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O Cech

Publications and source records attributed to O Cech.

At least 19 recordsLinked to original sources
PubMed2006

[Medial opening-wedge high tibial valgus osteotomy, using a stable TomoFix plate, in genu varum arthritis: surgical technique].

The authors present the technique of high tibial correction osteotomy by the medial opening procedure, with the use of an angle-stable TomoFix plate. The prerequisite for a long-term good outcome of corrective osteotomy in genu varum is to achieve limb alignment permitting transfer of weight-bearing from the affected medial compartment to the healthy lateral compartment of the knee. The development of implants that maintain a stable angle has facilitated corrective osteotomy with an opening wedge on the medial side of the proximal tibia. These implants provide stable fixation even when a high correction of the mechanical axis is needed. The authors present the case of a patient with varus malalignment following a fracture of the tibia. In order to achieve correction of the limb's mechanical axis, it was necessary to open the proximal tibia osteotomy with a wedge that was 2.5 cm on the outer side.

Adult↗
PubMed2005

The European school of total hip arthroplasty and 35 years of total hip arthroplasty in the Czech Republic.

The development of the European total hip arthroplasty in the sixties of 20th century is associated mainly with the names of G. K. McKee, J. Charnley and M. E. Muller. The SICOT meeting in Paris in 1966 introduced THA as a new method of treatment of osteoarthritis of the hip and paved the way for the commercialization of the manufacturing of prostheses. The success of this method consisted primarily in the fixation of individual components by bone cement and application of metal-to-polyethylene and metal-to-metal joints. The book presents these historical events as they have been reflected in the development of THA in the countries of the former Czechoslovakia and in the development of implants of domestic provenance. The development of THA in the former Czechoslovakia started in 1969 and was based on the Swiss school established by M. E. Muller. The Muller component with the "banana-shaped" stem was implanted using the Watson-Jones approach, the proximal femur canal was prepared by a rasp and the Palacos cement was used. This prosthesis served also as the model for the first Czech implant Poldi-Cech of I generation (the Chirulen cup available in three sizes, the "banana- shaped" femoral component with a 32 mm head-diameter and 130 degree neck-shaft angle) the development of which started in 1969 and the serial production began in 1972 in the Poldi Kladno steel company. Fatigue fractures of the "banana-shaped" stem led to the development of the concept of a femoral component with an "anatomical" stem. In Switzerland, this concept was developed by B. G. Weber. In the former Czechoslovakia the development of a new femoral component with an "anatomical" stem following the shape of the intramedullary canal with an ovoid profile and without sharp edges started in 1972. Due to the incidence of fatigue fractures of the "banana-shaped"stem and material that was not sufficiently strong (steel used for the production of osteosynthetic components), 144 degree neck-shaft angle was chosen. Reduction of the effect of bending forces on the valgus stem had eliminated fatigue fractures. This Poldi-Cech prosthesis of II generation was provided in nine sizes. The diameter of the head remained the same. Three Chirulen cups were supplemented with a "flat" cup for implantation in a dysplastic acetabulum. The prosthesis was implanted with an exact instrument set (reamer for acetabular preparation, rasp for proximal femoral preparation, alignment device for accurate positioning of both the cup and the femoral component) with the use of the Palacos cement. The production of the Poldi-Cech prosthesis of II. generation started in 1974 with the fabrication of a monoblock. Since 1986 it has been developed into a modular system (14/16 cone) with the possibility to use a ceramic head of 32 mm diameter (only in the nineties the cone size was changed to 12/14 and the heads were provided also in the 28 mm diameter). The Poldi-Cech prosthesis of II generation with the "anatomical" stem has been implanted since 1974 (i. e. during 30 years) in more than 140 000 patients in the Czech and Slovak Republics. In the same year cemented monoblock hemiarthroplasty was developed on the same basis as THA using the same "anatomical" stem and 36 to 60mm head diameter. Until now more than 35,000 of these hemiarthroplasty systems have been implanted. Until 1992 the Poldi-Cech implant was practically the only available cemented total hip replacement in the former Czechoslovakia and retrospectively it may be considered a highly successful implant. In the authors' view, the further development of THA will lead in the following years to the use of implants proved by a long-term follow-up. Preference will be given to prostheses the implantation of which will require a minimal loss of the bone stock during primary surgery and which will allow a technically easy reimplantation. The continental Europe has been recently preferring hybrid prostheses while Scandinavia witnesses an evident increase in the number of implanted cemented prostheses to the detriment of the cementless and hybrid ones. Naturally, cementless prostheses will keep dominating in young patients.

Arthroplasty, Replacement, Hip↗
PubMed2004

[Evaluation of results after reimplantation of total hip arthroplasty cemented cup].

PURPOSE OF THE STUDY: The aim of the study is to evaluate the results achieved after the replacement of a loosened or broken cemented cup by another cemented cup and to specify conditions under which such procedure may be successful. MATERIAL: In the period of 1992-1997, 158 revision surgeries of total hip arthroplasty were performed at the authors' Department. In 69 patients (57 women, 12 men) the cemented cup was replaced by another cemented cup and the original femoral monocomponent with the 32 mm head diameter the surface of which was not damaged was left in place. METHODS: The indication for operation was loosening of Degree 2 or 3 of the classification after Krbec et al. The surgery was performed from the Watson-Jones or Bauer approach. The cup was always revised with the use of the Palacos cement in combination with antibiotics by the cementing technique of 2nd generation. Augmentation was used in 11 cups. The original femoral component was always returned to the original cemented bed and a cement mantle was added in the proximal part in 15 patients. Poldi cups were replaced in all patients of the followed up cohort (63 times loosening--91%, 6 times breakage--9%) using 3 types of cups for revision surgery (Poldi--44 times, Ultima--20 times, SPC--5 times). During the period of March through December 2001, 48 patients were followed up in the out-patient department. The clinical condition was evaluated on the basis of the Harris Hip Score and a radiograph was made to monitor changes in the position of the cup, linear wear, the presence and size of the radiolucent zone. RESULTS: The results were evaluated in 48 patients (40 women and 8 men) with the average interval of 63 months after revision of the cup (range, 46 to 112 months). However, the clinical and radiograph evaluation of the condition was made only in 45 patients. Three patients re-operated on in 2001 were not included in the evaluation. The Harris Hip Score was on average 78 points (range, 51 to 97 points). Radiographs did not show any change in the position of the cup. The linear wear up to 1 mm was revealed in 4 cups and above 1 mm in 1 cup (11% of the evaluated patients). The radiolucent line in zone III after DeLee and Charnley was present in 4 cups, in zones II and III in another 4 patients, i.e. in total in 8 of 45 cups (18%). DISCUSSION: The group of 45 followed-up patients may be considered a sufficiently representative sample of the original 69-member cohort (minimally 7 patients died in the follow-up period, 3 patients were not included in the evaluation). With regard to the average follow-up of 63 months the results may be considered as medium-term. The average interval between primary total hip arthroplasty and revision of 130 months is comparable with the results of similar studies by other authors. The results of the clinical evaluation on the basis of Harris Hip Score are not convincing (range, 51 to 97 points, average 78 points). Radiographs showed a radiolucent zone in 8 cups (18%). Another 3 patients were at the time of evaluation after a repeated revision of the cup for loosening (at the interval of 22 to 34 months). CONCLUSION: A good integration of the cemented cup used in revision of the loosened cemented cup of total hip arthroplasty was evident only in infrequent cases of a perfectly preserved acetabulum both from the viewpoint of shape and structure. The evaluation of other patients of the followed-up cohort, however, produced rather unconvincing results. On this basis and also on the basis of their experience in the use of cementless cups in revision of total hip prostheses the authors recommend to prefer a cementless implant in the revision of the cup.

Aged↗
PubMed2004

[Long-term results of the Schenker cementless femoral component].

PURPOSE OF THE STUDY: The aim of the work is to evaluate the results achieved in the group of patients with implanted Schenker cementless femoral component (Schenker, Switzerland) and discuss the method of solution of loosening of these components in the group of patients who underwent revision surgery. MATERIAL: The first part of the followed-up group comprised 16 patients (11 women, 5 men) with the total of 18 operated on hips who underwent primary hip arthroplasty between 1989 and 1992 (Poidi cemented cup, Schenker cementless femoral component). The average follow-up period was 140 months (range 120 to 156 months). The second part of the group included patients who underwent revision for loosening of the Schenker cementless femoral component. This part consisted of 18 patients (11 women, 7 men) with 20 operated on hips. The average interval after primary hip arthroplasty was 65 months (range 36 to 118 months). METHODS: In the period between May and December 2002, 34 patients were examined in the out-patient department. The evaluation involved only patients who did not undergo revision surgery. The clinical condition was evaluated on the basis of the Harris Hip Score and a radiograph was made to monitor any signs of linear wear of the cup, the extent of the radiolucent zone in both components and a potential migration of components. RESULTS: Results were evaluated in 16 patients (11 women, 5 men) with 18 operated on hips. The average follow-up period was 140 months. Harris Hip Score averaged 76 points (range, 56 to 97 points). The linear wear up to 1 mm was recorded in 4 cups and that of up to 2 mm in 2 cups. The radiolucent line surrounding the cup in zone III after DeLee and Charnley was present in 5 cups, in zones II and III in another 1 patient. No cup showed any signs of migration. The radiolucent line surrounding the femoral component was present in 9 hips. The progress of subsiding as compared to the preceding radiograph check (interval of 1 to 2 years) was evident in 3 femoral components. At the time of the check 20 femoral components had been already revised, of this 7 hips were after repeated revision. DISCUSSION: Between 1986 and 1992, 74 primary hip arthroplasties in 61 patients were performed at the authors' department using Schenker cementless femoral component always in combination with Poldi cemented cup. Of 61 patients, the follow-up was not completed in 27 (10 patients died, 6 of them underwent a revision surgery at other hospitals, 11 patients were lost for the follow-up). In the evaluated 18 hips only 7 were without pain, another 3 patients from suffered occasional pain which responded to common analgesics. The results of clinical evaluation after Harris are unconvincing. During the follow-up 29 joints (39% of the original cohort) had been revised or indicated for revision surgery. Repeated revision surgery was performed in 7 hip joints where the Schenker cementless femoral component was originally replaced by cemented stem and this cemented component loosened within 3 to 7 years after the first revision. With regard to the success rate of other double tapered femoral components, the authors consider the material of the component (vitalium) as the main cause of failure. The surface of this stem did not provide for a long-term osteointegration and is at present successfully used only for production of femoral heads rather than for cementless femoral components. CONCLUSION: A favourable clinical finding and a good integration of the cementless femoral component Schenker were recorded within the average follow-up of 12 years only in 5 patients. All of them were young at the time of surgery and had a very good quality of bone. As a conclusion authors state that in general, Schenker cementless femoral component has not proved to be successful in clinical practice. For revision surgery of the loosened Schenker cementless femoral component it is necessary to use a titanium cementless component with a surface allowing long-term osteointegration.

Adult↗
PubMed2004

[Infection complications of total hip arthroplasty].

The authors present an overview of the current views on etiology and diagnostics of infectious complications of total hip arthroplasty and analyze the possibilities of individual therapeutic procedures (debridement with the preservation of total hip arthroplasty, revision of the endoprosthesis, long-term antibiotic therapy, final resection arthroplasty, arthrodesis). They discuss the pending issues relating to the therapy of infectious complications of total hip arthroplasty (the duration of antibiotic therapy, the interval between the extraction and revision surgery of the endoprosthesis, the use of antibiotic-containing cement). Based on their own experience they recommend the revision surgery with the preservation of the implant, debridement and irrigation as the first step only in case of an early post-operative infection and in case of a late hematogenous acute infection. In case of chronic infection they recommend a two-step revision surgery using the cement spacer and the antibiotic therapy for 3 to 6 months. During this period the laboratory and clinical signs of the infection must be back to their normal. Long-term antibiotic therapy in dependence on microbial sensitivity is recommended.

Anti-Bacterial Agents↗
PubMed2002

[Preoperative planning and surgical technic in achieving stability and leg length equality in total hip joint arthroplasty].

One of the prerequisites for a good outcome of total hip arthroplasty is preoperative planning. Using a roentgenogram, the size of an implant, incision level on the femoral neck, depth required for fitting the cup, restoration of the center of hip rotation and, if necessary, correction of length descrepancy between the legs are determined. The preoperative planning based on an X-ray image was introduced by M. E. Müller and, in 1976, was modified by R. Schneider who used a transparent sheet for a template on which all relevant points guiding the surgical procedure are marked, i.e., the right position for implantation of the cup and stem, and incision lines. In uncomplicated cases, however, this approach is not necessary and the "planning principle of parallel lines" developed by L. Spotorno in 1988 can be used instead. The determination of length discrepancy between the legs is derived from a drawing of three reference lines on the roentgenogram. The lines parallel to each other indicace the same length for both legs. If the legs differ in length, the lines will diverge from each other in a way typical for this condition.

Arthroplasty, Replacement, Hip↗
PubMed2001

[Personal experience with the Wagner revision stem in hip joint reoperations].

PURPOSE OF THE STUDY: Since 1993 we have been using the Wagner revision stem, initially in the length of 265 mm and 305 mm and later also the short stem of 190 mm and 225 mm, for revision surgery with the destruction of proximal femur. This technique provided for primary fixation of the stem in the unaffected femoral bone and creates prerequisites for the bone regeneration and bone formation of the destructed host bone by the loosened implant in the metaphysis and proximal part of diaphysis. MATERIAL AND METHODS: In the period of 1993-1998 we operated on and followed a group of 35 patients (18 men and 17 women), average age 69 years (age range, 52-89). In 32 patients we performed revision surgery of Poldi-Cech stem, twice CF-30 stem and once cementless J + J stem. The average time interval between the primary operation and revision surgery was 10 years (range, 2-22 years). Thirty patients had to be reoperated due to aseptic loosening of the implant and five patients due to infection. Wagner stem was applied no sooner than 6 months after the infect had healed. In the application of the short stem (190 mm or 220 mm) we use Bauer approach (4 times) or extended Bauer approach (4 times), in long stems we use transfemoral approach in our modification: osteotomy is performed from the extended Bauer approach in the frontal plane and the anterior part of femoral cortex is retracted. The retracted anterior part of the femoral cortex femoral bone is fixed back only by hemi-wire loops. RESULTS: Of the total number of 35 operated on 2 patients required revision surgery due to the subsidence of the stem and one removal of the stem in case of complete protrusion of the cup into pelvis. In short stems there were no post-operative complications. Dislocation of the hip occurred in three patients after the implantation of the long stem. After the closed reduction the surgery was not necessary. In one patient there developed an infection 5 months after operation. It was a hematogenous infect resulting from a pyogenic affection of the operated on limb. A two-step revision surgery was performed with a spacer and a subsequent reimplantation of a stem of greater diameter. DISCUSSION: Wagner presents results of 69 patients after the application of his own stem 265 mm and 305 mm long. In 62 patients of the total number no subsidence was encountered, in two cases post-operative dislocation was recorded. Isakson et al. do not consider subsidence resulting in fixation of the stem as a significant factor and correct the difference in the length by shoes. They point out that this method is suitable for the solution of defects of proximal femur in such a way that the implant has a stable fixation and provides for bone formation, restoration of the destructed part of proximal femur in the extent of the original loosened stem. We consider the Wagner technique a significant contribution to the solution of these severe complications. As compared to Wagner, instead of the sagittal plane we perform transfemoral approach in the frontal--horizontal plane which allows operation in the supine position of the patient and a more precise replacement of the cup. In our group of patients we incorrectly used the long stem without transfemoral approach in 3 patients, one patient required revision surgery, in the remaining two patients the period of osteointegration of the stem was substantially longer. CONCLUSION: The Wagner revision stem allows treatment of the destructed proximal part of femur caused by loosening of the stem and polyethylene granuloma. Of great importance is the preservation of the contact of muscles and residual parts of the destructed femoral bone. The short version of the Wagner stem (190 mm and 225 mm) has fully justified itself in revision surgeries of the replacement of the stem in cases of a preserved bone stock. Wagner stem sufficiently bridges the trepanation hole and is safely engaged in the femoral shaft. The long Wagner stem (265 mm and 305 mm) has proved suitable in revision surgeries in cases of thinner cortex and defects in the whole length of the loosened implant. This stem requires a transfemoral approach and a perfect stable anchoring of the stem in the stable skeleton of the femoral shaft. Bone formation and remodelling of proximal femur does not affect the length of the limb. Of great importance is its accurate planning. This procedure is a considerable contribution to the solution of these severe complications.

Aged↗
PubMed2001

[The uncemented cup of the CLS Spotorno joint endoprosthesis--5-years' results].

PURPOSE OF THE STUDY: 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. MATERIAL: 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. METHODS: 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. RESULTS: 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. DISCUSSION: 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. CONCLUSION: 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.

Acetabulum↗
PubMed1996

Morphological features of bone healing under the effect of collagen-graft-glycosaminoglycan copolymer supplemented with the tripeptide Gly-His-Lys.

The authors prepared 7.5% and 12.5% collagen gel, and supplemented it with the tripeptide Gly-His-Lys (GHK), perfloxacine and hypersulphated glycosaminoglycan (HSGAG). By means of 125l marking, its absorption was followed from small polyurethane sponges placed under the skin of rats. The absorption of gel without HSGAG was found to be faster. Antibodies against collagen (type I, II and III) or collagen gel were generated either in rabbits or in minipigs, in which collagen gel was tested. Microbiological tests proved the sterility of the collagen gel. The collagen gel supplemented with GHK, pefloxacine and HSGAG was named Colladel, and was used in a model experiment in guinea-pigs for filling artificially created bone defects in diaphyses of femurs, and with cementless endoprostheses. The healing process was followed by means of RTG and NMR, and histologically. The slowest healing process was found in unfilled bone defects. Defects filled with Colladel without GHK healed substantially more quickly, and the most accelerated healing was connected with complete Colladel application. When Colladel was used with cementless endoprostheses, vivid osteogenic activity at the interface of trabecular bone and metal stem was detectable in the course of the experiment.

4-Quinolones↗
PubMed1993

[Treatment of an infected pseudoarthrosis defect by callotasis of the bone fragments].

The authors demonstrate a method of filling a large total bone defect caused by resection of the bone on account of chronic osteomyelitis. The defect was filled with a regenerate prepared by calotassis of the fragment which was distracted from the proximal part of the bone to its distal part. It proved thus possible to fill a 16 cm long defect. The cosmetic, anatomical and functional result is excellent.

Adult↗
PubMed1993

[A sandwich-type hip joint socket with a ceramic lining].

The authors present a new type of sandwich socket with ceramic lining. Mechanical tests provide evidence that the submitted implant is very firm. It is a basic prototype from which cemented and non-cemented sockets of the hip joint will be derived. The authors use a 28 mm socket paired with a 28 mm head and 12/14 conus and 14/16 Euroconus. This means that the submitted socket is compatible with all types of cemented and non-cemented endoprostheses.

Ceramics↗
PubMed1993

[Experimental and clinical study of the Poldi isoelastic cervico-capital endoprosthesis. II. Clinical study].

In the second part of the paper on isoelastic cervicocapital prostheses the authors describe a group of patients with an implanted endoprosthesis. The selection of indication for implantation was very strict and the group of patients is very homogeneous. The endoprosthesis was implanted to biologically old patients with fractures of the neck of the femur where it was not possible to select treatment other than implantation of a cervicocapital prosthesis. The group of patients was evaluated subjectively according to a questionnaire sent to the first 50 patients, and objectively, i.e. by analysis of the clinical and radiological examination. A total of 85 patients were evaluated after more than two years after the implantation. Clinical examination revealed in almost 60% of the patients pain in the central part of the femur of changing quality. For evaluation of the effect the authors assessed the ability to walk and the quality of gait. Despite the above mentioned complaints 76% of the patients were able to walk unaided. By evaluation of the X-ray findings the authors did not only find evidence of osteoplastic reactions in the region surrounding the bone but also the probable cause of pain suffered by the patients, i.e. inadequate contact of the inner corticalis of the femoral cavity of varying width with the uniform shank. The most serious complication was fracture of the shank of the endoprosthesis, always at a typical site. This occurred in five patients from a total of 130 operated ones, i.e. in 3.8%. Modifications which led to the solution of this problem influenced, however, the elasticity and applicability of this prosthesis. Further investigations made in this group are compared in the discussion in great detail with available data on all other three so-called isoelastic prostheses used in other countries world-wide. In the conclusion the authors evaluate the positive and negative aspects of the endoprosthesis and they emphasize the necessity of certain technical modifications needed for future use of this type of implant.

Adult↗
PubMed1991

[Changes in collagen biosynthesis in patients with hip joint replacement surgery and reoperation].

The authors investigated the intensity of collagen synthesis in patients subjected to operation or re-operation of a total endoprosthesis of the hip joint. The patients suffered from osteoarthritis, rheumatoid arthritis and ankylosing spondylitis. The authors assessed the activity of collagen glucosyl transferase (S-GGT) and the concentration of the N-terminal propeptide procollagen type III by two methods (S-Pro III-N-P and S-Fab) in serum before and after operation. A significant rise of S-GGT and S-Fab, as compared with controls, occurred only after operation while S-Pro III-N-P was elevated already before operation. S-GGT did not differ before and after operation, while N-propeptide concentration rose when either method was used.

Adult↗
PubMed1989

[Surgical lengthening of the femur using the Poldi 7 device].

The work presents the evaluation of longterm results of the surgical prolongation of the femur. The examined group includes 10 patients: 5 boys and 5 girls which the authors treated in the years 1978-1986. Their average age in time of operation was 15.5 years. The youngest was 8 and the oldest 25 years old. Shortening was in 4 cases caused by poor healing of the fracture, in three cases it was a results of congenital hypoplasia of the femur or the whole lower extremity, in three cases it was caused by osteomyelitis. The duration of the prolongation was on average 4 months, the external fixation device was removed on average after 8 months. The mean prolongation was 8 cm, ranging from 4 cm to 11 cm. In 8 cases healing was without complications, twice there occurred a fatigue fracture which was treated by plate osteosynthesis.

Adolescent↗