Traumatology and Orthopedics of RussiaTraumatology and Orthopedics of RussiaТравматология и ортопедия России2311-29052542-0933Vreden National Medical Research Center of Traumatology and Orthopedics1741110.17816/2311-2905-17411Case ReportsСлучаи из практикиCase ReportsResearch ArticleDisengagement of Polyethylene Insert Locking Mechanism in Modular Tibial Components for Knee Arthroplasty: A Case ReportРазобщение фиксирующего механизма полиэтиленового вкладыша в модульном большеберцовом компоненте эндопротеза коленного сустава: клинический случайhttps://orcid.org/0000-0001-5127-5088ChugaevChugaev V.ЧугаевДмитрий Валерьевич
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук

dr.chugaev@gmail.comhttps://orcid.org/0000-0003-3175-4756KuliabaTaras A.КулябаТарас Aндреевич
Russian Federation

Dr. Sci. (Med.)

д-р мед. наук

taraskuliaba@mail.ruhttps://orcid.org/0000-0002-2403-6521PetukhovAleksey I.ПетуховАлексей Иванович
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук

drpetukhov@yandex.ruhttps://orcid.org/0009-0005-0525-6456MartynenkoAnastasiia I.МартыненкоАнастасия Игоревна
Russian Federation
martynenko.anst@yandex.ruVreden National Medical Research Center of Traumatology and OrthopedicsФГБУ «Национальный медицинский исследовательский центр травматологии и ортопедии им. Р.Р. Вредена» Минздрава России13032024310320243011201281011202326022024Copyright ©; 2024, Eco-VectorCopyright ©; 2024, Эко-ВекторCopyright ©; 2024,2024Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://journal.rniito.org/jour/article/view/17411

Background. Modular tibial components for knee arthroplasty are used in the majority of modern knee replacement systems. Despite a number of limitations, there are many aspects that make these types of implants indispensable for orthopedic surgeons.

Aim — to demonstrate possible risks associated with a modular polyethylene liner with metal locking clip using a clinical case as an example.

Case description. We present a case of primary total knee arthroplasty in a 70-year-old female patient. The surgery was performed by an experienced surgical team and resulted in good early radiologic and functional treatment outcome. After discharge, approximately 10 days after surgery, the patient developed knee pain. Control X-rays showed migration of the metal pin locking the polyethylene insert. The patient underwent an emergency revision surgery with replacement of the clip. The authors analyze possible causes of this complication and ways of its prevention.

Conclusion. Migration of the insert locking element and dislocation of the insert in locked systems are quite rare complications of the knee arthroplasty. Their causes are soft tissue imbalance of the knee joint during arthroplasty and a number of technical errors. The very fact of using modular components of the joint is a predisposing factor for the disassociation of these modules.

Актуальность. Модульные большеберцовые компоненты эндопротезов коленного сустава используются в большинстве современных систем для замещения коленного сустава. Несмотря на ряд ограничений, имеется множество аспектов, делающих такие виды имплантатов незаменимым инструментом для ортопедического хирурга.

Цель — на клиническом примере показать потенциальные риски, связанные с использованием модульного полиэтиленового вкладыша с металлическим фиксирующим механизмом.

Описание клинического случая. Представлен случай первичного тотального эндопротезирования коленного сустава у пациентки 70 лет. Операция была выполнена опытной хирургической бригадой с хорошим ранним рентгенологическим и функциональным результатом лечения. После выписки, примерно через 10 дней после операции, у пациентки появилась боль в коленном суставе. На контрольных рентгенограммах была выявлена миграция металлической «шпильки», фиксирующей полиэтиленовый вкладыш. В экстренном порядке пациентке была выполнена ревизионная операция с заменой вкладыша.

Заключение. Миграция замыкающего элемента вкладыша и вывих вкладыша в фиксированных системах являются достаточно редкими осложнениями эндопротезирования коленного сустава. Причинами, приводящими к данным осложнениям, являются неадекватный мягкотканный баланс коленного сустава в ходе эндопротезирования и ряд технических ошибок. Сам факт использования модульных компонентов сустава является предрасполагающим фактором разобщения этих модулей.

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