When choosing the right endoprosthesis for the patient, in addition to medical indications, age, gender, physical and professional activity of patients are also important.Considering the increasingly younger patients qualified for hip arthroplasty and their growing expectations in terms of activity and quality of life, femoral neck endoprosthesis may be increasingly used. This technique allows relatively high osteotomy in the femoral neck, with maximum bone tissue saving.However, this method also has its limitations and strict indications. Itcan not always be applied in situations of changed geometry of the femoral neck.Despite the lower risk of dislocation of the endoprosthesis, after this type of surgery there is a real risk of fracture of the femoral neck. Preliminary results of clinical trials are strongly encouraging, as they indicate a great opportunity to undertake physical and professional activity.It can also be used in very young patients with osteoarthritis of the hip due to sterile femoral head necrosis resulting from the use of steroid drugs in the treatment of autoimmune diseases [6-8].
Tsitlakidis S. et al. after analyzing available literature (27 works) on the assessment of the clinical status of patients with osteoarthritis of the hip, in whom the femoral neck endoprothesis was used in the proximal femoral end of the hip revealed, too short average survival of the implant (below 10 years) was foundAs the main reason for failure (revision), the authors pointed to aseptic loosening of the femoral stemand gave two main conditions for the success of this method: lopsided femoral neck and normal bone density .Our experience also shows that abnormal femoral neck geometry can affect a higher incidence of aseptic loosening in the early postoperative period. Tsitlakidis and our conclusions indicate that further observation of patients after femoral stemimplantation in hip arthroplasty is necessary and careful selection of patients qualified for this type of surgery is important.
Used anterior - lateral access is considered as short cut access. There is a lot of data indicating that a minimally invasive procedure shortens hospitalization, enables faster rehabilitation and an earlier return to full physical activity.It is also associated with less blood loss and less postoperative pain and a lower risk of infection [10-12].Confirmation of the above observations is the work of Xie J. et al. who showed that the type of surgical access in total hip arthroplasty closely correlates with pain experienced by the operated patients, measured by the VAS scale. Comparing the aforementioned parameter using the above-mentioned evaluation scale after a week, a month, 3 months and a year in equal groups of patientsoperated on using the posterior access method and minimally invasive supracapsulartransdermally assisted method, the authors showed a significant reduction in the second of the examined groups.Therefore, one can cite the authors of the study that minimally invasive supracapsular access transdermally assisted in hip arthroplasty results in a significant reduction of pain sensations from the time of surgery up to 3 months compared to pain experienced after classic posterior access in the same assessment periods. A lower level of pain sensations within a period of up to 3 months after implantation of the hip joint prosthesis should directly affect the earlier physiotherapy after surgery and shorten the period of stay in the ward, while allowing the possibility of earlier independent existence after surgery .In turn, in our study using anterolateral access according to Hardinge'a, we obtained a reduction in pain on the VAS scale of 0.58 points, in the assessment carried out after an average of 5 years.Therefore, the result obtained by us seems to be fully satisfactory.
Constantly rising expectations of patients with advanced cokearthrosis, their young age and willingness to return to full activity forces engineers-constructors and orthopedic physicians to seek ever newer solutions in hip replacement arthroplasty aimed at developing the concept of ultra-short cementlessstem.The authors, performing densitometry using the DXA method and assessing Radiostereometric Analysis (RSA) of the PRIMOR implant in 50 patients operated on within 2 years of surgery, found its settling 6 weeks after surgery and clubbing occurring between 6 and 12 months after arthroplasty.They found the test results to be satisfactory, showing a positive correlation between better bone quality and lower stemimplant migration in the proximal femur in operated patients .
The mere use of new technologies and structures is not enough to ensure a lasting, beneficial effect of the treatment.The success of arthroplasty still depends primarily on the experience of the surgical team performing the surgery; while access to modern techniques and implants allows to improve patients' quality of life [3,15].
Birkhauer B. et al. in their work in a group of 38 patients over 60 years of age using the SPIRON stem neck improved their clinical condition in the early observation period (over 1 year) on the HHS scale (24 points vs. 78 points), average - 94 points. The authors performed only one revision surgery within 3 months of surgery due to early joint infection (2.63%) .
In turn, Lugeder A. et al. on a group of 28 patients observed a significant improvement on the HHS scale (55.4 vs 90.5) after 3 months after surgery. Only in one case, there was aseptic loosening of the stem component and a revision surgery had to be performed (3.6%). In both of the above works, the authors made a clinical evaluation in the early observation period (3 months, 1 year) and obtained very good results .Our assessment was carried out after an average of 5 years after surgery.We obtained a slightly lower result (average 85.4 points) in the clinical assessment of HHS. In the examined group of patients, we also noted a higher percentage of revision procedures performed in three patients (11%) due to a defective implanted SPIRON stem (deformed).In two patients during revision surgery,the CorinMiniHipparanasalstemwas used, and in one case the classic cementlessCorrail J & J DePuy.
Among other complications that occurred after surgery, we found deep vein thrombosis (1 patient - 3.7%) and transient femoral nerve paresis (1 patient - 3.7%).The higher number of revisions probably resulted from the etiology of degenerative disease and worse conditions for proper - axial implantation of the endoprosthesis stem.In almost 1/3 (8 operated patients), the cause of the degenerative disease was sterile femoral head necrosis, which significantly worsened the conditions for femoral stem deposition.
Pyda M. et al. using surface arthroplasty in 30 patients with sterile femoral head necrosis achieved clinical improvement of over 94 points (on the HHS scale), improving the level of physical activity to 7.55 points (UCLA) in the mean follow-up of 7 years after surgery. The authorsdid not noteloosening of the endoprosthesiscomponents .
WhereasAmstutz H.C. et al. in the medium follow-up period (10.8 years) confirmed a significantimprovement in the clinicalcondition in a group of 82 patientsafter the application of surfacearthroplasty in the course of hip osteoarthritisbased on sterilefemoralosteonecrosis .
Keeney J.A. et al. performed retrospective pre- and postoperative demographic characteristics and functional activity profiles using classic assessment scales in two groups; under <50 years and> 65 <75 years in the mean follow-up period of a minimum of 1 year (12 months).The authors, analyzing the postoperative results of clinical condition assessment between the examined groups, did not find any significant differences. However, in the assessment of post-operative functional activity measured by UCLA classification, 37% of the operated in the group up to 50 years of age and 15.5% in the group between 65 and 75 years old returned to the previously implemented activity.The above authors concluded that the younger ones operated on after hip replacement are likely to return to high levels of functional activity.In turn, high levels of functional activity are less popular in younger patients with diagnoses other than osteoarthritis.In addition, the age of the operatedpatientsis not a simplesubstitute for the level of functionalactivity in patientsconsidering hip arthroplasty .
Cowie J.G. et al. in 239 patients, assessing the impact of hip replacement in relation to professional and sport activity, showed the possibility of their resumption after a minimum of 4-6 months after the surgery.In addition, they found that higher BMI in operated patients extended this time period .
In turn, Czech Sz. et al. in a group of 106 operated patients who were treated with the short metaphyseal stem. Nanos found a very beneficial effect of its application in the field of physical activity.At the same time, the authors drew attention to the decreasing level of physical activity in patients operated on with age .
Oken F.O. et al. analyzed 51 professionally active patients under the age of 60 who had hip arthroplasty during developmental dysplasia.The authors found a beneficial effect of arthroplasty on early return to work for most patients.The status of the unemployed who are ready to take up employment has also changed.In addition, carrying out endoprostheoplastyin the above-mentionedpatientsincreased the economic status of the region in whichtheyworked .
The constantly growing number of employed patients qualified for hip replacement requires knowledge of the factors conditioning their return to work after performing the surgery and undergoing the necessary rehabilitation.The authors analyzed a group of 408 patients employed in the public sector at an average age of 54; of which 73% of the total operated patients were women. 94% of patients employed before surgery returned to work after an average of 3 months after surgery. The identified significant risk factors for returning to work were: absence shorter than 30 days prior to surgery, occupied senior position and BMI less than 30. Factors such as age, gender, pre-operative health, and various health-related behaviors did not show any dependence on returning to work after endoprosthesis implantation. Obese manual workers with a period of absence from work before the endoprosthesis of more than 30 days constituted a group of patients at higher risk of not returning to work after surgery .
Fisher N.E. et al. evaluated sport and physical activity in 117 patients after hip arthroplasty in a short observation period (2 years), showing that 87% of the patients returned to physical and sport activity before surgery .
Perneger T.V. et al. assessed the quality of life with the SF-12 classification in patients undergoing hip and knee replacement. The tests were carried out before surgery and one year after it. In the analysis, the authors pointed to a significant increase in parameters on the SF-12 scale.However, it should be noted that the numerical value of the PCS components during the control test after one year was significantly higher than the MCS components.According to the authors, carrying out hip or knee arthroplasty has a positive effect on improving the quality of life in patients operated on both in the mental and physical sphere, although the more favorable impact of performing this procedure is more visible on a physical level .
The analysis carried out above shows that femoral neck endoprosthesis should be an alternative to pituitary and classical cementlessarthroplasty.The correct qualification of patients for this type of surgery is crucial and very important. However, it requires more attention from the surgeon when implanting this type of stem in the femoral neck with altered geometry.