Vol 24, No 3 (2018)

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The authors present a short analysis of autoabstracts of all theses in traumatology and orthopedics speciality (14.01.15), 10 doctoral and 59 candidate theses, that were defended at 11 dedicated dissertation boards starting mid of October 2016 until mid of October 2017 and underwent expert reviews during 2017 in expert council of the Higher certifying commission on surgical science.

The absolute majority of 26 papers in traumatology (16 candidate and 5 doctoral theses) were dedicated to treatment of patients with different fractures and another 5 candidate theses examined issues of arthroscopic procedures in case of a trauma. 25 dissertations in orthopedics mainly reviewed aspects of large joints replacement (6 candidate and 3 doctoral these) and treatment of periprosthetic infection (4 candidate theses). Spine pathologies (5 candidate theses) and oncology orthopedics (2 candidate theses) prevailed among dissertation topics on paediatric orthopedics. The only doctoral thesis on paediatric orthopaedics was dedicated to clubfoot.

In accordance with recommended criteria of clinical Orthopaedics and Related Research journal 40 (67,8%) candidate theses and 2 (20%) doctoral theses corresponded to evidence level III, 17 (28,8%) candidate and 8 (80%) doctoral theses were classified as evidence level IV and only 2 candidate theses (3,4%) formally corresponded to evidence level II. 

Purpose. Instability is a challenging complication of revision hip arthroplasty and a frequent cause of repeat revisions. Constrained liners and dual mobility systems have gained major attention among the options of dislocation prophylaxis.

 The aim of this study is to compare the outcomes of revision hip arthroplasy with use of constrained liners and dual mobility systems.

 Materials and Methods. We used DePuy Duraloc (inner diameter 28 mm) and Zimmer Trilogy (inner diameter 32 mm) systems in the constrained liners group (N 78, mean follow-up — 66.2 month, 54-82), Serf Novae and Biomet Avantage systems in the dual mobility group (N 58, mean follow-up — 17.8 month, 10-41). The two groups were comparable in age, sex and different potential dislocation risk factors, however, dual mobility cups were used more frequently in revisions due to unreduced and recurrent dislocations and in patients with the history of instability following total hip arthroplasty. There were also differences in the structure of primary diagnosis.

 Results. We observed 14 (17.9%) dislocations, 10 (12.8%) of which occurred within 2 years after surgery, and also 3 (3.8%) cases of aseptic loosening of the acetabular component, 4 (5.1%) cases of locking mechanism damage without dislocation and 8 (10.3%) cases of deep infection in the constrained liners group. In the dual mobility group we observed 3 (5.17%) large articulation dislocations, 1 (1.7%) case of aseptic loosening of the acetabular component and 4 (6.9%) cases of deep infection. The difference in dislocation rates in two groups was significant (p<0.05). The analysis of the constrained liners group revealed an increased risk of dislocation in cases when a constrained system was implanted into a retained acetabular component compared to cases with acetabular shell revision (p<0.01; RR = 7.2, 95% CI: 2.05-25.26), as well as a trend for increased risk of dislocation in cases when DePuy Duraloc liners (inner diameter 28 mm) were used compared to Zimmer Trilogy (inner diameter 32 mm) (p = 0.07; RR = 4.97, 95% CI: 1.03-24.04).

 Conclusion. Dual mobility systems proved to be more effective than constrained liners in revision hip arthroplasty although being used more frequently as a treatment rather than prophylaxis of instability. Constrained liners bear a higher risk of dislocations when implanted into retained acetabular components and when used with heads of lesser diameter.

Background. Total hip arthroplasty (THA) is reliable and successful intervention in terms of relieving pain and improving joint function. Between 7% and 16% of patients are dissatisfied after THA. To assess predictors and postoperative determinants of satisfaction 3 and 12 months after THA.

 Material and Methods. During our research from 2015 to 2017 prospectively 1015 patients were interviewed using patient related outcome measures (a questionnaire of functional outcome (Oxford Hip Score, Harris Hip Score), health-related quality of life (EQ-5D)) preoperatively, 3 and 12 months postoperatively. Satisfaction was assessed using Visual Analogue Scale (VAS). Also Univariate and multivariate analyses were performed.

 Results. A female gender, absence of interventions on the operated joint in history were preoperative predictors of satisfaction. The main postoperative determinant of satisfaction was the fulfillment of patient’s expectations, improve physical function, quality of life, relief of pain.

 Conclusion. To improve patient satisfaction after THA, patients’ expectations and their fulfillment need to be carefully addressed. Patients with a history of interventions on the operated joint with low physical function or quality of life, high level of pain should be identified and specifically informed on expected surgical outcome

Introduction. Pedicle subtraction osteotomy (PSO) provides for significant segmental correction of the sagittal balance of the spine. At the same time, the technique is associated with a high risk of complications, with rod fracture at the osteotomy site being the most common.

 The purpose of this study — to assess the effectiveness of four-rod fixation compared to literature data on standard two-rod fixation in patients undergoing PSO.

 Materials and Methods. The study is a retrospective analysis of 47 consecutive patients with rigid spinal deformities, who underwent pedicle subtraction osteotomy at the lumbar level. The average age of the patients (33 females and 14 males) was 59.7 years. In all cases spinal fixation carried out using a four-rod construct with additional short rods at the osteotomy site. The minimal postoperative follow-up was 2 years. A detailed analysis of the radiographic data was carried out with calculation of the global sagittal balance and spinopelvic parameters. A detailed assessment of complications in the early and late postoperative periods was also performed. After an exhaustive review of literature, a comparative analysis was made of the four-rod fixation technique with current literature data on the frequency of complications (in particular, rod fractures in the osteotomy zone) after two-rod fixation.

 Results. In all cases the osteotomy was performed at one level, most often at L3 (49%). The average length of fixation was 9.8 segments. The average angle of segmental correction was 27.1°. In most cases, it was possible to achieve adequate correction of spinopelvic parameters. Among complications, bone resorption around screws was most prevalent (23.4% of cases). Proximal junctional kyphosis occurred in 12.8% of cases, neurologic deficit — in 14.9% of cases, infectious complications — in 10.6% cases. Asymptomatic pseudarthrosis, confirmed by CT data, was observed in 12.8% of patients. Rod fracture at the PSO site and adjacent segments was not observed in any of the cases. Rod fractures of other localization were observed in 10.6% of patients.

 Conclusion. According to the literature, the frequency of rod fractures at the osteotomy site is the most frequent complication of PSO. The results of this study showed that four-rod fixation in PSO significantly reduces the incidence of pseudarthrosis and rod fracture rate in the long-term follow-up and provides greater control over the process of osteotomy closure.

Purpose of the study — to study impact of hemi-vertebrae extirpation technique in mono-segmental reconstruction on the surgical trauma.

Material and Methods. 34 patients underwent 36 mono-segmental extirpations of hemi-vertebrae followed by a posterior fixation during a single center four years cohort study. Mean age of children at the moment of procedure was 4 years and 3 months (min — 1 year, max — 14 years). The authors studied impact of pathology level, surgical approach, type of bony structures removal technique and age of the patients on the time of procedure and volume of blood loss.

 Results. Extirpation of thoracic hemi-vertebrae was characterized by a lengthier procedure and greater blood loss in contrast to lumbar hemi-vertebrae. Patients were divided into three groups depending on extirpation technique: 1)  extirpation from two approaches using a high-speed burr; 2) from a single dorsal approach using the same extirpation technique; 3) from dorsal approach using ultrasonic bone scalpel. Surgery time was 208±72 min in the first group, 187±54 min in the second group, and 170±30 min in the third group; blood loss volume was 181±39, 181±53, 132±73 ml respectively in the groups, or 11.5±4.3%, 9.4±2.8% and 9.6±5.2% of total blood volume, respectively.

Conclusion. Surgical approach and hemi-vertebrae extirpation technique in children have a varying impact on surgery time and intraoperative blood loss, and the least values were reported for posterior approach using ultrasonic bone scalpel.

Until now the problem of selecting a conservative or operative treatment option for calcaneal fractures and moreover the choice of the most optimal surgical procedure for such lesions have not been solved. Thus, comparative studies in this area is one of the most important tasks of the modern traumatology.

 Purpose of the study — to compare treatment outcomes, pattern and complications rate following the use of three treatment options for calcaneal fractures.

 Material and Methods. The authors analyzed treatment outcomes of 95 patients from 2013 till 2016. Mean age of patients was 39.04±12.51 years. Patients were divided into three groups: group 1 consisted of 41 patients with 54 fractures who underwent functional conservative treatment; group 2 consisted of 18 patients with 22 fractures treated by open reduction and plate fixation; group 3 consisted of 36 patients with 40 fractures treated by minimally invasive reduction and intramedullary fixation. Groups did not differ in respect of risk factors rate and rate of surgical risks under ABCDEF scale. Outcomes were evaluated basing on roentgenological criteria of reduction, complications rate and the functional scales FFI (Foot Function Index) and LEFS (Lower Extremity Functional Score).

 Results. Mean follow up was 20.8±9.0 months. Catamnesis was controlled in 68 out of 95 patients (71.6%). Variances were observed for all criteria of reduction quality between group 1 (no reduction) and groups 2 and 3. Groups 2 and 3 demonstrated similar criteria in respect of reduction quality of posterior articular surface, restoration of height and axis of calcaneus (р>0.05). FFI and LEFS scores in group 1 were inferior to results in groups 2 and 3 (р<0.05) at 6 and 12 months follow up. At 24 months follow up the variances persisted for mean values but were not statistically significant (р>0.05). No differences between groups 2 and 3 were observed during all follow up terms (р>0.05). Sum rate of complications in wound healing in group 2 was significantly higher than in groups 1 and 3 (р = 0.033).

 Conclusion. Any of the described options of surgical treatment resulted in an earlier functional restoration after calcaneal fractures as compared to conservative treatment. Reduction quality and late functional outcomes did not vary between the study groups, however, the rate of complications for wound healing in the group with open internal fixation was higher.

The authors present a clinical case of a female patient with seropositive rheumatoid polyarthritis mainly affecting the knee joints. The patient underwent a primary total bilateral knee replacement. Surgical site infection required multiple revisions including replacement of extensive bone defects of AORI type 3 by structural femur and tibia allografts as well as allografting of extensor mechanism. Repeated attempts to eliminate infection, to gain support ability of extremities and joints motion were not successful. Long-term staged surgical treatment resulted in removal of prostheses and bilateral knee arthrodesis to restore support function of the extremities.

 The sellar joint plays a key role in wrist function ensuring thumb contraposition when gripping. Lesions of sellar joint are accompanied by pain syndrome and deformity of the first metacarpal which substantially affects life quality of the patients. The authors carried the analysis of literature dedicated to surgical treatment of degenerative lesions of trapeziometacarpal joint. The present review describes features of joint anatomy and biomechanics, reports the key factors contributing to disease progression, covers various approaches and criteria for selection of surgical options for reconstruction of sellar joint.

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