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Biomedical subjects

J Bartonícek

Publications and source records attributed to J Bartonícek.

At least 19 recordsLinked to original sources
PubMed2005

[Femoral head replacement in intracapsular femoral neck fractures].

Hemiarthroplasty has still its place in the therapeutic algorithm of the treatment of dislocated intracapsular femoral neck fractures. As compared to internal fixation it is accompanied by less complications and allows an immediate postoperative weight bearing. In contrast to total hip arthroplasty, this operation is not so demanding for the patient. However in the long-term perspective it is often associated with erosion of acetabulum. Therefore it is indicated mainly for biologically older patients with less physical activity without osteoarthritis of the hip. In these patients we usually prefer a cemented monoblock hemiarthroplasty. In case of biologically younger patients where it is impossible to use total hip arthroplasty due to general or local condition, modular hemiarthroplasty is indicated with a removable head allowing in case of acetabular erosion an easy conversion to total hip arthroplasty. Hemiarthroplasty must be correctly indicated and technically properly performed. First of all it is necessary to respect the relation between the centre of the prosthetic head and the apex of the greater trochanter, i.e. the head centre should be 1-2 mm below the level of apex of the greater trochanter. Further, it requires a correct anteversion and suture of the articular capsule as a prevention of postoperative dislocation.

Aged↗
PubMed2005

[Osteosynthesis of intracapsular femoral neck fractures].

PURPOSE OF THE STUDY: To evaluate outcomes of internal fixation of intracapsular femoral neck fractures. MATERIAL AND METHODS: Between the beginning of 1998 and end of 2002 the authors performed internal fixation of intracapsular fracture of the femoral neck in 47 patients (21 women, 26 men). The average age of patients was 56 years, range, 17 to 86 years (men 54.5 years, women 58.2 years). Forty patients (18 women, 22 men) went through the follow-up at the minimal interval of 1 year after the surgery. Their average age was 56 years. The remaining 7 patients were lost to follow-up. In 21 patients the case was Garden 1 and 2 fractures, in 19 patients Garden 3 and 4 displaced fractures. Internal fixation by three lag screws was performed in 16 cases, fixation by DHS with antirotational screw in 24 cases. RESULTS: The fracture healed in 70% of cases, non-union occurred 3times and avascular necrosis developed 9times. Garden 1 and 2 fractures were associated with 14.3% and Garden 3 and 4 fractures with 47.4% of complications. Of fractures treated by lag screws, 71% of cases healed, while in those treated by DHS the percentage was 69%. Both duration of surgery and x-ray exposure was in lag screws by 50% longer than in DHS. In terms of the development of avascular necrosis, the study did not prove any advantage of a shorter interval between the injury and surgery. However, development of avascular necrosis was influenced also by other factors and therefore the significance of urgent surgery within 6 hours after injury should not be questioned. CONCLUSION: Garden 3 and 4 displaced fractures have a worse prospect than Garden 1 and 2 fractures. Duration of surgery and x-ray exposure in DHS is shorter than in lag cancellous screws with the same percentage of good results. Of great importance is an exact reduction of the fracture in both projections, a correct position of implants and evacuation of intracapsular haematoma as a prevention of avascular necrosis of the femoral head.

Adolescent↗
PubMed2005

[Pathologic proximal femoral fractures in children in an unicameral bone cyst].

PURPOSE OF THE STUDY: Proximal femoral fractures in children are rare, pathologic fractures being extremely rare. Despite many meanings these fractures are still "unsolved" there are some definite rules for treatment of true accidental injuries. Pathologic fractures are outstanding with their extremely rare incidence. The aim of the study is to overview a large clinical material, find out the incidence of this pathologic fracture, the extent and shape of the unicameral bone cyst (UBC), specific therapeutic approach, technical problems of eventual osteosynthesis, number of reoperations and sequels. MATERIAL: Altogether 49 children with 50 accidental and pathologic fractures of proximal part of the femur treated in the Regional Pediatric Trauma Centre of the Department of Pediatric and Trauma Surgery, 3rd Faculty of Medicine, Charles University, Prague. METHODS: Retrospective and prospective study of children (0 to 15 years of age) treated with proximal femoral accidental and pathologic fractures during the 20 year period (from August 1984 to November 2004). Classification of fractures according to Delbet and Colonna. Diagnosis of bone cyst with plain X-rays, eventually CT scans. RESULTS: During the 20 years period (August 1984 to November 2004) 49 children with 50 proximal femoral fractures were treated in the Department. Four patients sustained a pathologic fracture through an unicameral bone cyst. Two of these latter children were treated by an open reduction and osteosynthesis with the use of the proximal femoral AO-ASIF angled-plate and two children nonoperatively using skeletal traction because of impossibility of insertion of the osteosynthetic material without a damage of the growth plate. Subsequent operations of the UBC were necessary in these two children. All four patients recovered well without sequels. DISCUSSION: Pathologic fractures in UBC are usually treated nonoperatively and the cyst itself is treated after fracture healing. Proximal femoral impairment is the exception from this rule because of weigh bearing necessity. However, there may be problems with insertion of the implant when the cyst is very near to capital physis and traction treatment is then the method of choice with a delay of operative treatment of the cyst. CONCLUSIONS: Pathologic proximal femoral fractures in UBC are extremely rare and need individual approach. Some of them should be operated on the others primarily treated by traction with secondary operation of the cyst. Complications can be frequent.

Bone Cysts↗
PubMed2004

Avulsed posterior edge of the tibia. Earle's or Volkmann's triangle?

The term Volkmann's triangle for the avulsed posterior edge of the tibia in fracture-dislocations of the ankle is incorrect. Volkmann did not publish any articles relating to the posterior edge of the tibia. Credit should go to Henry Earle, who was an outstanding British surgeon of the first half of 19th century. He described avulsion of the posterior edge of the tibia in 1828. In 1823 he also published a monograph entitled Practical observations in surgery in which he described a specially designed bed for the conservative treatment of proximal fractures of the femur.

Ankle Injuries↗
PubMed2003

[The proximal femoral nail (PFH)--another alternative for osteosynthesis of trochanteric fractures].

The aim of the study was to test a new intramedullary implant PFH-Medin on internal fixation of trochanteric fractures. The basic group comprised 35 patients (average age 79.2 years). Indicated for the surgery were patients with all types of trochanteric fractures, i.e. 13 stable (AO 31A1), 15 unstable (AO 31A2) peritrochanteric fractures and 7 intertrochanteric (AO 31A3) fractures. Final outcomes were evaluated in 21 patients with the minimal follow-up of 6 months. From the viewpoint of the type of the fracture 9 cases were stable peritrochanteric, 7 cases unstable peritrochanteric and 5 intertrochanteric fractures. Duration of surgery was measured from the incision until wound closure and in the whole group of 35 patients it was on average 50 min. (range, 25-90 min.). X-ray exposure was recorded including the period necessary for the reduction of the fracture and was on average 80 sec. (range, 25-120 sec.). In the whole group we encountered only two complications. The first complication resulted from the insertion of the distal locking screw outside of the nail and the patient healed without problems. The second case involved aseptic necrosis of the femoral head eight months after the surgery and five months after the fracture had healed. All 21 patients followed up minimally for sixth months healed in anatomical position.

Aged↗
PubMed2003

[A socioeconomic study of patients treated for fractures of the proximal femur].

In recent decades an increase in the number of fractures of the proximal femur was recorded in this country and world-wide. The majority of patients with this diagnosis is above 70 years of age and their treatment comprises in addition to the medical aspect also economic and social problems. The objective of the present work is to summarize briefly the results achieved during the five-year trial focused on socio-economic problems of treatment of patients with fractures of the proximal femur. The investigated group comprised 244 patients hospitalized at the Orthopaedic Department of the Third Faculty of Medicine Charles University in 1997 with 248 fractures of the proximal femur. Thirty-nine fractures were treated conservatively, 116 by internal fixation and in 93 cases an arthroplasty was implanted. In the course of the first year of treatment 85 patients died. The therapeutic results after one year were evaluated in 159 patients. The total annual costs of the investigated group were 15.9 million crowns. The mean annual costs of treatment of one fracture of the proximal femur was 64,000 crowns. The ratio of deaths rose with age (p = 0.003), it did not depend on the social background of the patient (p = 0.16) and the quality of locomotor activity before the injury (p = 0.16). No type of fracture was associated with a higher or lower mortality (p = 0.09). A statistically significant higher mortality was recorded in patients included in the higher class of the ASA score (p < 0.001) and in conservatively treated patients (p < 0.001). The type of anaesthesia did not affect the mortality. The functional results were significantly worse in patients living before the injury in a dependent position (0.01 < p < 0.05) and with restricted physical activity (p < 0.01). The type of fractures did not affect significantly the functional results (p > 0.05). Poorer functional results were recorded in patients with ischaemic heart disease (p < 0.001) and neurological disease in their history (p < 0.001). Also inclusion into a higher class of surgical risk according to the ASA score was associated with poorer functional results (p < 0.001). Different types of anaesthesia and different methods of surgical treatment did not affect the quality of functional results. However the functional results were better in operated patients as compared with conservatively treated patients (p < 0.001).

Aged↗
PubMed2002

Internal architecture of the proximal femur--Adam's or Adams' arch? Historical mystery.

The designation 'Adam Bogen' describing the thick medial cortex of the femoral neck is an incorrect term. This arch was described by Robert Adams (1795-1871), an outstanding Irish anatomist and surgeon. He was famous mainly for his book on gout and the description of disorders of cardiac rhythm, the so-called Adams-Stokes syndrome. He published his original description in the today unfortunately almost forgotten Cyclopaedia of Anatomy and Physiology, Vol. II (London, Longman, 1836-1839). The main editor of this monumental six-volume work was the famous anatomist and surgeon R.B.Todd. This book represents a significant source of information on diseases and injuries of the great joints (shoulder, elbow, wrist, knee, ankle).

Anatomy↗
PubMed2002

[Osteosynthesis of trochanteric fractures using proximal femoral nails].

PURPOSE OF THE STUDY: Presentation of the existing experience in the use of Proximal Femoral Nail Synthes (PFN) in trochanteric fractures. MATERIAL: A prospective study evaluating a group of 41 patients, 12 men and 29 women, average age 68 years (range 21-93 years) operated on between September 1997 and March 2001 by means of PFN. The group comprised 11 unstable peritrochanteric fractures (31-A2), 26 high subtrochanteric fractures (31-A3), 3 low subtrochanteric fractures and 1 pathological fracture. METHOD: Monitored were first of all preoperative and post-operative complications and final results. RESULTS: The average duration of surgery was in the whole group of 41 patients 61 minutes (30-100 minutes), in the group of high subtrochanteris fractures 58 minutes (30-80 minutes). Average X-ray exposure including the time necessary of the reduction of the fracture was 2.9 minutes (1-6 minutes). In the group there occurred 3 complications. In the first case distal fixation of the mail failed. However, the fractures healed with any other complications. The second case was a patient with unstable peritrochanteric fracture when a too short lag screw was inserted to the head during surgery. In spite of this the fracture healed in 3 months, however, the resulting varus deformity caused a 1.5 cm shortening of the limb. In the third case, a female patient with a low subtrochanteric fracture, fragments were left in distraction and a large fragment of medial cortex bearing also lesser trochanter remained significantly displaced. Even after 6 months the fractures did not healed and therefore we performed dynamization of the nail and cancellous bone grafting in the region of the defect of medial cortex. Final results were evaluated in patients with a minimum follow-up of 6 months, i.e. in 22 patients, 9 patients did not come, 8 patients died. Most patients healed in 3 months (in total 20 patients of 28 followed up) but we set the minimum follow-up period of 6 months when we checked 22 patients of 39. Within six months 8 patients died and another 9 patients did not appear for the follow up. There were 17 cases of a high subtrochanteric fracture, 3 cases of unstable peritrochanteric fracture, one case of per-subtrochanteric fracture and one case of a low subtrochanteric fracture. Within 6 months the fracture healed in 21 patients, i.e. in 95% of the followed-up patients, of this in 20 cases (91%) in anatomical position. DISCUSSION: In literature we have found only one publication (Simmermacher et al.--Injury 30, 1999) dealing with PFN which presents very good experience with this implant. Our good results were significantly influenced by preceding experience in the use of Gamma nail. In comparison with it PFN represents an implant of the next generation. However, the basic prerequisite of a good result is a perfect mastering of the surgical technique. CONCLUSION: PFN is a method of choice in trochanteric fractures, namely in high subtrochanteric fractures (31-A3).

Adult↗
PubMed2002

[Mortality in patients with proximal femoral fractures during the first year after the injury].

PURPOSE OF THE STUDY: The authors present an overview of mortality of patients with proximal femur fractures treated at the authors' Department in 1997 in dependence on different factors relating to the preinjury condition and the treatment itself. The aim of the work was to determine the impact of these factors on the risk of mortality and compare the findings with the data published by other authors dealing with the same issue. MATERIAL: In the given year 244 patients with 248 proximal femur fractures, 58 men (24%), 186 women (76%), average age 77 years were treated. There were 115 (47%) fractures of femoral neck, 117 (47%) pertrochanteric fractures and 16 (6%) intertrochanteric (high subtrochanteric) fractures. Thirty-nine fractures (16%) were treated conservatively, internal fixation was performed in 116 fractures (47%), i.e. 6 times by a plate, 94 times by a DHS, 16 times by the Gamma nail, and 93 fractures (37%) were treated by arthroplasty (62 times by hemiarthroplasty and 31 times by total hip arthroplasty). METHODS: The following data was recorded in all patients of the monitored group: age, sex, social environment and physical activities of the patient prior to the injury, mechanism of the injury, type of fracture, surgical risk expressed by the respective class of the ASA score, therapeutic procedure, type of anesthesia and interval between the injury and operation. Recorded was also the number of mortality in the course of primary hospitalisation and one year after the injury or operation. At the end of the one-year monitoring statistical evaluation was made of the relation between mortality and the above mentioned monitored factors and the results were compared with those published in similar types of study. RESULTS: In the period of one year after the injury or operation 85 patients died of the total number of 244 (56 women and 29 men). The number of decreased patients was increasing in individual age decades and the highest number was recorded in case of men in 9th decade (80%) and 10th decade (100%). The lowest number of mortality related to patients who lived with their families prior to the injury (26.5%) and the highest number was in patients from social care institutes (43.8%). Patients with impaired mobility already prior to the injury and not leaving their homes accounted for 46.7% of mortality. In the course of one year after the injury 33.0% died of fracture of femoral neck, 30.7% of pertrochanteric and 35.7% of intertrochanteric (high subtrochanteric) fracture. Dependence of mortality on ASA score was as follows: ASA I-0%, ASA II-4.3%, ASA III-21.3%, ASA IV-42.1%, ASA V-68.9%. The highest number of mortality of operated on patients was in the group treated by hemiarthroplasty (41.1%). After spinal anesthesia 26.6% of patients died within one year and after general anesthesia 26.7% of them. There was an evident increase in the number of mortality in patients operated on in the interval longer than 3 days after the injury. DISCUSSION: The mortality in the followed up group was statistically significantly influenced by the age (p = 0.003), sex (p < 0.01) and ASA score (p < 0.001). This corresponds to the results of other studies. The dependence of mortality on environment and mobility prior to the injury, type of the fracture, type of surgical treatment and type of anesthesia has not been proved. CONCLUSION: Based on the evaluation of the data monitored in the group a conclusion was made that absolute mortality risk in the first year after the injury related to patients with pathological fractures due to metastasis. A higher risk related to male patients older than 80 years with the surgical risk of ASA IV and higher and this risk rate was the highest in the time interval within 3 months after the injury or operation.

Adult↗
PubMed2002

[The Essex-Lopresti forearm fracture (case report)].

The radial head fracture associated with dislocation in the distal end of the ulna and tear of interosseous membrane of the forearm with a subsequent proximal migration of the radial shaft is a relatively rare injury. For the first time it was described by Essex-Lopresti in 1951. Our report presents one case together with an analysis of available literature relating to the diagnosis and treatment. A man, 69 years old, hurt his right elbow and forearm in a fall on the outstretched arm. There was a 2 x 1 cm excoriation on the lateral portion of the elbow and a dominating pain and limitation of the range of motion of the right elbow and wrist. The radiograph of the elbow, forearm and wrist showed a dislocated comminuted fracture of the radial head, dorsal subluxation of the ulnar and proximal displacement of radius. The condition was assessed as Essex-Lopresti fracture of the forearm indicated for surgery. The four-fragment fracture of the radial head did not allow reconstruction and therefore the head was resected. Subsequently the distal radio-ulnar joint was revised from dorsal approach with a K-wire inserted transversally. In order to prevent proximal displacement of the radius a K-wire was inserted in the medullary cavity of the radius close to the distal end of the humerus with the elbow in 90 degrees flexion and slight supination. The wounds were sutured and plaster of Paris applied extending across the elbow up to the metacarpal heads. After 6 weeks the plaster fixation and K-wires were removed. Full weight bearing was permitted 4 months after the surgery. Ten months after the surgery the patient was without complaints. Flexion in the elbow ranged between 0-5-130 degrees, pronation-supination was limited by 10 degrees in both extreme positions. The ulnar head became prominent on the dorsal side, dorsiflextion and ulnar duction in the wrist were limited to 10 degrees. The radiograph of the wrist showed and evident proximal displacement of the radius, the dorsally subluxated ulnar head overhung by 7 mm. Our case has confirmed that a mere extirpation of the head with a subsequent stabilization and transfixation of the proximal end of the radius and transfixation of the distal radio-ulnar joint cannot prevent after the extraction of wires a proximal displacement of the radius and development of the "plus variant" resulting in the limitation of both the range of motion of the wrist and the pronation-supination movement of the forearm.

Aged↗
PubMed2002

[Fracture-dislocations of the ankle joint in adults. Part I: epidemiologic evaluation of patients during a 1-year period].

PURPOSE OF THE STUDY: The aim of the study is to present a basic statistical overview of fracture-dislocations of the ankle in adults in a one-year group of patients. MATERIAL: The analyzed group of patients comprised 232 patients (121 men, 111 women) treated for fracture-dislocations of the ankle at the authors' department between 1 January and 31 December 1999. In all patients the physes were closed. The type of fractures was classified after B. G. Weber. RESULTS: Type A fractures accounted for 23%, Type B fractures for 65% and Type C fractures for 12% of all cases. The average age of the injured was 49 years (range, 16-89), with men prevailing until 5th decade and women predominating from 6th decade. In 65% of Type A fractures there occurred only the fracture of lateral malleolus, in 31% the fracture involved also medial malleolus and in 4% it affected also the posterior margin of the distal tibia. In 49% of Weber B type of fractures the medial malleolus was fractured, in 20% the deltoid ligament was ruptured and in 31% there occurred no injury on the medial aspect. Avulsion of the posterior margin of the distal tibia occurred in 46%. In 71% of Type C fractures the fracture was located in the lower half of fibula, Maisonneuve type occurred in 29%. Medial malleolus was fractured in 57%, the deltoid ligament was ruptured in 36%, in 7% there was no medial injury. The posterior margin of the distal tibia was avulsed also in 46%. Fracture of the posterior margin of the distal tibia occurred in Type A in 4%, in Type B in 46% and in Type C also in 46%. In Types B and C the size of the avulsed posterior part of the distal tibia covered 1/4 of its articular surface in 75% of cases, 1/3 in 17% and 1/2 in 8% of cases. DISCUSSION: We have found an adequate group of patients for comparison only in the Lindsjö work who evaluated a group of adult patients treated at his department between the beginning of February 1972 and end of June 1975. Other groups of patients which we studied and which included some of the parameters that we have examined are not comparable from the viewpoint of the basic selection of patients as the selection was made in a different way, namely according to the manner of treatment, i.e. conservatively or surgically, or according to the preference of one of the types of the fractures or the period of follow-up. Also, the so called epidemiological studies concentrated only on one or two factors (men/women ratio, the cause of injury, the period of the year). In addition, some works also include fractures in growing individuals. CONCLUSION: Fracture-dislocations affect equally men and women. Men prevail until the age of fifty, women afterwards. The average age of patients was 49 years. Most frequent is Weber B Type, least frequent Weber C.

Adolescent↗
PubMed2001

Anchor limited arthrodesis of the wrist.

We present a case of lunate dislocation with total disruption of all ligaments and, consequently, nutrient vessels. The injury was handled by fusion of the lunate with the scaphoid, capitate and triquetrum. This 'anchor fusion' has led to a very good long-term result.

Adult↗
PubMed2001

Osteoid osteoma of olecranon process of ulna in subchondral location.

We present a case of a 15-year-old girl with osteoid osteoma in an unusual subchondral localization of the olecranon. Unspecific complaints and minimal X-ray findings at the onset of the disease led to an incorrect diagnosis and more than 2 years of inefficient treatment.

Adolescent↗
PubMed2001

Femoral neck fracture--the cause of death of Emperor Charles IV.

We present the oldest documented case of femoral neck fracture of a particular person in the history of orthopaedic surgery. Examination of the skeleton of Charles IV, the King of Bohemia and Roman Emperor living in XIVth century has revealed a fracture of the left femoral neck. This fracture was most probably an indirect cause of his death as it resulted in pneumonia, the immediate cause of death. This fact has been confirmed by contemporary chronicles.

Czechoslovakia↗
PubMed2001

[Tension cerclage using scews--a forgotten technique?].

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.

Acetabulum↗
PubMed2001

[The Bosworth ankle fracture (case report)].

The authors describe an atypical case of the so called Bosworth fracture of ankle. A woman, 26 years suffered a fracture of fibula in the proximal third of the shaft, the distal fibular fragment was displaced from the fibular insicure of distal tibia posteromedially where it remained locked behind posterior tibial tubercle, and a fracture of medial malleolus and fracture of the posterolateral fragment of distal tibia. Thus it was a fracture-dislocation of ankle of Weber C type. The primary examination showed an evident external rotation deformity of the foot with regard to tibia. Conservative reduction was performed with a subsequent surgical revision, fixation of medial malleolus, suture of anterior tibiofibular ligament and stabilization of the reduced fibula in the fibular insicure of distal tibia by a suprasyndesmal screw. At present, four years after the surgery the patient is fully satisfied. Objectively there occurred only a limitation of dorsiflexion in ankle by 10 degrees as compared to the contralateral joint. Radiograph shows healing of the fracture in the anatomical position, without sings of post-traumatic osteoarthritis. Analysis of literature has showed that only approximately 40 cases with various sub-types of this fracture have been so far described. Typical of all fractures is a marked external rotation of the foot with regard to tibia, radiograph shows posterior subluxation of talus with regard to distal tibia and posteromedial dislocation of distal fibula from the fibula insicure of distal tibia and its locking behind its posterior tubercle. Apart from the above mentioned, associated with the injury is always a rupture of anterior tibiofibular ligament and partial rupture or distension of posterior tibiofibular ligament. In a typical Bosworth fracture it is associated with fracture of lateral malleolus of Weber B fracture. Very frequent is also a minor avulsion of the posterolateral fragment of distal tibia. In atypical cases fibula breaks in its proximal third (this Weber C type of fracture is described only by Hamilton) or there is no fracture of fibula. In children or young adults fibula does not break, it only dislocates and in adolescents there may simultaneously occur epiphysiolysis of distal tibia. On the medial side there usually occurs a fracture of medial malleolus or rupture of deltoid ligament or there is no lesion on the medial side. Conservative reduction is successful only exceptionally, i.e. only in case of intact fibula or its high fracture (Weber C), the method of choice is open reduction and internal fixation.

Adult↗
PubMed2001

[The uncemented self-threading Ultima cup: first 5 years' experience].

PURPOSE OF THE STUDY: To present the first 3-5 year experience in primary implantation of the Ultima cementless hemispherical threaded cup. MATERIAL: In the period between October 1995 and June 1997 we implanted in total 30 Ultima cementless cups in 28 patients (10 men, 18 women). The average age of the operated on was 60 years (41-74 years). Twenty-four patients, i.e. 26 hips were available for the follow up. From the viewpoint of diagnosis the group of patients included 15 cases of primary osteoarthritis, 9 cases of acute intracapsular femoral neck fracture, 3 cases of postdysplastic osteoarthritis, 2 cases (1 female patient with bilateral affection) of rheumatoid osteoarthritis (RA) accompanied with the protrusion of acetabulum and 1 case of idiopathic necrosis of the head. METHODS: The average follow up was 39 months (31-51 months). Subjectively, we followed the patients' satisfaction with the result of the surgery, i.e. subsidence of pain, range of motions and the willingness to undergo the surgery once more on the basis of its result. Radiologically, we assessed the shape of acetabulum prior to operation, the position of the implanted cup in ap projection on the postoperative radiograph, on the last control radiograph we evaluated osteointegration of the cup and also potential particular ossification. RESULTS: Nineteen patients out of 24 were subjectively satisfied with the result of the operation. The primary shape of acetabulum was in 24 cases spherical, 4 times dysplastic slightly lower CE (Wiberg) angle and twice there occurred protrusion of the head (the female patient with RA). The position of the cup in ap projection was evaluated in 25 cases as correct (45 degrees declination), in 2 cases as valgus (more than 55 degrees declination), in 3 cases as varus (less than 35 degrees declination) and in 1 case the cup was inserted too deep. Osteointegration was evaluated in 25 cases. In 22 cases we considered the osteointegration as good, i.e. without signs of a radioluscent line around the circumference of the cup. This line we encountered in 2 patients around the whole circumference of the cup but without any signs of a change in the position of the cup and without subjective complaints (pain in the hip). Both patients operated on for the primary osteoarthritis had a spherical shape of acetabulum and the declination of the cup was assessed as satisfactory. In 1 case we had to re-operate on due to the migration of the cup in the pelvis, namely in the female patient with RA and bilateral affection. The migration occurred on the left side 2.5 year after the primary surgery. Particular ossification was encountered 3 times, one case required extirpation. Complications were recorded in 8 patients. In one case the lateral cortex was peroperatively perforated by the stem of the femoral component. In another patient with a dysplastic acetabulum the cup was inserted to deep in the medial wall of the acetabulum. In the third patient the greater trochanter got broken, remained displaced and only the ligaments healed. Early postoperative complications were recorded twice. In one case it was a serous secretion from the wound which subsided after a few days without the necessity of revision. Revision was required in the second case when the R-drainage broke in the course of its removal. Late complications occurred in 3 patients. In one case there developed a mitigated infection requiring revision surgery, in case of the female patient with RA the cup protruded in the pelvis which necessitated a revision surgery. DISCUSSION: So far there are no literary data on this type of cup. The only existing information relates to the preceding type of a similar design, i.e. Mecring cup, which failed. CONCLUSION: Despite relatively good but short-term results of this small series the unusual design of the Ultima hemispherical threaded cup requires a great prudence in its application and additional long-term follow-up. Therefore the cup cannot be recommended for a regular use for the time being.

Adult↗