[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.