Vol 28, No 1 (2022)


Orthopedic Consequences of COVID-19

Tikhilov R.M., Sereda A.P.
Traumatology and Orthopedics of Russia. 2022;28(1):5-6
pages 5-6 views


Comorbidity Index as a Risk Factor of Knee PJI Recurrence After Spacer Implantation

Preobrazhensky P.M., Bozhkova S.A., Kazemirsky A.V.


Background. Patient-related risk factors for periprosthetic joint infection (PJI) are currently investigated in detail. However, the influence of those factors on PJI recurrence and their confounding effect was not investigated. Identifying factors that influence PJI recurrence and establishing the role of each risk factor are important.

The study aimed to analyze the comorbidity structure in patients with knee PJI and create, based on obtained data, a rating scale that allows predicting the probability of PJI recurrence after spacer implantation.

Methods. A single-center study was conducted based on retrospective data of 161 patients with PJI after primary total knee arthroplasty treated with staged reimplantation from January 2007 to January 2017. To clarify comorbidity structure and the most important risk factors, all patients were divided into two groups: patients with PJI recurrence after spacer implantation (group 1, n = 48) and patients who successfully passed spacer implantation (n = 113, group 2). Based on the obtained data, the frequency of comorbidities was analyzed. The list included 17 points that characterized the presence and severity of different comorbidities. Then, we conducted a logistic regression analysis to identify the significance of each factor and thresholds for the comorbidity index (CI) for the interpretation of the final score. With the presented scale, spacer implantation in the compared groups was analyzed.

Results. The most significant comorbidities were anemia, chronic kidney disease, obesity, and cardiovascular pathology. The CI thresholds were calculated, which allowed interpretation of the obtained score. The distribution of patients by risk categories within each group was also analyzed, and differences between groups were determined. The CI value corresponding to the minimal risk of PJI recurrence was more common (p<0.0001) in group 1. Moreover, more than half of the patients with failed spacer implantation had a high risk of PJI recurrence according the CI value, and only 6.2% of patients who had successful treatment had CI high value (p<0.0001).

Conclusions. The multivariate analysis of the presence and severity of concomitant pathologies enabled the development of a comorbidity scale with the calculation of an integral indicator (comorbidity index) and establishment of its threshold values. The proposed CI could be the basis for a combined relapse risk calculator and an algorithm for choosing the surgical treatment strategy in patients with knee PJI, which requires further investigation.

Traumatology and Orthopedics of Russia. 2022;28(1):7-18
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Pelvic Osteotomies for Treatment of Young Patients With Hip Osteoarthritis Secondary to Developmental Dysplasia

Teplenky M.P., Oleinikov E.V., Bunov V.S., Fozilov J.T.


Background. The value of joint-sparing reconstructive procedures in patients with osteoarthritis in a dysplastic hip is controversial.

The study aimed to evaluate the immediate and mid-term results of reconstructive interventions performed in patients with this pathology.

Methods. The treatment results of 30 patients aged 14–40 years with osteoarthritis in the dysplastic hip were analyzed. The mean follow-up time was 6.8±1.5 years in group 1 and 4.1±0.7 years in group 2. The clinical condition and treatment results were assessed by D’Aubigne-Postel, Severin, Tonnis criteria, and the Ilizarov Center system. In all cases, extra-articular reconstructive procedures were performed on both articular components.

Results. The patients were divided into two groups by age. In group 1 (14–18 years), the functional result was 16.0±0.5 points. According to the Severin criteria, the joints were distributed as follows: Ia, 7; IIa, 7; IIb, 2; and III, 3. The degree of hip osteoarthritis did not change in 13 joints. Osteoarthritis progressed in one joint, and arthritic changes regressed in four joints. The treatment results according to the criteria of the RSC VTO were good in 14 joints, satisfactory in 5, and unsatisfactory in 1. In group 2 (>18 years, n = 11), the functional result was 15.0±0.4 points. The distribution of joints according to the Severin criteria was as follows: Ia, 3; IIa, 6, and III, 2. The degree of osteoarthritis did not change in 10 joints. Osteoarthritis progressed in one joint. The treatment results according to the criteria of the Ilizarov Center were good in seven joints, satisfactory in three, and unsatisfactory in one.

Conclusions. The differentiated use of joint-sparing reconstructive procedures makes it possible to slow down the progression of the pathological process in the joint even in patients with developed osteoarthritis and, in some cases, to use them as a temporary alternative to endoprosthesis in adolescents and young adults.

Traumatology and Orthopedics of Russia. 2022;28(1):19-27
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Adsorbent Dressings from Sodium Carboxymethyl Cellulose With Silver Ions in Primary Knee Arthroplasty: A Randomized Trial

Chugaev D.V., Konovalchuk N.S., Kogan P.G., Kornilov N.N., Sorokin E.P., Glaznyov D.N.


Background. The ideal wound dressing should have complex positive affect on a postoperative wound healing: absorb excessive wound exudate, allow adequate gas exchange, prevent secondary infectious complications, create optimal humidity, be durable and not to restrict patients’ mobility, which is crucial for early mobilization after total knee arthroplasty. We carried out this research to asses the effectiveness and safety of contemporary adhesive wound dressings and if they do have the abovementioned qualities.

Aim — to assess the effect of using absorbing wound dressing made from sodium carboxymethyl cellulose with silver ions on the quality of rehabilitation and the rate of superficial infection occurrence in patients who underwent total knee joint arthroplasty.

Methods. This prospective randomized (simple randomization) paralleled open study included 200 patients with terminal stage knee arthritis, who required total knee joint arthroplasty. Patients were divided into three groups, in two of the groups the innovate wound dressing made from sodium carboxymethyl cellulose with silver ions was used, in the third group traditional wound dressing was used.

Results. In the course of this study, it was confirmed that there was no statistically significant difference in pain syndrome intensity in the early postoperative period or Knee Society Score (KSS) at 3 months postoperatively in regard of type of wound dressing and time of its application. Subjectively the most comfortable wound cover method for the patients was the usage of adhesive dressings with silver impregnation from the first day postoperatively. As complications we observed epidermal blistering under the dressing, superficial wound necrosis, superficial wound infection and formation of prominent and rough postoperative scars. The highest rate of blistering was observed in patients with traditional patch wound dressing.

Conclusions. The usage of absorbing wound dressing made from sodium carboxymethyl cellulose with silver ions in our current study did not affect the rate of infectious complications and did not have any negative effects on rehabilitation. The usage of innovate dressings reduced the rate of epidermal blistering associated with dressings.

Traumatology and Orthopedics of Russia. 2022;28(1):28-38
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Protein-Energy Malnutrition as a Predictor of Early Recurrent Revisions After Debridement Surgery in Patients With Difficult-to-Treat Periprosthetic Infection

Bozhkova S.A., Liventsov V.N., Tikhilov R.M., Romano C.L., Kochish A.Y., Labutin D.V., Artyukh V.A.


Background. Protein-energy malnutrition (PEM) is an established risk factor of postoperative complications in orthopedic disorders, including arthroplasty of the large joints.

The study aimed to evaluate PEM prevalence and its association with the early postoperative revision in patients with the difficult-to-treat (DTT) prosthetic joint infection (PJI) of the hip.

Methods. The retrospective study included 132 patients with chronic DTT PJI of the hip. The patients underwent orthopedic implant removal, radical debridement of the infected tissues, and resection arthroplasty with non-free transplantation of an axial vastus lateralis muscle flap (n = 57) or installation of an antimicrobial spacer (n = 75). DTT PJI was defined as an infection caused by rifampicin-resistant staphylococcal strains, ciprofloxacin-resistant gram-negative bacteria, fungi of the genus Candida, and their associations. The assessment of the patient’s protein-energy status included the evaluation of reference laboratory parameters, such as levels of hemoglobin, total protein, and albumin and number of lymphocytes. The degree of PEM was determined by the number of laboratory markers below the threshold values. The statistical comparison was performed using Fisher’s test. The odds ratio (OR, 95% confidence interval [CI]) was calculated to assess the risk of PJI recurrence. Differences were considered significant at p<0.05.

Results. More than 70% of patients with chronic DTT PJI included in the study were diagnosed with preoperative PEM of varying degrees of severity. Hypoalbuminemia and decreased hemoglobin levels were diagnosed more often: 64.3% and 57.1% in the muscle flap plasty and 57.3% and 31.1% in the antimicrobial spacer group, respectively. In muscle plasty and antimicrobial spacer groups, a decrease in the values of three or more reference PEM markers was detected in 28.5% and 16.0% of patients, and this advanced impairment of the nutritional status increased the risk of early revision intervention by two (OR 2.0; CI 95% 0.47–8.56; p = 0.35) and six times (OR 6.11; 95% CI 1.06–35.35; p<0.04), respectively.

Conclusion. In general, the analysis of publications and results of our study show that PEM is associated with the development of surgical site infection and recurrence of PJI after revision surgery. A decrease in the values of three or more reference PEM markers is a significant predictor of repeated revisions after debridement surgery with the installation of an antimicrobial spacer. PEM complicates the postoperative course in patients with resection arthroplasty. Given the high incidence of PEM in patients with DTT PJI of the hip joint, further research is needed to develop methods for nutritional status correction and assessment of their effect on the outcomes of debridement surgery.

Traumatology and Orthopedics of Russia. 2022;28(1):39-45
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The Use of Electret In the Surgical Treatment of Children With Perthes Disease: Early Outcomes

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


The study aimed to evaluate the immediate results of the use of electret in the surgical treatment of children with Perthes disease.

Material and Methods. The study was based on the results of a comprehensive examination of 10 patients (10 hip joints; average age, 7.2±0.7 years). To stabilize the joint and comply with the principle of “containment therapy,” all children underwent triple pelvic osteotomy, which was supplemented by a transphyseal implantation electret. Postoperatively, all patients were evaluated for the severity of pain syndrome and amplitude of movements and underwent ultrasonography, radiometry of the main indicators of the structure and stability of the hip joint, computed tomography, and magnetic resonance imaging of the hip joints.

Results. The visual analog scale questionnaire indicated the presence of a moderately pronounced pain syndrome on postoperative day 3, with its complete relief by day 7. Ultrasound studies showed the absence of synovitis, and goniometry revealed the achievement of physiological indicators of flexion and abduction to the end of the hospitalization period. According to the radiation methods, all patients had elimination of subluxation with the restoration of hip joint stability and a significant improvement in the shape of the femoral head with the appearance of its single bone contour. The volume of the bone part of the femoral head increased by 15%–35% from the original, and there was a significant improvement in the shape of the cartilaginous model with the complete absence of a necrosis focus in the femoral head, close to the physiological position of the labrum acetabulum.

Conclusion. The use of electret in the surgical treatment of children with Perthes disease in Catterall groups III–IV and hip subluxation due to the anti-inflammatory effect makes it possible to alleviate pain syndrome and manifestations of synovitis early after surgery and to begin rehabilitation treatment with the achievement of the physiological amplitude of movements in the hip joint in the immediate postoperative period. The osteoreparative effect of the electrostatic electret field alone or in combination with anti-inflammatory treatment increased the volume of the newly formed bone tissues of the femoral head with a decrease in the area of its defect or disappearance of compression of the central part of the epiphysis with the differentiation of the initial elements of the trabecular pattern, in comparison with the homogeneous high-intensity structure of the femoral head.

Traumatology and Orthopedics of Russia. 2022;28(1):46-57
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Ultrasonographic Assessment of the Proximal Femoral Ossification Center in Children Under 1 Year

Babaeva K.B., Polukhov R.S.


Background. Developmental disorders of the secondary ossification center (SOC) of the proximal femoral epiphysis can be a marker of some childhood diseases that require timely diagnosis and treatment.

The study aimed to assess the capabilities of ultrasonography in the diagnosis of ossification processes of the proximal femoral epiphysis.

Material and Methods. The study is based on the results of a survey of 524 children aged 2 weeks to 1 year with normal hip joints, including 259 boys and 265 girls. All patients underwent ultrasound examination of the hip joints according to the method of R. Graf in a standard coronary section. In older children, to eliminate errors in measuring the size of the SOC, an additional cross-section was used.

Results. The SOC was detected in isolated cases in boys aged up to 3 months and girls up to 2 months. At age 3 months, the SOC was visualized in 45% of girls and 5% of boys. By age 5 months, 81% of girls had a SOC compared with 46% of boys. By 7 months, SOC was determined in more than 90% of cases of both groups. Thus, girls showed an earlier formation of the SOC than boys. The SOC was located in the center of the femoral head in 82% of cases, lateral in 14%, and medial in 4%. In 95% of the examined children, SOC development occurred symmetrically in both joints. In addition, discrepancies were revealed with simultaneous ultrasonography and X-ray of the hip joints since the SOC becomes visible earlier during ultrasonography.

Conclusion. Sonography is a highly informative method for determining the ossification processes of the proximal femur. Knowledge of the normal sonographic appearance of the femoral head SOC by age and sex will help clinicians diagnose and treat hip disorders.

Traumatology and Orthopedics of Russia. 2022;28(1):58-66
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Surgical Treatment of Children with Hip Dislocation in Amyoplasia-Type Arthrogryposis: A Rational Approach to Treatment Selection

Batkin S.F., Vissarionov S.V., Baindurashvili A.G., Agranovich O.E., Barsukov D.B., Buklaev D.S., Petrova E.V., Trofimova S.I., Kochenova E.A., Savina M.V.


Background. Patients with amyoplasia-type arthrogryposis and hip dislocation have different variants of hip contractures and deformities, but there is no difference in the selection of the type of surgery.

The study aimed to justify and evaluate the effectiveness of the original algorithm of the rational selection of surgical approaches in children aged <3 years with hip dislocation in amyoplasia.

Material and Methods. Level of evidence II. Seventy patients were examined, including 21 children aged <1 year (main group) who underwent 25 hip open reductions; 19 children aged 1.5–3 years (main group) who underwent hip open reductions, Salter innominate osteotomy, and femoral osteotomy; and 30 patients aged 3–7 years (control group) who had not previously received conservative and surgical treatment. All patients were divided into two subgroups depending on the variant of hip contracture: flexion–extension–abduction–external rotation (frog-like) (subgroup 1) and flexion–extension–adduction–external rotation (subgroup 2). Clinical, radiological, and statistical methods were used.

Results. In subgroup 1, after hip open reduction, good results were noted in 17% of cases, satisfactory in 50%, and unsatisfactory in 33%. Severe complications, i.e., classes III and IV according to the modified Clavien–Dindo–Sink classification, were noted in 83% of the cases. After hip open reduction, Salter innominate osteotomy, and femoral osteotomy in subgroup 1, good results were noted in 50% of cases and satisfactory and unsatisfactory each in 25%, and 50% had less severe complications (p = 0.041). In subgroup 2, after hip open reduction, good results were obtained in 90% of cases and satisfactory in 10%, and 10% had severe complications When this surgery was combined with Salter innominate osteotomy and femoral osteotomy, good results were noted in 75% of cases, satisfactory in 19%, and unsatisfactory in 6%, and 25% had severe complications (p = 0.05).

Conclusion. A differentiated treatment approach of children with hip dislocation in amyoplasia-type arthrogryposis will increase the effectiveness of treatment methods, and its introduction into clinical practice will help to improve outcomes.

Traumatology and Orthopedics of Russia. 2022;28(1):67-78
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Effect of Lanthanum Zirconate Ceramic on the Dynamics of Hematological Parameters and the Bone Remodeling Markers: Experimental Study

Antropova I.P., Volokitina E.A., Udintseva M.Y., Yushkov B.G., Tyumentseva N.V., Kutepov S.M.


Background. Zirconium oxide is actively used in medicine; however, research is underway to improve mechanical characteristics and biointegration. One of the promising areas is the study of materials based on lanthanum zirconate (LZ).

The study aimed to examine the effect of a new ceramic material based on LZ on the dynamics of hematological parameters and markers of bone tissue remodeling after intramedullary osteosynthesis (IO) of a hip fracture with LZ rods.

Material and Methods. The ceramic material La1.95Ca0.05Zr2O7 was used. The experiment was conducted in guinea pigs, which were divided into four groups: main group, modeling of a hip fracture (IO of the fracture with LZ rod, n = 9); comparison group, modeling of a hip fracture (IO of a fracture with a rod from b-tricalcium phosphate [TCP]; n = 9); control (C) group, modeling of a hip fracture without IO (n= 9); and native control (NC) group. Animals were withdrawn from the experiment before surgery (NC) and at 4, 10, and 25 weeks after surgery (n=3 for each time point). Hematological parameters, i.e., a tartrate-resistant acid phosphatase (TRAP) as an osteoresorption marker and osteocalcin (OC) as an osteogenesis marker, were determined.

Results. The red blood cell counts in all groups of the operated animals at 4, 10, and 25 weeks after surgery were not significantly different from the NK group. A significantly higher level of leukocytes in comparison with other groups was observed in the control group 10 weeks after surgery (p = 0.044), which was explained by the absence of fracture synthesis. The platelet level in all groups of the operated animals during the study period was not significantly different from the NK group. The TRAP activity in the LZ and TCP groups had maximum values after 4 weeks, and the OC level reached the maximum by 10 weeks after the operation without significant differences between the LZ and TCP groups of animals.

Conclusion. The study of the main hematological parameters did not reveal a negative effect of LZ on the experimental animals. A positive effect of this material on bone tissue remodeling was found. A new ceramic material based on LC appears to be promising for use in traumatology and orthopedics.

Traumatology and Orthopedics of Russia. 2022;28(1):79-88
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Features of the Extraction of the Anterior Tibial Vessels in the Formation of Vascularized Bone Grafts

Zelyanin D.A., Dubrov V.E., Zelyanin A.S., Filippov V.V., Yashin D.V., Petrosyan K.A.


Background. The currently existing techniques for dissection the anterior tibial vascular bundle in the proximal third of the lower leg do not provide sufficient length of the vascular pedicle to rotate the tibial bone graft to the level of the middle third of the thigh.

The aim of the study — to substantiate the possibility of pedicled transfer to the level of the thigh middle third of two blood-supplied bone autografts on a common permanent pedicle, including the anterior tibial vascular bundle.

Material and Methods. The study was conducted on 62 lower limbs of non-fixed (native) corpses. We studied the topographic and anatomical relationship between the anterior tibial vascular bundle and the deep peroneal nerve at the level of the proximal third of the leg.

Results. The distance between the tip of the greater trochanter of the femur and the distal edge of the anterior tibial bone graft using a combination of grafts at the same level in men was Me — 176.7 [173.7; 193.9] mm, in women — Me = 151.6 [146.9; 159.9] mm. An analysis of limb lengths ratios in men and women indicates standard level that can be achieved with graft rotation in each person.

Conclusion. Dissection of the anterior tibial vascular bundle at the level of the proximal third of the lower leg allows rotation of the complex of the anterior tibial bone autograft and the autograft of the second metatarsal bone into the area of the middle third of the femur on a single vascular bundle. Prevention of injury to the deep peroneal nerve branches during dissection of the vascular pedicle requires the use of microsurgical techniques and preoperative preparation.

Traumatology and Orthopedics of Russia. 2022;28(1):89-99
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Shoulder Arthrodesis: A New Technique

Voronkevich I.A., Varfolomeev A.P., Geraschenko N.I.


Background. The replacement of fusion by arthroplasty in terminal shoulder arthropathies has led to the emergence of cases contraindicated for revision arthroplasty. Performing fusion by traditional methods in such cases is extremely risky because of unfavorable conditions: absence of the humeral head, thinning of the metaphysis walls, and defects of the glenoid. Thus, the creation of a new shoulder fusion technique is necessary.

The study aimed to show the possibilities of a new shoulder fusion technique in treating arthroplasty complications and terminal shoulder arthropathies.

The surgical procedure includes the resection of the shoulder joint and internal fixation with a special device containing a scapular fork with four locking screws and a bone plate. The fork was put on the scapular spine from the side of its notch and was blocked by four tightening screws, which clamped the scapular spine in the fork. The bone plate fixed the diaphysis of the humerus. The fixator form set the scapulohumeral ratio for the formation of ankylosis in a functional position. Bone grafting was performed with a graft from the wing of the iliac bone according to the special technique after endoprosthesis removal or with the resected head of the humerus in case of arthrosis.

Conclusions. The developed technique can be used as a standard revision option for contraindications to shoulder arthroplasty and for any traditional indications for its fusion, such as oncological resections, consequences of open and gunshot trauma, lesions of the brachial plexus, and terminal arthropathies in persons engaged in heavy physical labor when it is impossible to change profession.

Traumatology and Orthopedics of Russia. 2022;28(1):100-109
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Case Reports

Avascular Necrosis of the Femoral Head After COVID-19: A Case Series

Panin M.A., Petrosyan A.S., Hadjicharalambous K.K., Boiko A.V.


The coronavirus disease-2019 (COVID-19) has adverse effects on various organs and systems. There are isolated reports concerning the development of osteonecrosis after COVID-19. These papers discuss the role of corticosteroids widely used in the treatment of COVID-19 in the development of osteonecrosis. This article presents clinical observations of four patients with bilateral osteonecrosis of the femoral heads after treatment with COVID-19. Prednisone doses in three patients were 4000 mg, 746 mg, and 533 mg. Corticosteroids were not used in one patient. Data showed that osteonecrosis in patients who underwent coronavirus developed in a shorter time compared with this pathology in patients without COVID-19. Two of four patients had a burdened family history (such as myocardial infarction, hypertension, and thrombosis). Hereditary vascular factors possibly played some roles in the genesis of the osteonecrosis of the femoral head in these patients. To understand the features of osteonecrosis development after COVID-19, further accumulation of evidence is necessary. Several synergistically influencing factors are important in the development of this disease after COVID-19.

Traumatology and Orthopedics of Russia. 2022;28(1):110-117
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Spine Pathologies in Osteogenesis Imperfecta: A Review

Shchurova E.N., Ryabykh S.O., Ochirova P.V., Popkov D.A., Ryabykh T.V.


Background. The scientific and clinical interest in the problems of osteogenesis imperfecta (OI) has grown in the last decade. However, the analysis of various variants of spinal pathologies in OI received insufficient attention.

The study aimed to analyze the current literature on various variants of the spinal pathology in patients with OI. OI is a phenotypically and genetically heterogeneous group of hereditary bone dysplasias. The spine pathology in OI is represented by scoliosis, kyphoscoliosis, anomalies of the craniovertebral junction, instability of the segments and fractures of the vertebral bodies, spondylolysis, and spondylolisthesis. Scoliosis and kyphoscoliosis are the most common forms of spinal pathology. In severe forms and at age >6 years, the prevalence of scoliosis can reach 89%. The exact mechanism of scoliosis formation in patients with OI is complex and incompletely defined. Anomalies of the craniovertebral junction are recorded in 37% of patients with OI and are determined in all four types of OI. Clinical manifestations of the craniocervical junction pathology can vary from asymptomatic to compression of the brainstem, restriction of cerebrospinal fluid circulation, leading to hydrocephalus, syringomyelia, and cranial nerve damage. The pathology of the lumbosacral spine is represented by spondylolysis and spondylolisthesis generally in the L5–S1 segment in 5.3%–10.9% of cases. The clinical significance and natural course of spondylolysis and spondylolisthesis in patients with OI are not fully defined in the literature, and the information on surgical indications and methods is available only in rare case reports. The changes in the axial skeleton in OI can lead to significant functional disability, pain, and potentially life-threatening complications, such as radicular neurological deficit, decrease in the ventilation capacity of the lungs, and cardiorespiratory complications. The overall severity of OI remains the best criterion for predicting the development of secondary spinal pathology. Given the generalization and heterogeneity of OI, an individual and multidisciplinary approach is necessary when diagnosing and planning the treatment strategy for this group of patients.

Traumatology and Orthopedics of Russia. 2022;28(1):118-127
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Osteonecrosis in Patients Recovering from COVID-19: Mechanisms, Diagnosis, and Treatment at Early-Stage Disease (Review)

Torgashin A.N., Rodionova S.S.


Background. Aseptic bone necrosis (osteonecrosis), as a consequence of the ongoing coronavirus disease-2019 (COVID-19) pandemic, is increasingly becoming the cause of severe pain syndrome in the hip, knee, and shoulder joints with disruption of their function. The discussion of the pathogenesis of post-COVID-19 osteonecrosis, possibility of its diagnosis, and treatment at early stages continue. As COVID-19 affects young and able-bodied people, the diagnosis and treatment of this form of aseptic necrosis at early stages have great social and economic importance.

Methods. The literature search was conducted in the databases of eLIBRARY, PubMed, and Scopus. The search depth was 10 years. Selected publications were related to the early diagnosis and treatment of aseptic necrosis following COVID-19.

Results. The form of osteonecrosis that developed after COVID-19 should now be classified according to ICD-10 as M87.3 (another secondary osteonecrosis). The review provides data on the possible mechanisms of osteonecrosis development in patients who had COVID-19, explains the role of MRI for the early detection of the pathology, provides the results of treatment that can influence both pathogenesis mechanisms, and leads to disease regression if treatment was initiated at an early stage.

Conclusions. Improving the doctors’ awareness about the pathogenesis, diagnostic methods, and treatment of early disease stages will reduce the risk of developing an advanced stage of aseptic necrosis post-COVID-19, slow down the progression of the pathology, and delay or even prevent the need for joint replacement. Our concern is based on the continuation of the pandemic, the observed fact of the dramatic increase in the frequency of aseptic necrosis post-COVID-19, and the number of total arthroplasties in young and middle-aged people for aseptic necrosis of the femoral head.

Traumatology and Orthopedics of Russia. 2022;28(1):128-137
pages 128-137 views

Surgical Treatment of Patients With Knee Pathology and Deformities of the Lower Extremities: А Systematic Review

Zhumabekov S.B., Pronskikh A.A., Pavlov V.V., Korytkin A.A.


Background. In patients with knee pathology, a phased approach to surgical treatment is often used: first, corrective osteotomies and then, if necessary, arthroplasty. This technique allows achieving optimal results of treatment.

The study aimed to determine promising methods of surgical treatment of patients with knee pathology and deformities of the lower limb axis.

Material and Methods. Publication search was conducted in the databases of eLibrary, PubMed, and Scopus from 2000 to 2020 (a search period of 20 years) using the following keywords: deformity of the lower limb axis, deformity correction, and total knee arthroplasty. Demographic data of the patients, features of surgical techniques, and treatment results were analyzed.

Results. The literature search identified 1,232 publications, of which 12 studies that analyzed a total of 2.428 patients were included in this review. The surgical treatment covered the period from 1987 to 2018. The average follow-up period was 64.1±7.4 months, the average patient age was 58.8±1.4 years, the average duration of surgery was 114.2±3.9 min, and the average volume of blood loss was 484.0±30.0 mL. The fixation period with a metal plate, from the moment of osteotomy to hardware removal, was on average 18.0±1.8 months.

Conclusion. Corrective osteotomies can prevent or delay knee replacement by an average of 11.8 years. Osteotomy preceding total arthroplasty does not negatively affect the survival of endoprosthesis, and its results are comparable with the medium- and long-term results of primary arthroplasty.

Traumatology and Orthopedics of Russia. 2022;28(1):138-147
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Vladimir P. Morozov. 75th Anniversary of the Birth

Traumatology and Orthopedics of Russia. 2022;28(1):148-148
pages 148-148 views

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