Vol 20, No 3 (2014)

Objective - to evaluate the effectiveness of the first phase of a two-stage method of surgical treatment of periprosthetic infection and to identify possible factors influencing the outcomes. Material and methods. The analysis of results of treatment of 217 patients with infection operated in 2008-2012. The mean age was 56.1 years (95% CI 48.3 to 67.4). All patients underwent surgery with removal of hip endoprosthesis and installation block or articulating spacers at different times after the primary (77%) or revision (23%) arthroplasty. Results. Relapse of infection was detected in 78 cases (35.9%). In 139 (64.1%) patients remission of infection was observed, which allowed an average of 10.2 weeks (95% CI 7.87 to 14.3) perform a full-fledged replacement for a spacer prosthesis. Relapse of infection was detected in 78 (35.9%) cases. Conclusion. The main risk factors leading to a recurrence of the infection are the combination and type of microorganism, laboratory parameters, weight of the patient and the type of previous surgery.

Osteonecrosis of the femoral head is one of the serious diseases of the hip. The outcome of the disease is the development of osteoarthritis of the hip in patients of working age. Today, one of the most popular surgical procedures in the early stages of the disease remains a core decompression. The purpose of the study was to understand the efficacy and safety of core decompression and filling bone defect bioresorbable materials. Material and methods. From 2006 to 2014 in Vreden Russian Research Institute for Traumotology and Orthopedics 62 patients (79 hips) with different stages of osteonecrosis of the femoral head were treated. In all patients the classical decompression chamber of femoral head osteonecrosis was performed. In 36 patients (48 hips) the decompression was done with no additional processing the chamber, in 25 patients (31 joints) after decompression the treatment of osteonecrosis zone to the healthy bone was performed. In 56 cases the bioresorbable granular material based on calcium sulfate was used for filling the defect, in 6 cases - β-3 calcium phosphate, in 17 cases - the bioresorbable material based on the combination of calcium sulfate and 3 ß-calcium phosphate. Results. In the mean follow-up of 26.9 (6 to 62) months, the overall survival rate was 54.4%. In patients with the second stage of the disease the arthroplasty was performed only in 17.6% of cases, while in patients with the fourth stage - in 100%. In the third stage of osteonecrosis a strong correlation of survival with the necrosis volume was observed. Conclusion. The success of surgical interventions directly depended on the stage of the process, volume and fullness of osteonecrosis zone, as well as on the type of bioresorbable material and fullness of bone defect filling.

The aim - to compare the results of simultaneous bilateral and unilateral surgical correction of hallux valgus and to create recommendations for treatment of the patients with this pathology. Material and methods. The authorse analyzed the data of 40 patients (60 feet) who carried out an operative treatment of hallux valgus in SPb multiprofile city hospital N 2 since 2011 to 2013. Functional (AOFAS score) and X-ray results were compared between groups with bilateral and unilateral correction. Mean AOFAS score in these 2 groups after 12 months after surgery was 85,6±6,2 and 85,5±6,9 (p>0,05), mean intermetatarsal angle - 8,4±0,5° and 8,8±0,8° (p>0,05) respectively. No statistically significant difference between these two groups was found. Conclusion. A bigger surgical trauma in case of simultaneous bilateral correction neither worsens functional and x-ray results nor increases a complication rate.

Objective - to study the effect of tunnelization and apparatus hip decompression on the state of proximal femur growing plate. Material and methods. A pattern of changes in proximal femur growing plate of the affected and intact extremities was investigated in 46 children with III degree Perthes disease. The follow-up was 3 years. To unload the affected joint, an external fixator (most often, the Ilizarov apparatus) was placed on pelvic and femoral bones, which was used in a mode of non-articulating arthrodiastasis. The measurements of width of proximal femur growing zone were performed on pelvic bones rentgenograms in anteroposterior projection with internal hip rotation achieved with 1 meter focal length and their subsequent transfer to a digital format. Results. In the study group wire tunneling and apparatus fixation were shown not to result in growing plate locking, providing conditions for recovery of the shape and structure of the femoral head, which was accompanied by a slowdown in its width decrease in the affected extremity and led to the compliance of this parameter between the intact and affected extremities. No correlation was revealed between the degree of structural metaphyseal damage and the state of proximal growing zone.

Purpose - effectiveness assessment of 500 acetabular transpositions after triple pelvic osteotomy in the treatment of children and adolescents with dysplastic hip joint pathology. Materials and methods. Using clinical, radiographic and computed tomography techniques we analyzed long-term results of surgical treatment of 470 patients with impaired stability of the hip of dysplastic genesis aged 4-19 y.o. who underwent 500 acetabular transpositions after triple pelvic osteotomy. Results and conclusions. The use of acetabular transposition after triple pelvic osteotomy in patients with dysplastic hip joint pathology in most cases allows to achieve regression of clinical manifestations and degenerative changes in patients with stage I and II of dysplastic coxarthrosis. Effectiveness largely depends on the initial state of the hip joint.

Objective: to determine the stability of bone fragments fixation with an external fixation device in the simulation of bilateral partly unstable pelvic injuries of B type according to AO/ASIF classification and to identify the role of different fixation elements in the stability of fixation. Material and methods: the study was performed on the finite element model of a system “an external fixation device - pelvis” developed for a software package MSCNastran. Formation of a fracture of pubic and ischial pelvic bones was accomplished by means of rupture in the finite element network and decrease of elasticity modulus in the ilio-sacral joint on both sides up to 35 mm at the site of a fracture. Loads were carried on top of the body of the first sacral vertebra with a force of 500H.The second area of application of the load was from the bottom-up on the acetabular roof with a force of 250H. In this study the effect of different elements of an external fixation device on the stiffness of bone fragments fixation was evaluated. Symmetrical elements were removed both separately and together. As a result, the stiffness of a system decreased and the displacement at the fracture site increased. Conclusion: in a model of partly stable pelvic injuries accompanied by general rotation instability in the horizontal and sagittal planes to 35 mm, an external fixation device provided high stability of bone fragments (to 3 mm) due to introduction of bone rods in the iliac wings with the obligatory introduction of the rod in the vertical branches of pubic bones and strengthening the anterior lower bar between the subsystems. What is more, installing the anterior upper bar or introduction of bone rods in the bodies of iliac bone are not necessary.

Patellar resurfacing is one of the unsolved problems of knee arthroplasty due to the high frequency of patella-femoral complications. In the present analytical review the authors traced the evolution of patellar resurfacing, analyzed the literature on the etiology of anterior knee pain and patellar biomechanics, discussed the indications for replacement or preservation the patella.

The review shows the evolution of understanding of the complex regional pain syndrome and its history. Presents modern views on the etiology and pathogenesis of the disease. Presents diagnostic and clinical aspects of this pathological condition. Describes modern methods of treatment.

We have the experience of open Latarjet procedures which were perfomed to 18 patients since 2011 to 2014 in the orthopaedic department Moscow city hospital № 12, among them 14 male (77,8%) and 4 female (22,2%) with anterior shoulder instability. Mean age of the group was 24,3 years. The mean follow-up was 16±4 months (from 6 to 26 months). Mean range of motion increased after 1 year post-op: flexion 178°±2° (from 170° to 180, increased at 2.4°). There was no post-op recurrent dislocation. The patients felt no subluxation or disturbance in operated shoulder. For functional scores, WOSI pre-op was 49,8, one year post-op decreased to 30,3. DASH-score pre-op was 16,5, post-op - 5,2. The results were defined as excellent in 12 patients, good in 6 patients, we had no bad or moderate results. All patients returned to normal life and sport activity.

Full-thickness rotator cuff tears - is abundant injury which leads to the expressed pain syndrome and functional violation of the top extremity. At making decision about necessary of surgery, MRI is the important source of information about the injury The purpose: to determine the qualitative and quantitative indicators of degenerative-dystrophic changes in muscular and tendinous parts of the rotator cuff. based on a combined MRI, arthroscopic and histological diagnostics of full-thickness rupture of shoulder cuff Methods: We have examined 28 patients with full-thickness rotator cuff tears. MRI of damaged joint to all patients before an operation was performed. Thereafter an arthroscopy was performed and intraoperative biopsy of the muscular and tendinous parts of the rotator cuff, with following histological examination. Results: It was found that at small full-thickness rotator cuff tears the intensity of degenerative changes in muscular and tendinous tissue was lower, so these tears are the most promising for all kinds of treatment. At medium and big tears intensity of degenerative changes in the tissues begins to prevail over productive inflammation and it limits to the ability of conservative treatment and increases the risk of unsuccessful outcomes of arthroscopic reconstruction. Conclusions: In this regard, it is necessary to search biological decisions, which complement the stage of arthroscopic reconstruction of the rotator cuff.

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