Vol 26, No 2 (2020)

EDITORIAL

Editorial

Tikhilov R.M.

Abstract

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Traumatology and Orthopedics of Russia. 2020;26(2):7-8
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COVID-19

Trauma Care in COVID-19 Pandemic

Sitnik A.A., Murzich A.E., Volotovski P.A., Gerasimenko M.A.

Abstract

The development of COVID-19 pandemic is the serious challenge for trauma care systems across the world. Recommendations on general principles of trauma care in the settings of pandemic, medical stuff protection and prevention of the spread of infection based on the data from international centers are presented in the article. Delay of all elective cases, restriction of surgical treatment of fractures with relative indications for surgery are recommended. The segregation of cases into COVID-19 confirmed or suspected and COVID-19 negative patients is important. When possible before the admission to in-patient department the patient shall be tested on COVID-19. When the COVID-19 status of the patient is unclear all possible protection measures shall be used: patient isolation and medical stuff protection. To prevent the spread of infection it is recommended to split the stuff of the traumacenter into 2 or 3 groups. Each of the groups is working during the week with subsequent period of the self-isolation (remote work) for the period of 1-2 weeks (according to the duration of incubation period of the COVID-19). During the surgical treatment the most dangerous stages of the surgery are endotracheal intubation / extubation and also aerosol-generative procedures: electrocoagulation, pulsed wound lavage, drilling, the use of oscillating saw and medullary reaming. The stuff in the OP-theatre has to be accordingly equipped (personal protection equipment). The risk factors for the medical stuff are fatigue from overwork, the absence of real-time training in infection-prevention measures and non-compliance with PPE.
Traumatology and Orthopedics of Russia. 2020;26(2):9-14
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COVID-19 Challenge: What Has Been Done and What Must Be Done?

Belenkiy I.G.

Abstract

The sequence of systemic measures to combat the COVID-19 pandemic in Russia is described. Some other countries experience of providing the specialized trauma care in a pandemic has been summarized. Almost everywhere, strict measures of infection prevention and treatment were introduced in stages. To date, there are the following generally accepted measures: discontinuation of planned surgeries, screening of emergency patients on COVID-19 with the subsequent separation of patient flows, the maximum reduction of hospital stay length. The special attention should be paid to personal protective equipment. The organizational and medical measures necessary for prevention of such pandemics in the future are described, namely equipping sanitary triage posts, creating a stock of personal protective equipment and disinfectants, developing a plan for transforming general hospitals into hospitals for infectious patients with the allocation of a primary patient reception post and their subsequent distribution into the green or red zones. The importance of pre-operative bed day reduction, telemedicine technologies and the need of healthcare financing increase to solve the tasks are substantiated.
Traumatology and Orthopedics of Russia. 2020;26(2):15-19
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ADDITIVE MANUFACTURING IN TRAUMA AND ORTHOPEDIC SURGERY

Custom Triflange Acetabular Components for Revision Hip Arthroplasty in the Patients with Severe Acetabular Defects: Planning, Surgical Technique, Outcomes

Korytkin A.A., Novikova Y.S., Morozova E.A., Gerasimov S.A., Kovaldov K.A., El moudni Y.M.

Abstract

Employment of custom triflange acetabular components (CTAC) is one of the few options for pelvic reconstruction in the patients requiring complex acetabulum revisions with Paprosky 2 C, 3 A and 3 B defects and pelvic ring disruption.

The purpose of the study was to describe the features of planning, surgical technique, and short-term treatment outcomes of the patients with significant acetabular defects, in which the revision hip arthroplasty was performed using the CTAC.

Materials and Methods. A single-center analysis of a series of consecutive patients was performed: 50 complex acetabulum revisions in 47 patients (16 men and 31 women). The average age of the patients was 60±12 years (from 31 to 82; Me 62 years), the average body mass index was 29.7±6.3 kg/m2 (18.4 to 46.3; Me 29.0 kg/m).

Results. The mean follow-up was 22±13 months (from 3 to 3.6 years; Me 20 months). The average Harris score increased from 27±7 (from 15 to 39; Me 27) before surgery to 64±16 (from 22 to 90; Me 67) a year after (p<0.001). The level of pain according to VAS before surgery was 7±1 points (from 5 to 9; Me 7), after treatment it decreased to 2±1 points (from 0 to 7; Me 1, p<0.001). In 17 cases out of 50 (34%), there was at least one complication: dislocations — 7 (14%) cases; infection — 3 (6%); loosening — 2 (4%); complications associated with the femoral component — 4 (8%), including 3 intraoperative fractures and 1 postoperative, associated with loosening of the implant; pronounced disturbances of static and locomotor functions — 2 (4%). 12 cases out of 50 (24%) required another surgery, all of which were performed in a year. The Kaplan-Meyer survival rate for the hip implants was 0.71, for the CTAC — 0.87.

Conclusion. Employment of the CTAC for revision hip arthroplasty in the patients with significant acetabulum defects and pelvic ring disruption allows reliable fixation of the endoprosthesis components. The STAC placement technique is more anatomical than use of structural allografts, several augments or sup-cage systems. It allows reconstruction of extensive bone defects, theoretically avoiding the long-term problems with allografts, modular trabecular components, antiprotrusion systems and cup-cage. Although, to prove this, the longer follow-up is needed.

Traumatology and Orthopedics of Russia. 2020;26(2):20-30
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What Characteristics of the Acetabular Defect Influence the Choice of the Acetabular Component During Revision Hip Arthroplasty?

Tikhilov R.M., Dzhavadov A.A., Kovalenko A.N., Denisov A.O., Demin A.S., Vahramyan A.G., Shubnyakov I.I.

Abstract

The purposes of the retrospective cohort study were: 1) to determine the severity of defects in the acetabulum and the probable causes of their formation in patients who underwent revision hip arthroplasty (RHA), as well as an assessment of factors that exacerbate the severity of the defects; 2) identifying the proportion of severe defects in the overall structure of acetabular revisions and determining the effectiveness of using serial implants in comparison with individual constructions made by 3D printing; 3) the rationale for rational indications for the use of individual constructions.

Materials and Methods. The structure and reasons for the formation of bone defects in the acetabulum were evaluated in 726 cases of revisions performed from 2004 to 2018. In addition, the results of revision operations in a group of patients with severe defects (type 3 according to Paprosky and pelvic discontinuity) were evaluated.

Results. The most frequent cause of defect formation was iatrogenic (53.2%), and the share of severe defects was 39.5% (287 observations). A factor aggravating the severity of the defect is the lack of its limitation by the support bone. The results of RHA in patients with severe defects were assessed in 186 cases out of 287 (64.8%). In 73 (39.2%) cases, individual constructions were used, the average follow-up was 26 months. (from 12 to 50), and in 113 (60.8%) cases, serial implants were used, the average follow-up period was 62 months. (12 to 186). Individual constructions were more often implanted in patients with 3B acetabular defects (p<0.05) and its uncontained defects (p<0.001). The number of cases of aseptic loosening in the group of patients undergoing endoprosthetics using serial implants was greater than in the group of patients with individual constructions for the entire period (p<0.05) and in the early stages of observation (p<0.05).

Conclusion. In case of RHA in patients with severe acetabular defects, individual implants, in comparison with serials, demonstrate better survival with an average follow-up of 26 months and due to design features, they can count on great long-term effectiveness. This study needs to be continued to increase follow-up.

Traumatology and Orthopedics of Russia. 2020;26(2):31-49
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Hip Arthroplasty in Patients with Hip Dysplasia by Individual Augments: Early Results

Rukin Y.A., Lychagin A.V., Murylev V.Y., Garkavi A.V., Tarasov D.A., Elizarov M.P.

Abstract

Relevance. The altered hip anatomy makes total hip arthroplasty in patients with hip dysplasia a difficult and non-standard task. The acetabulum is deformed with femoral head in subluxation or dislocation. The most important task of surgery is to restore the anatomical position of the hip center of rotation.

The study purpose — to evaluate the early results of hip arthroplasty with individual augments in the patients with hip dysplasia.

Materials and Methods. Since 2017, nine patients with hip dysplasia have undergone surgery using individually printed augments. All patients were women with average age 51.3±14.5 years (23 to 67). The mean follow-up was 14.3±5.2 months (8 to 20). Patients were evaluated using follow-up X-rays, a visual analogue scale (VAS), Harris Hip Score (HHS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC).

Results. There was no a single case of endoprosthesis dislocation, loosening of components, prosthetic infection or revision surgery in the analyzed group of patients. The planned sizes of the acetabular components were equal to the placed in 7 cases (77.8%). In two cases (22.2%), the acetabular components were 2 mm larger because the surgeon wanted a greater degree of press-fit fixation. The restoration of the anatomical position of the acetabular component was noted. Before the surgery, the femoral head was on average 22.7±11.7 mm (10 to 43 mm) higher. After the surgery, the level of the acetabular component was on average only 0.75±2.1 mm (1.7 to 5 mm), p = 0.008. Also, there were a decrease in pain and quality of life improvement by VAS from 6.78±1.39 before surgery to 2.22±1.09 at follow-up (p = 0.007), HHS increase from 30.5±18. 1 to 77.59±14.26 (p = 0.008), and WOMAC decrease from 73.3±14.1 to 18.22±8.2 (p = 0.008).

Conclusion. The individually printed augments have shown high efficacy for restoration of the anatomical center of rotation and good early results in the patients with hip dysplasia undergone hip arthroplasty.

Traumatology and Orthopedics of Russia. 2020;26(2):50-59
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Effects of 3D Imaging on Surgical Tactics in Primary and Revision Hip Arthroplasty

Bazlov V.A., Mamuladze T.Z., Golenkov O.I., Efimenko M.V., Pronskikh A.A., Kharitonov K.N., Panchenko A.A., Pavlov V.V.

Abstract

3D imaging tools significantly expand the ability to assess the bone tissue condition, both in terms of its qualitative properties and in terms of accurate determination of bone defect geometry and volume.

The purpose of the study was to determine the 3D imaging potential for the preoperative planning and correction of surgical tactics in hip arthroplasty.

Materials and Methods. A retrospective analysis of the preoperative planning of 110 primary and revision hip arthroplasties with 3D imaging was performed. The following specialized software were employed: RadiAnt DICOM Viewer file converter — for 3D models production; 3D/CAD designers — for volumetric models processing and correction; InVesalius 3.0 program — for bone density evaluation by the Hounsfield scale; K-Pacs — for viewing MSCT and X-ray images. All patients underwent pelvic bones radiography in the front and anterior-lateral planes. Post-traumatic acetabular deformity was described in accordance with the X-ray picture in each individual clinical case. For revision arthroplasty, the acetabular defect was determined according to the W.G. Paprosky classification. In 36 patients (32.7%), the acetabulum defect was the result of trauma. In 74 patients (67.3%), the cause of surgery was endoprosthesis components loosening.

Results. In 80% of cases (88 patients), the analysis of the 3D model did not change the surgical tactics determined in the preoperative planning using pelvic radiographs; in 20% of cases (22 patients), the use of 3D imaging revealed new circumstances and changed the surgical tactics.

Conclusion. In standard cases, it is possible to use the traditional preoperative planning using radiographs in several planes. In primary hip arthroplasty in the patients with post-traumatic deformity, including a false joint of acetabulum bottom or 2 to 3 degree osteopenia, it is advisable to perform 3D imaging. In the case of revision arthroplasty, 3D visualization is indicated in acetabulum Paprosky IIIA, IIIB defects with pelvic discontinuity.

Traumatology and Orthopedics of Russia. 2020;26(2):60-70
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Individual Lordotic Cages Implantation and Radiographic Evaluation of Segmental and Lumbar Lordosis Correction for Patients with Adult Degenerative Scoliosis

Denisov A.A., Ptashnikov D.A., Mikhaylov D.A., Masevnin S.V., Smekalenkov O.A., Zaborovskii N.S.

Abstract

Relevance. The development of minimally invasive surgery has led to the development of new methods for surgical treatment of the spine. Conventional surgical technique, such as vertebrotomy is accompanied by a several number of disadvantages (high blood loss, prolonged hospital stay, long intraoperative time, postoperative neurological deficit). An alternative to improve sagittal balance in the spine is to use custom-made hyperlordotic cages, which can also be used for indirect decompression of neural structures.

The objective is to compare the degree of segmental and total lumbar lordosis using hyperlordotic cages through ALIF and TLIF with posterior instrumentation.

Materials and Methods. A single-center retrospective cohort study using 96 patients treated from 2018 to 2019 about degenerative spinal deformities. Comparison of two groups: group 1 (A) consisted of 30 patients who were held anterior spinal fusion with individual lordotic cages from minimally invasive anterior approach (MISS ALIF) without posterior fixation. Group 2 (B) consisted of 33 patients whom were performed spinal fusion from the posterior approach (TLIF) with Smith-Peterson Osteotomy (SPO) and transpedicular fixation. Measuring segmental and lumbar lordosis, teleradiographs were used in a standing position. For an accurate assessment, the non-commercial available Surgimap software, © Nemaris, was used.

Results. Segmental lordosis were superior to preoperative ones. In the intergroup comparison, the ALIF group showed an excellent increase in the enlarged lordosis segment (L3-L4 in 8 degrees; p = 0.0005, L4-L5 in 7 degrees; p = 0.0002, L5-S1 in 7 degrees; p = 0.0001). When conducting an intergroup comparison of total lumbar lordosis in the preoperative period, there was a statistically significant difference between them (p = 0.0043). At the same time, a greater degree of correction of lordosis is shown in ALIF compared to TLIF group (29,1 in comparison with 22,5; p = 0.00005).

Conclusion. The results of this study confirm that the using of custom-made lordotic cages can significantly increase segmental and total lumbar lordosis for patients with degenerative scoliosis in adults.

Traumatology and Orthopedics of Russia. 2020;26(2):71-78
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Biomechanical Modeling of Options for Internal Fixation of Unilateral Fractures of the Sacrum

Kazhanov I.V., Mikityuk S.I., Dol’ А.V., Ivanov D.V., Kharlamov А.V., Petrov А.V., Kossovich L.Y., Manukovskiy V.A.

Abstract

Relevance. Currently, the stability of various options for the fixation of sacral fractures by the finite element method has not been sufficiently studied.

Purpose — the biomechanical characteristics of two variants of internal fixation of unilateral sacral fractures by various implants and the localization of the line of its fracture with respect to the articular facet of the L5-S1 vertebrae were studied.

Materials and Methods. Using the finite element method, we studied the biomechanical characteristics of two options for fixing a one-sided longitudinal fracture of the sacrum with different localization of the line of its fracture: outside, inside and directly on the joint facet L5-S1. Two fixation options are considered: cannulated sacroiliac screws and a similar option in combination with a bilateral lumbar-pelvic transpedicular system.

Results. The stresses in implants and bone under compression load and torso forward or backward are almost the same in all models. In the model of fixation with a sacroiliac screw of a one-sided longitudinal sacral fracture, the line of which passes through the articular process S1 of the vertebra (Isler II type), the greatest stress in the screws under compression load and bending moment was 619.7 MPa, which exceeds the yield strength of the titanium alloy and can damage the implants. In all models where the transpedicular system additionally acted as fixing structures, a decrease of 42–77% of maximum displacements was noted, by 28–79% of equivalent stresses in implants under all types of loads, while the equivalent stresses in the bone structures did not differ significantly. In models where the transpedicular system was additionally applied, a decrease of 42–77% of maximum displacements was noted, by 28-79% of stresses in implants under all types of loads, while the stresses in the bones did not differ much.

Conclusion. In all cases of localization of the line of unilateral fracture of the sacrum, the use of a transpedicular system in combination with sacroiliac screws is more stable from the point of view of biomechanics. The most unstable is a one-sided longitudinal fracture of the sacrum passing through the facet L5-S1.

Traumatology and Orthopedics of Russia. 2020;26(2):79-90
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Treatment of Pelvic Ring Injury with 3D Printed Patient-Specific Implant: Case Report

Solod E.I., Lazarev A.F., Petrovskiy R.A., Abdulkhabirov M.A., Alsmadi Y.M.

Abstract

Rationale. The development of 3D printing technology allows the manufacture of individual implants to treat the patients with diseases and consequences of musculoskeletal system injuries. However, the use of additive technologies in the patients with multiple trauma in the acute period is limited. The purpose of study was to demonstrate the possibility of using individual implants for the definitive fixation of the anterior pelvic ring in a patient with multiple trauma.

Patient concerns. A 22-year-old patient was admitted after an injury as a result of a fall from the 5th floor. The treatment was carried out in accordance with the ATLS protocol. Diagnosis: multiple trauma; closed chest, pelvis and limbs injuries; fracture of the left 2nd to 5th ribs; pelvic bones fracture AO/ OTA: 61-C1.3a; fracture of both bones of the left lower leg AO/OTA: 42-B3b; 2nd degree shock.

Interventions. An emergency external fixation of the pelvis and lower leg bones was performed. An individual implant for pubic bone fixation was made using 3D printing. On the 8th day, the definitive fixation of the pelvic and left lower leg bones was performed. The patient is activated on the 1st day after the surgery.

Outcomes. The early postoperative period was uneventful. The functional result on the Majeed scale in 6 months by remote filling out the questionnaire was 84 points. Lessons. The custom-made implants make it possible the successful fixation of the anterior pelvic ring. The use of 3D printing technologies for the osteosynthesis of pelvic fractures is promising, although requires further study.

Traumatology and Orthopedics of Russia. 2020;26(2):91-97
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Osseointegration of Titanium and Steel Additive Manufactured Implant in Rabbit Tibia under External Fixation: Comparative Study

Emanov A.A., Kuznetsov V.P., Gorbach E.N., Stogov M.V., Kireeva E.A., Ovchinnikov E.N.

Abstract

Relevance. The main goals of successful prosthesis remain ensuring the osseointegration and infectious safety of implants.

The purpose of the study — the comparative analysis of osseointegration of titanium and steel additive manufactured implants in the rabbit tibia under additional fixation by Ilizarov apparatus.

Materials and Methods. The study was performed on 20 chinchilla male rabbits. The animals of the first group (n = 8 ) were implanted a stainless steel product EOS PH1 (EOS, Germany), the animals of the second group (n = 12) — a titanium alloy Ti6Al4V product. The implant was additionally fixed by Ilizarov apparatus. The implants were processed with additive technology by selective laser fusion at the EOSINT M 280 installation (EOS, Germany). The survival and safety of the implants were assessed using clinical, histological, laboratory and statistical methods.

Results. The implant fall due to chronic inflammation was found in 2 animals of group 1 and none in group 2. The formation of weakly mineralized bone tissue on the surface of the implant was noted in 3 weeks in all cases. The bone became more mineralized by the 12th week of the experiment. However, in group 2, the calcium content and Ca / P ratio of the newly formed bone tissue at the 3rd and 12th week after implantation were significantly higher than in the animals of group 1. This indicated the greater maturity of the bone tissue in animals of group 2 at all stages of the experiment. In group 1, the compact plate osteoporosis and calcium-phosphorus balance disturbance were greater.

Conclusion. The results of the study indicate that the survival rate (osseointegration) and safety of the product made of the titanium alloy were higher compared with the stainless steel product.

Traumatology and Orthopedics of Russia. 2020;26(2):98-108
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Micro-Arc Zn- and Ag-Containing Coatings for Implants with Complex Porous Architecture Obtained by 3D Printing Method from Titanium Alloy

Sharkeev Y.P., Sedelnikova M.B., Tolkacheva T.V., Shcheglova N.A., Panchenko A.A., Krasovsky I.B., Solomatina М.V., Efimenko M.V., Pavlov V.V., Cherdantseva L.A., Kirilova I.A.

Abstract

Relevance. The creation of porous three-dimensional materials for bone defects compensation and its subsequent regeneration is an important direction of medical materials science. The key issue in the interaction of an implant and bone tissue is the surface properties of the implant.

The purpose of the study is to evaluate the physicochemical properties and compatibility of tissues of a living organism and porous implants with calcium phosphate Zn- and Ag-containing formed by microarc oxidation.

Materials and Methods. Implants with various types of porous structure were made by direct laser sintering of titanium alloy Ti-6Al-4V powders. The calcium phosphate coatings, including Zn- and Ag-containing, were formed on the implants surface by microarc oxidation.

Results. Coatings, deposited in electrolytes of various compositions, were uniformly distributed over the implants mesh structure. The phase composition of Zn-containing coatings, deposited in the acidic electrolyte, was represented by amorphous calcium phosphates. Ag-containing coatings, deposited in the alkaline electrolyte, had an amorphous-crystalline structure, the crystalline phase of which was identified as tricalcium phosphate in the α and β modifications. The samples of extracts of calcium phosphate Zn and Ag-containing coatings were co-cultured with pFb line of the human postnatal fibroblasts for 48 hours at 37°C in 5% CO2 atmosphere. The MTT test revealed a high metabolic activity of the co-cultured fibroblasts in comparison with the fibroblasts of control.

Conclusion. The pFb line of the human postnatal fibroblasts retained their viability for 48 hours of co-culturing with calcium-phosphate Zn- and Ag-containing coatings. The tested product and its components did not negatively affect the cellular respiration. However, further studies are needed to determine the rate of bioresorption and the degree of antibacterial activity of calcium-phosphate Zn- and Ag-containing coatings.

Traumatology and Orthopedics of Russia. 2020;26(2):109-119
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CLINICAL STUDIES

The Comparative Efficacy and Safety of Long- and Short-Term Continuous Use of Non-Steroidal Anti-Inflammatory Drugs for the Treatment of Knee Osteoarthritis

Zavodovskiy B.V., Papichev E.V., Sivordova L.E., Polyakova Y.V., Akhverdyan Y.R.

Abstract

Objective. To compare the efficacy and tolerability of long-term and short-term continuous NSAIDs in patients with knee osteoarthritis with insufficient efficacy “on demand” NSAIDs and SYSADOA.

Study design. 12-week, prospective, comparative, randomized, single-center study.

Materials and Methods. 180 patients with primary knee osteoarthritis aged 40 to 85 years with insufficient efficacy of “on demand” NSAIDs and SYSADOA were examined. Anti-inflammatory drugs were recommended for everyone: 56 people took Naproxen (31.11%), 63 — Etoricoxib (35%), 61 — Ketoprofen (33.89%). Patients were randomized into two groups: 1st group — with 8-week continuous intake of NSAIDs, 2nd group — with a 2-week continuous course of NSAIDs.

Results. There was a positive dynamics of pain syndrome according to VAS and decrease in the level of the WOMAC index in both groups after 2 weeks of therapy. The pain level (VAS) and WOMAC indices in 1st group achieved after 8 weeks significantly differed from the ones after 2 weeks of therapy (VAS dynamics —10.93±2.43 mm, t = 42.64; p<0.001). In both groups we noted gradual significant increase in the average pain level according to VAS and WOMAC indices after NSAIDs cancellation. However, there was better control of pain in 1st group with long-term NSAID than in 2nd one. Safety profile of drug therapy was similar in both groups.

Conclusion. The long-term 8-week use of NSAIDs in patients with knee osteoarthritis with insufficient efficacy “on demand” NSAIDs and SYSADOA provides better dynamics of the pain syndrome than with 2-week therapy. After treatment is canceled longer prior NSAID therapy contributes to better control of the pain syndrome. Continuous use of NSAIDs demonstrated good tolerance and safety, did not require dose reduction and/or discontinuation of therapy. Thus, anti-inflammatory therapy of osteoarthritis in this group of patients may be prescribed for a longer period with continuous use of NSAIDs.

Traumatology and Orthopedics of Russia. 2020;26(2):120-127
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The Use of a Corrugated Suture for Cortical Fixation of a Semitendinosus Tendon Autograft in Anterior Cruciate Ligament Reconstruction: Clinical Results

Slastinin V.V., Yarygin N.V., Parshikov M.V., Fain A.M., Sychevskiy M.V., Govorov M.V.

Abstract

The study purpose — to evaluate the clinical results and the condition of bone tunnels after anterior cruciate ligament reconstruction with a semitendinosus tendon graft using cortical fixation and corrugated sutures.

Materials and Methods. The results anterior cruciate ligament reconstruction with a semitendinosus tendon autograft were analyzed in 57 patients aged 18 to 53 years. The patients of the first group (n = 27) underwent anterior cruciate ligament reconstruction with a semitendinosus tendon graft using cortical fixation on the femur and tibia in combination with corrugated sutures at the proximal and distal ends of the graft. The patients of the second group (n = 30) underwent anterior cruciate ligament reconstruction in a similar way, but without the use of corrugated sutures. Clinical results were assessed using the Lysholm and IKDC scales. The degree of bone tunnels widening was evaluated by CT data in 6 months after the surgery.

Results. In the first group, the degree of postoperative bone tunnels widening was significantly lower (for the femoral tunnel by 18% and tibial — by 17%) compared with the second group (for the femoral tunnel by 30% and tibial — by 31%). Scores by the IKDC 2000 and Lysholm scales were higher in the corrugated sutured group. Although, the treatment outcome was interpreted as equally good for both groups. The time for graft preparation was on average 6 minutes longer in the first group. This slightly increased the duration of the surgery.

Conclusion. The anterior cruciate ligament reconstruction with a semitendinosus tendon graft using cortical fixation on the femur and tibia in combination with corrugated sutures ensured the tight contact of the tendon inside the bone tunnels without additional implants and reduced the degree of tunnels widening. This is important for a possible re-grafting. The proposed method does not significantly affect the clinical outcomes.

Traumatology and Orthopedics of Russia. 2020;26(2):128-138
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Cage Subsidence after Surgery on the Anterior Part of the Subaxial Cervical Spine: a Monocentric Prospective Clinical Study with a 3-Year Follow-Up

Kolesov S.V., Kazmin A.I., Skorina I.V., Shvets V.V., Sazhnev M.L., Panteleev A.A., Pereverzev V.S., Kolbovski D.A.

Abstract

The choice of an implant for vertebra body defect replacement in corpectomy for traumatic lesions remains a point of discussion among spinal surgeons. Nanostructured carbon cages are promising for use in spinal surgery.

The purpose of this study was to determine the rate and degree of cage subsidence in the patients with traumatic lesions of the cervical spine undergone a single-level anterior corpectomy in the subaxial part of the cervical spine with reconstruction using a carbon or titanium cage.

Materials and Methods. A prospective study included 47 patients undergone a single-level corpectomy of the cervical spine due to traumatic injury. Two groups were formed by adaptive randomization: group I with the patients with carbon cages (n = 23), and group II with the patients with titanium cages (n = 24). The evaluation of cages subsidence and stability was carried by X-rays and CT before and after surgery. The quality of life before and after the surgery was evaluated using NDI and VAS questionnaires.

Results. According to the questionnaires, the absolute majority of the patients in both groups showed a statistically significant improvement of quality of life in the postoperative period (p<0.01). The first signs of implant subsidence were noted 3 months after surgery in group II. There were none of such cases in group I. The final result of the subsidence at the end of the follow-up comprised: for group I 0.6±0.4 mm, for group II 3.1±1.4 mm (p = 0.023). In group II, the bone block between bone tissue and the cage was recorded in 30% of patients (p = 0.037), in group I, the bone block was not formed. At the same time, according to the functional X-ray data, there were no signs of carbon cages instability in group I. None of the patients in groups I and II required revision surgery due to complications associated with cages placement.

Conclusion. The outcomes of carbon nanostructure cages placement as bodyreplacing implants in the cervical spine were not inferior to the outcomes of titanium mesh cages using. In group I, the carbon cages subsidence was significantly lower than in group II with titanium cages. The bone block was not formed in the case of carbon cages. It is worth noting that the carbon structure of the cages allowed the radiological diagnostics of the operated segment without artifacts formation.

Traumatology and Orthopedics of Russia. 2020;26(2):139-147
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Double Trabecular Tantalum Cones as an Alternative to Additive Technologies for Revision Knee Arthroplasty (A Case Series)

Kulyaba T.A., Kornilov N.N., Kazemirskiy A.V., Bovkis G.Y., Stafeev D.V., Cherny A.A., Croitoru I.I., Petukhov A.I.

Abstract

Relevance. To compensate the extensive (AORI type III) bone defects, metal cones/ sleeves or massive allografts are used. In the absence of metaepiphyses, structural allografts or megaprostheses are usually used for tumor lesions of the bones. The aim of the study was to show the possibility of replacing extensive type III defects of the femur and tibia, covering the metaphysical and diaphyseal zones, with double tantalum cones.

Materials and Methods. The study included 13 patients undergone revision knee arthroplasty in 2015–2019. During the surgery, the primary fixation of the femoral or tibial component was achieved by the tight fit diaphyseal cone placement. The additional fixation is сarried out by cementing of the metaphyseal cone to the diaphyseal cone and the further osseointegration with the remaining bone of the metadiaphyseal zone. Fixation of the endoprosthesis component to the cones and to the bone is achived by use of the bone cement.

Results. The short-term outcomes of this technique in revision knee arthroplasty were evaluated in all patients. The results were evaluated as good if the primary stable fixation and the correct endoprosthesis components placement were achieved, the limb support ability and the knee function were restored, and there were no complications in the immediate postoperative period. In a year, one patient developed a relapse of infection in the operated knee. The endoprosthesis was removed and followed by knee arthrodesis after sanitation of the infection focus. Functional and radiological results one year after surgery were studied in 4 patients. The average functional scores were: by KSS 81 (good) and by WOMAC — 25 points (also good). On the control radiographs, the position of the components remained correct and stable with osseointegration of the cones in the metaphyseal and diaphyseal areas of the femur and tibia. In the remaining 8 patients, the time after surgery was less than a year. Their follow-up yet continued.

Conclusion. Thus, the tantalum cones technique is a reliable way to reconstruct extended metadiaphyseal defects in revision knee arthroplasty in the short-term prospect. The method can be considered as an alternative to megaprostheses, structural allografts, and individually made cones. But the long-term results of its application are still requiri ng further study.

Traumatology and Orthopedics of Russia. 2020;26(2):148-159
pages 148-159 views

REVIEW

Cementless Hip Implants: History and Current Status of the Issue

Shubnyakov I.I., Riahi A., Shubnyakov M.I., Denisov A.O., Khujanazarov I.E., Tikhilov R.M.

Abstract

Background. Total hip arthroplasty is an effective type of surgery with excellent survival rates of modern implants. From the very beginning of the widespread introduction of total hip arthroplasty, the cement technique of components fixing prevailed. However, many researchers associated the development of osteolysis and the following loosening with the reaction to cement. The subsequent studies clarified the situation regarding the nature of osteolysis, but there remained the problem of insufficient stability of the cemented stems to withstand the penetration of polyethylene wear particles into the distal part of the stem with the development of loosening. An ideal endoprosthesis should ensure the normal hip biomechanics, joint painless functioning and improve the quality of life of the patient without the need for revision. The optimal results of cementless femoral stems functioning depend on the achievement of initial stability, osseointegration and equable transmission of tension onto the femur. There are many factors that influence osseointegration processes and the subsequent behavior of the implant. Understanding these factors is the key to choosing the optimal implant for a particular patient, taking into account the anatomical features of the femur.

The purpose of this article is to discuss upon the literature review the application of cementless femoral components, the possible causes of failure and its prevention from the point of view of the evidence-based practice.

Materials. The search was conducted in the PubMed, eLIBRARY databases and through the Web of Knowledge. Survival rates and prevalence of various implants in the structure of primary arthroplasty were estimated on the basis of annual reports of a number of national registries, as well as the hip arthroplasty registry of the Vreden National Medical Research Center of Traumatology and Orthopedics. Among the factors discussed are the properties of the components material, the form of the implants, surface properties, and the influence of the anatomical features of the femur. Additionally, the most used types of cementless femoral components were assessed.

Conclusion. Cementless femoral components demonstrated the excellent long-term survival and functional results. The currently prevailing type of the prosthesis intimate attachment to the bone is the biological fixation, especially in groups of young patients. Future studies of cementless implants should necessarily take into account the patient’s age, level of activity, type of bone canal, the presence of deformities, and the friction pair used. This will make it possible to draw clearer conclusions in what clinical situation it is advisable to use the femoral components of a particular design.

Traumatology and Orthopedics of Russia. 2020;26(2):160-179
pages 160-179 views

Dislocations after Hip Arthroplasty (Review)

Sereda A.P., Smetanin S.M.

Abstract

One of hip arthroplasty complications is dislocation of the endoprosthesis head. In the vast majority of cases, the cause of dislocation is multifactorial. That is why only a thorough analysis of the patient’s peculiarities, surgery and rehabilitation will help to avoid the relapse. This review analyzed the risk factors of dislocation and treatment tactics. Risk factors associated with the patient include: old age, male gender, obesity, concomitant diseases, low level of preoperative physical activity, low compliance and a some others. The problem of the biomechanical ratio in the segment “spine – pelvis – lower limb” deserves special attention. Besides, there are risk factors associated with the surgeon: access option; type, fixation and position of endoprosthesis components, experience and surgical technique of a orthopedic surgeon. The strategy of dislocations rate reduction is based on a detailed study of dislocation causes and their elimination, and adequate surgery planning. The treatment of a patient with dislocation should take into account the multifactorial etiology of the condition.
Traumatology and Orthopedics of Russia. 2020;26(2):180-200
pages 180-200 views

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