Vol 22, No 3 (2016)

Today one of the most interesting organ surgical interventions for patients with osteonecrosis of the femoral head are still different core decompression procedure. However, in the literature, we could not find any indication on what stage of the disease is different proposed techniques is the most effective.

Purpose of the study compare the results of different methods of core decompression in the early stages of the disease, before the development of hip osteoarthritis.

Materials and methods. From 2006 to 2015 we treated 84 patients (96 hips) with a diagnosis of osteonecrosis of the femoral head. The mean age of patients was 37,4±9,1 (from 18 to 71) years. Classification Association Research Circulation Osseous (ARCO) was used to determine the stage of the disease. 20 patients core decompression performed on stage II, 71 stage III and 5 in stage IV of disease. Core decompression by one tunnel 9 mm diameter was performed in 55 cases, and in 33 cases, the destruction of the core to the healthy bone has been made. Grafting of the residual cavity has been made by allogeneic bone, calcium sulfate, a combination of calcium sulfate and p3-calcium phosphate and p3-calcium phosphate. Eight joints operated by core decompression multiple tunnels of small diameter without subsequent plastic tunnels. We assessed the results on the basis of X-ray and CT scan data of the operated hip, and according to Oxford Hip Score at 3, 6 and 12 months, and then once in 1 year after surgery. In case of subsequent hip replacement was performed pathological examination area of core osteonecrosis of the femoral head.

Results. The average period of follow-up was 31,6 months (from 12 to 110 months). Preventing hip arthroplasty during this time managed in 43 cases (44.8%), 53 joints (55.2%), total hip replacement has been made in the period from 4 to 72 months (average 21.6 months) from the date of implementation of core decompression. The greater the number of good and satisfactory results have shown methods aimed at complete destruction of nonviable bone on the border of core osteonecrosis healthy bone.

Frequency of hip replacement is directly dependent on the stage of the disease.In the second stage of the disease hip replacement made in 4 cases (20%) at the third stage satisfactory performance were observed mainly in the case of small and medium sized core osteonecrosis of the femoral head (4, 18 and 16 of the joints 27, respectively). In the fourth stage of the disease arthroplasty was performed in all five cases.

Conclusions. Different techniques of core decompression are most effective before the formation of the Impressions of the loaded part of the femoral head, which corresponds to stage III ARCO classification inclusive. Efficacy techniques depends not only on the stage but also on the size and location core of osteonecrosis.

Introduction. Operation Bristow-Latarjet proved itself as one of the most effective and predictable surgical treatments. despite its widespread use, there are various complications associated with improper installation of the bone block and the violation of its remodeling.

Objective: To obtain new data on the effect of location and remodeling of bone graft block on functional outcome and stability of the shoulder joint in patients with recurrent anterior instability after the operation Bristow-latarjet.

Material and methods. The material for the study served as the analysis of results of treatment of 64 patients with posttraumatic recurrent anterior shoulder dislocation who underwent Bristow-latarjet operation. postoperatively, assessed a provision and the degree of bone remodeling unit according to computed tomography in the sagittal, axial slices, and through 3d modeling. To evaluate the functional outcome scale were used western Ontario Shoulder Index (wOSI) and Rowe scale.

Results. At the level of the articular surface (congruent or flattening) in the axial plane were 89% bone blocks, too medially or laterally arranged 9% and 2% grafts, respectively. On sagittal cT images in the middle third of the articular surface of the scapula was located 28% of the bone blocks at the bottom 60%, in the upper third of 12%. Analysis of the dependence of the results of treatment of graft positioning showed that patients with excellent and good summary on the scale WOSI and Rowe, had a correct location of the bone block in the middle and lower third of the articular process of the blade. It can be assumed that excessive lateralized or medialized bone block position in the axial plane of a more profound effect on the outcome than cranial displacement of the latter with the sagittal plane. Bony union of the graft was found by CT in 74% of cases, soft tissue 26%, the degree of resorption of the graft revealed 0-1 84% 2-3 degree in 26% of cases. In the last periods of the investigation summary measure according to the scales WOSI and Rowe after Bristow surgery was 80±5 and 450±50 points, after Latarjet surgery 80±5 and 430±60 points. (p<0,05).

Conclusion. Positioning bone graft block affected the results of operations Bristow-Latarjet. Patients with excellent and good summary on the scale WOSI and Rowe had a correct location of the bone block relative to the articular surface of the scapula. The best overall performance on scales wOSI and Rowe were observed in patients with the fusion of the bone graft and block bone resorption does not exceed 0-1 degree compared with patients having soft tissue fusion and resorption 2-3 degree.

Purpose. To study the effectiveness of minimally invasive surgical treatment of patients susceptible to pathological fractures due to proximal femur metastasis.

Materials and methods. A retrospective study was done for a group of 46 women of mean age 44.5 years (range 38 to 60 years). The histologic diagnosis of each patient was breast cancer. The overall survival of included patients was more than 18 months after intramedullary nailing and cement injection of the proximal femur. In first subgroup, 22 patients underwent intramedullary nailing and cement injection immediately after RF (radiofrequency) ablation. Second subgroup included 24 patients who underwent internal fixation of impending pathologic fractures without RF ablation. Pain relief was evaluated by visual analogue scale (VAS). Functional outcomes and life quality were assessed with MSTS and SF-36 scores.

Results. The authors obtained statistically significant differences in the scores dynamics on SF-36 scale.

Most of the patients continued comprehensive treatment as well as were receiving bisphosphonates after 18 months postoperatively. Hip function, assessed on MSTS scale, did not demonstrate statistically significant differences (83.2 for the first subgroup and 88.1 for the second). Pain syndrome in the early postoperative period was statistically lower in the first subgroup.

X-ray and CT examination of patients in the first subgroup revealed 2 cases of continued metastatic growth accompanied by cut-out syndrome, implant instability or severe pain. In the second subgroup, where prophylactic fixation was performed without radiofrequency ablation such complication was observed in 6 cases.

Conclusions. RF ablation and internal fixation of impending femoral pathologic fractures can be combined in one stage procedure. Such method proved feasibility and efficiency for treatment of osteolytic and mixed metastatic lesions of proximal femur with low incidence of implant-related complications and lower risk of revisions.

Purpose: To Study immune status in patients with coxarthrosis consequent to treatment of congenital hip dysplasia and Perthes' disease as well as to determine additional variables indicating arthrosis progression.

Materials and methods: The authors analyzed results of preoperative immune examination of 13 male patients aged 11,4±0,7 years (10-13) with coxarthrosis of type I-II developed consequently to treatment of hip dysplasia and Perthes' disease. Based on obtained anatomical and functional outcomes the authors divided the patients into two groups. First group included 8 patients with postoperative improvement of joint function and absence of disease progression. Second group (5 patients) was featured by functional deterioration and arthrosis advancing.

Results: Patients of the second group demonstrated statistically significant elevation in certain parameters of humoral (circulating immune complex) and cellular immunity (CD3+HLA-DR (%), CD3+HLA-DR (109/l)) as well as interleukin-6.

Conclusion: Obtained results have proven that initial immune parameters (IL-6, circulating immune complex, lymphocytes with activation markers) can be used as additional variables for decision making in regard to option and advisability of reconstructive joint preserving procedures in patients with coxarthrosis consequent to treatment of hip dysplasia and Perthes' disease.

Purpose: in vitro study of ultrasound dissection devices' impact on meniscus and knee cartilage as well as comparison of outcomes with familiar arthroscopic techniques.

Materials and methods. Meniscus and joint cartilage specimen obtained during total knee replacement were placed in a normal saline. All experiments were conducted no later than in 2 hours after obtaining and followed by histology of biopsy specimens. In the first series of experiment the authors performed meniscus dissection with ultrasound instrument «Scalpel», cold plasm ablator and surgical scalpel.

Results. The first series of experiments demonstrated disruption of fibers orientation on meniscus rim after dissection with scalpel; necrosis depth after coblation is 0,7-0,8 mm. Ultrasound dissection devices leave necrosis depth of 0,1-0,2 mm and smooth cartilage surface. The second series of experiments proved that after shaver application cartilage surface was coarse; certain necrosis sections of 16-90 nm were observed on relatively smooth cartilage surface after coblation. Application of ultrasound «Miller» device leaves smooth cartilage surface with no fibers, no signs of cartilage thinning and necrosis not exceeding 15 nm.

Conclusion. The results of experiments confirm that use of low frequency ultrasound dissection devices is advantageous as compared to mechanical and ablation cutting techniques while ensuring histologically proven atraumatic handling of biopsy specimens of meniscus and hyaline cartilage.

The purpose of investigation is to approve the new method of minimally invasive plate osteosynthesis in cases of diaphyseal humeral shaft fractures with helical plate.

Materials and methods. During experimental cadaveric part of the study implantation of long helical plate on humerus using minimally invasive technique on 14 fresh cadaveric shoulders was done. plate was inserted from two incisions 3-5 cm long in the upper part of the shoulder on the lateral side and in the lower part on the anterior side. Clinical part of the study included 31 patients with isolated humeral shaft fractures and humeral shaft fractures associated with fractures of proximal humerus and treated by minimally invasive fixation with helical plate.

Results. Cadaveric study included preparation and special measuring and showed that implantation of the helical plate in proposed way gives safe distances between plate and axial, radial, musculocutaneous, median nerves, main humeral vessels and tendon of the long head of the biceps.

Results of the clinical part of the study: radiological evidence of bone healing were observed on the 12 weeks in 10 from 28 cases (36%), on the 18 weeks in 18 from 25 (72%), on the 24 weeks in all 25 cases (100%). On the 24 weeks after surgery results on the DASH scale in average were 13±3,6 (from 3 to 36). Where in good results were in 17 (68%) cases, satisfactory in 8 (32%) cases. On the Constant Shoulder Score at the same time averege results were 80±4,63 (from 60 to 91). Exellent result was in 7 (28%) cases, good in 12 (48%), satisfactory in 5 (20%) cases and bad in one (4%) case with subacromial impidgement after wrong plate positioning. There were no any cases of vascular and neurological complications and nonunions.

Actual principles of implant associated infection treatment require determined approach already in early symptoms stage. The paper describes a clinical case of infectious complication treatment after bone-tendon repair of supraand infraspinous muscles with anchors. Following conservative treatment with no positive dynamics the authors performed two stage surgical treatment of implant associated shoulder infection. First stage included radical debridement, removal of implants and filling the defect in left humeral head with antibacterial spacer. Following infection eradication, the second stage included arthroscopy of the left shoulder, spacer removal, grafting of defect and revision left rotator cuff repair using anchors.

The present clinical case demonstrates a lack of alertness in respect of possible postoperative infection, insufficient treatment experience of general orthopaedic surgeons and overall complexity of radical surgical procedure for treatment of such patients.

Despite a wide variety of surgical procedures utilized in clinical practice for treatment of articular cartilage lesions, the search for other options of articular reconstruction remains a relevant and open issue at the current stage of medicine and biotechnologies development. The recent years demonstrated a strong belief in cellular methods of hyaline cartilage repair such as implantation of autologous chondrocytes (ACI) or cultures of mesenchymal stem cells (MSC) including techniques for genetic modification of cells.

The purpose of presented review is to summarize the published scientific data on up to date results of perspective cellular technologies for articular cartilage repair that are being developed. Autologous chondrocyte transplantation originally performed by Swedish researchers in 1987 is considered the first clinically applied technique for restoration of hyaline cartilage using cellular technologies. However, the transplanted cell culture featured low proliferative capacity and inability to form a regenerate resistant to high physical activity. Another generation of methods originated at the turn of the century utilized mesenchymal stem cells instead of autologous chondrocytes. Preparation of MSCs is a less invasive procedure compared to chondrocytes harvesting and the culture is featured by a higher proliferative ability. Researchers use various biodegradable carriers (matrices) to secure cell fixation. Despite good clinical mid-term outcomes the transplanted tissue-engineering structures deteriorate with time due to cellular de-differentiation. Next generation of techniques being currently under pre-clinical studies is featured by the preliminary chondrogenic modification of transplanted cell culture. Usage of various growth factors, modified cell product and gene-activated matrices allow to gain a stable regulatory and key proteins synthesis and achieve a focused influence on regenerate's chondrogenic proliferation and in result to form a good hyaline cartilage resistant to high physical load in long term period.

Thus, development of methods for articular cartilage repair has long ago went beyond the interests of clinical physicians, and only the close interdisciplinary cooperation of clinicians and specialists for cytology, molecular genetics and, probably, virology would enable replacement of a defect with a rigorous hyaline cartilage.

Specific upper limb disorders accompanying spastic cerebral palsy substantially restrict self-care, writing abilities, hinder movements with external support aids and limit work capability. Spastic upper limb represents a complex multilevel abnormality progressing with age and leading to increased suffering of the patient. Little interest towards surgical correction of spastic upper limb along with insufficient awareness on surgical rehabilitation options leaves considerable number of patients without relevant treatment.

The present paper describes advances and complexities of orthopaedic correction for spastic arm in ICP, key classifications used and treatment outcomes based on scientific literature analysis.

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