival was 78% with matte stems and 61% with polished stems 13 years postoperatively (P=0.27). Stem survival was 82% for matte stems, and 88% for polished stems (P=0.54). In the second part of study, a significant relationship between increased capsular distension and cup loosening was determined (P=0.04). We did not find significant difference in capsular distension when compared matte and polished stems. Conclusion. Implant survival rates did not differ between the groups. The relationship between capsular distension and cup loosening was statistically significant.

To compare the influence of two different cemented stems each made of different alloys on survival and outcome.We analyzed 341 total hip replacements performed in 1998-2001. Two types of prostheses were implanted. Biomet Bi-Metric titanium stem, cobalt-chrome head and ultra high molecular weight all poly cup were implanted in 102 cases. Aesculap Centrament cobalt-chrome stem, head and ultra high molecular weight all poly cup were implanted in 239 cases. All prostheses were cemented; Palacos bone cement with gentamycin was used in all cases. Cementing technique was consistent in all cases. All data were collected prospectively. For every total hip replacement the form was filled in. The documental patients' data, implant type, cement type, cementing technique, intraoperative and postoperative complications were registered. All revision surgeries were registered; the patients' death dates were recorded from national register database up to December 31, 2004. Kaplan-Meier curves were used to calculate implant survival rates.The total implant survival for Biomet Bi-metric prostheses was 98%, 7 years postoperatively. The total implant survival as Aesculap Centrament prostheses were used was 98%, 6 years postoperatively.The mid-term implant survival of Biomet Bi-Metric titanium stems was the same as survival of Aesculap Centrament cobalt-chromium stems.

The upper cervical spine includes the articulations of the occiput with atlas and the atlas with the axis, as well as the bony structures of the base of the skull, axis, and atlas. The unique anatomy of the upper cervical spine and the typical mechanisms of injury yield a predictable variety of injury patterns. Injuries to this area include occipital condyle fractures, occipitoatlantal dislocations, subluxations and dislocations of the atlantoaxial articulation, atlas fractures, odontoid fractures, and fractures of the arch of the axis. Injuries to this region are relatively common and can be easily overlooked because patients with the upper cervical injury may have an associated head injury, which can alter their level of consciousness and complicate obtaining an accurate history and physical examination. The complex regional anatomy and overlying structures make plain radiographic images difficult to interpret. Delayed recognition can result in significant disability. A thorough understanding of the clinical presentation, radiographic assessment, and mechanisms of injury can minimize morbidity and enhance treatment effectiveness for the more common upper cervical ligamentous and bony injuries.

The purpose of this study was to compare the outcomes of mosaic-type osteochondral autologous transplantation (OAT) and microfracture (MF) procedures for the treatment of the articular cartilage defects of the knee joint in young active athletes.Prospective randomized clinical study.Between 1998 and 2002, a total of 60 athletes with a mean age of 24.3 years (range, 15 to 40 years) and with a symptomatic lesion of the articular cartilage in the knee were randomized to undergo either an OAT or an MF procedure. Only those athletes playing in competitive sports at regional or national levels were included in the study. Fifty-seven athletes (95%) were available for a follow-up. There were 28 athletes in the OAT group and 29 athletes in the MF group. The mean duration of symptoms was 21.32 +/- 5.57 months and the mean follow-up was 37.1 months (range, 36 to 38 months), and none of the athletes had prior surgical interventions to the affected knee. Patients were evaluated using modified Hospital for Special Surgery (HSS) and International Cartilage Repair Society (ICRS) scores, radiograph, magnetic resonance imaging (MRI), and clinical assessment. An independent observer performed a follow-up examination after 6, 12, 24, and 36 months. At 12.4 months postoperatively, arthroscopy with biopsy for histologic evaluation was carried out. A radiologist and a pathologist, both of whom were blinded to each patient's treatment, did the radiologic and histologic evaluations.After 37.1 months, both groups had significant clinical improvement (P.05). According to the modified HSS and ICRS scores, functional and objective assessment showed that 96% had excellent or good results after OAT compared with 52% for the MF procedure (P.001). At 12, 24, and 36 months after surgery, the HSS and ICRS showed statistically significantly better results in the OAT group (P = .03; P = .006; P = .006). Younger athletes did better in both groups. No serious complications were reported. There was 1 failure in the OAT group and 9 in the MF group. The ICRS Cartilage Repair Assessment for macroscopic evaluation during arthroscopy at 12.4 months showed excellent or good repairs in 84% after OAT and in 57% after MF. Biopsy specimens were obtained from 58% of the patients and histologic evaluation of repair showed better scores (according to ICRS) for the OAT group (P.05). MRI evaluation showed excellent or good repairs in 94% after OAT compared with 49% after MF. Twenty-six (93%) OAT patients and 15 (52%) MF patients returned to sports activities at the preinjury level at an average of 6.5 months (range, 4 to 8 months). Others showed a decline in sports activity level.At an average of 37.1 months (range, 36 to 38 months) follow-up, our prospective, randomized, clinical study in young active athletes under the age of 40 has shown significant superiority of OAT over MF for the repair of articular cartilage defects in the knee. We found that only 52% of MF athletes could return to sports at the preinjury level. Limitations of our study included a small number of athletes and a relatively short (3-year) follow-up. A long-term follow-up is needed to assess the durability of articular cartilage repair using these methods in young active athletes.Level I, Therapeutic study, randomized controlled trial, significant difference (a).

Quality of life in patients with femoral neck fracture is an issue frequently discussed in the literature. There is ongoing research on identifying factors that have an impact on quality of life in this particular group of patients. A great variety of factors affecting quality of life and lack of information on their importance encouraged us to perform a systematic literature review analyzing quality of life of patients who sustained femoral neck fracture. The search was performed in the PubMed and Medline databases according to the selected key words. In our systematic review, we included clinical and clinical randomized trials investigating patients with femoral neck fracture and their quality of life. Our analysis showed that treatment of femoral neck fracture with hip replacement was superior to osteosynthesis with regard to patients’ quality of life. The data regarding the impact of different rehabilitation programs on quality of life were controversial; a few reports showed that special rehabilitation programs were associated with better health-related quality life. However, other studies did not report any differences in patients’ quality of life when different rehabilitation programs were applied. Patient’s nutrition may be an important factor affecting the quality of life in patients with femoral neck fractures; however, data supporting this fact are insufficient.

Objective. A nonrandomized clinical study was performed to compare the clinical and radiological outcome between double-bundle and single-bundle anterior cruciate ligament (ACL) reconstructions with semitendinosus tendon in athletes. Material and methods. We examined 70 patients with unilateral anterior cruciate ligament injury. They were followed up for a mean of 24 months. Each group of 35 patients underwent either double- or singlebundle ACL reconstruction. The mean age of the patients was 24.7 years (range, 18–35 years). There were no differences between two groups regarding age at surgery, sex, follow-up period, period before surgery, combined meniscus injuries, athletic activity level, and International Knee Documentation Committee (IKDC) and Tegner scores. All patients followed the same postoperative program. They were evaluated using manual knee laxity tests, knee extension and flexion strength testing. General knee condition was evaluated by the IKDC and Tegner scores. Results. The results were excellent and good in 32 (91.4%) patients after double-bundle ACL reconstruction and in 30 (85.7%) patients after single-bundle ACL reconstruction, evaluating by IKDC system. However, statistical analysis showed no significant difference between the two groups regarding all IKDC-categorized data (P=0.87). The average scores of Tegner activity in double-bundle and single-bundle groups were 8.0 and 8.1, respectively. Conclusions. This trial showed no significant difference between the double and single-bundle ACL repairs.

A method of evaluating the antifibrillatory properties of drugs by their effect on the acceleration of the cardiac rhythm by electric pulses was developed. It permitted measurement of fibrillation thresholds and the maximal driving frequency of stimulation. The heart was accelerated in closed chest dogs, and this increased the fibrillation thresholds after the application of lidocaine (1 mg/kg), quinidine (5 mg/kg), and novocainamide (15 mg/kg body wt.). The development of an original programmed stimulator increased the accuracy of the method by means of establishing the initial and terminal stimulation rates and observing the constant steps of change of pulse intervals. Four methods of causing fibrillation were compared: (1) a single pulse during the vulnerable phase of the cardiac cycle; (2) a train of pulses overlapping the vulnerable phase; (3) sequential R on T pacing; (4) simple acceleration of the cardiac rhythm. In addition to the other methods, the method of accelerating the heart rate differs in that only a small amplitude of stimulating pulses is needed. The present method may be used in the case of an unstable initial cardiac rhythm.