Vol 24, No 2 (2018)

Purpose — to evaluate mid-term outcomes of reverse joint replacement in patients with shoulder arthropathy and massive rotator cuff tear.

Material and Methods. Reverse shoulder arthroplasty with delTa xTeNd (depuy) was performed in 38 patients in the period from december 2010 to december 2016 by the same surgical team. patients’ age ranged from 38 to 82 years. Indications for replacement were pain syndrome and pseudoparalysis of the upper limb in presence of a large or massive Rc tear as well as shoulder arthropathy of various severity degree. Outcomes were evaluated by standard aSeS, cS and ucla scales. Roentgenological examination included ap and axial x-rays during follow up from 1 to 6 years after the surgery with analysis of implants positioning. Mean follow up was 24,2±6,6 months.

Results. good outcomes were reported in 6 (15,8%) patients. average functional scores were: aSeS 87,4±2,1, ucla 29,7±1,5 and cS 14,0±2,3. Satisfactory outcomes were observed in 27 (14,2%) patients: aSeS 76,2±2,3, ucla 26,8±1,3 and cS 22,0±1,4 scores. poor outcomes were reported in 5 (14,2%) patients with persisting pain syndrome.

Conclusion. To avoid significant and multiple complications after reverse shoulder replacement a precise preoperative planning considering particular destructive changes of glenoid fossa is required. For young and physically active patients the authors recommend to use alternative treatment options aiming at restoration of normal shoulder biomechanics and prophylaxis of arthropathy.

A previous retrieval study analyzed the backside wear of short-term implanted liners against in vitro tested liners of similar life in service and showed comparable results among both groups, with no significant backside wear due to micro-motion.

The purpose — to obtain a picture of the overall wear (articulation and backside surfaces) of 0.1% vitamin e blended polyethylene liners, with a locking mechanism based on a press-fit cone in combination with a rough titanium conical inner surface in the fixation area, under a 20 million cycles hip wear simulation.

Materials and Methods. A semi-quantitative method was used in order to assess the damage on the backside of the liners and a 3d measuring machine to assess the creep and wear at the articulation surface.

Results. The total average backside wear score was 22.00±2.59 from a maximum total score of 147 after 5 million cycles (mc), increased to 31.92±5.57 after 10 mc, but showed no further increment after 15 and 20 mc. The reference liners (subjected only to axial load) showed similar wear scores and modes as the liners under wear simulation (axial load and movement). Small scratches produced during insertion and removal were clearly seen at the rim (fixation) area and no considerable abrasion was observed. The machining marks on the convex surface were always visible. Regarding the articulation surface, a steady state wear rate of 7 µm/year was measured.

Conlusion. These results determined that most of the backside wear produced on the liners occurred during their insertion and removal rather than during their life in service. Moreover, the wear at the articulation surface was similar to that seen in vivo at short- and mid-term on highly cross-linked polyethylene liners with and without vitamin e content.

Introduction. The intervertebral disc is considered the main source of pain syndrome in degenerative diseases  of the spine. The methods of laser, mechanical and cold plasma nucleotomy are widely used in Russia and are included into the system of high-tech medical care. The most promising annuloplasty methods are less known and have only recently been introduced into the national surgical practice. patients’ selection criteria and surgical procedure choice are not clearly defined and the information about annuloplasty in the national literature is practically not presented.

Purpose — to conduct the comparative analysis for efficiency of paracentetic nucleoplasty and radiofrequency annuloplasty for discogenic pain and to identify the factors determining the surgery outcomes.

Materials and Methods. The authors performed a retrospective cohort study. patients were divided into two groups: 107 patients underwent cold plasma nucleoplasty (Np), 72 patients received radiofrequency annuloplasty (RFap) at one or several levels. evaluation of outcomes was based on the dynamics of the NRS-11 digital pain scale and the Oswestry index (OdI). Positive results were recognized with decrease of NRS-11 index by 50% (or NRc-11 <4) and OdI by 20% from the original (or OdI <20%) when the outcome was preserved for 6 or more months postoperatively. To identify the factors influencing the outcome the authors assessed the following criteria prior to surgery: clinical findings (acute, chronic or recurrent pain syndrome), severity and prevalence of disc degeneration at the level of intervention and in adjacent segments, the use of other interventional diagnostic methods for excluding other sources of pain.

Results. In results of the procedures the authors reported a decrease of indices in both groups (p<0.001) in the absence of significant differences between the groups (p = 0.672). However, but the number of positive outcomes in the RFap group was higher than in the Np group — 49 (68.1%) and 55 (51.4%) respectively. Significant prognostic factors in the Np group were acute character of the pain syndrome (Spearman ρ = 0.252, p = 0.014), fewer operated levels (ρ = -0.304, p<0.001); in both groups such factors were failure of other procedures (Np ρ = 0.413, p<0.001; RFap ρ = 0.464, p<0.001) and the degree of disc degeneration of adjacent segments (Np ρ = -0.387, p<0.001; RFap ρ = -0.297, p<0.001). With regression analysis the best results were observed under the criteria “failure of other procedures”,  for Np (OR 0.77 at 95% cI (0.682-0.857) and for RFap (OR 0.81, 95% cI (0.701-0.924)).

Conclusion. Both methods of cold plasma nucleoplasty and radiofrequency annuloplasty demonstrate positive and similar outcomes provided the discogenic character of the pain syndrome has been defined correctly. The most significant is the exclusion of other sources of pain by diagnostic blockades, especially for patients with chronic pain syndrome and advanced multi-level lesion of the spine segments. 

The purpose of the work — is validation and cultural adaptation of the english-language rating systems for knee function assessment for use in scientific, medical and educational institutions of the Russian Federation.

Materials and Methods. The english versions of rating systems WOMac® 3.1 Index, The knee Society clinical Rating System©, FjS-12® were translated to Russian language by orthopedic surgeon with advanced level of english and the professional translator specializing in the translation of medical texts. Reverse translation was provided by third independent translator born in the english-speaking country (native speaker). a printed version of the various translations of the questionnaires was filled by patients with an interval of two days. The study group included 150 patients with Stage III knee osteoarthritis (90 women and 60 men aged 48 to 75 years, an average of 62.5 years) hospitalized in Vreden Research Institute of Traumatology and Orthopedics from February to april 2017 for total knee arthroplasty.

Results. good and very good retest reliability of WOMac (α = 0.87 and α = 0.9), kSS (α = 0.89 and α = 0.86) and FjS-12 (α = 0.94 and α = 0.96) was revealed. The study revealed a strong correlation between the results of the questionnaires performed by different translators: WOMac (Icc = 0.89), kSS (Icc = 0.86), FjS-12 (Icc = 0.92). The correlation dependence between subsections of WOMac (stiffness – Icc = 0.98, pain – Icc = 0.87, daily functions – Icc = 0.89) and kSS (knee score – Icc = 0.94, function score – Icc = 0.88), which indicates a good constructive validity.

Conclusion. The results of the study of criterial and constructive validity, as well as the retest reliability of the Russian versions of the WOMac, kSS and FjS-12 scales, indicate that they are a reliable and sensitive tool for assessing the function of knee joint, which can be widely used by Russian researchers in practical and scientific activities.

Реферат. Статья посвящена случаям спонтанного сращения ахиллова сухожилия с элонгацией. При этом состоянии нет пальпируемого дефекта сухожилия, сохраняется активная плантарная флексия, а пациенты жалуются на снижение силы. Авторы описали результаты хирургического лечения 25 пациентов, которым была выполнена укорачивающая тенопластика (гофрирующая и поперечная Z-образной (2 пациента), косой (1 пациент), поперечной (19 пациентов, Рисунок 6) или гофрирующей (3 пациента).). Результаты лечения по шкале Leppilahti после операции оказались достоверно лучше по сравнению с предоперационным статусом: 82,4±5,6 vs 62,2±7,7 баллов (p<0,0001). Описан протокол реабилитации.

A multidisciplinary approach to treatment of patients with mucopolysaccharidosis allows to achieve good results. However, progressive spinal canal stenosis at the level of the craniovertebral junction, characteristic of this disease, leads to neurological signs, as well as a decrease in quality and length of life. The solution to this problem is a difficult challenge for spinal surgeons, as it is associated with a high risk of complications. There is also a wide range of opinions and approaches to the surgical treatment of this group of patients.

Using the referred Reporting Items for Systematic Review and Meta-Analysis» (PRISMA) protocol, a PubMed and eLIBRARY search was conducted using keywords to find articles describing patients with mucopolysaccharidosis who underwent surgical treatment for cervical stenosis. In this review, information on demographic parameters, surgical technique and the results of cervical stenosis treatment in patients with mucopolysaccharidosis is collected and analyzed.

The authors present a review of current national and international literature related to the specifics of primary hip joint arthroplasty in patients with end-stage of chronic kidney disease. epidemiology aspects of such pathology are covered in detail. Screening of the patients with hip joint pathology undergoing substitute renal therapy remains a significant issue. The authors present the outcomes of use of various implant types and their fixation in primary hip joint arthroplasty such as cemented, cementless and monopolar prostheses, as well as consider features and structure of complications following primary replacements in such patients. unfortunately, the national literature lacks sufficient number of publications on the present problem. In addition, the paper presents a promising area for development of specialized care to patients on hemodialysis with hip joint pathology.

Traumatology and Orthopedics of Russia. 2018;24(1):44-52.

Aim. It’s common that revision arthroplasty of the large joints demands replacing of bone defects of irregular geometrical shapes and simultaneous restoring of support ability and ability to integrate surrounding muscular and tendinous structures into an implant that is required for a complete restoration of joint function.

The purpose. To experimentally study the process of integration for muscular and bone tissue as well as tendinous and ligamentous structures into porous titanium materials.

Material and methods. During in vivo experiment the authors created a standardized bone defect in 6 rabbits of chinchilla breed at the point of patella ligament attachment as well as a delamination area of muscular tissue in latissimus dorsi. Both knee joints and both latissimus dorsi were used in each animal. Study group included titanium implants with three-dimensional mesh structure. Control group — solid titanium implants with standard porosity. Titanium implants were produced by additive technologies with preliminary prototyping. The porosity corresponded to trabecular metal, striations — 0.45, pores size —100–200 microns. Study and control components were implanted in the identical conditions into the corresponding anatomical sites. Postoperative AP and lateral roentgenograms of knee joints were performed for all animals. Morphological research was conducted on day 60 after the implantation and strength properties were studied at day 90 after the implantation.

Results. The authors observed bony ingrowth into implant pores with minimal volume of fibrous tissue, a distinct connective integration was reported represented by a dense fibrous tissue in the pores of components implanted into the muscular tissue. Testing of fixation strength of the study implants demonstrated a clearly superior strength of soft and bone tissue integration into the experimental mesh implants produced using additive technologies.

Purpose — to evaluate the efficiency of the proposed method of arthrodesis by three cancellous screws in patients with posttraumatic arthrosis of the ankle joint.

Materials and Methods. After removal of talus and tibia cartilage and autografting the proposed method features placement of foot into the optimal position and fixation of the ankle joint with three cancellous screws. 23 patients with posttraumatic ankle deformity arthrosis of grades III–IV underwent surgery according to the described procedure. Condition of all patients prior to and after the surgery was evaluated using the international ankle and rear foot assessment scale of the American Orthopedic Society of the Foot and Ankle (AOFAS).

Results. In 20 patients (88%) the ankle ankylosis was reported within 2.5 months, which was confirmed by X-ray examination. In 2 patients (8%) the ankylosis took place in the period up to 4 months. Loss of the correct position of the foot with screws migration was reported in one patient (4%). The authors observed that patients with postoperative deviation of the tibiotalar angle not exceeding 5 degrees as compared to a healthy limb demonstrated the best functional outcomes.

Conclusion. The suggested technique ensures a secure fixation of talus in a predetermined position, a single-step compression between the closed joint surfaces and allows an early effective rehabilitation.

Purpose – to evaluate the efficiency and rationale for a mandatory ultrasound examination of patients with synovial cysts of the hand and wrist joint.

Material and methods. The authors performed examination and following treatment of 274 patients with synovial cysts of the hand from 2005 till 2017. The diagnostics was performed basing on clinical and medical history data, roentgenology findings, ultrasonographic data, intraoperative diagnostics and postoperative histological studies. When needed MRT was performed in 35 (12.8%) patients and CT scans in 7 (2.6%) patients. In the presence of clinical signs of lesions in the forearm nerves the examination algorithm was supplemented by electroneuromyography in 17 (6.2%) patients.

Results. The ultrasound tests for examination of soft tissues tumors included were characterized by sensitivity of 97.4%, specificity — 99.1% and diagnostic efficiency — 0.96%.

Conclusion. Ultrasonographic examination in cases of synovial cysts of the hand and wrist joint allows to perform topical diagnostics, to identify secondary alterations in adjacent anatomical structures and to determine the cause for secondary clinical semiology.