Traumatology and Orthopedics of RussiaTraumatology and Orthopedics of RussiaТравматология и ортопедия России2311-29052542-0933Vreden National Medical Research Center of Traumatology and Orthopedics3210.21823/2311-2905-2016-0-1-124-128Case ReportsСлучаи из практикиCase ReportsMULTIPLE DAMAGE OF THE TIBIAL POLYETHYLENE INSERT IN KNEE JOINT PROSTHESIS (CAN EXCELLENT POSTOPERATIVE OUTCOME BE THE CAUSE OF FRACTURE OF THE TIBIAL INSERT?) CASE REPORT AND LITERATURE REVIEWМНОЖЕСТВЕННЫЕ ПОВРЕЖДЕНИЯ ТИБИАЛЬНОГО ПОЛИЭТИЛЕНОВОГО ВКЛАДЫША ЭНДОПРОТЕЗА КОЛЕННОГО СУСТАВАSongE.СонгЮ.
Korea, Republic of

профессор

EshnazarovK.ЭшназаровК.
Korea, Republic of
kamolhuja77@mail.ruAsilovaS.АсиловаС.
Uzbekistan
SeonJ.СеонЙ.
Korea, Republic of
Department of Orthopaedic Surgery, Chonnam National University Hwasun Hospital, Seoul, KoreaОтделение ортопедической хирургии, Национальный университет Chonnam, госпиталь Hwasun, Сеул, КореяDepartment of Orthopaedic Surgery, Shinchon Yonsei Hospital, Seoul, KoreaОтделение ортопедической хирургии, Госпиталь Shinchon Yonsei, Сеул, КореяDepartment of Traumatology, Orthopedics and Neurosurgery, Tashkent Medical AcademyОтделение травматологии, ортопедии и нейрохирургии, Ташкентская медицинская академия2406201622112412827062016270620162016https://journal.rniito.org/jour/article/view/32

Despite improvements in prosthesis technology and use of high-quality materials in recent years, the number of revisions related to implant failures (4.7%) remains high. Several phenomena were reported in literature as reasons for dislocation and fracture of tibial insert in mobile bearing prosthesis: incorrect positioning of components, discrepancy of extension and flexion balancing or ligament weakness. However, in our cases neither of these causes were observed. The authors consider that bio-physiological and biomechanical aspects of total knee arthroplasty and knee joint prosthesis should be thoroughly studied and implemented into the clinical practice. In the described cases, multiple damage of the insert due to flexion instability and “twist-hyperflexion” in overweight patients is perceived as the reason for failures.

Несмотря на то, что в последние годы в производстве эндопротезов применяются усовершенствованные технологии и высококачественные материалы, число ревизионных вмешательств по причине несостоятельности имплантатов остается достаточно высоким (4,7%). В научной литературе описываются несколько причин вывихов и повреждений тибиального полиэтиленового вкладыша конструкций эндопротезова коленного сустава с мобильной платформой, а именно: неправильное позиционирование компонентов, дисбаланс сгибательного и -разгибательного промежуткова или слабость несостоятельность связочного аппарата. Однако, в своей клинической практике авторы не наблюдали подтверждения подобных причин. По мнению авторов, необходимо тщательно исследовать и учитывать в клинической практике физиологические и биомеханические особенности как методики тотального замещения коленного сустава, так и самих имплантатов. В описываемых ниже случаях в качестве причины неудовлетворительных исходов авторы отмечали множественные повреждения тибиального полиэтиленового вкладыша вследствие нестабильности при сгибании коленного сустава и/или избыточного глубокого сгибания в сочетании со скручивающим усилием у пациентов с избыточной массой тела.

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