Vol 25, No 1 (2019)

CASE REPORTS

Infection after Arthroscopic Cuff Tear Repair (Case Report)

Ryazantsev M.S., Il’in D.O., Magnitskaya N.E., Afanas’yev A.P., Logvinov A.N., Frolov А.V., Korolev A.V.

Abstract

Septic shoulder arthritis following arthroscopic surgery is a rare complication, according to the literature it arises from 0.006% to 2,1% of cases. We report on a case of 58 y.o. Patient, admitted to our setting 10 days after arthroscopic intervention on the right shoulder joint in another hospital. Based on clinical, laboratory and instrumental assessment septic shoulder arthritis was diagnosed. Arthroscopic lavage and debridement surgery with bioabsorbable antibacterial agent implantation was performed. Long term follow-up in 6 months showed good results with full range of motion, absence of pain and elimination of infection.

Traumatology and Orthopedics of Russia. 2019;25(1):159-164
pages 159-164 views

EDITORIAL

Editorial

Tikhilov R.M.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(1):7-8
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CLINICAL STUDIES

Mid-Term Outcomes of Revision Hip Arthroplasty with Acetabular Augments

Korytkin A.A., Novikova Y.S., Kovaldov K.A., Korolev S.B., Zykin A.A., Gerasimov S.A., Gerasimov E.A.

Abstract

Acetabular defects are a major obstacle to achieving good outcomes after revision hip arthroplasty. One way to deal with this problem is to use acetabular augments. We aimed to describe mid-term outcomes of revision hip arthroplasty using acetabular augments.

Materials and methods. We analyzed 85 cases (83 patients) of revision hip arthroplasty using acetabular augments performed during 2012-2018 period: 53 women and 30 men with average age of 57±13 years (25-79). Distribution of acetabular defects was: 51 cases — Paprosky IIIA, 17 cases — Paprosky IIIB, 12 cases — Paprosky IIB, 5 cases — Paprosky IIC. 14 patients had chronic pelvic discontinuity. Aseptic loosening was indication for the operation in 83 cases, periprosthetic hip fracture — 1, dislocation — 1. The amount of previously undregone ipsilateral hipsurgeries was 1 in 35 cases, 2 in 25 cases, 3 and more in 25 cases. Average follow-up period was 38±19 months (1-79).

Results. The average HHS score improved from 37±7 preoperatively to 73±9 after 3 months and to 80±11 after 12 months postoperatively (p = 0.001). Average VAS score improved from 7±2 preoperatively to 4±1 after 3 months and to 3±1 after 12 months postoperatively (p = 0.001). Stable acetabular fixation was achieved in each case according to X-ray findings at final follow-up. However, radiolucent lines were present around the cup in 10 cases (11.8 %) followed by no clinical evidence of aseptic loosening. Hip center of rotation was restored from 26.40±18.38 mm (4-75) preoperatively to 4.78±5.02 mm (0-20) postoperatively relatively to 0 point. Complications manifested in 9 out of 85 cases (10,6%). Distribution of complications was: periprosthetic joint infection in 6 cases, recurrent dislocation — 2, periprosthetic hip fracture — 1.7 patients required implant removal and exchange.

Conclusions. Good mid-term outcomes can be achieved using acetabular augments during hip revision surgery in setting of acetabular defects. Acetabular augments are a reliable option in case of Paprosky IIIB, IIIA defects and chronic pelvic discontinuity, providing good mechanical stability.

Traumatology and Orthopedics of Russia. 2019;25(1):9-18
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Comment to the Article „Mid-Term Outcomes of Revision Hip Arthroplasty with Acetabular Augments"

Denisov A.O.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(1):19-20
pages 19-20 views

Minimum One-Year Outcomes after Revision Hip Arthroplasty with Custome-Made Implants: Function, Quality of Life and Patients Satisfaction

Kovalenko A.N., Tikhilov R.M., Shubnykov I.I., Bilyk S.S., Denisov A.O., Cherkasov M.A., Ibragimov K.I.

Abstract

Purposes of our study were to estimate clinical short-term results of custom acetabular implants using in revision hip arthroplasty, to determine bone ingrowth percentage in the custom implant 3d printed coverage, and to estimate the custom malposition influence on the clinical results.

Materials and method. 30 patients were performed revision hip arthroplasty with using custom acetabular implants in 2016. Oxford hip score, life quality, expectation and satisfaction of patients were assessed in 12 months and more. Osteointegration was assessed with x-ray. Influence of malposition on clinical results was assessed with Pirson’s χ2.

Results. Oxford Hip Scores were increased from mean 16.8 to 34.4 (p<0.01). Life quality index EO-5D were increased from mean 0.315 to 0.651 (p<0.01). Osteointegration was confirmed in 96% cases, component migration was in 1 case. The influence of malposition on clinical results in short-term follow-up was absent.

Conclusion. The using of custom acetabular implants in revision hip arthroplasty improves hip function and life quality of patient. 3D printed custom implants coverage provides high percentage of inplants osteointegration, besides components malposiotion. Further followup requires for assessment long-term results.

Traumatology and Orthopedics of Russia. 2019;25(1):21-31
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Preoperative TKA Planning on Long-Leg Hip-Knee-Ankle Radiographs and It’s Impact on Postoperative Coronal Knee Alignment

Zinoviev M.P., Atmansky I.A., Belokobylov A.A., Rimashevskiy D.V.

Abstract

The importance of measuring of the angle between the mechanical and anatomical femoral axis (РУЛ) during the preoperative total knee arthroplasty (TKA) planning is not recognized by all. Some surgeons believe that it is acceptable to set distal femoral resection guide at 6° or 7° in all cases or adjust femoral resection guide FVA accordingly with patient height.

We conducted two studies. One — retrospective analysis of radiographs of patients with TKA performed since 1.09.2014 till 31.01.2015 (n = 261, 273 TKA). In this cohort, we were looking for correlation between the parameters obtained on long hip-knee-ankle radiographs (FVA, coronal knee alignment) and gender, age, body mass index (BMI) and height, as well as the implant model and the level of constraint. After that we conducted a prospective, randomized trial with TKA performed since 1.02.2015 till 31.05.2015 (n = 225, 225 TKA). The patients were randomly divided into two groups. In the “individual FVA” group (n = 121), the distal femoral resection guide FVA was set accordingly with measured FVA, in the control group (n = 104) — at 7° (average FVA for the Sverdlovsk area patients’ population). We compared TKA x-ray results of both groups.

Results. First stage. We found no correlation between FVA and age, BMI, height and sex of patients (p>0.05). After TKA residual varus deformity of more than 3° (malalignment) (3.9±1.06) was observed in 7% of cases (19 joints). We found correlation between coronal knee malalignment after TKA and two factors: BMI and initial severity of varus deformity (p = 0.003 and p<0.001). Second stage. In the control group we’ve seen femoral component deviation of more than 3° from the perpendicular to neutral mechanical axis (malposition) 3 times more often then in the “individual FVA” group (9 vs. 3, p = 0.021).

Conclusions. We did not identify the dependence of FVA on sex, age, BMI and height. With initial varus of more than 20° and BMI of more than 30 kg/m2, the risk of coronal components malalignment is increased. The average FVA in patients of Sverdlovsk area is 6,7±1,5° (3-11°). Implementation of preoperative FVA measurement and following femoral distal cut adjustments improves femoral component positioning and overall leg alignment postoperatively.

Traumatology and Orthopedics of Russia. 2019;25(1):32-40
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Mid- and Long-Term Results of Total Elbow Arthroplasty: Post-Traumatic Consequences and Rheumatoid Arthritis

Aliev A.G., Ambrosenkov A.V., Boyarov A.A., Zhabin G.I., Dzhavadov A.A.

Abstract

Objective of the study: to identify differences in the functional outcomes of total elbow arthroplasty in posttraumatic and rheumatoid cases, to determine the factors affecting the outcomes and rate of the complication.

Materials and methods. A retrospective study included 269 patients (272 elbows), who underwent primary total elbow arthroplasty (TEA), 100 men (37.2%), and 169 women (62.8%). The first group included 191 patients (191 elbows) who had elbow trauma. The average follow-up after the operation was 6.9 years (from 0.5 up to 21 years). The compared group included 78 patients (81 elbows) operated on for rheumatoid arthritis (RA). The average follow-up time after total elbow arthroplasty was 3.8 years (0.4 to 16.5 years).

Results. Tea significantly improved joint function (mean values in post-trauma patients on the Mayo score were 73.8±14.1 points, on the oxford questionnaire — 30.5±8.9, DASH — 40.3±18.4, EQ-5D — 0.536±0.234; in patients with rheumatoid arthritis, on the Mayo score — 75.4±15.5 points, DASH — 38.6±15.8, OES — 35.5±7.9, EQ-5D — 0.580±0.2). In the first group, the frequency of postoperative complications requiring a revision was significantly higher than in the compared group (23.8% and 13.6%, respectively, OR 3.2; 95% CI 0.7-3.0). In the first group, a statistically significant risk of aseptic loosening of the implants was observed in patients operated on for pseudarthrosis of the distal humerus (OR 8.5; 95% CI 1.7-43.6) and post-traumatic deformity (OR 10.5; 95% CI 1.3-88.5). The use of some endoprostheses is also associated with a high risk of aseptic instability (OR 3.5; 95% CI 0.9-13.3). A significant risk of a deep periprosthetic infection was observed in patients with post-traumatic bone defect (OR 7.0; 95% CI 1.2-40.1) and post-traumatic deformity of the elbow joint (OR 14.0; 95% CI 2.5-77.8). Risk factors for loosening endoprostheses in patients with RA were: defective cementation of humeral component (OR 35.0; 95% CI 3.8325.0), valgus deviation of the humeral component >9° (OR 9.2; 95% CI 1.0-82.2), low constructive reliability of the endoprosthesis (OR 13.6; 95% CI 2.3-79.4), patient age >59 years (OR 12.8; 95% CI 1.5-113.0 ), BMI >32 kg/m2 (OR 8.4; 95% CI 1.5-47.5), and CRP level >36.1 mg/l (OR 4.8; 95% CI 0.4-65.8).

Conclusion. Mid-term and longterm results showed that TEA helps restore the amplitudes of elbow movement and the function of the limb, both in elbows with post-traumatic consequences and with RA. However, the frequency of postoperative complications requiring a revision is significantly higher in the group of patients with consequences of the fractures than in the group of patients with RA.

Traumatology and Orthopedics of Russia. 2019;25(1):41-51
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Algorithm for Evaluation of Bipolar Defects in Anterior Instability of the Shoulder

Khominets V.V., Gladkov R.V., Zheleznyak I.S., Grankin A.S., Volov D.A., Emelyantsev А.A.

Abstract

Purpose of the study — to justify the algorithm for evaluation of bipolar defects in anterior shoulder instrability using the most accurate, statistically significant and reproducible methods which would make the algorithm applicable in practical surgery.

Materials and methods. The authors established 4 groups with 6 patients in each with shoulder instability, group distribution was based on glenoid defect size: small (<15%), moderate (15-19%), large (20-25%) and massive (>25%). All 24 patients underwent 3D-CT, 3D VIBE MRI and shoulder arthroscopy. Measurements were taken by 7 specialists 5 of whom measured defect during arthroscopy. Glenoid defect was measured by linear and sectional relation methods. Pico method on 3D-CT was taken as the “golden standard”. Accuracy was verified by analysis of variance with post-hoc comparison. Reproducibility was evaluated by intraclass correlation coefficient.

Results. All groups excluding the one with massive glenoid defects demonstrated significant differences from the model (p≤0,05) for measurements during arthroscopy and examinations by 3D-CT and 3D VIBE MRI. Restrospective analysis confirmed the least accuracy and the worst reproducibility of visual evaluation of glenoid defects less than 25%. Sectional relation method on 3D-CT had the maximum accuracy and reproducibility in all groups (PE = 1,29%±2,39%, ICC = 0,756-0,856), excluding the group with massive defects, where researched measurement methods had close accuracy when applied on 3D-CT, 3D VIBE MRI and during arthroscopy. Linear relation method on 3D-CT overestimated the defect volume at 2,1-7,9% and demonstrated less reliable reproducibility (PE = 3,22%±5,31%, ICC = 0,612-0,621). The highest error (up to 7,9%) was demonstrated by linear method in case of borderline defects in the III group of 20-25%. Insufficient conformity of results for linear (ICC = 0,42) method and moderate conformity for sectional (ICC = 0,62) method were observed during comparison of 3D VIBE MRI with 3D-CT. MRI underestimated the value of small defects and overestimated large defects. Reproducibility of measurements on 3D-CT by different operators was moderate for visual (ICC=0,594) and linear methods (ICC = 0,621) and good for sectional method (ICC = 0,756). Reproducibility of measurements by each operator also was moderate for visual and linear methods (ICC = 0,553 и ICC = 0,612) and good for sectional method (ICC = 0,856). The authors suggested an algorithm for selection of examination method and measurements for defects of articular surfaces which also considers the main factors of prognosis and risk of recurrent instability.

Conclusion. Sectional relation method on 3D-CT is the most precise and reproducible method of glenoid defect measurements used in the clinical practice. MRI use without CT is inadmissible for bipolar defects of borderline size. Suggested algorithm allows not to make CT examination at extreme ISIS values and increases the share of osteoplastic surgeries due to identification of off-track injuries with glenoid defects of borderline size (15-25%).

Traumatology and Orthopedics of Russia. 2019;25(1):52-64
pages 52-64 views

Comment to the Article „Algorithm for Evaluation of Bipolar Defects in Anterior Instability of the Shoulder"

Dokolin S.Y.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(1):65-67
pages 65-67 views

„Ischemic“ Distraction Regenerate: Interpretation, Definition, Problems and Solutions

Borzunov D.Y., Shastov A.L.

Abstract

The purpose of the study was to define «ischemic» distraction regeneration which happens during the compromised course of distraction osteogenesis and to show the effectiveness of the mechanical action on such regenerates in patients with bone defects and pseudarthrosis.

Materials and methods. Seventeen patients with long bone defects (forearm and lower leg) were successfully treated. They had compromised distraction osteogenesis during the transosseous osteosynthesis stages and developed ischemic regenerates. The mean size of the defects relative to the contralateral segment in the forearm bones was 22.3% and 20% in patients with defects in the lower leg bones. Mechanical stimulation of compromised bone formation was used by means of compression and compaction of problematic distraction regenerates with two techniques. In group I, an additional osteotomy of the fragment under lengthening was performed. In group II, regenerates were compacted to the height of the regenerate connective tissue layer until its bony parts contacted. We used descriptive statistics methods.

Results. The process of bone tissue formation restored in all patients due to the mechanical impact on the zones of compromised distraction osteogenesis, and its complete organotypic remodeling followed.

Conclusion. Based on clinical and radiological signs of a compromised course of distraction osteogenesis, the notion of «ischemic regenerate» was defined and its manifestations were described. A retrospective analysis of the results of mechanical action on compromised distraction regenerates through compression and compaction without a change in the osteosynthesis technology shows its effectiveness.

Traumatology and Orthopedics of Russia. 2019;25(1):68-76
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Comment to the Article „«Ischemic» Distraction Regenerate: Interpretation, Definition, Problems and Solutions

Shchepkina E.A.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(1):77-79
pages 77-79 views

Iliosacral Screw Fixation in Patients with Polytrauma

Kazhanov I.V., Manukovskiy V.A., Samokhvalov I.M., Mikityuk S.I., Gavrishchyuk Y.V.

Abstract

The need to perform iliosacral fixation in patients with polytrauma and unstable pelvic injuries in the acute period of injury is still an unresolved issue. Minimally invasive techniques of pelvis internal fixation allow to perform single step reconstructive surgery in the acute period of the trauma.

Purpose — to evaluate the results of minimally invasive acute iliosacral fixation in patients with polytrauma and unstable pelvic injuries.

Materials and methods. The authors analyzed treatment outcomes in 105 patients with polytrauma and unstable pelvic injuries after iliosacral screw fixation in acute period. 69 (65.7%) patients had B-type and 36 (34.3%) patients had c-type of unstable pelvic injuries by AO/ASIF classification. Mean age was 35.5±11.7 years. The severity of injury on the ISS scale was 22.5±12.9 points. Ап patients underwent minimally invasive iliosacral fixation with screws in the acute period of the trauma.

Results. Patients classified according to the severity of their status as «stable» (n = 50) and «borderline» (n = 26) with stable hemodynamics (SAD >90 mm Hg) underwent minimally invasive iliosacral screw fixation of posterior pelvic ring straight in the anti-shock surgery. Injured classified as «unstable» (n = 15) and «borderline» (n = 14) with unstable hemodynamic parameters (SAD <90 mm Hg), who needed urgent large surgical procedures (laparotomy, thoracotomy et al.), underwent temporary pelvis stabilization by external fixation and/or c-frame, and as the hemodynamic parameters were stabilized iliosacral screw fixation within 48 hours from the moment of injury. The functional pelvis state in 58 patients by S.A. Majeed scale rated 90.7±11.2 points. The quality of life was assessed using the SF-36 questionnaire.

Conclusion. Restoration of the anatomical shape of the pelvic ring and its fixation, primarily posterior aspects, in the acute period of trauma allowed to obtain good anatomical and functional treatment outcomes in 94.9% of the patients with polytrauma.

Traumatology and Orthopedics of Russia. 2019;25(1):80-91
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Anatomical and Anthropometric Features of Bone Bodies Structures in Children with Idiopathic Scoliosis of Lenke III Type

Vissarionov S.V., Kokushin D.N., Filippova A.N., Baindurashvili A.G., Bart V.A., Khusainov N.O.

Abstract

Objective. Lenke III type spinal curvature occurs in 11% of all types of deformities in idiopathic scoliosis. Knowledge of the features of the structure of the bone structures throughout the main curve of the deformity allows you to properly plan the installation of transpedicular supporting elements during the operation and carry out a specific sequence of correcting manipulations in order to achieve the optimal result.

Purpose. To study the anatomical and anthropometric features of the bone structures of the vertebrae in children with idiopathic scoliosis, type lenke III, using a navigation device.

Materials and Methods. The study included 23 patients with S-type idiopathic scoliosis type III according to the classification of L. Lеnke aged 14 to 18 years, of which 22 are female patients and 1 male. All children carried out spinal X-rays in standard projections (direct and lateral), multislice computed tomography, according to msct in the navigation unit measured anatomical and anthropometric indicators, certain parameters and coefficients were calculated mathematically.

Results. The following patterns were determined: pronounced asymmetry of both the width and height of the bases of the arches of the vertebrae along the concave and convex sides of the deformity in the thoracic spine and moderately pronounced structural changes in the bone structures in the lumbar spine. Strong direct correlations between the asymmetry coefficient of the base areas of the arcs and the asymmetry coefficients of the width and height of the base of the arcs, as well as a direct correlation between the values of the rotational value of the apical vertebra and the asymmetry coefficient of the base areas of the arcs in the thoracic region were revealed. In the lumbar spine, only a directly proportional relationship was found between the asymmetry coefficient of the areas of the bases of the arches of the vertebrae and the coefficient of asymmetry of the heights of the bases of the arcs of the vertebrae.

Conclusion. Ап analysis of the anatomical and anthropometric parameters of the bony structures of the vertebrae in children with idiopathic scoliosis of the lenke III type has made it possible to identify certain features, to establish patterns and correlations that characterize this variant of deformity.

Traumatology and Orthopedics of Russia. 2019;25(1):92-103
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Spine Tumor Epidemiology in Patients who Underwent Orthopaedic Surgery

Zaborovsky N.S., Ptashnikov D.A., Topuzov E.E., Levchenko E.V., Mikhailov D.A., Natalenko K.E.

Abstract

Purpose of the study — to evaluate the frequency of spine tumors in patients who underwent orthopaedic treatment in a specialized hospital.

Materials and methods. Ап patients treated in the Vreden Russian Research Institute of Traumatology and orthopedics (rniito) with spine tumor diagnosis were examined from 2000 till 2017. The data was obtained from medical histories. Patients’ distribution per gender, age, histological type and tumor location was evaluated.

Results. 2023 patients were included into the study, where 1298 (64.3%) were female. Patients with secondary metastases prevailed (59% overall), including breast cancer (43.6%), renal carcinoma (18%) and lung cancer (10.7%). Among benign tumors (overall 18.7%) symptomatic hemangiomas prevailed (93.8%). Primary malignant tumors (total 10.2%) were represented mainly by multiple myeloma (54.2%) and plasmacytoma (14.6%). Intermediate tumors with local aggressive growth were observed rarely (overall 3.9%).

Conclusion. Spine is affected mainly by secondary tumors, where metastases of breast, renal and lung cancer are observed most often. Benign symptomatic hemangiomas demonstrate a high prevalence. Primary malignant tumors are presented mainly by multiple myeloma. Other primary malignant tumors and tumors with local aggressive growth are observed rather rarely.
Traumatology and Orthopedics of Russia. 2019;25(1):104-112
pages 104-112 views

THEORETICAL AND EXPERIMENTAL STUDIES

Mathematical Modeling of the “Bone-Fixator” System during the Treatment of Intertrochanteric Fractures

Dubrov V.E., Shcherbakov I.M., Saprykina K.A., Kuzkin I.A., Zyuzin D.A., Yashin D.V.

Abstract

Relevance — the need for an objective justification in choosing the type of fixation in the treatment patients with pertrochanteric hip fractures.

Objective — to study the changes in the properties of a consolidating trochanteric fracture fixed by a dynamic cephalomedullary nail when subjected to cyclic dynamic loads.

Materials and methods. A mathematical model was developed for trochanteric fracture of the femur (A1 according to AO classification) when fixed with a dynamic cephalomedullary nail. Then, the properties of the system were studied (pressure between fragments, mechanical stress in the bone and fixation device, displacement amplitude, neck-diaphysis angle) under a virtual load of a 80 kg body at various amount of insertion of the dynamic screw (from 10 mm to 0 mm).

Results. In the process of shortening the femoral neck axis by 1 cm, the stability of the ‘bone-metal fixation device’ system increases, as indicated by a decrease in the maximum amplitude of displacements in the system under load by 16.8%, a decrease in the maximum stress in the fixation elements by 20.2%, a decrease in pressure at the site of contact of fragments by 19.8%. In addition, there was a decrease in the neck-diaphysis angle by 2.8%.

Conclusion. The mathematical modeling of the ‘bone-metal fixation device’ system simulating conditions of dynamic osteosynthesis showed that there is a potential increase in the stability of the cephalomedullary system and that favorable conditions are created for the consolidation of the fracture when subjected to cyclic load of body mass.

Traumatology and Orthopedics of Russia. 2019;25(1):113-121
pages 113-121 views

DISCUSSIONS

Classifications of Acetabular Defects: Do They Provide an Objective Evidence for Complexity of Revision Hip Joint Arthroplasty? (Critical Literature Review and Own Cases)

Tikhilov R.M., Shubnyakov I.I., Denisov A.O.

Abstract

The present paper bears discussion in nature and doesn’t claim for any scientific evidence.

The purpose is to identify which classification of acetabular defects currently is the most employed in revision hip joint arthroplasty, and how precise this classification reflects the true defect severity and gives the objective grounds for selection of revision implants.

Materials and methods. The authors conducted literature analysis in PubMed and eLIBRARY for the last five years. 170 publications in English, German and Spanish languages as well as 15 works in Russian language dedicated to classification of acetabular defects were selected.

Results. W.Paprosky classification was found to be the most applicable, namely, in 65,9% of foreign publications and in 100% of Russian papers. AAOS classification was used in 22.9% of cases, Gross and Saleh — in 4.1%, Gustilo and Pasternak — in 1.2%. 5.9% publications reported use of two classifications. The reasons for Paprosky classification popularity is the possibility to evaluate defect basing on standard pelvis x-rays in preoperative stage as well as in retrospective research. At the same time, according to literature, the confidence of Paprosky classification (accuracy of correspondence to intraoperative findings) varies from 16 to 66% for different areas of acetabulum, and during reliability assessment (consistency between different specialists) kappa coefficient varies from 0.14 to 0.75 depending on experience of the specialist and specifics of the defect. One of the possible reason for discrepancies in assessment of defect grade are the iatrogenic and posttraumatic changes of the acetabulum. Nevertheless, Paprosky classification is evolving and, considering additional parameters, like type of defect (contained or non-contained) and pelvic ring continuity, it allows to create a full-fledge algorithm for selection of revision implants and defect replacement which is adequate to the up-to-date surgical needs. At the same time onrush of digital technologies of 3D-visualization considerably expands our possibilities for preoperative defects assessment and offers promising potential for development of new classifications, whose benefits are yet to be evaluated.

Traumatology and Orthopedics of Russia. 2019;25(1):122-141
pages 122-141 views

Comment to the Article „Classifications of Acetabular Defects: Do They Provide an Objective Evidence for Complexity of Revision Hip Joint Arthroplasty? (Critical Literature Review and Own Cases)“

Murylev V.Y.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(1):142-143
pages 142-143 views

Comment to the Article „Classifications of Acetabular Defects: Do They Provide an Objective Evidence for Complexity of Revision Hip Joint Arthroplasty? (Critical Literature Review and Own Cases)“

Safir O.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(1):144-145
pages 144-145 views

Classifications of Non-Specific Hematogenous Vertebral Osteomyelitis. Critical Review and Suggestions for Clinical Use

Bazarov A.Y.

Abstract

For a long time classification of V.Ya. Fischenko published in 1983 and being solely descriptive was the main classification of vertebral osteomyelitis in the countries of the former ussr. In recent years some versions of tactical classifications appeared in the literature which were dedicated to standardization of tactics and methods of treatment. However, those classifications did not reflect distribution according to affection type, destruction degree, biomechanical instability and presence of neurological deficit and did not embrace all scenarios of disease progress.

Purpose of the study — to compare existing classifications and to offer an adapted Russian language version of tactical classification for hematogenous vertebral osteomyelitis.

Materials and Methods. The study included 209 patients with non-specific vertebral osteomyelitis treated in the period from 2006 till 2017. All cases of vertebral osteomyelitis were distributed in accordance with known classifications. The authors conducted the analysis of treatment tactics used in the clinic and by the authors of given classifications. The authors revealed a group of patients which is not classified in known literature.

Results. Full match of treatment tactics with standardized approaches suggested by authors of new classifications was 61,5% (n = 126), partial match (applied treatment tactics does not contradict to suggested) — 20,0% (n = 41), which overall was 81,5% (n = 167). The authors refer to patients who underwent ventral sanation or reconstructive procedures. The majority of patients had the septic form of disease. Four out of 209 patients were not classified while three patients features isolated injury of vertebral processes and one patient — injury of CI-CII.

Conclusion. Modern suggested classifications of hematogenous vertebral osteomyelitis are applicable in clinical practice and allow to standardize treatment algorithms. Tactics is determined not only by degree of destruction, involvement of paravertebral tissues, biomechanical instability of affected spine segment and neurological deficit, but by a presence of systemic inflammation response syndrome (SIRS). Considering the above it would be useful to introduce some additional subtypes which would characterize septic process of disease and determine the indications for sanation and reconstructive ventral procedures, which can be supplemented by instrumental fixation after stabilization of the patient.

Traumatology and Orthopedics of Russia. 2019;25(1):146-155
pages 146-155 views

Comment to the Article „Classifications of Non-Specific Hematogenous Vertebral Osteomyelitis. Critical Review and Suggestions for Clinical Use“

Grigorovsky V.V.

Abstract

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Traumatology and Orthopedics of Russia. 2019;25(1):156-158
pages 156-158 views

REVIEW

Some Aspects of Total Hip Replacement with Subtrochanteric Shortening Osteotomy in Patients with Congenital Hip Dislocation (Review)

Tryapichnikov A.S., Kamshilov B.V., Chegurov O.K., Zaytseva O.P., Ermakov A.M.

Abstract

Total hip replacement (THR) in patients with a high congenital dislocation of the hip (Crowe type IV dysplasia in Crowe classification) is a technically difficult operation, associated with a high risk of complications. The most common variations of THRs used to restore the true center of rotation of the hip are subtrochanteric shortening osteotomy and proximal shortening osteotomy using the Paavilainen technique. Numerous publications refer to the technique and outcomes of subtrochanteric osteotomy, but fundamental differences of opinion persist on a number of points relating to the topic.

The objective of the study is to analyze the publications on the treatment for crowe type IV hip dislocations using total replacement of the hip joint (HJ) with subtrochanteric shortening osteotomy.

The hypothesis of the study was as follows: the method of fixation of the femoral component, the type of osteotomy and the design features of the implant (philosophy) are the factors that determine the effectiveness of the operation. The electronic databases eLIBRARY and PubMed were searched for publications containing keywords in Russian or English: high dislocation of the hip, total replacement of the Hj, shortening subtrochanteric osteotomy. As a result of the study, the proposed hypothesis was partially confirmed. There were only minor differences in the overall incidence of complications and the survivorship of implants when using different types of cementless stems. The incidence of non-unions after the installation of cemented femoral components was higher than with the implantation of cementless. We did not find convincing evidence of the advantage of the step-cut, V-shaped and oblique osteotomies compared with the transverse osteotomy. Typical complications for such operations were the nerve injuries, intraoperative hip fractures, dislocations and non-unions of the femur at the osteotomy site.

Traumatology and Orthopedics of Russia. 2019;25(1):165-176
pages 165-176 views

Mid-Term Outcomes of Revision Hip Arthroplasty with Acetabular Augments

Korytkin A.A., Novikova Y.S., Kovaldov K.A., Korolev S.B., Zykin A.A.

Abstract

Acetabular defects are a major obstacle to achieving good outcomes after revision hip arthroplasty. One way to deal with this problem is to use acetabular augments. We aimed to describe mid-term outcomes of revision hip arthroplasty using acetabular augments.

Materials and methods. We analyzed 85 cases (83 patients) of revision hip arthroplasty using acetabular augments performed during 2012-2018 period: 53 women and 30 men with average age of 57±13 years (25-79). Distribution of acetabular defects was: 51 cases — Paprosky IIIA, 17 cases — Paprosky IIIB, 12 cases — Paprosky IIB, 5 cases — Paprosky IIC. 14 patients had chronic pelvic discontinuity. Aseptic loosening was indication for the operation in 83 cases, periprosthetic hip fracture — 1, dislocation — 1. The amount of previously undregone ipsilateral hipsurgeries was 1 in 35 cases, 2 in 25 cases, 3 and more in 25 cases. Average follow-up period was 38±19 months (1-79).

Results. The average HHS score improved from 37±7 preoperatively to 73±9 after 3 months and to 80±11 after 12 months postoperatively (p = 0.001). Average VAS score improved from 7±2 preoperatively to 4±1 after 3 months and to 3±1 after 12 months postoperatively (p = 0.001). Stable acetabular fixation was achieved in each case according to X-ray findings at final follow-up. However, radiolucent lines were present around the cup in 10 cases (11.8 %) followed by no clinical evidence of aseptic loosening. Hip center of rotation was restored from 26.40±18.38 mm (4-75) preoperatively to 4.78±5.02 mm (0-20) postoperatively relatively to 0 point. Complications manifested in 9 out of 85 cases (10,6%). Distribution of complications was: periprosthetic joint infection in 6 cases, recurrent dislocation — 2, periprosthetic hip fracture — 1.7 patients required implant removal and exchange.

Conclusions. Good mid-term outcomes can be achieved using acetabular augments during hip revision surgery in setting of acetabular defects. Acetabular augments are a reliable option in case of Paprosky IIIB, IIIA defects and chronic pelvic discontinuity, providing good mechanical stability.

Traumatology and Orthopedics of Russia. 2019;25(1):177-187
pages 177-187 views

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