Vol 29, No 1 (2023)

Background. The choice of pelvic reconstruction technique in children with developmental dysplasia of the hip (DDH) has been the subject of discussion for many years and is often determined by personal preferences of a surgeon rather than by X-ray anatomical state of the acetabulum. The variants of its anatomy structure have still not been reflected in the available scientific literature.

Aim of the study — to identify the most typical variants of acetabular deformation in children with varying severity of DDH, based on the X-ray anatomical analysis of structure of the acetabulum.

Methods. The study was based on the results of examination of 200 patients (200 hip joints) aged 2 to 4 years (3.1±0.45) with Tönnis grade II-IV DDH. All patients underwent conventional clinical and radiological examination. The latter consisted of hip radiography in several views and computed tomography. We took the values of acetabular index, the extent of acetabulum arch and the presence or the absence of bone oriel as criteria for determination of the most typical variants of acetabular deformation.

Results. X-ray analysis of anatomical structure of the acetabulum in young children with varying severity of DDH revealed 3 most common variants of acetabular deformity: 1 — moderate underdevelopment of the acetabulum arch (AI ≤ 35°), its shortening and the presence of bone oriel; 2 — pronounced underdevelopment of the acetabulum arch (AI > 35°), its shortening and the presence of bone oriel; 3 — pronounced underdevelopment of the acetabulum arch (AI > 35°), its sufficient length and the absence of bone oriel.

Conclusion. Suggested supplements to existing Tönnis DDH classification might become basic for choosing the surgical correction technique of the acetabulum in children with different severity of DDH.

Background. The problem of bone defects replacement is relevant nowadays, that is why many scientists create new synthetic bone substitutes, but the «ideal» material has not been found so far.

The aims of the study: 1) to determine the suitability of the monocortical defect model in the rat femur diaphysis with additional prophylactic reinforcement with a bone plate for assessing the biological properties of implanted materials using the commercially available ChronOS® material as an example; 2) to assess of the osteoconductive properties of composite materials based on poly(ethylene glycol)diacrylate and octacalcium phosphate with architecture Kelvin and gyroid types on the developed model.

Methods. A prospective study, level of evidence II. A monocortical defect of the rat femoral diaphysis (length 7 mm) was produced under anaesthesia in aseptic conditions and fixed with a polyetheretherketone plate and six titanium screws. In the control group, the defect was left empty. In other groups, blocks of one of three materials were implanted — сhronOS and composites of poly(ethylene glycol)diacrylate and octacalcium phosphate with 3D-printed Kelvin and gyroid architectures. After 3 and 6 weeks, the rats were sacrificed, and histological examination of the defect zone was performed. The amount of newly formed bone tissue was histometricly assessed, followed by statistical processing of the results.

Results. All rats have reached the planned endpoint, and there were no infectious complications or loss of fixation. Histological examination of the defect zone revealed minimal bone growth in the Control group, rather slow bone formation in the Gyroid group, and statistically significantly more pronounced bone formation in the pores of the materials in the Kelvin and Chronos groups.

Conclusions. Bone defect in this model was not spontaneously filled with bone tissue and allowed us to study the biological properties of bone substitutes (the ability to biodegrade and osteoconductive properties). The osteoconductive properties of a composite material based on poly(ethylene glycol)diacrylate and octacalcium phosphate with a Kelvin architecture are higher than with a gyroid architecture and are comparable to that of the сhronOS.

Background. At present, for a number of reasons the complete bone defect replacement with autogenous bone is not always possible. Bone substitute materials are used as an alternative to autogenous bone tissue and can be of either biological or non-biological origin. One of the ways of development of reconstructive technologies is the use of tissue-engineered constructs that fully imitate autogenous bone tissue in the required volume.

Aim of study — to define in vivo the possibility of using deproteinized human cancellous bone tissue as a matrix for creating tissue-engineered constructs.

Methods. An in vivo study was carried out on NZW rabbits. To create a construct, we used the fragments of deproteinized cancellous bone tissue of the human femoral head and stromal vascular fraction of rabbit adipose tissue as a matrix. Bone defect modeling with its subsequent replacement was performed to evaluate the efficacy of reparative osteogenesis during bone defects’ reconstruction. Study groups were defined: group 1 (control) — surgical modeling of a bone defect of the femur without its reconstruction; group 2 — surgical modeling of a bone defect of the femur with its reconstruction using fragments of deproteinized cancellous bone matrix; group 3 — surgical modeling of a bone defect of the femur with its reconstruction using fragments of deproteinized cancellous bone matrix in combination with stromal vascular fraction of adipose tissue (according to ACP SVF technology).

Results. Comparative analysis of reparative processes in case of applying tissue-engineered constructs based on deproteinized human cancellous bone matrix in combination with adipose tissue-derived stromal vascular fraction on in vivo experimental model revealed that the use of these bone substitute materials contributes not only to an early activation of reparative regeneration of main structural elements of the bone tissue in the area of the bone defect replacement, but also to its well-timed differentiation. This determines the restoration of structural and functional viability of the bone tissue at the damage site without developing discernible reactive inflammation. Moreover, the effect of the selected tissue-engineered construct with the combined influence of several factors (ACP SVF) in its composition turned out to be more effective in stimulating bone tissue repair and differentiation.

Conclusion. Combination of SVF and deproteinized bone matrix for creating tissue-engineered constructs enables to engage several regeneration mechanisms and accelerate the process of bone defect replacement in comparison with isolated deproteinized bone matrix without bone defect reconstruction.

Background. Today in our country, the follow-up of patients after arthroplasty is carried out in accordance with clinical guidelines, the wording of which is based on monographs from 2006, 2008, and 2014, in addition, clinical guidelines for follow-up do not take into account the results of treatment assessed by the patient himself.

The purpose of this study was to examine existing systems and develop a proprietary follow-up system for patients after hip and knee arthroplasty.

Results. A review of the literature revealed that follow-up of patients after arthroplasty is an unsolved problem, within which there is low coverage, reluctance or forgetfulness of the asymptomatic patient, the problem of accessibility of medical examinations, and an excessive financial burden on the health care system. Since 2022, fixed recommendations for follow-up after arthroplasty have been used in the clinical practice of our center in discharge epicrisis. Recommendations for the frequency of follow-up were formulated by experts based on a comprehensive review of the literature and their own experience. In the first three months, 221 hip and 235 knee evaluation questionnaires were collected through the proposed mechanism, with a progressive increase in the number of questionnaires based on weekly monitoring data.

Conclusion. Unfortunately, the outpatient clinic system is not always able to provide qualitative monitoring of patients after arthroplasty due to various reasons, therefore, in our opinion, the implementation of the mechanism of remote monitoring of patients will allow detecting various complications at the stage of early diagnosis, which will contribute to prompt solution of these problems. The remote monitoring system is also an important source of scientific data.

Background. Stenotrophomonas maltophilia (S. maltophilia) is a gram-negative non-fermenting bacillus and is a rare pathogen of orthopedic infection. Due to the relatively low virulence of S. maltophilia, many clinicians are still faced with the question of whether this bacterial species is simply a colonizing agent or the true cause of infection.

Aim of the study — to raise the awareness of practitioners about S. maltophilia as a rare pathogen of orthopedic infection.

Methods. A retrospective analysis was performed concerning the frequency of S. maltophilia isolation from patients treated at the Vreden Center for periprosthetic infection and/or osteomyelitis from January 1, 2009 to October 31, 2022. The literature search by keywords was carried out in the PubMed/MEDLINE, Scopus, eLIBRARY, and Cyberleninka databases. The search retrieved 587 articles published in Russian or English over the period from 2012 to November 2022.

Results. During the study period, 9 cases of orthopedic monoinfection with S. maltophilia were identified in 9 patients aged 36 to 83 years. At the time of admission, no leukocytosis was detected in patients, and only 2 of 9 patients had elevated C-reactive protein level. S. maltophilia is naturally resistant to many broad-spectrum antibiotics. Co-trimoxazole is considered the drug of choice for the treatment of S. maltophilia infection. The limited choice of drugs for targeted therapy, the presence of multiple determinants of antibiotic resistance, the existence of microbial associations and patient risks including implantation, chronic nature of infection, elderly age, as well as the presence of significant concomitant somatic pathology can lead to the ineffectiveness of the ongoing treatment of infections caused by S. maltophilia. Our experience shows that in the case of sensitivity of S. maltophilia strain to co-trimoxazole it is possible to prescribe this drug for a long course as monotherapy, provided that the radical surgical treatment of the focus is performed.

Background. Deep surgical site infection (DSSI) is one of the most severe complications in spinal surgery. The timing and nature of DSSI are the determining criteria in the choice of treatment tactics. The uniqueness of the clinical observation is the combination of early DSSI, epidural abscess and angular kyphotic deformity formed after a course of conservative antibacterial therapy in a patient who underwent surgery for degenerative-dystrophic disease of the cervical spine. Correction of angular kyphosis, removal of fractured vertebrae, interbody implants and three-column cervical reconstruction were performed in one surgical session.

Case presentation. A 57-year-old patient was admitted to the clinic after staged surgical interventions on the cervical spine for multilevel degenerative stenosis of the spinal canal. The primary surgical interventions were complicated by DSSI in the early period after the second surgery with formation of angular kyphosis of the cervical spine. The patient underwent revision one-stage reconstructive intervention to correct the deformity, decompress the spinal canal, and three-column reconstruction of C3-7 segments. Long-term follow-up showed persistent reduction of pain syndrome, improved quality of life and absence of recurrence of DSSI.

Conclusion. The presented case illustrates the possibilities of one-stage revision three-column cervical spine reconstruction for correction of sagittal profile, decompression of intracanal neural structures and ensuring stability of operated segments. Use of DSSI treatment algorithms based on Prinz V. and Vajkoczy P. classification contributes to the selection of the optimal tactics of patient management.

Background. Diagnostics and treatment of patients with chronic posterior and posterolateral instability of the knee is one of the most understudied problems of modern orthopedics. This is due to rather low frequency of this pathology, as well as to complex anatomy of tendoligamentous structures of the posterolateral part of the knee joint. Steadily increasing number of foreign publications dedicated to this topic say that there is no common approach to the tactics of surgical treatment of patients of this category at the moment.

Aim of review — to evaluate the main trends of surgical treatment of this pathology according to the stage of involvement of various anatomical structures responsible for posterolateral rotational instability in the pathologic process.

Results. Despite a large number of methods of surgical treatment of posterolateral corner injuries, when analyzing modern publications, several main trends concerning posterolateral instability of the knee joint can be identified. In case of type 1 posterolateral instability, an isolated arthroscopic posterior cruciate ligament plasty is the most optimal. As for types 3 and 4, today such anatomical techniques as Larson and LaPrade have completely replaced the methods of non-anatomical reconstruction of the posterolateral corner. In addition, a large number of publications have recently appeared concerning arthroscopic techniques of these surgeries. The most important problem concerns the extent and the methods of surgical intervention in case of type 2 instability. Authors of the article consider that an arthroscopic posterior cruciate ligament plasty combined with popliteal tendon plasty is the most optimal for such category of patients.

Conclusion. The actual problem is the question of the method of surgical treatment in case of type 2 instability. The optimal technique for such patients is arthroscopic posterior cruciate ligament plasty combined with popliteal tendon plasty.

Background. Irreparable anterior-superior rotator cuff tears can cause significant shoulder dysfunction due to the failure of normal biomechanics of the joint, because of the loss of compressive effect of the rotator cuff on the humeral head. Muscle-tendon transfers are an alternative to standard surgical treatment options: debridement of injured tendons, arthroscopic anchor suture, and reverse shoulder arthroplasty. Currently, several options of muscle-tendon transfers are described in the foreign literature, and there is an active discussion over the results of the already proposed techniques, and their improvements, while these techniques are practically not covered in the domestic literature.

The aim — to describe modern surgical technique options of the muscle-tendon transfers for the treatment of patients with anterior-superior rotator cuff tears based on a review of foreign literature sources.

Methods. The search for publications from 1988 to 2022 was carried out in the PubMed/MEDLINE and Google Scholar databases.

Results. Nowadays, the most common muscle-tendon transfers options for patients with anterior-superior rotator cuff tears are the sternocostal portion of the of pectoralis major tendon transfer and the latissimus dorsi tendon transfer. A review of foreign literature showed that muscle-tendon transfers are a well-described alternative to standard methods of treating profile patients with a predictable result.

Conclusion. Currently, there is no consensus on clear indications for certain types of muscle-tendon transfers in case of anterior-superior rotator cuff tears, there is a lack of data on long-term results. This determines the need of study of the long-term clinical results of use of these methods and develop an algorithm for choosing the tactics of surgical treatment of relevant patients.

July 18, 2023 marks the 100^th anniversary of the birth of an outstanding orthopedic traumatologist, scientist, teacher, organizer of military healthcare, Doctor of Medical Sciences, professor, laureate of the USSR State Prize, corresponding member of the Academy of Medical Sciences of the USSR, Major General of the medical service Sergei Stepanovich Tkachenko.