Total hip arthroplasty (THA) is now the gold standard for the surgical treatment of coxarthrosis. The appearance of bone loss after implantation of the hip endoprosthesis over time reduces the primary stability of the implant and leads to progressive looseningof the implant, or periprosthetic fracture, which are considered to be the most common causes of hip revision. The aim of this study is to evaluate the value of alendronate application in reducing periprosthetic osteolysis reduction after implantation of total cementless hip endoprosthesis. The study analyzed 50 patients operated on with implantation of a cementless total hip arthroplasty (THA). The first group of 25 patients recieved oral alendronate, calcium and vitamin D3 postoperatively. The second group of 25 patients were examined and followed postoperatively without any therapy. Patients were examined by RTG and DXA methods at 6, 12 and 18 months. The study showed a difference in the values of bone mineral density (BMD) and bone mineral content (BMC) in the interval of 6,12 and 18 months, using the DXA method. Alendronate therapy after total hip implantation reduces periprosthetic bone loss, maintains  bone mineralization and strengthens the implant

The development of aloarthroplasty of the hip is continuously rising. After implantation of a total cement-free hip endoprosthesis, often there is a periprosthetic femoral bone loss. Alendronate has been shown to be a potent inhibitor of bone resorption activity; it inhibits osteoclastic bone resorption, increases bone mass, and plays a significant role in post-implantation stabilization of the femur. The aim of this study was to determine the effect of alendronate on osteointegration of hip endoprosthesis.Material and methods: The study analyzed 10 patients operated on with implantation of a total cement-free hip endoprosthesis (THP). The included patients were examined by a radiographic method at 6 and 12 months and DXA method at 6 and 12 months. Results: The study showed differences in the values of bone mineral density and bone mineral content in the interval between 6 and 12 months in patients undergoing THP, and hence we can conclude that alendronate therapy after THP implantation reduced periprosthetic loss of bone mass and implant stiffening. Alendronate is a proven inhibitor of periprosthetic bone loss that occurs after prirmary impantation of a total cement-free hip endoprosthesis.

Background: Radiographic examination of extremities in surgical lengthening and/or correction of deformities is of crucial importance for the assessment of new bone formation. The purpose of this study is to confirm the diagnostic value of radiography in precise detection of bone parameters in various lengthening or correction stages in patients treated by limb-lengthening and deformity correction.Patients and Methods: 50 patients were treated by the Ilizarov method of limb lengthening or deformity correction at the University Orthopaedic Surgery Clinic in Skopje, and analysed over the period from 2006 to 2012. The patients were divided into two groups. The first group consisted of 27 patients with limb-lengthening because of congenital shortening. The second group consisted of 23 patients treated for acquired limb deformities. The results in both groups were received in three stages of new bone formation and were based on the appearance of 3 radiographic parameters at the distraction/compression site.Results: The differences between the presence of all radiographic bone parameters in different stages of new bone formation were statistically signficant in both groups, especially the presence of the cortical margin in the first group (Cochran Q = 34.43, df = 2, p = 0.00000). The comparative analysis between the two groups showed a statistically significant difference in the presence of initial bone elements and cystic formations only in the first stage.Discussion and Conclusions: Almost no statistical significance in the differences between both groups of patients with regard to 3 radiographic parameters in 3 stages of new bone formation, indicates a minor influence of the etiopathogenetic background on the new bone formation in patients treated by gradual lengthening or correction of limb deformities.

Treatment of the long bones defects and non-unions are among the most challenging cases to solve in the orthopaedic surgery. In these rare and difficult cases the method of compressiondistraction osteogenesis can be the only limb salvage procedure to promote healing of the bone with comprehensive approach to all aspects of the condition.Objective of this retrospective one centred study is to perform both radiological and functional evaluation of the treatment of tibial non-unions with segmental bone defects or significant axial deviation using the method of compression -distraction osteogenesis with the Ilizarov apparatus. In the period between 2006 and 2018 15 patients were surgically treated using this method (in 9 of them as an intercalary bone transport and in other 6 as a continuous distraction with correction of axial deviation). There was an average of 22.9 months from injury and all of them underwent previous surgeries with an average of 2.3/patient. ASAMI (Association for studying and application of Ilizarov methods) scoring system was used for both radiological (bone) and functional results. Also patient's satisfaction with the achieved results was ranked postoperatively. 80% of the patients achieved satisfactory (good and excellent) bone results and 73% satisfactory functional results. Approximately 87% of the patients were personally satisfied with the achieved results.The method of compression -distraction osteogenesis using Ilizarov apparatus proved to be effective as a limb salvage procedure with high degree of excellent and good both radiological and functional results.

Background: The aim of this study is to affirm the importance of operative treatment of severe dysplastic coxarthrosis through analysis of the results of implantation of total cementless endo-prothesis in patients with DDH Crowe types III and IV. Patients and methods: This retrospective study involved 28 patients (30 hips) with dysplastic coxart-hrosis, in whom an implantation of cementless total hip endoprothesis was performed at the University Clinic for Orthopaedic Surgery in Skopje. In 26 of the patients the involvement was unilateral and in two patients it was bilateral. The inclusion criterion was radiographically proved severe hip dysplasia Crowe types III and IV. Twenty-one of the patients were female and 7 male, and age distribution was in an interval from 30 to 65 years. The ingrowth of the implant was evaluated using the clinical method, native radiographs and radioisotopic examination with Tc99m. The follow-up period lasted 5 years, and the results were evaluated using the Harris hip score system. Results: 19 of the patients presented an excellent result of the operative treatment, there were 8 good results with persistent local pain 6 months postoperatively, in one case a surgical revision and reimplantation of the acetabular cup was performed, while one patient underwent a surgical revision and reimplantation of the femoral stem and in another patient there was nonunion at the place of the subtrochanteric osteotomy. Full weight-bearing without the use of crutches was achieved 3 months postoperatively, and no serious early postoperative complications were registered in our patients. Discussion and conclusions: In the majority of cases in whom a total hip replacement with cemen-tless endoprothesis is performed because of dysplastic coxarthrosis, a sufficient primary fixation both of the acetabular and the femoral component is achieved, unless one-third of the acetabular cup is left uncovered with bone stock. The problems of decreased muscle strength and limping are usually solved by means of physical therapy in a time period of 45 months.