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6 Abstract This thesis compared age and sex differences in lunate surface morphology using a 3D geometric-morphometric approach. The acetabulum of 240 individuals was compared using landmarks and semilandmarks placed along the edge of the lunate surface. The individuals ranged in age from 20 to 90 and came from three geographic areas. This thesis was based on the study of San-Millán et al. (2017a) that used a 2D geometric-morphometric approach to investigate the shape of the acetabulum. Analyses in this thesis showed that size, sex, and age significantly affect the acetabular shape. The differences between both sexes can be observed in the size and depth of the acetabulum, the width of the acetabular notch, and the amount of bone growth at the acetabular horns and along the edges of the lunate surface. Both sexes exhibit age- related changes, which are linked to gradual deposits of bone along the edge of the lunate surface, the acetabular horns, and the acetabular fossa, which tends to lose the 3-lobed cloverleaf shape. According to the geometric-morphometric analysis conducted in this thesis, the acetabulum provides more accurate age estimates for individuals younger than 65 years of age. Keywords: Bioarchaeology, forensic anthropology, age estimation, sex estimation, acetabulum, lunate surface of hip...

The authors report on three cases in which a custom-made 3D printed titanium acetabular component of total hip arthroplasty was used to manage an advanced acetabular bone defect with pelvic discontinuity. The implant surface structure impeded long-term bone integration. Nonetheless, the stable bridging of the acetabular defect resulted in full integration of impacted bone allografts at the base of the implant. The pelvic continuity was restored within 12 months after surgery, and thus the acetabulum was prepared for potential further implantation of a standard revision acetabular component. Only one of the three female patients underwent a revision surgery at 18 months after surgery, the other two female patients were satisfied to such a degree with the clinical outcome at 6 years and 5 years, respectively, after surgery that they refused to undertake the revision surgery, despite X-ray images showing signs of loosening of the custom-made titanium acetabular component. The authors concluded that the implantation technique of three-point fixed custom-made 3D printed acetabular component made of titanium combined with impaction grafting of the acetabular base is a good alternative in managing the advanced bone defects of acetabulum with pelvic discontinuity after the failure of total hip arthroplasty. Even though inadequate surface porosity of the thus produced component did not allow its permanent osteointegration, the assembly was stable enough to allow the bone allografts to rebuild and restore continuity of the pelvis and facilitated future implantation of the standard revision acetabular component. Key words: 3D printing, individual acetabular component, titanium, total hip prosthesis, revision hip arthroplasty, acetabular reconstruction, custom-made implants.

PURPOSE OF THE STUDY Two-year clinical results of a multicenter prospective randomized study in patients with arthroscopically treated Femoro - acetabular Impingement syndrome and concurrently performed microfracture for grade IV chondral lesions of the acetabulum. MATERIAL AND METHODS The study evaluated a group of 55 patients of the originally enrolled 92 patients with the underlying diagnosis of FAI syndrome with intraoperatively confirmed grade IV acetabular chondropathy of up to 4 cm2 in size, who had undergone a comprehensive hip arthroscopy (correction of structural cam-type and/or pincer-type deformity, labral refixation or partial labral resection etc.) performed by two experienced surgeons. The patients were randomized intraoperatively using a closed envelope method into two groups. In Group 1 (31 patients), microfractures for chondral defects was performed, while in Group 2 the patients underwent a defect debridement procedure only. The studied group included a total of 7 professional and 48 recreational athletes (33 men and 22 women), with the mean age of 34.4 in Group 1 and 31.1 in Group 2. Preoperatively and 6, 12 and 24 months postoperatively the modified Harris Hip Score (mHHS) parameters and VAS score were evaluated and also revision surgeries, conversion to endoprosthesis, and occurrence of complications were recorded. RESULTS Preoperatively, no statistical difference between the two groups was found in the studied parameters (mHHS and VAS). Postoperatively (after 6, 12 and 24 months), in both groups a statistically significant increase in mHHS and VAS score was reported. When comparing the mHHS parameter at individual evaluated times in Group 1 and Group 2, a statistically significant difference was confirmed at 12 and 24 months after surgery (P0.001), namely in favour of Group 1. At 6 months postoperatively, no statistically significant difference in this parameter between the two groups was confirmed (P = 0.068). When comparing the VAS score parameter in these two groups at individual times, no statistically significant difference was confirmed at 6 and 12 months after surgery (P= 0.83 / P= 0.39). A statistically significant difference in the VAS score parameter was observed only at 24 months after surgery, namely in favour of Group 1 (P0.037). In the course of the follow-up period, altogether 3 patients (2 patients from Group 1) were indicated for revision hip arthroscopy and in 1 female patient an endoprosthesis was implanted. No severe intraoperative or postoperative complications were observed. DISCUSSION In agreement with other authors worldwide, the arthroscopic treatment of FAI syndrome, if indicated and performed correctly, was confirmed to improve the clinical condition of patients postoperatively, regardless of the technique used in treating the chondral defect. Based on our results as well as conclusions of other world authors, in treating the grade IV defects of smaller size it is appropriate, in treating the cartilage, to prefer the microfracture surgery, which is less demanding both technically and financially and contrary to mere debridement allows to fill the original defect by fibrocartilage tissue. CONCLUSIONS The benefits of the acetabular microfracture in patients with the FAI syndrome treated arthroscopically were confirmed. A statistically significant difference between the two studied groups was reported in the mHHS parameter at 12 and 24 months after surgery and also in the VAS parameter at 24 months in favour of the group with performed microfracture. In both the studied groups, the arthroscopy resulted in a statistically significant improvement of the assessed quality of life parameters. Key words: hip arthroscopy, femoroacetabular impingement syndrome, chondral defect, microfracture, abrasive chondroplasty.

Autor: Zuzana Svobodová Název: Case study of physiotherapy treatment of a pacient after fracture of the distal radius and acetabulum Vedoucí práce: Mgr. Michaela Stupková Cíl: The aim of this bachelor thesis a summary of general knowledge about the issue of fracture of the distal part of the radius and fracture of the acetabulum. In the practical part, a detailed case report of the patient is elaborated and the subsequent rehabilitation care is described together with the results of the therapy. Metody: The bachelor thesis was written within the practice at the Department of Aftercare and Rehabilitation in the Havlíčkův Brod Hospital. The general part describes the anatomy, biomechanics and kinesiology of the forearms and acetabulum, along with the classification of fractures and rehabilitation procedures. In a special part of the bachelor thesis, a case report of a patient after polytrauma is processed, focusing mainly on the rehabilitation of the upper limb. Výsledky: The patient completed nine therapeutic units during the hospitalization, during which there was a significant improvement in range of motion, reduction of swelling and reduction of pain. The patient also reported subjective improvement in his mental health. Klíčová slova: Fractures, distal radius, acetabulum, polytrauma, rehabilitation

PURPOSE OF THE STUDY Continuous epidemiologic data on changes in the spectrum of acetabular fractures is rare. The purpose of this study is to evaluate changes in the types of acetabular fractures over the last two decades. MATERIAL AND METHODS In the period between 2007 and 2016, a total of 522 patients were treated at the authors department (Traumacentre Level I) for acetabular fractures. 15 patients sustained bilateral fractures. The group consisted of 361 men and 161 women, with the mean age of 49 years (the range of 10-96 years). Standard procedure was applied to diagnose the fractures (X-ray and CT scan). Non-operative treatment was opted for in fractures without displacement, fractures with minimum displacement of acetabular weight bearing area less than 2 mm, confirmed by the CT scan (e.g. low fractures of anterior column, low transverse fractures), fractures with secondary congruence in patients over the age of 70, and fractures in patients contraindicated for surgery due to their serious overall medical condition or severe osteoporosis. A surgery was indicated in case of instability or incongruent acetabular joint space due to the displacement of weight bearing area fragments, or a bone fragment or soft tissue interposition. A surgery was indicated also in a non-displaced acetabular injury with concurrent femoral head injury. AO/ASIF classification was used to classify the fractures. The following data was monitored in the referred to group of patients: gender, age, mechanism of injury, associated injuries, type of fracture, and treatment method. RESULTS Type A fracture was reported in 293 patients (56%), type B fracture in 150 patients (29%) and type C fracture in 79 patients (15%). A high-energy trauma occurred in 334 patients (64%), namely 254 men and 50 women, with the mean age of 41 years. A low-energy trauma was sustained by 188 patients (36%), namely 77 men and 111 women, with the mean age of 69 years (56-91). This difference in the share of men and women with respect to the seriousness of the mechanism of injury was statistically significant (p0.0001). Non-operative treatment was used in 248 patients (48%), of whom 167 were men and 81 were women. The mean age in this sub-group was 60 years, namely 58 years in men and 62 years in women. Operative treatment was opted for in 272 patients (52%), of whom 206 were men and 50 were women, with the mean age of 45 years in women as well as in men. The statistical processing of differences between the non-operative and operative treatment in dependence on the type of fractures revealed a significantly higher percentage of operative treatment in type C fractures compared to type A and B fractures (p0.0001, or p = 0.0009). In the group of patients treated by the authors in the 1996-2002 period, type A fractures constituted 45% of all fractures, where A1 fractures prevailed with 29%, A2 fractures represented 9% and A3 fractures only 6 %. In the recent group of patients, type A fractures constituted 56%, but A3 fracture were seen in 29% of patients, which was a significant increase (p0.0001). A3 fractures (anterior wall or anterior column fractures) were associated with a low-energy mechanism of injury and occurred in 48% of patients (73, mostly elderly women). DISCUSSION When compared to the published groups of other authors, the monitored group showed no difference in the mean age and gender ratio. There was an obvious increase in the number of patients with a low-energy mechanism of injury. The authors believe that this is the result of population ageing. It is also related to the growing share of patients treated non-operatively. The number of patients with a high-energy mechanism injury increased to a lesser degree. The spectrum of fractures significantly changed over the last 20 years. It was caused by an increase in low-energy injuries and partly also by improved diagnostics. CONCLUSIONS In the last 20 years, the authors noticed a rise in some types of acetabular fractures. It was caused by a statistically significantly higher number of fractures with a low-energy mechanism of injury, especially in elderly patients, the so-called "fragility fractures". Therefore, the share of non-operatively treated acetabular fractures increased as well. The number of acetabular fractures in young patients as a result of a high-energy injury grew more slowly, and it was only the share of posterior-wall acetabular fractures that was significantly higher. Key words: epidemiology of acetabular fractures, mechanism of injury, types of acetabular fractures.

INTRODUCTION The purpose of our study was to evaluate the clinical outcomes in patients at 3-6 years follow-up after primary implantation of RM Pressfit Vitamys cementless elastic cup and cementless Optimys short stem, including bone tissue remodelling around both the components. MATERIAL AND METHODS The evaluation covered 49 joint replacements in patients who had undergone surgery at our department between 2012 and 2015. The age at the time of primary surgery ranged from 29 to 71 years, with the mean value of 59.2 years. Postoperatively, the position of endoprosthesis, changes in femoroacetabular offset, signs of osseointegration of the implant, bone tissue remodelling around both the components and potential signs of aseptic loosening were assessed. The functional status of the joint was evaluated according to the Harris scale. RESULTS The mean follow-up time of Vitamys cup and Optimys stem was 5.6 years and 4.6 years, respectively. We focused on the combination of RM Pressfit Vitamys (49x), Optimys (28x) and Bionit 2 (41x) implants. All the cups showed good osseointegration. Based on the comparisons with a postoperative X-ray, at least mild osteoporosis in the acetabular roof was confirmed in 6 cases. All Optimys femoral components were in direct contact with the Adams arch and with the endosteal side of lateral cortex of proximal femoral metadiaphysis. Femoroacetabular offset was slightly decreased in 5 patients only. The final evaluation in 2018 did not confirm any radiolucent lines or signs osteolysis around any of the components. In 2 stems only, distal migration less than 2 mm was obvious, with subsequent good osseointegration. Signs of stress shielding were present in 2 femoral components in the form of mild cortical atrophy in the region of the Adams arch. Distal femoral cortical hypertrophy was not observed, the greater trochanter did not show the loss of bone tissue in any of the patients. There were no signs of polyethylene wear. The mean value of HHS increased from 53 to 97 points. An excellent result was achieved in 44 total hip replacements, of which 100 points in 28 cases. In the remaining 5 patients the result was good. The survival rate of both the components was 100% according to the Kaplan-Meier analysis. DISCUSSION The successful functioning of cementless total hip arthroplasty is the correct placement of both components with good primary fixation. Excessive proximal and lateral shift of the centre of rotation results in increased load of endoprosthesis and risk of earlier aseptic loosening, its reduction leads to the weakening of pelvitrochanteric muscles. The shift of the centre of rotation from the original anatomical position should therefore not exceed 5 millimetres. Insufficient cup fixation always results in mechanical failure of an endoprosthesis. Distal migration of stems without contact with external femoral cortex with full weight-bearing of the operated lower extremity in the postoperative period does not constitute a sign of instability, but only its placement enables good osseointegration. Bone remodelling can be assessed by imaging techniques at 2 years after the primary implantation at the earliest. At places with lower load, the bone loss occurs and the loss of bone trabeculae can lead to the failure of fixation of the component. At places with load accumulation, the bone hypertrophy occurs that can be manifested by thigh pain. In case of cementless press-fit cup, the degree of bone remodelling depends on its elasticity, in case of stem on the used material, shape and fixation site. CONCLUSIONS The RM Pressfit Vitamys monobloc cup through its mechanical properties approximates the best the elasticity of bone tissue. The stress distribution around the implant is more symmetrical as against other conventional cementless cups. The Optimys stem enables the reconstruction of anatomical conditions corresponding a healthy hip joint. Respecting the rule of at least three-point fixation is a precondition for good and fast secondary stability of components. Minimising the wear of articulating surfaces and physiological remodelling of adjacent bone tissue are the main factors that help prolong the survivorship of both the components, while also securing more favourable conditions and better outcomes in case of necessity of reimplantation. Key words: cementless elastic cup, short cementless stem, femoroacetabular offset, stress shielding, osseointegration of the implant.

PURPOSE OF THE STUDY Non-operative and operative treatment of acetabular fractures is associated with a risk of development of posttraumatic avascular necrosis of femoral head or with the development of posttraumatic coxarthrosis. The purpose of the study was to identify the occurrence of these two complications in patients in our group and to determine the risk factors for the development of these complications. MATERIAL AND METHODS The retrospective study was conducted in two Level I trauma centres in the period from 2009 to 2014. The group included patients with an acetabular fracture. The inclusion criteria were the following: outpatient follow-up for the period of 3 years after the injury, full radiology and CT documentation. The exclusion criteria were the following: pathological fractures, missing documentation after the union, insufficient follow-up period or dissent of the patient. The inclusion criteria were met by 192 patients, 48 women and 144 men, with the mean age of 48.9 years. The following basic epidemiological data were monitored: age, sex, cause of injury, type of fracture according to the Letournel classification, occurrence of associated injuries and type of therapy. The patients undergoing non-operative treatment as well as patients undergoing operative treatment underwent clinical and radiological examinations at 3 and 6 weeks after the injury, then at 3, 6 and 12 months after the injury, subsequent follow-up checks were done at a year-interval up to 3 years after the injury. RESULTS The posttraumatic avascular necrosis of femoral head developed in 22 patients (11.7%, 17 men, 5 women, p = 0.1159), with the mean age of 55.3 years (STDEVP 15.5, range from 22 to 82). The average time to the development of femoral head necrosis was 13.1 months (STDEVP 17.0, range from 1 to 80), median 6 months, 95% percentile 34 months. In a total of 16 patients necrosis developed within 18 months after injury, while in 6 patients after a longer period of time. Progression of coxarthrosis was observed in 63 patients (33.5%, 44 men and 19 women, p = 0.0447). Within 24 months progression was seen in 55 patients, beyond 2 years in 8 patients. Confirmed as risk factors for the development of posttraumatic avascular necrosis of femoral head and progression of posttraumatic coxarthrosis were the age 60 years and above (p = 0.0023), posttraumatic medialisation of the femoral head greater than 2 mm (p0.0001), displacement in the weight bearing area within the acetabulum greater than 2 mm (p0.0001), operative treatment (p = 0.0014), combined surgical approach (p = 0.0044), and higher caput-collum-diaphyseal (CCD) angle of proximal femur (p = 0.0142). At risk for the development of avascular necrosis were the A5 type fractures (p = 0.0214) and B2 type fractures (p = 0.0218), at risk for the development of coxarthrosis were the C1 type fractures (p = 0.0122). The isolated fractures of the anterior column were by contrast associated with a significantly lower risk for development of both the AVN (p = 0.0052) and posttraumatic coxarthrosis (p = 0.0006), the isolated fractures of the posterior wall were associated only with a higher risk for AVN and coxarthrosis summation (p = 0.0399), and the same applies to the T fractures (B3, p = 0.0200). DISCUSSION Majority of current studies regarding acetabular fractures focuses on operative treatment, short-term complications and comparison of outcomes of operative and non-operative treatment. Only a few studies are dedicated to epidemiological data, or risk factors for the development of medium-term and long-term complications. In the presented study attention was paid to two main complications arising from these fractures and requiring subsequent operative treatment: posttraumatic avascular necrosis of femoral head and posttraumatic coxarthrosis. The limitations of the study are its retrospective nature, summation of groups from two trauma centres (potential bias in patient enrolment or in assessing radiographs), lower frequency of clinical surveillance in non-operatively treated patients after healing, a fairly low number of non-operatively treated patients - especially those with osteoporosis-related insufficiency fractures. Ranking among the relative limitations is also the Letournel classification which, though most commonly used at present, shows a low level of correlation in comparisons by more evaluators. CONCLUSIONS Confirmed as significant risk factors for the development of posttraumatic avascular necrosis of the femoral head and posttraumatic coxarthrosis progression were the age of 60 and above, posttraumatic medialisation of the femoral head greater than 2 mm, displacement involving the weight bearing area of the acetabulum greater than 2 mm, operative treatment, combined operative approach. At risk are also the transverse fractures (A5 according to the Letournel classification), transverse posterior wall fractures (B2 according to the Letournel classification) and at risk for the development of coxarthrosis are both-column fractures with the high fracture line of the anterior column (C1 according to the Letournel classification). Femoral neck valgosity was a risk factor for the development of femoral head necrosis. Conversely, sex and instability of osteosynthesis detected on the radiograph within 3 months postoperatively were not confirmed as the risk factors for the development of aforementioned complications. To verify the results of this retrospective study other multicentric and prospective studies should be conducted. Key words: complications of treatment of acetabular fractures, risk factors for avascular necrosis of femoral head, risk factors for coxarthrosis.

PURPOSE OF THE STUDY The prevalence of nerve structure injuries accompanying pelvic and acetabular fractures is stated to be 5-25 %, with most frequent injuries to motor nerve structures associated with fractures of the posterior wall of the acetabulum. Prognostically worse outcomes of regeneration are documented mainly in iatrogenic, intraoperative injuries to nerve structures. This study aims to document the functional effect of muscle transfers restoring the movement of lower extremities with irreversible nerve lesion caused by the pelvic and acetabular fracture. MATERIAL AND METHODS A total of 18 patients with irreversible palsy of lower extremities in L4-S1 segments underwent a reconstruction surgery in the period 2006-2016, of whom 13 patients with the mean age of 42 (21-79) years arrived for a follow-up. The group included 10 patients with the loss of function of peroneal portion of the sciatic nerve, one patient sustained femoral nerve lesion and two patients suffered complete sciatic nerve lesion (both the peroneal and tibial portion). The patients were evaluated at the average follow-up of 77 (24-129) months after the reconstruction surgery. The average time interval from pelvic fracture to reconstruction by muscle transfer was 47 (18-151) months. Due to a wide spectrum of functional damage, the patients were evaluated in terms of the overall effect of the reconstruction surgery on the activities of daily living using the LEFS (The Lower Extremity Functional Scale). The surgical techniques used transposition of tensor fascie latae for femoral nerve lesion, transposition of tibialis posteriormuscle for palsy of the peroneal division of the sciatic nerve and tenodesis of tibialis anterior tendon and peroneus longustendon for the palsy of the peroneal and tibial portion of sciatic nerve. RESULTS The effect of movement restoration on daily living evaluated using the LEFS achieved 65 points (53-79) which is 85% of the average value of LEFS in healthy population. The transposition of active muscles tibialis posterior and tensor fasciae latae resulted in all the patients in active movement restoration. A loss of correction of foot position following the performed tenodesis of the paralysed tibialis anterior muscle was observed in one patient, with no significant impact on function. No infection complication was reported in the group. In 78% of patients the intervention was performed as day surgery. DISCUSSION There is a better prognosis for restoration in incomplete nerve lesion than in complete lesions and also in the loss of sensation than in the loss of motor function. The mini-invasive stabilisation of pelvic ring according to literature does not increase the risk of nerve lesions, while on the other hand a higher incidence of femoral nerve damage by INFIX fixator is documented. The type of muscle transfer is selected based on the availability of active muscles suitable for transposition and also with respect to functional requirements of the patient. CONCLUSIONS Irreversible palsy of lower extremity after the pelvic fracture is easily manageable as to the restoration of function. Surgical interventions using the preserved active muscles to restore the lost movement should be a component part of comprehensive surgical care for patients who sustained a pelvic fracture and should be performed centrally at a centre availing of comprehensive expertise. Key words: nerve lesion, tendon transfer, acetabulum, pelvis, fracture.

PURPOSE OF THE STUDY The aim of our prospective study was to establish correlation between the arthro-MRI and arthroscopic findings in patients active in sports clinically suspected of having a hip labral tear. We sought to identify the benefits of arthro-MRI for clinical practice prior to the considered hip arthroscopy. MATERIAL AND METHODS The prospective study included 34 patients with hip pain and clinically suspected of having a labral tear. The group consisted of 19 men (55.9%) and 15 women (44.1%) of the mean age of 32.2 years (18 to 50 years). All our patients were active athletes, either professional (12; 35.3%) or recreational (22; 64.7%). Included in the study were exclusively patients aged 18-50 with hip pain lasting longer than 3 months, not responding to conservative therapy, with normal X-ray findings, or FAI syndrome. The patients underwent arthro-MRI and subsequently also hip arthroscopy, namely within no more than 3 months. The description of findings was translated into simple numerical scales, assessed using Spearman s rank correlation coefficient. We also examined the specificity, sensitivity, positive and negative predictive values and the odds ratio at various cut-off values of the scale for arthro-MRI. The statistical significance was set at the alpha level = 5%. The quality of tests was also evaluated using the ROC curve. RESULTS In hips assessed by the radiologist as reliably with no pathological finding (MRI type 1) the negative predictive value achieves 83.3% and the positive predictive value of 85.7%, with 96.0% sensitivity and 55.6% specificity. When evaluating the reliably negative finding together with the likely negative finding (MRI type 2) as against the pathological and certainly pathological findings (MRI type 3 and 4), the negative predictive value is 57.1%, the positive predictive value 95.0%, the specificity 88.9% and the sensitivity 76.0%. DISCUSSION In our study, the values achieved were comparable to or better than those reported by foreign authors in their studies establishing correlations between the arthro-MRI and intraoperative findings. Significantly higher was primarily the negative predictive value. CONCLUSIONS The results of our study indicate that the arthro-MRI performed as a part of preoperative examination prior to hip arthroscopy has adequate specificity and sensitivity in patients with suspected labral tear. Based on this examination a decision can be made as to whether to perform arthroscopy. Our study also shows that it is essential to have a highly competent radiologist to evaluate the arthro-MRI results. Key words: hip arthroscopy, labral tears, arthro-MRI, hip joint, predictive value of tests, sensitivity and specificity, minimally invasive surgical procedures/methods.

INTRODUCTION The purpose of our paper is to evaluate the mid-term to long-term results and to confirm the basic criteria of a high-quality revision implant: safe bridging of bone defects, achievement of reliable primary fixation of revision acetabular cup, achievement of good secondary stability with documentable osteointegration of cup and demonstration of remodelling of transplanted bone tissue in the area of defects and in spaces between the implant ribs. MATERIAL AND METHODS Altogether 36 patients (38 cups) were evaluated who had undergone revision hip arthroplasty in the period from 2004 to 2010. The mean follow-up was 8.2 years (5.1-11.6 years after the reimplantation, more than 10 years in 16 patients who underwent surgery). The position and osseointegration of the implant were assessed by digital radiography, the remodelling of transplanted bone tissues in the area of defects and between the implant ribs by computed tomography with reducing artefacts around the metal implant (Aquilion 64 - Toshiba Medical Systems), and for the clinical outcomes the Harris Hip Score was used. RESULTS Preoperatively, the condition of the hip joint based on the Harris Hip Score was in 30 cases evaluated as poor, in 8 patients as satisfactory. At the time of final evaluation, 8 patients achieved excellent results, in 19 patients the condition of the joint was very good (in 2 patients bilaterally), in 6 patients it was considered satisfactory and in 3 patients poor. The mean value for HHS increased from 39.5 to 84.5. Based on the radiography evaluation, in 27 patients (in 2 patients bilaterally) the osseointegration of the revision cup was good, in 8 cases with a radiolucent line of 2-4 mm in width in DeLee zone III, in one case proximal migration of the cup occurred caused by deep infection. The informed consent form for pelvic CT was signed by 25 patients of our cohort. Remodelling of bone tissue in the space between the ribs of the implant was always detected, the presence of bone cysts was not reported, the bone defects following the application of autologous spongioplasty in the monitored patients were healed. In 6 patients, an ingrowth of fibrous tissue of 2-4 mm in width in the convexity of the cup was detected. The mean survival of the revision oval-shaped cup - TC type with a follow-up of 8.2 years after the reimplantation based on Kaplan-Meier analysis was 91.4 %. DISCUSSION The number of revision total hip arthroplasties due to a younger age of patients who undergo alloplasty keeps growing. The choice of a revision implant should always match the intraoperative finding and the bone tissue quality. The standard uncemented implants with osteoactive surface can be opted for when anterior and posterior column of the acetabulum are intact (IIA and IIB according to Paprosky). Starting from type IIC, also the proximal part of acetabulum shall be considered. At our department, preference is given to the revision cup - TC type. The oval shape facilitates a lower degree of bone resection and easier restoration of the anatomical centre of rotation. Careful debridement of granulating and necrotic tissue, thorough treatment of bone defects and osteoactive surface of implants in case of adequate primary fixation of the cup substantially contribute to the quality of its osseointegration. Greater rigidity of fixation verified by pull-out tests enables to insert angular stable screws into the gaps in the proximal part of the cup. There is still room for improvement in treating the bone defect. The application of allogenic bone grafts into the defects and spaces between the ribs of the TC cup is more challenging than the use of augmentation in the systems with trabecular titanium. Based on the evaluation of CT scans, remodelling of the transplanted bone occurs, therefore the defect zone is reduced. CONCLUSIONS The oval-shaped uncemented cup - type TC meets the requirements placed on a state-of the art revision implant, moreover its specific construction helps improve the conditions where another re-operation of acetabulum is necessary. By evaluating mid-term to long-term results of non-homogenous group of 36 patients (38 cups) we have obtained data on joint function comparable to similar groups with revision uncemented implants presented in our and foreign literature. Key words: revision oval-shaped cup, bone remodelling, pull-out tests, angular stable screws, computed tomography.

PURPOSE OF THE STUDY The aim of this retrospective study was to evaluate the results of surgical management of patients with ipsilateral injuries to the femur and the pelvis or acetabulum (floating hip). MATERIAL AND METHODS A total of 54 patients with injury to the pelvic ring or acetabulum concomitant with an ipsilateral femoral fracture were treated at our Department in the period from 2005 to 2013. The group consisted of 35 men and 19 women with an average age of 36.5 (22 to 72) years. Only patients undergoing surgery were included. Excluded were patients who died within 48 hours of injury, those whose pelvic injury was treated conservatively and patients with Pipkin type IV fracture. The average follow-up was 6.1 (2 to 10) years. The mechanism of injury included a traffic accident in 36 patients, fall from a height in 15 patients and fall off a horse in two patients; one patient was buried under a collapsed trench wall. Functional outcomes were evaluated using the Harris Hip Score and the Majeed scoring system. RESULTS Of 15 patients with type A fractures (pelvic ring and diaphyseal femur fractures), 12 (80%) had excellent and three (20%) had good results. The outcomes of type B fractures in 28 patients (acetabular and femoral fractures) were excellent in 12 (43%), very good in 10 (36%), good in four (14%) and poor in two (7%) patients. In the sub-group of seven patients with type C fractures (fractures of the pelvic ring and acetabulum with concomitant femoral fracture), the results were satisfactory in five patients (72%), good in one (14%) and poor also in one patient (14%). DISCUSSION The general health status of a patient after traumatic injury is decisive for choosing amongst treatment options of damage control surgery, primary temporary stabilisation and definitive stabilisation. Early definitive stabilisation of fractures gives best results. Primary external fixation of a diaphyseal femur facture with subsequent conversion to internal osteosynthesis, in relation to a change in the patient's general health state within the concept of damage control surgery, has no effect on the functional results of femoral or pelvic fracture treatment. Delayed definitive fixation of an acetabular fracture, however, makes reduction of the fracture more difficult and results in a poorer functional outcome. CONSLUSIONS Injuries to the femur concomitant with pelvic and/or acetabular fractures are serious traumatic events requiring a correct evaluation of the patient's general health status and soft tissue conditions as well as an appropriate treatment timing. The results do not differ from those of treatment for each isolated injury. They are related to types of fracture and experience of the operating team. Complications in floating hip injuries are not higher in number, but their combination may have unpleasant consequences. Key words: floating hip, surgical treatment, complications, outcomes.

The aim of this thesis was to construct an osteobiografical profile of two individuals from the early medieval locality of Kostice-Zadní hrúd, identified, on the basis of grave inventory, as warriors. In order to obtain a clear picture of early medieval warriors and to provide a basis for comparison, we also tried to find out what characterised an average early medieval Great Moravian warrior. Individuals from the early medieval locality Pohansko-Břeclav were chosen as comparative samples of regular population and warriors. The following methods were used to construct an osteobiographical profile: tracking of entheseal changes of muscle attachments, analyses of cross-sectional geometry of long bones and a Fourier analysis of acetabular morphology. We found out that warriors from Pohansko-Břeclav were horse riders trained in close combat, they did not wear heavy armour and did not train with bow. Due to bad preservation, only one of the individuals subject to our study, the individual labelled KZH H003, could be analysed. The man was short in stature, he did not perform hard manual work, but he trained with sword and bow and rode a horse. Klíčová slova: Acetabulum, Warriors, CSG, entheseal changes, Fourierova analysis, early medieval, osteobiography

The aim of the study was to describe a novel Omega plate and the procedure for obtaining an accurate pelvic inlet view, the mode of pre-operative plate contouring, the surgical procedure used and the evaluation of results in the first 15 patients treated using this method.In the period 2009-2011, a total of 232 patients underwent osteosynthesis for pelvic fractures. Out of them, 52 were treated by the modified Stoppa approach and 12 with the original Omega plate. Between July 2010 and January 2014, a novel 3.5-mm Omega plate was used in 12 men and 3 women. The average duration of follow-up was 8.5 months in 11 patients; four were shortly after surgery. The multi-functional Omega plate is described in detail. An exact pelvic inlet projection, named the "computer tomography-defined (CTD) view", was based on pre-operative CT examination. It facilitates pre-operative contouring of the plate according to a mirror image of the uninjured half of the pelvis. The surgical procedure enables us to apply the contoured plate to the correct position; the plate completes reduction, restores normal pelvic anatomy and makes operative time shorter. The radiographic evaluation of post-operative results was done using the Matta classification and functional outcome was assessed by the Harris Hip Score.Surgery using the isolated Stoppa approach was carried out in 11 patients and a procedure combining the Stoppa approach with another method was used in four patients. All operations were successfully completed, during two of them the external iliac vein was injured and treated by vascular suturing. No other vascular or nerve injury occurred. One deep wound infection successfully healed was recorded. The post-operative radiographic results were excellent or satisfactory in 12 and poor in three patients. At follow-ups of 6 to 12 months, no failure of fracture reduction or osteosynthesis was recorded in 11 patients. Neither avascular necrosis of the femoral head nor heterotopic ossification was found. One patient showed signs of post-injury arthritis at 6 months after surgery. The functional result assessed by the Harris Hip Score was excellent in seven patients, good in two (one of them with gonarthrosis), satisfactory in one patient with contralateral total hip replacement and ipsilateral gonarthrosis, and poor in one patient with hemiparesis after a stroke.Shape and size variability in CTD pelvic inlet views do not allow us to create a unified anatomically correct implant. Contouring during the operative procedure may not be accurate enough and significantly prolongs the time of surgery. Therefore, a custom-made plate for each patient seems to be an optimal method. It has been demonstrated on a group of 50 patients that CTD images of the right and left halves of the pelvis are identical in 68% and very similar (variation in length up to 5 mm and in curvature up to 3 mm) in 18%. At present plate contouring according to a mirror image of the acetabulum, which will be obtained by 3D printing, is prepared.Pre-operative contouring of an Omega plate based on a post-injury CT scan of the uninjured half of the pelvis is over 80% accurate or almost accurate. The multi-functional 3.5-mm pelvic plate Omega allows us to stabilise complicated fractures of the superior ramus of the pubic bone, anterior acetabular column or quadrilateral plate as well as fractures above the linea arcuata or uncomplicated fractures of the posterior column. The stabilisation of all fragments of the anterior column and quadrilateral plate is very firm and the Omega plate is resistant to fragment redisplacement. Also, it is its advantage that it can remain in situ if total hip arthroplasty is required later.

The aim of our study is to solve the problem of insufficient fixation of comminuted fractures of the quadrilateral plane and the iliopectineal line. These fixation problems occur while using the standard narrow 3.5 mm fixation plate applied from a modified Stoppa approach. A new plate developed by the authors--the Omega plate--fulfils the requirements.In the period 2010-2012, we performed 156 stabilisations of pelvic ring fractures and acetabular fractures. We used the modified Stoppa approach applying the standard fixation plate in 24 patients and the Omega plate in 15 patients. The patient group with the Omega plate included 10 male and five female patients with the average age of 61 years (range, 30-72). Only 11 patients were followed up, with an average period of 13.3 months, because one patient was lost to followup and three patients were shortly after surgery. The surgical technique of Omega plate application is described in detail. The clinical evaluation of post-operative results was based on the Harris Hip Score; the graphical results were rated using the Matta and Pohlemann criteria.The Stoppa approach alone was used in four patients, combination of two approaches (Stoppa and Kocher-Langenbeck approach) was used in six cases and three approaches were employed in five patients. No adverse intra- or post-operative events were recorded. Excellent or satisfactory graphical results were obtained in 12 patients and an unsatisfactory graphical outcome was recorded in three cases. In the follow-up period ranging from 8 to 22 months, 11 patients healed. Late complications included avascular femoral head necrosis in two and severe post-traumatic coxarthrosis in three patients. Due to these complications, all five patients underwent total hip arthroplasty without previous Omega plate removal at an average interval of 15 months from the primary pelvic surgery. They were not included in the follow-up evaluation. The remaining six patients had an average Harris Hip Score of 88 points (range, 81-98).The novel plate, shaped as a reverse omega letter, enables fixation of the quadrilateral area of the acetabulum through pressure of the arc of the plate against this area. Hitches, with holes for screw insertion, attached to the Omega plate in its middle part allow for fixation of fragments above the linea arcuata simply by pressure. Hitches in the ventral part provide for plate fixation to the ventral acetabular column and the superior pubic ramus. Hitches in the posterior segment of the plate facilitate insertion of a long screw in the posterior acetabular column from an additional iliac approach for stabilisation of simple acetabular fractures. The Omega plates are manufactured in several modifications.The Omega plate enables us to fix fractures of the superior pubic ramus, fractures of the anterior acetabular column, fractures of the quadrilateral acetabular plate, fractures in the iliopectineal line and simple fractures of the posterior column. A CT-defined projection of the pelvic inlet based on pre-operative CT scans allows us to choose the appropriate plate size and to shape the plate pre-operatively. After a technically well performed Stoppa approach and good fragment reduction, the application of an Omega plate is easy if our recommendations are followed. Fixation of all fragments of the anterior column and the quadrilateral plate is very stable and the Omega plate is highly resistant to secondary loss of reduction. A potential total hip arthroplasty does not require Omega plate removal.

To evaluate the mid-term results of using the Allofit cementless acetabular cup for primary hip replacement.The Allofit cup is a cementless hemispherical acetabular component. The macrostructure on the external surface, including 1200 concentrically arranged teeth, and the rough-blasted surface of the biocompatible pure titanium provide good conditions for press-fit fixation. From 1998 to 2005 we used it in 182 cases of primary total hip replacement (THR) in 164 patients. (18 patients had bilateral THRs) The average age at the time of surgery was 58.3 years in men (range, 39-74 years) and 64.1 years in women (range, 33-80 years). We used the Bauer anterolateral approach as our standard procedure. The cup was combined with one of six types of cemented or cementless stems and a 28-mm ceramic head. At a minimum follow-up of five years, we evaluated clinical and radiological findings, i.e., the Harris hip score, radiological signs of loosening, migration and polyethylene wear. The average follow-up was 7.4 years (range, 5-11 years). For more accurate reading of X-ray films, the photographs were zoomed to 115%.The final evaluation included 147 primary THRs in 129 patients. We recorded no intra-operative complications. The average Harris hip score increased from pre-operative 44 to post-operative 87 points (range, 31-100). The loosening of a cup occurred in three patients (2.1%), of which two were infected (1.4%) and one was aseptic (0.7%). We had to replace the polyethylene insert in three patients, in one for abnormally high polyethylene wear and, in two, because of a ceramic head fracture due to a fall. Cup migration was not recorded. Eight cups (5.4%) had a thin (less than 1 mm) radiolucent line without signs of loosening. Polyethylene wear indicated by an asymmetric position of the head was detected by the Dorr method in 32 cups (21.8%). A shift of the head centre towards the proximal pole of the titanium shell ranged from 0.4 to 6.0 mm. The average polyethylene wear of all cups was 0.29 mm in 5 years, which is 0.06 mm per year.The Allofit acetabular cup is suitable for younger patients with good bone quality. In elderly patients or in those with severe osteoporosis, we preferably indicate cemented components. Press-fit cups can also be used in patients with postdysplastic osteoarthritis of the hip on condition that enough bone is left around the cup margin for press-fit fixation.Cementless press-fit cups have very good outcomes, even in a long-term follow-up. Our experience gives support to these results because of a low number of hips with loosening, both septic and aseptic, or polyethylene wear of the primary implanted acetabular cup, and no cup migration in our patients. The five-year survival rate of the Allofit acetabular cup was 95.8%.

The aim of the study was to assess differences in the number and severity of associated injuries between patients with pelvic injury and those with acetabular fracture.The patients treated in the period from January 1, 2008, to December 31, 2010, were enrolled. The group comprised 249 patients (130 women and 119 men) with pelvic injuries and 58 patients (14 women and 44 men) with acetabular fractures. In the patients with pelvic injury, the average age was 52 years, 61 in women and 43 in men, in the range of 17 to 91 years. In the patients with acetabular fracture, the average age was 54 years, 59 in women and 53 in men, in the range of 21 to 96 years. The relevant data including age, sex, cause of injury, associated injuries and the overall severity of injury were obtained from the patient database. The results were statistically analysed using Pearson's .2 test at a 5% level of significance.Acetabular fractures were recorded in more men than women and this difference was significantly higher (p = 0.002) than in the patients with pelvic injury in whom similar numbers of men and women were affected. A fall from height was significantly more frequent as a cause of pelvic injury than that of acetabular fracture (p = 0.034). The patients with pelvic injury also had significantly more associated injuries (p = 0.016) and the number of these patients with an Injury Severity Score (ISS) higher than 16 was significantly higher compared with the number of patients with acetabular fractures (p0.001).Little published information is available on comparison of the severity of injuries in patients with pelvic injuries and those with acetabular fractures because these conditions are in fact two nosological units. In pelvic injuries, as conditions usually accompanied by multiple trauma, associated injuries, risk factors for death, requirements for primary life-saving measures, complications and treatment outcomes have been studied. Less attention has been paid to these issues in patients with acetabular fractures; the authors focused on determining the quality of intra-articular fracture treatment in relation to a subsequent risk of avascular necrosis of the femoral head or early arthritis.The study comparing the patients with pelvic injury with those having acetabular fracture showed a significantly higher proportion of men in the group with acetabular fractures. A fall from height significantly more often caused a pelvic injury than an acetabular fracture. In traffic accidents, drivers usually suffered acetabular fractures while pedestrians and cyclists had pelvic injuries. However, a significantly higher number of associated injuries and multiple trauma with an ISS16 recorded in the patients with pelvic injury in comparison with those with acetabular fractures was the most important difference between these two groups.

Revision total hip arthroplasty is a demanding surgical procedure. It involves a massive loss of acetabular bone stock associated with primary implant removal, and a complicated revision cup fixation in the highly damaged surrounding bone. The authors describe the use of a novel oblong acetabular cup, type TC (Trč-Cingr), for replacement of a loose acetabular component. The aim of the study is to present this novel implant with evaluation of the first clinical results and to report on the authors' experience with revision arthroplasty assessed at 24 to 62 months of follow-up.The TC cup was used in revision total hip arthroplasty in 40 patients treated between February 2004 and June 2007. Aseptic loosening of a cemented cup was an indication for surgery in the majority of patients. The first 10 treated patients were supervised, according to the strict rules of good clinical practice, by the State Institute for Drug Control. A total of 31 patients were evaluated. There were 20 women and 11 men with an average age of 68 years (range, 41 to 81 years) at the time of primary implantation.At the end of 2009, 31 patients were evaluated at a follow-up of 24 to 62 months (average, 44.8 months) after revision surgery. The patients' age, gender, body mass index, physical activity, diagnosis for indication, implant size and intra- and post-operative complications were recorded. The development of secondary implant stability was assessed on X-ray films taken at 3, 6, and 12 months and then at 1 year after surgery. Attention was paid to implant and screw positions and potential implant migration and signs of osteolysis around the cup and screws. An objective assessment of the results was obtained by comparing the pre- and post-operative values of the Harris hip score (HHS).A femoral component was replaced together with a revision cup in 20 patients. The average HHS value increased from 41.86 points pre-operatively to 82.70 points post-operatively. The results were recorded as excellent in six, very good in 17, satisfactory in six and poor in two patients. The radiographic findings showed good bone-implant integration in 26 patients and radiolucent lines . 1mm in width in DeLee zone 3 in three patients. In one overweight patient, discontinuity of two proximally inserted screws, but no detectable implant migration, was recorded. There was only one case of proximal migration of the TC cup, with osteolysis detected around all screws (Paprosky type 3B defect).The acetabular cup is the most frequently re-implanted component in our country. This is due to a high proportion of total hip arthroplasties with the previous frequent use of a cemented POLDI prosthesis whose neck in a valgus position probably played its role in increased wear of the cup. Acetabular bone defects are usually extensive and the operative tactics are based on the Paprosky classification. Type 3A and 3B defects, exceptionally also type 2C defects, are most serious and acetabular cup replacement is most difficult. The oval-shaped uncemented TC cup was developed with the objective to reconstruct defects on the bottom of the acetabulum, with stable and firm primary fixation of the implant secured in bone with implant augmentation screws and additional fixation screws. Good primary fixation with bone grafting to fill defects and spaces between implant ribs should facilitate bone remodelling in the close vicinity of the cup. A minimum of 24 months after revision cup implantation is regarded as sufficient for an objective evaluation of hip function and radiographic evidence of good bone-implant integration.The results show good applicability of the oval-shaped implant which is easy to implant, maintains good primary fixation and allows for good bone remodelling in its vicinity.

Current trends in minimally invasive surgery together with advances in computed tomography and fluoroscopic guidance allow us to perform close reduction and percutaneous fixation also in non-displaced or minimally displaced fractures of the pelvic ring and acetabulum. Authors report the method of percutaneous screw fixation.During the period from 1998 to 2010, a total of 568 patients were surgically treated for fractures of the pelvic ring and acetabulum. The patient series included 132 men and 46 women with an average age of 41.6 years (from 15 to 88 years). In this cohort, 225 single screws were placed at various sites of the pelvis. Of the screws, 197 were applied percutaneously and 28 in open procedures. A definition of six screw categories is proposed as well as the list of indications for their use. A detailed description of the techniques for screw placement, including the associated risks, is also presented. A novel method of minimally invasive stabilisation of the ruptured symphysis by means of two pubic screws and a two-hole plate is reported. A total of 157 patients were followed for the average period of 11.9 months (from 3 to 144 months). The navigation methods used in pelvic fracture stabilisation are described.It is difficult to provide an overall evaluation of the results in such a heterogeneous group of patients and therefore the outcome was assessed according to the placement of single screws. The types of injury with the use of appropriate screws are described in detail. Complications and the final graphical and clinical outcomes are reported. As the pelvic ring and acetabular injuries vary too much, it was not easy to assess the clinical outcome for each screw category.Percutaneous screw fixation is indicated in non-displaced fractures having a potential for displacement as well as in minimally displaced fractures that can be fixed with precisely placed screws. Dislocated fractures have to be reduced before surgery. Percutaneous screw placement can be performed as a single surgical procedure and this technique can also be part of a limited open approach. Percutaneous or open placement of cannulated screws facilitates stabilisation of individual fragments and allows for low surgical invasivity. This type of screw fixation in pelvic surgery provides all benefits of minimally invasive procedures. In this respect, some authors' view that the advantages outweigh a less successful result of fracture reduction can be accepted. A relatively high risk of iatrogenic complications is a disadvantage of this technique. The correct placement of screws has the highest priority because all percutaneous pelvic screws described here are inserted into the sites known as "narrow safe zones".In specific localisations, the percutaneous fixation of pelvic ring and acetabular fractures using single screws presents a new surgical technique for which the indications have not been exactly defined yet. The procedure should be performed by an experienced surgeon ready to convert surgery from a minimally invasive procedure to an open one, if the navigation technique used does not provide a reliable guidance or when the fracture reduction or stabilisation fails.

Percutaneous fluoroscopy-assisted fixation of acetabular fractures is not a widely used technique. Its advantage lies particularly in percutaneous placement of screws in the anterior column of the acetabulum. The operative procedure is described and the first experience of the authors with this minimally invasive technique at their department is reported.Between December 2007 and April 2009, 10 fractures of the anterior column of the acetabulum were treated by percutaneous stabilisation in 10 patients. There were six men and four women aged 25 to 76 (average, 46) years. Retrograde screw fixation was used in three, anterograde screw fixation in two and anterograde screw placement following retrograde guide wire insertion in five patients.The minimally invasive method of acetabular stabilization using 6.5-mm or 7.3-mm cannulated screws was facilitated by the use of intra-operative fluoroscopic imaging. Following fracture reduction, a percutaneous guide wire, aided by a C-arm, was placed in the upper pubic ramus and the anterior column of the acetabulum in either an anterograde or a retrograde mode. Subsequently, a traction cannulated screw was inserted. When anterograde guide wire placement was difficult to do, the retrograde guide wire placement was used for anterograde screw insertion. The quality of fracture reduction and the placement of screw were evaluated by a post-operative CT examination.The average follow-up was 11 (range, 2-19) months. The average operative time necessary for percutaneous screw insertion in the anterior column of the acetabulum was 26.4 (range, 15-45) min, and the average X-ray exposure time for the screw placement was 3 min and 13 sec (range, 40-448 sec). The average time needed for screw insertion following the retrograde guide wire was 2 min and 30 sec (range, 40-242 sec). The average post-operative fragment dislocation leading to incongruency was 1.3 mm (range, 0-4 mm). The results of reduction assessed as excellent (2 mm) and poor (or=2 mm) were achieved in six and four patients, respectively. No screw malplacement was recorded. Post-operative infectious complications occurred in one (10 %) patient.Important factors for avoidance of intra-operative complications included a thorough pre-operative planning on the basis of CT diagnostic examination, meeting the indication criteria and using a safe stabilisation technique. However, the percu- taneous fluoroscopy-assisted method requires a longer exposure to X-ray than do the techniques utilising computerised navigation. The occurrence of infectious complications was not lower than with the use of open reduction and internal fixation methods.After the operative technique has been mastered, the minimally invasive method of osteosynthesis is likely to become a method of choice for certain kinds of acetabular fractures. The current, most frequent indications are minimally displaced transverse fractures, T-shaped fractures and anterior column acetabular fractures. A limiting factor of this technique is reduction. It is certain that further evolution of this technique and its more frequent use will be associated with computerised navigation.

The Stoppa approach used in acetabular and pelvic ring fractures provides an excellent visualisation of the anterior column, quadrilateral plate and part of the posterior column for its exact reduction. Our first experience of this surgical approach and preliminary results are reported.Between April 2008 and September 2009, the Stoppa approach was used 15 times in 14 patients. This series includes 13 males and one female with an average age of 47.7 years. The mean follow-up was 6.8 months (range from 3 to 15) in 11 patients. In three patients, the post-operative period was too short for evaluation. The surgical procedure is described in detail and associated risks are rated. The Harris hip score was used for clinical evaluation. Radiographic results were assessed according to the criteria described by Matta and Pohlemann.Ten patients suffered from an isolated acetabular fracture, two displayed an acetabular fracture combined with the pelvic ring injury. An isolated pelvic ring fracture was identified in one patient. One patient sustained an acetabular and pelvic ring fracture at one side associated with a simple pelvic ring injury contra-laterally. In five cases, surgery was carried out using three approaches; two approaches were used in another five patients. In remaining five cases, an isolated Stoppa approach was used. An exact anatomical or satisfactory reconstruction of the acetabulum was achieved in 10 patients; in three patients a poor result with 5-mm displacement was found. The pelvic ring fractures were anatomically reduced in two patients. The average Harris hip score in nine patients was 85 points (range from 70 to 95). No serious intra-operative vascular or nerve damage was detected, deep wound infection was revealed in one case.The Stoppa approach makes the surgery of the anterior column and quadrilateral plate easier. It can be combined with other surgical techniques, usually with an approach using an "iliac window" over the iliac crest or with a Kocher-Langenbeck's approach. Indications for this type of surgery include acetabular fractures, combined acetabular and pelvic ring fractures and pelvic ring fractures without an injury to the acetabulum as well. Compared to the conventional ilioinguinal approach, the Stoppa approach is less extensive and does not endanger integrity of the lateral femoral cutaneous nerve. It facilitates the treatment of fractures in the posterior part of the quadrilateral plate because the visual control of reduction allows us to restore anatomical conditions. Some technical problems may occur if the screws inserted from the posterior approach into the fracture line of the inner acetabular surface, in order to stabilise the posterior column, interfere with an exact reduction. The use of a narrow plate for stabilisation of comminuted fractures of the quadrilateral plate may create problems as well.The Stoppa approach changes the conditions for treatment of acetabular and pelvic ring fractures fundamentally. It affords an excellent visualisation of the anterior column and quadrilateral plate and allows for an exact reduction and stable fixation of their fractures. In combination with other approaches it permits anatomic reconstruction of the most serious fractures of the acetabulum and pelvic ring.

Acetabular erosion is the most serious late complication of the hemiarthroplasty of the hip. We analyzed the factors influencing acetabular erosion after hemiarthroplasty for intracapsular femoral neck factures. Twelve patients of average age 71 years initially treated by one type of hemiarthroplasty in which conversion to total hip arthroplasty was performed due to pain and acetabular erosion. Evaluation was made of the interval between hemiarthroplasty and revision, indication for conversion and position of the head with regard to the apex of the greater trochanter. In case of a marked erosion of the acetabulum the evaluation included also the direction of the head migration. The basic group was further divided into two groups. The first group included 7 patients with an early revision, i.e. on average 22 months. The second group comprised 5 patients with a late revision at the average interval between the primary surgery and revision of 68 months. High position of the prosthetic head was found out in all patients of the first group while neutral or low position was recorded in all patients of the second group. In 7 cases with marked acetabular erosion we reconstructed the direction of the prosthesis migration. We recorded three directions of migration of the prosthetic head--proximomedial, purely proximal and proximolateral. The direction of migration depended on the position of the head, CE angle and position of the prosthetic stem in the medullary canal. The resection level of the femoral neck and resulting from it the position of the prosthetic head is a significant factor influencing the progress of acetabular erosion.

Developmental dysplasia of the hip (DDH), treated either conservatively or surgically, may result in a dysplastic acetabulum. To treat this after bone maturation is completed, Bernese periacetabular osteotomy, also known as the Ganz procedure, has recently been used as the method of choice at our department. The evaluation of the first results is presented here.The group evaluated comprised 25 hips (21 female and 4 male) in 22 patients. Nineteen hips were treated for residual dysplasia of the acetabulum due to DDH, and six for a spastic hip. The average age was 26 years (range, 12 to 44) and 14 right and 11 left hips were involved On pre- and post-operative radiographs the AC index, Wiberg lateral CE angle, Wagner index, improvement in Shenton's line, and lateralisation and anteversion of the acetabulum were compared. Bernese periacetabular osteotomy is an extensive surgical procedure requiring special instrumentation. It may be associated with serious complications and has a relatively long learning curve.The average follow-up was 18 months (range, 2 to 36). The average duration of surgery was 2 hours and 44 min (range, 2 to 31/ 2 h). The average values improved in the AC index by 24 degrees, lateral CE angle by 29 degrees and Wagner index by 18 %. Shenton's line was corrected by surgery in 20 hips and lateral migration in 16 hips. In two hips lateralisation did not changed. Two serious complications were recorded: para-articular ossification requiring excision and concomitant acetabular trimming, and great intra-operative blood loss.Various mechanisms of damage to the hip are discussed and the methods of treatment outlined, together with prerequisites for successful surgery. Potential complications and their treatment are mentioned.Bernese periacetabular osteotomy makes the range of roofing procedures for hip joint treatment wider. These, as well as hip joint reduction techniques, should be performed in major specialized centres.

To analyse retrospectively complications of the surgical treatment of displaced acetabular fractures.In the years 1996 to 2006 a total of 251 patients with acetabular fractures were treated. The group comprised 162 men and 89 women; the average age was 35 years. The average follow-up was 71 months (range, 16 to 138). Based on the AO classification, type A fractures were found in 58%, type B in 23% and type C in 19% of the patients. Indications for surgical intervention were hip instability or hip incongruence.The complications included intra-operative, and early and late post-operative problems. Of the intra-operative complications, 2% were vascular injuries, 5% were damage to the static nerve, 13% were due to incomplete reduction and 2% due to bone non-union. Early post-operative complications in five patients (2%) required revision surgery for early infection in two, haematoma in the wound in one and failed osteosynthesis in two patients. In one patient failed osteosynthesis was associated with hip dislocation. Late complications included aseptic necrosis in 7%, post-traumatic arthritis in 17%, para-articular ossification grades III and IV of the Brooker classification in 7% and late infection in 0.5% of the patients.The outcome of surgical treatment depends on quality reconstruction of the articular surface and complications, and is related to the fracture type and method of treatment. Not every poor outcome means it is a complication, nor is it always related to the type of fracture. Some fracture types are bound to heal poorly. The complex anatomy of the joint involves rather frequent injury to nerve structures and imperfect reduction and fixation.The most frequent complication is the development of post-traumatic arthritis due to imperfect reduction. However, the current limit of achieving correct reduction and weight-bearing surface reconstruction remains an open issue. Aseptic necrosis in type A fractures was three-times as high as in type B and C fractures. Imperfect reconstruction of the acetabulum and failure to restore hip joint congruence were twice higher in type B than type A and C fractures.

PURPOSE OF THE STUDY To evaluate the results of primary total hip replacement with the CLS acetabular cup at a minimum of 15 years of follow- up. MATERIAL AND METHODS A total of 105 patients, with 112 hips, undergoing hip arthroplasty with the use of CLS acetabular cup between 1991 and 1993 were evaluated. The group comprised of 33 men and 72 women with an average age of 51.3 years (range, 28 to 66) at the time of surgery. All patients received the CLS expansion cup with a polyethylene Sulen-type liner. Cemented femoral stems were used in 75 hips and uncemented CLS stems were implanted in 37 hips. Ceramic heads of the femoral component were used in 86 hips and metal heads were used in 26 hips. The clinical outcome was assessed by the Merle dAubignnd Postel score and the Harris hip score, and the radiological results were evaluated on anterior posterior X-ray films of the pelvis and the affected hip. RESULTS The average follow-up was 16.2 years (range, 15 to 17). The average Merle dAubignnd Postel score increased from 8.1 (range, 5.7 to 9.8) pre-operatively to 14.6 (range, 14.1 to 16.8) post-operatively. The average Harris hip score improved from 42 to 86 points (range, 71 to 99). The complications requiring revision arthroplasty included aseptic loosening in two hips, fracture of the CLS shell in three, dislocation in three and replacement of the liner due to high wear in two hips. The cumulative proportion of clinical survivorship with revision for any reason was 92 %. Fixation by bone ingrowth, assessed by the method of Engh et al. occurred in 98 cases, fibrous tissue fixation was found in ten hips. Unstable fixation was recorded in four hips (two with aseptic loosening and two with fracture of the shell). There were no signs of rarefaction of bone along acetabular shell in 98 hips. No noticeable migration was found in the stable cups. Only in ten cups from 112, polyethylene wear exceeded 4 mm. Cumulative probability of radiological survivorship of the CLS acetabular cup with any radiological sign of loosening was 86.6 %. DISCUSSION The causes of fracture of the CLS cup can be explained by insufficient bone support or bone resorption in the proximallateral part of the acetabulum in patients with developmental hip dysplasia, by low bone quality due to severe osteoporosis or by insufficient primary stability of the cup. The advantages of the CLS cup include removal of a small amout of bone and favourable force distribution in circumferential anchorage. The cup showed good osteointegration even in a bone of lower quality and with defects of the acetabular bottom. CONCLUSIONS The CLS acetabular cup shows good results at 16-year follow-up period. No increase in fractures of the shell, migration or radiolucent lines, or in bone rarefaction or osteolysis was recorded with time. The reliability of this implant has been recently increased with the use of cross-linked polyethylene (Durasul). Key words: primary total hip replacement, uncemented cup.

To present the results of primary total hip arthroplasty (THA) with use of the hemispheric threaded Ultima cup at 8.5-year follow-up.Between 1996 and 1999, a total of 40 Ultima acetabular components were used in 33 patients (15 men and 18 women). The average age at the time of surgery was 61.2 years (range, 45 to 71). By the end of 2006, 36 cups were assessed. Indications for the primary THA procedure included primary arthritis in 32 hips, post-traumatic arthritis in three, post-dysplastic arthritis in two, femoral neck fracture in two and rheumatoid arthritis in one.The average follow-up was 8.5 years (range, 7 to 10). The indication criteria for primary implantation were evaluated, i.e., body mass index, patients' activity and their age. THA outcome was evaluated on the basis of clinical rating (Harris hip score) and pain assessment and on radiographic findings on which the acetabulum before and cup position after THA were compared, and potential changes in cup position, acetabular cup loosening or para-articular ossifications were observed.Good outcomes were found in 88.9 % of the hips. In most, cup position was satisfactory. One acetabular component was implanted in a varus position (34 degrees ). An intraoperative complication included fracture of the greater trochanter, which was left untreated for spontaneous healing. The early-postoperative complications were one dislocation, two wounds with serous secretion not requiring revision surgery, and one large haematoma. Stem fracture as a late complication was recorded in two THAs. Radiolucencies were found in six hips and paraarticular ossifications in four. Migration of the cup with protrusion into the acetbulum occurred in one patient 3 years after THA. Four cups showed aseptic loosening within 3 to 7 years of surgery. No infection was recorded in this THA group.Information on mid- and long-term outcomes of the use of cementless acetabular cups in the relevant literature is sparse. The Ultima cup is dealt with only in the report by Pazdírek et al., whose results are in agreement with ours, but involve a lower number of implanted cups and a shorter follow-up. In this study, loosening was recorded only in cups larger than 32 mm in diameter. In comparison with our group of cementless BMT acetabular components, the use of cementless Ultima cups gives better results at mid-term follow-up.At 8.5-year follow-up, 88.9 % of the Ultima acetabular components were without radiographic signs of loosening. Attention should be paid primarily to THA patients with a thin wall acetabulum requiring a larger cup and a 32-mm liner.

Acetabuloplasty as an isolated surgical procedure is one of the options allowing for hip joint realignment in cerebral palsy patients. Also, it is often involved in combined techniques used for hip joint reconstruction.In the years 2004-2005, 20 cerebral palsy patients, aged from 4 to 13 years, were indicated for acetabuloplasty. The group included children with varying degrees of locomotor disability, ranging from inability even to crawl to ability to move without support (stages 2 to 7 on the Vojta scale).Clinical and X-ray findings were evaluated at 2 and 6 months after surgical treatment and then every 6 months of follow- up. The X-ray finding was described by means of CE angle (Wiberg) values and hip migration percentage.Of 21 hips (in 20 patients) treated by acetabuloplasty in our modification during the two years, one developed recurrent dorsal dislocation which was possible to deal with by conservative treatment. All hips pre-operatively categorized as group B or group C were post-operatively assessed as group A hips. Subsequent migration of the acetabulum occurred within a year in two patients with distinct original asymmetry.Surgery on bones comprising the hip joint in cerebral palsy patients is indicated according to the degree of lateral migration and changes in hip joint geometry involving the proximal femur or pelvis, or in combination with open reduction. Acetabuloplasty is indicated as an isolated procedure or as part of combined techniques leading to a better coverage of the hip joint. It is recommended for children up to 10 years of age, but also older ones, in whom the flexibility of child bones enables us to do without internal osteosynthesis.Acetabuloplasty is indicated as an isolated surgical procedure for hip joint subluxation in cerebral palsy children. It has no adverse effects on hip abductors that, in cerebral palsy patients, are 85 % insufficient. It improves hip joint symmetry and helps to avoid more demanding reconstructive or palliative procedures. Key words: cerebral palsy, acetabuloplasty, lateral migration.

The diagnosis of femoroacetabular impingement (FAI) syndrome is relatively recent. Therefore, the concept of early hip arthritis development is an interesting issue. The assumed prevalence of this disease is rather high and any postponement of necessity to perform total hip arthroplasty (THA) for hip arthritis, as a FAI sequela, should bring benefits to medical care as well as economy. To make an exact diagnosis it is necessary, in addition to essential clinical examination and standard conventional radiography, to carry out MRI that, in indicated cases, is combined with arthrography. Surgical treatment includes extensive procedures, such as controlled surgical dislocation of the hip with modeling of the femoral head and periacetabular osteotomy. In the case of primary surgery for FAI, short- and middleterm results so far obtained are promising, but only long-term results will show whether, and for how many years, this therapy is able to postpone the necessity of THA. For the future, biological therapy using autologous hyaline cartilage transfer will remain a challenge also for this indication.

Currently, conventional diagnosis of acetabular fractures is often supplemented and even replaced by CT examination, as this can provide a more detailed image of the extent of fracture and its morphology. Supported by developmental anatomy, Harris et al. proposed a new classification for acetabular fractures in which the pubic bone component of the acetabulum is shown to coincide with the anterior column of the acetabulum. There is no need to abandon the generally accepted and much used Letournel-Judet classification, but changes in the algorithm of acetabular fracture examination will certainly require that the CT classification of acetabular fractures is included. The Harris classification, based on evaluation of simple and unambiguous axial CT scans, is readily understood by both radiologists and orthopedic trauma surgeons and thus the use of it will foster greater interdisciplinary cooperation resulting in a better care for patients with acetabular fractures. Key words: acetabular fracture, CT-based classification, CT-based diagnosis.

The authors evaluated the mid-term results in 133 patients to whom 143 uncemented Beznoska (BMT) acetabular cups were implanted.A total of 143 acetabular cups were implanted to 133 patients in the period from 1994 to 2002. Thirteen patients died or dropped out of the study during follow-up.The patients were followed up at 3, 6 and 12 months after surgery and then, according to their conditions, every one or two years. In each patient, the following information was recorded: age at the time of implantation, gender, pre-operative diagnosis, physical activity, body mass index, Harris hip score, acetabular cup size, stem type, cup and stem alignment immediately after arthroplasty, intra-operative complications, early complications during hospital stay, and late complications. Attention was paid to infection, aseptic loosening and polyethylene wear. Loosening of both the cup and the stem was evaluated in each zone, using the criteria of Krbec and Cech. Malalignment of the stem and cup as well as thinning of the acetabular wall, as signs of loosening, were also recorded.Of the 133 patients treated, 35 had poor results (24.5 %) and 17 of them underwent revision surgery. Deep wound infection was recorded in seven hips, the prosthesis was removed from six, and subsequently three of them had reimplantation. Loosening of the stem occurred in nine patients and two were revised. In three patients with a thin acetabular wall, indication for surgery was not correct; in another patient an operative fault occurred. All of them underwent revision arthroplasty. One hip showed asymmetric wear of the polyethylene liner without sings of acetabular cup loosening. Aseptic loosening was found in 15 patients (10.5 %), eight were revised. In the group of patients who had surgery 5 and more years before, 13 cups out of 81 implanted ones were loosened (16 %). In the group operated on at 8 and more years earlier, aseptic loosening was found in nine hips out of 49 (18.4 %). DISCUSSION The mid-term results of the use of uncemented Beznoska acetabular cups are fully comparable with those of cemented Beznoska acetabular cups. However, the outcomes initially hoped for in relation to this component have not been achieved.The uncemented BMT acetabular cup cannot be recommended for the same indications as are those for which other uncemented components are used. It is not suitable for young and active patients under 70 years of age and for patients who have a thin wall of the acetabulum. Also, it is not recommended to combine this component with an uncemented femoral component. In our opinion, it is not suitable for revision hip arthroplasty, either.

The aim of the study is a retrospective evaluation of our patients with a dysplastic acetabulum treated by total hip arthroplasty (THA), who were followed up for at least 5 years, and a comparison of our intermediate-term results with those in the relevant literature.In the period from June 1995 to June 2005, a total of 1305 total hip replacements were performed. Of these 293 were done in patients (213 women and 48 men) with the diagnosis of a dysplastic acetabulum; bilateral total hip arthroplasty was carried out in 18 women and four men. The evaluation was based on the Harris scoring system. The condition of at least 5-year follow-up was met by 65 patients (54 women and 11 men; average age, 53 years; average follow-up, 82 months). Eventually, 63 patients were assessed, because one patient died and one moved away.The Hartofilakidis radiological system was used for preoperative evaluation. In more severe cases, 3D CT and multiplanar reconstruction were used. Intraoperative findings were assessed by the AAOS classification, and postoperative radiograms were evaluated on the basis of Gruen's criteria. The Bauer transgluteal approach to the hip joint was used. Antibiotics in prophylactic doses and medication for prevention of thromboembolic disease were administered in all cases. The final assessment of Harris hip scores was carried out in 63 patients in September and October 2005. All underwent implantation of a Zweymüller Bicon-Plus acetabular component. As diagnosed according to the Hartofilakidis radiological system, 42 type I, 21 type II and two type III hips were operated on for a dysplastic acetabulum.The average preoperative and postoperative Harris scores were 39 (range, 21-58) and 85 (range, 66-98) points. All patients reported satisfaction with the results; excellent outcomes were achieved in 41, good in 10 and satisfactory in six patients. No radiographic cup loosening was found at 3- and 6-month follow-up or at 1 year. None of the patients received a solid bone graft.The crucial problem in treating hip arthritis due to acetabular dysplasia is precise surgical reconstruction of the acetabulum. This involves implantation of an acetabular component into the original anatomical position in order to sufficiently cover the cup and provide mechanical stability. Various operative procedures discussed in the literature include the use of a small cup placed into the original acetabulum, techniques of acetabular component medialization, with perforation or "controlled fracture" of the acetabular wall, when indicated, and involvement of bone grafts to repair the acetabular defect in both cemented and cementless acetabular components.Our intermediate-term results with the use of Zweymüller Bicon-Plus acetabular components give support to the previous good experience with this prosthesis in the treatment of hip arthritis following acetabular dysplasia.

A group of 49 patients treated by total hip arthroplasty after previous surgery for an acetabular fracture are evaluated in this retrospective study.In the period from 1997 to 2004, 49 patients, 35 men and 14 women, with posttraumatic arthritis following acetabular fracture were treated in our department. The average age was 42 years, with 67 % of the patients being younger than 40 years. The average follow-up was 42 montsh (range, 18 to 92). The acetabular fractures evaluated by the AO classification included type A1 in 17 patients, type A2 in seven, type B1 in nine, type B2 in six, type B3 in seven, type C1 in three and type C2 in two patients.In 11 patients with aseptic necrosis of the femoral head without acetabular deformity, cementless Zweymüller Bicon or Spotorno CLS acetabular components were used. Twenty-nine patients with acetabular defects of type I and II, according to the American Academy of Orthopedic Surgeons (AAOS) classification, underwent acetabular reconstruction with the bone impaction grafting technique, using allogenic grafts and cementless Zweymüller Bicon acetabular components. Four patients with AAOS type III acetabular defects were treated with impacted morsellized bone allografts, using titanium mesh and cemented polyethylene acetabular cups. Three patients were treated with solid bone grafts fixed with osteosynthetic material. In two patients with type IV defects, osteosynthesis using a plate completed with allogenic bone graft, a mesh and a cemented cup were used.The patients were evaluated with the use of Harris hip scores. In 20 patients (43 %) the outcomes were excellent, and very good in 18 (37 %), satisfactory in six (12 %) and poor in four (8 %) patients.Hip joint arthroplasty following the surgical treatment of acetabular fracture is indicated in patients with post-traumatic hip arthritis. This frequently occurs due to complications associated with surgery for acetabular fractures, or the cause remains unknown. Some types of these fractures show a high proportion of poor results. The group can be divided into two different subgroups: the patients with a spherical, healed acetabulum and the patients with acetabular deformity or defect, of which the most serious condition is pseudoarthrosis of one or both columns. In the first subgroup, the surgical technique of acetabulum replacement is the same as in cases with arthritis due to degenerative disease. In the other subgroup, the procedure for cup implantation resembles revision arthroplasty for acetabular loosening. The options for treating defects or deformities and the implants used are identical in both situations. Therefore the results should be compared with those of revision arthroplasty and not primary implantation. Scars, fibrotic changes in muscles, para-articular ossification, bone defects, residual deformities of the acetabulum, devitalized bone fragments or hindering previous implants make the surgical procedure more difficult and interfere with good results.Total hip arthroplasty carried out after acetabular fracture is technically demanding. The prerequisite for a good result is to achieve primary stability of the acetabulum. Acetabular reconstruction is based, in the first place, on replacement of the missing bony tissue, and on providing conditions for correct alignment of the acetabulum and reliable primary and early secondary osteointegration. THA after acetabular fracture achieves poorer results than when it is indicated for degenerative disease. Key words: acetabular fracture, post-traumatic hip arthritis, total hip replacement.

The Burch-Schneider cages (BSC) are designed to manage severe acetabular defects by bridging large bone gaps and preventing medial and superior migration of the prosthetic cup. The purpose of the study was to evaluate the results of such revisions after prolonged follow-ups.From 1985 to 2000 sixty-nine acetabular revisions with BSC were performed in 68 patients with an acetabular defect classified as type Paprosky 3A (32) and 3B (37) at our institutions. After meticulous debridement of the entire acetabulum cancellous chips were pressurized into the bone defects to restore the hemispherical shape. The cage flange for the ischium was then placed after slight contouring into the foramen obturatum or inside the ischium. Finally, the cage was fixed against the ilium with at least three screws. The average age at the time of surgery was 67.9 years (range, 51-78), the mean follow-up equalled 8.3 years (range, 5-20), and the mean Harris hip score was 48 points (range, 29-76). A clinical follow-up study was performed with using conventional measures such as Harris hip score, x-ray analysis, strength of the abductor muscles, and ability to walk without support.A total of 55 patients (80.9 %) remained without any revision until the latest follow-up. Six components were removed due to aseptic loosening (8.7 %); five for septic loosening (7.2 %), and two revisions had to be performed for recurrent instability (2.9 %). Moreover, there were another six hips definitely or probably loose according to x-ray analysis resulting in a 17.4 % (12/69) rate of aseptic failure. Successful cage re-replacement was achieved only in two cases while the remaining nine hips ended as resection arthroplasties. At the time of follow-up examinations the average Harris hip score was 74 points (range, 51-91), only twelve patients were able to walk without support (12/68, 17.6 %), and insufficiency of the abductor muscles was found in fifteen hips (15/69, 21.7 %). Consolidation of the bone graft was observed in 79.7 % (55/69) of our hips.The severe acetabular bone defect reconstructions have been deteriorating with time as reported by most of the published studies. The results of the current study are no exception. On the other hand, the rate of complications observed in our study was comparable or even lower than in similar studies.Despite relatively worse results with prolonged follow-ups, the BSC remains a considerable part of the current orthopaedic armamentarium especially when extensive acetabular bone loss is countered. Loosening belongs to the most common complications of the BSC.

To evaluate the results of acetabular reconstruction in total hip replacement and to compare them in view of the use of autologous or allogenic solid bone grafts.The author evaluates a group of 48 total hip replacements carried out in the years 1990-1999, in which solid bone graft was used for reconstruction of an insufficient acetabulum. In 25 hips, the patient's own femoral head was used in primary surgery and, in 23 hips, a frozen femoral head from a tissue bank was used in revision arthroplasty. Most of the acetabular components used in this study were cemented. The patients were evaluated at 5- to 15-year follow-up. Each group was assessed separately and the results were divided into three categories according to X-ray and intra-operative findings, as follows: I. No radiographic evidence of cup loosening and incorporated graft II. Loosened cup and incorporated graft suitable for use in reimplantation III. Loosened cup and graft non-union or resorptionIn the autograft group, 80 % of the patients fell in category I and 12 % in category II; in the allograft group, 82 % of the patients were in category I and 9 % in category II. Complete failure, i.e., graft resorption and acetabular loosening, was recorded in 8 % and 9 % of group I and group II patients, respectively. Biopsy samples obtained during revision hip surgery showed good incorporation of both autografts and allografts.Other authors' views on the function of solid bone grafts after implantation and on methods of treating a defective acetabulum are discussed. The author puts the good outcomes shown in this study down to a careful implantation technique and thorough preoperative planning.By using a solid graft, the surgeon will achieve good primary fixation of a standard hip socket in a defective acetabulum and will make conditions for repair of defective bone tissue. The results imply that incorporation of both graft and acetabular component can be expected regardless of whether the graft is fresh or frozen. Although this method has its drawbacks and contraindications, it should be considered one of the options when planning total hip arthroplasty for an insufficient acetabulum.

The aim of the study was to present our own method of measuring acetabular polyethylene wear in total hip arthroplasty, including assessment of basic measurement characteristics. It is a well known fact that, in total hip replacement, polyethylene liners wear out with use. The rate of acetabular polyethylene wear can then be related to clinical or demographic data.Our method, using a universal measuring microscope, is based on the ability of exact identification of central positions of the head of total hip replacement before implantation and after prosthesis removal. The difference between the original and final positions allows us to calculate both linear and volumetric wear of polyethylene. During one month, the same components were repeatedly measured by two independent investigators and a total of 10 ABG 1 acetabular components were checked. The results of measurements were evaluated by a series of statistical tests, including correlation and regression analyses and analysis of variance.High correlations were found among individual measurements made by each observer (r = 0.998; r = 0.973) as well as between the mean values obtained from the two observers (r = 0.996). The reliability of measurements was proved by a high correlation of the regression curve of each measurement with the "ideal" line. With two exceptions, the differences between paired measurements were not significant.Our method facilitates an in vitro measurement of polyethylene wear with considerable accuracy and high reliability.

The authors describe the case of a 35-year-old man with an injury to the left hip joint. When examined at the surgical ward, the patient complained of pain and restricted motion of the left hip. No traumatic changes in the left hip joint were revealed on X-ray and CT examination. When checked-up 13 days later, the patients still complained of persistent pain and restricted movement. Because of the discrepancy between the results of X-ray and clinical examinations, magnetic resonance imaging was recommended. This revealed an infraction of the roof of the acetabulum without trauma to the soft joint tissues and adjacent muscles. A retrospective analysis of the X-ray and CT examination data showed an infraction of the acetabular roof on CT scans. The authors emphasize the role of non-invasive magnetic resonance imaging in the diagnosis of occult fractures.

The aim of this retrospective study was to compare the efficacy of femoral osteotomy alone with that of osteotomy combined with an acetabular procedure in patients with unstable hips due to spastic cerebral palsy.Sixty-one hip joints in 50 patients who had shown distinct subluxation or dislocation of the joint were operated on. Eleven patients underwent bilateral surgery. Before bone surgery, soft-tissue release involving both the flexors and adductors was performed on 19 hips. Femoral osteotomy alone was performed on 29 hip joints and combined femoral and pelvic osteotomy was carried out on 32 joints.Twelve resections of the proximal femur in seven patients were evaluated as a separate group. All treated hip joints were assessed by clinical and radiographic examination at a follow-up of more than 5 years.The skiagraphs taken in a strictly neutral position of the lower limbs before surgery and at the final examination were evaluated on the basis of Reimers's migration index and Wiberg's centre-edge angle. The locomotor abilities of each child were categorized according to the Vojta scoring system for locomotor development. The range of motion in the treated hip joint was assessed using the standard S. F. T. R. method. The results obtained were statistically analyzed by the Kruskal- Wallis, one-way ANOVA test.A comparison of the results of femoral osteotomy alone with those of combined femoral and pelvic osteotomy showed that the post-operative values of the migration index and centre-edge angle, as compared with the pre-operative ones, were statistically higher (p0.05) in the latter. In a long-term perspective, the surgery had no adverse effects on a natural development of locomotor abilities of the child. The children had higher scores by the modified Vojta rating system. There was no change in the range of motion in the treated hip joints after the operation.In 28, out of the 32 joints treated by combined femoral and pelvic osteotomy, Salter osteotomy was performed and it showed a high efficacy in providing hip joint stability. The main emphasis during surgery was placed on the maximum acetabular rotation laterally. Femoral osteotomy alone was less effective in providing hip joint stability; in addition, in order to achieve this, tilting of the proximal fragment to a varus position was generally higher than in combined operations. In three patients this treatment resulted in fixed adduction of the hip joint with negative consequences for movement.In the treatment of unstable hip joints a combination of varus derotation femoral osteotomy and pelvic osteotomy provides better containment of the joint than femoral osteotomy alone.

To compare, on the basis of clinical and radiographic findings, the results of non-cemented acetabulum implantation involving the use of a CT-free navigation system with those of implantation without its use.A total of 50 patients undergoing implantation of a non-cemented acetabulum in the period from April 2002 to September 2003 were evaluated. Twenty-five patients operated on without the navigation system were included in group 1 on a random basis and 25 patients treated with the use of the system constituted group 2.Both groups were evaluated on the basis of clinical and X-ray findings. The radiographic measurement of acetabulular inclination was based on anteroposterior projection of both hips made on films on films equal in size. Anteversion of the acetabulum was assessed according to the Ackland system. The Merle d'Aubigne and Postel scores were used for clinical evaluation. The results were compared statistically.In group 1, the average inclination was 50.6 degrees (range, 38-62) and the average anteversion was 9.4 degrees (range, 3-18). In group 2, the values were 43.0 degrees (32-55) and 10.4 degrees (8-16) for the average inclination and anteversion, respectively. The difference in acetabular inclination between the two groups was statistically significant. When accuracy was evaluated, the difference in acetabular anteversion was statistically significant.The achievement of an optimal position of the acetabular component is one of the important factors for good, long-term outcomes of hip replacement. The optimal position that, as suggested by many authors, involves an inclination of 45 +/- 10 degrees and an anteversion of 15 +/- 10 degrees provides sufficient stability, low wear and a satisfactory range of motion in the hip joint. The results close to these values were achieved in the patients included in group 2.A comparison of the groups showed that the computer-assisted navigation system used in implantation resulted in an optimal position of the acetabular component.

The article presents a retrospective evaluation of a group of 119 patients treated for acetabular fractures between 1996 and 2002.In the monitored period 119 patients, (89 men, 30 women) average age 35 years, were hospitalized with an acetabular fracture. Surgically treated were 91 patients (70 men, 21 women), average age 29 years. Prevailing in this group were Type A fractures which accounted for 45%, Type B was represented by 35% and Type C included 19%. Twenty-eight patients were treated conservatively.Indication for surgical treatment was instability, hip incongruence or combination of both. Conservative treatment was chosen in the fractures without displacement, in fractures with secondary congruency and in case of contraindication of surgical treatment. The indication was always based on CT examination with a three-dimensional reconstruction. The surgery was performed within 24 hours in 42%, within 48 hours in 64%, within 72 hours in 87%. Posterior Kocher-Langenbeck approach was used in 54%, anterior ilioinguinal approach in 22% and the combination of both approaches in 24%. Posterior approach was indicated in A1, A2, B1 fractures, ilioinguinal approach in A3, B3, C1 Types, the combination of both approaches in B2, C2, C3 fractures. Osteosynthetic material was chosen according to the fracture type, bone quality and fragment size.The evaluation was based on subjective complaints, radiograph and clinical examination using Harris Hip Score. In the group of 91 patients treated surgically we achieved excellent result in 41 cases (45%), very good result in 28 cases (31%), fair result in 7 cases (9%) and poor result in 13 cases (15%). We recorded 17 peroperative complications--11 times inadequate reduction, 5 times nerve injury, once vascular injury. Early complications included infect--twice and loosening of implant--once. Late complications occurred in 26 cases--paraarticular ossification in 17 cases, aseptic necrosis of the femoral head in 8 cases.The treatment of fractures of the acetabulum as any intraarticular fracture is based on a precise anatomical reduction, stable fixation and early mobilization. Difficulties of the treatment of the acetabulum arise from the anatomical relations. Decisive for the indication, the method of treatment and prognosis is the type of the injury of the weight-bearing area of the acetabulum. In order to understand the type of the fracture it is necessary to make a careful preoperative examination based particularly on CT examination with a three-dimensional reconstruction. The indication and treatment strategy--surgical approach, method of reduction, type of fixation--is selected accordingly. Each surgical approach has its limits and also the possibilities of fixation are limited by the type of the fracture. The outcomes depend directly on the quality of the reconstruction of the articular surface and the incidence of complications, caused either by the injury or preoperatively.The treatment of displaced fractures of the acetabulum is on principle surgical. Satisfactory results are produced only by anatomical reconstruction of the weight-bearing area of the acetabulum. Surgical treatment is highly demanding and the long-term results not always correspond to the efforts made.

To present the results of a trial of the non-cemented Beznoska cup.During the period from 1993 to 1997, a total of 43 Beznoska cups were implanted in 40 patients, 17 men and 23 women, with the average age of 61 and 65 years, respectively. Primary hip arthritis was the most frequent indication for arthroplasty. Most cups were used in combination with a cemented stem.In 2002, 37 patients were examined. The follow-up period ranged from 5 to 10 years. Clinical evaluation was based on the Harris hip scores. X-ray films were examined for cup osteointegration and wear, and para-articular ossification.During the follow-up period, two patients died and one underwent reimplantation. The remaining 37 patients were satisfied with the surgical outcome. The Harris hip scores higher than 80 points were achieved in 80% of the patients. No loosening or wear of the cup was found at the follow-up.Good primary fixation in the acetabulum is the results of reliable anchorage by means of 16 spikes on the metal surface of the cup. Good secondary fixation is shown by the results of this study, although to confirm that the incorporation of a surface without a bioactive coat is long lasting will require at least 5 more years of follow-up.Total hip arthroplasty with the Beznoska cup achieved good outcomes. It was used several times to manage situations in which a press-fit cup initially indicated lacked sufficient primary retention because of the bone being too soft or the acetabulum defective.

The acetabular protrusion changes anatomical conditions for implantation of a cup in total hip replacement. The aim of this study was to evaluate different approaches to implantation of acetabular components in patients with this condition.A total of 50 hips in 33 patients who had surgery for osteoarthritis with acetabular protrusion between 1992 and 2000 were evaluated. Their initial diagnoses were: idiopathic rotrusio acetabuli in 20 patients, rheumatoid arthritis in nine, arthropathy due to psoriasis in two and Bekhterev's disease in two patients. The average age of the patients was 64.1 years (range, 27 to 74 years). In group I including 18 hips, cemented polythylene cups were used (11 Poldi, 5 Ultima and 2 Weber prostheses). In group II involving 32 hips, uncemented cups were employed (29 CLS, 2 Morscher and 1 Balgrist prostheses). Bone grafts inserted in the acetabular bottom were used in eight and 25 cases of groups I and II, respectively. The mean follow-up was 7.1 years.The following parameters were evaluated: Wiberg's angle, protrusion grades according to Sotelo-Garzy, Charnley scores, teardrop collapse, angle of acetabular inclination, approximate femoral head center and center of the femoral prosthesis head, and the distance between them in both horizontal and vertical directions, deviation of the center of the femoral component head from the anatomical center of rotation in horizontal and vertical directions, radiolucent zones according to de Lee and Charnley, position of the femoral head center inside or outside the TAR triangle and aseptic loosening of the acetabular component.At a follow-up of 7.1 years in group I, 10 hips showed full osteointegration, five underwent revision arthroplasty for aseptic loosening and three showed some degree of aseptic loosening. All failures occurred in the acetabular cups implanted without bone grafting of the acetabular bottom. In group II, 29 hips showed full clinical survival with complete osteointegration of the acetabular cup and three were found to have a radiolucent zone of 1 mm in width.The complete osteointegration of a cemented acetabular cup was achieved in 10 out of 18 hips, with eight having spongioplasty of the acetabular bottom. The use of uncemented cup resulted in full clinical survival and complete osteointegration in 29 cases out of 32. The best outcome was achieved with the use of an expansion, uncemented CLS cup. This is designed for peripheral fixation, which is useful in the protrusion of an acetabulum with a thin bottom and permits acetabular bottom grafting and positioning of the femoral component head in the center of hip rotation. It provides full osteointegration even with low bone quality.Prerequisites for successful arthroplasty in hips with acetabular protrusion include the firm implantation of an acetabular component, placement of the femur lateral to Köchler's line, location of the center of the femoral component head inside the TAR triangle and an agreement between the approximate center of the femoral head and the center of the femoral component head. The firm and lasting implantation of a cemented cup requires spongioplasty of the acetabular bottom. At an average of 7.1 years after surgery, uncemented cups in conjunction with bone grafting of the acetabular bottom showed better outcomes than cemented acetabular components.

We describe the collection, storage and examination of allogenic bone grafts and their use in revision hip arthroplasty, indicated because of acetabular loosening, that involved either an uncemented cup or an augmentation device with a cemented cup according to the extent and nature of acetabular defects.Allogenic bone grafts, usually long bones, were collected from deceased humans within 12 hours of death. They were processed according to the standards of US tissue banks. Using ELISA, the blood of each donor was serologically examined for antibodies against selected antigens (HIV I, HIV II, syphilis, HbsAg, HCV, and p24HIV I, HTLV I and II, and HbcAg, if required). Microbiological examination of each bone sample was also included. The samples were kept in a quarantine box until the examination results were known. When these were negative, the bones were cut, under aseptic conditions, to obtain parts (condyle, metaphysis, diaphysis, patella, etc.) weighing from 80 to 150 gr. Subsequently, another quality check, involving microbiological and histological examination, was performed. The allografts were stored at -80 degrees C.Between October 1999 and October 2000, 67 revision total hip replacements were performed. Of these, allogenic bone grafting was used for acetabular reconstruction in 30 cases (45%). The average amount of graft tissue per operation was 107 gr (range, 43 to 163 gr). Eleven grafts had been harvested from the tibial condyle, nine from the trochanters, eight from the femoral condyle and two from the patella. The graft bone, ground into coarse chips, was washed with an antibiotic solution. Two techniques were used in graft implantation. 1) Impaction grafting, under pressure, of the acetabulum whose surface was free from any granulation tissue and scratched to make the bone bleed, and implantation of a cemented cup (LOR or Spotorno CLS). 2) Filling of large defects with a bulk of allograft bone chips, using an augmentation ring, mesh or Burch-Schneider cage, and implantation of a cemented polyethylene acetabular component. Uncemented implants were used in 17 and cemented cups with an augmentation device in 13 cases. The hips were checked by X-ray at 3, 6 and 12 months and then at yearly intervals.In the postoperative period of 26 to 38 months, an early recurrent infection led to temporary removal of the implant in one case, one hip showed superficial infection that responded to therapy and there was one case of aseptic acetabular loosening. A recurrent dislocation led to femoral stem exchange for a modular component with a longer neck in one case. The remaining 28 cases showed good incorporation of the graft without any signs of implant migration.Segmental defects of the acetabulum can be treated by implantation of specific types of acetabular cups or by massive bone grafting. Cavitary defects can be filled with cancellous allograft bone or bioactive, artificial materials. We prefer morselized allograft bone from the tissue bank and this was used in 45% of repeat surgeries for failure of the acetabular component. An uncemented cup is more convenient, supposing sufficient primary stability can be ensured. When defects are extensive, augmentation devices and filling with graft bone are necessary. Cadaver allografts offer advantages over autologous bone because they are available at any amount and thus enable us to avoid extensive damage to the iliac crest by autologous tissue harvesting. Cadaver grafts are bones of good quality, free from degenerative or dystrophic changes because they are usually taken from young subjects. The size of 7 to 10 mm is optimal because it permits the grafts to maintain both structure and strength. The strict procedure of sample collection and examination minimizes the risk of infection transfer. The progress of graft bone ingrowth was evaluated on radiographs that showed incorporation of allograft into the surrounding bone during 3 to 6 months and no radiolucent areas at host bone-implant contact.Our patients showed good allogenic bone ingrowth in relation to the acetabular bed and good bone restructuring and incorporation in relation to the implant. Neither mechanical failure of implants nor graft rejection were recorded. The risk of infection transfer was low and comparable with routine blood transfusion. The necessary prerequisite for revision hip arthroplasty is a well-operating bone tissue bank.

The material of prospective study involving 57 surgically treated hips in 55 patients suffering with a severe form of Legg-Calvé-Perthes disease (LCPD) was analysed by the use of statistical methods to depict the influence of age, of sex, of the amount of head involvement on the outcomes of surgical treatment by rotational acetabular osteotomy (Salter or Steel osteotomy from 9 years of age).During the period 1990-2000 rotational acetabular osteotomy for Legg-Calvé-Perthes disease was performed totally in 124 patients. Excluded were cases, in which the operation was done for residual subluxation as a definitive outcome of former LCPD, cases which did not return for controls, cases with not yet completed consolidation after surgery and cases operated by me abroad. Totally were analysed stastistical sheets from 57 rotational acetabular osteotomies, including basis dates from medical history, clinical and x-ray examinations. Special concern was given to the evaluation of remodellation of the affected femoral head chronologically.All patients were operated by the group of three senior orthopaedic surgeons. Indication for surgery was based on the evidence of the progressive collapse of the femoral head issuing in the lateral and anterior head extrusion. As the Mose as well as Stulberg classification are showing inter-rater discrepancies, authors measured as well head-neck index, epiphyseal index and acetabulum-head index to eliminate subjectives errors.Age at operation and sex did not affect the results expressed in epiphyseal quotient and acetabulum-head index. With the increasing age the head-neck index dropped down depicting the progressive shortening of the femoral neck the older kids. The periods from the operation till the consolidation of the lateral pillar of the femoral head were longer in younger than in older children. Although the evaluation of results in Mose classification showed poorer results generally and also specifically in relation to the increasing age, distribution of results in Stulberg classification showed excellent and fair results in almost 90% of all treated patients.Prospective study based on the use of rotational osteotomy, avoiding the routine combination with varisation of the proximal femur in older kids using in them Steel triple osteotomy, showed promising results especially in Stulberg classification. Contrary to Salter and others prerequisiting for the indication of operation only slight deformity of the affected femoral head, many of the enrolled cases appeared with the remarkable deformity of the femoral head before the operation. Rotational acetabular osteotomy showed its potential to involve the enlarged head and follow-up depicted its subsequent slow remodellation.Submitted study was prepared to be matched nextly with the conservative group, which will be published in another publication. Internal analysis of the presented cohort disclosed that presented surgical treatment (Salter or Steel osteotomy respectively) assured, that irrespective of higher age, the important parameters like epiphyseal quotient and acetabulum-head index did not become worse than in younger groups. Even in the group over 9 years of age, 87.5% were categorised like excellent and fair results in Stulberg classification.

The aim of the study is an assessment of short-term results after the implantation of cementless Zweymüller Bicon cup in patients with a complicated anatomy after acetabular fractures.The group of 10 patients indicated for Zweymüller cementless THR in post-traumatic osteoarthritis after acetabular fracture was selected of the total number of 703 primary implantations performed in 1998 and 1999 at the authors' Orthopaedic Department. The group includes patients treated conservatively as well as by means of open reduction and fixation.For the evaluation we used Harris Hip Score and radiographic assessment based on radiographs in two projections on which signs of implant loosening and incidence of particular ossifications were monitored.Harris Hip Score was in 6 cases higher than 90 points, in 2 cases its value was 80 points. The low score in another 2 patients related to the limitation of the function resulting from the trauma and in one case from the injury of sciatic nerve during open reduction and fixation with a subsequent common peroneal nerve palsy. Radiographic check did not reveal any signs of loosening of the implant. Within the evaluation of particular ossifications the finding was 3 times classified in Group 1 and twice in Group 2.The number of patients of the authors' group corresponds with the numbers of patients presented in literature, however, due to a short time of the follow-up both clinical and radiographic results in our group are better. In all cases a good primary stability and position of the acetabular cup in the complicated anatomical conditions was obtained. Structural bone grafting was not necessary in any of the cases. Peroperative complications were not encountered.Short-term results of our small group of patients are very good. Both in the clinical and radiographic evaluation they correspond with the results of Zweymüller THR performed in patients with dysplastic acetabulum.

The aim of the study was to verify the method after Slooff in our modification, i.e. "a cemented cup--cancellous bone grafts--a metal net" for the revision surgery of aseptic loosening of cemented polyethylene acetabular cup in combined defects of acetabulum.The followed-up group of 52 patients (36 women and 16 men), average age of 65 years (age range, 50-81 years) with aseptic loosened cemented polyethylene Poldi cups included 52 operated on hip joints. The average interval between the primary implantation and the revision surgery was 9 years (2-21 years).We reconstructed acetabulum with combined bone defects (AAOS III Degree--as a result of aseptic loosening and migration of cemented acetabular cups) by means of cancellous bone allografts, a shaped Howmedica metal net, Simplex bone cement and a polyethylene cup.Average follow-up was 36 months (range, 14-49 months). Clinical evaluation of the group was performed after Harris Hip Score averaging 80 points. Radiological evaluation focused on the density and presence of bridging trabeculae between the grafts and the host bone. Positive finding was in 46 patients, i.e. 90%. Further, we evaluated migration of the cup after Conn. In 4 patients (7.7%) it was less than 2 mm and in 3 patients (5.7%) it was greater than 5 mm. Reconstruction failed in 1 patient (1.9%). Radiolucent line was found in the zone between the host bone and bone grafts only in III zone after De Lee and Charnley in 8 cases (15.3%), in zones I and II it was not encountered in any of the patients in the group. One case required another revision surgery in which Burch-Schneider ring, bone allografts and Müller cemented cup were used for the reconstruction. In two patients of this group there developed a phlebographically verified phlebothrombosis without signs of embolism into pulmonary artery. In two cases there occurred a superficial inflammation of the wound which subsided before the removal of the suture. No deep infection of the wound was encountered. Particular ossifications were assessed after Brooker. Type I occurred in 7 cases and Type II in 1 patient.At present several methods are used for the reconstruction of acetabulum and their choice is limited by the extent of the bone loss. For cavitary defects it is possible to use the combination of bone grafts with cementless cups. In segmental and combined defects the situation is more complicated and it can be solved by the application of a solid bone graft. In case the solid bone graft assumed greater load, the situation logically resulted in the fatigue fracture of screws and failure of the whole reconstruction prior to the bone graft-host bone osteointegration. In cementless cups and solid bone grafts the situation is slightly more favourable. If there is a timely biological (secondary) osteointegration of the cup the reconstruction has a chance to survive. The timeliness of biological (secondary) osteointegration is significantly influenced also by the quality of the applied bone graft and a good contact of the bone graft and the host bone and the surface of the cementless cup. Our method of the reconstruction of acetabulum by means of cancellous bone grafts, metal net and cemented cup allows a relatively good primary stability of the cup. Due to its partial elasticity the metal net does not prevent transmission of forces on the bone grafts which are placed under the net. As a result there occurs a faster union of bone grafts with the host bone.The method of cemented cup--cancellous bone grafts--metal net after Slooff is in our modification one of the accepted options of the reconstruction of acetabulum. Its benefit is the possibility of early weight bearing of the limb operated on. The stress on the bone grafts under an elastic construction conduces to a relatively fast good secondary osteointegration. The method can be recommended for II and III Degrees of acetabular bone loss according to AAOS classification. Of no less importance is also the economic aspect of the whole reconstruction.

Authors deal with the screw-wire technique described by Brunner and B. G. Weber in 1981. The principle of the technique consists in passing a wire loop around the heads of divergently driven screws. After tightening the screws the wire loop is put under tension which results in interfragmental compression. Mostly used for this purpose are 4.5 mm cortical screws but, if need be, any screw from a standard or small set of instruments is applicable. This type of fixation they use mainly for acetabulum fractures, diastasis of symphysis or for the stabilization of knee osteotomies.

The aim of the study is the verification of the applicability of the Zweymüller system of total hip replacement in dependence on the size of defects of acetabulum and femur and evaluation of early results in patients operated on in 1998 and 1999.In 1998 and 1999 we reimplanted 125 total hip replacements. In 60 revision surgeries we used at least one component of Zweymüller Bicon Plus system. We prospectively followed defects of acetabulum and femur in DGOT classification. The size of the stem was planned, final indication of the cup was determined peroperatively.During the implantation of the cup we tried to achieve primary stability of the implant. The cup was implanted in uni- and bisegmental defects. In total we implanted 50 Bicon cups, in 24 hip joints we applied morselized allograft in the defect. In tri-segmental defects we used twice the Burch Schneider cage and in 4 hip joints a bone allo-graft with a cemented cup in combination with SL-Plus stem. In one female patients after the implantation of Bicon cup in type 7 defect there occurred an early failure. When removing bone cement we preferred fenestration of the cortical bone of the femoral shaft. In 30 hips SL-Plus stem was used and in 13 hip joints SLR-Plus was applied. We checked 50 hip joints operated on by the method after Harris and by radiographs in two projections.Fifteen patients are without pain, 14 patients take analgesics. The final result is excellent in 24% of patients, good result in 32%, satisfactory in 24% and poor in 20% of patients followed up. By comparison with HHS value prior to the surgery HHS got worse in two patients who are not satisfied with the result of the operation. Average score prior to surgery was 47.4 points (range, 23-82.6). Five times we encountered a radioluscent line of acetabular component in zone III. Radiograph signs of loosening of the cup or stem were not found in any of the hip joints.Zweymüller system is applicable in revision surgeries of both cemented and cementless hip joint replacements. The cup may be applied in uni-segmental and bi-segmental acetabular defects under the condition of achievement of primary stability. Applied morselized bone allografts have a good potential for osteointegration and remodeling. The rectangular stem is suitable for the treatment of defects extending as far as 5 cm below the level of lesser trochanter. Bone cement was extracted from fenestration, transfemoral approach was not required in any of the patients. Even with the use of SLR (revision) stem we did not transfer fixation of the femoral component to the lower half of femur.

The aim of the study is to present complications of acetabular component of CLS total hip replacement and their solution.In the period of 1986-1999 in total 219 cementless CLS total hip replacements and 2012 CLS cups in hybrid replacements were implanted at 1st Orthopaedic Department in Brno--primary surgeries--2026, revision surgeries--205. Of 2231 CLS cups we encountered 25 complications requiring a revision surgery (1.1% of all cases): 2 cases of the broken metal shell, 3 cases of cup penetration into pelvis, 4 cases of cup migration, 5 cases of aseptic loosening, 5 cases of dislocations and 6 cases of deep infections.Broken metal shells were treated by Müller and Eichler ring, cancellous bone grafting with a cemented PE cup. Penetration of cups into pelvis were managed by Girdlestone procedure. Migration of the cup was solved in 1 case by Burch-Schneider ring, other cases with a good function were left in situ. Aseptic loosening with defects of acetabulum was solved by means of metal rings, cancellous bone grafting and cemented PE cup. Dislocation was managed by adjustment of CLS cup in the correct position, longer or closed reduction and orthesis. In infections a two-step procedure was used with a repeated application of CLS cup, Prostalac technique or Girdlestone procedure.The results of cases solved by means of acetabular metal rings, cancellous bone grafting and cemented PE cup are after 2-5 years good. The patients are capable of full weight bearing and have no pains, Harris score is 83-89 points. The radiograph shows in all but one patients a stable implant without radiolucent interface. The function of all patients with dislocations of CLS implant is now very good or good. No recurrence was recorded in patients with infections. The function of the hip with Girdlestone procedure is in 2 patients low--Harris score is 58 and 63 points. Harris score in patients after a two-step revision with a repeated application of CLS cup is 80-89 points.In cases of the broken metal shell there occurred a proximolateral defect of the acetabular bone as a result of development dysplasia of the hip. The cup had inadequate circumferential support. The cases of cup penetration into pelvis are connected with a marked primary or subsequent deficiency of the acetabular floor, excessive reaming of subchondral bone and osteoporosis. Revision surgery with a metal ring requires a careful extensive cancellous bone grafting with a complete filling of all defects, support of the ring by the bone and development of a stable bone-ring-cemented PE cup composite. The best results in infections were achieved by a two-step revision with a repeated application of CLS cup.Of the total number of 2231 implanted CLS cups in the period of 1986-1999 only 25 complications were recorded requiring a revision surgery, i.e. 1.1% of all cases. Complications relating to the cup were treated in case of acetabular defects by means of metal acetabular rings, cancellous bone grafting and cemented cups. In infections a two-step procedure was used with a repeated application of CLS cup, Prostalac technique or Girdlestone procedure.

Authors report on five-year results in patients after THR operated on between 1994 and 1995 in which a cementless CLS Spotorno cup was used.In the given period 59 patients were operated on (35 women and 24 men). The average age at the time of implantation was 54.6 years. The most frequent causes of the indication for THR was primary osteoarthritis of the hip in 27 patients and postdysplastic osteoarthritis in 16 patients. Applied were 46-62 mm cups for 28 mm and 32 mm diameters of the head. The femoral component used was a cementless Poldi--42 times, cemented MS-30--16 times and cementles CLS--once. The surgical approach was first anterolateral, later Bauer transgluteal approach which allows a better visualization of the location during the reaming of acetabulum and cup positioning. The reaming of acetabulum and implantation of the cup were performed in a standard way. Prior to incision Kefzol (cefazolin) was administered intravenously in the dosage of 2 g. In patients with a preceding operation on the hip joint the administration of Kefzol was extended to 24 to 72 hours (3 x 1 g each 8 hours intravenously). Standard antithrombotic prevention by miniheparinization was applied in all patients until they were able to walk with the help of crutches (7 to 10 days). In case of an increased risk of thromboembolic complications heparin with a low molecule weight (Fraxiparine) was applied over the same period.In the period between autumn 1999 and spring 2000 clinical examination of the patients operated on was performed together with a radiograph of the hip joint involved. Clinical findings were evaluated after Harris hip score. Radiograph findings were compared to the postoperative and the control ones made one year after the operation. Evaluated were the position of components and signs of their loosening, if any.After the average follow-up of 59 months 57 patients were checked. Excellent results according to Harris were achieved in 40 patients, good results in 13 patients and satisfactory results in 4 patients. No poor result was recorded. Radiographs proved a full integration of CLS Spotorno cups without any signs of loosening in all checked patients.Not very numerous works in both foreign and domestic literature list according to the experience of individual authors the following advantages of CLS Spotorno cup: a small bone loss during reaming of acetabulum, excellent primary stability, excellent secondary stability and its easy reimplantation as compared to all types of cementless cups. Only in one female patient after a peroperative fissure of proximal femur the control examination showed a lower value of Harris score than was the average value of the whole group. Similarly, the Harris score was lower in female patients who postoperatively experienced complications of neurological and internal nature (1 temporary paresis of n. ischiadicus, 1 phlebothrombosis of veins of the limb operated on). Control radiograph examination proved a full bone integration without signs of loosening in both components of the implant in all 57 checked patients.After five years the authors have a good experience with CLS Spotorno cup and recently they have started to indicate it more often in postdysplastic coxarthrosis in younger patients and in revision surgery for aseptic loosening of a cup. In young patients they recommend its matching with CLS Spotorno cementless femoral component and in middle-aged patients its matching with MS-30 (Morscher-Spotorno) cemented femoral component the centralizer of which allows an ideal anchoring of the stem in the cement mantle.