Vol 19, No 4 (2013)

Surgical site infections remain a major complication of arthroplasty, spinal stabilization or other orthopedic surgeries. The pathogenesis of these complications is related to use orthopedic implants. This retrospective study investigated the microbiological etiology of implant-associated infection after orthopedic surgery over a 3-year period (2010-2012). The antibiotic resistance profiles of 1350 clinical microbial isolates were determined. The biofilm forming capacity of 394 staphylococcal strains was tested. Statistical analysis was performed using Z-criterion. From a results of the microbiological culture, Staphylococcus aureus and Staphylococcus epidermidis were isolated in 49,9% of cases, followed by: Enterococcus faecalis - 6,4%, Pseudomonas aeruginosa - 5,9%, Acinetobacter spp - 5,1% and members of the family Enterobacteriaceae - 4.1%. MRSA amounted to 23,9% and MRSE - 56,6% (p<0,05) . The percentage of strong biofilm forming strains was more among S.epidermidis strains compared to S. aureus strains (46,4 vs 37,3%; p<0,05). The strains of both Staphylococcus spp, isolated from tissue bioptates and removed orthopedic implants, possessed strong biofilm forming capacity more often than isolates from aspirates (p<0,05). The recommendations for empirical and etiotropic therapy of implant-associated infection after orthopedic surgeries were developed on the basis of data on antibiotic resistance of studied microorganisms.

Purpose - retrospective analysis of the causes of complications after knee replacement in tumor lesions depending on the type of implants and classification of complications by severity. Material and methods. The outcomes of operations of knee replacementin tumor lesions performed in 161 patients in the period between 1993 and 2012 were studied. All patients were divided into two groups. The first group included 68 (42.2%) patients, whom the Russian endoprostheses were implanted. The second group included 93 (57.8%) patients, who were operated using modern foreign endoprostheses. Results. 74 (45.9%) patients underwent revision surgery due to the complications in different terms after primary oncologic replacement, with 67 (90.5%) requiring a removal of the primary endoprosthesis. By severity, all complications were divided into 5 types. Infections were the most frequent complications of knee replacement resulting in revision surgery (19 cases, 25.7% of all revision operations). Conclusion. Improvement of oncological systems quality lead to the decrease in the rate of revision surgery due to mechanical reasons. However, the complication rate after knee replacement remains higher than after conventional arthroplasty.

Purpose. Estimation of critical value of acetabular component uncoverage enabling its implantation without an additional support. Methods. A comparative analysis of an original method for intraoperative measurement of uncoverage space of acetabular component based on the measurement of the depth of uncovered sector with X-ray control by the same technique was carried out. Mathematical computer modeling based on the finite element techniqueand the mechanical experiment were performed. Critical values of uncoverage enabling safe primary fixation of acetabular component were estimated in designed models. Results. High rate of coincidence of direct intraoperative and postoperative measurements by radiograms was obtained, testifying to the possibility of application of this technique of uncoverage estimation at the stage of preoperative X-ray planning in patients with different degree of dysplasia. Using the finite element technique and the mechanical experiment on pelvis models, a possibility of mounting anacetabular component with moderate uncoverage within 25% without screws and with significant uncoverage to 35% with additional two screws fixation was demonstrated.

In the period from 2011 to 2013 in Botkin City Hospital 17 patients with unstable injuries of pelvic ring and lumbosacral junction were operated using the method of transpedicular vertebropelvic fixation. In the preoperative period a comprehensive instrumental examination, including X-rays and CT was performed in all patients. In 11 (64.7 %) patients neurological complications were detected, of which 4 (23.5%) - cauda equina syndrome (patients with transverse fractures of the sacrum). The follow- up of patients was 1.5 years In all cases the X-ray pattern after surgical treatment was regarded as satisfactory. During the observation period the necessary to remove the fixation devices didn’t appear. The regression rate of neurological symptoms in the postoperative period depend on the severity of the initial injury and the intensity of symptoms. In the group of patients with transverse fractures of the sacrum disorders of pelvic organs remained, caused by primary severe damage in the sacral canal zone. In the other groups there was a gradual regression of motor and sensory disorders in the year after surgery. The complications in the early postoperative period: 2 (11.8 %) cases of delayed healing of surgical wounds in the sacral region (secondary healing) and one (5.9%) case of postoperative wound infection that requested the secondary surgical treatment, rehabilitation and installation of the suction-irrigation system. The method of transpedicular vertebropelvic fixation is effective in the treatment of unstable pelvic injuries if braking-down of gemipelvis is necessary and also in the combined damage of low-lumbar spine.

A new method of microsurgical reconstruction of soft tissues defects of a knee in the conditions of inability to form pedicled flaps of thigh and shin has been offered. Prefabricated pedicled fasciocutaneous donor flap of the thickness needed is created on the anterior and anterior-medial surface of the same thigh. The donor flap is based on the previously transplanted radial forearm fascial free flap. This method provides recreation of wholesome periarticular soft tissues, eradication of the local infection, increase of range of motion in the knee joint and possibility to fulfill in the future perspective total knee arthroplasty as well as any other surgical operations.

The authors presented a rare clinical case - the injury of forearm complicated by the formation of the pseudarthrosis of the radial shaft in combination with old dislocation of heads the radius and ulna. The differentiated approach to the choice of surgical tactics was proposed, which consists of several consistent stages: taking free autotransplant from the crest of iliac bone, resection of pseudarthrosis of radius with replacement of the bone defect by the graft for restoration of anatomic length, conducting combined strained osteosynthesis and elimination of dislocation of a head of radial and ulnar bones by transosseous osteosynthesis. The chosen treatment strategy allowed to restore the anatomy and function of the upper extremity.

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Although total knee arthroplasty (TKA) improves function and reduces pain for the large majority of the patients, a few continue to have pain and require investigation. The causes of dysfunction and pain after total knee arthroplasty can be described as intrinsic (intra-articular) or extrinsic (extra-articular) sources of pain. For the majority of the cases, following a complete evaluation protocol, the cause of pain can be identified and a specific treatment can be applied, however occasionally there remains a group of patients with unexplained pain whose management is difficult. It was our hypothesis that revising a TKA without pre-operative diagnosis of the failure is not worth. Therefore, the aimed of this review was to: 1) analyse the results of revision TKA for unexplained pain, and 2) described the potential solutions for an alternative conservative management of the painful TKA.

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Purpose: on the basis of study of histologic changes characterizing the condition of tendinous autografts of the anterior cruciate ligament ^TACL) to establish dependencies between clinical and morphologic indicators in patients with signs of knee joint anteromedial instability relapse. Material and methods: 30 resected tendinous transplants have been used received from own patellar ligament (10 cases) and semitendinous and gracilis muscles of the femur (20 cases). After histologic study the parameters of some graduated morphologic indices that versatile characterize the basic processes condition in АТА^ tissues, frequency of their occurrence separately for femoral and tibial parts of the graft, have been determined. Results: АТАСЦ by the moment of their insufficiency with relapse of antero-medial instability, the complex of unevenly expressed pathologic changes has been observed: ischemic-necrotic, dystrophic, inflammatory, reparative-fibrosing and in rare cases metaplastic changes; their topographical combinations and quantitative expressiveness occasionally can vary. In different parts of ATACL the degree of expressiveness of certain morphologic indices of the graft condition varies and can not correspond to separate types of macroarthroscopic estimates. The correlation analysis of pairs relations for nonparametric clinical and morphologic indices separately in femoral and tibial loci has revealed that only some values of coefficient of association corresponding to an moderate range or close to it - both with positive, and negative signs, some values of the coefficient of association have appeared significant by a number of observed cases. Conclusions. The cause of small number of moderate force correlations and absence of close correlations in pairs of indicators «clinic-morphology» is supposed to be in considerable inequality, and probably in cyclic processes of reparation, dystrophy, inflammation and uncontrollable damage of an immature fibrous tissue in ATACL-regenerates, developing during adaptation of the transplant to physical activities and preparing development of its insufficiency.