Vol 29, No 4 (2023)

CLINICAL STUDIES

Periprosthetic Knee and Hip Infection — Is It Possible to Compare Treatment Outcomes?

Bozhkova S.A., Preobrazhensky P.M., Kochish A.A., Tikhilov R.M., Artyukh V.A., Klitsenko O.A.

Abstract

Background. It is known that the outcomes of patients treatment with periprosthetic joint infection (PJI) are significantly influenced by the state of the patient’s body, the nature of the pathogen, the state of tissues in the area of the infectious focus and the treatment tactics. However, topographic and anatomical features of the blood supply to the knee and hip joints, as well as the volume of soft tissues, can affect the spectrum of pathogens, manifestations of the infectious process and, as a consequence, the effectiveness of treatment.

The aim of the study was to conduct a comparative analysis of the somatic status of patients, the etiology of the infectious process and the effectiveness of treatment of PJI depending on its localization.

Methods. A single-center retrospective study was conducted. The cases of 337 patients were studied — 119 patients with knee and 218 patients with hip PJI who underwent treatment with a two-stage technique during the period from 2007 to 2017. A comparative analysis of the PJI pathogens structure and concomitant pathology between patients with hip and knee PJI was carried out. The frequency of infection relief in the groups following the first stage was counted.

Results. Recurrence was diagnosed four times more frequently in patients with hip PJI compared to knee PJI. Risk factors for recurrence were gram-negative pathogens, microbial associations, and fistulous forms of the infectious process. Localization of the infectious process in the hip area was associated with a statistically significant greater volume of blood loss during the prolonged debridement surgery.

Conclusion. Recurrences of PJI occur more frequently in the hip area compared to the knee joint. Further analysis of critical factors in recurrence development is necessary for potential intervention.

Traumatology and Orthopedics of Russia. 2023;29(4):5-13
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Treating Periprosthetic Joint Infection With Silver-Impregnated Carbon-Coated Spacers: Mid-Term Outcomes

Malyuchenko L.I., Nikolaev N.S., Yakovlev V.V., Preobrazhenskaya E.V.

Abstract

Background. Periprosthetic joint infection (PJI) is a severe complication of arthroplasty. The widely accepted treatment standard for PJI is a two-stage revision arthroplasty involving the articulating spacers. The implant surface provides an ideal environment for bacterial adhesion, facilitating mature biofilm formation. To prevent bacterial adhesion effectively, the surface of the implanted device must be modified with an efficient coating. The ability of a modified coating based on two-dimensional linear carbon chains (2D LCC) with silver (Ag) impregnation to inhibit biofilm formation and provide efficient bacterial eradication has been investigated in several experimental studies. However, there is a lack of publications on clinical studies evaluating the effectiveness of such coatings.

The aim of the study — to assess mid-term outcomes of knee and hip PJI treatment using spacers coated with two-dimensional linear carbon chains impregnated with silver.

Methods. This study is based on the results of the examination and two-stage revision arthroplasty of 144 patients with newly diagnosed knee and hip PJI. Patients were divided into two groups: the first (main) group received articulating spacers coated with 2D LCC+Ag, while the second (control) group received articulating spacers with antibiotics. Anamnestic, clinical, laboratory, microbiological, and statistical methods were used in this study. The evaluation of short-term results was performed using the KSS, Harris, VAS, and EQ-5D-5L scales at 3 months after surgery, and mid-term results were assessed at 2 years.

Results. The study confirmed the high antibiofilm activity and safety of spacers coated with 2D LCC+Ag. Both groups showed a reduction in inflammation markers during treatment. Before the second stage of treatment, both groups experienced a statistically significant decrease in CRP, procalcitonin, and presepsin levels, as well as synovial cytosis and neutrophil content. The frequency of recurrences after two-stage treatment was significantly lower in the first group compared to the second group. In the mid-term period, the first group had higher scores on the KSS and Harris scales by 20.5 and 7.0 points, respectively. Results on the EQ-5D-5L were 10/0.08 points higher, and the intensity of pain according to VAS was three times lower in the first group.

Conclusion. The use of spacers coated with 2D LCC+Ag allows for a faster resolution of the inflammatory process, reduces the incidence of PJI recurrences, and predicts active protection of the implant surface from microbial colonization and biofilm formation. This, combined with antibiotic prophylaxis, provides a favorable therapeutic and preventive effect against PJI recurrence.

Traumatology and Orthopedics of Russia. 2023;29(4):14-23
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Results of Arthroscopic Treatment of Patients With Femoroacetabular Impingement Depending on the Type of Hip Deformity

Bogopolskiy O.E., Filonov P.V., Tikhilov R.M.

Abstract

Background. Femoroacetabular impingement (FAI) is one of the most common causes of pain syndrome and limited mobility in the hip joint among young and middle-aged individuals.

The aims of this study: 1) To evaluate the impact of the type of hip joint deformity in patients with FAI on treatment outcomes; 2) To identify the type of hip joint deformity that is optimal for correction using arthroscopy; 3) To determine the impact of the acetabular structure in conditions of borderline dysplasia on the treatment outcome.

Methods. A retrospective uncontrolled single-center study was conducted, including 121 patients (135 hip joints), among them 49 (40.5%) women and 72 (59.5%) men. Patients were divided into four groups based on the type of deformity. The first group included 33 (24.4%) joints with cam-type FAI, the second group — 72 (53.4%) joints with mixed-type, the third group — 17 (12.6%) joints with dysplasia (LCEA-O<25°) and cam-type deformity of the femoral head-neck junction, and the fourth group — 13 (9.6%) joints with a combination of dysplasia, cam-type deformity, and retroversion of the acetabulum. All patients underwent physical examination and radiographic diagnostics. In patients with borderline dysplasia, the version of the acetabulum was additionally assessed. The iHOT-33 and HOS scales were used to evaluate the preoperative status and postoperative results.

Results. The best treatment outcome was achieved in the first group of patients, which was statistically significantly different from the results in the third group. The treatment outcomes in the second group of patients did not show statistically significant differences from the first group according to the HOS questionnaire, but differed according to the iHOT-33 scale. The treatment outcomes in the fourth group of patients were almost indistinguishable on the iHOT-33 scale from the first group and on the HOS scale from the second group. In the third group, a statistically significant result on the HOS-Sport subscale was achieved in only 30% of patients, while in other groups it was not less than 58%. Other scales showed a slight superiority of treatment results in the first and fourth groups compared to the second and third groups. In the first years after surgery, all groups of patients showed a significant improvement in sports activity, but after 2 years, there was a tendency for a decrease in patients in the second and third groups.

Conclusion. The highest results of arthroscopic treatment were shown by patients in the first group with isolated cam-type deformity, slightly worse were results by patients in the second group (with mixed-type). In patients with borderline dysplasia, the effectiveness of arthroscopy depended on the structure of the anterior wall of the acetabulum. The worst result was observed in patients with borderline dysplasia and insufficiently developed anterior wall of the acetabulum — in that group of patients, it is worth preferring isolated periacetabular osteotomy or in combination with arthroscopy.

Traumatology and Orthopedics of Russia. 2023;29(4):24-34
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Effect of Radical Hip Reconstruction in Children With Hip Subluxation on Sagittal Balance and Type of Vertical Posture: Mid-Term Results

Bortulev P.I., Vissarionov S.V., Barsukov D.B., Pozdnikin I.Y., Poznovich M.S., Baskaeva T.V.

Abstract

Background. Hip instability in the form of hip subluxation, regardless of its etiology, leads not only to the formation of excessive pelvic anteversion and lumbar hyperlordosis, but also to the early development of hip osteoarthritis. The lack of information in the world literature on possible changes in sagittal balance parameters in this category of patients after triple pelvic osteotomy requires such studies.

Aim of the study is to evaluate the spino-pelvic sagittal balance and the type of vertical posture in children with hip subluxation of different genesis after radical reconstructive intervention in the mid-term follow-up period.

Methods. The study is based on the analysis of clinical and X-ray results of 50 patients (50 hip joints) aged 10 to 17 years with hip subluxation operated on between 2018 and 2019. The patients were divided into two groups: group I consisted of 30 patients (30 hip joints) with Crowe type I dysplasia; group II consisted of 20 patients (20 hip joints) with Legg-Calvé-Perthes disease. All children underwent triple pelvic osteotomy.

Results. Different approaches to triple pelvic osteotomy in patients with hip instability of various genesis allowed to significantly affect the spino-pelvic sagittal balance and the type of vertical posture. In all patients there was a decrease in the sacral slope value, spino-sacral angle, the magnitude of lumbar lordosis, as well as a change in the sagittal vertical axis value from strongly negative to neutral.

Conclusion. Analysis of mid-term results of surgical treatment of children with hip instability in the form of hip subluxation and Legg-Calvé-Perthes disease using 3D modeling and prototyping of individual guides showed that the triple pelvic osteotomy leads to the reduction of both excessive pelvic anteversion and lumbar hyperlordosis, resulting in the transformation of physiologically disadvantageous hyperlordotic type of vertical posture into harmonious one.

Traumatology and Orthopedics of Russia. 2023;29(4):35-48
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Osteonecrosis of the Femoral Head: Another Legacy of COVID-19?

Myasoedov A.A., Shubnyakov I.I., Sereda A.P., Karelkin V.V., Yunkina E.A., Berezin G.V.

Abstract

Background. Recovery from COVID-19 does not always proceed without complications, especially in patients who have suffered severe forms of the disease. Most researchers confirm a significant increase in the incidence of osteonecrosis of the femoral head (ONFH) after COVID-19. However, there is no clear opinion on the individual aspects of the development and course of the disease. This is an extremely important issue that allows us to identify the main risk groups for the development of post-COVID-19 osteonecrosis and, consequently, to perform the earliest possible screening of this complication.

Aims of the study: 1) To evaluate the impact of the past COVID-19 on epidemiologic parameters and clinical course of osteonecrosis of the femoral head in patients; 2) to study the causes of its development.

Methods. We have analyzed the data of medical histories of 674 patients diagnosed with osteonecrosis of the femoral head who sought medical care in 2018 and in 2022. Patients were divided into 4 groups according to the presumed causes of development of the disease. The first group enrolled 183 patients who underwent COVID-19 and received steroid therapy (ST). The second group included 78 patients who underwent COVID-19 without ST therapy. The third group consisted of 103 patients with ONFH that manifested in 2022 without COVID-19 in the previous medical history. The comparison group was made up of 310 patients who developed ONFH in 2018 before the appearance of the SARS-CoV-2 virus.

Results. The sample of patients with COVID-19-associated osteonecrosis differed significantly from patients without COVID-19, in terms of gender, age, time of disease onset, extent of the femoral head damage, and disease progression rate (p<0.001). The level of early ONFH diagnosis was extremely low, not differing from that in the pre-pandemic period.

Conclusion. The COVID-19 pandemic has increased the incidence of ONFH, significantly modifying both its epidemiology and clinical picture. Nevertheless, the vigilance of practitioners remains extremely low, which affects the timely diagnosis of the disease.

Traumatology and Orthopedics of Russia. 2023;29(4):49-58
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Results of Surgical Treatment of Ankle and Posterior Malleolus Fractures Using Different Surgical Techniques

Sergeev G.D., Belen’kiy I.G., Refitskii Y.V., Savello V.E., Maiorov B.A.

Abstract

Background. Almost half of the patients with ankle fractures have fracture of the posterior malleolus. Conclusions of the existing studies are contradictory and do not provide a decisive answer to the question of the need for fixation of the posterior tibial fragment.

Aim of the study — to compare the radiologic and functional outcomes of osteosynthesis of the posterior tibial fragment in unstable ankle fractures using closed reduction and minimally invasive technique and direct open reduction using posterolateral and posteromedial surgical approaches.

Methods. Prospective multicenter study enrolled 132 patients with complex ankle and posterior malleolus fractures. They were divided into three groups depending on the technique of fixation of posterior tibia. Functional and radiologic results of treatment were assessed at 12, 24, and 48 weeks after osteosynthesis. The AOFAS and Neer scales were used.

Results. Bone union occurred in all patients at an average of 8.3±0.8 weeks after surgery. Analysis of postoperative CT scans showed that the use of posterior approaches provided statistically significantly more precise reduction of the fragments of posterior tibia. Functional results of patients of the second (posterolateral approach) and third (posteromedial approach) groups at 24 and 48 weeks of follow-up were statistically significantly superior to those of the first group. The median AOFAS score at 48 weeks of follow-up was 86 for group 2 patients and 90 — for group 3. The median scores on the Neer scale were 88 and 94 points respectively.

Conclusion. Posterior approaches in the surgical treatment of patients with complex ankle and posterior malleolus fractures allow for more precise fragment open reduction compared to closed one. These patients also show better mid-term functional outcomes.

Traumatology and Orthopedics of Russia. 2023;29(4):59-68
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Mid-Term Results of Surgical Treatment for Rhizarthrosis Using Interposition and Suspension-Interposition Arthroplasty

Egiazaryan K.A., Parsadanyan G.K., Ershov D.S., Skvortsova M.A., Ratiev A.P., Afanasiev A.V.

Abstract

Background. Rhizarthrosis is most commonly observed in individuals whose work and activities involve heavy use of the wrist. Conservative treatment methods are effective in the early stages of the disease, but in advanced stages, surgical intervention becomes the primary treatment approach. In recent years, resection interposition and resection suspension-interposition arthroplasty techniques for the first carpometacarpal joint have gained popularity. However, there is a lack of comparative studies on the effectiveness of these techniques based on key indicators.

The aim of this study was to compare the results of surgical treatment for stages II–IV rhizarthrosis using resection suspension-interposition arthroplasty and resection interposition arthroplasty of the first carpometacarpal joint.

Methods. This prospective cohort study included 85 patients with stages II–IV rhizarthrosis who underwent surgery between 2017 and 2022. Patients were divided into two groups. In the first group (52 patients), resection suspension-interposition arthroplasty of the first carpometacarpal joint was performed using an original technique. In the second group (33 patients), resection interposition arthroplasty was performed. The effectiveness of surgical treatment was assessed based on the intensity of pain using the Visual Analog Scale for Pain (VAS), upper limb function recovery assessed with the Disabilities of the Arm, Shoulder, and Hand (DASH) scale, measurement of the distance between the base of the first metacarpal bone and the distal pole of the trapezium bone on anteroposterior X-rays, and an increase in grip strength of the affected hand at 12 months postoperatively.

Results. At the 12-month follow-up, the first group showed superior results compared to the second group: a 73% improvement in DASH score (p<0.01); a 76% improvement in VAS (p = 0.000); a 60% increase in cylindrical grip strength (p = 0.010); and a 30% improvement in the measurement of the distance between the base of the first metacarpal bone and the distal pole of the trapezium bone (p<0.01).

Conclusion. Resection suspension-interposition arthroplasty of the first carpometacarpal joint is more effective than resection interposition arthroplasty in terms of pain relief, improvement in function and grip strength of the affected hand, and preservation of the distance between the base of the first metacarpal bone and the distal pole of the trapezium bone.

Traumatology and Orthopedics of Russia. 2023;29(4):69-77
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Cross-Cultural Adaptation and Validation of the Russian-Language Version of the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS)

Fomichev V.A., Sorokin E.P., Konovalchuk N.S., Pashkova E.A., Sereda A.P.

Abstract

Background. Developed in 1994 by H. Kitaoka et al. the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale (AOFAS-AHS) allows to assess pain, function, deformity and alignment of the foot and ankle. There is no Russian-language AOFAS-AHS questionnaire adapted according to current standards in the scientific literature.

The aim of this paper is to perform the cross-cultural adaptation and to assess the validity of the Russian-language version of the AOFAS-AHS scale, including the evaluation of its psychometric properties.

Methods. The original English version of the AOFAS-AHS scale was translated from English into Russian by a native Russian speaker. Then the questionnaire was back-translated into English by another translator whose native language is English. The next stage was the comparison of the original and back-translated versions, followed by the presentation of a pre-final cross-culturally adapted version, which was tested on 10 patients to ensure that the questions were comprehensible. The next step was the approval of the final version and its completion by patients to be operated on the hindfoot or ankle. The printed copy of the final version of the questionnaire was completed by the patients with an interval of 3 days. Total of 44 consecutive patients were enrolled, including 18 women (41%) and 26 men (59%), with a mean age of 61.7 (32-78) years. The psychometric properties of the Russian-language version of the AOFAS-AHS questionnaire (internal consistency, retest reliability, measurement error, responsiveness, and construct validity) were assessed based on the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) principles.

Results. The mean score according to the AOFAS-AHS scale was 49.6 (min 2; max 82) out of a possible 100. The average time to complete the questionnaire was 4.2 minutes. All hypotheses formulated showed correlations of varying moderate to strong degrees. The Cronbach’s alpha coefficient was 0.76, which indicates a high level of internal consistency of the elements of the validated questionnaire. A good intra-class consistency of 0.83 was obtained, which shows a high degree of reliability of the questionnaire’s reproducibility. The ceiling and floor effects for the primary results of the questionnaires did not exceed 15%. The mean value of the Russian-language version of the AOFAS-AHS increased to 86.6 after surgical treatment. The values of standardized effect size (ES) and standardized response mean (SRM) were 5.56 and 4.83, respectively.

Conclusion. The adapted Russian-language version of the AOFAS-AHS scale showed good psychometric properties and can be recommended for assessment of the physical activity in patients with ankle and hindfoot-related pathology and can also be used for monitoring the changes during the treatment.

Traumatology and Orthopedics of Russia. 2023;29(4):78-86
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Discussions

Suggestions for Introducing Some New Terms in Pelvic and Acetabular Surgery

Zadneprovskiy N.N., Kulikov V.V., Vladimirova Y.B., Ivanov P.A.

Abstract

Background. The rapid advancement of modern surgical methods for treating pelvic bone fractures has underscored the necessity for developing a new terminological framework. This is because the classical anatomical terminology of the pelvis no longer aligns with the demands of the therapeutic process and scientific research in this field. The traditional set of anatomical names and landmarks falls short in providing detailed descriptions of all intricacies of injuries when employing contemporary surgical techniques. The existing terminology system needs to catch up with the level of contemporary pelvic surgery, enabling a comprehensive and understandable characterization of existing pathology and the treatment being administered for all medical professionals.

Purpose of the study was to create names for certain parts of the pelvic bones and their areas that currently lack specific designations and to propose the developed terms for professional discussion.

Methods. A retrospective analysis was conducted on X-rays and computer tomography scans of patients with pelvic bone injuries, performed from 2020 to 2022. A list of potential new anatomical terms was compiled through a literature review.

Results. In several cases, we encountered a deficiency of terms in diagnosing pelvic injuries and describing surgical procedures. New terms were developed to denote areas of the pelvis and their injuries, including the pubic bone base, vertical fractures of the pubic bone base, longitudinal fractures of the pubic bone base, incomplete rupture of the pubic symphysis, the base of the ilium, longitudinal fracture of the iliac base, fracture-subluxation and fracture-dislocation of the iliac base, calcar of the iliac bone, calcar spike, and the bone corridor.

Conclusions. The incorporation of new anatomical terms into clinical practice will help enhance the precision of diagnosis and surgical planning in pelvic fractures. Standardizing the terminology will promote uniformity in approaches and knowledge sharing among specialists, ultimately improving the quality of surgical care for patients with pelvic injuries.

Traumatology and Orthopedics of Russia. 2023;29(4):87-100
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Total Knee Arthroplasty in Hemodialysis Patients: Routine or Complex Surgery?

Tsed A.N., Mushtin N.E., Dulaev A.K., Schmeljew A.V.

Abstract

Background. Chronic hemodialysis significantly increases the risks associated with knee replacement. Among the late complications of knee arthroplasty in hemodialysis patients, deep periprosthetic joint infection (PJI) and aseptic loosening are more frequent. The frequency of revision interventions in patients with end-stage kidney disease (ESKD) is substantially higher compared to patients with normal kidney function.

The aim of the study — based on the perioperative parameters and midterm outcomes to justify the primary knee replacement in chronic hemodialysis patients as complex case of arthroplasty.

Methods. A retrospective randomized single-center cohort study was conducted, including 62 patients with various forms of knee osteoarthritis. Patients were divided into two groups: Group 1 — 29 (46.8%) patients with end-stage renal disease (ESRD) undergoing dialysis, Group 2 — 33 (53.2%) patients without kidney pathology. The average follow-up period in both groups was 3.7 years (min — 1, max — 6). The following parameters were assessed: patient age, length of hospital stay, morphocortical index, body mass index (BMI), duration of hemodialysis, functional assessment of the knee joint using the KSS Function Score and Forgotten Joint Score-12 (FJS-12), radiological results on the KRESS, and the frequency of various complications.

Results. In Group 1, patients had significantly lower BMI compared to Group 2. Length of hospital stay in Group 1 were 1.7 times longer. According to the KSS Function Score, no significant differences were observed between the groups in the first 36 months after the operation. However, by the 4th year of follow-up, average KSS Function Score in Group 1 decreased to 77.3 points, which was due to infectious complications. The FJS-12 showed worse scores in Group 2, averaging 68.7 points. After more than three years post-operation, no statistically significant differences were observed between the groups, which was associated with an increase in the number of complications in Group 1. Results on the KRESS after 43 months did not differ between the groups and averaged 4.8 points. Group 1 had more orthopedic complications and cases of PJI, accounting for 7 out of 37.

Conclusion. Age and constitutional characteristics of patients undergoing hemodialysis significantly differ from the normal population. The frequency of complications in Group 1 was 23.5%. These patients require the implantation of more constrained implant components and modular systems. Therefore, primary knee replacement in hemodialysis patients can be classified as a complex case of arthroplasty.

Traumatology and Orthopedics of Russia. 2023;29(4):101-112
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Comments

Editorial Comment on the Article by A.N. Tsed et al. “Total Knee Arthroplasty in Hemodialysis Patients: Routine or Complex Surgery?”

Kornilov N.N.

Abstract

Severe comorbidities, like chronic kidney disease, strongly associated with higher risk of complications after total knee arthroplasty. Therefore hemodialysis patients need specific pre-operative as well as peri-operative management, including proper analgesic, antibacterial and thromboembolic pharmacological prophylaxis. Nevertheless the technical issues that surgeon has to solve in achieving proper leg alignment, knee stability and range of motion does not differ from other complex knee primary cases when revision implants and instruments are essential part of surgical requisite.

Traumatology and Orthopedics of Russia. 2023;29(4):113-115
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EXPERIENCE EXCHANGE

Treatment Outcomes After Open Reduction, Varus Derotational Osteotomy and Dega Acetabuloplasty in Children With Dislocated Dysplastic Hip: Retrospective Analysis

Kehayov R.I., Semenistyy A.A., Georgiev P.R., Gerchev A.I.

Abstract

Background. Treatment of developmental dysplasia of the hip (DDH) poses a great challenge for pediatric orthopedists due to the high risk of complications, the most severe of which are avascular necrosis of the femoral head and recurrent dislocation. In the most severe form of dysplasia, hip dislocation, the surgery is indicated after 18 months of age. However, the issue of determining the exact surgical intervention remains controversial.

The aim of the study was to provide our own midterm treatment outcomes of patients with DDH, who underwent open reduction for DDH through a modified Ganz digastric approach and varus derotational femur osteotomy combined with Dega acetabuloplasty.

Methods. The treatment outcomes of 12 patients with DDH grade III-IV according to the IHDI classification at the age of 1.5 to 3.5 years were analyzed. Thirteen operations were performed: open reduction, derotational varus femur osteotomy combined with Dega acetabuloplasty. In one case, surgery was performed bilaterally in two stages. The average follow-up period was 31.9±4.9 months (from 12 to 66 months). To evaluate the correction performed, a comparative analysis of X-ray images (acetabular index (AI) and femoral neck-shaft angle (FNSA) and Reimers migration index (MI)) was performed before, after surgery and at the last follow-up. The incidence of complications was assessed: recurrent dislocation, avascular necrosis of the femoral head (AVN), nonunion, infection, and loss of correction. In 8 patients with a follow-up period of more than 2 years, the limb length discrapancy was assessed.

Results. Dega acetabuloplasty allowed to reduce the AI value from 38.62° to 18.76° (p<0.05) after surgery and to 20.61° at the last follow-up. As a result of varus derotational femur osteotomy, a decrease in the FNSA value was noted from 143.62° to 110.53° (p<0.05). AVN was observed in 4 cases in 3 patients (25%) (including the patient who underwent bilateral surgery). At the last follow-up, the FNSA increased to 119.11° in 9 patients without AVN and decreased to 87.75° in patients with AVN. In one patient with AVN, the development of medial dislocation of the femoral head due to progressive varus deformity was noted (up to 41°). No nonunions or infectious complications were observed.

Conclusion. The combination of open reduction, varus derotational femur osteotomy with Dega acetabuloplasty is an effective method for treatment of DDH in toddlers. The small sample size and the absence of a control group do not allow us to draw conclusions regarding the effectiveness of the modified Ganz digastric approach as a measure to prevent the development of avascular necrosis of the femoral head after surgery.

Traumatology and Orthopedics of Russia. 2023;29(4):116-124
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Case Reports

Repair of Bone Defect of the Talus with Calcaneus Autograft and Autologous Matrix-Induced Chondrogenesis: A Case Report

Korobushkin G.V., Akhmedov B.G., Chebotarev V.V., Gaidarov A.R.

Abstract

Background. The question of choosing a treatment strategy for full-thickness osteochondral defects of the tarsal bone remains relevant. When choosing a treatment strategy, two key points should be considered: restoring the architecture of the tarsal bone and achieving long-term restoration of cartilage-like coverage in the area of the osteochondral defect.

Case report. A 34-year-old physically active patient sustained an ankle injury in 2011 and was treated conservatively. In 2020, he complained of pain and reduced activity. Initial assessment scores were: VAS (Visual Analog Scale) — 6 points, AOFAS-AHS (American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score) — 49 points, FAAM (Foot and Ankle Ability Measure) — 55 points. An MRI revealed an osteochondral defect in the medial part of the tarsal bone dome, measuring 16.4×9.4 mm and with a depth of 20.8 mm. The patient underwent the replacement of the bone defect with an autograft taken from the heel bone, using autologus matrix induced chondrogenesis (AMIC) procedure. After 6 months, a follow-up examination was performed, including ankle arthroscopy and removal of metal fixators. Arthroscopic findings showed that the chondroplasty area was almost identical to intact joint cartilage. One year after chondroplasty, the patient returned to his previous level of physical activity. Assessment scores were: VAS — 1 point, AOFAS-AHS — 94 points, FAAM — 83 points.

Conclusion. The proposed method allows for the restoration of the architecture of the tarsal bone along with the cartilage surface. The use of a bone autograft helps to fill the tarsal bone defect, and covering the autograft with a collagen membrane contributes to the formation of hyaline-like cartilage tissue in the defect area.

Traumatology and Orthopedics of Russia. 2023;29(4):125-133
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Reviews

Correction of Multiapical Deformities of Long Bones of the Lower Extremities: A Review

Golovenkin E.S., Solomin L.N.

Abstract

Background. Multiapical deformities of the long bones of the lower extremities represent a complex and widely prevalent orthopedic pathology. A numerous of publications address its individual aspects: diagnosis, planning, and correction. However, no single study was found that offers a comprehensive assessment of contemporary views on treating patients with multiapical deformities of long bones.

Aim of the review — to define current concepts and unresolved issues in the analysis, planning, and correction of multiapical deformities of the long bones of the lower limbs based on the scientific literature.

Methods. Electronic databases were utilized for literature search: PubMed/MEDLINE, SAGE Publishing Journals, Embase, eLIBRARY, Google Scholar. Particular attention was paid to studies that provide information on diagnosis, planning, and correction methods for multiapical deformities. A total of 46 publications were included in the review.

Results. In the literature, the terms “multiapical deformity” and “multilevel deformity” are used synonymously. At the same time, the term “multilevel deformity” is used to denote uniapical deformities of different limb segments. The main diagnostic feature of a multiapical deformity is the location of the apex outside the bone. Unlike uniapical deformities, the correction planning of multiapical deformities uses the axis of the intermediate fragment(s). Most authors define it as the mid-diaphyseal line. The correction of multiapical deformities is performed either acute or gradually. Acute correction with internal fixation is undoubtedly more comfortable for the patient. If there are contraindications to it, the deformity correction is performed gradually using Ilizarov hinges or orthopedic hexapods.

Conclusion. The term “multiapical deformity” inherently indicates that the deformed bone has more than one apex, so it should take precedence over the term “multilevel deformity”. The diagnostic feature of the multiapical deformity “localization of the AOD outside the bone” is not absolute and requires clarification. There are challenges in planning the correction using mechanical axes, as well as in determining the axis of the nonlinear (bowing) intermediate fragment(s). The “spring technique” has significant advantages over other variants of using orthopedic hexapods in correcting a multiapical deformity. However, a rationale for the optimal characteristics of springs, their fixation points to supports, and clarification of the computer program’s use method is required. Addressing these issues will enhance the treatment efficiency for patients with multiapical deformities.

Traumatology and Orthopedics of Russia. 2023;29(4):134-146
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Role of Infrapatellar Fat Tissue in the Pathogenesis of Knee Osteoarthritis: A Review

Korneva Y.S., Borisenko M.B.

Abstract

Osteoarthritis (OA) is one of the most common joint diseases in the adult population. The role of indolent inflammation and predominance of catabolic cytokines over anabolic ones in OA has now been proven. The influence of obesity on the development of OA by releasing inflammatory mediators by fat tissue has been confirmed. Infrapatellar fat tissue (Hoffa’s fat pad) is a potential donor of proinflammatory cytokines, including specific fat tissue proinflammatory cytokines - adipokines. In a healthy person, infrapatellar fat tissue contributes to the distribution of mechanical load on the joint and metabolism of the synovial fluid. Infiltration of infrapatellar fat tissue by macrophages and lymphocytes leads not only to the production of proinflammatory cytokines with chondrolytic properties, but also to the maintenance of chronic inflammation in the synovial membrane, articular cartilage, and subchondral bone. Morphologic changes in Hoffa’s fat pad can be both an indicator of the inflammatory process in the joint cavity and a predictor of pathologic changes of the joint. Among histological changes, infiltration with macrophages and lymphocytes, fibrosis, thickening of the interlobular septa, reduction in the size of fat lobules and adipocytes, and increased vascularization are important for the course of OA. Morphologic changes can be assessed using a non-invasive method - magnetic resonance imaging, which makes it possible to evaluate the presence and severity of synovitis, thickening of the synovial membrane, edema, thickening of the interlobular septa, and a decrease in the volume of Hoffa’s fat pad. Histologic and tomographic signs can potentially be used to assess the severity of OA and develop prognostic scales. Infrapatellar fat tissue is also a source of mesenchymal stem cells phenotypically similar to chondrocytes, which can be used for regeneration of joint cartilage tissue with minimally invasive intervention to harvest them.

Traumatology and Orthopedics of Russia. 2023;29(4):147-155
pages 147-155 views

History of medicine

Georgii S. Bom — the founder of the Department of Traumatology, Orthopedics and Military Surgery of Pirogov Russian National Research Medical University

Egiazaryan K.A., Ershov D.S.

Abstract

Georgii S. Bom was the founder of the Department of Traumatology, Orthopedics and Military Surgery of Pirogov Russian National Research Medical University. In 2023 the Department celebrated its 90th anniversary. Prof. S. Bom was also one of the founders of the Moscow orthopedic school and specialized in the treatment of pediatric orthopedic diseases, as well as bone and joint tuberculosis. He developed a number of original surgeries, in particular, an intervention for hallux valgus, which was called «Bom’s surgery». He offered a classification of all types of clubfoot, which is still used in orthopedics. Prof. G.S. Bom is the author of several monographs and a large number of scientific articles.

Traumatology and Orthopedics of Russia. 2023;29(4):156-159
pages 156-159 views

Anniversaries

Vladimir S. Zubikov

Traumatology and Orthopedics of Russia. 2023;29(4):160-161
pages 160-161 views

MEMORIAL DATES

Vladimir F. Tsel

Bragina S.V.

Abstract

The article is dedicated to the 125th anniversary of the birth of Doctor of Medical Sciences, professor V.F. Tsel. He was the founder of the school of surgery, traumatology and orthopedics in Arkhangelsk, who made a huge contribution to the formation and development of the northernmost medical institute.

Traumatology and Orthopedics of Russia. 2023;29(4):162-163
pages 162-163 views

Letters to Editor

pages 164-166 views


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