Vol 20, No 2 (2014)

ORIGINAL ARTICLES

THE STRUCTURE OF EARLY REVISIONS AFTER HIP REPLACEMENT

Tikhilov R.M., Shubnyakov I.I., Kovalenko A.N., Totoyev Z.A., Lyu B., Bilyk S.S.

Abstract

The authors retrospectively reviewed RNIITO Arthroplasty Registry data of revision total hip arthroplasties performed in RNIITO in 3 year period (2011-2013). Part of early revisions within 5 years after the index procedure in general revision structure was 33% . Two hundred seventy three (64%) procedures had infection reason, 79 (19%) - aseptic loosening, 35 (8%) - dislocation and 27 (6%) - periprosthetic fractures in reasons of revision, respectively. More than half of revisions were performed within the first year after the index procedure. Early primary revisions after index total hip arthroplasty were performed in 254 (59,8%)cases, and repeated revisions were performed in 171cases one or more times. Of early primary revisions 125(49,2%) patients had index total hip athroplasty in our hospital, and 129 (50,8%) patients had index total hip athroplasty in other hospitals of Russian Federation. Our THA early revision structure is differs significantly from published in literature, moreover there is difference between revision reasons after primary total hip arthroplasty of our hospital and other hospitals. Revision reasons structure doesn’t show rate of primary THA complications, but defines main problems that should be solved.
Traumatology and Orthopedics of Russia. 2014;20(2):5-13
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SHORTAND MIDDLE-TERM RESULTS OF HIP ARTHROPLASTY FOR TUMORS OF THE PROXIMAL FEMUR

Tikhilov R.M., Ptashnikov D.A., Zasulskiy P.J., Mikailov I.M., Grigoriev P.V., Pliev D.G.

Abstract

A purpose of the study was to evaluate the immediate and medium-term outcomes of the treatment of patients with primary tumor lesions of proximal femur after the lesion resection together with total hip arthroplastyby total revision systems. Material and methods. 34 patients with primary tumors of proximal femur [chondrosarcoma - 9 (26.5%),giant cell tumor - II (32.4%),osteosarcoma - 2 (5.8%), other malignancies - 5 (14.7%),benign neoplasms - 7 (20.6%)] underwent the conserving surgery at R.R. Vreden Russian Research Institute of Traumatology and Orthopedics since 2003 through 2013. The follow-up was from one to five years. The age of patients ranged from 16 to 70 years, patients younger than 40 years accounted for 61.8%. Acetabulum was replaced by standard components. To replace post-resection defects of proximal femur, in 21 (61.8%) patents revision legs of cementless fixation Wagner Revision (Zimmer) were used, in 10 (29.4%) - “Fenix”, and in 3 (8.8%) - Solution (DePuy, J&J). Results. A technique of total hip arthroplasty with the use of revision systems demonstrated excellent and positive results in 32 (94.2%) cases. Complications leading to revision surgery occurred in 3 (8.8%) patients. Conclusion. The method allows achievement of favorable functional outcomes and early patients’ activation without worsening the oncologic component of treatment and being not inferior to expensive modular systems.
Traumatology and Orthopedics of Russia. 2014;20(2):14-21
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EVALUATION OF DEBRIDEMENT EFFECTIVENESS FOR THE TREATMENT OF PERIPROSTHETIC JOINT INFECTIONS OF THE HIP

Lyu B., Tikhilov R.M., Shubnyakov I.I., Bozhkova S.A., Artyukh V.A., Denisov A.O.

Abstract

Purpose - evaluation of the effectiveness of debridement in the treatment of periprosthetic infection and detection of possible factors affecting the outcome. Material and methods: Analysis of the effectiveness of treatment in 125 patients with periprosthetic infection operated at Vreden Russian Research Institute of Traumatology and Orthopedics in 2008-2012 was carried out. All patients underwent endoprosthesis-saving sanitation surgery at different times. The effectiveness of surgery was evaluated using clinical, X-ray, laboratory, and statistical methods. To estimate a subjective component, Harris and visual analog scales were used. Results: Recurrent infections after sanitation surgery were detected in 20 (15.7%) patients (Group 1). 105 (84%) patients in the follow-up of above 12 months demonstrated remission of infectious process (Group 2). Cardiovascular pathology and obesity were significantly more common in Group 1 patients (р<0.01). In 63% patients of Group 2 sanitation operation was performed within a month after primary arthroplasty, whereas in patients with relapses this figure was only 25% (р<0.01).Gram-positive bacteria dominated in the spectrum of pathogens of periprosthetic infection in both study groups, however, S. epidermidis was somewhat more common in the group with relapses. Conclusion: The time of sanitation surgery, cardiovascular diseases and bacterial species are the main risk factors leading to recurrent infections.
Traumatology and Orthopedics of Russia. 2014;20(2):22-29
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EFFECTIVENESS OF RADIOFREQUENCY DENERVATION FOR PAIN RELIEF IN HIP DEGENERATIVE DISEASES

Nazarenko G.I., Cherkashov A.M., Kuz'min V.I., Sharamko T.G., Gorokhov M.A.

Abstract

Objective - to compare the effectiveness of radiofrequency denervation (RFD) and conservative treatment of patients with hip degenerative diseases. Material and methods. 66 patients with various stages of hip degeneration were followed up for 12 months, including 36 patients who underwent RFD and 30 patients of control group with conservative treatment. Treatment results were assessed using Visual Analogue Scale (VAS) and Harris Hip Score before treatment, during the first day, 2 days later, as well as at 1, 6 and 12 months. Results: RFD patients demonstrated significantly better results compared with conservative group. Patients with coxarthrosis stage I and II, besides higher efficiency had prolonged period of remission, while patients with coxarthrosis stage III returned to the near-baseline level of pain only in 3-6 months. Conclusions: RFD is an effective treatment modality for patients with initial coxarthrosis stages, which helps to reduce significantly the disability period compared with conservative therapy. RFD is the only method of effective hip pain relieve in patients with severe comorbidities allowing to reduce analgesic consumption. This method is minimally invasive, has low cost, permits repeated procedures, making it attractive for both physicians and patients.
Traumatology and Orthopedics of Russia. 2014;20(2):30-36
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EARLY AND LONG-TERM RESULTS OF SURGICAL TREATMENT OF THE THORACIC AND LUMBAR VERTEBRAL AND SPINAL TRAUMA

Usikov V.D., Vorontsov K.E., Kuftov V.S., Ershov N.I.

Abstract

The article demonstrates the outcomes of operative treatment of 190 patients with spinal cord injuryof thoracic and lumbar spine for 10 years. Associated injuries were revealed in 96 patients, the mean ISS score being27.5. All patients underwent decompressive and stabilizing interventions using a transpedicular system of “Synthes” production (Saint Petersburg). Ventral interventions were performed in 27 (14.2%) patients. In all cases, decompression of the spinal canalcontents at the level of damage was achieved. In those patients who were operated within two weeks after trauma, transpedicular system allowed for recovery of a form and size of the spinal canal and the damaged vertebral body. The fractures of transpedicular system were observed in patients operated both with only rear and with combined access. The errors and complications, which happened during surgery, did not influence the outcomes of treatment. The outcomes of treatment were assessed according to the neurological statusdynamics (ASIA score), recovery of support ability of the spine, the presence of pain, and patients’ recovery (Е Denis score). Favorable outcomes were achieved in 114 (61.3%) patients, satisfactoryin 53 (28.5%),and poor in 19 (10.2 %).
Traumatology and Orthopedics of Russia. 2014;20(2):37-44
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ENDOSCOPIC SURGICAL TREATMENT OF RECURRENT BAKER’S CYSTS

Dulaev A.K., Zayats V.V., Dydykin A.V., Dzhusoev I.G.

Abstract

Purpose of the study - to study the causes of synovitis in patients with recurrent Baker’s cyst, to evaluate the effectiveness of endoscopic treatment of popliteal cysts . Materials and methods. From 2009 till 2013 we observed 34 patients with Baker's cyst. In 18 (52.9%) patients of the main group endoscopic technique was applied, in 16 (47.1%) patients of the comparison group a cystic bag was isolated and dissected with open technique, and then cystic gate was sutured. Results. In 10 (55,6%) patients of the main group the pain disappeared in the first postoperative day (p<0,05), the average hospital stay was 3,5±0,6 days (p<0,05), and the knee function completely recovered in 16 (88.9%) patients in 2 weeks postoperatively (p<0,05). A year later in 1 (5.6%) patients of the main group the signs of knee function disorders of 1 degree on a Rauschning & Lindgren scale were revealed, and in the comparison group - in 6 (37.5%) patients - disorders of varying severity (p <0.05). In 4 (25,0%) patients of the comparison group the recurrence of Baker’s cyst developed that required arthroscopic treatment, followed by complete recovery. Conclusions: Formation of Baker’s cyst is associated with an excess formation and accumulation of a synovial fluid in the knee joint owing to chronic damage of the meniscus and synovial membrane disease (p <0,05). Endoscopic technique allows to eliminate the causes of synovitis and the valve mechanism of fluid flow in the gastrocnemius-semimembranosus bag, to stop pain at earlier date, to restore the amplitude of active movement in the knee, to reduce the hospital stay and the risk of cyst recurrence, to prevent scarring in popliteal region (p <0,05).
Traumatology and Orthopedics of Russia. 2014;20(2):45-52
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TREATMENT OF BRACHIMETATARSIA IN CHILDREN

Kovalenko-Klychkova N.A.

Abstract

Brachimetatarsia is a malformation of one or more of the metatarsal bones, characterized by its shortening. Abnormal anatomy of the forefoot leads to the convergence of epiphyses of adjacent metatarsals, deformation of the forefeet, including the formation of hallux valgus, pain and cosmetic defects. The authors have conducted the surgical treatment (lengthening the shortened metatarsal bones) in 18 female patients (28 feet, 32 metatarsal bones) and determined the optimal method of surgical correction. Depending on the severity of metatarsal bone shortening 3 methods of surgical treatment were applied: in shortening of less than 1,2 cm -the slide osteotomy; in shortening up to 1.8 cm - a one-staged lengthening of metatarsal bone with autograft; more than 1.8 cm - the distraction osteosynthesis. Due to existing disorders it is advisable to perform restoration of the shortened toe length according to the type of the metatarsal parabola, inherent to the patient. The optimal method of surgical treatment is a one-staged lengthening of the shortened metatarsal bone with the use of autograft from the iliac wing borrowed by means of “window-form” method without damage to the integrity of the apophysis.
Traumatology and Orthopedics of Russia. 2014;20(2):53-61
pages 53-61 views

POSTERIOR INTEROSSEOUS FLAP IN PEDIATRIC HAND RECONSTRUCTIONS

Golubev I.O., Grishin V.M.

Abstract

Purpose: to assess early and long-term results of the pediatric hand reconstructions with posterior interosseous flap, including those in children younger than 3 years old. Materials and methods: results of the hand reconstructions with posterior interosseous artery reverse flap were studied in 10 children (4 males and 6 females) aged from 1 year and 1 month to 13 years old. In 4 cases flap coverage were performed due to acquired posttraumatic hand deformity, in 6 cases reconstruction was assumed for congenital hand deformities. Combined procedures consisted of posterior interosseous artery flap coverage and other types of microsurgical reconstructions were suggested in 4 patients. Preoperative color doppler visualization of the posterior interosseous vessels were mandatory. All flaps were risen under 3.5x-4.5x magnification. Results: all flaps survived completely in 3 weeks postoperatively. There were no postoperative complications such as flap’s arterial or venous insufficiency, deep infection, or posterior interosseous nerve palsy. Nearly whole group (9 of 10) of patients and/or their parents were satisfied with the esthetic view of the reconstructed hand and donor site of the forearm 1 year postoperatively. Conclusion: posterior interosseous flap is a reliable and versatile option in pediatric hand reconstructions, providing excellent skin coverage with good color match and texture. Preservation of major vascular bundles of the forearm (radial and ulnar arteries) during flap harvest gives a possibility to perform a simultaneous microsurgical reconstructions of the hand (e.g. free toe transfer).
Traumatology and Orthopedics of Russia. 2014;20(2):62-67
pages 62-67 views

THEORETICAL AND EXPERIMENTAL STUDIES

EXPERIMENTAL AND CLINICAL STUDY OF PHENOTYPIC FEATURES OF S. EPIDERMIDIS STRAINS AND THEIR ROLE IN THE EMERGENCE AND DEVELOPMENT OF IMPLANT-ASSOCIATED INFECTION AFTER ORTHOPAEDIC SURGERY

Bozhkova S.A., Bogdanova T.Y., Krasnova M.V., Anisimova L.O., Netyl'ko G.I., Rukina A.N., Lyu B.

Abstract

S. epidermidis is one of the most common cause of implant-associated infections. Infections due to S. epidermidis rarely develops into life-threatening, however, its prevalence and the difficulties in treating constitute a serious financial burden to the health care system. This study is based on the investigation of phenotypic features (ability to biofilm formation and resistance to antibiotics) of S. epidermidis strains isolated from patients with deep surgical site infection after implantation of orthopaedic devices, and on the investigation of the dynamics of clinical and morphological changes during the development of implant-associated infection due to S. epidermidis based on in vivo experimental models. Multidrug-resistance was found in 23% MSSE isolates and 97,3% - MRSE. Vancomycin, linezolid and fosfomycin were the most active in relation to these pathogens. About 40% of the tested isolates were strong biofilm-producing strains. 43,2% of MRSE strains and only 21,4% of MSSE isolates demonstrated strong biofilm production. The proposed experimental model shows that intra-operative infection of implant by multidrug-resistant clinical MRSE strain led to the development of osteomyelitis in rats for 4 weeks after surgery, in spite of the revision operation and installation of antimicrobial cement spacer in the area of bone defect. Thus, S. epidermidis is a clinically significant aetiological factor with high risk of development of infections after major orthopaedic surgery.
Traumatology and Orthopedics of Russia. 2014;20(2):68-77
pages 68-77 views

MORPHOFUNCTIONAL STATUS OF REGIONAL LYMPH NODES IN CONDITIONS OF INTRAMEDULLARY OSTEOSYNTHESIS BY RETAINERS WITH COAT BASED ON SUPERHARD COMPOUNDS

Akhtyamov I.F., Gatina E.B., Shakirova F.V., Baklanova D.A., Aliev E.I.

Abstract

Objective: to evaluate the morphofunctional state of the popliteal lymph nodes of the operated and intact pelvic rabbit limbs in conditions of intramedullary fixation of the tibia fracture with the implant coated with titanium nitride and hafnium. A morphological study of two groups of experimental animals was conducted. Osteoclasis of tibia and subsequent osteosynthesis with medical steel needles coated with and without titanium nitride and hafnium was made. In the lymph nodes of the animals in the comparison group both inflammatory (acute and chronic lymphadenitis) and immunomorfologycal (hyperplasia of T-and B-dependent areas, sinus histiocytosis) reactions were observed, with the latter being more common in the operated limb, and the inflammatory - in the intact one. The obtained data have proved the feasibility of using metal structures coated with nitrides of group IV metals (titanium and hafnium) for external osteosynthesis.
Traumatology and Orthopedics of Russia. 2014;20(2):78-84
pages 78-84 views

EXPERIENCE EXCHANGE

RESULTS OF SHOULDER STABILIZATION BY A MODIFIED BRISTOW - LATARJET PROCEDURE WITH ARTHROSCOPY

Gladkov R.V., Rikun O.V., Averkiev D.V., Grankin A.S.

Abstract

The authors describe the minimally invasive technique for Bristow-Latarjet bone unfree autoplasty with arthroscopy in patients with bone loss more than 25% of anterior-posterior diameter of the glenoid, the poor quality of the capsule or deep defects of Hill-Sachs. The analysis of the early results of treatment in 19 patients and midterm results - in 13 soldiers operated in 2011-2014. Features of the proposed technique are the shortening of surgical approach and the reduction of subscapularis muscle damage. In addition, arthroscopic support allows to attain the precision location of the graft relative to the articular surface of scapula, at the same time restoring the damaged anatomy SLAP, rotator cuff tendons and posterior labrum and restore shoulder ligaments tension and isolate bone graft from the joint cavity, contributing to a better articulation of the humeral head and reducing the risk of nonunion and resorption.
Traumatology and Orthopedics of Russia. 2014;20(2):85-92
pages 85-92 views

BUILDING OF EXTENSIVE DIAPHYSIS DEFECTS IN LONG BONES

Barabash A.P., Kesov L.A., Barabash J.A., Shpinyak S.P.

Abstract

The problem of extensive diaphysis bone defect replacement in long bones has been investigated. Treatment results of three patients (one with neoplastic process, two with supparative bone damage) are given. The sizes of defects were from 16 to 20 cm. Su pervision terms consisted 1-3 years. There were two defect replacement variants: cellular titanium nickelide alongside with interlocking internal fixation - in 2 patients, and metallic prosthesis of ProSpon company (Czech Republic) - in 4 patients. Two patients after segmental resection of limb bone tumours and diaphysis endoprosthesis show positive treatment results. Long-term treatment by different methods in 4 patients with chronic fistulous form of post-traumatic osteomyelitis were unsuccessful.
Traumatology and Orthopedics of Russia. 2014;20(2):93-99
pages 93-99 views

SURGICAL TREATMENT OF ANEURYSMAL PELVIC BONE CYSTS IN CHILDREN

Zubairov T.F., Pozdeev A.P.

Abstract

The outcomes of evaluation and treatment of 9 patients aged from 3 to 17 years with aneurismal Ilium cysts (AIC) are described. All patients with AIC were operated in a stage of delimitation. A surgical technique including an open removal of abnormal tissue with replacing a formed bone defect with an osteoplastic materialin isolation or in combination with an unfreebone graft out of iliac crest was applied for treatment. Recurrence of the pathological process was not observed in any case. Inactive residual cavities were found in 3 patients. 6 patients demonstrated complete organotypic restructuring of allografts in the zone of surgery. Application of a wedge resection of the pathological focus accompanied by post-resection defect grafting with a mix of cortical and demineralized allografts, localization of aneurysmal cyst in the ilium wing, and performing combined bone grafting to treat a pathological focus located in over-acetabular area, demonstrated favorable outcomes in a 4-year follow-up.
Traumatology and Orthopedics of Russia. 2014;20(2):100-106
pages 100-106 views

TRAUMA AND ORTHOPEDIC CARE

ORGANIZATION OF CORRECT TREATMENT OF PATIENTS WITH PROXIMAL FEMORAL FRACTURES

Klyuchevskiy V.V., Belov M.V., Bystrov S.V., Serov I.A.

Abstract

A retrospective analysis of the quality of specialized care provided to 820 patients with proximal femur fractures (PFF) at Solovyov Hospital (Yaroslavl) in 2013 was performed. A direct relationship was established between the time elapsed from the injury to hospital admission and the rate of vein thrombosis of the lower limbs. Operative activity in the treatment of patients with this pathology was 91.7%. A need for different implants for operative treatment of patients with this injury per 100,000 population was determined. Operative treatment of PFF in elderly and old-aged people should be considered a life-saving procedure to be performed on urgent indications(within 24 to 48 hours since the injury).
Traumatology and Orthopedics of Russia. 2014;20(2):107-111
pages 107-111 views

REVIEWS

COMPARATIVE ANALYSIS OF TOTAL KNEE ARTHROPLASTY REGISTERS (REVIEW)

Tikhilov R.M., Komilov N.N., Kulyba T.A., Fil A.S., Drozdova P.V., Petukhov A.I.

Abstract

The rapid growth the number of joint replacements in the second half of the XX century required the creation of a system for monitoring the results of these operations. The most promising organizational structure that takes into account the number of performed surgeries and evaluates its results, is a national arthroplasty register. Followed by Sweden, where the first time the National Register of knee arthroplasty was created in 1975, many countries in Europe and North America began to develop own registers in the field of traumatology and orthopedics. By publishing annual reports and scientific papers, as well as through participation in national and international conferences, register distributes information to doctors, health care administrators, manufacturers and other interested bodies, allowing to track the results of arthroplasty at all levels, from the certain hospital to the international level. The authors of this review provide the analysis of the structure of existing registers of knee replacement and compare it with randomized clinical trials.
Traumatology and Orthopedics of Russia. 2014;20(2):112-121
pages 112-121 views

CONSERVATIVE TREATMENT OF CHILDREN WITH VERTEBRAL COMPRESSION FRACTURES OF THORACIC AND LUMBAR SPINE USING ORTHOSIS (REVIEW)

Pavlov I.V., Vissarionov S.V., Gusev M.G., Lein G.A.

Abstract

A review of the literature on conservative and restorative treatment of children with vertebral compression fractures of thoracic and lumbar spine is presented. Conventional treatment techniques with prolonged bed rest and application of braces onlyduring the recovery period are described. In addition, the issues of early application of functional braces as the main treatment modality for patients with compression fractures are considered. This work demonstrated that an issue of conservative treatment of compression spine fractures using orthotics as the main treatment requiresfurther study.
Traumatology and Orthopedics of Russia. 2014;20(2):122-129
pages 122-129 views

JUBILEE

NEVEROV VALENTIN A.

Article E.
Traumatology and Orthopedics of Russia. 2014;20(2):130-131
pages 130-131 views

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