Vol 23, No 2 (2017)

CLINICAL STUDIES

SYNOVIAL FLUID D-LACTATE — BACTERIAL-SPECIFIC MARKER FOR INFECTION OF NATIVE AND PROSTHETIC JOINTS

Karbysheva S.B., Grigoricheva L.G., Zhyltsov I.V., Semenov V.M., Zolovkina A.G., Veremei I.S., Trampuz А.

Abstract

Infection  of native  and prosthetic joints  remains  a critical  disease, associated  with  both  significant  mortality and morbidity. The diagnosis of joints infection is extremely  difficult since presentation and preoperative tests are not always obvious and precise, while correct  and timely diagnosis of septic etiology is crucial. In this case a rapid and accurate  test would be helpful.

Purpose of the study — тo evaluate  the analytical performance  and diagnostic  capabilities  of measuring  the synovial fluid D-lactate for early diagnosis of infection in native and prosthetic joints.

Material and methods. Test group of patients (n = 86) contained two subgroups – patients with periprosthetic infection (PPI) (n = 58) and patients with bacterial arthritis (BA) (n = 28). Control group (n = 104) also included two subgroups – patients with aseptic instability of implant components (n = 75) and patients with osteoarthritis (OA) (n = 29).

Results. The authors  observed  that  SF D-lactate ≥1,2 mmol/l was the optimal  cutoff value for identifying patients with bacterial  causes. The higher SF levels of D-lactate were observed in patients with BA compared  to aseptic causes, (p<0,0001), as well as in patients with PJI in contrast to aseptic loosening of prosthesis (p<0,0001). In patients with native joints,  SF D-lactate had better sensitivity (92,8%)  compared  to SF leucocytes  (66,6%)  and percentage of neutrophils (44,4%).  D-lactate had  better sensitivity for diagnosis  of PJI  (96,5%, 89,6% and  60,3% respectively). There  were no significant differences in SF D-lactate levels due to different bacterial  strains.

Conclusion. The study demonstrated high analytical performance and diagnostic  capabilities  of measuring of synovial fluid D-lactate for diagnosis of BA and PJI. It is a rapid and accurate  test for differentiating bacterial  joint infection from the aseptic  inflammatory joint diseases. This procedure can be carried  out within  less than  one hour and be helpful in outpatient setting.

Traumatology and Orthopedics of Russia. 2017;23(2):6-14
pages 6-14 views

TREATMENT OUTCOMES IN ELDERLY AND SENILE PATIENTS WITH DEGENERATIVE DEFORMATIONS AND INSTABILITY OF THE SPINAL COLUMN

Mikhaylov D.A., Ptashnikov D.A., Masevnin S.V., Smekalenkov O.A., Zaborovski N.S., Lapaeva O.A., Mooraby Z.

Abstract

Degenerative  scoliosis  is  a  prevalent  issue  among  the  aging  population.  Controversy  remains   over  the  role of surgical intervention in patients with such disease. The authors  present  the results of 14-year experience in treatment of this pathology.  Various approaches  to the surgical treatment depending  on the stage of the disease and the degree of deformation, including  decompression, instrumental posterior spinal fusion, anterior spinal fusion, and osteotomy were examined. Above treatment options are based on the analysis of clinical aspects, mechanical  stability of deformation, the degree of imbalance in the body and causes of pain or neurological  deficit.

The  risk of postoperative complications is extremely  high and seems to be outweighed by the  possible successful outcomes of surgical treatment. The results presented in the treatment of degenerative scoliosis mainly provide positive outcomes and can assist in the selection of treatment for this group of patients.

The purpose of the  study  is to  evaluate  the  treatment outcomes  of elderly  and  senile patients with  degenerative deformations and instability of the spinal column using various surgical techniques.

Material and methods. During  the present  retrospective study the authors  analyzed 437 patients (337 (77%) women and  100  (23%)  men)  aged  60 years  and  older  who  underwent surgical  treatment at  Russian  Research  institute of traumatology and orthopaedics named  after  R.R.Vreden between  2000 and 2016. The  study  group  included  patients with  diseases and consequences  of injuries  in the  spine, leading  to its deformation and following spinal stenosis  with development of neurological  deficit in some cases.

The  patients were subdivided into  four  groups  depending  on surgical  procedure.  Patients in group  I underwent decompression  of neural  structures at affected levels on both  sides without implants  for fixation. This group was used as the  comparison  group.  Patients in group  II  underwent fixation  the  affected  spinal  motion  segments  locally  with transpedicular system without correction of deformity  and with decompression  of neural structures at the level of spine stenosis.  Patients of group  III  underwent surgery  for fixation  of affected  PDS  up to lower thoracic  spine using short transpedicular system along with decompression  of the neural  structures and correction of spine deformity.  Patients in group IV underwent surgery  for fixation  of affected PDS  up to upper thoracic  spine using transpedicular system, bone cement, decompression  of neural structures and correction of spine deformity.

The average postoperative follow up was 5 years (from 3 months  to 15 years), 266 patients were followed for more than three years.

Results.  The  best  results   were  obtained  in  group  IV:  good  results   – 57,2%  (60  patients),  satisfactory  40% (42 patients), poor 2,8% (3 patients).

The  worst  results  were  obtained in group  I: after  5 years  follow up satisfactory results  were  observed  in 13,4% (15 patients), poor in 86,6% (97 patients) and no good results were reported.

Conclusion. Thus, the performed  study  and observed outcomes indicate  the rationale for performing a full deformity correction by transpedicular fixation and bone cement, applying all the required  methods  and techniques of osteotomy. This approach  allows to maximally  quickly  achieve  the  desired  treatment outcomes  in mid-and long-term follow up period and to avoid complications and revisions.

Traumatology and Orthopedics of Russia. 2017;23(2):15-26
pages 15-26 views

TREATMENT OF INSUFFICIENT JOINT EXTENSOR MECHANISM IN PRIMARY AND REVISION KNEE REPLACEMENT

Kulyaba T.A., Kornilov N.N., Mikhailova P.M., Bovkis G.Y.

Abstract

Insufficiency  of the  knee  joint  extensor  mechanism  is the  absolute  contraindication for total  knee  arthroplasty. Therefore, it is necessary to restore the extensor  mechanism before arthroplasty or to change the treatment approach.

Purpose of the study  – to evaluate  the  outcomes  of surgical  reconstruction of the  knee joint  extensor  mechanism during primary or revision knee arthroplasty.

Materials and methods. 25 reconstructions of extensor  mechanisms  (24 patients) were performed  in the period from 2006 to 2015. Five procedures out of 25 were performed in primary TKA and 20 in revision TKA. Indications for extensor mechanism  reconstruction were as follows: patellar  tendon  rupture in 15 cases (60,0%),  fracture  of patella  in 5 cases (20,0%), quadriceps tendon  rupture in 3 cases (12,0%) and other indications in 2 cases (8,0%). One of the following four techniques was used to restore  the extensor  mechanism: “Frame / Loop” allograft of patellar  tendon  in 6 cases (24,0%); bone – patellar  tendon  – bone allograft in 9 cases (36,0%); quadriceps tendon  – patella-patellar tendon  – bone allografts in 7 cases (28,0%); weber’s internal fixation of patella in 3 cases (12,0%).

Results.  All patients were  evaluated based  on  clinical  examination,  KSS  and  WOMAC  scores  (18  patients), and standard x-rays (13 patients). The mean follow-up  period  in the  present  study  was 44 months  postoperatively. Reconstruction of the knee joint extensor  mechanism  resulted  in a significant  reduction of pain in 38.8% of patients, the knee stability was restored  in 83,3% of patients and the active  knee extension  improved  significantly  in the vast majority  of patients.

Conclusion. Despite  the  objective  improvement of the  knee  joint  function  after  the  reconstructions of extensor mechanism,  the  KSS and WOMAC evaluation scores remained  low which  should  be taken  into  consideration during preoperative planning.

Traumatology and Orthopedics of Russia. 2017;23(2):27-38
pages 27-38 views

RESEARCH METHODS

HISTOPATHOLOGICAL SCALE AND SYNOVITIS ALGORITHM – 15 YEARS OF EXPERIENCE: EVALUATION AND FOLLOWING PROGRESS

Krenn V., Perino G., Rüther W., Krenn V.T., Huber M., Hügle T., Najm А., Müller S., Boettner F., Pessler F., Waldstein W., Kriegsmann J., Häupl T., Wienert S., Krukemeyer M.G., Sesselmann S., Tikhilov R.M., Morawietz L.

Abstract

The diagnostic  histopathology scales are mainly  the  multilevel  evaluation systems. The same principle  is lying in the  basis of synovitis  scale elaboration. This  scale gradually  and  semi-quantitatively assesses the  inflammatory and immunological changes in case of synovitis  considering  three  synovial components: thickness  of synovial cellular layer, cellular  stroma  density  and  severity  of inflammatory infiltration. The  scale comprises  four semi-quantitative  grades: normal 0, mild, moderate  and severe. Scale points from 0 to 9 are summated. Such sum evaluation allows to identify high and low degree synovitis.  Scale points  from 1 to ≤4 correspond to low degree synovitis  which determines and includes the following diagnosis: arthritis associated  synovitis;  synovitis  associated  with  meniscus  pathology;  hemochromatosis associated  synovitis.  Scale points  from ≥5 to  9 determine high  degree  synovitis  including  diagnosis  like rheumatoid arthritis; psoriatic  arthritis; Lyme arthritis; post  infection  (reactive) arthritis and  peripheral arthritis in Bekhterev’s disease. Thus, the synovitis scale allows to assess degenerative or posttraumatic (low degree synovitis) and inflammatoryrheumatoid pathology  (high  degree  synovitis) based  on histopathological diagnostics with  sensitivity of 61,7% and specificity  of 96,1%. The scale is characterized by a good diagnostics significance  by ROC  analysis (area  under  curve: 0,8–0,9).  Two versions of synovitis  scale was published:  first in 2002, second reworked  in 2006 and the latter includes the concept  of subdivision  into two groups of high and low degree synovitis.  Thanking to both  versions a national  and international recognition of histological  evaluation during  15 years was gained.   To clarity  diagnosis description using synovitis  scale particularly in rheumatology various  inflammatory antigens  were suggested  for immunohistochemical analysis (including Ki-67, CD68-, CD3-, CD15и CD20).  This immunohistochemical scale and subdivision into low and high degree synovitis  provided  a possibility  to assess the risk of development and biological sensitivity of rheumatoid arthritis. Thus, an important histological  input  was made into primary rheumatology diagnostics which did not consider tissue  changes.  Due  to  formal  integration of synovitis  scale into  the  algorithm of synovial  pathology  diagnostics a comprehensive classification was developed specifically for differentiated orthopaedics diagnostics.

Traumatology and Orthopedics of Russia. 2017;23(2):39-48
pages 39-48 views

MODERN TECHNOLOGIES IN TRAUMATOLOGY AND ORTHOPEDICS

MINIMALLY INVASIVE LUMBAR-PELVIC STABILIZATION FOR UNSTABLE PELVIC RING INJURIES

Dulaev A.K., Kazhanov I.V., Manukovsky V.A., Mikityuk S.I., Presnov R.A., Gavrishchyuk Y.V.

Abstract

Reconstructive operations for unstable  pelvic ring injuries  in most cases are performed  at later  date  after  trauma (period  of complete  stabilization of the vital functions). The paper presents  treatment outcomes  of three  patients with vertically unstable  pelvic ring injuries where minimally invasive lumbar-pelvic fixation with pedicle screws was applied. The morphology  of sacrum  injury  determined a configuration of the  lumbar-pelvic transpedicular system. In all cases the final surgery was performed  in the early period of traumatic disease, which made it possible to restore  the anatomy of the pelvic ring and obtain good functional outcomes.

Traumatology and Orthopedics of Russia. 2017;23(2):49-58
pages 49-58 views

CASE REPORTS

SYNOVIAL CYST IN THE PROJECTION OF TIBIAL TUNNEL AFTER ACL RECONSTRUCTION (CASE REPORT)

Bogatov V.B., Sadykov R.S., Ponamarev I.R.

Abstract

ACL  tears  are the  most  widespread  lesions  among  isolated  trauma  of knee  ligaments  that  require  early  surgical treatment especially in young active patients. There  are various ACL reconstruction techniques where femur and tibia tunnels are formed and graft is fixed by cannulated interference screws. One of the possible complications is the formation of a postoperative soft tissue cyst in the projection of tibial tunnel.  The nature  as well as mechanism of cyst formation  is still unclear.

A relevant  clinical case of cyst formation  in a patient five years after ACL grating  is described  in this publication. MRI findings demonstrated that  the origin of the cyst was hole of the tibial interference screw.

Conclusion. The authors  observed that  synovial cyst was formed due to use of cannulated interference screws where synovial  fluid was leaking  from joint  cavity  through screw holes. Cystectomy and  autografting of tibial  bone tunnel allowed to reduce such complication.

Traumatology and Orthopedics of Russia. 2017;23(2):59-63
pages 59-63 views

COMMENT ON THE ARTICLE

Kuznetsov I.A.

Abstract

.
Traumatology and Orthopedics of Russia. 2017;23(2):63-65
pages 63-65 views

CONTINUOUS THROMBOPROPHYLAXIS DURING SURGICAL TREATMENT OF PATIENT WITH POLYTRAUMA IN A MULTIDISCIPLINARY HOSPITAL (CASE REPORT)

Belenky I.G., Sergeev G.D.

Abstract

The paper presents  a clinical case of a staged surgical treatment according  to damage control  protocol  for a patient with multiple limb fractures, sternum  trauma as well as brain injury due to traffic accident. Following temporary external fixation during emergency treatment, 6 internal fixation procedures were performed on the patient during three surgical sessions. 4,5 months  postoperatively the authors  observed  consolidation of all fractures  with good restoration of joints function. Prophylaxis of venous thromboembolic events included low molecular heparins administration prior to the first and consequent surgical  sessions as well as oral anticoagulants during  intervals between  procedures and for extended prophylaxis. Apart from medicinal prophylaxis  the authors  utilized therapeutic exercises at all treatment stages.

Traumatology and Orthopedics of Russia. 2017;23(2):66-73
pages 66-73 views

OSTEOID OSTEOMA OF THE HAMATE AS A CAUSE OF COMPRESSION NEUROPATHY OF THE ULNAR NERVE IN GUYON CANAL (CASE REPORT)

Semenkin O.M., Izmalkov S.N., Solopikhina E.B., Doskovskaya E.M., Balakleyets S.V.

Abstract

Osteoid  osteoma of the wrist bones is rare and its diagnostics is complicated. A clinical case of the surgical treatment of the patient with osteoid osteoma is presented. The clinical manifestations included  pain, extensors  tenosynovitis and neuropathy of the ulnar nerve in guyon’s canal. The diagnosis was confirmed by computer tomography, ultrasonography and electromyography. Partial resection of the hamate including pathology area, and mobilization of the ulnar nerve in the wrist enabled authors  to obtain a good functional outcome.

Traumatology and Orthopedics of Russia. 2017;23(2):74-80
pages 74-80 views

DATA OF JOINT ARTHOROPLASTY REGISTERS

EPIDEMIOLOGY OF PRIMARY HIP ARTHROPLASTY: REPORT FROM REGISTER OF VREDEN RUSSIAN RESEARCH INSTITUTE OF TRAUMATOLOGY AND ORTHOPEDICS

Shubnyakov I.I., Tikhilov R.M., Nikolaev N.S., Grigoricheva L.G., Ovsyankin A.V., Cherny A.Z., Drozdova P.V., Denisov A.O., Veber Е.V., Kuz’mina I.V.

Abstract

The   paper   presents   data   analysis   of  the   Hip   Arthroplasty  Register   of  Vreden   Russian   Research   Institute of Traumatology and Orthopedics, namely information on 37373 primary THA performed at the Vreden Institute and at several other orthopedic centers and 1200 hip replacements at other hospitals of St. Petersburg.

There were 1.5 times more women in the studied cohort than men. A significant predominance of women with dysplastic osteoarthritis (72.4%) and rheumatoid arthritis (82.1%) was reported. A male predominance was noted in patients with secondary osteoarthritis (53.1%), post-traumatic changes of hip (61.0%) and osteonecrosis of the femoral head (68.6 %). The mean age of patients was 58.0±12.9 years (95% CI from 57.9 to 58.1, median 59 years). Age data of the study revealed that  patients were 10-12 years younger than reported in the national  arthroplasty registers of other countries.

Total  hip arthroplasty was performed  in the  absolute  majority  of patients – 37295  cases (99,8%).  Uncemented implants  were used in 59.3% of cases, hybrid – in 29.6%, cemented – in 10.2%, reverse-hybrid – in 0.9% of all patients. The  most  common  bearing  used  was metal  on  crosslink  polyethylene, which  was applied  in 50.1% of all cases of arthroplasty. The  type  of fixation  of the  implant,  and  the  use of different  bearings  varied  in different  age groups. The paper presents  not only the absolute  numbers  of the data, but also demonstrated the dynamics  of the changes in time starting from 2007.

The  present  epidemiological  study  does not  claim the  absolute  completeness of the  presented data,  but  contains the  analysis of the  large number  of cases, comparable  with  follow-ups  of patients in some national  registers  of certain European countries. The authors  analyzed about  10% of all cases of hip replacements performed  on the territory of the Russian Federation in ten-year  period.

Traumatology and Orthopedics of Russia. 2017;23(2):81-101
pages 81-101 views

REVIEW

ADULT ACGUIRED FLATFOOT DEFORMITY (REVIEW)

Bulatov A.A., Emelyanov V.G., Mikhailov K.S.

Abstract

Flatfoot deformity represents a complex pathology often observed in active adult population. Conservative treatment does not  always yield the intended outcome.  Various  surgical  methods  addressing  mentioned pathology  were actively developing  during  past decades. However,  despite  diversity  of procedures there  are many contradictions in respect  of necessity  and efficiency of a certain  procedure especially in grades II and IV of the disease. The paper presents  clinical, roentgenological and biomechanical  features of acquired flatfoot deformity. The authors  analyzed literature publications dedicated to different correction methods  adopted  in world orthopaedics.

Traumatology and Orthopedics of Russia. 2017;23(2):102-114
pages 102-114 views

ARTHROPLASTY FEATURES IN OVERWEIGHT PATIENTS (REVIEW)

Yousef A.I., Akhtyamov I.F.

Abstract

The paper represents a review of modern foreign literature dedicated to joint replacement in patients with increased body mass index. The authors  examine the epidemiology,  pathogenesis features  of osteoarthritis (arthrosis) in obesity. The majority  of experts  consider  the increased  body mass index an aggravating factor in the surgical treatment of large joints arthrosis.  There is also the opposite point of view, confirmed by many orthopedic surgeons.

The analysis of publications in foreign scientific literature regarding the risk of intraand postoperative complications after arthroplasty in obese patients yields controversial results. The authors  regret  availability of only a few studies  on such an interesting and important topic  carried  out  in Russia. The  need for a detailed  study  of the  issues related  to treatment of patients with obesity is prompted by our time.

Traumatology and Orthopedics of Russia. 2017;23(2):115-123
pages 115-123 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies